Although many attempts have been made to address cultural bias in assessment instruments, such biases still exist .

Unfortunately, although culture speci?c or culturally fair testing procedures are sometimes available, such approaches limit valuable information available to the interviewer. Culture speci?c assessment limits the person’s experience to membership of a particular group, thus missing the uniqueness of the individual; culturally fair assessment instruments tend to wash out the cultural in?uences, thus neglecting the impact culture has on a person’s life . While speci?c information regarding instrumentation is beyond the scope of this article, an interviewer working with a culturally different client should consider the following general questions: Are there other, less culturally bound options to obtain the necessary information? Are there ways to accommodate or ameliorate the cultural differences? Will the use of this assessment procedure help me to understand the individual’s experience as a unique cultural being? Additional guidelines for interviewing culturally different clients are provided in Table 13.1.

Multicultural and Diversity Issues 395396 Interviewing Special Populations Table 13.1. The Dos and Don’ts of Initial Sessions with Multicultural Clients The following are suggestions for interviewers working with clients who come from cultural, racial, ethnic, religious, or life experience backgrounds different from themselves. The applicability and relevance of each suggestion must be evaluated with the particular clinical situation at hand. Our intention is to provide a thought provoking checklist.

How do language differences affect the ability of the interviewer to communicate with the client? Ask: “What language would you prefer to use in counseling? Are you able to understand my ?” Or, if you cannot speak any other languages, ask: “How comfortable are you with my English?” INTERVIEWING CONTEXT AND PROCEDURES Thus far, we have discussed counselor awareness of himself or herself as a cultural being, and the importance of knowing the cultural characteristics of the client-whether those are attributable to group, universal, or individual in?uences. We have also covered the importance of broad contextual elements as they interact with the individual as a unique ethnocultural being. What has been left out until now is how the actual interviewing context and procedures might impact the interviewing process.

For many people raised in many cultures, consulting with a mental health professional comes as a last resort. Seeing an outsider for personal problems goes against traditional problem solving strategies. This means that clients from another culture may experience an enormous amount of stress or anxiety because of the counseling process-in addition to the stress that brought them in. Moreover, they have expectations for counseling that may or may not match the abilities or styles of the interviewer.

Therefore, extra care should be taken to ensure that clients feel welcome, to establish credibility, and to build trust . At the very least, the counselor must ensure that clients feel and believe their interests are being served without threatening their worldview.

Using standardized assessment instruments may produce anxiety, confusion, or anger in ethnoculturally different clients. For all the reasons described, standardized assessment procedures may be inappropriate for the ethnoculturally different client. In the past, testing procedures used to aid in diagnosis and treatment have been misused.

Concluding comments should be brief, reassuring, and upbeat. Again expressing your respect for their choice to come in, your appreciation for their work, or noting events upcoming in the week can be good transitional termination talk.

FORMAL COUPLE AND FAMILY ASSESSMENT PROCEDURES Numerous couple and family assessment devices exist. It is beyond the purpose of this article to provide detailed descriptions of these devices. Therefore, instead of providing an exhaustive review of couple and family assessment procedures, we have listed some of the most popular instruments and procedures, along with their original references, in Table 12.1.

Interviewing Couples and Families Table 12.1. Couples and Family Assessment Instruments

Instrument and Citation General Description

Family Environment Scale The assumption underlying this measure is that environments, , Moos and Moos, 1986 such as families, have unique personalities that can be measured in much the same way as individual personality. Thus, the 90 item family environment scale seeks to measure the unique social climate within the family.

The Family Genogram, The family genogram is a procedure that enables therapists to McGoldrick and Gerson, graphically represent family structure. It is very popular among 1985 family therapists. The genogram is essentially a visual map of family relationships. It contains factual information such as names, ages, deaths, divorces, etc., as well as relationships.

Marital Satisfaction Inventory This instrument is a self report designed to assess marital in, D. Snyder, 1981 teraction and marital distress. It includes 11 subscales . The inventory should be completed by both partners and results are graphed on a single pro?le so that partner differences can be identi?ed, discussed, and addressed in counseling.

To summarize, the body of an initial family interview most likely involves seeing the family from a systems or ecological perspective. Problems, tensions, and distress are discussed in relation to the context in which they occur, rather than to the pathology of one or more family members. Many, if not most, family counselors send the family home with homework or experiments, or at least new ways to think about their situation. The bulk of the interview body provides the foundation for designing and implementing these interventions.

Common Areas to Address

Regardless of theoretical orientation in working with couples or families, there are certain assessment domains that should be considered and, in most cases, explored during the body of an initial interview. These domains are described in the following section.

The ?rst three assessment domains-sex, money, and level of commitment-are speci?c to couples.

354 Interviewing Special PopulationsSex When working with romantic partners, satisfaction with sexual intimacy is a central area to assess. However, it can be dif?cult for interviewers to ask questions about sexual functioning. Therefore, you should practice asking unusual or dif?cult questions.

One of our favorite homework assignments for interviewers consists of the following: “During the next week, spend several hours loudly discussing the details of your sex life with your class partner while out at a crowded local restaurant.” Of course, after giving this assignment, we follow it with: “Okay, if you’d rather not complete the original assignment, then simply discuss sex with each other quietly, in a very private and con?dential setting.” The point is that interviewers, as well as couples, need to become comfortable talking about sex.

SUMMARY In many ways, interviewing children is qualitatively different from interviewing adults.

This chapter identi?ed basic differences between children and adults and discussed ways to professionally address these differences. In the introduction phase of the interview, the role of the child’s caretaker must be considered and clari?ed. However, it is imperative for the interviewer to pay attention to the child, address him or her directly, and help him or her to understand the upcoming interview.

During the opening phase, if young clients are unable or unwilling to identify personal goals for therapy, we advocate using a procedure called wishes and goals to establish a positive tone, allow the child to engage in the process, and give parents a sense of being heard as well. With young clients, there are special issues in con?dentiality that must be addressed. The child is a legal minor, and therefore, parents and guardians have certain rights to therapy information.

Obtaining assessment information during the body of a child interview is enhanced by the use of many nonverbal play tools and strategies. In addition, speci?c userfriendly assessment and information gathering strategies should be used to assist the interviewer in obtaining information at the same time as developing rapport. When formal assessment instruments are used with young clients, their use should be explained to the client and assessment feedback should be provided.

Closing and termination procedures with children are similar to processes with adults, but they become more complicated for several reasons: There are more players to consider, more time demands to balance, and children may express their reactions to their interview experiences more overtly or bluntly than adults.

Therefore, I’d guess that you are a keen observer and you notice how other people’s actions relate to you. An example might include noticing that other people are laughing and then wondering if maybe they are laughing at you. Also, higher scores on scale 6 are associated with intelligence. So your high score here might mean that on your good days, you are intelligent and sensitive, but on your bad days, days when you’re experiencing lots of stress, you can become touchy and suspicious of others. Does any of this seem to ?t how you see yourself ?” Perhaps more important than the speci?c scores obtained by young clients who complete such questionnaires is the manner in which the tests are administered and feedback is provided. Openness with young clients regarding the purpose of formal assessment procedures and results can facilitate the development of trust. Because assessment procedures, depending on how they are used, can either interfere with or facilitate trust development, select speci?c procedures carefully and present them to clients in an open and honest manner.

Considerations of when, why, and how to administer formal assessments should be informed by graduate training in appraisal, test construction, and diagnosis. With regard to young people, it is especially important to note that formal assessment can have Interviewing Young Clients 327a strong impact on the therapeutic relationship and often does not yield as much information as you might have hoped.

General Considerations for the Body of the Interview When using play or physically interactive strategies with children, think through stated and/or unstated ground rules and be prepared to set limits that ?t within your theoretical framework. In an assessment situation, the fewer rules, the better, as this allows the child more free expression. However, children often test limits. They try leaving the room, tinkering with items on your desk, opening windows, or even placing a call on your phone. More infrequently, they try mild aggression toward you: poking with a tack, spitting a spitball, swearing, and blowing smoke . Rather than having stated rules covering all such potentials, it is better to be prepared to set ?rm limits as needed. Some theoretical orientations prefer to leave all rules unstated; others suggest the statement of one or two basic rules . The most common rule is usually stated something like this: “Billy, you’re welcome to play with things in my of?ce . We don’t have too many rules about playing here, but it’s important that you know my one basic rule: It is not okay to break things or hurt yourself or anyone else with the toys or the art supplies.” Cleaning up and putting things away is also an assessment activity. It is challenging to keep time boundaries that include cleanup time before moving into the closing few minutes of the interview. Doing so provides information about how the child interacts when play is ending. An abrupt shift in attitude toward the toys or game may occur. The emotions directed at the toys may be an important signal about how the child feels about endings. In addition, note behaviors directed toward you. Does the child refuse to cooperate? Does he or she scurry around, cleaning frantically to impress you? Those few cleanup minutes at the session’s end can be very revealing.

Young clients often express criticism and/or sarcasm when asked to participate in traditional assessment . They may resist completing the instruments fully and thoughtfully. Fortunately, there are alternatives to using formal assessment procedures for obtaining information. The following procedures help interviewers gather information, while at the same time, capture client interest and coop322 Interviewing Special Populations Finally, I have a right to be a child. I shouldn’t have to be your spy, your special con?dant, or your mother. Just because you hate to talk to each other, I shouldn’t have to be your personal message courier. I exist because you created me. Therefore, I have a right to be more than a child of divorce. I have a right to be a child whose parents love me more than they’ve come to hate each other.

Note. From “The Divorced Children’s Bill of Rights” [Guest editorial], by J. SommersFlanagan, 2000, Counseling Today, p. 9. Reprinted with permission from the American Counseling Association.

INDIVIDUAL AND CULTURAL HIGHLIGHT 11.2 eration. Because these techniques can facilitate rapport and trust, they usually have a positive effect on cooperation with and validity of subsequent traditional, self report assessments . Using these qualitative information gathering procedures can increase youth cooperation with therapy and provide the interviewer with assessment information.

They are not a replacement for formal assessment procedures, but add a great deal of information and simultaneously enhance the working relationship.

What’s Good about You? A relationship building assessment procedure that provides a rich interpersonal interaction between young clients and counselors is the “What’s good about you?” question and answer game . The procedure also provides useful information regarding child/adolescent self esteem. Initially, it is introduced as a game with speci?c rules: “I want to play a game with you. Here’s how it goes. I’m going to ask you the same question 10 times. The only rule is that you can’t answer the question with the same answer twice. So, I’ll ask you the same question 10 times, but you have to give me 10 different answers.” When playing this game, interviewers ask their young client, “What’s good about you?” . Each client answer is responded to with a “Thank you” and a smile. If the client responds with “I don’t know,” the response is simply written down the ?rst time it is used; but if “I don’t know” is used a second time, the interviewer kindly reminds the client that answers can be used only one time.

INDIVIDUAL AND CULTURAL HIGHLIGHT 11.2send parents to the waiting room with an assignment or questionnaire . If you need a direct interview with parents, young clients can be given drawing assignments or questionnaires to complete in the waiting room. In most cases, it is useful to spend individual time with an adolescent and then to have parents return for 5 to 10 minutes at the end of the time to review therapy or follow up procedures .

THE BODY After obtaining child and parent versions of problem areas and possible treatment goals, it is time to shift to the body of the interview. Depending on developmental and temperamental factors, children are more or less verbal. Therefore, anyone planning to communicate fully and effectively with children must develop and be comfortable with a wide variety of methods. Textbooks, graduate classes, workshops, and even core emphases in graduate programs focus exclusively on assessment and therapy strategies with children. An effective child interviewer is familiar with principles and procedures far beyond what is included in this brief chapter .

User Friendly Assessment and Information Gathering Strategies The purpose of formal assessment or evaluation procedures is to obtain information about client functioning that may be used to make diagnoses and treatment recommendations and/or facilitate therapy . While many mental health professionals use traditional, formal assessment procedures when interviewing children, many do not.

Those who do not sometimes have negative attitudes toward assessment or view formal assessment as interfering with the therapy process and with understanding the “whole life of the child” rather than narrow diagnostic aspects .

Most treatment planning approaches are useful because they provide an organizing framework for the material you and your client must consider in charting a course for your work together. In addition, The Complete Psychotherapy Treatment Planner , from which the previously described steps were taken, gives you a valuable way to make sure you have covered the basics likely to be required by managed care companies, even if the actual chosen treatment includes components not mentioned in the planner. Jongsma and Peterson’s model has the advantage of being simple, straightforward, and relatively easy to learn. Putting It in Practice 10.2 includes a case example for rehearsing your treatment planning skills.

Our own amalgamation of these various treatment planning aids follows: 296 Structuring and Assessment Treatment Planning: Application You are working with Michael, a 26 year old African American male. He is single, has a bachelor’s degree in business management, and is employed as a manager at a local appliance store. He reports a history of hypertension , which is well managed using medication. During the session, he complains that although he can work with his employee team effectively and regularly meet individual and team sales goals, he has a long history of heterosexual social anxiety. He also claims he can socialize outside work without signi?cant problems. When asked what he would like to accomplish in counseling, he states, “I want to have a date at least a couple times a month, and I want to ask the person out on the date without feeling like I’m going to have a heart attack every time I start to approach her.” Michael also reports intermittent insomnia, muscular tension, and increased irritability, all three of which worsened after his mother passed away nine months ago. Develop a treatment plan for Michael using Jongsma and Peterson’s model. Note: You may target one or more problems for Michael’s treatment.

Sixth, based on criterion F, before establishing a de?nitive diagnosis, interviewers need to determine whether their client’s anxiety symptoms may be caused by exposure to or intake of a substance or general medical condition. Take note that substances and medical conditions need to be ruled out as causal factors in virtually every DSM IVTR diagnostic category.

Overall, the generalized anxiety disorder example illustrates a range of tasks and issues with which diagnostic interviewers must grapple. Unfortunately, when it comes to developing diagnostic interviewing acumen, it may be appropriate to borrow a phrase that we often use with new clients: Although it is good to have hope about learning diagnostic interviewing procedures, sometimes the confusion associated with identifying a correct diagnosis gets worse before it gets better.

Assessment and Diagnosis Problems

To competently determine that a client meets the diagnostic criteria for generalized anxiety disorder, an interviewer must determine, by collecting assessment data, whether the client has three of six symptoms from criterion C. Given this fact, it may be suf?cient to directly ask the client a series of speci?c DSM IV TR