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.
Their personal or family con?icts have become too great; and the answers, cures, or solutions within their religious framework have failed.
Because religion represents both culture and personal choice, differences between counselor and client, though not visible, can still be pronounced and unsettling . You might be directly asked about your religious beliefs in an initial interview. We recommend a balanced response:
- First, as a professional, it is your job to explore both the cause for concern and the
concerns themselves as they relate to the client’s problems and needs.
- Second, have a truthful and carefully considered answer ready. Refusing to share
a brief summary of your own religious or spiritual orientation only exacerbates the concerns in most situations. After your summary, return the topic to how it feels for the client to work with you. Do not debate matters of faith.
One of our colleagues, a psychologist who is also an ordained minister, often provides religious clients with the following commentary about the relationship between religious and psychological well being: I understand it can be hard for a person with strong religious beliefs to consult a professional about personal problems. One way I look at it is like this: I know some people who are doing very well psychologically and very poorly when it comes to their religious adjustment. On the other hand, I know some people who are doing ?ne with their religious life, but they have some psychological or emotional work to do. Although many times religious and psychological well being are highly connected, being well in one area doesn’t necessarily mean you are feeling well in the other. I guess what I’m saying is that, if you want, I think we can work on the emotional and psychological concerns here, without violating issues of faith.
It is important to be respectful to all clients, but Asian American clients may respond especially well to being treated with formal respect. Using Mr., Mrs., and Ms.
and a last name is a signal of respect and should not be discontinued until the client directly invites a ?rst name address. However, be aware that traditionally, in most Asian countries, women keep their own family surnames and may wish to be called by that surname even if, because of customs in the United States, she has begun to use her husband’s surname. A simple inquiry along these lines indicates respect.
Spiritual and Religious Matters
A common practice among many Asian cultures has been the keeping of an ancestor altar. A reverence toward ancestors and various beliefs regarding ancestral spirits, wishes, or presence in family matters can be central to individual and family function386 Interviewing Special Populations
Working with an Asian American Client
In a recent issue of Psychotherapy, John Chambers Christopher, a colleague of ours, reports on the following case: Simon, an East Asian international student, referred himself to the university counseling center after about one year of studying in the United States. Simon reported low self esteem, dif?culty concentrating, and problems with socializing. His stated goal for therapy was to become “more assertive in his interactions with others” . In particular, Simon expressed a desire to become more similar to his American roommates and less like other international students from his homeland.
Presented by a different therapist and/or a different client, this case might simply be cast into the rather straightforward mold of assertiveness training.
Further complicating the ?rst visit is the fact that such a visit and the problems that made the visit necessary might be experienced as shameful. The client may not be forthcoming but may, instead, minimize problem areas or attempt to describe them in vague, impersonal ways.
Asian families living in the United States are almost all in some phase of acculturation. The children often become bilingual, therefore assuming a power in the family that upsets traditional roles. Further, some families have members living in the home country and some members living here, which adds more relational and role strain .
Orientation toward Authority
Many Asian cultures are rigid and hierarchical in structure . This is directly related to a concept called ?lial piety, which refers to the honor, reverence, obedience, and loyalty owed to those who are hierarchically above you . The deference toward authority manifests in a number of ways. Asian American clients expect a counselor to be an expert and to act with authority.
In the same vein, verbal communication with a mental health professional may not be direct and certainly is not confrontive. It is likely that an Asian American client, when faced with uncertainty, simply offers the most polite, af?rmative response available. Among Asians, as among many American Indian tribes, silence is a sign of respect. Also similar is the pattern of eye contact. Direct eye contact is invasive and disrespectful, especially when interacting with persons of higher status or authority .
Even during a ?rst interview, many Asian American people expect concrete and tangible advice. This runs contrary to most training models for beginning interviewers; therefore, you need to practice how to give quick advice. This practice is necessary, too, Multicultural and Diversity Issues 385because the advice being offered will likely be coming from a non
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Putting It in Practice 11.2marize what we’ve talked about and see if I remember everything. Then we’ll make a plan for next week, okay?” As with adult interviews, you will probably always wish you could gather more information than you were able to get in 50 minutes. Unfortunately, you need to stop playing or gathering information and begin to wind down activities to ensure a smooth, unhurried closing with your child client.
Reassuring and Supporting Young Clients
Young people need support in their efforts to relate to you, so be sure to offer support throughout the interview. Especially during the closing, provide reassuring, supportive feedback. Make comments such as: “You did some neat things with that Lego set.” “I know you told me this is your ?rst time in counseling, but know what? You’re pretty good at it.” “I appreciate all that you told me about your family and your teachers and you.” “Thanks for being so open and sharing so much about yourself with me.” Because most child clients do not come to therapy on their own, it is all the more important to let them know you appreciate them and the risks they have taken. Some young clients, especially challenging adolescents, may have behaved rudely or engaged in defensive, resistive actions. You might experience countertransference impulses such as urges to withdraw, reprimand, or even punish the child . It is certainly permissible to note the dif?culty of being “dragged off to counseling” in an empathic comment and notice that the client seemed to have some reluctance about being open with you. However, as with adults, expressing anger or disappointment toward young clients who are resistant, defensive, or nondisclosing is inappropriate; such reactions make it less likely they will seek professional help again in the future. Instead, if your client is defensive, try to remain optimistic: “I know it wasn’t your idea to come in and talk with me today, and I don’t blame you for being a little upset about it. We might be able to ?nd some ways, together, to make this less of a pain. In fact, I might even know some ways that would make this whole thing go by pretty fast and then you’d be all done with counseling.”
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After discussing con?dentiality and informed consent, it is time to begin to get an idea of the reasons the client has come for therapy. Common reasons for bringing preschool to latency age children in for clinical interviews include:
- Moodiness, irritability, or aggressive behavior patterns.
- Behaviors that caretakers believe to be abnormal or especially irritating.
- Unusual fears or tendencies to avoid age appropriate play activities.
- Unusual or precocious sexual behaviors.
- Exposure to trauma or dif?cult life circumstances, such as divorce, death, or
abuse.
- Hyperactivity or problems with inattentiveness .
- Custody battles between parents.
This list is neither exhaustive nor comprehensive. It is intended to help you glimpse a typical young child referral. Like younger children, older children and adolescents Interviewing Young Clients 315Individualizing Introductory Statements with Young Clients In this chapter, we provide sample statements for introducing yourself to young clients and introducing interviewing and counseling to young clients. These statements are a good start, but you can come up with better opening statements for yourself. Whatever you say the ?rst few minutes should ?t your personality.
If you’re using some standard opening with young clients, but the opening is uncomfortable for you, children will sense that there’s something unauthentic or phony about you. Therefore, this activity involves formulating opening statements to use with young clients that ?t with your personality. Of course, these statements should be somewhat serious and not offensive. They should focus on: Introducing yourself to the child and family.
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Young clients in general and adolescents in particular respond better to therapists who, even in their choice of dress, indicate they can connect with the adolescent world.
This does not mean you have to shop at Old Navy or Eddie Bauer. Nonetheless, we recognize that one of the most successful female therapists we know attracts and maintains relationships with dif?cult adolescent girl clients, at least in part, because she dresses “way cool.” If you are wondering how we know this bit of information, it is because teens seen in therapy often compare notes; they talk with each other about their respective “shrinks” and often offer therapist progress reports pertaining to their friends who are seeing other therapists. Listening to these assessments can be informative.
In contrast, some clothing choices may be “uncool.” For example, traditional, conservative attire may be viewed by adolescents, especially those with oppositional and conduct disorder behaviors, as signs of a rigid authority ?gure. Delinquent adolescents have strong transference reactions to authority ?gures, and such reactions can impair or inhibit initial rapport .
Generally, more casual attire is recommended when interviewing young clients. This is not to suggest that young clients cannot overcome their reactions to a therapist’s clothing choices. However, when working with youth, it is useful to eliminate even the most super?cial obstacles to rapport whenever possible. Although interviewers need to present themselves and their work in a way that feels personally and professionally authentic, keeping an eye to youth friendly accessories can be helpful.
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Most adults can express their disappointments and needs in a way that makes sense to the counselor; often, children cannot or will not communicate so directly, and when 308 Interviewing Special Populationsthey do, they are sometimes ignored. For all these reasons, we must be especially attuned to the skills, education, and attitudes necessary to work effectively with children.
The remainder of this chapter is organized based on interviewing stages identi?ed by Shea and discussed in Chapter 6. Because interviewing children usually requires involving the child’s caretaker, the stage model becomes a bit complicated. Time management is important. For the initial interview, you may need to schedule an extended session so the child has adequate time for self expression and the caretakers also feel their concerns are suf?ciently addressed.
When it comes to working with young clients, this chapter merely scratches the surface. Students who want to work extensively with young clients need much more education and training. As usual, additional readings and professional resources are listed at the conclusion of this chapter.
THE INTRODUCTION Many, if not most, young people do not seek mental health services willingly . It is unlikely they will be the ones making the initial call to request a clinical interview and/or counseling. Generally, children are referred to a mental health professional’s of?ce by their parents, guardians, caretakers, or school personnel. They may or may not have any advance ideas about whom they will meet with and/or the meeting’s purpose. In some cases, they may not think there is anything wrong in their world or, even worse, they may not have been informed in advance that they have a counseling appointment. In other cases, they may be very clear regarding their distress or the distress others are experiencing because of them.
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Rogers, R. . Handbook of diagnostic and structured interviewing.New York: Guilford. This text includes reviews and research perspectives on many different approaches to diagnostic and structured interviewing with mental health clients.
Roth, A., & Fonagy, P. . What works for whom? A critical review of psychotherapy research.
New York: Guilford. This is a comprehensive review of the status of psychotherapy research. It includes evaluations of various therapeutic interventions for addressing symptoms associated with various DSM IV diagnostic categories.
Diagnosis and Treatment Planning 303PART FOUR INTERVIEWING SPECIAL POPULATIONS INTERVIEWING YOUNG CLIENTS Mr. Quimby wiped a plate and stacked it in the cupboard. “I’m taking an art course, because I want to teach art. And I’ll study child development-” Ramona interrupted. “What’s child development?” “How kids grow,” answered her father.
Why does anyone have to go to school to study a thing like that? wondered Ramona.
All her life she had been told that the way to grow was to eat good food, usually food she didn’t like, and get plenty of sleep, usually when she had more interesting things to do than go to bed.
-Beverly Cleary, Ramona Quimby, Age To this point, our primary focus has been on interviewing, assessment, and treatment planning with individual adult clients. However, young people present the interviewer with challenges and opportunities that are quite different than those presented by adults. In this chapter, we explore the unique considerations and interviewing procedures necessary for mental health professionals who work with young clients. We also describe dif?culties associated with interviewing young clients and suggest strategies for addressing these dif?culties.
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When working with suicidal clients, it is important to establish rapport and a therapeutic relationship through effective listening strategies. Supportive empathy is crucial.
Suicidal clients may not have informed anyone previously of suicidal thoughts and wishes. Let them know you hear their pain and misery, but at the same time, help them begin to see that there are good reasons to be hopeful; most depressed and suicidal clients improve and begin to feel life is worth living again.
Avoid arguing with clients about whether suicide is a viable life option. Instead, focus on widening the client’s view of personal options by emphasizing that suicide is only one of many life options. Help clients understand that because suicide is a permanent choice, all other options should be explored ?rst. Try to reinvolve clients in reinforcing life activities.
Many interviewers establish suicide prevention contracts with suicidal clients. Mahoney recommends requiring that the client commit to a face to face session before attempting suicide. Client willingness to establish contract usually indicates that client self control is adequate and suicide intent is low. Sometimes, interviewers must become very directive and take action when working with suicidal clients.
Deciding whether a client’s suicidal impulses warrant immediate hospitalization is dif?cult. A client’s suicide risk can be rated to help facilitate decision making, but there is no foolproof formula available to help interviewers decide how to most effectively manage each suicidal case. Ratings of suicidality range from nonexistent, mild, moderate, severe, to extreme. Clients who are mildly or moderately suicidal can normally be managed in an outpatient setting. Severely and extremely suicidal clients usually require hospitalization.
