Giving Constructive Feedback
Getting and giving feedback regarding attending and listening skills is essential to interviewer development. Specific and concrete feedback regarding eye contact, body language, vocal qualities, and verbal tracking can be obtained through in-class activities, demonstrations, role plays, and audio- or videotape presentations. For example, positive feedback such as You looked into your client's eyes with only two or three breaks, and although you fidgeted somewhat with your pencil, it didn't...
Summary 1
Clinical interviewing involves a systematic modification of normal social interactions. Although the relationship established between interviewer and client is a friendly one, it is much different from friendship. Clinical interviews serve a dual function to evaluate and to help clients. Clinical interviewing is defined in different ways by different writers. Our definition includes the following components a A professional relationship between interviewer and client is established b a client...
Structural Models
Just as many professional and social interactions have a normal, implicit sequence, ritual, or set of phases, so does the clinical interview. Shea 1998 identifies these phases as Shea's five-part format is helpful partly because it enlarges on the more common beginning, middle, and end schema sometimes referred to in training texts Benjamin, 1987 . Shea's model also remains generic and atheoretical it may be applied to virtually all interviewing situations. This chapter outlines and discusses...
Identification and Internalization
Identification and internalization are terms that come primarily from psychoanalytic and object relations theory. However, concepts that share very similar meanings can be found in other schools of thought, a fact that underscores the importance of identification and internalization and their central role in therapeutic relationship development and treatment outcome. For example, behaviorists emphasize the importance of modeling in behavior therapy Bandura, 1969 Raue, Goldfried, amp Barkham,...
Motivational Interviewing A Contemporary Approach to Substance Abuse
Over the past 20 plus years, the most well-respected and empirically validated approach to interviewing clients about substance use is largely, and perhaps surprisingly, non-confrontational. Drawing from his experiences treating problem drinkers, William Miller 1983 began writing about his beliefs and practices, calling his methodology motivational interviewing. He and his colleague Stephen Rollnick published a book by that name in 1991 a second edition in 2002 , and published a number of...
Using a Comprehensive Checklist for a Thorough Suicide Assessment
After practicing and gaining familiarity with risk factors, the following checklist can be used in practice sessions and role plays to help you conduct a thorough suicide assessment in almost any circumstance. It is important to practice actually obtaining the information from different types of clients because the energy, setting, time allotted, and so forth, can make for interesting challenges when it comes to getting this information. Either in pairs in class or with a willing friend or...
Basic Attending Listening And Action Skills
Meryt listened in stillness, watching my face as I recounted my mother's history, and the story My friend did not move or utter a sound, but her face revealed the workings of her heart, showing me horror, rage, sympathy, compassion. For the most part, we all know a good listener when we meet one. However, it's not quite so easy to figure out exactly what good listeners do to make it so comfortable for other people to talk openly and freely. This chapter analyzes the mechanics of effective...
The Mental Status Examination
There are some who make a point of trying to investigate the world we live in with full scientific rigour without becoming estrangedfrom it. This is never easy is it possible R. D. Laing, The Voice of Experience Your professional identity as a mental health professional requires that you have the skills to evaluate and communicate about your client's mental status. In this chapter, we discuss the basic components of a typical mental status examination. In particular, you will learn practical...
Nondirective Listening Responses
Nondirective listening responses are designed to encourage clients to talk freely and openly about whatever they want. Similar to attending behaviors, these techniques do not overtly direct or lead clients. Instead, they track central client messages by reflecting back to clients what they already said. Even nondirective responses may influence clients to talk about particular topics. There are at least two reasons for this. First, interviewers may inadvertently, or purposefully, pay closer...
Unconditional Positive Regard
Carl Rogers 1961 defines unconditional positive regard as a warm regard for him sic as a person of unconditional self-worth of value no matter what his condition, his behavior, or his feelings p. 34 . Unconditional positive regard suggests warmth, caring, respect, and a nonjudgmental attitude. No one knows clients better than they know themselves. Therefore, even as interviewers, we are not in a good position to judge clients. Usually, all we know is a thin slice or sample of their lives and...
A Managed Care Intake Checklist
A managed care intake outline is included in Table 7.2. We recommend that you practice full-scale intake interviews as well as scaled-down managed care intake interviews see Putting It in Practice 7.2 . Table 7.2. A Managed Care Intake Checklist When necessary, the following topics may be covered quickly and efficiently within a managed care setting. _ 1. Obtain presession or registration information from the client in a sensitive manner. Specifically, explain This background information will...
Interpretive Reflection of Feeling
Interpretive feeling reflections are feeling-based statements made by interviewers that go beyond the client's obvious emotional expressions. The goal of interpretive feeling reflections is to uncover emotions that clients are only partially aware of. Interpretive feeling reflections may produce insight i.e., the client becomes aware of something that was previously unconscious or only partially conscious . Interpretive feeling reflections have been referred to elsewhere as advanced empathy...
Brief Intake Interviewing A Managed Care Model
Given the current managed care and cost containment climate in all aspects of health care, it is essential for interviewers to be trained to conduct more abbreviated intake interviews. Intake interview objectives remain the same when operating under a managed care philosophy. Obtaining information about clients' problems and goals, the clients themselves, and clients' current situation is essential. However, three primary modifications are necessary for obtaining this information within managed...
Speech and Thought
In mental status exam formulations, speech and thought are intimately linked. It is primarily through speech that mental status examiners observe and evaluate thought process and content. There are, however, other ways for interviewers to observe and evaluate thought processes. Nonverbal behavior, sign language in deaf clients , and writing also provide valuable information about client thinking processes. In a mental status exam, speech and thought are evaluated both separately and together....
Resistance
At times, we are at odds with our clients. We want them to talk about their life history, and they want to talk about their last trip to the mall, the Olympic games, or some other matter that seems distant or irrelevant. If clients are avoiding important topics, yet at the same time wanting the benefits of therapy, it is likely that resistance is occurring. Some of the best examples of resistance come from the medical world. We avoid the dentist even though our tooth aches because we do not...
How This Book Is Organized
This text is divided into four parts. Part One, Becoming a Mental Health Professional, includes two chapters. Chapter 1, Introduction Philosophy and Organization, begins by orienting readers to our general philosophy toward clinical interviewing. In this chapter, we cover basic, state-of-the-art practices in clinical interviewing and encourage readers to begin their own theoretical and philosophical development. In Chapter 2, Foundations and Preparations, we outline the definition of clinical...
The Interviewers Opening Statement
The opening statement signals the client that small talk, introductions, and explanations of confidentiality and the interview are over and it is time to begin. An opening statement consists of the interviewer's first direct inquiry into what brought the client to seek professional assistance. The statement can usually be delivered in a calm, easy manner, so it doesn't feel like an interruption in the flow. However, occasionally, you will need to be assertive as you start the interview. Most...
The Interview as a Data Collection Procedure
The interview has long been viewed as a natural, easy, and convenient method for gathering data. In a general sense, interviews are used throughout our society. For example, if a father wants to know what activities his teenage daughter engaged in during her school day, he's most likely to use one type of interview format. He will probably sit down with her and ask a few questions such as, What did you do in school today and Did you learn anything new In this instance, as a data-gathering...
The Intake Report
Report writing constitutes a unique challenge to clinicians. You must consider at least five dimensions 2. Choosing the structure and content of your report. 3. Writing clearly and concisely. 4. Keeping your report confidential. 5. Sharing the report with your client. Before discussing these dimensions, it should be emphasized that interviewers have a responsibility to keep and maintain client records. Although this responsibility varies depending on your professional affiliation and...
Cultural Background and Personal Space
You should be sensitive to cultural differences in eye contact, body language, vocal qualities, and verbal tracking. Although most Whites in North America interpret eye contact as a positive sign of interest, people from other cultures e.g., Asian and Native American tend to prefer less direct eye contact and may view excessive eye contact as disrespectful or invasive. During a visit to Europe and North Africa, we became acutely aware of cultural differences in body language. We had a limited...
Mental Status Examination Reports
Following are sample mental status reports. A good report is brief, clear, concise, and addresses all the areas noted in this chapter. Gary Sparrow, a 42-year-old Caucasian male, was disheveled and unkempt on presentation to the hospital emergency room. During the interview, he was agitated and restless, frequently changing seats. He was impatient and sometimes rude in his interactions with this examiner. Mr. Sparrow reported that today was the best day of his life, because he had decided to...
Theoretical Orientations
Professional interviewers should obtain a broad range of training experiences, both in a variety of settings and from a variety of theoretical orientations. In our own training, we learned important lessons from different theoretical perspectives, even those with which we tended to disagree. As Freud, a person not often remembered for his openness and flexibility, once said There are many ways and means of conducting psychotherapy. All that lead to recovery are good in Trilling amp Marcus, 1961...
What Is An Intake Interview
The intake interview is primarily an assessment interview. Before initiating counseling, psychotherapy, or psychiatric treatment, it's usually necessary and always wise to conduct an intake interview. Intake interviews are designed to answer a number of critical questions, which typically include Is the client suffering from a mental, emotional, or behavioral problem If so, are his or her mental, emotional, or behavioral problems sufficient to require treatment What form of treatment should be...
The Generic Mental Status Examination
The main categories covered in a basic mental status examination vary slightly among practitioners and settings. In our work, we find the following list of categories most useful 2. Behavior psychomotor activity 3. Attitude toward examiner interviewer 7. Orientation and consciousness 9. Reliability, judgment, and insight Putting It in Practice 8.1
Affect and Mood
Affect is defined as the prevailing emotional tone observed by the interviewer during a mental status examination. In contrast, mood is the client's self-reported mood state. Affect is usually described in terms of its a content or type, b range and duration also known as variability and duration , c appropriateness, and d depth or intensity. Each of these descriptive terms is discussed further. Affect Content To begin, you should identify what affective state you observe in the client. Is it...
Seating Arrangements
When teaching interviewing, we routinely ask students how two people should sit during an interview. The variety of student responses to this question is surprising. Some students suggest a face-to-face seating arrangement, others like having a desk between themselves and clients, and still others prefer sitting at a 90- to 120-degree angle so that client and interviewer can look away from each other without discomfort. A few students usually point out that some psychoanalytically oriented...
Paraphrase or Reflection of Content
The paraphrase is a verbal tracking skill and a cornerstone of effective communication. Its primary purpose is to let clients know you have accurately heard the central meaning of their messages. Secondarily, paraphrases allow clients to hear how someone else perceives them a clarification function , which can further facilitate expression. Paraphrasing is the act or process of restating or rewording Random House Unabridged Dictionary, 1993, p. 1409 . In clinical interviewing, the paraphrase is...
The Pros and Cons of SelfDisclosure
Clients will ask you personal questions. It's only a matter of how many personal questions you get asked. In addition, from time to time you'll feel the urge to disclose something about yourself both appropriately and inappropriately to a client. Consequently, the big questions to ask right now include Is there anything basically wrong about self-disclosing personal information to clients Are there any benefits associated with therapist self-disclosure How much disclosure is too much Is it...
Evaluating Interpersonal Style
The claim that individuals have personality traits resulting in consistent or predictable patterns of behavior is more or less controversial, depending on a person's theoretical Table 7.1 Personal History Interview Sample Questions 2. Descriptions and memories of parents 3. Descriptions and memories of siblings 5. Peer relationships in and out of school 6. Middle school, high school, and college experiences What is your first memory How old were you then Do you have any very positive or...
Instilling Hope
If appropriate, after you accurately summarize why your client has sought professional assistance, you should make a statement about how counseling or psychotherapy may help address the client's personal issues and concerns. It can be as simple as making the following very brief, but positive, statement I want you to know, I think therapy can help M. Spitzform, personal communication, October 1982 . In a sense, if we believe in our best clinical judgment that therapy can be helpful to a...
Coping with Cultural Countertransference
Pitfalls of countertransference are lurking everywhere. Imagine that you're a Vietnam War vet and therapist, and a Southeast Asian client comes to you for therapy. Unless you've done your personal work previously, you're likely to have a few reactions and issues to work through. Countertransference is omnipresent and tricky because it can be triggered by so many different variables. Not only can you succumb to a client who behaves in ways similar to your domineering sister, but you can also...
Congruence
Congruence means that a person's thoughts, feelings, and behavior match. There are no discrepancies congruent interviewers think, feel, and behave in a consistent and integrated manner. Congruent interviewers are described as genuine, authentic, and comfortable in their interactions with clients. Congruence implies spontaneity and honesty. Rogers 1961 was clear that congruence requires expression of various feelings and attitudes which exist in me p. 33 . He also emphasized that congruent...
Carl Rogerss Core Conditions
Carl Rogers 1942 believed that establishing a therapeutic relationship constituted the essence and totality of what is therapeutic about counseling. Rogers's three core conditions are Unconditional positive regard. Thus, the relationship which I have found helpful is characterized by a sort of transparency on my part, in which my real feelings are evident by an acceptance of this other person as a separate person with value in his own right and by a deep empathic understanding which enables me...
Coping with Countertransference
Countertransference is defined as therapist emotional and behavioral reactions to clients. As an example, imagine an interviewer who lost his mother to cancer when he was a child. His father's grief was very severe. As a consequence, little emotional support was available when the interviewer was a child. The situation eventually improved, his father recovered, and the interviewer's conscious memory consists of a general sense that losing his mother was very difficult. Now, years later, he's a...
Positive Attending Behavior
Many authors have described different positive and negative attending behaviors A. Ivey amp Ivey, 1999 Pipes amp Davenport, 1999 Shea, 1998 . Positive attending behaviors open up communication and encourage free expression. In contrast, negative attending behaviors inhibit expression. When it comes to identifying positive and negative attending behaviors, there are few universals because cultural background and previous experiences affect whether clients view a particular attending behavior as...
Nondirective Reflection of Feeling
The primary purpose of nondirective reflection of feeling is to let clients know, through an emotionally oriented paraphrase, that you are tuned in to their emotional state. Nondirective feeling reflections also encourage further emotional expression. Consider the following example of a 15-year-old male talking with an interviewer about his teacher Client That teacher pissed me off big time when she accused me of stealing her watch. I wanted to punch her lights out. Interviewer So you were...
Open and Closed Questions
The four sets of questions that follow are designed to obtain information pertaining to the same topic. Imagine how you might answer these questions, and then compare your imagined responses. 1. Open How are you feeling about being in psychotherapy Closed Are you feeling okay about being in psychotherapy 2. Open What happened next, after you walked onto the subway and you felt your heart begin to pound Closed Did you feel lightheaded or dizzy after you walked onto the subway 3. Open What was it...