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.

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 .

Discussing Assessment and Therapy Procedures

After initial concerns and goals have been identi?ed, a brief review or explanation of interview procedures is appropriate. Depending on the situation, you may choose to 320 Interviewing Special PopulationsInterviewing Young Clients

Children and the Culture of Divorce

The following Divorced Children’s Bill of Rights is a document written to divorced and divorcing parents from the child’s perspective. It is included here to give you a deeper sense of children’s views of the culture of divorce.

The Divorced Children’s Bill of Rights

I am a child of divorce. I hold these truths to be self evident: I have the right to be free from your con?icts and hostilities. When you badmouth each other in front of me, it tears me apart inside. Don’t put me in the middle or try to play me against my other parent. And don’t burden me with your relationship problems, they’re yours, not mine.

I have the right to develop a relationship with both parents. I love you both. I know you will sometimes be jealous about that, but you need to deal with it because you are the adult and I am the child.

I have a right to information about things that will affect my life. If you’re planning on getting a divorce, I have a right to know, just as soon as possible. Likewise, if you’re planning to move, get remarried, or any other major life change, I have a right to know about it.

Just as I have a right to basic information about my life, I also have a right to be protected from inappropriate information. This means you shouldn’t tell me about sexual exploits or similar misbehavior by my other parent. You also should not apologize to me-for my other parent-because this implies a derogatory judgment of my other parent. If you apologize to me, apologize for yourself.

Because of the preceding disadvantages, formal diagnostic interviewing procedures are rarely used in actual clinical practice . Given their time intensive requirements in combination with mental health provider needs for time ef?cient evaluation and treatment, it is not surprising that diagnostic interviewing procedures are underutilized and sometimes unutilized in clinical practice. In reality, researchers and academicians studying the prevalence, course, prognosis, and treatment of mental disorders use these procedures almost exclusively.

THE SCIENCE OF CLINICAL INTERVIEWING, PART II: DIAGNOSTIC RELIABILITY AND VALIDITY As suggested in Chapter 6, the clinical interview is the cornerstone of diagnostic assessment. To put it bluntly, no self respecting mental health professional would ever consider diagnosing a client without conducting a clinical interview. Nevertheless, the scienti?c question remains: Does a diagnostic interview provide reliable and valid diagnostic data and thereby conclusions? In terms of judging the psychometric qualities of a given procedure, reliability refers to replicability and stability. If a procedure, such as a diagnostic interview, is reliable, it consistently produces the same result; two interviewers, interviewing the same client, would come up with the same clinical data and therefore the same diagnosis. Statistically speaking, it is a commonly agreed on fact that an instrument or procedure must be reliable for it to have a chance at being valid . It is also possible for a diagnostic interview procedure to be highly reliable but invalid-as in the case where two or more interviewers consistently agree on diagnoses, but the diagnoses are incorrect.

When there is a situation in a class and a patient collapses, there should be an agreed and established emergency protocol with designated responsibilities. The following is an example of a plan of action at a phase III exercise class:Leadership, Exercise Class Management and Safety ?A local plan of action should be established and adopted as the emergency protocol, where speci?c responsibilities to manage the emergency incident are assigned: Role A lead nurse responsible for immediate care of patient, delegation of activities to other staff and responsibility for using AED; Role B staff member deemed competent in airways management, responsible for maintaining patient’s airway in event of a cardiac arrest and assisting lead nurse in BLS procedures; Role C staff member responsible for emergency call and care of other group members.

• Plan of emergency procedures and appropriate telephone numbers

should be displayed in exercise area.

• Hospital crash call or ambulance emergency services

should be advised of the exercise session times/venue in case a call is required.

• Documentation should include a record that regular checks of emergency

equipment have been conducted.

• Incident and accident forms should be available and completed, as

appropriate.

Emergency plan of action Once a patient has collapsed, the following steps should be taken:

• assessment by the lead nurse, and BLS commenced as appropriate ;

• emergency help called,AED provided; assistance from other staff ;

• other patients reassured, removed from area and appropriate cool down

and monitoring undertaken by other team member ;

• resuscitation procedures continued until arrival of medical/emergency

services;

• clinical details of patient and incident given to medical services by lead

nurse;

• care of patient’s partner, if present; or contact partner to inform about

the incident; * continued management and reassurance of group before discharge home.

Motivational Interviewing Procedures and Techniques

Although motivational interviewing procedures are largely nondirective and nonconfrontational, conducting a substance related interview requires that the interviewer structure the interview around a number of substance use and abuse questions and issues. Rollnick and Bell recommend covering 10 different content areas.

Bring up the subject of substance use. Do this gently and openly. For example, following about 5 to 10 minutes of building rapport and establishing a minimal amount of trust, transition to the substance issue by using a summary statement and swing question: “We’ve been talking a while in general about how your life is going. It sounds like you’ve had a bit of stress lately. Would you mind if I asked you now about your use of alcohol?” Intake Interviewing and Report Writing 191In most cases, clients-even alcohol abusing clients-cooperate with a gentle effort to explore their drinking patterns. As you can see, this approach is tentative and gives clients a sense of control over the interview. From the motivational interviewing perspective, this approach allows the client to become engaged in a conversation. In contrast, the confrontation of denial approach tends to elicit denial and resistance by using more accusatory questions or only closed questions.

Ask about substance abuse in detail. Rollnick and Bell suggest questions such as, “What kind of a drinker are you?” or “Tell me about your use of marijuana; what effect does it tend to have on you?” . The purpose of these questions is to let clients talk about their view of their drinking. These questions can be followed up with more speci?c queries: “You said you like to have a few beers with your friends after work. What’s a