clinical interview and counseling exam 2

The Interview Environment

 The Agency
 The Professional Office
 Home Visits
 Online
 Other Settings

the agency

 Create a warm, welcoming entry area
appropriate for the cultures the agency serves
 Be aware clients observe staff demeanor and
behavior at all times
 Maintain confidentiality in public areas

The Professional Office

should be arranged

ethically

 As private and soundproof as possible
 Accessible to persons with disabilities

comfortably

 Analyzed from the client perspective
 Considerate of other needs of client

Flexibly

 Personal space
 An invisible area around people that serves as a protective
emotional barrier against the unwanted approaches of others.
 Proxemics
 Degree and effect of spatial separation between people in the
context of environment and culture.
 Unexpected others

what should decorating look like

 Furniture arrangement should reflect equality,
respect, and comfort
 Décor should be soothing, not distracting
 Décor should reflect cultures served
 Make the best of the situation

home visits opportunities

Give an expanded perspective of client

home visits challenges

 Unfamiliar environment
for clinician
 Not a controlled setting
 Social rituals

online couseling

Delivering services to clients using any Internet-based sources of communication, such as email, videoconferencing, virtual reality platforms, and Internet-based tests or exercises.

online counseling opportunites

 Brings services to isolated
others
 Continuity for clients who
cannot regularly come to
clinician’s office
 Natural for clients used to
the Internet

online counseling challenges

 Confidentiality
 Quality of care
 Emergency response
 Limited information

online counseling guidelines

 Ensure privacy
 Set up a private setting
 Discuss online confidentiality
 Recognize limitations
 Technology alters communication
 Prepare for technological breakdowns

 Ensure safety
 Set clear boundaries
 Know where the client is
 Maintain competency
 Receive professional training in technology
 Legal and ethical standards for online practice.

borrowed environments

Any non-office setting or locale adopted for interviewing purposes.

Physical Safety

 Violence as a professional risk
 Critical incident review process

Critical incident review process

A formalized and retrospective team process in which members review incidents of threats or harm to staff and plan strategies for managing such incidents in the future.

Physical Safety

 Violence as a professional risk
 Critical incident review process
 Environmental assessment

Environmental Assessment

Gathering information about the neighborhood and community of the client. For home visits, it includes determining which routes to the home are safest at various hours, how area residents regard outreach workers, being aware of who is in the home and whether weapons may be present, as well as the location of exits in case danger arises within or outside a residence.

Safety Cautions: In the Office

 Avoid working alone in isolated location
 Don’t keep anything in office can be used as
weapon
 Don’t reveal personal information
 Don’t interview people who are intoxicated or
carrying weapons
 Have a way to call for help

Safety Cautions: Out of the Office

 Always let someone know where you are
 Carry a cell phone for emergencies
 Someone should accompany you if it could be
dangerous

Safety Cautions: If a Client is Angry

 Don’t turn your back
 Mirror client’s body language...sometimes...
 Speak in clear, short, direct sentences
 Don’t step into a fight
 Call for backup
 Carefully evaluate before intervening
 If feel endangered, leave and get help

other safety concerns

 Clients worry about consequences of revealing
information
 Abuser may retaliate
 Lose custody of children
 Confidentiality important
 Clinicians sometimes harm clients
 Sexual abuse
 Physical abuse
 Financial exploitation

Psychological attending

The discipline of putting aside personal distractions, worries, and self-concerns and setting up “radar” to receive the signals the client is sending.

Psychological Attending includes

 Psychological readiness and openness to client
 Create an environment where others feel
appreciated, cared about, and heard
 The client’s story is center stage
 Requires discipline and flexibility

Physical attending

The physical manifestation—literally, the embodiment—of the clinician’s interest in and openness to the client, to the story, to the relationship, and to the work to be done together. It readies the interviewer to listen.

Posture of attention
 SOLER

 Communicates presence, interest, and close following

SOLER Gerard Egan’s acronym:

S- sit squarely
O- open posture
L- lean forward
E- eye contact
R- relax

Culture bound

The sociological principle asserting that human behaviors are shaped by the culture in which they are lodged and that their meanings can be understood only in the context of that culture.

Physical Attending

 Other guidelines
 Stable presence regardless of interview setting
 Flexible attentiveness with multiple participants
 Adapt to the needs of the client

Clinical listening

is a form of attending closely to verbal and nonverbal communication, to themes and patterns, and to the context in which clients’ stories take place. This process includes attending to the relationship and to the clinician’s own inner process.

Nonverbal communication

is a form of communication that includes physical appearance, body posture, gestures, movements, and facial expressions. appearance, body posture, and kinesics

Kinesics

The term used to denote bodily movements such as posture, facial expression, gestures, eye contact, and other forms of body movement, such as gait.

Nonverbal Communication examples

 Appearance
 Body posture and kinesics
 Gestures
 Facial expressions
 Involuntary body movements

Low context cultures

 Direct verbal communication and linear logic
 Intention and meaning are explicitly stated

High context cultures

 Indirect communication and nonverbal nuance
 Rely on implicit meanings shared by those
communicating
 Emphasis is on the context of the exchange, not
necessarily on what is said

Clinician Nonverbal Communication

 Clients may be highly sensitized to nonverbal
changes in demeanor
 Harder to be aware of our facial expressions
than gross body movements
 Videotape clinical interactions to increase
awareness of mannerisms

Verbal Communication

 Pay attention to specific words clients use
 May have special and crucial meanings
 Words can be vehicles and barriers
 Same word may mean different things in
different cultures
 Don’t pretend to understand what client has
said when you do not

Paralinguistic Cues

 How things are said:
 Tone and pitch of voice
 Rate of speech
 Emphasis
 Stuttering, sighing, and other vocalizations
 Give nuance and meaning to interpersonal
communication
 How clients (and clinicians) say things is as
important as what they say
 Cultural differences in paralinguistic cues

silence

 A form of communication
 Can indicate comfort, discomfort, anger, calm,
or many other things
 May have different cultural meanings

Metacommunication

 Messages about the message
 Nonverbal and paralinguistic cues about what
client is saying
 May affirm, accent, modulate or contradict
what is said verbally
 Look for changes in style

Listening to Clients’ Stories

 Behaviors
 Feelings or Affect
 Thoughts and
Cognitive Style
 Context
 Meaning
 Emphasis
 Listening for
Themes and
Patterns
 Listening to the
Relationship

behaviors

 Look for effective as well as problematic
behaviors
 How flexible? Rigid? Rational? Irrational?
 Understand behaviors within client’s cultural
context

Feelings or Affect

 Note the frequency of each feeling state and
which feelings predominate
 Listen for the behaviors clients use to express
their feelings
 Listen to discern whether clients can regulate
their feelings or feel overwhelmed by them

Thoughts and Cognitive Style

 Clinicians should listen for:
 What clients think about their inner lives, external
events, relationships to others
 Are their thoughts positive? Ordered? Flexible?
 How they handle new thoughts or conflicting
ideas

Context

 The immediate context-personal circumstances
 Current living arrangements, family and social
relationships, economic status, personal history,
health
 Embedded in a larger systems context
 Economic, social, political, and religious forces and
institutions

meaning

 Listen for how clients make sense of their
situations, feelings, behaviors, and thoughts
 Listen if clients are open to alternative
meanings
 Listen for whether they can hold multiple
perspectives simultaneously

Emphasis

 Different theoretical models emphasize
different components of the client’s story
 Agencies often impact whether focus on
feelings, thoughts, or behaviors
 Clinicians also influence the focus of the
sessions

Listening for Themes and Patterns

 Themes
 Repeated sets of ideas and beliefs
 Often emerge indirectly and without conscious
recognition
 Patterns
 Repeated behavioral or affective sequences
 Within an interview or across a series of
interviews
 Both also emerge in clinicians

Listening to the Relationship

 Thoughts, feelings, and reactions to the
relationship
 Themes, patterns, and developments within
the relationship

Bridging Linguistic Differences:
Talking in a Non-Native Language

 Happens very frequently
 Difficult to communicate complex experiences
 Ask clients to say meaningful words in their
native language
 Best to use interpreter

Using Interpreters in Clinical Work

 Trained interpreters are preferable
 Enables effective cross-cultural
communication
 Converting what is spoken in one language to
another or spoken communication into sign
language
 American Sign Language interpreters use oral
interpreting or tactile signing
 Capacity building for all three members

Interpreter Roles

 Invisible interpreter
 Interpreter as culture broker
 Interpreter as junior partner
 Interpreter as advocate

Invisible interpreter

Words in one language are simply replaced with equivalents in another

Interpreter as culture broker

Explains the client’s behaviors and their meanings in their cultural context

Interpreter as junior partner

Has had training in mental health and offers opinions and observations about client’s behavior

Interpreter as advocate

Empowers the client who does not speak dominant language and therefore in less powerful position

Challenges of the Interpreted Interview

 Complexity of three-person relationships
 Overlapping relationships and competing
agendas may affect reliability of translation
 Clinician may feel sidelined at times
 May interfere with flow of interview
 Potential for error or bias

Common Errors While Interpreting

 Omission
 Addition
 Condensation
 Substitution
 Role exchange

Guidelines for Use of Interpreters

 Whenever possible, don’t use family members
or others with dual relationships
 Don’t ask a staff person, student, or intern
who is bilingual but is not paid
 Use professional interpreters
 Be sure the interpreter is fluent in client’s
specific dialect
 Keep the same interpreter throughout the
relationship

Guidelines for Use of Interpreters more

 Have a pre-interview meeting
 Familiarize interpreter with specific terms that will
be used
 Schedule extra time or adjust agenda
 Consecutive interpretation
 Simultaneous interpretation
 Directly address confidentiality with all three
participants present

Guidelines for Use of Interpreters extra

 Directly address and look at the client, not the
interpreter
 Check in with both client and interpreter
about the process
 Meet with the interpreter after the interview
 Remember the interpreter is not a machine
 May have reactions- secondary traumatic stress

Secondary traumatic stress (STS)

A response to witnessing or hearing about another’s traumatic experience in which the person develops some of the same symptoms as the victim.