AN OVERVIEW OF THE INTERVIEW PROCESS

we can dissect the interview into components

each interview involves at least two unique human beings, interacting with and responding to each other. This
guarantees that no two interviews are ever the same.

Human interactions are guided by spoken and unspoken rules that depend on variables such as setting,
purpose, individual differences, and cultural differences

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:

1. The introduction.

2. The opening.
3. The body.
4. The closing

5. Thetermination.

Foley and Sharf (1981) five sequential interviewer tasks common to interviews:

1. Puttingthepatientatease.

2. Eliciting information.
3. Maintaining control.
4. Maintaining rapport.

5. Bringing closure.

Ivey & Ivey (1999), who also identify five stages or components in a typical clinical interview:

1. Establishing rapport and structuring.

2. Gathering information, defining the problem, and identifying assets.
3. Determining outcomes (setting goals).
4. Exploring alternatives and confronting client incongruities.
5. Encouraging generalization of ideas and skills to situations outside therapy.

THE INTRODUCTION

The introduction begins when the clinician and the patient first see one another. It ends when the clinician
feels comfortable enough to begin an inquiry into the reasons the patient has sought help

The introduction phase of an interview primarily involves initiating a helping relationship, which involves
putting the client at ease in such a way that facilitates an open discussion of a wide range of personal
information

first contact, whether via mail, email, telephone, questionnaire, or in person, directly affects your relationship
with clients.
Establishing Rapport

Rapport is a generic relationship variable. Interviewers of all theoretical orientations acknowledge the
importance of having a positive rapport with clients. Positive rapport is defined as having an especially
harmonious connection.

It’s best to try to strike a balance and to be aware that the purpose of your self-disclosure is to build rapport,
rather than to build a social friendship outside the office.

THE OPENING

The opening begins with an interviewer’s first questions about the client’s current concerns and ends when
the interviewer begins determining the interview’s focus by asking specific questions about specific topics.

the opening is a nondirective interview phase lasting about five to eight minutes. During this phase, the
interviewer uses basic attending skills and nondirective listening responses to encourage client disclosure. The
main interviewer task is to stay out of the way so clients can tell their story.

The Interviewer’s Opening Statement

The opening statement signals to the client that small talk, introductions, and explanations of confidentiality
are over and it’s time for the interview to begin. An opening statement consists of the interviewer’s first direct
inquiry into what brought the client to seek professional assistance.

The Client’s Opening Response

a place to begin their communications with you

Ideal client responses to your opening statement usually reflect thoughtfulness and the initiation of a working
alliance.

Evaluating Client Verbal Behavior during the Opening

As clients proceed during the opening phase of the interview, you should evaluate their approach and begin
modifying your responses accordingly

Where Does the Problem Reside: Exploring Society’s Contributions to Client Problems

the locus of pathol- ogy was not simply in the individual, but occurred within the context of the family

In contrast, the DSM-IV-TR, defines mental disorders as residing within the individual

A more extreme view has been articulated by biological psychiatry—where the cause of mental disorders is
not only considered to be a function of an individual’s behavior, but also to be initiated by genetic causes

David Smail (1997) holds culture responsible for causing symptoms in an individual.

Externalizing clients tend to believe their troubles stem from other people. Although there may be truth to
their complaints, it can be difficult to get them to accept responsibility and focus on their own feelings,
thoughts, and behavior in a constructive manner.
Realistically, client problems usually stem from a combination of personal (internal) and situational (external)
factors.

THE BODY

The body of an initial or assessment interview primarily involves information gather- ing. The quality and
quantity of information gathered depends almost entirely on the

More typically, the purpose of a clinical interview is, at least in part, to determine a client’s clinical diagnosis
and formulate a treatment plan. If so, data gathered during the interview body will focus primarily on
diagnostic clues and criteria

However, in all cases, the purpose or focus of the interview body may change, depending on information
shared by the client during the course of the interview.

As an interviewer, you must obtain certain information to formulate the case and make recommendations.

Defining Psychological and Emotional Disorders

All interviewers must distinguish normal and healthy emotional or psychological function- ing from disturbed
or disordered functioning.

These (DSM) are not diagnostic criteria. Instead, they are guidelines to aid your clinical judgment and
thinking about normal and abnormal behavior

One way of defining abnormality or psychopathology is through statistical infrequency.

In each of these cases, as a clinical interviewer, you can compare his reports to statistical normality.

Obviously, all statistically infrequent behavior does not indicate a mental disorder. Such reasoning is too
simplistic and can result in classifying exceptional, creative, or cul- turally divergent people as disordered
Statistically infrequent behavior should be further examined for the following conditions.

 Disturbing to Self or Others: Mental disorders may also be characterized by the fact that they
consist of behaviors that disturb or bother others.
 Maladaptive Behaviors: a behavior pattern is maladaptive when it interferes with effective
occupational, social, physical, or recreational functioning.
 Rationally or Culturally Unjustifiable: If a client’s behavior, thought, or feeling appears unusual
or maladaptive, you should ascertain whether there is any reasonable excuse or justification for it.

APPLYING INTERVENTIONS

The body of the interview is also the time when interviewers use interventions to facili- tate client change.
Ideally, most interventions will be applied after a suitable assessment has been completed. However, in many
cases, assessment and interventions are happening simultaneously.

Whatever your theoretical orientation, the body of the interview is where you will most actively work for
change. Behavior therapists will use reinforcement, response cost, participant modeling and exposure during
this stage. Cognitive therapists will question maladaptive thoughts. Person-centered therapists will work to
enable the client to engage in deeper and deeper encounters with the self. Psychoanalytic therapists will listen
and interpret. Constructive therapists will use therapeutic questions. Feminist therapists will begin the process
of helping the client sort out the influences of power and the social order in the client’s distress. In most cases,
the body of the interview is where the therapeutic action resides.

THE CLOSING

Tension on both sides due to the termination of therapy session

most clients come to their first interview session with ambivalent feelings; they experience both hope and fear
about coming to therapy. Therefore, the interviewer should support the client’s decision to seek professional
services, siding with the hope evidenced by that decision
One of the best methods for enhancing a client’s likelihood of returning for therapy is to clearly identify,
during the closing phase, precisely why the client has come for professional assistance. This can be difficult
because often clients themselves are not exactly sure why they’ve come

a client’s interest in pursuing therapy can be enhanced if the interviewer provides an early, tentative, but
accurate interpretation, explanation, or formulation of the client and his or her chief complaint.

When offering early interpretations at the end of an initial session, it’s important for the interpretations to be
easy for clients to understand. Essentially, they should be brief, based on what you’ve been talking about, and
not particularly deep.

Establishing a Collaborative Treatment Plan

During an initial session and on the basis of assessment information obtained from and with the client,
interviewers begin to establish a collaborative treatment plan.

Instilling Hope

it’s time to make sure you include a positive statement or two.

The presence of hope in the counseling process has long been shown to be a cen- tral force in treatment
outcome (Frank & Frank, 1991). Consequently, you should make a statement about how counseling or
psychotherapy may help address the client’s personal issues and concerns. It can be a very brief, but positive,
statement.

Guiding and Empowering Your Client

“I’ve done all the questioning here. I wonder if you have any questions for me?”
“Has this interview been as you expected it to be?”
“Are there any areas that you feel we’ve missed or that, if we meet again, you would like to discuss at greater
length?”

These queries help give power and control back to the client. Although it is important to maintain control
toward the end of an interview, it’s also important to share that control with the client.

Tying Up Loose Ends

The final formal task of the interviewer is to clarify whether there will be further professional contact. This
involves specific and concrete steps such as scheduling additional appointments, dealing with fee payment,
and handling any other administrative issues associated with working in your particular setting.
TERMINATION

Certainly, the way clients cope with a session’s end may foreshadow the way therapy terminates.

The ideal is to finish with all clinical business on time so the client’s termination behavior can be observed.

Session termination occurs as both parties acknowledge the meeting is over.

Time limits are important from both a practical and an interpretive perspective.

At a deeper level, model for your clients that therapy, too, is bound in time, place, and real-world demands.
You are not omniscient; you are not the all-good parent, and you cannot give your clients extra time to make
up for the difficult lives they’ve had. Your time with clients, no matter how good, must end. You must stand
firm when your clients’ push the time boundaries.