Clinical Interview Techniques

Therapists have an array of techniques that they use in an interview:

1. Questioning:

   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
2. Reflection:

   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
3. 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)
4. Clarification:

   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?

5. usually done by using one of the other techniques (questioning, paraphrasing, restating)
6. purpose is to provide understanding of the client in the interview
7. rarely evokes defensiveness - client wants therapist to understand the problem
8. gives client additional opportunity to tell story
9. Confrontation:

   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
10. Self-disclosure

    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
11. Silence:

    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
12. Exploration:

    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
13. 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

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