Interview, Case History and Testing in Psychology
Interview, Case History and Testing in Psychology
Interview, Case History and Testing in Psychology
TESTING
Structure
1.0 Introduction
1.1 Objectives
1.2 Interview
1.2.1 Definition of Interview
1.2.2 Characteristics of Interview
1.2.3 Types of Interview
1.3 Case History Interviews
1.3.1 Basic Issues in Case History
1.3.2 Case History Taking (Format)
1.3.3 Mental Status Examination
1.4 Psychological Testing
1.4.1 Definition and Characteristics of Good Psychological Test
1.4.2 Classification of Tests
1.5 Let Us Sum Up
1.6 Unit End Questions
1.7 Glossary
1.8 Suggested Readings
1.0 INTRODUCTION
There are various assessment techniques in counselling and guidance. Interview,
case study and psychological testing are popularly used for assessment of the
client. These techniques enable the counselor to obtain specific information and
to explore behaviour or responses in depth. Interview is a conversation with a
particular purpose. We have seen and are aware of the selection of candidates
through interview and other assessment methods and we also know how the
employees’ interview is taken. These interviews are of different types, as for
instance some are structured, some unstructured, and some others semi structured
and so on. The intake interview is one of the most important interview which
takes place in the first contact of the client with the counselor. Depending upon
the purpose the most appropriate type of interview is selected. In counseling all
forms of interview are used. Case history taking requires one type of interview.
Often it is in standardised format. Psychological testing is objective measure
which is used to assess the client. To measure personality, aptitude, intelligence,
and interest etc. psychological tests are used. All these tools help the counselor
in diagnosing the client’s problem. In this unit we are going to discuss some
features of interview, case history and psychological testing.
1.1 OBJECTIVES
When you have completed this unit, you will be able to:
• Define interview as a method of counselling;
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Approaches to Assessment • Identify some of the characteristics of interview;
in Counselling
• Explain different types of interviews;
• Explain how interview skills are acquired and developed;
• Describe the role of interviewee and interviewer; and
• Analyse the various sources of error in the interview.
1.2 INTERVIEW
Interview technique is widely used by the psychologist for increasing counsellor’s
understanding of the client. It enables the counselor to obtain specific information
and to explore behaviour or response in depth. In many respects, an interview
resembles tests which has reliability, validity, prediction and structure. The
interview remains one of the most prevalent devices in clinical, industrial,
counseling agencies, schools and correctional settings. This technique is important
since this is scientific in nature. Interview is interaction between two or more
people. The situations may differ. In some interviews it is one to one interaction,
in others it might be that a single person is taking interview of many people at
the same time, like family interviews that are conducted for therapy.
4) Measuring understanding
A great deal of research has been carried out by Carl Rogers in this regard. He
has analysed the responses that are given by the client to classify them on five
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Approaches to Assessment levels. The basis for this is the empathy by that person. If the person has more
in Counselling
empathy then it is likely that he will have higher level of understanding of the
client and his or her problems. Level 3 and 2 are adequate for conducting the
unstructured and semistructred interview.
5) Recoding responses
Responses of client should be taken in some form. It can be taken in detail writing
while interview is in progress. It has an important advantage in that the client
may feel that whatever is being conveyed by him/her appears important as
whatever the client says is being recorded by the interviewer. This encourages
the client to part with more and also in depth information.
If whatever the client says is not noted down immediately, the possibility of the
counselor distorting or forgetting certain information that the client gave is high
and this can be avoided by writing it immediately.
If the counselor chooses to write down whatever is being told by the client, the
same may be done by noting down points and not verbatim or in detail.
a) Structured Interviews
As the name implies the structured interviews are the ones in which interviewer
asks a pre planned set of questions in the same manner and sequence for each
client. This method is used when same information is required from all
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interviewees or for getting information from the same client on other occasions. Interview, Case History and
Testing
The questions that are asked are structured and standardised. These are objective
questions, irrespective of the fact who is being interviewed. These are followed
by everyone. The sequence of the questions is also important. And to conduct
this type of interview, it is necessary that the interviewer is properly trained in
this skill. There are clear cut guidelines given how and in what sequence the
questions should be asked. For example, take the ‘clinical assessment
questionnaire’ that is given by the DSM IV classification system. The interview
is quite structured here and requires the interviewer to follow a very clear guideline
relating to particular disorder. Each disorder has different criterion and accordingly
the questions are formed. To conduct such clinical interviews, the person
concerned should get formal training in the clinical set up. Otherwise the data
collected by this method is not taken as valid.
b) Unstructured interviews
Unstructured interview is opposite to structured interview. The interviewer may
have an idea about possible questions but depending upon the needs of the client,
the order and sequence of questions can be changed, modified etc. by the
interviewer. Certain questions which may not be very relevant or wrongly worded
can be modified by the counselor. During the interview if the counselor finds
that certain questions need to be added or deleted the counselor may do so.
Thus questions are asked as per the flow of communication. Due to this freedom
in asking questions more spontaneous responses are given by the client. The
major advantage of this method is flexibility. Example of this type is the interview
that is conducted by the media on the opinion of the common man on certain
issues. They address the issues that are important to the common man but that
does not assure that the information that is gathered is always valid. They may
just hide the information that does not fit to their belief system. However,
unstructured interviews are less reliable and more prone to error than structured
interviews.
c) Semi-Structured Interview
Many times semi structured method is used to minimize the disadvantages of
both methods. It is a combination of structured and unstructured method. Certain
questions are always asked, but there is freedom to add questions.
d) Intake Interview
The initial interview is the first meeting in which interviewer works with client
to gather information about the problem with which the client has approached
the counselor. This interview includes presenting problem, general life situation,
history and interpersonal functioning. Some time it is called as history interview.
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Approaches to Assessment The basic purpose of this interview is to get information about the client and
in Counselling
their problems. In most of the cases the provisional diagnosis is made on the
basis of this information. This is an one to one interview technique, in which the
counselor tries to gain as much information as possible which would help the
counsellor to formulate the problem and understand the causes leading to the
problem.
The interview is directed by the counselor through out, and it should be done in
such a way that the counselee is able to talk most of the time expressing the
problem that is bothering the person. If the interview is too direct, the directness
of the counselor’s questions may make the client take a passive role. The way
the interview is structured also affects the interview and gathering of information.
For instance too much of structuring, may give the clients an impression that
they need not give any information on their own, as the counselor will any case
ask them about all these aspects.
The other limitation is that the responses of clients are given before counselling
relationship development and may not be accurate. Counsellor has to reexamine
this information once rapport and trust have been established.
Another aspect in interviewing is that the questions should not be repeated lest
the client gest bored talking about the same thing over and over again and possibly
delete some of the details. Hence every effort should be put in to see that the
interviews are conducted in a manner that not only the counselor is able to establish
trust and confidence on the part of counselee but also make the counselee feel so
uninhibited that the latter expresses even the most unpleasant experiences to the
counselor.
In the first part of case history taking, details about demographic information
such as name, age, gender, residential address, education, occupation, marital
status etc. are taken in detail. All the minor things like where he stays and the
area, all these things are mentioned in details. Then details about who has referred
him are taken into account. All these information may not seem quite useful at
face value, but with increasing experience we understand that this information
can be used later for the management of the case.
The next part is about the referral. Who has referred this person? The next
information is about the actual problem that the person is facing right now is
taken. The sequence for this purpose is in the order that the complaints have
started. Details about how these symptoms started, how they progressed and
what is the duration of this, etc., are all mentioned. To understand if the person
had difficulty in developmental years, the details about this are taken. The person
is asked about his schooling and the education.
By the time the counsellor reaches this point he is oriented to the kind of
personality the person has. To utilise the information constructively, this
information is very important. This is clinical evaluation of the personality. In
most of the cases, the tests are not administered at this point. If a formal assessment
is needed then the referral is made at a later stage.
Then the interviewer asks about the medical history if any. As a psychologist we
may not be aware about the details of some of the serious physical illnesses the
client might have suffered from. As is known physical illnesses also have an
impact on the mental status of the client. However we can judge the psychological
impact it has on the client. In this aspect information centers about the illnesses,
and also what treatment has worked so far, for that person.
The next issue relates to the person’s interest and attitude towards life and other
related aspects. This is mentioned in the case history. This will also include the
client’s political and religious belief system. This includes what the person prefers
when he has free time.
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Approaches to Assessment The other important aspect of history taking is Mental Status Examination. This
in Counselling
is also called Present Status Examination. In this the examiner tries to confirm
the information that he has gained in the previous part of the case history. The
points like persons’ appearance, his speech and thoughts are at the beginning of
this section. Then it is also considered if the person was able to attend and
concentrate on the interview.
The other important aspect is regarding the pathology. The speech sample is
mentioned. The examiner also asks specific questions to evaluate if the thinking
normally. According to the phenomenology certain questions about the
hallucination and delusion are asked. The person is evaluated on this dimension.
In the mental status examination it is also essential to assess if the person is
suicidal if he has had any previous attempts.
Overall this segment of the case history taking, leads to the diagnosis. And if not
diagnosis at least the clinician is able to reach the provisional diagnosis.
4) Family History
Family is essential source of personality and development, and also in many
cases source of frustration. Therefore what are the family ties, what is structure
of the family?
• Family Constellation:
• Socio-Economic status: The income of the family, the place where they live,
the kind of work that they do, the kind of status they have in the community
in which they live, and many such related aspects are important to understand.
• Relationship with Parents: This is especially very important when we are
dealing with adolescents problems. Family is the first and important unit in
the person’s life. This shapes many relations in life. This can be asked to the
client and should be confirmed with the parents also. Because it may happen
that the client perceives his parents in a misconstrued manner and thus forms
an image of them as supportive or non supportive towards self. This
perception maybe quite different from the one that is factual in that the
parents may not be at all as the client perceives them but may be doing
things with good intention. Exactly opposite may also happen, that is, a
person may have a false image of his parents. So in both the cases it is very
important that we confirm it with reliable source of information.
• Interpersonal Relationship: (within family): This is an important aspect of
the family dynamics. How the family members relate to each other is
important. The client may not be the victim of the conflict, but he may
witness it with some other family members. So this becomes important to
see, how much the emotional tie is strong with the family in case of the
client.
This is the evaluation of the client at the time of the interview. The clinician
completes taking the case history. Then he reaches a tentative diagnosis on the
basis of the information that is provided by the client and the informant. Now
this is the evaluation that tries to confirm the diagnosis. Based on a diagnostic
system the clinician asks questions. This helps him to come to a conclusion
about the diagnosis. This also confirms the clinical understanding of the symptoms
that are given by the client.
• Behaviour: The behaviour of the client, if it is age appropriate or not. How
does the client behave with the examiner? What is his attitude towards the
examiner? These are all the points that are included under this heading.
•. Thoughts: The thoughts are significant in two important ways. One is
assessment of these will tell us more about the personality of the person.
Second and very important is that it will also tell us if the person has any
disorder of thoughts.
• Speech: This is related to the quality of speech of the client. The volume
tone and other things are good parameters of the speech quality.
• Perception: These are related to all the five senses of the person. Questions
regarding this tell us if the person has any illusion or hallucination. This
will tell us about the intensity of the problem the client is facing.
Higher Mental Processes
• Intelligence: This is the key factor. It helps the client to understand his own
problem. If the person is aware about his surroundings and what is his general
level of knowledge is the indication intelligence. If there is any indication
of low sub normality then a particular test may be administered to assess
the intelligence.
• Memory: This is also important aspect of intelligence. But this is at the
same time an indication of the brain functioning. Disturbance of this is an
indication.
• Attention: This is one more indication of the brain functioning of the person.
Disturbances of attention may be an indication of some problem at brain
level functioning.
• Concentration: As mentioned above attention and concentration are related
to each other. If the attention can be sustained it is called as concentration.
• Insight: This means the person understands of his state. Whether he has any
understanding of his illness or not.
Psychological Examination
In the following format, the test that has been used for the assessment can be
mentioned in an organised manner. This gives us quick understanding in summary
of the test administered.
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Approaches to Assessment
in Counselling Name of the Test Row Score Stand Score Interpretation
• Integrated Note (with theoretical base): This is the summary of the interview
that is conducted by the clinician so far. This leads to a diagnosis. These are
usually the positive findings that support the diagnosis.
• Diagnosis: This is the final understanding about the client. According to the
classification system that the counselor follows, he will diagnose the client.
There are two widely used systems as we know. One is DSM IV and other is
ICD-10. Since counseling is for normal people above two systems are not
used. In counseling different classification is used such as study problem,
adjustment problem, negative self concept etc. So with the help of the case
history and the Mental Status Examination the client is diagnosed. Diagnosis
helps to know symptoms, etiology and therapy planning.
• Prognosis: This gives us a clear understanding of what are the chances of
recovery. There are few factors which are asset for recovery while some are
negative. Counsellor considers good and bad factors and decides the
probability of recovery of problem.
Counseling Design
• Choice of therapy: After understanding all the essential aspects of the client’s
problem this is the time to actually do the intervention. The problem that
the client is facing can be treated in different ways. It is the skill of the
counselor to convey to the client what he has understood about him in the
language that the client understands. At this stage with the mutual
convenience of the client and the counselor the further contracting for his
therapy or counseling is done, the counselor shares this with the client. If
there is any need to involve someone in the counselling process in addition
to the client, that may be conveyed to the client and to the family member
who is to be involved in the programme.
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Interview, Case History and
1.4 PSYCHOLOGICAL TESTING Testing
What is a test?
A test is a measurement device or technique used to quantify behaviour or aid in
the understanding and predicting the behaviour. We all do appear for such tests
many a times in our lives. The situations may differ, right from the interview that
one faces as a child for the school admission till interview as a parent. We all
have experiences of appearing for the test in the formal atmosphere, as for instance
the job selection tests. These tests will be considered in detail in the next section.
Thus tests in general do scrutinise and give us fair idea about the person’s
performance for a particular position. This predicts the person’s behaviour in
that situation. Many tests are devised specially with the purpose of getting the
objective information from people in particular area.
Also, specific tests have been devised over a period of time by different experts,
which focused on a particular aspect of the person. For example tests were devised
to understand the person’s ability to appreciate and understand music. The journey
of the testing started from the objective evaluation of intelligence and reached
very minute but essential aspects of daily life. A wide variety of tests have been
devised for the purpose of recruitment during the second world war, since this
was the immediate requirement after the economic recession.
Group tests are those in which the same test can be administered to a group at the
same time. In fact there are certain tests which also have the norms of the test in
the group format. Like the test of creativity. In this group administration is more
useful than the individual administration. Most of the paper pencil tests belong
to this category. These are the tests which have common instruction and many
times the tests are self administering. That means the subject can administer the
test on himself by just reading the instructions.
b) Personality tests
As the name suggests these are the tests that assess the personality of individuals.
Personality tests are of many types as for example, pencil paper test, story telling
test, ink blot tests, etc. One of the tests is 16 Personality Factors or the 16 PF Test
as it is popularly known. This test gives us understanding of the person on various
aspects of his or her life, whether suffers from anxiety, depression etc., and the
level of intelligence that the person has.
It must be remembered that the tests differ in their contents and structure
depending on the factors that it measures. There are certain tests which are based
on a particular model. For example the NEO PI is based on the Five Factor
Model. Eysenck’s personality questionnaire is based on the Three Factor model.
c) Projective tests
These are tests which try to unravel the unconscious material. In certain cases it
may happen that the client is not aware of certain aspects of his own mind. These
tests help to understand such aspects. The unknown unresolved conflicts and the
motivational forces behind the actions are seen through these tests.
e) Intelligence tests
The tests of intelligence measure different aspects of the intellect. There are
different intelligence tests for different age groups. Also the same test may be
differently administered to the different age group individuals.
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Approaches to Assessment
in Counselling Self Assessment Questions
1) What is mean by psychological test? Explain characteristics of good
test.
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2) Give definition and classification of psychological tests.
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3) Discuss the different types of tests and their use.
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Test is objective and standardised tool for measuring some human behaviour
like personality, intelligence, attitude, aptitude, study habits etc. Objectivity,
reliability, validity, norms are characteristics of good test.
1.7 GLOSSARY
Structured interview : This is an interview questionnaire which is
arranged in a certain order and which cannot be
changed to suit any situation. Its questions have
been so structured that there is no scope for any
modification.
Unstructured interview : This is an interview in which questions can be
asked in any order that the counselor chooses. It
is flexible and open ended. The main purpose is
to elicit maximum information from the client.
This type of questioning helps to organise the
interview in such a manner that the client is
comfortable and does not feel that he or she is
questioned formally.
Psychological test : These are standardised tests which are
administered to clients to assess varied aspects
of cognitive, emotional and behaviourala
aspects.
Reliability : This is concerned with the reliability of a
psychological test. For instance if this test is
administered to the same group at two different
places or occasions should produce similar
results. It is like a ruler (scale), which has 12”
arranged in an interval of one inch on a
continuum of 1 – 12 ”. If this scale measures a
table as 10” long and 8” wide, wherever that
table is measured by the same scale it would
give the same measurement.
Validity : This refers to the test in terms of what it purports
to measure. That is if the scale isto measure
anxiety, it must accurately state that the particular
score will indicate high anxiety etc. When tested
by any other instrument it should show high level
of anxiety.
Norms : This is a frame of reference against which the
scores obtained by the concerned subject are seen
and interpretation made.