The Clinical Interview

By: Henry Kellerman and Anthony Burry

This subject considered the clinical interview that takes place during the testing of a patient. A structure based on psychological and psychiatric organizing principles was presented as a guide to synthesizing the impressions, observations, and conclusions that the psychologist forms.

The aim of this synthesis was to formulate a preliminary, broad diagnostic hypothesis with respect to discriminating psychosis from non-psychosis. Further described were the remaining broad diagnostic possibilities of organic, characterological, or neurotic psychopathology, completing a four-level diagnostic discrimination that begins to form during the interview and observational phase of testing.

Some of the salient focuses of the clinical interview.

• All expressive behavior gathered from the clinical interview is utilized to formulate diagnostic impressions and to generate diagnostic hypotheses.

• First impressions, even on first greeting, can be valuable to the psychologist and should not be minimized because they are samples of the patient’s personality pattern. These samples of behavior constitute a microcosm of the patient’s overall functioning.

• Clinical data is not collected as judgmental evidence. Clinical data is an accumulation of samples of behavior that affords the psychologist an opportunity to understand possible conflicts in the personality.

• The psychologist should address the referral problem but not be limited by the main referral question. Frequently, it becomes necessary for the psychologist to clarify or augment the referral problem. Thus, the psychologist should obtain information regarding the referral problem directly from the patient.

• Tentative conclusions about the patient’s behavior and its probable meaning can be pointed out in this section of the report.

• Random observations are not useful here. Rather, tentative hypothesis building is relevant. Thus, general diagnostic statements may be made as, for example, in the distinction between organicity, psychosis, character disorder, or neurosis.

• It is useful in the general diagnostic discrimination for the clinical interview section to ascertain a diagnostic domain by assessing the psychosis-nonpsychosis dimension. To clarify this dimension, an evaluation of Bleuhler’s four “A”s—autism, affect, ambivalence, and association—can be a useful assessment tool. Evaluation of anxiety is also especially important with respect to its appropriateness, conscious affect, or symptoms it may produce.

– Autism. Indicated by withdrawn interpersonal contact.
– Affect. Assess the normalcy of mood, modulation of affect, appropriateness of affect, and degree of lability.
– Ambivalence. Apparent from the need to balance responses, fear of directness, approach-avoidance conflicts, surfacing of severe self-doubt and indecision, and need to maintain characteristic internal equilibrium.
– Association. The patient’s capacity to be logical, cogent, clear, incisive, and relevant as opposed to exposing disassociative ideation and tangential thoughts. Involves an assessment of the degree to which thinking is structured within the context of cause and effect as opposed to thinking that is circumstantial and irrelevant.

• Phenomena of delusions (fixed, false beliefs) or hallucinations (gross misperceptions of reality)
need to be noted along with any disorientation with reference to time, place, or person—an assessment, essentially, of the patient’s state of consciousness.

– Time Orientation. The patient’s sense of time is distorted.
– Place Orientation. The patient is confused about current defining aspects of location.
– Person Orientation. The patient’s self-identification is confused.

References

Henry Kellerman and Anthony Burry, Handbook of Psychodiagnostic Testing, Fourth Edition, 2007, Springer ScienceBusiness Media, LLC.

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