CLINICAL INTERVIEWING - PART 9

354 Interviewing Special Populations differentiation and multigenerational transmission, writers and therapists with a fam-ily orientation attend to a much broader domain than those focusing on individuals or even nuclear families (see Goldenberg & Goldenberg, 2000). A family therapist working in the structural family theory model approaches the family as a living organism, which leads to an open definition of both family and nor-mality (J. Patterson et al., 1998). During an initial interview, the therapist absorbs all aspects of family functioning to begin to draw a family map. This map, or schema, al-lows for an analysis of structural strengths and weaknesses in the family. Orienting to a family and to the family’s distress systemically will substantially change interviewer-client interactions and interviewer inquiry. For instance, in the body of a family interview, coming from an ecosystemic approach, Amatea and Brown (1993) recommend seeking answers to the following: 1. What is the nature of the problem and what solutions have been tried to solve this problem? 2. Who else has been involved in helping with this problem? 3. If you were to bring in anyone to help with this problem, whom would you invite? 4. Who would be the last person(s) to bring in to help with this problem? 5. If this problem were solved, how would things be different? The authors also advocate assessing the entire ecosystem that surrounds the problem and intervening at whatever junctions in the system seem most likely to positively effect change. Amatea and Brown draw heavily from the MRI (Mental Research Institute) approach, which stems from the early work of Gregory Bateson, Paul Watzlawick, Don Jackson, Jay Haley, Virginia Satir, and others (see Goldenberg & Goldenberg, 2000, for review; Bertolino & O’Hanlon, 2002; Fisch, Weakland, & Segal, 1982). Using a systems or ecological perspective to some extent, behavioral family therapy shares similarities with behavioral couples therapy. Behavioral family therapists believe that families develop behavioral patterns that may be counterproductive or maladap-tive, but these behaviors represent the family’s best efforts to respond to their situation (I. Falloon, 1988). Behavioral therapists’ intentions are to conduct a functional anal-ysis of the problem(s) and begin altering behaviors through traditional behavioral change strategies. Education and communication training are also important features of behavioral family therapy. To summarize, the body of an initial family interview most likely involves seeing the family from a systems or ecological perspective. Problems, tensions, and distress are discussed in relation to the context in which they occur, rather than to the pathology of one or more family members. Many, if not most, family counselors send the family home with homework or experiments, or at least new ways to think about their situa-tion. The bulk of the interview body provides the foundation for designing and imple-menting these interventions. Common Areas to Address Regardless of theoretical orientation in working with couples or families, there are cer-tain assessment domains that should be considered and, in most cases, explored during the body of an initial interview. These domains are described in the following section. The first three assessment domains—sex, money, and level of commitment—are spe-cific to couples. Interviewing Couples and Families 355 Sex When working with romantic partners, satisfaction with sexual intimacy is a central area to assess. However, it can be difficult for interviewers to ask questions about sex-ual functioning. Therefore, you should practice asking unusual or difficult questions. One of our favorite homework assignments for interviewers consists of the following: “During the next week, spend several hours loudly discussing the details of your sex life with your class partner while out at a crowded local restaurant.” Of course, after giving this assignment, we follow it with: “Okay, if you’d rather not complete the original assignment, then simply discuss sex with each other quietly, in a very private and confidential setting.” The point is that interviewers, as well as couples, need to become comfortable talking about sex. For the most part, you may find relief in the fact that couples probably have a more difficult time answering your questions about their sex life than you have asking, which makes your comfort with this aspect of couple functioning all the more important. In the first interview, you may or may not get a chance to ask about sex, and in addition, when you do ask, you may get a quick “Oh, fine. We’re fine in that area.” Later, after more trust has been established, very different answers to questions about sexual func-tioning may surface. What matters is that you ask about sexual functioning, compati-bility, and satisfaction in a natural, caring way. Money Although easier to ask about than sex, money is often a difficult issue for couples. Ques-tions about money practices include who pays the bills, whether checking accounts are joint or separate, if there is agreement with regard to saving and spending, and so on. By evaluating how couples manage money in their relationship, interviewers may also glimpse how power is managed (or abused) in the relationship. Level of Relationship Commitment Only a minority of couples enter counseling because they simply want to improve their relationship. They arrive excited and interested to explore ways to increase their rela-tionship satisfaction, and are fully committed to continuing the relationship. Other couples come to counseling to repair or work on certain troublesome areas in their re-lationship but have not seriously considered ending the relationship. They are commit-ted, but are experiencing significant distress. Still other couples come to counseling with a marked imbalance in their commitment, with one deeply questioning whether to stay in the relationship and the other desperately committed to keeping things together. Finally, there are couples who come to counseling as a last resort; they are not very committed to each other anymore and hold little hope for continuing their relationship. Either directly or indirectly, you need to obtain a clear idea of where the couple you are interviewing fits along this continuum. The Stuart Couples’ Precounseling Inven-tory provides each client with questions that interviewers can use to assess commitment without asking about it directly in front of the other partner during an interview (Stu-art & Stuart, 1975). Additional couple relationship measures range from the 280-item Marital Satisfaction Scale (D. K. Snyder, 1979) to the 32-item Dyadic Adjustment Scale (Spanier, 1976; see Sporakowski, Prouty, & Habben, 2001, for a brief review). Family of Origin It is certainly not feasible to devote a great deal of time to each person’s upbringing and family of origin relationship patterns, but it helps to at least get an overview of this im- 356 Interviewing Special Populations portant area, both in couple and family work. You can gain a great deal of information by designing your intake paperwork to include the family history of each member of the couple with regard to relationships, deaths, divorces, and so on. It is also helpful to know about siblings’ marriages. However, beginning interviewers may have the follow-ing question when working with couples: Should I interpret the couple’s unresolved family of origin issues early on? Despite our belief that unresolved family of origin issues can strongly influence couple or marital interaction, we strongly advise against family of origin–based couple conflict interpretations during initial interviews. Premature interpretation in the couple context is generally inappropriate and certainly can turn couples off to counseling. In-stead, make a mental note or written progress note indicating that family of origin is-sues may be fueling couple conflict. Additionally, it may be appropriate to acknowledge this likelihood, but not describe the dynamics in an initial session. For example: “As you both probably know, your childhood experiences, your relationships with your mother and father or brothers and sisters can shape the way you relate to each other. I’m not sure if this is the case with the two of you, but as we work together, it may be useful for us to occasionally discuss how your family of origin experiences may be contributing to your current conflicts and the ways you go about trying to resolve these conflicts. But, because this is our first session, I won’t even venture any guesses about how your childhood experiences might be influ-encing your relationship.” As some theoretical perspectives suggest, family of origin issues may be deeply in-fluential, but they may also be outside client awareness (Gurman & Jacobson, 2002; Odell & Campbell, 1998). Consequently, as in the case of psychoanalytic interpreta-tions (discussed in Chapter 5), family of origin interpretations must wait for sufficient rapport and supporting information (or data) before they can be used effectively. As a family therapy technique, interpreting intergenerational family themes is probably less threatening, but should still be approached carefully. Genograms Most modes of family therapy and some modes of couple therapy use a schematic drawing of the family tree of both parents, including stepparents and half siblings. There are slight variations in the construction guidelines, but knowing how to do a ba-sic genogram is essential in working with families (Hartman, 1995; McGoldrick & Ger-son, 1985). The counselor may not actually do a genogram with the family present but may accumulate the data necessary to complete one. However, it is a common activity to do with families early in treatment. Numerous books are available for teaching in-terviewers how to complete genograms (Hood & Johnson, 1997; McGoldrick & Ger-son, 1985). Gathering Family Therapy Goals Many family therapists, when gathering information during the body of an interview, maintain balance by systematically orienting toward each family member. For ex-ample, Lankton, Lankton, and Matthews (1991) state: “We always ask each member what he or she would like to have changed in the family and how, and even if members contradict each other, each input becomes the basis of a goal” (p. 241). A key to gathering goals in family therapy is to emphasize inclusion and minimize Interviewing Couples and Families 357 scapegoating or constant references to the identified patient. It is crucial to explore the range and quality of strengths and deficits of all family members and to begin deter-mining how they are influencing the identified patient (I. Falloon, 1988). Willingness to Make Changes A close corollary to the level of commitment in couple interviewing is each person’s will-ingness to do homework, try new things, experiment with change, and try out new per-spectives. Besides asking directly, a good way to assess this area is to have each member try a new behavior or listening skill during the interview. This can be as simple as saying: “Barney, I wonder if you could take Betty’s hand for a minute and just let her cry.” “Mom, it seems like you and Karen are sitting closer together than anyone else. I wonder if you could have Karen sit by her brother for a few minutes while Dad moves over here and we talk a bit further.” If the couple or family agrees to homework or to setting aside talking time, interview-ers should inquire as to exactly when such a new behavior might fit into their schedules. Kids, Parents, Neighbors, Friends Often, couples and/or families are the core of a circle of wider relationships, all of which contribute to one another’s well-being or struggles. Getting an idea of these interper-sonal and role demands operating on the couple or family system is important. Grand-parents, children and their friends, stepchildren, in-laws, close friends, and other asso-ciates can play influential roles in the happiness or unhappiness of a couple or family and can contribute to, or use up, many relationship resources. Considering the rich and interactive ways in which many outside factors influence couples and families is a core concept of the ecological approach to therapy (Brofenbrenner, 1979, 1986). Drugs, Alcohol, and Physical Violence Intake forms may help with gathering information about concerns in these areas. Sometimes, this opens the door to further sharing regarding fears of alcohol abuse or instances of past violence. This, like sex, may be an area wherein you get a simple “Everything’s fine” answer until much later, when trust has been established. However, simply asking, either in writing or verbally, begins the process of letting everyone know that you are open to hearing about trouble in these areas. When questionnaires or in-take forms are used to inquire about sensitive issues, interviewers should review the forms thoroughly and discuss significant issues with the couple or family. Depending on your perspective, it should be made clear to couples and families that any issues mentioned on questionnaires or intake forms are not confidentialin the family or couple system and, therefore, may be discussed during the interview. The Closing Watching the clock closely is essential, but very difficult, in an initial interview with families and couples. There are more clients to manage and profound issues may be raised with just moments left in a session. We believe that when new issues are raised at the session’s end, it is appropriate, unless the issue represents a true crisis, to close the session by stating something such as: 358 Interviewing Special Populations “Rosa, I’m glad you brought up the fact that you want to change your curfew. Un-fortunately, we’re out of time for today. So, next time, I want you to remind us about the curfew issue and we can discuss it earlier in the session, when we have enough time to deal with how everyone feels about it.” When working with families, it is often best to meet for an hour and a half or even two hours, but interviewers should be careful to stay within whatever time boundaries are originally agreed on. Make sure you allow plenty of time to “put things back to-gether” because the session may involve some intensely emotional material. You can-not be responsible for making each person feel better about the situation, nor is it eth-ical to minimize the problems so everyone leaves feeling artificially hopeful. On the other hand, it is in your power to support and compliment everyone’s efforts in coming for help. It is in your power to provide structure that enables each person to regain com-posure. In addition, it is usually in your power to offer a sense of direction for the fam-ily counseling work. As with all closings, summarization is an important tool. Couples or families who come and share their problems and fears need to be reassured that they have been heard. They also need help finding closure and preparing to leave. A thorough, sensi-tive summary helps facilitate these goals: “Well, today we certainly covered a lot of important material. Your family has been through a lot and you have ideas about things that you would like to work on. Grandma’s death seemed like it would be much easier than it has been, given she had been ill for so long. Her death, along with Peter’s recent legal trouble and Ginny’s decision to move in with her boyfriend next month, has just seemed like too much, and your old comfortable ways of talking with each other seem to have disappeared. Dad, you’re often angry. Mom, you feel torn 50 different ways. Ginny, you feel nobody pays much attention to you, and Peter, everyone pays too much attention to you. Now, I may not have repeated everything, but I think that catches some of the main areas. Did I miss any big ones?” Another common closing tool for many theoretical orientations is the homework as-signment. This might involve communication time, journaling, charting behaviors, go-ing on dates, reading, listening to instructional tapes, or any number of activities. The important thing to remember is that your opening explanation of how you work should alert the couple or family to the notion that you would be asking them to do something between sessions. Finally, in closing with multiple people, try to acknowledge that their lives will con-tinue to intersect after the session. You may want to devise a short statement, the es-sence of which communicates “This will be different at home.” An example is: “Being in counseling together, with me here to guide, ask questions, and even boss people around, is obviously different from when you are together at home. We’ve talked about some areas that are really troubling and hard. I’m sure you’ll con-tinue talking about them at home, but I hope you will remember to try some of the guidelines we’ve used today. If it gets too damaging, or too hard, we’ll have more time to work on things next week. It’s okay if everything doesn’t get solved at once.” ... - tailieumienphi.vn