are the types of speech characteristics the professional can observe and record.
The next major category is thought processes. In describing thought processes, the professional can note if the individual answers the questions that are asked and adds more information when appropriate. On the other hand, some individuals will produce responses that are not related to the question asked or tell a narrative in which each sentence is not related to the one that came before it. This is referred to as a flight of ideas. The content of the individual’s thought is also important. Is there a theme to the thoughts, such as that the CIA is out to get the individual? This would be referred to as delusional thinking. Does the individual keep repeating a certain theme? For example, some individuals express constant concern that they will have a heart attack or that their spouse is cheating on them. This is referred to as obsessional thinking. The professional should also take particular note if the person is talking about suicide or homicide. This may require an intervention.
flight of ideas: spoken expression in which comments are not related to a question asked or jump abruptly from one topic to another unrelated topic
delusional thinking: an unrealistic pattern of thoughts forming a theme
obsessional thinking: a pattern of repeated thoughts beyond the control of the person
Another major category is perceptions and a general awareness of the surroundings. Distortions of perceptions can include hallucinations in which the individual perceives experiences without external stimulation. Individuals with a psychotic disorder may hear a radio program talking to them directly or respond to voices in their head. General awareness of the surroundings includes the question of whether the person knows who and where he or she is and the present date and time.
The final categories describe intellectual functioning and insight. Intellectual functioning is generally noted in terms of current vocabulary used in the interview as well as previous academic achievement. The professional can also note if the person has an abstract understanding of the information he or she is reporting. Insight refers to the individual’s awareness of his or her own self and the factors related to his or her current situation and distress.
Structured Interviews and Assessment Considerations
A structured interview is an evaluation technique that is tightly systematized in terms of the questions asked. The idea is that by asking clients the same set of questions, it is possible to have better consistency across interviewers. Likewise, because every client receives the same questions, it is assumed that there will be more consistency across clients.
structured interview: an evaluation technique that is tightly systematized in terms of the questions asked, allowing for better consistency across interviewers and clients
Structured Clinical Interview for DSM Disorders
The current classification manual used by most clinicians in North America is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) (American Psychiatric Association [APA], 2013).The DSM will be discussed in some detail later in this chapter. Based on the DSM–5, with its specific criteria for each category of psychological disorder, it is possible to ask questions in an interview that directly probe for the existence of these criteria. The Structured Clinical Interview for DSM Disorders (SCID) sets forth these questions along with a decision tree for directing follow-up questions. For example, if you want to determine if a person displayed an obsessive–compulsive disorder, you would begin with a general question concerning whether the individual experiences thoughts that kept recurring. If the person said yes, you would then ask what those thoughts were. The decision tree would help you to determine if these thoughts were seen by the individual as something produced in his or her own mind or imposed on the person by an outside agent. Thoughts experienced as not from oneself would be more characteristic of a psychotic disorder, whereas those recognized as coming from one’s own mind might indicate a possible obsessive–compulsive disorder. Individuals with anxiety may also experience worries as thoughts coming into their mind, and the SCID would help to determine whether the person experiences obsessive–compulsive disorder or anxiety. The next set of questions would help the professional determine whether compulsions were also present. The SCID would instruct the interviewer to ask if there was anything the person had to do over and over again such as constant hand washing or checking a door lock several times.
Structured Clinical Interview for DSM Disorders (SCID): an interview that directly probes for the existence of the criteria for disorders within the current classification manual, the DSM–5
Assessing Cultural Dimensions
Over the past 40 years, there has been an increasing awareness that mental illness takes place within the context of a particular culture (Henderson et al., 2016; Marsella & Yamada, 2007). Initially, there was a realization that specific disorders such as depression, schizophrenia, and stress-related disorders are understood differently in different cultures (Draguns, 1973; Draguns & Tanaka-Matsumi, 2003). That is to say, a fuller understanding of mental illness requires an understanding of context. Although every culture has words for severe mental illness such as psychosis, mood disorders such as depression, and anxiety, there is also variation in what is considered normality and deviance. Cultural LENS: Empirically Supported Research Approaches and Cultural Competence notes that culture not only informs one as to how to view one’s distress but also influences how that distress is expressed.
Cultural Formulation Interview (CFI): a set of questions developed to help mental health professionals obtain information concerning the person’s culture and its influence on behavior and experience
With DSM–5, a Cultural Formulation Interview (CFI) has been developed to help mental health professionals obtain information concerning the person’s culture. In general, the CFI focuses on five domains. These are described in DSM–5 as follows:
Cultural identity of the individual—This domain in DSM–5 describes how the individual sees himself or herself in terms of ethnic, racial, or cultural identity. It can also include how connected the person is with the culture of origin.
Cultural conceptualizations of distress—This domain refers to how the person’s culture would influence his or her experience of the disorder. For example, different types of symptoms might be more acceptable in one culture than another. Also, some individuals may be unwilling to describe the experience they are having in certain aspects of their lives.
Psychosocial stressors and cultural features of vulnerability—Psychological concerns, as noted in Cultural LENS: Empirically Supported Research Approaches and Cultural Competence, vary by culture. Likewise, the amount of support offered by the family and community also vary. In conducting an interview, the mental health professional needs to obtain an overall picture of the individual’s social environment with an emphasis on how cultural elements affect the presentation of a particular distress or disorder.
Cultural features of the relationship between the individual and the clinician—This domain emphasizes how the relationship between an individual and a mental health professional can be influenced by cultural factors. If a person has experienced negative situations with those of authority in the world outside of the interview, this could influence how the person relates to the mental health professional. Likewise, if the culture places a high regard on health professionals, then the person may not correct or interrupt with additional information during the interview. This domain
