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Chapter 6

PSYC32 Chapter 6.docx

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University of Toronto St. George
Michael Inzlicht

Chapter 6: Interviewing in Clin Neuro Case: • Jess was referred by an SW bc lots of anger and frequent abusive behv toward his gf • Part of military, believes that exacerbated his anger problems • Was physically + emotionally abused by his parents • Had behv problems in school too (he said not bc angry, but bc fighting was a release of tension) • He was a bully and when his parents were contacted about his behv, he was abused even more • Was also abusive to his ex-wife • Divorce • Had a therapist for a while but quit therapy bc he felt they were helping him pursue triggers • Motivated to change • PTSD bc severe physical abuse at the hands of his schizophrenic mother • He also had concussions in the military that went untreated Intro: • Assessment process = term by Holtz that describes the info gathering process o It is a structure/flowchart to guide the clin npsy’ist in gathering as amuch info as possible through interview + testing o 4 pillars:  1- interview • A skill that can be learned but an art in its actual delivery • Similar to general clnical interviewing in the sense that the goal is to obtain the most accurate picture of all parts of a person’s life • But npsy interview is also a bit different bc it leans more in a CNS dir • Tries to obtain etiological = causal and congenital factors • Interviewer also tries to watch out for mismatch between verbal and nonverbal behvs bc this can be a diagnostic sign • But also must watch out to keep on nonverbal behv neutral to not influence pt • Structured (Standardized) vs. Unstructured (Non-standardized) o Also various other interviews focusing on specific diagnoses • Each interview also has a referral source, reason for referral, and a presenting complaint • The experienced interviewer can get all the needed info in approx 1 hr for typical cases o Most common mistakes = talking too much, trying to help as opposed to gaining info, asking q’s that imply yes-no answers, rephrasing q’s while asking them , asking multiple-choice q’s  2- formal tests  3- informal tests  4- Observation o If records are available (and client is willing to sign a release of information form, + their guardian if child/vulnerable adult), record review may occur before or after the interview, depending on the circumstances • When pt’s are greeted in the waiting room, you should not address them by their last name bc confidentiality • “I’m Dr. Smith, I will be meeting with you today, please follow me.” • Handshaking is optional, bc some clients may have difficulties with touch • Spend a short time in small talk to build rapport and put client at ease • The interview determines whether testing is possible Referral Source • Most common in general practice is self-referral, but not in clin neuro • since ppl will have a CNS difficulty, self-referral is less likely (as this would imply that the person has insight into their own problem and already has motivation to change) o Self-referrals mainly happen if they have moods or behvs they do not understand or that are embarrassing and if they feel like other people around them do not understand • More often though, referrals from family or SO o In this case, individ usually feels anger, pressure, shame, etc bc other ppl think they have a problem and they have not initiated action on their own and feel less in control of sit’n o Thus, lower level of motivation for change • Friends could also refer you. When this occurs, it is often the case that family and/or SO has also noticed issues. This may be a more positively-viewed referral by individual. • Workplace can also refer you, but usually when employer feels employee is not performing adequately. This often involves an ultimatum. • School can also refer if poor grades, absenteeism. This could lead to consequences like being removed from a class, or from school on the whole. • Physician referral is quite often who ~s happen though. o In this case, the person is more likely to be motivated bc they don’t feel repercussions from the other referral sources o Physicians are more objective and often considered experts, authority figures • Legal Sys is another ~ o When law is broken and court decides that clin neuro is needed o Often significant ramifications when this is the ~ o Also, when this is the ~, there is often concern over whether the client will be lying/faking during the npsy assessment o It may not even be intentional lying but bc of the CNS difficulties o Often poor motivation bc lack of control over the process + ramification risk  i.e. the npsy’ist can conclude that the person is unable to care for themself and therefore should be placed in assisted living • Social Service ~, not part of legal system, but still carries substantial weight in a clicnt’s life o i.e. parenting deficits  removal of children Presenting Complaint • before the ~ is even addressed, client must be made aware of the principles of confidentiality o there are also certain federal stipulations that void confidentiality:  ex. voicing a direct physical threat to President, etc. (though this actually happens often, without force behind the threat, with demented pt’s. But these instances must be reported all the same) • ~ = reason client is here, stated in their own words (same as for general clinical interview) o May or may not be accurate depending on insight and/or likelihood that they even are willing to tell you (referral source often gives you a clue to this) o Even a self-referral may not imply self-awareness though, bc CNS difficulties Structured Interviews • Completely standardized • Useful if referral source wants to compare pt’s fxn to others • Comparison to norm groups can also aid diagnosis + treatment • Also, research • Blind analysis = when test scores are eval’d w/o interview, records, observing the patient o This sort of analysis will not be appropriate to make clinical decisions • Very similar to a usual clinical interview, but towards the end, there are CNS q’s • Verbal s+ nonverbals are observed during interview o You can gauge that they understand you o Could be diagnostic markers o Could indicate that they are withholding info, lying, etc. o But must beware of cultural diffs • Since, following any negative event, individuals are more likely to attribute symptoms (both current and previous!) to that event, it is important to conduct interview in a chronological, causal order • History of the presenting complaint = description of any similar symptoms the client has exp’d • Family history of mental health + CNS difficulties gives insight to which behvs they may have genetically inherited or also behv’lly learned • Work-sample evaluation= an eval of work-related tasks, particularly that are timed vs untimed, that can help npsy’ist assess the person. These are often completed by a vocational rehab specialist or an agency such as a sheltered workshop Unstructured Interviews • The term ~ is not entirely accurate and thus they are sometimes called semi-structured interviews • Same goal as structured = to gain as much info about all possible areas of pt`s life • Same topics are covered • But in this, the exact same standard does not have to be followed to a tee o Clin npsyìst has flexibility to pursue a potential area if it appears
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