Cormier 08 Interviewing and Change Strategies For Helpers - Ch8 Interviu Consiliere
Cormier 08 Interviewing and Change Strategies For Helpers - Ch8 Interviu Consiliere
Cormier 08 Interviewing and Change Strategies For Helpers - Ch8 Interviu Consiliere
CONDUCTING AN INTERVIEW
ASSESSMENT WITH CLIENTS
LEARNING OUTCOMES ancillary use of some of the other methods named above.
After completing this chapter, you will be able to In actual practice, it is important not to rely solely on the
interview for assessment data but to use several methods of
1. When given a written description of a selected client, obtaining information about clients. Recent developments
outline in writing at least 2 interview leads for each in assessment are focused on the use of evidence to support
of the 11 assessment categories that you would explore the assessment process. Evidence-based assessment involves
during an assessment interview with this person. a decision-making process that targets data from multiple
2. In a 30-minute role-play interview, demonstrate leads measures (Hunsley & Mash, 2005). Trends in evidence-
and responses associated with 9 out of 11 categories for based assessment point to the need for empirically derived
assessing the client. assessment guidelines and for the use of assessment measures
3. Given a role-play interview, help the client complete a that are reliable, valid, and clinically useful (Hunsley & Mash,
social network map and an ecomap. 2005).
leads that in applied settings are likely to elicit certain kinds intake interviews come with a lengthy standardized format
of client information. However, as Sarwer and Sayers (1998) that the practitioner must complete with the client in its en-
observe, little research on the effects of interview procedures tirety. In other places, the helpers conduct their own intakes.
has been conducted. The leads that we suggest are supported For helpers who work either in private practice or in a school
more by practical considerations than by empirical data. As or agency in which intakes are not required, it is still a good
a result, you will need to be attentive to the effects of us- idea to do some history taking with the client
ing them with each client. Edelstein and colleagues (2003) An example of a computer-assisted intake interview is the
note that because the clinical assessment interview relies on “computerized assessment system for psychotherapy evalua-
client self-report, its accuracy and reliability are very much tion and research,” called CASPER (Farrell & McCullough-
dependent on the accuracy and veracity of what the client Vaillant, 1996). In this system, 122 intake interview ques-
says to the clinician. tions covering a wide range (18) of content areas appear on a
computer screen. After identifying certain areas of concern,
the client rates the severity and duration of each concern,
INTAKE INTERVIEWS AND HISTORY as well as the extent to which he or she wants to focus on a
Part of assessment involves eliciting information about the concern in treatment.
client’s background, especially as it may relate to current A semistructured intake and assessment protocol for child
concerns. Past, or historical, information is not sought as an and adolescent clients is the CAFAS—Child and Adoles-
end in itself or because the helper is necessarily interested in cent Functional Assessment Scale—developed by Hodges
exploring or focusing on the client’s “past” during treatment. (1997). An advantage of this interview protocol is that it
Rather, it is used as a part of the overall assessment process assesses for strengths and goals as well as for problems in
that helps the practitioner fit the pieces of the puzzle to- performance in school, work, home, community, behav-
gether concerning the client’s presenting issues and current ior toward others, moods, self-harm, substance use, and
life context. Often a client’s current issues are precipitated thinking. Other examples of interview protocols for child
by events found in the client’s history. In no case is this more and adolescent clients are found in Morrison and Anders
valid than with clients who have suffered trauma of one kind (1999). Edelstein and colleagues (2003) provide examples
or another. For example, a 37-year-old woman came to a crisis of interview protocols suitable for older adults. Chief among
center because of the sudden onset of extreme anxiety. The these more structured interviews is the Structured Clinical
interviewer noticed that she was talking in a “little girl” voice Interview for DSM-IV disorders, commonly referred to as
and was using gestures that appeared to be very childlike. the SCID-IV (First, Spitzer, Gibbon, & Williams, 1996,
The clinician commented on this behavior and asked the 1997). The SCID-IV has good validity and reliability and is
client how old she felt right now. The client replied, “I’m used extensively in research on anxiety disorders, personality
seven years old,” and went on to reveal spontaneously an disorders, and mood disorders. Although it is arguably the
incident in which she had walked into a room in an aunt’s most commonly used semistructured interview in clinical
house and found her uncle fondling her cousin. No one settings, the duration of administering it (two hours) pre-
had seen her, and she had forgotten this event until the vents even more widespread use.
present time. In cases such as this one, history may serve Various kinds of information can be solicited during his-
as a retrospective baseline measure for the client and may tory taking, but the most important areas are the following:
help to identify cognitive or historical conditions that still
exert influence on the current issue and might otherwise 1. Identifying information about the client
be overlooked. 2. Presenting problems/symptoms including history re-
The process of gathering this type of information is called lated to the presenting concerns
history taking. In many agency settings, history taking oc- 3. Past psychiatric and/or counseling history/treatment
curs during an initial interview called an intake interview. and previous diagnosis
An intake interview is viewed as informational rather than 4. Educational and job history
therapeutic and, to underscore this point, is often con- 5. Health and medical history
ducted by someone other than the practitioner assigned 6. Social/developmental history (including religious, spiritual,
to see the client. In these situations, someone else, such as and cultural background and affiliations, predominant
an intake worker, sees the client for an interview, summa- values, description of past problems, chronological/
rizes the information in writing, and passes the information developmental events, military background, social/
along to the helper. leisure activities, present social situation, legal problems,
In managed care and some state and federally funded men- and substance use history)
tal health programs, intakes often are required before reim- 7. Family, marital, sexual history (including any abuse history,
bursement for services is given. Sometimes these mandated partnered status, and sexual orientation information)
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 191
The sequence of obtaining this information in a history to provide such information and in a shorter amount of
or an intake interview is important. Generally, the inter- time. Learning Activity 8.1 provides an opportunity for you
viewer begins with the least threatening topics and saves to role-play a history-taking interview.
more sensitive topics (such as 6, 7, and 8) until near the
end of the session, when a greater degree of rapport has
been established and the client feels more at ease about re- HANDLING SENSITIVE SUBJECTS IN THE INTERVIEW
vealing personal information to a total stranger. Not all of ASSESSMENT PROCESS
this information may be required for all clients. Obviously, Morrison (1995) has pointed out that some important sub-
this guide will have to be adapted for use with different jects that come up in intake and assessment interviews can
clients—especially those of varying ages, such as children, be sensitive for both helpers and clients. This potential sensi-
adolescents, and the elderly, who may need a simpler way tivity does not mean that such subjects should be overlooked
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 193
LEARNING ACTIVITY
8.1 Intake Interviews and History
To gain a sense of the process involved in After the session, it might be helpful to write a summary
doing an intake or history interview (if you of the session, using the major categories listed in Box
don’t already do lots of these on your job!), 8.1 as a way to organize your report. Review your report
we suggest you pair up with someone in your with your instructor. As the client in this particular activity,
class and complete intake/history interviews with each rather than playing a role, be yourself. Doing so will allow
other. Conduct a 30- to 45-minute session, with one person you to respond easily and openly to the helper’s questions,
serving as the helper and the other taking the client’s role; and both of you can more readily identify the way in which
then switch roles. As the helper, you can use the format in your particular history has influenced the current issues in
Box 8.1 as a guide. You may wish to jot down some notes. your life.
or discarded. However, it does mean that the helper should substance abuse, antisocial personality disorder, persistent
proceed with good judgment and seek consultation about violent thoughts and fantasies, and anger control issues).
when it is appropriate to assess these areas. On the one hand, The findings of the MacArthur risk assessment study are
it may be seen as voyeuristic if a male counselor asks a young summarized in Monahan and colleagues (2001).
female presenting with an academic/career issue about her In the area of suicide risk assessment, there are several
sexual practices and activity. On the other hand, if a client useful structured clinical interview guides to assess poten-
comes in and discusses problems in dating persons of the op- tial danger to self. Chief among these are the Adolescent
posite sex and feelings of attraction to same-sex people, not Suicide Assessment Protocol-20 (Fremouw, Strunk, Tyner,
pursuing this subject would be an important omission. & Musick, 2005) and the Suicidal Adult Assessment Pro-
Specific subjects that may fall into the category of sensitive tocol (Fremouw, Tyner, Strunk, & Musick, in press). These
topics include questions about (1) suicidal thoughts and be- two protocols present a brief, user-friendly, structured clini-
havior; (2) homicidal ideas and violent behavior; (3) substance cal interview designed for practitioners to obtain an ini-
use, including alcohol, street drugs, and prescribed medica- tial objective measure of adolescent and adult suicidal risk
tions; (4) sexual issues, including sexual orientation, sexual (Fremouw et al., 2005, p. 207). Both interview protocols
practices, and sexual problems; and (5) physical, emotional, include assessment of client demographic factors (such as
and sexual abuse, both historic and current. Koven, Shreve- gender, age, and marital status), historical factors (such as
Neiger, and Edelstein (2007) recommend an interviewing prior attempts, and childhood abuse), clinical items (such
strategy for handling sensitive subjects called the “plus minus as depression and hopelessness, impulsivity, and substance
approach.” In this approach, the clinician balances difficult abuse), specific suicidal risk questions (such as thoughts,
questions with those that are less threatening so that if a cli- plans, and intentions), contextual factors (such as firearm
ent reacts emotionally to a difficult question, the interviewer access, recent loss, stressors, and social isolation), and pro-
follows up with a question that is more benign. tective factors (such as family responsibilities, spiritual and/
A particular category of sensitive subjects has to do with or religious beliefs, and social support). At the completion of
potential lethality or danger to self or others. Interest in the structured interview, each client is classified according to
this sensitive area has mushroomed with recent events such level of risk; depending on that level of risk, the interviewer
as suicide bombings and school shootings. Although an will identify various forms of action and intervention such
in-depth discussion of the assessment of lethality and risk as consultation, increased monitoring, contracting, notifica-
is beyond the scope of this book, we include some brief tion, referrals to other forms of treatment, and elimination
comments about this topic and recommend additional re- of the method of suicide.
sources. The MacArthur study of high-risk clients for vio-
lence (excluding verbal threats for violence) identified over
100 potential risk factors for violence but found no “magic MENTAL-STATUS EXAMINATION
bullet” predictor of future violence. The findings from this After conducting an initial interview, if you are in doubt
study suggest that a person’s propensity for violence is the about the client’s psychiatric status or suspicious about the
accumulation and interaction of a number of risk factors possibility of a cognitive disorder, you may wish to conduct
including criminological factors (such as prior history of (or refer the client for) a mental-status examination. According
violence and criminality), childhood experiences (such as to Kaplan and Sadock (1998), the mental-status exam is one
physical abuse), environmental conditions (such as pov- that classifies and describes the areas and components of mental
erty and unemployment), and clinical risk factors (such as functioning involved in making diagnostic impressions and
194 CH A PTER 8
classifications. The major categories covered in a mental- (p. 75). In some cultural groups, there is a sanction against
status exam are general description and appearance of the revealing personal information to someone outside the fam-
client; mood and affect; perception; thought processes; level ily or extended-family circle. Also, clients’ perceptions of
of consciousness; orientation to time, place, and people; what is socially desirable and undesirable behavior as well as
memory; and impulse control. Additionally, the examiner their perceptions of psychological distress may reflect values
may note the degree to which the client appeared to report the different from the ones held by the practitioner: “Certain
information accurately and reliably. Of these categories, dis- cultural factors must be considered in determining the nor-
turbances in consciousness (which involves ability to perform malcy or pathology of a response. For example, ‘hearing
mental tasks, degree of effort, and degree of fluency/hesitation the Lord speak’ may be a culture-specific impression and
in task performance) and orientation (whether or not clients therefore nonpathological for some religious groups. An inner-
know when, where, and who they are and who other people city African American adolescent’s statement ‘All Whites
are) are usually indicative of brain impairment or cognitive are out to get us’ may actually represent the thinking of the
disorders and require neurological assessment and follow- community in which he lives rather than qualify as a sign of
up as well. Examples of specific mental-status exams for paranoia” (Canino & Spurlock, 2000, p. 80).
the elderly are given in Hill, Thorn, and Packard (2000): In interpreting the information received from an intake
examples of ones for child and adolescent clients can be interview and mental-status exam, remember that some in-
found in Morrison and Anders’s (1999) pragmatic guide. formation can have cultural meanings that are unknown to
It is important for practitioners to know enough about the you. For example, some cultures view the child as one year
functions and content of a mental-status exam to refer clients old at the time of birth; other cultures may favor the use of
who might benefit from this additional assessment procedure. culturally sanctioned healing remedies instead of traditional
A summary of the content of a brief mental-status exam is Western medical or psychological treatment. Also, cultures
given in Box 8.2. For additional information about mental- have different practices regarding discipline of children and
status examinations and neurophysiological assessment, see adolescents, so what you may view as either indulgent or
Kaplan and Sadock (1998) and Morrison (1995). harsh may not be seen that way by the client and the
History taking (and mental-status exams, if applicable) client’s collective community. What constitutes a “family”
usually occur near the very beginning of the helping pro- also varies among cultures; in assessing for family history,
cess. After obtaining this sort of preliminary information it is important to ask about extended-family members who
about the client as well as an idea of the range of presenting may live outside the household as well as about a parent’s
complaints, you are ready to do some direct assessment in- significant other. Clients might also report religious and
terviewing with the client in order to define the parameters spiritual beliefs that are unfamiliar to the helper, and these
of concerns more specifically. can affect the client’s help-seeking behavior and perceptions
of distress.
Another issue pertaining to cultural dimensions of clients
CULTURAL ISSUES IN INTAKE AND ASSESSMENT in intake interviews has to do with microaggressions—verbal
INTERVIEWS comments or queries that communicate a derogatory slight or
It is important to note and account for sources of cultural insult to the client (Sue et al., 2007). For example, a cultur-
bias within a traditional intake interview and within assess- ally insensitive interviewer may actually demonstrate some
ment interviews in general. Canino and Spurlock (2000) form of racial or ethnic profiling in an intake interview by
point out that “in some cultures disturbed behavior may assuming something pejorative about the client based solely
be viewed as related to a physical disorder or willfulness”; on the client’s race or ethnicity. An example of this would
thus, talking about the behavior is not expected to help be a practitioner posing more questions about substance use
with Native American clients than with other clients and also summarized in the Interview Checklist at the end of the
viewing their reports of a nonexistent history with substances chapter (page 222).
as “suspicious” (Sue et al., 2007, p. 282). Another example
provided by Sue et al. (2007) of a microaggressive act in an 1. Explanation of purpose of assessment—presenting ra-
intake interview would be acting on the assumption that tionale for assessment interview to the client
Asian Americans and Latino Americans are “foreign born” 2. Identification of range of concerns—using leads to help
(p. 282). As Sue and his colleagues (2007) explain, “A female the client identify all the relevant primary and second-
Asian American client arrives for her first therapy session. ary issues to get the “big picture”
Her therapist asks her where she is from, and when told 3. Prioritization and selection of issues—using leads to
‘Philadelphia,’ the therapist further probes by asking where help the client prioritize issues and select the initial area
she was born. In this case, the therapist has assumed that the of focus
Asian American client is not from the United States and has 4. Identification of present behaviors—using leads to
imposed through the use of the second questions the idea help the client identify the six components of current
that she must be a foreigner” (p. 281). behavior(s): affective, somatic, behavioral, cognitive,
There are several examples of culturally sensitive interview contextual, and relational
protocols. One such protocol developed by Hays (2001), 5. Identification of antecedents—using leads to help the
uses a framework known as ADDRESSING. This frame- client identify categories of antecedents and their effect
work calls attention to the following cultural influences: on the current issue
6. Identification of consequences—using leads to help the
A age and generational influences client identify categories of consequences and their
influence on the current issue
D developmental and acquired
7. Identification of secondary gains—using leads to help
D disabilities the client identify underlying controlling variables that
R religious and spiritual orientation serve as payoffs to maintain the issue
E ethnicity 8. Identification of previous solutions—using leads to help
the client identify previous solutions or attempts to
S socioeconomic status
solve the issue and their subsequent effect on the issue
S sexual orientation 9. Identification of client individual and environmental
I indigenous heritage strengths and coping skills—using leads to help the client
N national origin identify past and present coping or adaptive behavior
and how such skills might be used in working with the
G gender
present issue
10. Identification of the client’s perceptions of the concern—
Another example, developed by Tanaka-Matsumi, Seiden,
using leads to help the client describe her or his under-
and Lam (1996), is the Culturally Informed Functional
standing of the concern
Assessment (CIFA) Interview. Designed to define client
11. Identification of intensity—using leads and/or client
issues in a culturally sensitive manner, this interview proto-
self-monitoring to identify the impact of the concern
col includes a variety of steps such as assessing the cultural
on the client’s life, including (a) degree of severity and
identity and acculturation status of the client, assessing the
(b) frequency and/or duration of current behaviors
client’s presenting issues with reference to the client’s cul-
tural norms, probing explanations of the client’s issue and The first three categories—explanation of the purpose
possible solutions to avoid pathologizing seemingly unusual of assessment, identification of the range of concerns, and
but yet culturally normative responses, and conducting a prioritization and selection of issues—are a logical starting
functional assessment of the client’s problem behaviors, and place. First, it is helpful to give the client a rationale, a reason
determining whether the client’s reactions to controlling for conducting an assessment interview, before gathering
variables are similar to or different from customary reactions information. Next, some time must be spent in helping the
of one’s cultural referent group(s). client explore all the relevant issues and prioritize issues to
work on in order of importance, annoyance, and so on.
The other eight categories follow prioritization and selec-
ELEVEN CATEGORIES FOR ASSESSING CLIENTS tion. After the helper and client have identified and selected
To help you acquire the skills associated with assessment in- the issues to work on, these eight categories of interviewing
terviews, we describe 11 categories of information you need leads are used to define and analyze parameters of the issue.
to seek from each client. These 11 categories are illustrated The helper will find that the order of the assessment leads
and defined in the following list and subsections. They are varies among clients. A natural sequence will evolve in each
196 CH A PTER 8
interview, and the helper will want to use the leads associ- “What situations are not going well for you?”
ated with these content categories in a pattern that fits the “Tell me about anything else that concerns you now.”
flow of the interview and follows the lead of the client. It
is important in assessment interviews not to impose your After using range-of-concerns leads, the practitioner
structure at the expense of the client. The amount of time should look for the client’s indication of some general areas
and number of sessions required to obtain this information of concern or things that are troublesome for the client. An
will vary with the concerns and with clients. It is possible occasional client may not respond affirmatively to these
to complete the assessment in one session, but with some leads. Some clients may be uncertain about what infor-
clients, an additional interview may be necessary. Although mation to share, or clients may be from a cultural group
the practitioner may devote several interviews to assessment, in which it is considered inappropriate to reveal personal
the information gathering and hypothesis testing that go information to a stranger. In such cases, the helper may
on do not automatically stop after these few sessions. Some need to use an approach different from verbal questioning.
degree of assessment continues throughout the entire help- For example, Lazarus (1989) has recommended the use of
ing process just as the importance of the helping relationship an “Inner Circle” strategy to help a client disclose concerns.
continues throughout this time as well. The client is given a picture like this:
the client. The client is the person who wants a change and may then make other, related issues more accessible to
who seeks assistance for it. In the example above, if the treatment. Leads to use to help determine the initial or
student had desired a change and had requested assistance, presenting issue include “Which issue best represents
the student would be the client; if it were the teacher who the reason you are here?” and “Out of all these concerns
wanted a change and requested assistance, the teacher would you’ve mentioned, identify the one that best reflects
be the client. Sometimes, however, the helper gets “stuck” your need for assistance.”
in a situation in which a family or a client wants a change 2. Start with the issue that is primary or most important
and the person whose behavior is to be changed is “sent” as to the client to resolve. Often this is the one that causes
the client. Determining who the appropriate client is can the client the most pain or discomfort or annoyance or
be very important in working with these mandated clients, is most interfering to the client. Modifying the more
who are required to see a helper but have little investment important issues seems to lead to lasting change in that
in being helped! One strategy that can be useful with clients area, which may then generalize to other areas. Here are
in these situations is to establish a win–win contract where some responses to use to determine the client’s most
they agree to talk about what you want to discuss for half the important priority: “How much happiness or relief
session in exchange for talking (or not talking) about what would you experience if this issue were resolved?” “Of
they want to for the other half of the session. these concerns, which is the most stressful or painful
The question of who is the appropriate client is also tricky for you?” “Rank order these concerns, starting with
when the issue involves two or more persons, such as a rela- the one that is most important for you to resolve to
tionship, marital, or family issue. In rehabilitation counseling, the one least important.” “How much sorrow or loss
for example, the client may be not only the individual with a would you experience if you were unable to resolve
disability but also the client’s employer. Many family thera- this issue?”
pists view family issues as devices for maintaining the status 3. Start with the concern or behavior that has the best
quo of the family and recommend that either the couple or chance of being resolved successfully and with the
the entire family be involved, rather than one individual. least effort. Some issues/behaviors are more resistant to
change than others and require more time and energy
to modify. Initially, it is important for the client to be
Prioritizing and Selecting Issues
reinforced for seeking help. One significant way to do
Rarely do clients or the results of assessment suggest only
this is to help the client resolve something that makes a
one area or issue that needs modification or resolution.
difference without much cost to the client. Responses
Typically, a presenting concern turns out to be one of several
to determine what issues might be resolved most suc-
unresolved issues in the client’s life. For example, the assess-
cessfully include “Do you believe there would be any
ment of a client who reports depression may also reveal that
unhappiness or discomfort if you were successful at re-
the client is troubled by her relationship with her teenage
solving this concern?” “How likely do you think we are
daughter. History may reveal that this adult woman was
to succeed in resolving this issue or that one?” “Tell me
also physically abused as a child. After a client describes all
which of these situations you believe you could learn to
of her or his concerns, the practitioner and client will need
manage most easily with the greatest success.”
to select the issues that best represent the client’s purpose for
4. Start with the issue that needs resolution before other
seeking help. The primary question to be answered by these
issues can be resolved or mastered. Sometimes the pres-
leads is “What is the specific situation the client chooses to
ence of one issue sets off a chain of other ones; when
start working on?”
this issue is resolved or eliminated, the other ones either
Prioritizing issues is an important part of assessment and
improve or at least move into a position to be explored
goal setting. If clients try to tackle too many issues simul-
and modified. Often this concern is one that, in the
taneously, they are likely to soon feel overwhelmed and
range of elicited ones, is central or prominent.
anxious and may not experience enough success to stay in
5. Giving mandated clients the responsibility for prior-
therapy. Selection of the issue is the client’s responsibility,
itization of concerns is particularly important. This
although the helper may help with formulating the client’s
choice allows them to set the agenda and may foster
choice.
greater cooperation than clinician-directed prioritiza-
The following guidelines form a framework to help clients
tion of concerns.
select and prioritize issues to work on:
1. Start with the presenting issue, the one that best rep- Understanding the Present Behaviors
resents the reason the client sought help. Fensterheim After selecting the initial area of focus, it is important to
(1983, p. 63) observes that relief of the presenting con- determine the components of the present behavior. For
cern often improves the client’s level of functioning and example, if the identified behavior is “not getting along
198 CH A PTER 8
very well with people at work,” with an expected outcome (Wolpe, 1990), with 1–10 or a 0–100 range to assess inten-
of “improving my relationships with people at work,” we sity. Example interview leads to assess positive and negative
would want to identify the client’s feelings (affect), body sen- affect are the following:
sations (somatic phenomena), actions (overt behavior), and
thoughts and beliefs (cognitions) that occur during the situa- “How do you feel about this?”
tions at work. We would also explore whether these feelings, “What kinds of feelings do you have when you do this
sensations, actions, and thoughts occurred with all people at or when this happens?”
work or only with some people (relationships) and whether
“Describe the kinds of feelings you are aware of when
they occurred only at work or in other settings, at what times,
this happens.”
and under what conditions or with what concurrent events
(context). Without this sort of exploration, it is impossible “Describe the positive feelings you have associated with
to define the behavior operationally (concretely). Further- this. Also the negative ones.”
more, it is difficult to know whether the client’s work con- “On a 10-point scale, with 1 being low and 10 being
cerns result from the client’s actions or observable behaviors, high, how intense is this feeling?”
from covert responses such as feelings of anger or jealousy, “If the number 0 represented no distress, and the number
from cognitions and beliefs such as “When I make a mistake 100 represented severe distress, how would you rate the
at work, it’s terrible,” from the client’s transactions with feeling on this 0 to 100 scale in terms of intensity?”
significant others that suggest an “I’m not okay—they’re
okay” position, from particular events that occur in certain A second category is concealed or distorted feelings—that
times or situations during work, as during a team meeting is, feelings that the client seems to be hiding from, such as
or when working under a supervisor, or from toxic people anger, or a feeling like anger that has been distorted into
or environmental conditions in the workplace. hurt. Below are example responses for this:
Without this kind of information about when and how
the present behavior is manifested, it would be very difficult “You seem to get headaches every time your husband
and even presumptuous to select intervention strategies or criticizes you. Describe what feelings these headaches
approaches. The end result of this kind of specificity is that may be masking.”
the behavior is defined or stated in terms such that two or “When you talk about your son, you raise your voice
more persons can agree on when it exists. We next describe and get a very serious look on your face. What feel-
specific things to explore for each of these six components, ings do you have—deep down—about him?”
and we suggest some leads and responses to further this
“You’ve said you feel hurt and you cry whenever you
exploration with clients.
think about your family. Tune in to any other feelings
you have besides hurt.”
Affect and Mood States “You’ve indicated you feel a little guilty whenever your
Affective components of behavior include self-reported feel- friends ask you to do something and you don’t agree
ings or mood states, such as “depression,” “anxiety,” and to do it. Try on resentment instead of guilt. Try to get
“happiness.” Feelings are generally the result of complex in touch with those feelings now.”
interactions among behavioral, physiological, and cognitive
systems rather than unitary experiential processes. Clients The practitioner can always be on the lookout for con-
often seek help because of this component—that is, they feel cealed anger, which is the one emotion that tends to get
bad, uptight, sad, angry, confused, and so on, and they want shoved under the rug more easily than most. In exploring
to get rid of such unpleasant feelings. concealed feeling, the clinician needs to pay attention to
One category of things to ask the client about to get any discrepancies between the client’s verbal and nonverbal
a handle on feelings or mood states is feelings about the expressions of affect. Distorted feelings that are common
present behavior. After eliciting feelings, note the content include reporting the feeling of hurt or anxiety for anger,
(pleasant/unpleasant) and level of intensity. Remember that guilt for resentment, and sometimes anxiety for depression,
positive feelings are as important to identify as negative or vice versa. Remember that clients from some cultures may
ones, for they build resources, enhance creative problem be reluctant to share feelings, especially vulnerable ones,
solving, increase coping skills, and enhance health (Snyder & with someone they don’t yet know or trust.
Lopez, 2007). Although there are many ways to assess for
content and level of intensity of affect, one simple way is Somatic Sensations
to use a checklist such as the Positive and Negative Affect Closely tied to feelings are body sensations. Some clients
Schedule (Watson, Clark, & Tellegen, 1988) or a rating are very aware of “internal experiencing”; others are not.
scale such as the Subjective Units of Distress (SUDS) Scale Some persons are so tuned in to every body sensation that
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 199
they become somaticizers, while others seem to be switched lack of physical exercise and body conditioning programs.
off “below the head” (Lazarus, 1989). Neither extreme is Again, it is important to keep a cultural context in mind
desirable. Some persons may describe complaints in terms here: what might be considered a behavioral excess or deficit
of body sensations rather than as feelings or thoughts—that in one culture may be different in another. The helper may
is, as headaches, dizzy spells, back pain, and so on. Behavior also wish to inquire about “behavioral opposites” (Lazarus,
can also be affected by other physiological processes, such 1989) by asking about times when the person does not be-
as nutrition and diet, exercise and lifestyle, substance use, have that way. This is important because you are balancing
hormone levels, and physical illness. The helper will want the assessment interview by focusing on what the client
to elicit information about physiological complaints, does well, not just on the problematic behaviors. Prosocial
about lifestyle and nutrition, exercise, substance use, behaviors are as important to assess as nonsocial ones. Here
and so on, and about other body sensations relating to the are examples of leads to elicit information about overt be-
behavior. Some of this information is gathered routinely haviors and actions:
during the health history portion of the intake interview,
but bear in mind that the information obtained from “Describe what happens in this situation.”
a health history may vary depending on the client’s “What do you mean when you say you’re ‘having trou-
cultural affiliation. Helpers can ask clients who have ble at work’?”
trouble reporting somatic sensations to focus on their
“What are you doing when this occurs?”
nonverbal behavior or to engage in a period of slow,
deep breathing and then to conduct a “body scan.” Use- “What do you do when this happens?”
ful leads to elicit this component of the present behavior “What effect does this situation have on your behavior?”
include these: “Describe what you did the last few times this oc-
curred.”
“What goes on inside you when you do this or when
“If I was photographing this scene, what actions and
this happens?”
dialogue would the camera pick up?”
“What are you aware of when this occurs?”
“Notice any sensations you experience in your body Occasionally the practitioner may want to supplement
when this happens.” the information gleaned about behavior from the client’s
“When this happens, describe anything that feels bad oral self-report with more objective assessment approaches,
or uncomfortable inside you—aches, pains, dizziness, such as role plays and behavioral observations. These ad-
and so on.” ditional assessment devices will help practitioners improve
their knowledge of how the client does and doesn’t act in the
situation and in the environmental setting.
Overt Behaviors or Motoric Responses
Clients often describe a behavior in very nonbehavioral Cognitions, Beliefs, and Internal Dialogue
terms. In other words, they describe a situation or a process In the last few years, helpers of almost all orientations
without describing their actions or specific behaviors within have emphasized the relative importance of cognitions
that event or process. For example, clients may say “I’m not or symbolic processes in contributing to, exacerbating,
getting along with my partner” or “I feel lousy” or “I have a or improving situations that clients report. Unrealistic
hard time relating to authority figures” without specifying expectations of oneself and of others are often related to
what they do to get along or not get along or to relate or presenting issues, as are disturbing images, self-labeling
not relate. and self-statements, and cognitive distortions. When the
When inquiring about the behavioral domain, the helper cognitive component is a very strong element of the con-
will want to elicit descriptions of both the presence and the cern, part of the resulting treatment is usually directed to-
absence of concrete overt behaviors connected to the issue— ward this component and involves altering unrealistic ideas
that is, what the client does and doesn’t do. The helper also and beliefs, cognitive distortions and misconceptions, and
needs to be alert to the presence of behavioral excesses and dichotomous thinking.
deficits. Excesses are things that the person does too much or Assessment of the cognitive component is accordingly di-
too often or that are too extreme, such as binge eating, ex- rected toward exploring the presence of both irrational and
cessive crying, or assaultive behavior. Deficits are responses rational beliefs and images related to the identified issue.
that occur too infrequently or are not in the client’s reper- Irrational beliefs will later need to be altered. Rational be-
tory or do not occur in the expected context or conditions, liefs are also useful during intervention. Remember though
such as failure to initiate requests on one’s behalf, inability that cognitions and belief systems may be quite culturally
to talk to one’s partner about sexual concerns and desires, or specific.
200 CH A PTER 8
Irrational beliefs take many forms, and the most damag- “Let’s set up a scene. You imagine that you’re starting
ing ones seem to be related to automatic thoughts or self- to feel a little upset with yourself. Now run through
statements and maladaptive assumption such as “shoulds” the scene and relate the images or pictures that come
about oneself, others, relationships, work, and so on, “awful- through your mind. Tell me how the scene changes
izing” or “catastrophizing” about things that don’t turn out [or relate the thoughts or dialogue—what you say to
as we expect, “perfectionistc standards” about ourselves that yourself as the scene ensues].”
often are projected onto others, and “externalization,” the “What are your mental commentaries on this situation?”
tendency to think that outside events are responsible for our
“What’s going through your mind when _______ occurs?
feelings and problems. The practitioner will also want to be
Can you recall what you were thinking then?”
alert for the presence of cognitive distortions and mispercep-
tions, such as overgeneralization, exaggeration, and drawing
Context: Time, Place, Concurrent Events, and Environment
conclusions without supporting data. Underlying these au-
Behaviors occur in a social context, not in a vacuum. Indeed,
tomatic thoughts and assumptions are cognitive schemas.
what often makes a behavior a “problem” is the context
A schema is a deep-seated belief about oneself, others, and
surrounding it or the way it is linked to various situations,
the world that takes shape in the client’s early develop-
places, and events. For example, it is not a problem to
mental history and confirms the client’s core belief about
undress in your home, but the same behavior on a public
himself or herself, others, and the world. For example, de-
street in many countries would be called “exhibitionism.”
pressed or anxious clients often focus selectively on cognitive
In some other cultures, this same behavior might be more
schemas “that mark their vulnerability” (Leahy & Holland,
commonplace and would not be considered abnormal or
2000, p. 296).
maladaptive. Looking at the context surrounding the issue
Although clients may have difficulty verbalizing specific
has implications not only for assessment but also for inter-
cognitions and beliefs, their nonverbal cues may be impor-
vention, because a client’s cultural background, lifestyle, and
tant indicators that core beliefs and schemas are being ac-
values can affect how the client views the issue and also the
tivated in the assessment process. Linscott and DiGiuseppe
treatment approach to resolve it.
(1998) note that
Assessing the context surrounding the issue is also impor-
when the therapist has touched on a core-disturbed belief sys- tant because most issues are situation specific—that is, they
tem, the client will frequently exhibit emotional and behavioral are linked to certain events and situations, and they occur at
reactions. The client who was previously actively engaged in the certain times and places. For example, clients who say “I’m
conversation with the therapist may abruptly begin to avoid the uptight” or “I’m not assertive” usually do not mean they are
therapist’s questions, make little eye contact, evidence disturbed always uptight or nonassertive but, rather, in particular situ-
facial expressions, and work to change the subject. Or the client ations or at particular times. It is important that the helper
may become enlivened, as if a light bulb has been illuminated not reinforce the notion or belief in the client that the feel-
by the therapist’s inquiries . . . . In addition, the client’s sudden ing, cognition, or behavior is pervasive. Otherwise, clients
anger and confrontational arguments with the therapist may are even more likely to adopt the identity of the “problem”
also signal that a core belief has been elicited. (p. 117)
and begin to regard themselves as possessing a particular
trait such as “nervousness,” “social anxiety,” or “nonassert-
Leads to use to assess the cognitive component include
iveness.” They are also more likely to incorporate this trait
the following:
into their lifestyles and daily functioning.
In assessing contextual factors associated with the issue,
“What beliefs [or images] do you hold that contribute
you are interested in discovering
to this concern? Make it worse? Make it better?”
“When something doesn’t turn out the way you want or 1. Situations or places in which the issue usually occurs
expect, how do you usually feel?” and situations in which it does not occur (where the
“What data do you have to support these beliefs or as- issue occurs and where it does not).
sumptions?” 2. Times during which the issue usually occurs and times
“What are you thinking about or dwelling on when this during which it does not occur (when the issue occurs
[issue] happens?” and when it does not).
3. Concurrent events—events that typically occur at or
“Please describe what kinds of thoughts or images go
near the same time as the issue. This information is
through your mind when this occurs.”
important because sometimes it suggests a pattern or
“Notice what you say to yourself when this happens.” a significant chain of events related to the issue that
“What do you say to yourself when it doesn’t happen clients might not be aware of or may not report on
[or when you feel better, and so on]?” their own.
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 201
“Describe some recent situations in which this issue oc- Culture and
Work
curred. What are the similarities in these situations? religion
“Describe the relationship between yourself and all A clinician sensitive to cultural issues chose to work very closely
these systems and structures in your current environ- with the school, a decision that facilitated access for Mario to a
ment.” bicultural, bilingual program. The clinician also realized that Mario
was a target of racial slurs and physical attacks by other children on
“How do you experience your current environment? his way to and from school. The school responded to the clinician’s
How has this experience been affected by your gen- request to address these issues at the next parent–teacher confer-
der, race, ethnicity, income status, and so on?” ence. With the ongoing support of a dedicated principal, Mario’s
“What is the relationship between you and these larger symptoms abated, and he was able to adjust to his new environ-
systems in your ecomap? What has this relationship ment. (Canino & Spurlock, 2000, p. 74).
been like so far in your life? How has this affected
your current concerns?” Other persons involved in the issue often tend to dis-
“Do you feel that you need more relationships with count their role in it. It is helpful if the practitioner can get
any of these larger systems in your ecomap? If so, a handle on what other persons are involved in the issue,
what has made it difficult for these relationships to how they perceive the issue, and what they might have to
develop?” gain or lose from a change in the issue or the client. As
Gambrill (1990) observes, such persons may anticipate
“How would you describe the sociopolitical and socio-
negative effects of improvement in an issue and covertly
economic environment you are in? How has it af-
try to sabotage the client’s best efforts. For example, a hus-
fected your concerns?”
band may preach “equal pay and opportunity” yet secretly
“How much has your concern been affected by oppres- sabotage his wife’s efforts to move up the career ladder for
sion, prejudice, and discrimination in your environ- fear that she will make more money than he does or that
ment?” she will find her new job opportunities more interest-
“How has your environment fostered empowerment? ing and rewarding than her relationship with him. Other
Or disempowerment? How has this affected the con- people can also influence a client’s behavior by serving as
cerns you are bringing to me?” * role models. People whom clients view as significant to
them can often have a great motivational effect on clients
To familiarize yourself with assessing an individual in in this respect.
relationship to her or his environment, complete Learning An important aspect of the relational context of the
Activity 8.2. client’s concern has to do with availability and access to
resources in the client’s social and interpersonal environ-
Relationships, Significant Others, and Social Support ment, including support from immediate and extended
Just as issues are often linked to particular times, places, family, friends, neighbors, and people affiliated with the
events, and environmental conditions, they are also of- client in work, school, and community organizations. Re-
ten connected to the presence or absence of other people. member that purposeful, positive relationships are just
People around the client can bring about or exacerbate as important to identify as problematic ones (Snyder &
a concern. Someone temporarily or permanently absent Lopez, 2007).
from the client’s life can have the same effect. Assessing One specific tool that can supplement the interview
the client’s relationships with others is a significant part of leads to understanding about a client’s social support sys-
many theoretical orientations to counseling, including dy- tem is the social network map (Tracey & Whittaker, 1990).
namic theories, Adlerian theory, family systems theory, and It has been used empirically with a variety of client prob-
behavioral theory. lem situations (Kemp et al., 1997). The social network
Interpersonal issues may occur because of a lack of signifi- map is designed to identify both the type and the amount
cant others in the client’s life, because of the way the client of support the client receives from seven social systems (see
relates to others, or because of the way significant others Figure 8.2):
respond to the client. Consider the role of “other people” in
the development of Mario’s “school phobia”: 1. Household
2. Other Family
Mario, a 9-year-old new arrival from Central America, had 3. Work/school
moved with his family to a homogeneous neighborhood in 4. Clubs/associations/faith and church groups and
which they were the first Spanish-speaking family. Conse- organizations
quently, Mario was one of the few Latino children in his class-
5. Friends
room. He soon developed symptoms of school phobia and was
referred to an outpatient mental health clinic.
6. Neighbors
7. Formal services and programs, especially community-
*Adapted from Kemp, Whittaker, & Tracy, 1997, pp. 103–106. based
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 203
LEARNING ACTIVITY
8.2 Ecomaps
1. Using the ecomap format in Figure 8.1, draw 3. Draw a solid line from your circle to any circles that represent
a circle representing yourself in the middle of systems with which your connection is positive or strong.
a piece of paper, and around that circle list 4. Draw a broken line from your circle to any circles that
the systems that are part of your current represent systems with which your relationship is stressful
environment—for example, work, school, family, friends, reli- or negative.
gion and cultural groups, community groups, recreation, and 5. Draw a wavy line from your circle to any circles that
extended family. represent systems that are needed by you but are not
2. Around each systems draw circles of varying sizes to indi- available to you.
cate the degree of influence of that environmental system 6. Look over your ecomap. What conclusions can you draw?
in your life. You may wish to share your conclusions with a classmate.
This list can be modified for any given client, with catego- Information gleaned from the social network map can
ries of social support added or deleted. be used in helping clients set treatment goals and in plan-
Using the map displayed in Figure 8.2, “clients are en- ning useful intervention strategies For example, are people
couraged to write in the people in their social network that in the network draining the client, or is the client a drain on
fit in each sector. This can be accomplished by drawing the network? Are there responsive and dependable people in
in small circles with names to represent women and small the network whom the client can involve in an intervention
squares with names to represent men, or the gender sym- plan? Does the client feel “surrounded by a network that is
bols for male and female may be used” (Garvin & Seabury, perceived as negative, nonsupportive, or stress-producing?”
1997, p. 197). If necessary, the map can be enlarged for Or does the client or the network lack skills to access people in
more room. Clients can also use symbols such as arrows to the network effectively (Kemp et al., 1997, pp. 117–118)?
indicate closeness or distance between themselves and their Example leads for assessing the relational component of
identified circles, as well as the type and direction of help the issue include the following:
received. Also, as noted by Kemp and associates (1997),
clients sometimes list deceased network people or religious “Tell me about the effects this issue has on your rela-
or spiritual leaders on the map (p. 117). tionships with significant others in your life.”
“What effects do these significant others have on this
concern?”
“Who else is involved in this issue besides you?
How are these persons involved? What would their re-
action be if you resolved this issue?”
“From whom do you think you learned to act or think
in this way?”
“Describe the persons present in your life now who have
the greatest positive impact on you. Negative impact?”
“Describe the persons absent from your life who have the
Image not available due to copyright restrictions greatest positive impact on you. Negative impact?”
“What types of social support do you have available in
your life right now—too much support or too little?”
“Who do you think you need in your life right now
that isn’t available to you?”
“Who are the main people in this social support system?”
“Which of these people are there for you? Which of
these people are critical of you?”
“What people and social support systems in your life
empower you? Disempower you?”
204 CH A PTER 8
“What things get in your way of using these social sup- “Is there anything going on with you physically—an
port systems and the effective people in them?” illness or physical condition—or anything about the
“What people in your life are nourishing to you? Toxic way you eat, smoke, exercise, and so on, that affects
or depleting to you?” or leads to this issue?”
“What people in your life do you look up to? What
qualities do they have that help you in your current Behavioral
situation?” “If I were photographing this, describe the actions and
dialogue the camera would see before this happens.”
Identifying Antecedents “Identify any particular behavior patterns that occur
Antecedents are certain events that happen before and con- right before this happens.”
tribute to an issue. Much of the assessment process consists “What do you typically do before this happens?”
in exploring contributing variables that precede and cue the “Can you think of anything you do that makes this
issue (antecedents) and things that happen after the issue more likely to occur? Less likely to occur?”
(consequences) that, in some way, influence or maintain it.
Remember that, like behaviors, antecedents (and con- Cognitive
sequences) are varied and may be affective, somatic, be-
“What kinds of pictures or images do you have before
havioral, cognitive, contextual, or relational. Further, an-
this happens?”
tecedents (and consequences) are likely to differ for each
client. Antecedents are both external and internal events “What are your thoughts before this happens?”
that occasion or cue the behaviors and make them more or “What are you telling yourself before this happens?”
less likely to occur. Some antecedents occur immediately “Identify any particular beliefs that seem to set the
before (stimulus events); other antecedents (setting events) issue off.”
may have taken place a long time ago.
“Describe what you think about [see or tell yourself ]
In helping clients explore antecedents, you are particularly
before the issue occurs that makes it stronger or
interested in discovering (1) what current conditions (covert
more likely to occur. Weaker or less likely to occur?”
and overt) exist before the issue that make it more likely to
occur, (2) what current conditions (covert and overt) exist
Contextual
that occur before the issue that make it less likely to occur,
and (3) what previous conditions, or setting events, exist that “Has this ever occurred at any other time in your life? If
still influence the issue. so, describe that.”
Example leads for identifying antecedents follow and are “How long ago did this happen?”
grouped by category: “Where and when did this occur the first time?”
Affective “Describe how you see those events related to your con-
cern.”
“What are you usually feeling before this happens?”
“Tell me about anything that happened that seemed to
“When do you recall the first time you felt this way?” lead up to this.”
“Describe the feelings that occur before the issue and “When did the issue start—what else was going on in
make it stronger or more constant.” your life at that time?”
“Identify the feelings that occur before the issue that “What were the circumstances under which the issue
make it weaker or less intense.” first occurred?”
“Tell me about any holdover feelings or unfinished feelings “What was happening in your life when you first no-
from past events in your life that still affect this issue.” ticed this?”
“Are there any ways in which your cultural affiliation
Somatic and values contribute to this issue? Make it more
“Notice what goes on inside you just before this happens.” likely to occur? Less likely?”
“Are you aware of any particular sensations in your “Are you aware of any events that occurred before
body before this happens?” this issue that in some way still influence it or set
“Describe any body sensations that occur right before it off?”
this issue that make it weaker or less intense. Stronger “Do you see any particular aspects or structures in your
or more intense?” community that have contributed to this issue?”
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 205
who is constantly disrupting her school classroom may be Leads to help the client identify previous solutions in-
similarly reluctant to give up such disruptive behavior even clude the following:
though it results in loss of privileges, because it has given her
the status of “class clown,” resulting in a great deal of peer “How have you dealt with this or other concerns be-
attention and support. fore? What was the effect? What made it work or not
It is always extremely important to explore with clients work?”
the payoffs, or secondary gains, they may be getting from “Tell me about how you have tried to resolve this con-
having the issue, because often during the intervention cern.”
phase such clients seem “resistant.” In these cases, the resis-
“What kinds of things have you done to improve this
tance is a sign the payoffs are being threatened. The most
situation?”
common payoffs include money, attention from significant
others, immediate gratification of needs, and avoidance of “Describe what you have done that has made the con-
responsibility, security, and control. cern better. Worse? Kept it the same?”
Questions you can use to help clients identify possible “What have others done to help you with this?”
secondary gains include these: “What has kept the issue from getting worse?”
are geared to using the kind of problem-solving and coping “Describe your strengths or assets that you can use to
skills already available in the client’s repertoire. Narratives help resolve this concern.”
with particular sources of adversity can be revised with “When don’t you act this way?”
the practitioner’s help. For example, clients who have ex-
“What kinds of thoughts or self-talk help you handle
perienced trauma can help to heal themselves by telling or
this better?”
drawing the story of the trauma and its key events. It is also
important for these clients to put an ending on the story. “Notice when don’t you think in self-defeating ways.”
Clients with trauma histories usually feel helpless in the “What do you say to yourself to cope with a difficult
face of the trauma. As these clients coconstruct their stories, situation?”
they can also narrate strengths and resources they used to “Identify the steps you take in a situation you handle
help cope with the trauma. Images of strength are especially well. What do you think about and what do you do?
important in healing stories of adult survivors. How could these steps be applied to the present issue?”
Information to be assessed in this area includes the
“In what situations is it fairly easy for you to manage or
following:
control this reaction or behavior?”
1. Behavioral assets and problem-solving skills. When “Rate the degree of confidence you have in your ca-
does the client display adaptive behavior instead of pabilities when you are immersed in this situation.”
problematic behavior? Often this information can be (self-efficacy query)
obtained by inquiring about “opposites”—for example, “When you think about this situation, is your expectancy
“When don’t you act that way?” that it will go well or go poorly?” (optimism query)
2. Cognitive coping skills—such as rational appraisal of a “Tell me about what kind of resources in any aspect of your
situation, ability to discriminate between rational and ir- community or environment you are currently using.”
rational thinking, selective attention and feedback from dis-
tractions, and the presence of coping or calming self-talk. “What aspects of your community and overall environ-
3. Self-control and self-management skills—including the ment do you find helpful?”
client’s overall ability to withstand frustration, to assume “What kinds of things in your community and environ-
responsibility for self, to be self-directed, to control unde- ment would you describe as strengths or assets?”
sired behavior by either self-reinforcing or self-punishing “Describe what strengths and resources in your com-
consequences, and to perceive the self as being in control munity and environment are available that you need
rather than being a victim of external circumstances. to use more often.”
4. Environmental strengths and resources. In addition to
the three “individual” client strengths described above,
it is increasingly important to assess the strengths and re- Exploring the Client’s Perception
sources available within the client’s environment. These of the Concern
include not only the support network we mentioned Most clients have their own perceptions of and explanations
earlier but also such things as availability of adequate for their concerns. It is important to elicit this information
employment, housing, transportation, and health care. during an assessment session for several reasons. First, it
Environmental strengths also include cultural strengths adds to your understanding of the concern. The helper can
of belonging to a collective community, such as com- note which aspects of the concern are stressed and which are
munity cohesiveness, community racial identity, and ignored during the client’s assessment of the issue. Second,
community resources, groups, and organizations (Kemp this process gives you valuable information about patient
et al., 1997). Cultural affiliations can give clients certain position, the client’s strongly held beliefs and values—in this
“protective” factors that serve as sources of strength when case, about the nature of the issue. Clients usually allude to
clients experience adversity. Such factors as racial and such “positions” in the course of presenting their percep-
ethnic pride, spirituality and religion, and interconnect- tions of concerns. Ignoring the client’s position may cause
edness of mind, body, and spirit are other examples of the practitioner to develop a counseling strategy that the
culturally protective factors for clients from marginalized client resists because it is incompatible with this “position.”
groups (Constantine & Sue, 2006). You can get a client to describe his or her view of the con-
cern very concisely simply by asking the client to give the
The following leads are useful in identifying these kinds of concern a one-line title as if it were a movie, play, or book.
individual and environmental strengths and resources: Another way to elicit the client’s perception of the concern
is to describe the concern in only one word and then to use
“What skills or things do you have going for you that the selected word in a sentence. For example, a client may
might help you with this concern?” say “guilt” and then “I have a lot of guilt about having an
208 CH A PTER 8
affair.” The same client might title the concern “Caught “How strong is your feeling when this happens?”
between Two Lovers.” This technique works extremely well “How has this interfered with your daily activities?”
with children, who typically are quick to think of titles and
“How would your life be affected if this issue were not
words without a lot of deliberation. It is also important
resolved in a year?”
to recognize the impact of culture, ethnicity, and race on
clients’ perceptions and reports of concerns. For example, “On a scale from 0 to 100, with 0 being no distress and
clients from some cultural groups may report the cause of 100 being extreme distress, where would you place
concerns in terms of external factors, supernatural forces, or your distress now?”
both. Helpers must not minimize or ridicule such explana-
tions; also, they should incorporate such explanations into In assessing degree of intensity, you are looking for a client
the assessment and treatment process. response that indicates how strong, interfering, or pervasive
In the change phase of helping, successful interventions the concern seems to be.
often depend on recognizing and validating the client’s “per-
ception of the problem.” This emphasis on the client’s per- Frequency and/or Duration
spective has made a dramatic impact on the care of elderly In asking about frequency and duration, your purpose is to
clients, but the principle extends to all clients. When clients have the client identify how often (frequency) and/or how
speak out about their perspectives, there is more collabora- long (duration) the current behaviors occur. Data about
tion and shared investment in the change process. how often or how long they occur before a change strategy
Leads to help clients identify and describe their views of is applied are called baseline data. Baseline data provide in-
concerns include these: formation about the present extent of the problem. They can
be used later to compare the extent of the problem before
“What is your understanding of this issue?” and after a treatment strategy has been used. Leads to assess
the frequency and duration of the current behavior include
“Tell me how you explain this concern to yourself.”
the following:
“What does the issue mean to you?”
“What is your interpretation [analysis] of this concern?” “How often does this happen?”
“What else is important to you about the concern that “How many times does this occur?”
we haven’t mentioned?” “How long does this feeling usually stay with you?”
“Give the issue a title.” “How much does this go on, say, in an average day?”
“Describe the issue with just one word.”
Some clients can discuss the severity, frequency, or dura-
Ascertaining the Intensity of the Concern tion of the behavior during the interview rather easily. How-
It is useful to determine the intensity of the concern. You ever, many clients may be unaware of the number of times
want to check out how much the concern is affecting the cli- the behavior occurs, how much time it occupies, or how
ent and the client’s daily functioning. If, for example, a client intense it is. Most clients can give the helper more accurate
says, “I feel anxious,” does the client mean a little anxious or information about frequency and duration by engaging in
very anxious? Is this person anxious all the time or only some self-monitoring of the behaviors with a written log. Use of
of the time? And does this anxiety affect any of the person’s logs to supplement the interview data is discussed later in
daily activities, such as eating, sleeping, or working? There are the model dialogue.
two kinds of intensity to assess: the degree or severity and the Box 8.3 provides a review of the 11 categories of cli-
frequency (how often) and/or duration (how long) of it. ent assessment. This table may help you conceptualize and
summarize the types of information you will seek during
Degree of Intensity assessment interviews.
Often it is useful to obtain a client’s subjective rating of the
degree of discomfort, stress, or intensity of the concern.
LIMITATIONS OF INTERVIEW LEADS IN ASSESSMENT
The helper can use this information to determine how
much the concern affects the client and whether the client The leads we present in this chapter are simply tools that the
seems to be incapacitated or immobilized by it. To assess the helper can use to elicit certain kinds of client information.
degree of intensity, the helper can use leads similar to these: They are designed to be used as a road map to provide some
direction for assessment interviews. However, the leads alone
“You say you feel anxious. On a scale from 1 to 10, with are an insufficient basis for assessment because they represent
1 being very calm and 10 being extremely anxious, only about half the process at most—the helper responses.
where would you be now?” The other part of the process is reflected by the responses
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 209
(4.) Antecedents (5.) Behaviors (6.) Consequences and (7.) secondary gains (payoffs)
Affective Affective Affective
Somatic Somatic Somatic
Behavioral Behavioral Behavioral
Cognitive Cognitive Cognitive
Contextual Contextual Contextual
Relational Relational Relational
these leads generate from the client. A complete interview as- what is going on with you and school and anything
sessment includes not only asking the right questions but also else that concerns you. I’m sure there are ways we can
synthesizing and integrating the client responses. work with this dissatisfaction, but first I think it would
Think of it this way: In an assessment interview, you are be helpful to both of us to get a better idea of what all
simply supplementing your basic skills with some specific leads the issues are for you now. Does this fit with where you
designed to obtain certain kinds of information. While many want to start today?
of your leads will consist of open-ended questions, even assess-
ment interviews should not disintegrate into a question-and- Client: Yeah. I guess school is the main problem. It’s really
answer or interrogation session. You can obtain information bugging me.
and give the information some meaning through other verbal
Helper response 2 is a lead to help Isabella identify the
responses, such as summarization, clarification, confrontation,
range of her concerns.
and reflection. Demonstrating sensitivity is especially impor-
tant because sometimes during assessment, a client may reveal 2. Helper: Okay, you just said school is the main concern.
or even reexperience very traumatic events and memories. From the way you said that and the way you look right
The quality of the helping relationship remains very impor- now, I have the feeling school isn’t the only thing you’re
tant during assessment interviews. Handling the assessment concerned about in your life.
interview in an understanding and empathic way becomes
critical. It is also extremely important to clarify and reflect Client: Well, you’re right about that. I’m also kind of not
the information the client gives you before jumping ahead to getting along too well with my parents. But that’s kind of
another question. The model dialogue that follows illustrates related to this school thing too.
this process. (See also Learning Activity 8.3.)
In the next response, the helper simply listens to Isabella and
synthesizes what she’s saying by using a paraphrase response.
MODEL DIALOGUE FOR INTERVIEW ASSESSMENT:
3. Helper: So from your point of view, the school thing
THE CASE OF ISABELLA
and the issue with your parents are connected.
To see how these assessment leads are used in an interview,
read the following dialogue in the case of Isabella. An ex- Client: Yeah, because I’m having trouble in some of my classes.
planation of the helper’s response and the helper’s rationale There’s too much competition. I feel the other kids are better
for using it appears before the responses. Note the variety of than I am. I’ve thought about changing from this college prep
responses used by the helper. program to the work-study program, but I don’t know what to
Helper response 1 is a rationale to explain to the client, do. I don’t like to make decisions anyway. At the same time, my
Isabella, the purpose of the assessment interview. parents put a lot of pressure on me to perform well, to make top
grades. They have a lot of influence with me. I used to want to
1. Helper: Isabella, last week you dropped by to schedule do well, but now I’m kind of tired of it all.
today’s appointment, and you mentioned you were feel-
ing unhappy and dissatisfied with school. It might be In the next response, the helper continues to listen to
helpful today to take some time just to explore exactly Isabella and reflect her feelings.
210 CH A PTER 8
LEARNING ACTIVITY
8.3 Interview Assessment
Part One Client: Well, I call Freddie to get up and tell him to dress
This activity is designed to assist you in iden- before he comes down for breakfast. He comes down
tifying assessment leads in an interview. You all right—in his pajamas. I warn him after breakfast
are given a helper/client dialogue that consists to get ready. Usually about five minutes before the bus
of an interview with a mother, Ms. Weare, about her rela- comes, I’ll go up. He’ll just be sitting in his room! He’s
tionship with her son Freddie (Chapter 7). For each helper still not dressed. I’ll yell at him and then dress him so
response, your task is to identify and write down the type of he’s not late.
assessment lead used by the helper. You may find it helpful to 8. Helper: And your main feeling at this point is that you’re
use the Interview Checklist at the end of this chapter as a guide mad. Anything else you feel?
for this activity. There may be more than one example of any Client: No, just very mad.
given type of lead. Also, identify the listening and influencing 9. Helper: And what exactly do you do when you go
responses used by the helper. Feedback follows on page 212. upstairs and he’s not dressed?
Client: I yell at him. Then I help dress him.
Dialogue between Ms. Weare and the Helper
10. Helper: What kinds of things do you usually say to him?
1. Helper: Hello, Ms. Weare. Could you tell me about some Client: I tell him he’s dumb and he’s going to be late for
things going on now that are concerning you? school, and that I have to make sure he won’t be.
Client: Not too much. Family Services sent me here. 11. Helper: You mentioned this happens in the morning.
2. Helper: So you’re here just because they sent you — or is Does this situation go on every morning or only some
there something bothering you? mornings?
Client: Well, they don’t think my kid and I get along too Client: Just about every morning except weekends.
well. My kid is Freddie. 12. Helper: When did these incidents seem to begin?
3. Helper: What do you think about the way you and Client: Ever since Freddie started going to school.
Freddie get along? 13. Helper: So it appears that this has been going on for
Client: Well, I yell at him a lot. I don’t like to do that, but about five years, then?
sometimes he gets me so mad. I don’t like to, but he Client: Yes, I guess so.
needs to learn. 14. Helper: Okay, now let’s go back over this situation.
4. Helper: So there are times when you get real mad at You told me you remind Freddie every morning to get
Freddie and then you yell at him. You don’t like to do dressed. He never dresses by breakfast. You remind him
this, but you see it as a way to help him learn right and again. Then, about five minutes before the bus comes,
wrong. you go upstairs to check on him. When do you notice
Client: That’s it. I don’t like to, but there are times when that you start to feel mad?
he needs to know something. Like yesterday, I bought Client: I think about it as soon as I realize it’s almost time
him new pants, and he came home from school with a for the bus to come and Freddie isn’t down yet. Then I
big hole in them. Now, I just don’t have money to keep feel mad.
buying him new pants. 15. Helper: And what exactly do you think about right then?
5. Helper: You just mentioned the incident with Freddie’s Client: Well, that he’s probably not dressed and that if I
pants. What are some other times that you get mad at don’t go up and help him, he’ll be late. Then I’ll look like
Freddie? a bad mother if I can’t get my son to school on time.
Client: Every morning. Freddie’s in fourth grade now. But 16. Helper: So in a sense you actually go help him out so
he still doesn’t dress himself in the morning. I want to be he won’t be late. How many times has Freddie ever
a good mother and get him to school on time, and he been late?
tries to be late. He waits around not getting dressed. Client: Never.
6. Helper: Any other times you can remember getting mad? 17. Helper: You believe that helping Freddie may prevent
Client: Well, not too long ago he was playing outside him from being late. However, your help also excuses
and broke a window. I got mad then. But that doesn’t Freddie from having to help himself. What do you think
happen every day like his not getting dressed does. would happen if you stopped going upstairs to check
7. Helper: So one thing that really bothers you is what goes on Freddie in the morning?
on in the mornings. Tell me exactly what does happen Client: Well, I don’t know, but I’m his only parent.
each morning at your house? Freddie’s father isn’t around. It’s up to me, all by
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 211
LEARNING ACTIVITY
8.3 Interview Assessment
myself, to keep Freddie in line. If I didn’t go up and if 24. Helper: Gee, I imagine that all the responsibility for a
Freddie was late all the time, his teachers might blame 9-year-old boy would start to feel like a pretty heavy
me. I wouldn’t be a good mother. burden after a while.
18. Helper: Of course, we don’t really know what would Client: Yeah. I guess a lot of the time it does.
happen if you didn’t go up and yell at him or help him 25. Helper: Those may be feelings we’ll want to talk about
dress. It might be so different for Freddie after the first more. I’m also wondering whether there are any
day or two he would dress himself. It could be that other things in your life causing you any concern
he thinks it’s easier to wait and get your help than to now?
dress himself. He might think that by sitting up there Client: No, this is about it.
and waiting for you to help, he’s getting a special 26. Helper: Ms. Weare, we’ve been talking a lot about some
advantage or attention from you. problem situations you’ve had with Freddie. Describe
Client: You mean like he’s getting a favor from me? some times when the two of you get along okay.
19. Helper: Sure. And when we find a way to get a favor Client: Well, on weekends we do. Freddie dresses
from someone, we usually do as much as we can to keep himself whenever he gets up. I sleep later.
getting the favor. Ms. Weare, I’d like to ask you about 27. Helper: What happens on weekends when the two of
something else. Do you think maybe that you see helping you get along better?
Freddie out as a way to avoid having Freddie be late Client: Sometimes I’ll take him to a movie or a game.
and then not having someone blame you for this? And we eat all our meals together. Usually, weekends
Client: Sure. I’d rather help him than get myself in hot water. are pleasant. He can be a good boy, and I don’t
20. Helper: Okay, so you’re concerned about what you think scream all the time at him.
might happen to you if he’s late. You see getting him 28. Helper: So you realize it is possible for the two of you
ready on time as a way to prevent you from getting the to get along. How do you feel about my talking with
heat for him. Freddie and then with both of you together?
Client: Yes. Client: That’s okay.
21. Helper: How do you usually feel after these incidents in
the morning are over?
Client: Well, it upsets me. Part Two
22. Helper: Okay, you feel upset. Do these feelings seem to To incorporate the interview leads into your verbal repertory,
make you want to continue or to stop helping Freddie? we suggest that you try a role-play interview of the case of
Client: Probably to stop. I get worn out. Also, sometimes Ms. Weare (Chapter 7) or the case of Mr. Huang (Chapter 7)
I don’t get my work done then. with a triad. One person can take the role of the client
23. Helper: So helping Freddie so he won’t be late and you (Ms. Weare or Mr. Huang); another can be the helper. Your
won’t be blamed sort of makes you want to keep on task is to assess the client’s concerns using the interview leads
helping him. Yet when you feel upset and worn out described in this chapter. The third person can be the ob-
afterward, you’re tempted to stop helping. Have I heard server, providing feedback to the helper during or following
you accurately? the role play, using the Interview Checklist at the end of the
Client: I guess that could be true. chapter as a guide.
4. Helper: It seems like you’re feeling pretty overwhelmed Client [Pause—eyes fill with tears]: I guess I just feel like all this
and discouraged right now. stuff is coming down on me at once. I’d like to work something
out, but I don’t know how—or where, even—to start.
Client: Yeah, I am [lowers head, eyes, and voice tone].
Helper continues to attend, to listen, and to reflect the
Helper senses Isabella has strong feelings about these client’s current experience.
issues and doesn’t want to cut them off initially. Helper in-
structs Isabella to continue focusing on the feelings. 6. Helper: It seems like you feel you’re carrying a big load
on your shoulders—
5. Helper: [Pause]: Let’s stay with these feelings for a few
minutes and see where they take you. Client: Yeah.
212 CH A PTER 8
F E E D B A C K
8.3 Interview Assessment
In response 7, the helper summarizes Isabella’s concerns, college, or maybe just go to culinary school. But I’ve been
then uses a lead to determine whether Isabella has prioritized thinking about this for a year, and I can’t decide what to do.
her concerns. I’m not very good at making decisions on my own.
7. Helper: I think before we’re finished I’d like to come Helper response 9 is a summarization and instruction. The
back to these feelings, which seem pretty strong for you helper goes back to the three areas of concern. Note that the
now. Before we do, it might help you to think about helper does not draw explicit attention to the client’s last
not having to tackle everything all at once. You know self-deprecating statement.
you mentioned three different things that are bothering
you—your competitive classes, having trouble making 9. Helper: Well, your concerns about your present class
decisions, and not getting along with your parents. problems and about making this and other decisions
Which of these bothers you most? are somewhat related. Your parents tie into this too.
Maybe you could explore all concerns and then decide
Client: I’m not really sure. I’m concerned right now about later about what you want to work on first.
having trouble in my classes. But sometimes I think if I
were in another type of curriculum, I wouldn’t be so tense Client: That’s fine with me.
about these classes. But I’m sort of worried about deciding
Helper response 10 is a lead to identify some present
to do this.
behaviors related to Isabella’s concern about competitive
Helper response 8 is a clarification. The helper wants to classes. Asking the client for examples can elicit specificity
see whether the client’s interest in work-study is real or is a about what does or does not occur during the situation of
way to avoid the present issue. concern.
8. Helper: Do you see getting in the work-study program 10. Helper: Okay, give me an example of some trouble
as a way to get out of your present problem classes, or you’ve been having in your most competitive class.
is it a program that really interests you?
Client: Well, I guess I shut down in these classes. Also, I’ve
Client: It’s a program that interests me. I think sometimes been cutting my math classes. It’s the worst. My grades are
I’d like to get a job after high school instead of going to dropping, especially in math class.
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 213
Helper response 11 is a behavior lead regarding the context and other times I’m thinking about myself or about
of the concern to see whether the client’s concern occurs at something else I’m going to do. So I’m wondering what
other times or other places. you’ve noticed you’re thinking about during the class.
11. Helper: Where else do you have trouble—in any other Client: Well, some of the time I’m thinking about the math
classes, or at other times or places outside school? problems. Other times I’m thinking about the fact that I’d
rather not be in the class and that I’m not as good as the
Client: No, not outside school. And, to some degree, I other kids, especially all the guys in it.
always feel anxious in any class because of the pressures my
parents put on me to get good grades. But my math class is The client has started to be more specific, and the helper
really the worst. thinks perhaps there are still other thoughts going on. To ex-
plore this possibility, the helper uses another covert behavior
Helper response 12 is a lead to help the client identify overt lead in response 16 to assess cognition.
behaviors in math class (behavioral component of concern).
16. Helper: What else do you recall that you tell yourself when
12. Helper: Describe what happens in your math class that you’re thinking you’re not as good as other people?
makes it troublesome for you [could also use imagery
assessment at this point]. Client: Well, I think that I don’t get grades that are as good
as some other students’. My parents have been pointing this
Client: Well, to start with, it’s a harder class for me. I have to out to me since junior high. And in the math class I’m one
work harder to do okay. In this class I get nervous whenever of four girls. The guys in there are really smart. I just keep
I go in it. So I withdraw. thinking how can a girl ever be as smart as a guy in math
class? No way. It just doesn’t happen.
Client’s statement “I withdraw” is vague. So helper re-
sponse 13 is another overt behavior lead to help the client The client identifies more specific thoughts and also sug-
specify what she means by “withdrawing.” Note that since gests two possible antecedents—parental comparison of her
the helper did not get a complete answer to this after re- grades and cultural stereotyping (girls shouldn’t be as good
sponse 8, the same type of lead is used again. in math as boys). The helper’s records show that the client’s
test scores and previous grades indicate that she is definitely
13. Helper: What do you do when you withdraw? [This is not “dumb” in math. The helper will summarize this and
also an ideal place for a role-play assessment.] then, in the next few responses, will focus on these and on
other possible antecedents, such as the nervousness the client
Client: Well, I sit by myself; I don’t talk or volunteer an- mentioned earlier.
swers. Sometimes I don’t go to the board or answer when
the teacher calls on me. 17. Helper: So what you’re telling me is that you believe
most of what you’ve heard from others about yourself
Now that the client has identified certain overt behaviors and about the fact that girls automatically are not sup-
associated with the concern, the helper will use a covert be- posed to do too well in math.
havior lead to find out whether there are any predominant
thoughts the client has during the math class (cognitive com- Client: Yeah, I guess so, now that you put it like that. I’ve
ponent of issue). never given it much thought.
20. Helper: You know, Isabella, earlier you mentioned that The client has established that the nervousness seems
you get nervous about this class. When do you notice mainly to be exhibited in somatic forms and is more intense
that you feel this way—before the class, during the before class. The helper will pursue the relationship between
class, or at other times? the client’s nervousness and overt and covert behaviors de-
scribed earlier to verify that the nervousness is an antecedent.
Client: Well, right before the class is the worst. About Another antecedent lead is used next.
10 minutes before my English class ends—it’s right before
math—I start thinking about the math class. Then I get 25. Helper: Which seems to come first—feeling nervous,
nervous and feel like I wish I didn’t have to go. Recently, I’ve not speaking up in class, or thinking about other people
tried to find ways to cut math class. being smarter than you?
The helper still needs more information about how and Client: Well, the nervousness. Because that starts before I
when the nervousness affects the client, so response 21 is get in the class.
another antecedent lead.
The helper will summarize this pattern and confirm it
21. Helper: Tell me more about when you feel most ner- with the client in the next response.
vous and when you don’t feel nervous about this class.
26. Helper: Let’s see. So you feel nervous—like in your
Client: Well, I feel worst when I’m actually walking to the stomach and hands—before class and when math class
class and the class is starting. Once the class starts, I feel starts. Then during class, on days you go, you start
better. I don’t feel nervous about it when I cut it or at other thinking about not being as smart in math as the guys
times. However, once in a while, if someone talks about it and you don’t volunteer answers or don’t respond some-
or I think about it, I feel a little nervous. times when called on. But after the class is over, you
don’t notice the nervousness so much. Have I heard you
The client has indicated that the nervousness seems to be accurately?
more of an antecedent than a problem behavior. She has also
suggested that cutting class is a consequence that maintains Client: That’s pretty much what happens.
the issue, because she uses this to avoid the math class that
brings on the nervousness. The helper realizes at this point The helper has a clue from the client’s previous comments
that the word nervous has not been defined and goes back in that there are other antecedents in addition to nervousness
the next response to a covert behavior lead to find out what that have to do with the client’s concern—such as the role of
Isabella means by nervous (affective component). her parents. The helper will pursue this in the next response,
using an antecedent lead.
22. Helper: Tell me what you mean by the word nervous—
what goes on with you when you’re nervous? 27. Helper: Isabella, you mentioned earlier that you have
been thinking about not being as smart as some of your
Client: Well, I get sort of a sick feeling in my stomach, and friends ever since junior high. When do you recall you
my hands get all sweaty. My heart starts to pound. really started to dwell on this?
In the next response, the helper continues to listen and Client: Well, probably in seventh grade.
paraphrase to clarify whether the nervousness is experienced
somatically. The helper didn’t get sufficient information about what
happened to the client in the seventh grade, so another
23. Helper: So your nervousness really consists of things antecedent lead will be used to identify this possible setting
you feel going on inside you. event.
The helper has no evidence of actual parental reaction but 32. Helper: You know, studies have shown that when
will work with the client’s report at this time, because this is young women drop out of math, science, and engi-
how the client perceives parental input. If possible, a parent neering programs, they do so not because they’re doing
conference could be arranged later with the client’s permission. poorly but because they don’t believe they can do well.*
The parents seem to be using negative rather than positive con- It is evident to me from your records that you have a lot
sequences with Isabella to influence her behavior. The helper of potential for math.
wants to pursue the relationship between the parents’ input and
the client’s present behavior to determine whether parental re- Client: Really?
action is eliciting part of Isabella’s present concerns. The helper
will use a lead to identify this as a possible antecedent. Helper response 33 is an interpretation to help the client
see the relation between overt and covert behaviors.
29. Helper: How do you think this reaction of your parents
relates to your present problems in your math class? 33. Helper: I don’t see why not. But lots of times the way
someone acts or performs in a situation is affected by
Client: Well, since I started high school, they have talked how the person thinks about the situation. I think some
more about needing to get better grades for college. And I of the reason you’re having more trouble in your math
have to work harder in math class to do this. I guess I feel a class is that your performance is hindered a little by your
lot of pressure to perform—which makes me withdraw and nervousness and by the way you put yourself down.
just want to hang it up. Now, of course, my grades are get-
ting worse, not better. In the next response, the helper checks out and clarifies the
client’s reaction to the previous interpretation.
The helper, in the next lead, will paraphrase Isabella’s
previous comment. 34. Helper: I’m wondering now from the way you’re look-
ing at me whether this makes any sense or whether what
30. Helper: So the expectations you feel from your parents I just said muddies the waters more for you?
seem to draw out pressure in you.
Client: No, I guess I was just thinking about things. You
Client: Yes, that happens. mentioned the word expectations. But I guess it’s not just
that my parents expect too much of me. I guess in a way I
In response 31, the helper will explore another possible expect too little of myself. I’ve never really thought of that
antecedent that Isabella mentioned before—thinking that before.
girls aren’t as good as boys in math.
35. Helper: That’s a great observation. In a way the two sets
31. Helper: Isabella, I’d like to ask you about something of expectations are probably connected. These are some
else you mentioned earlier that I said we would come of the kinds of issues we may want to work on if this
back to. You said one thing that you think about in your track we’re on seems to fit for you.
math class is that you’re only one of four girls and that,
Client: Yeah. Okay, it’s a problem.
as a girl, you’re not as smart in math as a boy. Do you
know what makes you think this way? The helper is going to go back now to pursue possible
consequences that are influencing the client’s behavior. The
Client: I’m not sure. Everyone knows or says that girls have
next response is a lead to identify consequences.
more trouble in math than boys. Even my teacher. He’s
gone out of his way to try to help me because he knows it’s 36. Helper: Isabella, I’d like to go back to some things you
tough for me. mentioned earlier. For one thing, you said your teacher
The client has identified a possible consequence of her has gone out of his way to help you. Would you say that
behavior as teacher attention. The helper will return to this your behavior in his class has got you any extra atten-
later. First, the helper is going to respond to the client’s tion or special consideration from him?
response that “everyone” has told her this thought. Help-
ers have a responsibility to point out things that clients Client: Certainly extra attention. He talks to me more
have learned from stereotypes or irrational beliefs rather frequently. And he doesn’t get upset when I don’t go to the
than actual data, as is evident in this case from Isabella’s board.
academic record. The helper will use confrontation in the *From studies conducted at Wellesley College’s Center for Research on
next response. Women.
216 CH A PTER 8
Helper response 37 will continue to explore the teacher’s In the next response, the helper uses summarization and ties
behavior as a possible consequence. together the effects of “dropping grades” to math class and to
the earlier-expressed concern of a curriculum-change decision.
37. Helper: Do you mean he may excuse you from board
work? 43. Helper: Right. And letting your grades get too bad
will automatically mean that decision is made for you,
Client: For sure, and I think he too almost expects me not to so you can take yourself off the hook for making that
come up with the answer. Just like I don’t expect myself to. choice. In other words, it’s sort of a way that part of you
The teacher’s behavior may be maintaining the client’s has rather creatively come up with to get yourself out
overt behaviors in class by giving extra attention to her and of the hassle of having to decide something you don’t
by excusing her from some kinds of work. A teacher confer- really want to be responsible for deciding about.
ence may be necessary at some later point. The helper, in
Client: Wow! Gosh, I guess that might be happening.
the next two responses, will continue to use other leads to
identify possible consequences. 44. Helper: That’s something you can think about. We
didn’t really spend that much time today exploring the
38. Helper: What do you see you’re doing right now that
issue of having to make decisions for yourself, so that
helps you get out of putting yourself through the stress
will probably be something to discuss the next time
of going to math class?
we get together. I know you have a class coming up in
Client: Do you mean something like cutting class? about 10 minutes, so there are just a couple more things
we might look at.
39. Helper: I think that’s perhaps one thing you do to get
out of the class. What else? Client: Okay—what next?
Client: That’s right. 47. Helper: How do you think this solution has helped?
41. Helper: I’m wondering whether one possible reason for Client: Well, like I said before—it helps mainly because on
letting your grades slide is that it is almost an automatic the days I don’t go, I don’t feel uptight.
way for you to get out of these competitive classes.
48. Helper: So you see it as a way to get rid of these feelings
Client: How so? you don’t like.
42. Helper: Well, if you became ineligible for these classes Client: Yeah, I guess that’s it.
because of your grades, you’d automatically be out of
this class and others that you consider competitive and 49. Helper: Can you think of any ways in which this solu-
feel nervous about. What do you think about that? tion has not helped?
Client: I guess that’s true. And then my dilemma is whether Client: Gee, I don’t know. Maybe I’m not sure what you’re
I want to stay in this or switch to the work-study program. asking.
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 217
50. Helper: Okay, good point! Sometimes when I try to Client: Yeah. Mm-hmm. Also, although I’m usually uptight
do something to resolve a concern, it can make the is- in my math class, I don’t have the same feeling in my history
sue better or worse. So I guess what I’m really asking is class. I’m really doing well in there.
whether you’ve noticed that your “solution” of cutting
class has in any way made the problem worse or in any In response 56, the helper will pick up on these “pluses” and
way has even contributed to the whole issue? use another coping skills lead to have the client identify partic-
ular ways in which she handles positive situations, especially
Client: [Pause] I suppose maybe in a way. [Pause] In that, by her history class. If she can demonstrate the steps to succeed
cutting class, I miss out on the work, and then I don’t have in one class, this is useful information that can be applied in a
all the input I need for tests and homework, and that doesn’t different area. This topic is continued in response 57.
help my poor grades.
56. Helper: So there are some things about school that are
51. Helper: Okay. That’s an interesting idea. You’re saying going okay for you. You say you’re doing well in your
that when you look deeper, your solution also has had history class. What can you think of that you do or
some negative effects on one of the issues you’re trying don’t do to help you perform well in this class?
to deal with and eliminate.
Client: Well, I go to class, of course, regularly. And I guess
Client: Yeah. But I guess I’m not sure what else I could do. I feel like I do well in the reading and writing assignments
in there. I don’t have the hang-up in there about being one
52. Helper: At this point, you probably are feeling a little of the few girls.
bit stuck, like you don’t know which other direction or
road to take. 57. Helper: So maybe you can see some of the differences
between your history and math classes—and how you
handle these. This information is useful because if you
Client: Yeah.
can start to identify the things you do and think about
At this point, the helper shifts the focus a little to explora- in history that make it go so well for you, then you po-
tion of Isabella’s assets, strengths, and resources. tentially can apply the same process or steps to a more
difficult situation, like math class.
53. Helper: Well, one thing I sense is that your feelings
of being so overwhelmed are sort of covering up the Client: That sounds hopeful!
resources and assets you have within you to handle the
Isabella and the helper have been talking about individual
issue and work it out. For example, can you identify any
strengths. Next (in responses 58–62), the helper will explore
particular skills or things you have going for you that
any environmental and cultural strengths and resources that
might help you deal with this issue?
can help Isabella in this situation.
Client: [Pause] Well, are you asking me to tell you what I 58. Helper: So far we’ve been talking about your own
like about myself? individual assets. Can you think of any assets or re-
sources—including people—in your immediate envi-
Clients often talk about their pain or limitations freely ronment that could be useful to you in dealing with
but feel reluctant to reveal their strengths, so in the next these concerns?
response, the helper gives Isabella a specific directive and
permission to talk about her assets. Client: Well, I mentioned my math teacher. He does go out
of his way to help me. He even has given all of us his e-mail
54. Helper: Sure. Give yourself permission. That’s certainly address to use if we get stuck on a homework problem, and
fine in here. he has a tutoring session after school every Thursday too.
But I haven’t used his help too much outside of class.
Client: Well, I am pretty responsible. I’m usually fairly loyal
and dependable. It’s hard to make decisions for myself, but 59. Helper: So you rely on him more during class?
when I say I’m going to do something, I usually do it.
Client: Yup.
55. Helper: Okay, great. So what you’re telling me is you’re
good on follow-through once you decide something is 60. Helper: Are there any other people or resources avail-
important to you. able to you that you may or may not be using?
218 CH A PTER 8
Client: Hmm. 66. Helper: Not quite. After this, list the names of people,
groups, and organizations with-in each circle. Next I’d
61. Helper: Earlier you mentioned your friends. Do you like you to draw a solid line from yourself to anything
ever do homework with them or have study groups with (or anyone) you’ve circled that is positive or represents
them? a strong connection for you.
Client: No—we mainly just go out on weekends to do Client: Okay [draws several solid lines].
things. But I think that might be a good idea, and I think
my parents would be in favor of that one too. 67. Helper: Almost there. Next, I’d like you to draw a bro-
ken line from yourself to anything that feels negative or
62. Helper: Anything else you can think of? represents a stressful connection for you.
Client: Well, I’m kind of stuck; I don’t see anything else that Client: Okay [continues drawing—this time, broken lines].
could help me right now.
68. Helper: Last thing—now draw a wavy line from yourself
To help Isabella explore contributing conditions of her en- to anything that you need that is not available to you.
vironment, the helper uses an ecomap in responses 63–69.
Client: Okay, here goes [draws several wavy lines]. That was
kind of fun.
63. Helper: One thing we could start today and finish next
time is kind of a chart or drawing. It is actually called 69. Helper: It is fun, and it is also surprising how much
an ecomap, and what it does is help us to get a picture information you can get from this.
about your world and the ways that other people and
systems in it can either contribute to your concerns or In the next few responses, the helper tries to elicit Isabella’s
can be used to help resolve them. Would you like to give perception and assessment of the main issue.
this a try with my assistance?
70. Helper: Right. It is. Just a couple more things. Chang-
Client: Sure. What do I do—is it like a map of a state or ing the focus a little now, think about the issues that
something? you came in with today—and describe the main issue
in one word.
64. Helper: Sort of. Here is a piece of paper with a big
circle in the center. In that circle simply write your Client: Ooh—that’s a hard question!
name or “Me.” That circle represents you in the
center of your world. Then around that center circle 71. Helper: I guess it could be. Take your time. You don’t
which represents you, I would like you to draw other have to rush.
circles—each representing some aspect of your cur-
rent environment. For example, one circle might be Client: [Pause] Well, how about “can’t”?
family, one might be extended family, one might be
church or religion, another may be friends, while still 72. Helper: Okay, now, to help me get an idea of what that
another would be school, and another could be recre- word means to you, use it in a sentence.
ation. Can you think of any other important systems
Client: Any sentence?
in your current life?
73. Helper: Yeah. Make one up. Maybe the first thing that
Client: Well let me think. I do some community service—not comes in your head.
a lot—but some volunteering at the local boys and girls club.
Client: Well, “I can’t do a lot of things I think I want to or
65. Helper: Okay, so maybe another circle would be a should be able to do.”
community group or community groups such as that
boys and girls club you just mentioned. Can you think Next, the helper uses a confrontation to depict the incon-
of any other places or people in your environment that gruity revealed in the sentence Isabella made up about her
are important to you other than what we have already concern. This theme is continued in response 75.
mentioned? If so, draw a circle there.
74. Helper: Okay, that’s interesting too, because on the one
Client: Is that it? hand, you’re saying there are some things you want to do
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 219
that aren’t happening, and on the other hand, you’re also 75. Helper: Okay, so you’re identifying part of the whole issue
saying there are some things that aren’t happening that as wanting to please yourself and others at the same time.
you think you should be doing. Now, these are two pretty
different things mixed together in the same sentence. Client: Mm-hmm.
Client: Yeah. [Clarifies.] I think the wanting stuff to happen In response 76, the helper identifies this issue as an ex-
is from me and the should things are from my parents and tension of the secondary gain mentioned earlier—avoiding
my teachers. deliberate decisions.
For Isabella
Week of Nov. 6–13
Behavior Date Time Place (Frequency/ (Antecedents) (Consequences)
observing duration) What precedes What follows
Number or behavior behavior
amount
1. Thinking of self as Mon., 10:00 A.M. Math IIII Going into class, Leaving class, being
not as smart as other Nov. 6 class know have to with friends.
students take test in class.
Tues., 10:15 A.M. Math IIII IIII Got test back Teacher consoled me.
Nov. 7 class with a B.
Tues., 5:30 P.M. Home IIII II Parents asked Went to bed.
Nov. 7 about test. Told
me to stay home
this weekend.
Thurs., 9:30 A.M. English II Thought about Got to math class.
Nov. 9 class having to go to Had substitute
math class. teacher.
Sun., 9:30 P.M. Home III Thought about Went to bed.
Nov. 12 school tomorrow.
2. a. Not volunteering Tues., 10:05 A.M. Math II Felt dumb. Nothing.
answers Nov. 7 10:20 class
b. Not answering Thurs., 10:10 A.M. Math III Felt dumb. Nothing.
teacher questions Nov. 9 10:20 class
10:40
c. Not going to class Thurs., 10:30 A.M. Math I Teacher called Nothing.
Nov. 9 class on me.
Fri., 10:10 A.M. Math II Teacher called Nothing.
Nov. 10 10:35 A.M. class on me.
Thurs., 10:45 A.M. Math I Didn’t have a Nothing.
Nov. 9 class substitute teacher.
Fri., 10:15 A.M. Math I Teacher asked Teacher talked to
Nov. 10 class girls to go up me after class.
to board.
3. Cutting class Wed., 9:55 A.M. School 1 hour Didn’t want to Cut class. Played
Nov. 8 hassle with class sick. Went to
or think about nurse’s office
test. for an hour.
76. Helper: I can see how after a while that would start to clients, intakes or history interviews may be followed by
feel like so much trouble that it would be easier to try to a mental-status exam, which aids the helper in assessing
let situations or decisions get made for you rather than the client’s psychiatric status.
making a conscious or deliberate choice. In direct assessment interviews, practitioners are interested
in defining six components of behavior: affective, somatic,
In the next two responses, the helper explores the con- behavioral, cognitive, contextual, and relational. They also
text related to these issues and sets up some self-monitoring seek to identify antecedent events that occur before the issue
homework to obtain additional information. Note that this and cue it, and consequent events that follow the issue and
is a task likely to appeal to the client’s dependability, which in some way influence it or maintain it. Consequences may
she revealed during exploration of coping skills. include “payoffs,” or secondary gains, that give value to the
dysfunctional behavior and thus keep the issue going. An-
77. Helper: That’s something else we’ll be coming back to, tecedents and consequences may also be affective, somatic,
I’m sure. One last thing before you have to go. Earlier behavioral, cognitive, contextual, and relational. Contextual
we talked about some specific times and places con- and relational ABCs form the basis of an environmental
nected to some of these issues—like where and when assessment to determine the ways in which clients’ social
you get in the rut of putting yourself down and think- network (or lack thereof ) and environmental barriers and
ing you’re not as smart as other people. What I’d like resources affect the issue. Other important components of
to do is give you sort of a diary to write in this week direct assessment interviewing include identifying previous
to collect some more information about these kinds solutions the client has tried for resolving the issue, explor-
of problems. Sometimes writing these kinds of things ing individual and environmental strengths, exploring the
down can help you start making changes and sorting client’s perceptions of the issue, and identifying the fre-
out the issues. You’ve said that you’re pretty dependable. quency, duration, or severity of the concern.
Would doing this appeal to your dependability? In addition to direct assessment interviewing, other as-
sessment tools include ecomaps, social network maps, role
Client: Sure. That’s something that wouldn’t be too hard playing, imagery, self-report measures, and self-monitoring.
for me to do. All these techniques can be useful for obtaining more spe-
cific information about the identified concerns.
78. Helper: Okay, let me tell you specifically what to keep Cultural variables also play a role in assessment inter-
track of, and then I’ll see you next week—bring this back views. Factors such as age, ethnicity, and race impact both
with you. [Goes over instructions for self-monitoring diagnoses and assessment processes. Interviewers need to
homework.] (See Isabella’s behavior log in Figure 8.3.) be culturally sensitive to clients and avoid bias and cultural
misunderstandings. Culturally sensitive assessment inter-
At this time, the helper also has the option of giving view protocols are reviewed in this chapter.
Isabella a history questionnaire to complete and/or a brief
self-report inventory to complete, such as an anxiety inven-
tory or checklist.
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222 CH A PTER 8
8 K N O W L E D G E A N D S K I L L B U I L D E R
Using the description of the client in Part One, conduct a 30- You may wish to continue this part of the activity in a triad or
minute role-play assessment interview in which your objective do it by yourself, jotting down ideas as you proceed. At some
is to demonstrate leads and responses associated with at least point, it may be helpful to share your ideas with your group
9 out of the 11 categories described for assessment (Learning or your instructor.
Outcome 2). You can do this activity in a triad in which one
person assumes the role of helper, another the “anxious” cli- Part Three
ent, and the third person the role of observer; trade roles two
times. If groups are not available, audiotape or videotape your Conduct a role-play interview with the client from Part One in
interview. which you help her complete an ecomap using Figure 8.1 as a
Use the Interview Checklist below as a guide to assess your guide and a social network map using Figure 8.2 as a guide
performance and to obtain feedback. (Learning Outcome 3). If possible, continue with this activity in
After completing your interview, develop some hypotheses, your triad and obtain feedback from the observer.
or hunches, about the client. In particular, try to develop
“guesses” about
1. Antecedents that cue or set off the anxiety, making its
occurrence more likely
Yes No
____ ____ 1. Explain purpose of “I am going to be asking you more ____ (check if client confirmed understanding of purpose)
assessment interview questions than usual so that we can get
an idea of what is going on. Getting an
accurate picture about your concern will
help us to decide what we can do about it.
Your input is important.”
____ ____ 2. Identify range of “What would you like to talk about today?” ____ (check if client described additional concerns)
concerns (if you don’t “What specifically led you to come to see
have this information someone now?”
from history) “Describe any other issues you haven’t
mentioned.”
____ ____ 3. Prioritize and select “What issue best represents the reason ____ (check if client selected issue to focus on)
primary or most you are here?”
immediate issue “Of all these concerns, which one is most
to work on stressful (or painful) for you?”
“Rank order these concerns, starting with the
one that is most important for you to resolve
to the one least important.”
CONDUCTING AN INTERVIEW ASSESSMENT WITH CLIENTS 223
8 K N O W L E D G E A N D S K I L L B U I L D E R
8 K N O W L E D G E A N D S K I L L B U I L D E R
8 K N O W L E D G E A N D S K I L L B U I L D E R
8 K N O W L E D G E A N D S K I L L B U I L D E R
8 K N O W L E D G E A N D S K I L L B U I L D E R
Part One “Does the presence of any particular people in any way set
See whether the interview leads that you gen- these feelings off?” (Antecedent—relational)
erated are similar to the following ones: “Are you aware of any particular other feelings that make
“Is this the only issue you’re concerned about now in your the anxiety better or worse?” (Consequence—affective)
life, or are there other issues you haven’t mentioned yet?” “Are you aware of any body sensations or physiologi-
(Range of concerns) cal responses that make these feelings better or worse?”
“When you say you feel anxious, what exactly do you (Consequence—somatic)
mean?” (Behavior—affective component) “Is there anything you can do specifically to make these
“When you feel anxious, what do you experience inside feelings stronger or weaker?” (Consequence—behavioral)
your body?” (Behavior—somatic component) “Can you identify anything you can think about or focus
“When you feel anxious, what exactly are you usually on that seems to make these feelings better or worse?”
doing?” (Behavior—behavioral component) (Consequence—cognitive)
“When you feel anxious, what are you typically thinking “At what times do these feelings diminish or go away?
about [or saying to yourself]?” (Behavior—cognitive com- Get worse? In what places? In what situations?”
ponent) (Consequence—contextual)
“Try to pinpoint exactly what times the anxiety occurs or “Do certain people you know seem to react in ways that
when it is worse.” (Behavior—contextual component) keep these feelings going or make them less intense? If so,
how?” (Consequence—relational)
“Describe where you are or in what situations you find
yourself when you get anxious.” (Behavior—contextual “As a result of this anxiety, have you ever gotten out of or
component) avoided things you dislike?” (Consequence—secondary
gain)
“Describe what other things are usually going on when you
have these feelings.” (Behavior—contextual component) “Has this problem with your nerves ever resulted in
any special advantages or considerations for you?”
“How would you describe the relationship between your-
(Consequence—secondary gain)
self and these concerns and your current environment?”
(Behavior—contextual component) “What have you tried to do to resolve this issue? How have
your attempted solutions worked out?” (Previous solutions)
“How do your cultural community and affiliation affect this
issue?” (Behavior—contextual component) “Describe some times and situations when you don’t have
these feelings or you feel calm and relaxed. What goes on
“Can you tell me what persons are usually around when
that is different in these instances?” (Coping skills)
you feel this way?” (Behavior—relational component)
“How have you typically coped with other difficult situa-
“How would you describe your support in your life right
tions or feelings in your life before?” (Coping skills)
now?” (Behavior—relational component)
“What resources are available to you from your culture
“Who in your life now empowers you? Disempowers you?”
and community that you can use to help with this prob-
(Behavior—relational component)
lem?” (Individual and environmental strengths—coping)
“Are there any feelings that lead up to this?” (Antecedent—
“What kinds of things in your community and environment
affective)
do you feel are strengths and assets?” (Individual and envi-
“What about body sensations that might occur right before ronmental strengths—coping)
these feelings?” (Antecedent—somatic)
“If you could give this problem a title—as if it were a movie or
“Have you noticed any particular behavioral reactions or a book—what would that title be?” (Client perceptions of issue)
patterns that seem to occur right before these feelings?”
“How do you explain these feelings to yourself?” (Client
(Antecedent—behavioral)
perceptions of issue)
“Are there any kinds of thoughts—things you’re dwelling
“How many times do these feelings crop up during a given
on—that seem to lead up to these feelings?” (Antecedent—
day?” (Frequency of issue)
cognitive)
“How long do these feelings stay with you?” (Duration of
“When was the first time you noticed these feelings? Where
issue)
were you?” (Antecedent—contextual)
“On a scale from 1 to 10, with 1 being not intense and 10
“Can you recall any other events or times that seem to be
being very intense, how strong would you say these feel-
related to these feelings?” (Antecedent—contextual)
ings usually are?” (Severity of issue)
C H A P T E R
LEARNING OUTCOMES 9. Looking at where you are now and where you’d like to
After completing this chapter, you will be able to be, are there some steps along the way to get from here
to there? If so, rank them in an ordered list ranging from
1. Identify a situation about you or your life that you “easiest to do now” to “hardest to do.”
would like to change. Identify, define, and evaluate one 10. Identify any obstacles (people, feelings, ideas, situations)
desired outcome for this issue, using the Goal-Setting that might interfere with the attainment of your goal.
Worksheet in the Knowledge and Skill Builder as a 11. Identify any resources (skills, people, knowledge) that
guide. you would need to use or acquire to attain your goal.
2. Given a written client case description, describe the 12. How could you evaluate progress toward this outcome?
steps you would use with this client to explore and
define desired outcome goals, with at least 10 of the These questions reflect the process of identifying, defining,
13 categories for identifying, defining, and evaluating and evaluating goals for counseling. Goals represent desired
goals represented in your description. results or outcomes and function as milestones of client
3. Demonstrate at least 10 of the 13 categories associated progress. In this chapter we describe and model concrete
with identifying, defining, and evaluating outcome guidelines you can use to help clients identify, define, and
goals, given a role-play interview. evaluate outcome goals for counseling.
4. With yourself or another person or client, conduct an
outcome evaluation of a real or a hypothetical counsel-
ing goal, specifying when, what, and how you would OUTCOME GOALS AND THEIR PURPOSES
measure the outcome. IN THE HELPING PROCESS
Treatment goals represent results or outcomes described by cli-
Pause for a few minutes to answer the following questions ents and are a direct outgrowth of the problems identified during
by yourself or with someone else: the assessment process. Goals have six important purposes:
First, goals provide some directions for helping. Clearly
1. What is one thing you would like to change about defined goals reflect the areas of client concern that need
yourself? most immediate attention. Establishing goals can also
2. Suppose you succeeded in accomplishing this change. clarify the client’s initial expectations. Goals may help
How would things be different for you? both practitioner and client anticipate more precisely
3. Would this outcome represent a change in yourself or what can and cannot be accomplished through the helping
for someone else? process.
4. What would be some of the risks—to you or others—of Although each theoretical orientation has its own direc-
this change? tion, specifying goals individually for each client helps to
5. What would be your payoffs for making this change? ensure that helping is structured specifically to meet the
6. What would you be doing, thinking, or feeling as a needs of that person. Clients are much more likely to sup-
result of this change? port and commit themselves to changes that they create than
7. In what situations would you want to be able to do they are to implement changes imposed by someone else.
this? Without goals, the helping process may be directionless or
8. How much or how often would you like to be able to may be based more on the theoretical biases and personal
do this? preferences of the helper. Some clients may go through
229