(Adapted from Craig, RJ (1989) The clinical interviewing process. In Craig, RJ. (Ed.) Clinical and Diagnostic Interviewing)
Therapists have an array of techniques that they use in an interview:
C: As a kid I was alwaus in trouble
T: What kind of trouble were you in?
- Most often used by clinical interviewers
- patient is asked direct questions in areas determined by interviewer
- questioning may be open or closed ended
- Direct questions usually begin with now, what, and why
- Closed-short answers, become "regressive"
- Open-"how does it make you feel"
- newer clinicians use direct questioning
C: I just can't seem to get anywhere in my life
T: Your lack of progress frustrates you?
- requires interviewer to skillfully restate the patients cognitive or emotional material
- demonstrate to the patient that their feelings are understood
- Rogerian Client-Centered Therapists rely heavily on reflection
- requires clinical skill to be effective
- overuse is counterproductive - important areas are left unaddressed
- Restatement (Paraphrasing):
C: Thoughts are racing in my mind, I just cant concentrate, I'm confused
T: These strange things in your mind are disturbing to you?
- rephrase what client said in clearer or more articulate terms
- lets the patient know you are paying attention
- differs from reflection - to facilitate understanding or for clarification (reflection is type of intervention)
C: My mother is out most of the night leaving me alone. She comes home at all hours, sometime she doesnt' come home at all.
T: What is your mother doing when she is out like this?
- usually done by using one of the other techniques (questioning, paraphrasing, restating)
- purpose is to provide understanding of the client in the interview
- rarely evokes defensiveness - client wants therapist to understand the problem
- gives client additional opportunity to tell story
C: I only drink a couple of times a day.
T: let's be honest. You drink every morning and every night after work. Wouldn't you say you were dependent on alcohol?
- therapist poiints our discrepancies between what is observed and what is stated
- can be used to clarify therapist's perception or when statements are inconsistent
- often used with substance abusers, with character disorders
- to break denial and/or rigid defenses
- often increases anxiety and avoidance
- can be constructive or destructive
- most beneficial when it is factual content and not hostile
- focus on material that client should be addressing but isn't
C: People don't understand what it's like to not be able to learn. I can't get good grades in school. I'm stupid.
T: When I was in school, I was dyslexic too. But you can still do well in life despite this problem. You're not stupid, you have a learning disorder.
- therapist conveys personal experiences or feelings to patient
- intented to facilitate patient self-disclosure - Research supports this (Colby 1973)
- should be used only sparingly
- may set up false expectations
- must be careful what type of information is shared
C: I get so angry I feel like hitting someone
T: no response
- new therapists dread silence
- may occur due to therapist's failure to lead interview
- can be a technique as well as therapeutic intervention
- provides client with opportunity to process and understand what is being said
- can move interview in a positive direction
- must be timed appropriately so patient understands that it is being used for a reason
- to promote introspection, allow patient to reassimilate emotions
C: My father used to beat me.
T: Can you give me more information on that? How often did he beat you? How did he do it? Why did he do it?
- therapist covers areas in a clients live that that require more in-depth review
- "test the limits' approach -
- determine how much insight a client has
- or, how much pressure it takes before a client experiences a specific feeling
- most clients expect this, might wonder wny not explored
- therapists should not be afraid, even sensitive areas
- Reframing (Cognitive reframing):
C: I realize now he'll never change I have to accept that.
T: How could you take advantage of the situation so that it can benefit you?
- either client or therapist restates beliefs, attitudes, feelings
- in a manner more closely tied to reality
- provides fresh perspective on a situation
- serves to undercut negative self-statements and irrational thoughts that accompany maladaptive behavior
- can promote new ways of thinking and new insights
- can lead to behavioral change