1. FOUNDATIONS & PREPARATIONS
CHAPTER 2 Uzm. Psk. Özlem Ataoğlu

2. What will we learn from this chapter?
What is clinical interviewing?
How will you prepare?
Why people seek for help?
What will we do at the beginning of the interview? What can be the biases?
How should the physical settings be?
Practical applications - Presenting yourself, informed consent, stress management, etc.

3. As we have discussed before, clinical interviewing is like trying to know someone BUT we apply some techniques
Generally, during the first interview anxiety problems are due to lack of practice
What is clinical interviewing?

4. Clinical Interviewing
2 people, verbal and non verbal behaviours, communication affects and is affected by both of the attendants
Interviewer  has specified goals to reach
Client  tries to answer the questions, tell him/herself
Interviewer uses active listening techniques, applies psychological techniques and tests
The relationship should be in a respectful and professional frame and affected by a variety of factors

5. Professional Relationship
The client should be ready for the intervention
What will happen if the patient is not ready?
Informed consent  includes all of the important information. What is its importance?
It means the patient agrees for the intervention. It eliminates possible conflicts

6. In professional relationship, your sessions cost a fee.
Instead of a fee, can you do an exchange? For instance, can you get a ticket from your client who has a travel agency, as a fee for your sessions?
A therapist should create a bond with the client that has respect, closeness, attention/interest AND professional distance, objectivity
It can sometimes look like friendship and it is ok as long as you control it

7. Consultation Reasons What can be the 3 main types of consultation?
Reactive problems (develop suddenly), they want suggestions, not satisfied with their lives, unhappiness, someone close directed them to a therapist, personal development (very rare)
Reactive problems  they could not solve by themselves, they seek help for a resolutions, answers to their problem, their motivation is high but not for general development
What can be their feelings when they consult to a therapist?
Despair, insufficiency, defeated, depressed

8. Directed by someone  motivation for change is really low, show resistance to the therapy/therapist
What can be the reason behind that?
Either they try to end the session as soon as possible (give short answers) or try to prove that they are “OK” (give answers for approval
This type of session is tough for the therapist since s/he needs to break this resistance

9. Personal development  very rare, have high motivation since they consult without a reason but just for development and awareness
Their therapy sessions proceed easily

10. Defining Common Goals
It is very important to give the chance to the client to evaluate and judge themselves. WHY?
Client’s perspective on the problem, how s/he presents it, what s/he wants to achieve, what are the goals at the end of the therapy
The client’s perspective and expectation is very important at this point because they present the problem and we, as therapists, shape and frame the therapy sessions accordingly

11. The client has partial insight, the therapist is very flexible
So, according to these, who should set the therapy goals?
WE DO NOT, NEITHER THE CLIENT!
At the end of the therapy session, after we have the information about problems and background of the client, we ask the goals. Then, we summarize the problems and possible goals.
What if they are too different?
You should have a consensus on the problems and therapy goals
If you don’t have a consensus what may happen?

12. BALANCE = Sensitivity, Empathy, Communication Skills, Philosophical Depth
Even if your goals are too different, you should be too sensitive against your client’s goals because there is always a motivation.
Sometimes you feel that your patient tries not to solve the problems, do not apply the techniques s/he has learnt, question the motivation behind that, probably has secondary acquisition

13. What is the goal behind the first evaluation?
Intervention and accelerate the helping process. How can we do this?
How the patient presents the problem, therapy goals, expression language, previous treatment/therapy attempts, reasons of consultation should be taken into account
If we skip some information while we evaluate, or during the intervention we may make some mistakes.
How we do the social phobia treatment?

14. Active (Efficient) Listening & Application of Psychological Techniques
Your goal can be either testing/measurement AND/OR intervention – IT DOES NOT MATTER – firstly we need to show that we listen effectively
Effective listening = Asking questions?
NO! Asking question directs the patients, the patient may not sometimes express him/herself effectively & truly

15. At the beginning, we do not ask questions
At the beginning, we do not ask questions! We let the patient express him/herself
The patient wants to express the problems freely, our active behaviours do not solve our patients’ problems
It only leads the patient to give the expected reactions by the therapist
“Nobody understands me!”

16. The Interaction Between the Client and the Therapist
Every patient’s background is different, the therapist changes his/her manner according to each patient
This means that there is no ideal interviewing, there is ideal interaction (depending on the patient)
There are 3 participants in the interviewing room
Interviewer, Patient, Interaction between Patient & Therapist

17. Self – awareness Within the application room, what do we need?
Information (theoretical background), application, self – awareness
In a short time, we try to know a person from different physical, psychological, social, cultural and psychological backgrounds and we are different from them, as well
We need to respect, be aware of the patient and ourselves

18. How do we gain self – awareness?
Listening voice and watching video recordings. It can be really disturbing!
You will hear & see your tone of voice, speech patterns, mimics, body language, physical patterns
Self – awareness is a positive feature of a good therapist. What does it provide?

19. You will gain insight to your personal biases & psychological states
You will see how you distort the ideas
You will see how you react to emotional reactions (Crying? Anger? Euphoria?)
Before you interact to your patient, knowing your strengths and weaknesses will make you stronger

20. (Objective) Self - Awareness
It should be thought as consciousness and awareness
Without focusing on ourselves, it will let us know ourselves, develop ourselves, and increase our clinical skills
You will definitely have feedbacks from your patients, be flexible, get the feedback. Being defensive does not bring you anything in your therapy sessions and as a therapist

21. Being defensive gives a message to your patient. What can it be?
If you get that feedback from only one of your patients, what does it mean?
What are the expectations from yourself?
“Easy success?”, “It will be really hard, I will fail.”, “How am I going to behave?”

22. The Physical Setting
So far, we have learnt that our personal factors (physical, psychological, social, cultural) can affect our patients and we are affected from them, as well
What about physical settings of the interview room?
These factors will affect clinical interviewing process & outcome

23. Room: The interview should be in a private room but some hospitals/private clinics do not have private rooms
The interview is in the room but sometimes for application, it can be run outside of the interview room (elevator, OCD patient). BUT NOT FOR THE FIRST COUPLE OF INTERVIEWS!!
At the beginning, if you are a student, the room should have strict rules

24. Most basic requirement is privacy
Professional decoration should be minimum. It is not your area to express your ideas, it’s your patients’ area.
Room should be private – no one express their feelings, ideas and personal information in a café. It should be neither as formal as a manager room nor as comfortable as a living room. There should be a balance between professional formality and daily comfort.

25. The room should be bright, give trust, hope and make the patient feel that they are safe and free to discuss any idea
THE GOAL is to create rapport (therapeutic relationship)
You are in control of your interviewing room. Try to think you are the host, the patient is the guest – there are some basic ground rules but you try to make your guest comfortable
There should not be any interruptions (the time, the goal is clear). No one can interrupt the session, you should set the interview area accordingly (close your phone voice and vibration) OR you can hang a warning sign on the door,

26. However sometimes there can be some occasions that are out of our control and interrupt the session
- someone who don’t know the rules may interrupt
- there can be an emergency (you can call your partner/home mate)
- there can be an emergency that you may need to leave
** In any situation, we apologize, give a general information about the situation, return the fee or add the time to the next session, create a new appointment and BE CALM!!

27. NEVER LOCK THE DOOR!
There can be an attack from the patient, you may need some help
You need to feel yourself as comfortable as you can run away
The patient may distort this behaviour (“The door is locked, the interviewer didn’t say anything, s/he wants it as well.” or “S/he abused me after locking the door.”)

28. Seating Arrangements: There are some hospitals/clinics that you cannot change the seating arrangement
It is related to your theoretical orientation – psychoanalysis: couch, behaviourist: recliner, client – centered+BDT: chairs of equal status and comfort – can be the same
According to the research, therapists choose these seating arrangements according to their personality – assertive interviewers choose equality, controllers choose couches BUT it does not mean you insist on what you choose

29. Generally we set the seats around 120 – 150 degrees angle, especially in the first interview and a small table between them
By this way you and your patient can make the eye contact or look away and the table has a function
Do not insist on the seating arrangement if the patient feels more comfortable in another way
If the patient is child/adolescent, we may offer some seating arrangements instead of setting borders

30. Office Clutter & Decor: You should not leave your personal stuff on the ground, on your table, or couch. Of course your laptop, mug, books, notebooks, etc. can be BUT not your family portrait, hotel reservations, etc.
Note Taking: It’s open to debate – some of your patients may feel really uncomfortable but others may feel that you take their problems seriously.
- Before starting, explain why you need to take notes
- The patient is always the first, not note taking
- Do not hide your notes and do not write what you cannot say to your patient
- Offer them to read your notes if they want to

31. Audio & Video Recording: Explain the reason behind recording, give the consent form (privacy and therapeutic relationship reasons) and include the possible future uses, storage, and how it will be destroyed
If you are comfortable with the recording, your patient will be as well

32. Professional and Ethical Issues
Self – Presentation: It is important for professional clinical interviewer
1. Clothing The important thing here is self – awareness. Your physical appearance will give a first impression to your patient. The thing is how do you want to make an impression on your patient? Turn it to an advantage – first impression matters, feeds the rapport, trust and competence
2. Presenting your credentials Introduce yourself as the way you are, do not lie. Tell your patient why you are running the session, which program you are in, who is your supervisor, etc.

33. Time: Regardless of the pathology, your patient actually pays for your time. Generally sessions last 50 – 60 mins. (if outpatient). We can show flexibility if there is an emergency or it is the first interviewing
1. Start the session on time Starting on time to your sessions gives the message that “I respect you”. If you are late, say sorry and offer choices for the time passed.
If your patient is early, you do not have to start early but if you are available, you can.
If your patient is late and asks for additional time, we do not give extra time (unless it is a case of emergency) – we want the patient to take responsibility
If your patient is always late for the sessions, you should clear the rules. (If you are late more than 20 mins, we do not make the session, you still need to pay.
Do we call the patient to rearrange an appointment? If it is always happening, it’s about the boundaries so you should not. But if it developed suddenly, you should because… ???

34. 2. Ending on time No matter what, you should end your session on time
2. Ending on time No matter what, you should end your session on time. Since we start on time, we end on time  matter of respect to other patients and yourself If the patient pops out something really important, we gently end the session and give the message that you may continue this topic on your next session. Your clock should be somewhere you can see while you are looking at your patient.

35. Confidentiality: In theory, we do not inform the patient’s relatives if there is no action. However in practice, you should warn the family that the patient is suicidal and give information about the precautions. BUT remember, suicide thoughts are the first and most important reason for inpatience indication
Confidentiality is debatable, but it is for sure that we need to keep private the patient’s id and personal information
We, as psychologists, have the responsibility to judge whether the patient’s suicide thoughts lead to break the rules or not

36. Informed Consent: When we give the information to the patient, s/he whether accepts the treatment or not. It should not include terminology, you should write it in a way that the patient can understand.
Confidentiality, when you can break them, family’s role, patient/clinician rights, session rules, missed appointments, emergency situations information should be included.
You set the ground rules with informed consent. During the period, you may add/change them

37. Documentation: It is so important to fill the patient files because
- No one’s memory is perfect, it enables us to remember the details
- You may need to share your notes with a colleague
- You may face with unexpected turns, so you can go back and check
- If you are accused of malpractice, you will use them in your defense
**Note – taking format: S – O – A – P  subjective, objective, assessment, plan

38. Stress Management: You will afraid of stress and it is a realistic and functional reaction. YOU WILL MAKE MISTAKE AND SOMETIMES YOU MAY GIVE HARM TO THE PATIENT.
The important thing is to learn the mistake
Sometimes, those mistakes show the patient that we are human, as well. This will increase our therapeutic relationship.
Try as much as possible not to show your stress to your patient