Clinical Interviewing

JOHN SOMMERS-FLANAGAN, PhD, is a clinical psychologist and professor of counseling at the University of Montana. He is the author or co-author of over 100 professional publications and a longtime member of the American Counseling Association and the American Psychological Association. RITA SOMMERS-FLANAGAN, PhD, is Professor Emerita at the University of Montana. Her work is focused on professional ethics, women’s issues, and spirituality’s connection to science and human well-being. She is a published poet, essayist, and clinical psychologist.

Preface xiii

About the Authors xxi

Part One: Foundations of Clinical Interviewing 1

Chapter 1: An Introduction to the Clinical Interview 3

Learning Objectives 3

Chapter Orientation 3

Welcome to the Journey 3

What Is a Clinical Interview? 5

Clinical Interviewing versus Counseling and Psychotherapy 7

Multicultural Competencies 13

Multicultural Humility 17

A Learning Model for Clinical Interviewing 25

Chapter Summary 28

Chapter 2: Preparation 31

Learning Objectives 31

Chapter Orientation 31

The Physical Setting 31

Professional and Ethical Issues 38

Multicultural Preparation 55

Stress Management and Self-Care 65

Chapter Summary 68

Chapter 3: An Overview of the Interview Process 71

Learning Objectives 71

Chapter Orientation 71

Stages of a Clinical Interview 71

The Introduction 73

The Opening 84

The Body 90

The Closing 95

Ending the Session (Termination) 104

Chapter Summary 107

Part Two: Listening and Relationship Development 111

Chapter 4: Nondirective Listening Skills 113

Learning Objectives 113

Chapter Orientation 113

Listening Skills 113

Adopting a Therapeutic Attitude 114

Why Nondirective Listening Is Also Directive 123

The Listening Continuum in Three Parts 125

Skills for Encouraging Client Talk 126

Ethical and Multicultural Considerations 142

Not Knowing What to Say 145

Chapter Summary 146

Chapter 5: Directive Listening Skills 149

Learning Objectives 149

Chapter Orientation 149

Skills for Encouraging Insight 150

Ethical and Multicultural Considerations 175

Chapter Summary 178

Chapter 6: Skills for Directing Clients Toward Action 181

Learning Objectives 181

Chapter Orientation 181

Readiness to Change 181

Skills for Encouraging Action 184

Using Educational and Directive Techniques 192

Ethical and Multicultural Considerations 204

Chapter Summary 215

Chapter 7: Evidence-Based Relationships 217

Learning Objectives 217

Chapter Orientation 217

The Great Psychotherapy Debate 217

The Core Conditions 218

Other Evidence-Based Relationship Factors 233

Evidence-Based Cross-Cultural Relationships 250

Chapter Summary 253

Part Three: Structuring and Assessment 255

Chapter 8: Intake Interviewing and Report Writing 257

Learning Objectives 257

Chapter Orientation 257

What’s an Intake Interview? 257

Exploring Client Problems and Goals 259

Obtaining Background and Historical Information 267

Assessment of Current Functioning 276

Brief Intake Interviewing 280

The Intake Report 282

Do's and Don'ts of Intake Interviews with Diverse Clients 298

Chapter Summary 300

Chapter 9: The Mental Status Examination 303

Learning Objectives 303

Chapter Orientation 303

What Is a Mental Status Examination? 303

Individual and Cultural Considerations 305

The Psychiatric Mental Status Examination 308

When to Use Mental Status Examinations 340

Chapter Summary 342

Chapter 10: Suicide Assessment 345

Learning Objectives 345

Chapter Orientation 345

Facing the Suicide Situation 345

Suicide Risk Factors, Protective Factors, and Warning Signs 348

Building a Theoretical and Research-Based Foundation 356

Suicide Assessment Interviewing 360

Suicide Interventions 380

Final Ethical and Professional Issues 385

Chapter Summary 389

Chapter 11: Diagnosis and Treatment Planning 393

Learning Objectives 393

Chapter Orientation 393

Modern Diagnostic Classification Systems 393

Defining Mental Disorders 396

Diagnostic Interviewing 404

The Science of Clinical Interviewing 406

Less Structured Diagnostic Clinical Interviews 409

Case Formulation and Treatment Planning 415

Extended Case Example 423

Additional Cultural Modifications and Adaptations 427

Chapter Summary 428

Part Four: Diverse Populations and Situations 431

Chapter 12: Challenging Client Behaviors and Demanding Situations 433

Learning Objectives 433

Chapter Orientation 433

Challenging Clients 433

Motivational Interviewing and Other Strategies 436

Violence Risk Assessment (VRA) and Prediction 451

Demanding Situations: Crisis and Trauma 456

Cultural Competencies in Disaster Mental Health 468

Chapter Summary 470

Chapter 13: Interviewing Young Clients 473

Learning Objectives 473

Chapter Orientation 473

Considerations in Working With Young Clients 473

The Introduction 475

The Opening 479

The Body of the Interview 490

Closing and Termination 503

Culture in Young Client Interviews 506

Chapter Summary 508

Chapter 14: Online and Distance Clinical Interviewing** 553

Learning Objectives 533

Chapter Orientation 553

Technology as an Extension of the Self 554

Definition of Terms and Communication Modalities 557

Distance and Online Assessment and Intervention Research 561

Ethical and Practical Issues: Problems and Solutions 565

Conducting Online or Distance Interviews 573

Culture and Online Culture 575

Chapter Summary 576

Epilogue

References 589

Author Index 639

Subject Index 655