Most of us, when we start interviewing clients, we focus more on the interview as content. As a set of specific questions that get to be asked like family history or past mental health services or substance use. We tend to be anxious to make sure we are not missing something important.
Without suggesting that content is not important, the focus for this post is to provide an introduction to aspects that have to do with the process of interviewing. We can start by defining the process aspects of interviewing as ‘the other things we do’ in addition to collecting data or information.
And, as we will see below, there is a lot of stuff to do. A good process will create a sense of safety for the child, the family and the examiner. It is about creating rapport, the basic ingredient of what will hopefully become therapeutic alliance. A good process is sometimes straightforward and even easy to achieve. Other times is complicated, frustrating and an apparently impossible task.
It is said that it takes two to tango. Same here, there are client factors and clinician factors. Any clinician will find that some dynamics are easier to handle than others. It is probably about a ‘goodness of fit’ and we may feel that in some situations we are ‘spontaneously competent’. Our unique mix of personality traits, past experiences and current knowledge will work sometimes and will stumble other times. Over time we can expand the spectrum of situations where we can achieve good responses but this is always an active, challenging and at times painful process.
Experienced clinicians display a range of semi-automatic behavioral repertoire and make instantaneous adjustments during the interview. For example, they change body posture, vocabulary, tone of voice and even affective display. These adjustments of verbal and nonverbal communication put the clinician in immediate contact with the client’s current mental state.
This ‘fine tuning’ is called empathic attunement. It relies on the capacity to quickly read and respect the perspective and the emotional shifts of the interviewee. But this is a more advanced set of skills.
A good process starts with displaying reasonable amounts of basic attitudes like:
It strives for an equidistant relationship with the child and the family. It is a balancing act between being a child advocate without alienating the parents and ‘hearing the parent’ without estranging the child.
The client enters the interview with her apprehensions (biases toward evaluation and evaluator), thoughts (ruminations, worries, obsessions, attributions, beliefs), with her abilities and level of development (cognitive, emotional, social) with her defensive level and reactive potential (level of defensive functioning in times of calm or stress).
The interviewer enters with one’s own agenda: the need or anxiety to cover information, one’s insecurities, one’s personal problems, one’s concerns about the daily schedule, one’s worries about another patient etc.
From this state of ‘separateness’ we need to work on building a state of ‘togetherness’ that can be both the support and motivation for our future working together.
Ongoing supervision can be a great tool for professional development, but in the context of busy practice it is hard and expensive to get.
Deliberate practice is a known process for achieving expert level performance. One aspect of deliberate practice is to break down the task into manageable parts.
Below there is a list of goals. On their achievement in proper balance it often lies the success of an interview.
Sensitivity – empathize with the clients, adjust to their developmental level, attend to their anxiety, make the interview go smooth and painless.
Fluidity – be careful with transitions from one topic to the other, from parent to the patient.
Coherence – try not to jump around too much, connect and integrate information, fight fragmentation.
Versatility – adapt to various circumstances, discrepancies, tension, even conflict.
Efficiency – prioritize important vs. unimportant, have a flexible but clear plan, get job done.
Specificity – understand and identify the problem at hand, the concerns, the context, psychopathology and problems of adaptation.
Depth, meaningfulness – explore the main issues at hand, including ramifications and meanings before moving on. Pay attention to verbal and nonverbal manifestations of affect: look for it, notice it, reflect discrepancies, ask, and go with it.
Comprehensiveness – explore all possible ramifications.
Achieving expert level interviewing skills takes time. Be kind with yourself but try to face openly the challenges.