Scholing & Visser (2019). The interview

During the diagnostic phase, the psychologist employs interview (1), observation (2) and standardized measuring instruments (3). The intake interview refers to the initial contact between the psychologist and the client. The main objectives of the intake interview are the collection of information (1) and establishing a good working relationship (2).

There are several requirements for a diagnostic interview:

1. Environment
   The room must not distract (1), must be neutral but pleasant (2), must be comfortable (3). Furthermore, the organization’s general attitude towards the client must be respectful (1), the interviewer must dress appropriately (2) and the interviewer must keep an appropriate distance from the client (i.e. both emotionally and physically) (3).
2. Interviewer’s knowledge
   The interviewer must have extensive knowledge of his subject area (1), must be up-to-date on the content of the classification systems (e.g. DSM-5) (2) and must have appropriate knowledge of epidemiology (3).
3. Interviewer’s skills
   The interviewer must be empathetic (1), needs to provide unconditional positive acceptance (2) and needs to be authentic (3). Furthermore, the interviewer needs to have appropriate interview skills (e.g. short paraphrases, selecting good questions).

Developing a good rapport with a client requires the interviewer to conform to the client’s frame of reference. The purpose of the intake interview is to establish the client’s request for help (1), assess whether the organization is capable of adequately meeting this request for help (2), assess what type of treatment is deemed appropriate (3) and provide the details of the organization to which the client should preferably turn (4).

In somatic health care, exclusion criteria are used whereas mental health care employs inclusion criteria (i.e. collecting more information to get a complete picture of the client). A consequence of this is that the intake can be unnecessarily long (1) and time-consuming (2).

Age influences (for adults) the topics that are discussed according to the stage in which the client is in; early adulthood (1), middle adulthood (2), late adulthood (3) and old age (4). There are topics that are more relevant, depending on the stage. For older people (i.e. late adulthood and old age), a cognitive disorder is more likely, which may require the psychologist to interview a partner of the client to collect information too.

Collecting information prior to the interview (i.e. questionnaires) can make the intake interview more effective. Questionnaires can also be beneficial for the client, as they often find it more easy to disclose using a self-report questionnaire than in a direct conversation. A structured interview can be useful to collect as many relevant information as possible. A psychologist should examine the objective information of the client prior to the interview but the subjective information after forming an impression of the client.

Rating scales require the assessor to provide a standardized judgement on a number of predefined topics. The process is not determined in advance. The product of using rating scales is structured clinical judgement. Rating scales and structured interviews differ in width and depth.

A broad-based instrument addresses a variety of topics or disorders but only does so in a superficial way. A specific instrument examines a particular disorder or category of disorders in greater detail. The choice of instrument depends on the interviewer’s objective.

Advantages of structured interviews are better and higher reliability (1), a fairer estimation of the seriousness of the complaints (2), a reduction in both information variance and criterion variance (3) and a greater comprehensiveness (4). Disadvantages of structured interviews are that it is time-consuming (1), the interviewers need to be regularly retrained (2) and the interviewer may conduct the interview too routinely (3).

There are several relevant instruments:

1. Structured Clinical Interview for DSM Disorders (SCID-S and SCID-P)
   This is a semi-structured interview for the classification of mental disorders according to the DSM. There is a variant for symptom disorders and personality disorders. The interviewer is encouraged to use other sources of information in addition to the questions. It has satisfactory interrater reliability.
2. Mini International Neuropsychiatric Interview (MINI)
   This is a structured interview that allows clinicians to systematically establish both DSM and ICD-10 classifications. There are different versions and the administration time is relatively short. There are reasonably effective psychometric characteristics.
3. Diagnostic Interview Schedule (DIS)
   This is a structured interview to assess the most common mental disorders. The interview costs a lot of time. However, the advantage is that it can be administered by less-specialized personnel because it presumes the interviewer has somewhat limited knowledge of psychopathology.
4. Composite International Diagnostic Interview (CIDI)
   This is a highly structured interview which aims to establish classifications according to the ICD and the DSM.

There are several relevant rating scales:

1. Schedules for Clinical Assessment in Neuropsychiatry (SCAN)
   This is a rating scale that is not intended to classify clinical disorders according to the DSM but to standardize the diagnosis of psychiatric symptoms that occur in different mental disorders.
2. Health of the Nation Outcome Scales (HoNOS)
   This is a rating scale for examining a client’s psychological and social functioning. It is suitable for routine outcome measurements. It requires limited training and it has good validity and reliability. It consists of behavioural problems (1), limitations (2), symptomatology (3) and social problems (4). It can be used to examine the severity of impairment in mental and social functioning and for measuring changes in the different life domains.
3. Meten van Addicties voor Triage en Evaluaties (MATE)
   This rating scale is developed for the addiction treatment sector. It can be used to establish a client’s use of psychoactive substances (1), the client’s history of addiction treatment (2), diagnoses of dependence (3), abuse according to the DSM (4) and the extent to which the client craves psychoactive substances (5).
4. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
   This is structured interview for obsessive-compulsive symptoms. It distinguishes between compulsions and obsessions. It is a reliable and valid rating scale for examining the severity of compulsions in clients with an obsessive-compulsive disorder.

The intake interview can be divided into three phases:

1. The interviewer introduces himself and explains the purpose of the interview. In this phase, general information regarding the interview is disclosed.
2. The client gives information regarding his visit to the psychologist.
3. This is the conclusion of the interview.

There are several potential obstacles during the interview:

1. Interviewer obstacles
   The interviewer may avoid topics he is not comfortable with. Self-awareness can be a solution to this problem. Topics that also relate to the interviewer (e.g. talking about relationship problems when going through a divorce) can also be a problem to the interview.
2. Client obstacles
   The obstacles that tend to originate with the client are often the result of psychopathology. The obstacles depend on the psychopathology (e.g. depression, anxiety).
3. Interaction obstacles
   These are obstacles that arise in the interaction between the psychologist and the client (e.g. client does not accept psychologist’s authority, client disagrees with the one-sided nature of the interview).

There are several other type of interviews that may be conducted during the intake phase:

1. Crisis intervention
   This is an interview which consists of a crisis. The main purpose of crisis intervention is to ensure that the crisis is defused or overcome after which can be decided whether the client can still partake in the more common intake procedure. The immediate cause of the crisis must be examined. In crisis intervention, the interviewer’s approach is more direct and target-oriented.
2. The consultation
   This is the end of the intake phase. The interviewer takes an active role and gives his own perspective. The client needs to understand the message and the interviewer should be aware that the message can be emotional or dramatic.
3. Bad news interview
   This is an interview in which the interviewer has to disclose information that the client would preferably not hear.

There are four factors which contribute to caregivers dreading bad news interviews:

1. Delivering bad news elicits strong emotions in the client which confronts the caregiver with his own powerlessness.
2. The well-being of seriously ill clients is contingent on the manner in which the bad news is delivered to family members and their relatives.
3. Messengers of bad news may occasionally have to deliver a message with which they themselves do not agree.
4. Caregivers may be confronted with complaints from the client.

There are five steps for a bad news interview:

1. Preparation
   This step includes making sure the interviewer has all the relevant information.
2. Conveying the bad news
   This step includes conveying the bad news gradually in very bad terms.
3. Blowing off steam and allowing space for emotions
   This step includes acknowledging the emotions of the client and allowing room for discussion. The interviewer needs to give the client room to process the news emotionally.
4. Impact of the message and explanation and/or argumentation
   This step includes discussing the reasons for the message and the background of the message.
5. View of the future and the search for solutions
   This step includes looking at the future and searching for solutions. This should be done with care, as this is not always a good idea.