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Re-evaluating the use of standardized assessments

© Michael Decaire

When I began my masters academic training, our clinical professors were quite good at pounding into our heads the critical importance of standardized psychometric assessment instruments (i.e., the MMPI-II, the WAIS-III). In the required clinical assessment class the standardized test was the rule. We were to use these tools as a method of hypothesis creation and/or hypothesis testing (in that we are adding quantitative measures to hunches brought out by the referral source or the pre-test interview). It is however interesting to me how our clinical assessment courses spent no time on teaching us the "clinical assessment interview."

The clinical assessment interview is a comprehensive history taking that tends to precede formal psychometric testing (it of course can be used as a comprehensive intake irregardless of whether or not other testing occurs). The histories I take tend to create a "readers digest" version of an individuals life; including, but not limited to, chapters on the clients clinical presentation, the individuals current social environment, examinations of home, school and social environments of early childhood, adolescence, early academic, late academic, the individuals relationships, employment, substance usage, trauma history, and future goals. A history tends to take me an hour to complete, though I could take significantly longer if I so desired. When all is said in done the history tends to fill up at least one third of my psychological report.

Since the clinical assessment interview contributes so much (and it does seriously allow you to know the individual better then any other assessment) one would expect our clinical assessment classes would have had a good foundation in this area. In reality we received none. Perhaps they expected our clinical interviewing class to provide it? That would make sense. Unfortunately, that was not the case. Clinical interviewing provided us with a good foundation on how to structure situations and build repoir. How did it teach intakes? We learned the structured clinical interview for the DSM-IV (SCID), an interesting diagnostic tool in a structured interview format.

When you need to label an individual he SCID is nice. Unfortunately structured interviews leave numerous areas of potentially important information ignored. If you do not ask the right questions you will not get the answers.

In a semi-structured clinical assessment interview there is a certain number of topics the interviewer wants to discuss. They can initiate the area with the client via a default question. However, for the most part one simply (though that may be a poor choice of word) explore the topic until you have a good understanding of what information encompasses the individual in that particular topic.

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