CLINICAL INTERVIEWING - PART 4

124 Listening and Relationship Development problems presented by clients (depression, bereavement, anxiety, substance abuse, and so on), and the type of change aimed at (specific target complaints, symptom reduction, in-terpersonal functioning, general functioning, intrapsychic change and so on), therapists should make deliberate and systematic efforts to establish and maintain a good therapeu-tic alliance. (pp. 111–112) Strupp (1983), among others, has pointed out that a client’s ability to establish a therapeutic or working alliance is predictive of his or her potential to grow and change as a function of psychotherapy. In other words, if clients cannot or will not engage in a working alliance with an interviewer, there is little hope for change. Conversely, the more completely clients enter into such a relationship, the greater their chances for pos-itive change (Krupnick et al., 1996; Raue, Castonguay, & Goldfried, 1993). Many re-searchers and theorists agree that, ironically, people’s abilities to enter into productive relationships are determined in large part by the quality of their early interpersonal re-lations (Mallinckrodt, 1991). Therefore, unfortunately, those most in need of a curative relationship may be those least able to enter into one (Strupp, 1983). Ainsworth’s (1989) and Bowlby’s (1969, 1988) work on attachment has been applied to components of the psychotherapy process. Specifically, as infants explore and learn from their environment, they venture away from their caretakers for short periods, re-turning from time to time for reassurance of safety, security, making sure they have not been abandoned by their caretakers. This venturing and returning is one mark of a se-cure, healthy attachment. Similar to a caretaker, a therapist provides a safe base from which clients can explore and to which they can return. In optimal situations, all of the relationship factors discussed in this chapter come into play to help interviewers serve as a safe base to which clients can return for comfort, support, and security. RELATIONSHIP VARIABLES AND BEHAVIORAL AND SOCIAL PSYCHOLOGY Social and behavioral psychology has contributed significantly to our understanding of interviewer-client relationships. In particular, Stanley Strong (1968) identified three characteristics that make it more likely that clients will accept suggestions and recom-mendations put forth by their interviewers. These characteristics are expertness, at-tractiveness, and trustworthiness. Expertness (Credibility) As Othmer and Othmer (1994) claim, empathy and compassion are important, but ef-fective interviewers must also show expertise and establish authority. In other words, no matter how understanding and respectful you are of your client, at some point you must demonstrate that you’re competent. Behaviorists generally refer to this as estab-lishing credibility. Goldfried and Davison (1976) state, “The principle underlying this utilization technique is that it reinforces the client’s perception of the . . . [therapist’s] credibility” (p. 62). Clients generally want their interviewers to be competent and cred-ible. There are many ways that therapists can look credible, including: • Displaying your credentials (e.g., certificates, licenses, diplomas) on office walls. • Keeping shelves of professional books and journals in the office. Relationship Variables and Clinical Interviewing 125 • Having an office arrangement conducive to open dialogue. • Being professionally groomed and attired. Specific interviewer behaviors also communicate expertise, credibility, and author-ity. Othmer and Othmer (1994) identify three strategies for showing expertise. First, they suggest that interviewers help clients put their problems in perspective. For ex-ample, you may reassure your clients that their problems, although unique, are similar to problems other clients have had that were successfully treated. Second, they recom-mend that interviewers show knowledge by communicating to clients a familiarity with their particular disorder. This strategy often involves naming the client’s disorder (e.g., panic disorder, obsessive-compulsive disorder, dysthymia). Third, they note that inter-viewers need to deal effectively with their clients’ distrust. For example, when clients ex-press distrust by questioning your credentials, you should manage such challenges ef-fectively. Finally, when it comes to expertness, Cormier and Nurius (2003) express an appro-priate warning: “Expertness is not in any way the same as being dogmatic, authoritar-ian, or one up. Expert helpers are those perceived as confident, attentive, and, because of background and behavior, capable of helping the client resolve problems and work toward goals” (p. 50). Attractiveness With therapists, as with love, beauty is in the eye of the beholder. However, there are some standard features that most people view as attractive. Because of its subjective na-ture and the fact that self-awareness is an important attribute of effective clinical inter-viewers, we refer you to the activity included in Individual and Cultural Highlight 5.2. This activity helps you explore behaviors and characteristics you might find attractive if you went to a professional interviewer. Note that when we speak of what is attractive, we are referring not only to physical appearance but also to behaviors, attitudes, and personality traits. Trustworthiness Trustis defined as “reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence” (Random House, 1993, p. 2031). Establishing trust is crucial to ef-fective interviewing. S. Strong (1968) emphasized the importance of interviewers being perceived as trustworthy by their clients, finding that when interviewers are perceived as trustworthy, clients are more likely to believe what they say and follow their recom-mendations or advice. It is not appropriate to express trustworthiness directly in an interview. Saying “trust me” to clients may be interpreted as a signal that they should be wary about trusting. As is the case with empathy and unconditional positive regard, trustworthiness is an in-terviewer characteristic that is best implied; clients infer it from interviewer behavior. Perceptions of interviewer trustworthiness begin with initial client-interviewer con-tacts. These contacts may be over the telephone or during an initial greeting in the wait-ing room. The following interviewer behaviors are associated with trust: • Initial introductions that are courteous, gentle, and respectful. • Clear and direct explanations of confidentiality and its limits. 126 Listening and Relationship Development INDIVIDUAL AND CULTURAL HIGHLIGHT 5.2 Defining Interviewer Attractiveness Attractiveness is an elusive concept, but being aware of our own values and of how we appear to others is invaluable in interviewer development. Reflect on the following questions: 1. How you would like your interviewer to look? Would your ideal interviewer be male or female? How would he or she dress? What type of facial expres-sions would you like to see? Lots of smiles? Do you want an expressive in-terviewer? One with open body posture? A more serious demeanor? Imag-ine all sorts of details (e.g., use of makeup, type of shoes, length of hair). 2. Now, think about what racial or ethnic or other individual characteristics you would like your interviewer to have? Do you want someone whose skin color is the same as yours? Do you want someone whose accent is just like yours? Would you wonder, if you had a counselor with an ethnic background different from your own, if that person could really understand you? How about your counselor’s age or sexual orientation; would those characteristics matter to you? 3. What types of technical interviewing responses would your attractive inter-viewer make? Would he or she use plenty of feeling reflections or be more di-rective (e.g., using plenty of confrontations or explanations)? Would he or she use lots of eye contact and “uh-huhs,” or express attentiveness some other way? 4. How would an attractive interviewer respond to your feelings? For example, if you started crying in a session, how would you like him or her to act and what would you like him or her to say? 5. In your opinion, would an attractive interviewer touch you, self-disclose, call you by your first name, or stay more distant and focus on analyzing your thoughts and feelings during the session? Ask these same questions of a fellow student or a friend or family member. Although you may find initially that you and your friends or family don’t seem to have specific criteria for what constitutes interviewer attractiveness, after dis-cussion, people usually discover that they have stronger opinions than they originally thought. Be sure to ask fellow students of racial/ethnic backgrounds, ages, and sexual orientations different from yours about their ideally attractive therapist. • Acknowledgment of difficulties associated with coming to a professional therapist (e.g., Othmer and Othmer’s [1994] “putting the patient at ease”). • Manifestations of congruence, unconditional positive regard, and empathy. • Punctuality and general professional behavior. With clients who are very resistant to counseling (e.g., involuntary clients), it is often helpful to state outright that the client may have trouble trusting the therapist. For ex-ample: Relationship Variables and Clinical Interviewing 127 “I can see you’re not happy to be here. That’s often the case when people are forced to attend counseling. So, right from the beginning, I want you to know I don’t expect you to trust me or like being here. However, because we’ll be work-ing together, it’s up to you to decide how much trust to put in me and in this coun-seling. Also, I might add, just because you’re required to be here doesn’t mean you’re required to have a bad time.” Throughout counseling relationships, clients periodically test their interviewers (Fong & Cox, 1983; Horowitz et al., 1984). In a sense, clients “set up” their interview-ers to determine whether they are trustworthy. For example, children who have been sexually abused often immediately behave seductively when they meet an interviewer; they may sit in your lap, rub up against you, or tell you they love you. Left alone with an interviewer for the first time, some abused children even ask the interviewer to un-dress. These behaviors can be viewed as blatant tests of interviewer trustworthiness (i.e., the behaviors ask, “Are you going to abuse me, too?”). It is important for thera-pists to recognize tests of trust and to respond, when possible, in ways that enhance the trust relationship. FEMINIST RELATIONSHIP VARIABLES Feminist theory and psychotherapy emphasize the importance of establishing an egal-itarian relationship between client and interviewer (L. Brown & Brodsky, 1992; War-wick, 1999). The type of egalitarian relationship preferred by feminist interviewers is one characterized by mutuality and empowerment. Mutuality Mutualityrefers to a sharing process; it means that power, decision making, goal selec-tion, and learning are shared. Although various psychotherapy orientations (especially person-centered) consider treatment a mutual process wherein clients and therapists are open and human with one another, nowhere are egalitarian values and the concept of mutuality emphasized more than in feminist theory and therapy (Birch & Miller, 2000; Nutt, Hampton, Folks, & Johnson, 1990). The following example illustrates this concept: CASE EXAMPLE Betty, a 25-year-old graduate student, comes in for an initial interview. The inter-viewer’s supervisor has urged the interviewer to stay neutral and to resist any urge to-ward self-disclosure. The interviewer says, “Tell me about what brings you in at this time.” Betty begins crying almost immediately and says, “My mother is dying of cancer. She lives two hundred miles away but wants me there all the time. I’m finish-ing my PhD in chemistry and my dissertation chair is going on sabbatical in three months. I have two undergraduate courses to teach, and my husband just told me he’s thinking of leaving me. I don’t know what to do. I don’t know how to prioritize. I feel like I’m disappearing. There’s hardly anything left of me. I’m afraid. I feel like a fail-ure being in therapy, but . . .” Betty cries a while longer. 128 Listening and Relationship Development The interviewer feels the overwhelming sadness, fear, and confusion of these situ-ations. She is tempted to cry herself. She works hard, internally, to think of some-thing appropriately neutral to say. After just a slight pause, in a kind voice, she says, “All of these things leave you feeling diminished, afraid, perhaps like you’re losing a sense of who you are. Being in therapy adds to the sense of defeat.” Betty says, “Yes, mymother always said therapists were for weak folks. Her term was addle-brained. My husband refuses to see anyone. He thinks if I stay home and drop this education thing, we could be happy together again. Sometimes I feel that even my dissertation chair would be happier if I just gave it up.” The interviewer responds, “The important people in your life somehow want you to do things differently than you are doing.” Although the preceding interactions are acceptable, if both Betty and the inter-viewer stay with this modality, Betty would finish knowing very little about her thera-pist and she would feel, generally, that the therapist was the provider of insight, and she, Betty, was the provider of problems. In a more mutuality-oriented interaction, when the interviewer feels overwhelming sadness, fear, and confusion, she might say, “Wow, Betty. Those are some very difficult situations. Just hearing about all that makes me feel a little bit of what you must be feel-ing—sad and overwhelmed.” Betty might then say, “Yes. I feel both. It’s nice to have you glimpse that. See, my mom says counseling is a waste of time. My husband thinks I’m too busy outside the home . . . and I even get the same message from my disserta-tion chair.” The interviewer might then say, “Yeah. It’s hard to decide to get into ther-apy, or to even keep going when those close to you disapprove of your choices.” The differences in responses may not seem huge, but the underlying framework of the interviewer-client relationship being built in mutuality-oriented therapies contrasts sharply with traditional frameworks. The client is not excluded from the interviewer’s emotional reactions. She is not given the message that she is the bearer of problems and the interviewer is the bearer of insights or cures. Instead, the groundwork is laid for a relationship that includes honest self-disclosure on the interviewer’s part and that may, later in therapy, even include times when the client observes and comments on patterns in the interviewer’s behavior. In a mutuality-oriented relationship, interviewers and therapists are ready to respond to such offers from clients in a genuine manner that nei-ther merely reflects client statements nor interprets them as coming from client patho-logical needs (L. Brown, 1994). When interviewers engage in mutuality, they usually do so for the ultimate purpose of empowering clients. Their clients see therapy as a working relationship in which they are equal members rather than subordinates. Although mutuality does not entirely al-ter the fact that a certain amount of authority must rest with the counselor (Buck, 1999), the feminist interviewer actively works to teach clients to respond to authority with a sense of personal worth and with their own personal authority. Feminist thera-pists believe that respectful, reciprocal interactions can result in a growing sense of per-sonal power in clients. Empowerment Most therapies have as underlying goals the development, growth, and health of clients. However,therapies vary in the routes they take to reach these goals; and, therefore, dif-ferent approaches inevitably leave clients with different beliefs as to how they “got bet-ter.” The interviewer who begins therapy with an emphasis on authenticity and mutu- ... - tailieumienphi.vn