1
Q
Ethical Issues Limiting Confidentiality
A
Protection from harm and when required by law
2
Q
Why does protection from harm pose as an exception
A
Must intervene if there are credible harm risks to the client or others and has duty to report in cases like self-harm or suicide threats, harm to others, a child in need of protection from abuse/neglect, etc. (in Ontario there is a mandatory report policy that health professionals must follow for sexual abuse)
3
Q
When does law pose as an exception
A
- Legal obligations to override confidentiality depending on who requested the intervention or assessment; if a judge, lawyer or court requested for this, they get report, but the client does not
- Psychologists in Canada do not have ‘client privileges’ like lawyers do
4
Q
Unstructured interviews
A
- Start with “what got you here” and let the client take the lead
- Encourages natural conversation and deep exploration, while adapting to clients’ needs
- Less standardized, so less of an interrogation vibe but it is harder to compare to others clients and there is a risk of conversation going anywhere
- Features include a safe, protected, positive, and comfortable environment, with established trust and out of others’ earshot; a positive client-practitioner relationship, encouraging honest and meaningful conversation; and the gathering of pertinent information while the conversation remains open, free-flowing and with the possibility of going in depth if the client is comfortable
5
Q
The Role of the Psychologist in an Unstructured Conversation
A
- Setting a context
- Asking a mix of open and closed questions and pursuing a line of questioning
- Clarifying, reflecting and paraphrasing, to demonstrate understanding, allow for clarity, summarize the key points, and promote talking
- During these interviews, many psychologists find it useful to begin the discussion with open-ended questions, followed by closed questions
6
Q
What are the major differences between assessment interviews and conversations with friends - Purpose
A
- AI: Gathers clinical or diagnostic information
- CF: Social connection and sharing experiences
7
Q
What are the major differences between assessment interviews and conversations with friends - Structure
A
- AI: Guided by psychological frameworks and goals
- CF: Free-flowing and informal
8
Q
What are the major differences between assessment interviews and conversations with friends -Questioning
A
- AI: Intentional use of open/closed questions
- CF: Natural, spontaneous exchanges
9
Q
What are the major differences between assessment interviews and conversations with friends - Confidentiality
A
- AI: Protected by ethical and legal guidelines
- CF: No formal confidentiality obligations
10
Q
What are the major differences between assessment interviews and conversations with friends - Objectivity
A
- AI: Psychologists maintain neutrality and minimizes person bias, by being less emotionally involved and not sharing their experience
- CF: Friends share opinions and personal biases, sharing their experiences and being emotionally involved
11
Q
What are the major differences between assessment interviews and conversations with friends - Role of Listener
A
- AI: Active listening with professional interpretation
- CF: Mutual exchange and personal support
12
Q
What are the major differences between assessment interviews and conversations with friends - Emotional Focus
A
- AI: Focus on client’s emotions for insight and intervention
- CF: Shared emotional expression and support
13
Q
What are the major differences between assessment interviews and conversations with friends - Outcome
A
- AI: Used for clinical assessment, treatment planning, or diagnosis
- CF: Strengthens personal bonds or social support
14
Q
Semi-Structured diagnostic interviews
A
- Blending of structured (standardized) and open-ended questions allows for diagnosis while allowing free-flowing conversation
- More specific questions with more goals, direction oriented, while remaining flexible and taking it as the client goes
15
Q
Structured Clinical Interview for DSM-5 (SCID-5):
A
Most widely used in North America
16
Q
Research Version
A
The most comprehensive interview, covering most of the DSM-5 diagnoses
17
Q
The Clinician Version
A
A somewhat shorter interview designed to cover disorders most commonly encountered in clinical settings and practice; use specific books with all these questions they want to hit and all the information needed available
18
Q
General issues in interviewing
A
- Skills in questioning (balancing open-ended and closed questions is hard especially at the start)
- Skills in listening (active listening, paying attention to verbal and non-verbal cues, paraphrasing)
- Asking about sensitive issues (approaching difficult issues with sensitivity and remaining open)
- Cultural sensitivity (acknowledge different styles, values and own personal biases to eliminate assumptions)
- Adapting to different clients (children, couples, families, older adults, etc.)
19
Q
How to adapt to different clients
A
- With children ask questions using age appropriate language and use play based techniques, like toys and drawing, etc.)
- For couples use constructive dialogue to help maintain a balance between both ppl
- For families, managing group dynamics and different povs with respect for all opinions
- For OA, acknowledge cognitive, emotional, and contextual factors, with the collateral based on ability level
20
Q
Pros and Cons of Unstructured Interviews
A
- Pros: highly flexible and client centered, builds strong rapport and trust, allows for in-depth exploration of individual experiences
- Cons: Lack of standardization reduces reliability, harder to compare responses across clients, may overlook key diagnostic criteria
21
Q
Pros and Cons of Semi-Structured Interviews
A
- Pros: balance between structure and flexibility, standardized format improves reliability, allows for clinical judgment while maintaining diagnostic rigor
- Cons: Less spontaneous than unstructured interviews which hurts the report, can still be time-consuming, requires skill to balance structure with client-centered, individualized approach and support
22
Q
Pursuing a line of questioning
A
- Tell me more about… (encourages collaboration)
- Can you explain what you meant by… (clarifies responses)
- Give me an example… (grounds abstract concepts into real experiences)
- What does depressed mean to you? (in cases of generalized aspects of diagnoses and pathologization of personal experiences, helps avoid assumptions)
- I want to be sure I understand…/ Help me understand what you mean by out of control… (active listening and understanding, promoting validation)
- Persist until answer is obtained, allowing for deeper meaning and insight (persistence why interviews are unlike conversations)
23
Q
Problem definition questions
A
- Tell me what you mean by…
- What happens when… (triggers or consequences)
- Give me an example…
- Describe what it is like when…
- Tell me about last time that… (recall of incidences)
- Can explore what happens when triggers happen, understand their contexts and reactions/consequences, situations, and emotions
24
Q
Problem definition questions - The three goals
A
- Frequency: patterns (how often does this happen), triggers and support (are there times when it is better or worse)
- Intensity: effort and difficulty (how hard is it to do) and Impacts on daily life and functioning (what is the effect)
- Duration: Onset/etiology and situational/ongoing (when did this start) and progression and chronicity (how long has it been going on)
- Super important to understand how often and for how long issues have been present for diagnosis
25
Benefits of Problem Definition
- Multiple perspectives (gathers well-rounded info)
- Clarifies problem scope (identifies frequency, intensity and impact of concerns)
- Guides intervention (provides valuable insights for tailoring treatment strategies
26
Challenges of Problem Definition
- Limited insight (some individuals may struggle to articulate their experiences, like children, older adults, etc.)
- Subjectivity (individuals define issues differently)
- Bias (multiple ppl say different perspectives than clients)
- Emotional sensitivity (have a hard time articulating problems, potentially discomfort and defensiveness)
27
Observations
- Provide insights into clients' functioning and behaviours across different settings and contexts, as there may be variation
- Areas of observations with typical behaviours involve clinic (anxiety, compliance), school (social challenges, task avoidance) and home (emotional outbursts (feel safest), difficult with routine consistency, sibling conflict, more physical touch)
- Accounts for observer effect and for potential variations in symptom and behavioural variations by context
28
What factors may lead to inaccurate or invalid observations in these settings?
- Child factors (low energy and distress, motivation, fatigue, illness, language barriers)
- Environmental factors (distractions, testing, observer effects, unfamiliarity of setting, noise)
- Examiner factors ([confirmation] bias, subjectivity, inconsistent administration, rapport)
29
Advantages of Self-Monitoring
- Enhances awareness (helps indivs recognize patterns in bhvrs/symptoms)
- Encourages accountability, by tracking progress
- Supports data collection (provides realtime insights on ecological functioning)
- Facilitates Intervention Planning (guides tailored strategies based on patterns)
- Improves treatment engagement (active participation)
30
Challenges of self-monitoring
- Accuracy and bias issues (response may be influenced by memory issues or social desirability)
- Inconsistent recording
- Reactivity effect (temporary effects on bhvr)
- Cognitive and emotional load
- Interference w Natural Bhvr (active monitoring affects response)
31
Should we trust data from self-monitoring diary procedures?
- Should be cross-validated with other events, research, assessments, etc. and use some standardization to maintain validity
- Not taking it 100% to their word but maintaining accountability
- Provides real time insights
- Encourages awareness
32
Concerns with Self-Monitoring
- Memory and recall issues
- Inconsistent data
- Social desirability
- Reactivity
33
Why do some clients decide to misrepresent their experiences when completing self-monitoring tasks?
- Desire for approval (really want to impress assessor)
- Social desirability ( downplaying benefits or symptoms or exaggerating)
- Avoidance of consequences (avoiding intervention, fear of judgement and intervention)
- Cognitive barriers (emotional avoidance)
Psych 335
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