ASSESSMENT INTERVIEW TYPES OF INTERVIEWS STRUCTURED - - interviewer reads from a printed set of questions, using a standardized interview. all interviewees will be asked the same questions in the same sequence UNSTRUCTURED - allows the clinicians to ask any questions in any order questions follow from interviewee’s responses ❖ The initial interview attempts: - to evaluate the patient’s situation before admission to the hospital/clinic, - to determine whether the services provided by the hospital/clinic can meet the patient’s needs, to instill trust, rapport, and hope. MENTAL STATUS INTERVIEW - DIRECTIVE - the course of the interview is guided, and controlled by the interviewer - NON-DIRECTIVE - Interviewee determine the direction of the interview. Interviewer rarely ask questions, tend to comment or reflect on interviewee’s previous statement TYPES OF INTERVIEWS • • • • • • Employment Interview Initial Intake or Admissions Interview Mental Status Interview Crisis Interview Diagnostic Interview Termination Interview EMPLOYMENT INTERVIEW - - designed to elicit information pertaining to applicant’s qualifications and capabilities for particular employment duties (selection/promotion) complicated because the applicant and the employer are motivated to slant their presentation in order to make an impression, not necessarily to be completely honest INITIAL INTAKE OR ADMISSIONS INTERVIEW - To develop an understanding of the patient’s symptoms or to recommend the treatment or intervention plan. Typically used in medical settings To quickly assess how a client is functioning at that time Mental status interview is conducted to screen the patient’s level of psychological functioning and the presence or absence of abnormal mental situation such as delusions, delirium, or dementia. They include a brief evaluation and observation of the patient’s appearance and manner, speech characteristics, mood, thought processes, insight, judgment, attention, concentration, memory, and orientation. CRISIS INTERVIEW - Crisis interview is conducted when a patient is in a significant and traumatic or life-threatening crisis. We might encounter such a situation in an emergency room, a clinic, or a student health service on campus. - It is critical to determine whether the person is at significant risk of hurting him- or herself or others. It is important to determine whether the alcohol, drugs, and/or medication the person taken is a lethal dose. ❖ Primary Goal: resolve the immediate problem ❖ Secondary Goal: refer to appropriate resources DIAGNOSTIC INTERVIEW - Goal: to arrive at a diagnosis Patient’s symptoms and problems are examined in order to classify into a diagnosis TERMINATION INTERVIEW - - After completion of treatment, a termination interview may be used to evaluate the effectiveness of treatment. It might focus on: ❖ how the patient experienced the treatment, ❖ what the patient found useful or not useful, ❖ how he or she might best deal with problems in the future. CLINICAL INTERVIEWING ✓ telephone contact or the initial face-to face meeting ✓ establishing rapport ✓ putting the client at ease (engage in conversation or small talk) ✓ explaining confidentiality and purpose of the interview ✓ exploring client’s expectations of the interview OPENING • START: clinician’s initial questions about the client’s concerns • END: when the clinician has identified the focus of the interview and start to ask specific questions about certain topics Important things to note: ✓ appropriately choose an opening statement (may influence how the client will begin to talk about themselves/problems) ✓ statement should allow client to begin talking freely ✓ the clinician should evaluate the responses to opening statement as it provide cues on the client’s personality and frame of reference BODY • phase where information is gathered • diagnostic information is obtained • mainly depend on the purpose of conducting the interview Examples: 1) A good candidate for psychoanalytic psychotherapy→ determine if psychologically minded, motivated and capable financially INTRODUCTION • START: clinician meet the client 2) Determine clinical diagnosis and formulate treatment plan → focus on diagnostic clues and criteria • END: when the clinician is comfortable enough to start asking the client of the reason for seeking help. • the body is considered as the “heart of the interview” May involve: • very important for the clinician to listen, pick up necessary information, and use directive and nondirective responses that will aid case formulation and make recommendations. ✓ instill hope in clients by providing Directive responses → encourage clients to change the way they think, feel, or act (persuasion techniques, pushing clients to specific change) SOURCES OF CLINICAL JUDGMENT: MAKING INFERENCES • Clinicians make professional inferences that may relate to: ✓ Statements about client personality & functioning; ✓ Recommendation on whether psychotherapy is needed ✓ Statements about client’s diagnosis; ✓ Estimates of client intellectual or cognitive functioning ✓ Statements regarding possible addictions, past criminal behavior; past employment, relationship, and educational experiences. DEFINING PSYCHOLOGICAL AND EMOTIONAL DISORDERS • Interviewers must distinguish normal and healthy emotional or psychological functioning from disturbed or disordered functioning ✓ Statistical infrequency (atypical behavior; e.g. sleeps 12 hours every night and drinks 6 cases of beer weekly). ✓ Maladaptive behaviors (repeatedly engage in self-defeating behavior/beliefs or experience negative emotion) ✓ Rationally or Culturally Unjustifiable CLOSING ✓ clinician should consciously and skillfully stop gathering new information somewhere between 5 and 10 minutes before your interview time is over. ✓ reassure and support client by openly appreciating the client’s efforts at expressing themselves ✓ summarize crucial themes and issues suggestions of explaining counseling/psychotherapy process ✓ guide and empower client by asking comments or questions ✓ tie up loose ends by clarifying the nature of further contact (if any), and schedule next appointment. TERMINATION ✓ the phase where the clinician ends the interview ✓ It is necessary for clinician to end the session on time as prolonging the interview session may not be helpful to the client as well ✓ Clinicians need to control the termination of the session and the client should be able to also acknowledge the end of the session. PRINCIPLES OF EFFECTIVE INTERVIEWING There are no set rules that apply to all interviewing situations. However, some principles facilitate its conduct. The Proper Attitudes Good interviewing skills Include: ✓ Warmth ✓ Genuineness ✓ Acceptance ✓ Understanding ✓ Openness ✓ Honesty ✓ Fairness Involved, concerned, committed, interested RESPONSES TO AVOID • Being judgmental - evaluating the thoughts, feelings, or actions of another. When we use such terms as good, bad, excellent, terrible, disgusting, disgraceful, and stupid, we make evaluative statements. • Asking “Why?” - tends to place others on the defensive, has judgmental quality. We may induce the interviewee to reveal something that he or she is not yet ready to reveal. If this happens, the interviewee will probably feel anxious and thus not well disposed to revealing additional information. Replace “Why” with “Tell me” or “How”… clinician: (smiling) Hello, What brings you here today? Client: i’m having a tough time. Nobody wants to talk to me. I can’t seem to make friends. Attending clinician: (leaning forward) Please, tell me more. Attending/Encouraging helps the clinician • Better understand the client through careful observation Attending/Encouraging helps the client • Relax and feel comfortable • Express their ideas and feelings freely in their own way • Hostile statements – directs anger toward the interviewee. • Trust the clinician • Reassuring statement - attempts to comfort or support the interviewee: “Don’t worry. Everything will be all right.” Proper attending/encouragemnet involves the following: Though reassurance is sometimes appropriate, you should almost always avoid false reassurance. • Take a more active role in their own sessions • • Appropriate eye contact, facial expressions Maintaining a relaxed posture and leaning forward occasionally, using natural hand and arm movements Verbally “following” the client, using a • variety of brief encouragements such as “Um-hm” or “Yes,” or by repeating key words Observing the client’s body language • INTERVIEWING SKILLS STRATEGIES IN BUILDING RAPPORT, ENCOURAGING CLIENT DIALOGUE ACTIVE LISTENING • Active listening by the clinician encourages the client to share information by providing verbal and nonverbal expressions of interest. • Active listening includes the following skills: • Attending and Encouraging • Restating and Paraphrasing • Reflection of feelings • Summarizing Attending and Encouraging ➢ show the clients that they are being heard and the clinician wants them to continue sharing information ➢ expressing awareness and interest in what the client is communicating both verbally and nonverbally. Encouraging DON’T FORGET: MIND YOUR NONVERBAL LANGUAGE!!! EYE CONTACT • Too much or too little eye contact often creates an uncomfortable feeling and vigorous when made during calmer moments. • too little eye contact: you are not interested ; not listening, or upset POSTURE • Too much eye contact: can make you be perceived as "strange", be interpreted as an invasion of privacy, or communicate an inappropriately high level of attraction or interest. • The "right" amount of eye contact : ✓ spend most of the time looking at the other person's eyes when they are speaking, ✓ between one-quarter and one-half of the time maintaining eye contact with the other person when you are speaking. ✓ should be made in an attentive manner, as opposed to an intense staring or disinterested glance. FACIAL EXPRESSION • You can easily communicate messages with your eyes, mouth, and the rest of your face that cause problems for you • "rolling" your eyes can express contempt or disrespectful disagreement, • frowning can express dissatisfaction, • "squinting" your eyes and tensing your face can express anger, confusion, or annoyance. • frequent smiling can express approval, happiness, interest, and satisfaction. • Make sure your facial expressions match the emotions that you are intending to communicate. • may communicate something we do not intend or are not aware of. You might consider asking those close to you what expression you "usually" have on your face - you may learn something interesting about yourself. Then, if you wish to change you facial expression you can work on it. BODILY GESTURES • nodding your head up and down during a conversation communicates agreement or understanding • nodding it from side to side communicates disagreement or disbelief. • Hand and arm movements: more pronounced, more rapid, and more vigorous when communicating excitement, anger, anxiety, or other intense emotions, • Hand and arm movements: less obvious • Body appears tense: you are anxious, angry, or uncomfortable in their presence. • Crossing your arms during a conversation: disapproval, a judgmental attitude, or an unwillingness to be open and honest. • Appearing overly relaxed (slouching while sitting or standing): uninterested in the other person or in what they have to say, or that you are being defiant. • Not orienting or facing your body toward the person you are speaking to: communicate disinterest, disrespect, or dissatisfaction. • When your body appears tense (that is, when your shoulders and face are tightened, or when your fists are clenched), others may think that you are angry or uncomfortable and they may respond to you accordingly. • Try to have a natural posture in which you stand or sit straight, feel comfortable and seem open to others. TO SUMMARIZE • Maintain eye contact • Move closer to the person, but do not cross over any personal boundaries • Nod from time-to-time • Say things like “yes” or “uh huh” • Keep your posture open to the person by keeping your arms unfolded and uncrossed REFLECTION OF FEELINGS • enable the clinician to provide feedback to the client regarding emotion (feelings) that the client is expressing. • a clinician goes beyond the ideas and thoughts expressed by the client and responds to the feelings or emotions behinds those words. • Reflection of feelings is when the clinician expresses the client’s feelings, either stated or implied. The clinician tries to perceive the emotional state of the client and respond in a way that demonstrates an understanding of the client’s emotional state. Reflection of feelings helps the clinician • Check whether or not they accurately understand what the client is feeling • Bring out problem areas without the client being pushed or forced Reflection of feelings helps the client • Realise that the counsellor understands what they feel • Increase awareness of their feelings • Learn that feelings and behaviour are connected EXAMPLE: Client: Ya, sabotage is a good word. I move towards making friends. Then suddenly I move in the opposite direction. clinician: You’re afraid of getting close to someone, so you create a wall between the other person and yourself. I hear you are hoping someone will come running to be your friend. SUMMARIZING • Summarizing is putting together a group of reflections. • enables the clinician to verbally review various types of information that have been presented • to highlight what the clinician sees as significant information based on what has bee discussed; • to provide the client with an opportunity TO HEAR the various issues that he or she has presented • this review allows both clinician and client to establish priorities. Summarising helps the clinician • Provide focus for the session • Confirm the client’s perceptions • Focus on one issue while acknowledging the existence of others • Terminate a session in a logical way Summarising helps the client • Clarify what they mean • Realize that the clinician understands EXAMPLE: Client: I want to have friends. But I want to be myself and not change just to have friends. Clinician: We’ve talked about many things today. I’d like to review some of them. Apparently, you are lonely and desire to have friends. Your behaviour drives away people. You refuse to change. Am I missing anything? BLOCKS TO ACTIVE LISTENING DAYDREAMING - Daydreaming is allowing your attention to wander to other events or people. It is a time when you stop listening and drift away into your own fantasies. REHEARSING - Rehearsing is when you are busy thinking about what you are going to say next, so that you never completely hear what the other person is telling you. FILTERING - Filtering is when you listen to certain parts of the conversation, but not all. JUDGING - Judging is when you have stopped listening to the other person because you have already judged, placed labels, made assumptions about, or stereotyped the other person. DISTRACTIONS - Distraction occurs when your attention is divided by something internal to you (headaches, worry, hunger) or external to you (traffic, whispering, others talking) PRACTICAL SUGGESTIONS: 1. Prior meeting clients, calm yourself down: meditate, pray, jog, blow out air to calm your inner self 2. Clear your mind of extraneous thoughts that are not relevant to hearing the client 3. Concentrate on the client and be prepared to focus on the meaning and feeling of what the client is discussing 4. Do not talk except to gently encourage the client to talk. 5. Listen LEADING • encourage the client to respond to specific topic areas • enables the clinician to explore at greater depth areas that are seen as important to progress within the session • Leading involves: ✓ Silence ✓ Open Questioning/Probing/Clarification SILENCE ❖ The clinician remains silent when a client pauses in his remarks but indicates attitude that he understands and accepts what the client is saying ❖ The client will feel that someone needs to speak THERAPEUTIC SILENCE Silence is used as a technique that aids therapy: ✓ “I want us to move a bit more slowly” ✓ “I want you think more about what you just said ✓ “I care very much about you and your feelings in this moment” GUIDANCE FOR USING SILENCE •When a client pauses after making a statement or after hearing your paraphrase, let a few seconds pass rather than immediately jumping in with further verbal interaction. Give them a chance to associate to a new material • As you are sitting silently, waiting for your client to speak, tell yourself that this is your client’s time to express, not your time to prove that you are an expert. • When silence comes, sometimes wait for the client to speak next and other times break the silence yourself • Avoid using silence if you believe your client is confused, experiencing an acute emotional crisis or psychotic (abnormal thinking and perceptions). Excessive silence provokes anxiety. • Relax when you feel uncomfortable. Use your attending skills to let them understand that it is their time to talk. • If client appear uncomfortable with silence, you may give them instructions to free associate (“Just say whatever comes to mind”) or use an empathic expression (“It’s hard to decide what to say next”). • Remember to observe your body and face while communicating silence: cold and warm silence are different • Observe client closely; Be sensitive to the themes, issues, and feelings being expressed; ✓If the client’s eyes is fixed on something without being too focused = the client is thinking about or pondering something, examining a new idea, or ruminating (deep thinking) around in his or her mind. ✓If client is tense, appearing nervous, looking from one object to another and avoiding eye contact = avoiding some topic or idea. OPEN QUESTIONING/PROBING CLARIFICATION • enables the clinician to gain important information about his or her client. • prevent the client from answering yes/no or answer nonverbally by nodding his or her head. • This type of questioning places responsibility on clients and allows them a degree of control on what to say. • enable a clinician to gather information in a specific area related to the client’s concerns or problems • enables the clinician to ask the client to define or explain words, thoughts or feelings. EXAMPLES OF OPEN QUESTIONING/PROBING/CLARIFICATION 1) Client: I’ve thought a lot about what we talked about last week and I feel I have to work on changing my behavior. Clinician: Would you tell me what you think needs to be changing? ***** Clinician: You keep on saying that you are afraid of your father. I want you to be more specific about “afraid”. 2) Client: If what you say is true, I’m a real jerk. What chance do I have to be happy if I create barriers every time I get close to someone. Clinician: You say you want to be happy. What does happy mean to you? 3) Clinician: You said that this boy stops you after school and demands money from you. You told me he is a big boy, but you didn’t tell me how it makes you feel. EXAMPLE OF PROBING: Work problems related to drug use? Client: I was always known to be a good worker. I even received an award. Lately I had some issues…my husband is just not helping…that is why I am always late. Clinician: Tell me about the problems you have been having at the work place? Client: Actually, I have had lots of problems, not only being late. UNSTRUCTURED INVITATIONS • Gives the client an opportunity to talk; • prevents the clinician from identifying the topic the client should discuss • Best done during initial meeting; starting the session (multiple sessions; in-between sessions) EXAMPLES: • Please feel free to go ahead and begin • Where would you like to begin todays? • You can talk about whatever you’d like. • Perhaps there’s something particular you want to discuss • What brings you to counseling? • What brings you to see me now? EXPRESSING EMPATHY • Empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experiences of another • let clients know we have heard and respected their message EXAMPLE OF EXPRESSING EMPATHY 1) Client: I am so tired, but I cannot sleep… So I drink some wine. Clinician: I see Client: When I wake up…I am already too late for work. Yesterday my boss fired me… Clinician: I understand. I am sorry about your job. Client: ...but I do not have a drinking problem! 2) Client: Sometimes, I get so depressed I just don’t know what to do. Clinician: Sometimes you feel like you’re not going to get up again. Client: Right. I just don’t know what to do with myself. EXAMPLE OF EXPRESSING EMPATHY “I understand this has been a great loss for you.” “I feel your grief.” “I can see how angry you have been feeling. . .” “I feel and understand your pain”
