CLINICAL INTERVIEWING - PART 3

78 Listening and Relationship Development meet her next week in Dallas and I’m like a nervous Nellie. I’ve got a friend who’s telling me I’m nuts, but I just want some action in my life again.” Interviewer-1: “Somehow, you’re thinking that having a rendezvous with this young woman, rather than working on things with your wife, might help you feel better.” Interviewer-2: “Your plans seem a little risky. It sounds like you’re valuing a pos-sible quick sexual encounter with someone you’ve never met over your 20-year marriage. Have I got that right?” Interviewer-3: “I need to tell you that you’re playing out a mid-life fantasy. You’ve never seen this girl, you don’t know if she’s really 20, whether she’s got AIDS or some other disease, or if she plans to rob you blind. You think getting together with her will help you feel better, but you’re just running away from your prob-lems. Sooner or later, getting together with her will only make you feel worse.” A confrontation’s effectiveness may be evaluated by examining your client’s subse-quent response (A. Ivey & Ivey, 1999). For example, a client may blatantly deny the ac-curacy of your confrontation, partially accept it, or completely accept its accuracy and significance. True confrontation does not contain an explicit prescription for change. Instead, it implies that action is necessary (but does not specify or prescribe the change). In the next chapter, we review technical responses that explicitly suggest or prescribe action. Table 3.2 summarizes the directive listening responses, while Table 4.1 on page 86 sum-marizes the directive action responses. Table 3.2. Summary of Directive Listening Responses and Their Usual Effects Directive Listening Response Interpretive reflection of feeling Interpretation Question Feeling validation Confrontation Description Statement indicating what feel-ings the interviewer believes are underlying the client’s thoughts or actions. Statement indicating what meaning the interviewer believes a client’s emotions, thoughts, or actions represent. Often includes references to past experiences. Query that directly elicits in-formation from a client. There are many forms of questions. Statement that supports, affirms, approves of, or validates feelings articulated by clients. Statement that points out or identifies a client incongruity or discrepancy. Ranges from very gentle to very harsh. Primary Intent/Effect May enhance empathy and encour-age emotional exploration and insight. Encourages reflection and self-observation of clients’ emotions, thoughts, and actions. Promotes client insight. Elicits information. Enhances inter-viewer control. May help clients talk or encourage them to reflect on something. Enhances rapport. Temporarily re-duces anxiety. May cause the inter-viewer to be viewed as an expert. Encourages clients to examine them-selves and their patterns of thinking, feeling, and behaving. May result in personal change and development. Basic Attending, Listening, and Action Skills 79 SUMMARY Attending behavior is primarily nonverbal and consists of culturally appropriate eye contact, body language, vocal qualities, and verbal tracking. Positive attending behav-iors open up and facilitate client talk, while negative attending behaviors tend to shut down client communication. Negative attending behavior consists of a wide range of annoying behaviors, includ-ing any positive attending behavior displayed excessively. Considerable cultural and in-dividual differences exist among clients regarding the amount and type of eye contact, body language, vocal qualities, and verbal tracking they prefer. To improve communi-cation and attending skills, beginning interviewers should seek feedback from their peers and supervisors. Beyond attending behaviors, interviewers employ many different nondirective listen-ing responses—including silence, clarification, paraphrasing, nondirective feeling re-flection, and summarization. Each nondirective listening response is designed to facil-itate client self-expression. However, evennondirective listening responses influence or direct clients to talk more about some topics than others. Directive interviewer responses are defined as responses that clearly bring the inter-viewer’s perspective into the session. Interviewers can be too directive, leaving clients feeling as if they have had no control in the interaction. They can also be too nondirec-tive, leaving clients feeling lost and suspecting that the interviewer is evasive or manip-ulative. Generally, directive interview responses are advanced techniques that encour-age clients to change their thinking, feeling, or behavior patterns. Therefore, most directives should be used after an adequate clinical assessment has occurred. Directive listening responses include interpretive reflection of feeling, interpreta-tion, questioning, feeling validation, and confrontation. These techniques involve the therapist’s indicating or pointing out particular issues for clients to focus on during therapy. SUGGESTED READINGS AND RESOURCES Several of the following textbooks and workbooks offer additional information and ex-ercises on attending skills, as well as therapeutic techniques from different theoretical orientations. In addition, some of these readings can enhance your knowledge of and sensitivity to various social and cultural groups. Bandler, R., & Grinder, J. (1979). Frogs into princes. Moab, UT: Real People Press. This is one of the early books on NLP (neurolinguistic programming) and the concept of representational systems. Cormier, S., & Nurius, P. (2003). Interviewing strategies for helpers: Fundamental skills and cog-nitive behavioral interventions (5th ed.). Monterey, CA: Brooks/Cole. Chapter 4 of this text provides extensive and in-depth information regarding nonverbal behavior. Gibbs, M. A. (1984). The therapist as imposter. In C. M. Brody (Ed.), Women therapists working with women: New theory and process of feminist therapy. New York: Springer. This chapter is a strong appeal to therapists to acknowledge their insecurities and inadequacies. It provides insights into how experienced professionals can and do feel inadequate. Greenson, R. R. (1967). The technique and practice of psychoanalysis (Vol. 1). New York: Inter-national Universities Press. This classic work provides extensive ground rules for the use of interpretation. 80 Listening and Relationship Development Meador, B., & Rogers, C. R. (1984). Person-centered therapy. In R. J. Corsini (Ed.), Current psy-chotherapies(3rd ed.). Itasca, IL: Peacock. This chapter contains an excerpt of Rogers’s clas-sic interview with the “silent young man.” Miller, J. B. (1986). Toward a new psychology of women (2nd ed.). Boston: Beacon Press. This book is about women (and men) and the issues they deal with in contemporary society. It helps articulate the depth and meaning of some difficulties traditionally associated with be-ing female. Rogers, C. R. (1951). Client-centered therapy. Boston: Houghton Mifflin. This text includes Rogers’s original discussion of feeling reflection (Chapter 4). Sue, D. S., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477–486. Standards and competencies in the area of multicultural issues are outlined for the counsel-ing profession. Weiner, I. (1998). Principles of psychotherapy (2nd ed.). New York: John Wiley & Sons. This is a good general text on psychoanalytically oriented psychotherapy. It provides clear examples and descriptions of interpretation, free association, and other concepts. Yalom, I. D. (1995). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books. Chapters 1 and 2 discuss therapeutic factors in group psychotherapy. These factors are extremely relevant to individual psychotherapy and help illustrate the importance of specific responses, such as feeling validation. Chapter 4 DIRECTIVES: QUESTIONS AND ACTION SKILLS Grown-ups love figures. When you tell them that you have made a new friend, they never ask you any questions about essential matters. They never say to you, “What does his voice sound like? What games does he love best? Does he collect butterflies?” Instead, they demand: “How old is he? How many brothers has he? How much does he weigh? How much money does his father make?” Only from these figures do they think they have learned anything about him. —Antoine de Saint-Exupéry, The Little Prince CHAPTER OBJECTIVES Clinical interviewers must move beyond listening and assess clients through the skillful use of questions. The interview is not an investigation, but, at times, the interviewer takes the role of investigator. In addition, interviewers sometimes en-courage clients to take specific actions—actions the interviewer deems adaptive or healthy. In this chapter, we analyze a wide range of questions and directive ac-tion responses often used by clinical interviewers. After reading this chapter, you will know: • The many types of questions available to interviewers, how to use them, and their usual effects (and side effects). • The benefits and liabilities of using questions with clients. • Howasking certain questions can be inappropriate and how asking other ques-tions can be unethical. • General guidelines for using questions in an interview. • Howand why clinical interviewers use a range of directive action responses, in-cluding explanation, suggestion, advice, agreement, disagreement, urging, ap-proval, and disapproval. Imagine digging a hole without a shovel or building a house without a hammer. For many interviewers, conducting an interview without using questions constitutes an analogous problem: How can you be expected to complete a task without using your most basic tool? Despite the central role of questions for interviewing, we have managed to avoid dis-cussing them until this chapter. The reason for this is similar to having a carpenter con-sider building a house without a hammer. Our purpose has been to stimulate your cre- 81 82 Listening and Relationship Development ativity and to help you understand the depth, breadth, and application of your other listening and communication tools. If you can develop your complete range of inter-viewing skills, it may help you avoid depending too much on questions to conduct in-terviews. Questions are an incredibly diverse and flexible interviewer tool; they can be used to stimulate client talk, to restrict it, to facilitate rapport, to show interest in your clients, to show disinterest, to gather information, to pressure clients, and to ignore the client’s viewpoint. As you proceed through the section on using questions and directive action responses, reflect on how it feels to freely use what many of you will consider your most basic tool. USING QUESTIONS When you ask a question, in any context, you take control of the conversation. Ques-tions, by definition, are directive and are an integral part of human communication. In the context of clinical interviewing, questions constitute a technique and deserve our scrutiny. Asking questions, especially if you are interested in particular information, can be hard to resist. Unfortunately, as in the case of The Little Prince, there is also no guarantee that the questions you ask (and their corresponding answers) are of any in-terest whatsoever to the person being questioned. Types of Questions Interviewers have many types of questions at their disposal. It is important to differen-tiate among them because different types of questions tend to produce different client responses and response patterns. The most common questions used by interviewers are open, closed, swing, indirect or implied, and projective. Open Questions Open questions are designed to facilitate verbal output. By definition, open questions require more than a single-word response; they cannot be answered with a simple yes or no. Ordinarily, open questions begin with the word HoworWhat.Writers sometimes classify questions that begin with Where, When, Why, and/or Who as open questions, but such questions are really only partially open because they don’t facilitate talk nearly as well as How and What questions (Cormier & Nurius, 2003; Hutchins & Cole, 1997). The following hypothetical dialogue uses questions sometimes classified as open: Interviewer: “When did you first begin having panic attacks?” Client: “In 1996, I believe.” Interviewer: “Where were you when you had your first panic attack?” Client: “I was just getting on the subway in New York City.” Interviewer: “What happened?” Client: “When I stepped inside the train, my heart began to pound. I thought I would die. I just held onto the metal post next to my seat as hard as I could be-cause I was afraid I would fall over and be humiliated. I felt dizzy and nause-ated. Then I got off the train at my stop and I’ve never been back on the sub-way again.” Interviewer: “Who was with you?” Client: “No one.” ... - tailieumienphi.vn