What is a Clinical Interview?
A clinical interview is a part of a psychological assessment. A clinical interview may be structured or semi-structured dialogue with the client that is focused on information gathering.
Fully Structured Interview
Fully structured interviews follow a question template. In such an interview all clients are asked the same set of questions. This kind of interview is often done by larger organizations in an attempt to identify clients with particular issues and then match them with clinicians who have expertise in this area. These interviews are often conducted by psychology students or technicians as they are not intended to gather highly personal information about the client, and generally do not have any therapeutic value beyond that of allowing the client an opportunity to tell their story. In some cases, these interviews are transformed into paper and pencil questionnaires that may be done online before the appointment, or as a telephone interview, or while seated in the office before the first session.
Fully structured interviews are also used when a therapist is attempting to make a differential diagnosis. A differential diagnosis is way a decision is made about which illness a client might have, even if the illnesses have many similar symptoms. To differentiate or 'tell apart' the which is the correct diagnosis, the clinician will ask a very standardized set of questions to see if the client expresses experiencing a sufficient number of symptoms to meet 'diagnostic criteria' for one disorder and not another. Meeting diagnostic criteria islike having all the ingredients to make one kind of cake, but not another. For example, if you have lemon flavouring but not cocoa powder in your cake mix, you are more likely making lemon cake, and not chocolate cake, even though most of the rest of the ingredients are the same. Based on the symptoms a client describes experiencing, the clinician may believe the client meets criteria for a diagnosis of Cyclothymic Disorder (a type of depression), but not Major Depressive Disorder.
Why is it Important to Get the Correct Diagnosis?
Being able to accurately differentiate (choose between) between similar diagnosis allows the client and clinician to develop a targeted and personalized treatment plan. A personalized treatment plans is far more likely to result in a successful outcome than a 'one size fits all' treatment plan. Therapy is also more likely to succeed when a clinician uses a research based treatment shown to work for that disorder, rather than a treatment based on what the clinician happens to be good at. For example, if your computer stops working because you have a virus then you want to get rid of the virus, rather than just putting in a new hard drive. Yes, the new hard drive will work will not have a virus, but it also will not have any of your data.
Semi-structured interviews are the most common form of mental health interview. Here the clinician has a standard set of questions they ask to be sure they cover the most common areas of mental health. Likely questions in a semi-structured interview will ask about sleep patterns, eating habits, mood, thinking processes, and communication styles. Follow-up questions will be based on the client's response. In this way the standard questions are used as starting points to get the conversation going, but once going the client is encouraged to explain their unique situation. Semi-structured interviews help insure key data is gathered, while allowing the client's particular challenges and goals to rise to the forefront. This helps insure that the co-developed treatment plan is on target for the client's needs.
- Clinicians may include additional information to help diagnose and develop the treatment plan. Clients may be asked to complete surveys and screeners. Screeners are typically short questionnaires (10-20 questions) that ask the client if they are experiencing symptoms commonly seen for one type of disorder.
- During interviews clinicians observe how the client responds no-verbally to various questions. Does the client become upset or angry when talking about specific events? Does the client avoid answering certain questions? What is the client's body language like? Do they look at the clinician, other people in the room (if any), do they try to divert the conversation or repeat themselves.
- Along with surveys/questionnaires, and observations, clinicians may also gather information about the client from other people. This is only done with the client's knowledge and permission. For example, a clinician may ask a child's parents about the child's behavior, moods, and development. They may also talk with the child's teacher to find out how the child is managing in school. Adult clients may ask the therapist to speak with their physician about medial issues that may be impacting the client's mental health, or they may bring in a partner or friend to help expand on details the client has difficulty talking about. People who provide information about the client are often referred to as 'collateral contacts'.
All of the information from clinical interviews, surveys/questionnaires, observation of the client, and collateral contacts is combined to help more fully understand the client. While many issues may be identified and treated based soley on clinical interview information, the additional sources may help shed further light on a problem increasing the chance of treatment success.