Words cannot adequately express what can and does happen during a clinical interview. Nevertheless, here are a few words from the Clinical Interviewing text anyway. We start with short lists of the advantages and disadvantages of structured diagnostic interviews and then move on to a less structure diagnostic interviewing model. Therapists systematically ask clients a menu of diagnostically relevant questions. Diagnostic interview schedules generally produce a diagnosis, consequently relieving clinicians of subjectively weighing many alternative diagnoses. Diagnostic interview schedules show better diagnostic reliability and validity than less structured methods.
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Clinical Interviewing Differential Activation Theory Differential activation theory suggests that when previously depressed and suicidal individuals experience a negative mood, they are likely to have their negative information processing biases reactivated. The original theory:. Any return of the mood reactivates the pattern, and if the content of what is reactivated is global, negative, and self-referent e.
In fact, there are many studies indicating that both depressed and non-depressed clients and non-clients can be quickly and powerfully affected by mood inductions Lau et al.
For example, in a recent study, participants were divided into three groups: a those previously depressed with suicide ideation; b those previously depressed without suicide ideation; and c those with no history of previous depression Lau et al.
Additionally, the participant group with a history of depression and suicide ideation exhibited significantly greater impairment in problem solving than the comparison groups. Overall, the research clearly indicates that all individuals, depressed or not and suicidal or not, can have their mood quickly and adversely affected through rather simple experimental means.
Additionally, it appears that previously depressed individuals may experience differential activation and therefore also have increases in negative cognitive biases about the self, others, and the future. Further, it appears that previously suicidal individuals may be particularly vulnerable to having their problem-solving abilities adversely affected when they experience a negative mood state.
Depressogenic Social, Cultural, and Interview Factors In addition to the preceding research findings, there are a number of contemporary social and cultural factors that may predispose or orient individuals toward depressive and suicidal states. More than ever the United States media is involved in defining depressive states and promoting medical explanations for depression and suicidality.
In particular, pharmaceutical advertisings encourage individuals to consult with their doctor to determine whether they might benefit from a medication designed to treat their emotional and behavioral symptoms.
Unfortunately, as most of us know from personal experience and common sense, it is very easy to move into a negative mood in response to suggestions of personal defectiveness which, over time, certainly may be as potent as eight minutes of a slow Russian opera.
Consequently, it would not be surprising to find that continually rising depression rates and accompanying pharmaceutical treatments are, in part, related to increased awareness of depressive conditions. Even more relevant to the suicide assessment interviewing process, it may be that interviewers who focus predominantly or exclusively on the presence or absence of negative mood states inadvertently increase such states.
This possibility is consistent with constructive theory in that whatever we consciously focus on, be it relaxation or anxiety or depression or happiness, tends to grow. It is also consistent with anecdotal data from our students who report feeling surprisingly down and depressed after conducting and role-playing suicide assessment interviews. Our concern is that traditional medically oriented depression and suicide assessment interviewing may sometimes inadvertently contribute to, rather than alleviate, underlying depressive cognitive and emotional processes.
Consequently, in the following sections on suicide assessment interviewing, we guide you toward balancing negatively oriented depression and suicidality questions with an equal or greater number of questions and prompts designed to increase the focus on more positive client experiences and emotional states. This serves two functions. First, including positive questions and prompts may help clients focus on positive experiences and therefore improve their current mood state and problem-solving skills.
Second, if clients are unable to focus on positive personal experiences or display positive affect, it may indicate a more chronic or severe depressive and suicidal condition. Overall, our primary message is that we should always pay close attention to the manner in which we use words, questions, and language when conducting depression and suicide assessment interviews. Specifically, consider these attitudinal statements: Depression and suicidality are natural conditions that arise, in part, from normal human suffering.
Consequently, just because a client arrives in your office with depressive symptoms and suicidal features, this does not necessarily indicate deviance—or even a mental disorder.
Given that depressive and suicidal symptoms are natural and normal, it is acceptable for you, as an interviewer, to validate and normalize these feelings if they arise.
This is especially important because many suicidal individuals feel socially disconnected, emotionally invalidated, and as if they are a burden to others Joiner, There is no danger in accepting and validating client emotions—even self-destructive emotions. Forgetting to ask your client about positive experiences is like forgetting to go outside and breathe fresh air.
Fortunately, most people who experience depression recover, with or without treatment. Additionally, most people at least briefly consider suicide as an alternative to life, and of those who seriously contemplate—or even attempt—suicide, most end up choosing life instead of suicide. A note of caution is in order. People often hesitate to ask directly about suicidal ideation out of a fear that they will somehow cause a sad person to suddenly think of suicide as an option.
Asking about suicidal thoughts or impulses is not the same as dwelling on negative and depressing thoughts and feelings. Balancing the focus between negative and more positive, solution-focused material can be both wise and helpful.
Failing to ask about suicide is neither. Full citations for the references listed below are available in the text. It is especially important when working with suicidal clients to document the rationale underlying your clinical decisions. For example, if you are working with a severely or extremely suicidal client and decide against hospitalization, you should outline in writing exactly why you made that decision.
You might be justified choosing not to hospitalize your client if a suicide-prevention or safety agreement has been established and your client has good social support resources e. When you work with suicidal clients, keep documentation to show you: 1.
Conducted a thorough suicide risk assessment. Obtained adequate historical information. Obtained records regarding previous treatment. Asked directly about suicidal thoughts and impulses. Consulted with one or more professionals. Discussed limits of confidentiality. Implemented suicide interventions. Developed a collaborative treatment plan. Gave safety resources e. Remember, the legal bottom line with regard to documentation is that if an event was not documented, it did not happen see also, Putting It in Practice 9.
Using a Comprehensive Suicide Risk Factor Checklist for a Thorough Suicide Assessment For graduate students and practicing clinicians, having knowledge of suicide risk factors is very important, but a bit of a paradox. Similarly, if you know someone is in a very low risk population e. Although suicide risk factors as well as protective factors are no guarantee of anything, they do provide clinicians with useful information. However, rather than relying on risk factors alone to try to predict suicide which is always a losing proposition , the effective clinical interviewer establishes rapport, works collaboratively with clients, and uses risk factors in combination with a thorough suicide risk interview.
Additionally, during this interview the clinician should be sure to move beyond the medical model, also evaluating for strengths and protective factors. Finally, although establishing a suicide prevention agreement can help reassure us that the client is committed to life, these agreements or contracts have little empirical evidence supporting their effectiveness and if completed in a cursory manner, can even cause clients to feel more negative about the treatment alliance than they would otherwise.
When agreements are used they should be done so in a way that communicates compassion and collaboration so clients feel clinicians are working with them to address their distress and isolation. The client has made a previous suicide attempt. The client meets DSM-IV or ICD diagnostic criteria for a specific mental disorder clinical depression, bipolar disorder, schizophrenia, substance abuse or dependence, substance — induced disorders, borderline personality disorder, antisocial personality disorder, anorexia.
The client is unemployed. The client is unmarried, alone, or isolated. The client is experiencing physical health problems. The client recently experienced a significant personal loss of ability, objects, or persons; e. The client is a youth and is struggling with sexuality issues. The client was a victim of childhood sexual abuse or is a current physical or sexual abuse victim.
If depressed, the client also is experiencing one or more of the following symptoms: Panic attacks Lack of interest or pleasure in usually pleasurable activities Alcohol abuse increase during depressive episodes Diminished concentration The client reports significant hopelessness, helplessness, or excessive guilt. The client reports presence of suicidal thoughts. Note in your evaluation: Frequency of thoughts How often do these thoughts occur?
Duration of thoughts Once they begin, how long do the thoughts persist? Intensity of thoughts On a scale of 0 to 10, how compelling are the thoughts? The client reports a specific plan.
The client reports a lethal or highly lethal plan. The client reports availability of the means to carry out the suicide plan. The client does not have social support nearby. The client reports little self-control. The client has a history of impulsive behavior. The client reports suicide ideation and a plan and has a history of overcontrolled behavior or presents as emotionally constricted or displays psychomotor agitation. The client reports a moderate to high intent to kill self or has made a previous lethal attempt.
The client was recently discharged from a psychiatric facility after apparent improvement. The client was recently prescribed an SSRI and has associated disinhibition or agitation. The client has access to firearms. Share this:.
Clinical Interviewing, 6th Edition
Clinical Interviewing Differential Activation Theory Differential activation theory suggests that when previously depressed and suicidal individuals experience a negative mood, they are likely to have their negative information processing biases reactivated. The original theory:. Any return of the mood reactivates the pattern, and if the content of what is reactivated is global, negative, and self-referent e. In fact, there are many studies indicating that both depressed and non-depressed clients and non-clients can be quickly and powerfully affected by mood inductions Lau et al.
The clinical interview is a fundamental assessment and intervention procedure that mental and behavioral health professionals learn and apply throughout their careers. Psychotherapists across all theoretical orientations, professional disciplines, and treatment settings employ different interviewing skills, including, but not limited to, nondirective listening, questioning, confrontation, interpretation, immediacy, and psychoeducation. As a process, the clinical interview functions as an assessment e. Either way, clinical interviewing involves formal or informal assessment.
Category Archives: Clinical Interviewing