Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society 7th Edition Allen E. Ivey University of Massachusetts Mary Bradford Ivey Microtraining Associates Carlos P. Zalaquett University of South Florida Copyright © 2009 Chapter 13 Skill Integration: Putting It All Together Not to decide is to decide. Harvey Cox Chapter goal ▲ Help you integrate the microskills smoothly into a naturally flowing interview and treatment plan. Competency objectives ▲ Conduct a well-organized career interview based on a decisional model derived from trait-and-factor theory ▲ Develop long-term treatment plans for your work with a client and keep systematic interview records ▲ Utilize the concepts of this chapter to further your skills and understanding of other theoretical models of the helping process The Case of Mary Mary, the client, is a 36 years old divorced woman, with two children. She has worked as a physical education teacher for a number of years. Currently she is bored and stymied with her job as a PE teacher and wants help searching for a new career. She is thinking about doing something related to business but says that she is somewhat depressed by her situation and wants help. The Case of Mary Reflection Questions ▲ What do you think about Mary’s situation? ▲ How might you help Mary? INTRODUCTION: ANALYZING THE INTERVIEW ▲ Integrate skills, strategies and concepts of intentional interviewing and counseling into a naturally flowing interview and treatment plan. ▲ Conduct well-organized vocational interviews based on a decisional model from trait-and-factor theory. ▲ Develop long-term treatment plans for your clients and keep systematic interview records. ▲ Facilitate an examination of your own style. INTRODUCTION: ANALYZING THE INTERVIEW ▲ The analysis of Allen and Mary’s interview provides a model to examine your own work and style. Systematically apply the skills and concepts learned so far to analyze the full interview. Think ahead to how you will conduct your interviews. Develop a plan. Keep notes and integrate your own ideas into a long-term treatment plan. Audio- or video record an interview to do comprehensive analysis of your own style and its impact on clients. INSTRUCTIONAL READING 1: DECISIONAL COUNSELING ▲ Also called problem-solving counseling. ▲ Basic framework useful in many settings for counseling or interviewing. ▲ Recognizes decision-making as vital part of most systems of counseling. ▲ Facilitates client decision-making. ▲ How can we help clients work through issues and come up with new answers? Systematic Decision Making Model Ben Franklin originated the systematic decision making model. a) Identify the problem clearly; b) Generate alternative answers; c) Decide what to do. The Trait-and-Factor Legacy Frank Parsons developed the Boston Vocational Bureau in 1908. In vocational counseling, client needs to: a) Consider personal traits, abilities, skills, and interests. b) Examine the environmental factors -- opportunities, job availability, location. c) Develop “true reasoning” on the relations of these two groups of facts. Emotional aspects of decisions ▲ Emotions play a critical role in decision making for it is how we feel about the alternative answers/solutions that leads us to a decision ▲ Insufficient attention to emotional aspects is a common problem observed in decisional models. Few of us would be satisfied if our decisions reflected only executive left brain activity and cognitive processes. Decisions require emotional energy and agreement with our long-term memory if they are to be meaningful and lasting. ▲ Bring feeling and emotion to the interview/session when you work with clients and decisions. The Balance Sheet and Future Diary: Bringing Emotions Into Decisional Practice Leon Mann developed the Balance Sheet and Future Diary to help people “take decisions” Decision making involves: 1. Facts of the problem. 2. Option chosen to solve it. 3. Factual outcome to the solution. 4. Emotional outcome of the solution. The Balance Sheet and Future Diary: Bringing Emotions Into Decisional Practice ▲ Developing a balance sheet and future diary: List all possible solutions Rate each outcome with + or – Anticipate and rate emotional impact ▲ Remember, decisions need to be emotionally satisfying for client. Decisions, Problem Solving, and the Five Stages/Dimensions of the Interview ▲ Decisional counseling concepts are basic to the fivestage/dimensions model of the interview. Decisional issues and problem-solving theory are parallel. Neuropsychology research reveals similar learning model, with special emphasis on emotion. ▲ How do these five elements fit with the traditional problem-solving models? Example: Should we move to a new town? (This maps out plus and minus of decision) +Plus -Minus + New job is exciting - Like coworkers& boss + Pays more - Spouse doesn’t want to leave + Better weather than here ++ Can learn new ideas that will enhance career long term - Schools better here - House difficult to sell - Moving is agony Comparing the five stages/dimensions of Decisional Counseling with traditional problemsolving models The Five Stages/ Dimensions of Intentional Interviewing and Counseling Problem-Solving Models and the Trait-and-Factor Legacy 1. Relationship—Initiating the session—Rapport and structuring (“Hello; this is what might happen in this session.”) This step has often not been stressed as a separate element, but it is obviously an important part of any problem-solving attempt. Comparing the five stages/dimensions of Decisional Counseling with traditional problemsolving models The Five Stages/ Dimensions of Intentional Interviewing and Counseling Problem-Solving Models and the Trait-and-Factor Legacy 2. Story and strengths— Gathering data—Drawing-out stories, concerns, problems, or issues (“What’s your concern? What are your strengths or wellness resources?”) Benjamin Franklin talked of defining the problem whereas trait-and-factor theorists speak of the need to consider personal traits, abilities, skills, and interests; with environmental emphasis. Comparing the five stages/dimensions of Decisional Counseling with traditional problemsolving models The Five Stages/ Dimensions of Intentional Interviewing and Counseling Problem-Solving Models and the Trait-and-Factor Legacy 3. Goals —Mutual goal setting— Part of defining the problem in Establishing outcomes (“What problem-solving approaches. do you want to happen?”) Goal setting is often the first issue addressed in brief solution-oriented interviewing and counseling. Comparing the five stages/dimensions of Decisional Counseling with traditional problemsolving models The Five Stages/ Dimensions of Intentional Interviewing and Counseling Problem-Solving Models and the Trait-and-Factor Legacy 4. Restory—Working—Exploring These models often use alternatives, confronting client brainstorming to find incongruities and conflict, alternatives and employ “true restorying (“What are we going reasoning” to discover the to do about it?”) relationship of the person to the environment. Comparing the five stages/dimensions of Decisional Counseling with traditional problemsolving models The Five Stages/ Dimensions of Intentional Interviewing and Counseling Problem-Solving Models and the Trait-and-Factor Legacy 5. Action— Terminating— Generalizing and acting on new stories (“Will you do it?”) Generalization is not always stressed but it is implicit in brainstorming and true reasoning. Applications to Counseling Theories and Multiple Settings ▲ Decisional issues and the microskills model underlie many theoretical approaches to helping. ▲ If you have intentional competence in the microskills and the relationship— story and strengths—goals — restory—action model, you are well prepared to work with many different approaches to the helping process. Time spent in stages/dimensions by different theoretical orientations Stage/Dimension Decisional Counseling PersonCentered Theory Cognitive Behavioral Therapy Brief Counseling Motivational Interviewing 1. Relationship Medium Some, emphasis in rapport Some Medium, goal setting done early Medium 2. Story and Strengths Medium Great Medium Medium Medium 3. Goals Medium Little emphasis Medium Great, central issue Medium 4. Restory Medium Great Medium Medium— Dimensions 4 and 5 combined Medium 5. Action Great Little Great See above Great INTERVIEW PLANNING AND CASE CONCEPTUALIZATION First Interview Plan and Objectives ▲ Before the first interview Study the client file and anticipate what issues you think are important. Think how you want to help the client. What issues will be important in the session. How you might handle them Prepare a tentative plan as a guide. Be flexible and modify plan if needed. INTERVIEW PLANNING AND CASE CONCEPTUALIZATION Develop an interview plan ▲ Interview plan characteristics: is tentative. based in intake records and other information (e.g., questionnaires, diagnosis, case conceptualizations). oriented toward helping with client’s concerns and discussion of personal issues. remind us about what we need to consider as we start. provides a useful checklist to help ensure that you cover key issues in the session. INTERVIEW PLANNING AND CASE CONCEPTUALIZATION ▲ Interview plan: It is not rigid. it changes as interview progresses and new issues are brought up. it is not imposed on the client. ▲ Use cultural intentionality and flex with what actually does happen in the session. First Interview Plan and Objectives Before the first interview ▲ Relationship Do you anticipate any special issues in regard to rapport development? What structure do you have for this session? Do you plan to sue a specific theory? First Interview Plan and Objectives Before the first interview ▲ Story and strengths What are the anticipated problems? Strengths? How do you plan to define the issues with the client? Will you emphasize behavior, thoughts, feelings, meaning? First Interview Plan and Objectives Before the first interview ▲ Goals What is the ideal outcome? How will you elicit the idealized self? Idealized world? First Interview Plan and Objectives Before the first interview ▲ Restory What types of alternatives should be generated? What theories would you probably use here? What specific incongruities have you noted or do you anticipate in the client? First Interview Plan and Objectives Before the first interview ▲ Action What specific plans, if any, do you have for transfer of training? What will enable you personally to feel that the interview was worthwhile? INTERVIEW PLANNING AND CASE CONCEPTUALIZATION How are you going to develop a working alliance with a new and unique client? ▲ Allen and Mary Ivey’s transcript provides a good model. They transcribed the interview, then Allen analyzed his behavior in the session, and Mary reviewed his comments and analysis. Not all responses were equally effective. Our ability to learn from these and change makes us more effective interviewers and counselors. ▲ Develop a Plan DEMONSTRATION INTERVIEW AND ANALYSIS: ALLEN AND MARY’S DECISIONAL SESSION ▲ Developing a relationship is basic to case conception, case planning, and treatment plans. ▲ Basic attitudes such as warmth and smiling help but what else can you do to make the client comfortable and ready to talk? DEMONSTRATION INTERVIEW AND ANALYSIS: ALLEN AND MARY’S DECISIONAL SESSION Reflection Questions ▲ What do you think about Allen and Mary Ivey interview? ▲ What do you think about Allen’s responses? ▲ What responses make more sense to you? ▲ Which responses could be phrased more effectively? ▲ What would you do differently? INSTRUCTIONAL READING 2: INTERVIEW TRANSCRIPT ANALYSIS AND PLANNING Following up, analyzing, and planning for the future are critical for case management and treatment ▲ Skills and their influence on the relationship. What skills did you use and what was their effect on the client? ▲ Referral and consultation. When shall you refer and how can you obtain feedback on your interviews? ▲ Case management and case conceptualization. Planning for future interviews. First Interview Plan and Objectives Analysis after first interview Allen’s tentative plan demonstrates that it is possible to plan a session before it happens. ▲ Were Allen’s objectives achieved in the session? ▲ How appropriate each of his interventions was? ▲ What would you have done differently? First Interview Plan and Objectives Analysis after first interview Analyzing a Session ▲ Observe interviewer style -- maybe yourself on video. ▲ Consider appropriateness of interventions. ▲ What would you do differently? ▲ Assess your own style for strengths and improvement opportunities. Analyzing a Session Skill Classifications Listening & Influencing Focus C* Counselor and Client Conversation Process Comments See Table in chapter 13 (List Skill) (See Chapter 9) * Record “C” for confrontations. Skills and Their Influence on the Client Text example session, Allen and Mary ▲ Identifies some of the impact of his skills on the client. ▲ Fulfilled the functions suggested for each stage. ▲ Achieved predictable results with intentional use of each skill. Skills and Their Influence on the Client Text example session, Allen and Mary ▲ Used about 2 attending skills for every influencing skill. ▲ Combined dual focus on Mary and the issue. ▲ Identifies and classifies several skills and stages of the interview. Skills and Their Impact on the Client ▲ Rapport-building: More comfortable interview ▲ Open questions: Encouraged client talk ▲ Definition stage: Client identifies specific issue ▲ Basic listening: Brought out concrete goals ▲ Summarizing: Revealed Mary’s key thoughts ▲ Confrontation: Explore deeper issues Skills and Their Impact on the Client ▲ Mary appears ready and willing to take action. ▲ The next session will “tell” whether she acted on the generalization plan. ▲ The work that clients do after interview is as important as what they do in the session. ▲ Use the Client Change Scale to assess your effectiveness as an interviewer. Client Change Scale (CCS) The Creation of the New Denial 1 Full Examination Decides to Live With But No Partial Incongruity Change Examination 2 Denies or Discusses fails to hear part, but not incongruity. all of incongruity. 3 Discusses incongruity completely, but will not change. 4 Discusses and is fully aware of decision impact. Decides to Change From Incongruity 5 Discusses and alters choices when faced with incongruity. Referral ▲ No interviewer has all the answers. ▲ Helps clients find community resources for their continued growth. ▲ Helps when counselor skills are insufficient to aid client. ▲ Maintain contact with the client as referral process evolves. ▲ Sometimes you continue to work with the client while additional help is acquired from specialized professionals. Note Taking ▲ Helps when the interviewer forgets what happened last. ▲ Facilitates planning for subsequent sessions. ▲ Required for legal and professional accountability. ▲ Can be structured using the five stages. ▲ Structured notes provide data to interviewer supervisor, as needed. Case Management, Case Conception, and Planning for Future Interviews Treatment Plan ▲ Interview plan IS the treatment plan for short-term counseling. ▲ Treatment plan is more detailed for long-term counseling. ▲ Outline all issues raised by the client. ▲ List problems, issues, priorities and desired outcomes at greater length. ▲ Many alternative plans and methods may be used longterm. Treatment Plan ▲ Treatment plans are often required by agencies and insurance companies. ▲ Plans with specific goals are becoming more standard. ▲ May be structured using the five-stages. ▲ Notes highlights from each stage. ▲ Summarizes issues. ▲ Notes decisions, interventions, and shifts in topic direction. ▲ Captures generalization/homework plans. Developing a Long-Term Treatment Plan 1. Relationship ▲ How does this client develop rapport? ▲ What issues are of most comfort/ discomfort? ▲ How does the client respond to structuring? ▲ At what place will structuring be most helpful? Developing a Long-Term Treatment Plan 2. Story and strengths ▲ List, in order of importance, the several areas of concern. ▲ Include a list of the client’s strengths and assets for coping with these issues. Developing a Long-Term Treatment Plan 3. Goals ▲ What are your and the client’s ideal outcomes for these and other issues? Developing a Long-Term Treatment Plan 4. Restory ▲ What are the client’s main alternatives? ▲ What are your treatment alternatives? ▲ How might they best be confronted? Developing a Long-Term Treatment Plan 5. Action ▲ What are the specific thoughts, feelings, and behaviors that you and the client would like to generalize to real life? ▲ Wherever possible, work with the client to set up specific goals of generalization. SUMMARY ▲ This chapter is designed to serve as a model for you transcribing and generating your own analysis of the interview. ▲ No interview is perfect. ▲ Ability to be intentional is what counts. ▲ “Its not the mistakes make, but what you do to correct them that counts.” ▲ All interviewing and counseling are decisional processes. Key Points Decisional counseling ▲ Decisional counseling, a modern reformulation of traitand-factor theory, assumes that most, perhaps all, clients are involved in making decisions. By considering the many traits of the person and factors in the environment, it is possible to arrive at a more rational and emotionally satisfying decision. Key Points Decisional structure and alternative theories ▲ The restorying model of the interview can be considered a basic decisional model underlying other theories of counseling and therapy. ▲ Once you have mastered the skills and strategies of intentional interviewing and the five-stage model, you will find that you can more easily master other theories of helping. Key Points Interview analysis ▲ Using the constructs of this book, it is possible to examine your own interviewing style and that of others for microskill usage, focus, structure of the interview, and the resultant effect on a client’s cognitive and emotional developmental style. Key Points Interview plan and note taking ▲ It is possible to use the restorying model structure to plan your interview before you actually meet with a client. This same five-stage structure can be used as an outline for note taking after the interview is completed. Key Points Treatment plan, case conceptualization, and case management ▲ A treatment plan is a long-term plan for conducting a course of interviews or counseling sessions. Case conceptualization is your integration of client, issues, challenges, and goals for the future. Case management often leads to alternative change strategies beyond the original interview and may involve efforts with the family, community, and other agencies. COMPETENCY PRACTICE EXERCISE AND SELF-ASSESSMENT Chapter 13 Individual Practice Self-assessment Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Scope of Assignment Prepare a transcript from a taped session of a practice interview. Complete or partial interview, minimum 20 minutes. Prepare a treatment plan; outline the interview before the session. Suggested topics can include: •Career counseling, Interpersonal conflict, Feelings/ meanings specific to the client, Controversial topic—abortion, divorce, death Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Scope of Assignment Acquire client’s permission to participate and be taped. Only use volunteer client who understands your assignment and is willing to participate. Client is free to withdraw at any time. Include written permission in the final transcript. Complete the checklist and answer discussion questions. Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Checklist Describe the client. Do NOT use the client’s real name. Follow the model in Chapter 13. Number each interviewer/client interaction. Score each focus/attending/influencing skill. Double scoring may be required for some comments. Rate confrontations on the CCS. Comment on interactions when appropriate. Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Checklist Develop interview notes on your session using the fivestage structure of the interview. Develop a Second Interview Plan and Case Conceptualization for the next session (Ch. 13). Develop a Long-term Case Conceptualization and Treatment Plan (Ch 13). Analyzing a Session Final Transcript Format Skill Classifications Listening & Influencing Focus C* Counselor and Client Conversation Process Comments See Table in chapter 13 (List Skill) (See Chapter 9) * Record “C” for confrontations. Client Change Scale (CCS) Final Transcript Evaluation Denial 1 Full Examination Decides to Live With But No Partial Incongruity Change Examination 2 Denies or Discusses fails to hear part, but not incongruity. all of incongruity. 3 Discusses incongruity completely, but will not change. 4 Discusses and is fully aware of decision impact. Decides to Change From Incongruity 5 Discusses and alters choices when faced with incongruity. FORM IIC Interview Plan and Objectives Form (in this Ch.) As you practice, we encourage you to use the forms provided. Study your client after the preceding session. Complete this form indicating issues you anticipate being important in the next session and how you plan to handle them. We provide specific forms for each specific skill. FORM IIC Creating a Long-Term Treatment Plan (in this Ch.) As you practice, we encourage you to use the forms provided. Use this form to develop a long-term treatment plan. We provide specific forms for each specific skill. Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Discussion Questions What did you do well, poorly, and why? Where would more appropriate skills have been better? Note what worked and what you feel good about. From observation, note how you influenced the direction of the interview. Be aware of the stages of the interview. Indicate when you feel each stage ended. Individual Practice -- Practice Exercise in Case Conceptualization and Interview Analysis IIC Discussion Questions Summarize use of skills with skill count. Include a summary commentary of the interview. Assess your competence level. What have you mastered? Where do you have room for growth? What are your plans for further development? PORTFOLIO OF COMPETENCE What Is Your Level of Mastery of this Skill? IIC After completing the practice exercise please go back to the interview you completed as you started this book. Note how your style has changed and evolved since then. What particular strengths do you note in your own work? Are you meeting your client’s needs as described in this chapter? How much do you understand and use cultural/ environmental/ contextual issues. How would a person from a different cultural group and gender evaluate your work? SELF-ASSESSMENT Exercise: Self-Evaluation of Skill Integration IIC A checklist for your portfolio has not been developed for this chapter. At this point, developing and evaluating your own interviewing style becomes the major exercise for your portfolio. DETERMINING YOUR OWN STYLE AND THEORY: CRITICAL SELF-REFLECTION ON SKILL INTEGRATION CRITICAL SELF-REFLECTION ON SKILL INTEGRATION The decisional counseling model can be very beneficial to understand how you integrate the skills learned. What single idea stood out for you among all those presented in this chapter, in class, or through informal learning? What have you learned and observed about yourself? How could you use the decisional counseling model to further your development? What is your plan to continue developing your own style? Write your ideas in your journal.