THE INTERVIEW

- l professions count interviewing as a chief technique for gathering data and making decisions.
For politicians, consumers, psychiatrists, employers, or people in general, interviewing has
always been a major tool.
- assessment interview is at once the most basic and the most serviceable technique used by the
clinical psychologist
- a major instrument for clinical decision making, understanding, and prediction.

General Characteristics of Interviews

An Interaction.

- An interview is an interaction between at least two persons. Each participant contributes to the
process, and each influences the responses of the other
- Interviewing, like conversation, involves face to-face verbal encounters or exchanges
- The interviewer approaches the interaction purposefully, bearing the responsibility for keeping
the interview on track and moving toward the goal.
- A good interview is one that is carefully planned, deliberately and skillfully executed, and goal-
oriented throughout.

interviews Versus Tests.

- In a sense, interviews occupy a position somewhere between ordinary conversation and tests
- Interviews are more purposeful and organized than conversation but sometimes less formalized
or standardized than psychological tests.
- The exceptions are the structured diagnostic interviews, the exceptions are the structured
diagnostic interviews

The Art of Interviewing.

- Interviewing has often been regarded as an art. there is a degree of freedom to exercise one’s
skill and resourcefulness that is generally absent from other assessment procedures.
- Decisions such as when to probe, when to be silent, or when to be indirect or subtle test the skill
of the interviewer
- This is why gaining experience in a supervised setting is so important; it enables the interviewer
to achieve some awareness of the nature of this interaction.
Interviewing Essentials and Techniques

- the likelihood that interviews will be productive. Training and supervised experience in
interviewing are very important.
- there is a crucial interaction between technique and interviewer. This is why gaining experience
in a supervised setting is so important; it enables the interviewer to achieve some awareness of
the nature of this interaction.

The Physical Arrangements

- An interview can be conducted anywhere that two people can meet and interact
- Usually, the clinician does not choose such a setting. But the needs of the patient, the degree of
urgency in the situation, or even, in some instances, sheer coincidence may make an interview
of sorts inevitable
- Two of the most important considerations are privacy and protection from interruptions.
- But even more important is the message they subtly convey—that the patient and his or her
problems are of secondary importance.
- Because lack of privacy can lead to many deleterious outcomes, soundproofing is also very
important. If noise from a hallway or an adjacent office intrudes, patients will probably assume
that their own voices can also be heard outside.
- The office or its furnishings can be as distracting as loud noises and external clamor
- However, many clinicians prefer offices that are fairly neutral, yet tasteful. In short, an office
with furnishings that demand attention or seem to cry out for comment would not be ideal

Note-Taking and Recording

- All contacts with clients ultimately need to be documented. However, there is some debate over
whether notes should be taken during an interview.
- Therefore, a moderate amount of note-taking seems worthwhile. Most patients will not be
troubled by it, and if one should be, the topic can be discussed.
- Occasionally, a patient may comment that what is said must be really important since you are
taking it down. Occasionally, too, a patient may request that the clinician not take notes while a
certain topic is being discussed.
- One danger in taking verbatim notes is that this practice may prevent the clinician from
attending fully to the essence of the patient’s verbalizations
- An overriding compulsion to get it all down can detract from a genuine understanding of the
nuances and significance of the patient’s remarks
- In addition, excessive note-taking tends to prevent the clinician from observing the patient and
from noting subtle changes
- a fully transcribed interview will have to be read in full later. The clinician must plow through 50
minutes of notes to extract the most important material, which may have taken up only 10
minutes of the interview
- With today’s technology, it is easy to audiotape or videotape interviews. Under no
circumstances should this be done without the patient’s fully informed consent.
- with an accompanying assurance to the patient that the tape will be kept confidential
- There may be a few passing moments of self-consciousness, but these quickly fade
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Rapport

Definition and function

- Perhaps the most essential ingredient of a good interview is a relationship between the clinician
and the patient
- Rapport is the word often used to characterize the relationship between patient and clinician
- Rapport involves a comfortable atmosphere and a mutual understanding of the purpose of the
interview
- A cold, hostile, or adversarial relationship is not likely to be constructive
- Although a positive atmosphere is certainly not the sole ingredient for a productive interview (a
warm yet ill-prepared interviewer will not generate the best of interviews),

Characteristics

- attitude does not require that the clinician like every patient. It does not require the clinician to
befriend every patient.
- It does not require the clinician to master an agreed-upon set of behaviors guaranteed to
produce instant rapport. It does require that patients not be prejudged based on the problems
they seek help for
- Attitudes of understanding, sincerity, acceptance, and empathy are not techniques; to regard
them as such is to miss their true import. To ask to be taught how to appear sincere, accepting,
and empathic is to confess the absence of these qualities
- When patients realize that the clinician is trying to understand their problems in order to help
them, then a broad range of interviewer behavior becomes possible. Probing, confrontation,
and interviewer assertiveness may be acceptable once rapport has been established.
- If the patient accepts the clinician’s ultimate goal of helping, a state of mutual liking is not
necessary.
- The patient will recognize that the clinician is not seeking personal satisfaction in the interview.
- Rather, it is a relationship founded on respect, mutual confidence, trust, and a certain degree of
permissiveness. It is neither a prize bestowed by an awed client nor a popularity contest to be
won by the clinician
- A common mistake of beginning interviewers in early interviews is to say something like, “There,
there, don’t worry. I know exactly what you’re feeling.” Such comments may convince clients
that the interviewer does not really know how they feel.

Special Considerations

- a family therapy or couples’ therapy case involves simultaneously establishing a connection with
multiple individuals, each of whom may have very different perspectives and varying enthusiasm
for attending the session
- Rapport also can be especially challenging when the client is aware that the information
collected during the interview likely will be used to determine a school placement, to meet
employment criteria, or to formulate a legal disposition regarding child custody, legal sanctions,
or maltreatment allegations
Communication

- Whether we are helping persons in distress or assisting patients in realizing their potential,
communication is our vehicle.
- The real problem is to identify the skills or techniques that will ensure maximum
communication.

Beginning a Session.

- It is often useful to begin an assessment session with a casual conversation.

- a brief conversation designed to relax things before plunging into the patient’s reasons for
coming will usually facilitate a good interview.

Language.

- Of extreme importance is the use of language that the patient can understand.
- It is not necessary to infantilize people seeking help; asking for help need not imply that one has
a diminished capacity to understand.
- At the same time, it may be necessary to abandon psychological jargon to be understood by
some patients.
- similarly, clinicians who try to use “teenage” language when interviewing a 15-year-old may
wind up not only alienating the client but looking foolish in the process. In short, if your respect
for the patient is intact, you generally need not reach for shallower techniques
- It is also important to clarify the intended meaning of a word or term used by a client if there
are uncertainties or alternative interpretations. For example, a clinician should not assume he or
she knows what a client means by the statement “She’s abusive.” It may indicate that the
individual does not treat others particularly well, or it may indicate that the individual is
physically abusive— something that warrants immediate intervention it is important to use
words that will be interpreted by the patient as you mean them to be. ” Sometimes
psychologists become so focused on concepts such as behavior that we forget what these words
mean to most people.

The Use of Questions.

- Maloney and Ward (1976) observed that the clinician’s questions may become progressively
more structured as the interview proceeds. They distinguish among several forms of questions,
including open-ended, facilitative, clarifying, confronting, and direct questions.
- Open-ended: Gives patient responsibility and latitude for responding, “Would you tell me about
your experiences in the Army?”
- Facilitative: Encourages patient’s flow of conversation “Can you tell me a little more about
that?”
- Clarifying: Encourages clarity or amplification, “I guess this means you felt like …?”
- Confronting: Challenges inconsistencies or contradictions, “Before, when you said …?”
- Direct: Once rapport has been established and the patient is taking responsibility, “What did you
say to your father when he criticized your choice?
Silence

- Perhaps nothing is more disturbing to a beginning interviewer than silence

- The important point is to assess the meaning and function of silence in the context of the
specific interview
- The clinician’s response to silence should be reasoned and responsive to the goals of the
interview rather than to personal needs or insecurities.
- Perhaps the client is organizing a thought or deciding which topic to discuss next. Perhaps the
silence is indicative of some resistance. But it is as inappropriate to jump in and fill every
momentary silence with chatter as it is to simply wait out the patient every time,
- Whether the clinician ends a lengthy silence with a comment about the silence or decides to
introduce a new line of inquiry, the response should facilitate communication and
understanding and not be a desperate solution to an awkward moment

Listening.

- clinician’s role, our communication must reflect understanding and acceptance. We cannot hope
to do this if we have not been listening, for it is by listening that we come to appreciate the
information and emotions
- If we are concerned about impressing the client, if we are insecure in our role, if we are guided
by motivations other than the need to understand and accept, then we are not likely to be
effective listeners.
- Sometimes therapists are so sure of an impression about the patient that they stop listening and
thereby ignore important new data. The skilled clinician is one who has learned when to be an
active listener.

Gratification of Self

- The clinical interview is not the time or the place for clinicians to work out their own problems.
Sometimes a clinician is professionally insecure or inexperienced.
- clinicians must resist the temptation to shift the focus to themselves
- None of us is so self-controlled that our thoughts never wander or our concentration never
falters.
- ” When a question seems to suggest something of importance about the patient’s problems, it is
usually best to deflect it or to turn it around so that you can pursue your clinical hypothesis
- But if a question is trivial, innocent, or otherwise basically inconsequential, a failure to respond
directly will probably be perceived as the worst kind of evasion.

The Impact of the Clinician.

- Each of us has a characteristic impact on others, both socially and professionally

- As a result, the same behavior in different clinicians is unlikely to provoke the same response
from a patient. The tall, well-muscled, athletic therapist may somewhat intimidate certain kinds
of patients.
- Therefore, it is important for all clinicians to cultivate a degree of self-insight or at least a mental
set to consider the possible effects of their own impact before attaching meaning to the
behavior of their patients.
 The Clinician’s Values and Background

- Therefore, clinicians must examine their own experiences and seek the bases for their own
assumptions before making clinical judgments of others.
- This case illustrates how all the behavioral cues that clinicians typically rely on may lose their
meaning when applied to a patient from another culture.
- We begin to realize how much a clinician’s ability to make sense of a patient’s verbalizations
depends on a shared background.
- For example, some Midwestern clinicians listening to Asian American patients may suddenly feel
as if they have lost their own frame of reference
- In other cases, gender differences can sometimes produce nearly the same effects. Gender
related factors can interact with a clinician’s values and background.

The Patient’s Frame of Reference

- If the clinician is going to be effective in achieving the goals of the interview, it is essential that
he or she have an idea of how the patient views the first meeting.
- A patient may have an entirely distorted notion of the clinic and even be ashamed of having to
seek help. Sometimes patients have been pressured into seeking help
- Whatever the reason, it will inevitably color the nature of interview behavior.
- For many individuals, going to see a clinical psychologist arouses feelings of inadequacy. Some
individuals will respond to this by “clamming up.” Others will display a kind of bravado that says,
“See, I’m not weak at all!”
- In contrast, there are patients who start with a view of the clinician as a kind of savior

The Clinician’s Frame of Reference

- In a sense, the general dictum here, as in any endeavor, is “Be prepared.” This implies that the
clinician should have carefully gone over any existing records on the patient, checked the
information provided by the person who arranged the appointment, and so on.
- In addition, the clinician should be perfectly clear about the purpose of the interview. Is it to
evaluate the patient for hospitalization? Is the patient seeking information? If the interview is
being conducted on a referral basis
- the clinician should be quite sure that he or she understands what information is being
requested by the referring person
- it suggests that the clinician must be secure enough to maintain composure and not lose sight of
the purposes of the interview.
- the clinician must remember that the first obligation is to understand. The clinician should be
secure enough to distinguish between reality and the forces that drive the patient
- Depending on the purpose of the interview, the clinician should also be prepared to provide
some closure for the client at the conclusion of the interview.
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