times, a psychiatric social worker conducts such
interviews. Often, these talks are face-to-face, but
there has been an increasing tendency to use tele-
phone contacts prior to the initial interview.
A skilled, sensitive telephone interviewer can
obtain much of the information that has tradition-
ally been gathered at the clinic. Under some
conditions or in particular clinics, the intake inter-
view may be conducted by the same person who
later does the diagnostic interview or the test
workup. An advantage of this procedure is that
patients do not get shoved from pillar to post as
they make the rounds from one type of interview
to the next.
Another function of the initial interview is to
inform the patient of such matters as the clinic’s
functions, fees, policies, procedures, and personnel.
Patients are consumers and have every right to
information regarding services and charges. These
concrete details can certainly influence patients’
motivation for therapy and can often dispel some
myths that might decrease their expectations for
help. Box 6-2 presents an example of an intake
report based on an interview with a prospective
client in a community-based outpatient clinic.
The Case-History Interview
In acase-history interview, as complete a personal and
social history as possible is taken. The clinician is
interested both in concrete facts, dates, and events
and in the patient’s feelings about them. It is impor-
tant to note that a relentless pursuit of dates and
names can sometimes obscure important data and
create in the patient a set to respond in concrete
terms. This mental set can sometimes impede prog-
ress in later interviews.
Basically, the purpose of a case history is to
provide a broad background and context in which
both the patient and the problem can be placed.
Our diagnostic and therapeutic technology is not
yet so advanced that specific behaviors, problems,
or thoughts can always be understood in exactly the
same way in every person. It is therefore essential
that the patient’s problems be placed in a proper
historical-developmental context so that their
diagnostic significance and their therapeutic impli-
cations can be more reliably determined.
The range of material covered in personal-
social histories is quite broad. It covers both child-
hood and adulthood, and it includes educational,
sexual, medical, parental-environmental, religious,
and psychopathological matters. Although, as
noted earlier, much of this material will be factual,
it is extremely important to note how patients pres-
ent the material—how they speak about it, the
emotional reactions to the material, evasiveness or
openness, and so on.
Although most patients, particularly competent
adults, provide their own personal-social history,
other knowledgeable adults can often furnish
invaluable data and impressions. A parent, spouse,
an employer, a teacher, or a friend can be rich
sources of information. Depending on the age or
cognitive ability of the client, these“external infor-
mants”sometimes are the only valid sources of use-
able information. In addition, there are issues of
confidentiality and trust. Even when the patient
gives consent and helps recruit the informants,
many clinicians fear that using them can impede
the subsequent therapeutic relationship. Still, outside
sources can often provide a picture of the patient that
cannot be achieved in any other fashion. Table 6-2
presents a typical case-history outline.The Mental Status Examination Interview
Amental status examinationis typically conducted to
assess the presence of cognitive, emotional, or
behavioral problems. The general areas covered in
these interviews, along with excerpts from a sample
report, are shown in Table 6-3.
A major limitation of mental status interviews
has been their unreliability, because they are often
highly unstructured in execution. To address this
problem, structured mental status examination
interviews have been devised. Here, specific ques-
tions are asked to assess behavior in a variety of
areas. It is important for clinical psychologists to
be familiar with the mental status examination
because these interviews are one of the primary174 CHAPTER 6