Interviewing in Action in a Multicultural World Fourth

  • Slides: 41
Download presentation
Interviewing in Action in a Multicultural World Fourth Edition Chapter 6 © 2011 Brooks/Cole

Interviewing in Action in a Multicultural World Fourth Edition Chapter 6 © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Chapter 6 Exploration and Elaboration © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Chapter 6 Exploration and Elaboration © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration • In elaboration, the clinician encourages the client to

Levels of Exploration & Elaboration • In elaboration, the clinician encourages the client to expand on the story. • Exploration and elaboration are important to every aspect of clinical work. • Arnold Lazarus (1971) suggested that people keep their most private thoughts in an inner circle, shared with few others. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • Dusty Miller (1996) proposed that interview conversation

Levels of Exploration & Elaboration continued • Dusty Miller (1996) proposed that interview conversation has outer, middle, and inner layers or circles. • The outer circle houses the opening – sometimes surface – exploratory conversation between people who are just getting to know each other. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • The goals of the outer circle of

Levels of Exploration & Elaboration continued • The goals of the outer circle of exploration are: – To develop knowledge of the presenting situation and to establish a relationship of trust and collaboration by talking about subjects that do not push the client too quickly into forbidden or overly distressing topics; – To clarify the reasons for referral; – To elicit the strengths and vulnerabilities of the client and his or her systems; – To flesh out client demographics; and – To spell out interviewer-client roles and agreements on how to proceed. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • The middle circle houses more revealing exploration

Levels of Exploration & Elaboration continued • The middle circle houses more revealing exploration of deeper-level content, conflicts, and feelings as the relationship develops. – This level usually elicits more complicated feelings and meaning. • The inner circle houses feeling and content about frightening, taboo, or shame-bound areas. – Clients often discover things about themselves and their relationships with others about which they previously were unaware. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • Family and cultural norms about sharing personal

Levels of Exploration & Elaboration continued • Family and cultural norms about sharing personal information that might “shame” the client also affect the client’s willingness to disclose information. • Levels of conversation do not appear in neat sequences, one right after the other. • It is not unusual for clinical interviews to stay at the outer and middle circles. – It is very possible for the clinical relationship to stay almost entirely at the outer and middle circles and still get very important work done. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • Both clinicians and clients may move rapidly

Levels of Exploration & Elaboration continued • Both clinicians and clients may move rapidly to inner circle conversation without necessarily building the relationship first during times of CRISIS. – Accelerated questioning is often appropriate when the time available is limited. • A common result of rushing into inner circle conversation is having the client cancel appointments for a time or never coming back. • An equally important goal to “deepening” the level of conversation is to maintain the safety of the clinical experience. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Levels of Exploration & Elaboration continued • Success is most often measured by the

Levels of Exploration & Elaboration continued • Success is most often measured by the realization of agreed-upon aims and goals, not by the number of painful subjects covered. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Techniques of Exploration & Elaboration: Questions & Questioning • Asking questions is one of

Techniques of Exploration & Elaboration: Questions & Questioning • Asking questions is one of the most reliable and effective techniques for gathering information, deepening discussion, or broadening focus. • In general, interviewers routinely ask more questions in the engagement and assessment phases of work than in others. • The use of many questions early on is particularly prevalent in managed care settings. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Techniques of Exploration & Elaboration: Questions & Questioning • Asking appropriate and timely questions

Techniques of Exploration & Elaboration: Questions & Questioning • Asking appropriate and timely questions is one of the hardest skills to master. • Beginning interviewers frequently either ask too many or too few questions and they can delve too soon into personal questions before a relationship is established or cultural norms about self-disclosure are clarified. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning • Questions should be intentional or purposeful.

General Principles Regarding the Use of Questioning • Questions should be intentional or purposeful. • Clients should know why questions are being asked and how the answers will be used. – Clinicians should invite clients’ questions about them or any aspect of the process. – Clients should be told that they are free to consult with family members before answering questions. – Some believe that clients should be told that they can decline to answer any question that does not feel right to them. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning continued • Clinicians need to be sensitive

General Principles Regarding the Use of Questioning continued • Clinicians need to be sensitive to cultural attitudes toward questioning. • Questions should be well timed. • Too much questioning makes the clinician the director. • Questions can interrupt concentration. – Every question interrupts the natural flow of the client’s narrative. • Flexibility in data gathering is essential. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning continued • Good questions can be supportive

General Principles Regarding the Use of Questioning continued • Good questions can be supportive and therapeutic, as well as useful for gathering data. • Difficult questions should be introduced carefully. • Too little questioning can make for drift or leave the client at a loss for direction. – Clinicians may also need to ask questions for purposes of clarification or to get more information. • Follow-up questions are often necessary. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning continued • Clinician questions can be both

General Principles Regarding the Use of Questioning continued • Clinician questions can be both verbal and nonverbal. – Raising an eyebrow, cocking one’s head, and responding wide-eyed to statements are best used in the context of a solidly established working relationship. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning continued • Answers to questions can be

General Principles Regarding the Use of Questioning continued • Answers to questions can be both verbal and nonverbal. – Any discrepancies in clients’ verbal and nonverbal answers are stored away as potentially important pieces of information for possible future exploration. – Clinicians should also listen for discrepancies between clients’ stated intentions and their actual behaviors. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

General Principles Regarding the Use of Questioning continued • Clinicians need to attend to

General Principles Regarding the Use of Questioning continued • Clinicians need to attend to apparent patterns and themes that emerge in client answers to questions. • Clinicians need to be aware of what they are not asking. • Questions can be used as defenses or weapons by both clinician and client. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Closed-Ended and Open-Ended Questions • Closed-ended questions are the more focal of the two

Closed-Ended and Open-Ended Questions • Closed-ended questions are the more focal of the two types and can usually be answered with a word or two. • Open-ended questions give the client more opportunity or flexibility in responding and elaborating. – These questions often begin with interrogatives like “what” or “how, ” but not necessarily. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Problems with Closed-Ended Questions • These questions give the client little opportunity or encouragement

Problems with Closed-Ended Questions • These questions give the client little opportunity or encouragement to expand on theme at hand. • The clinician keeps the initiative, thus disempowering the client. • These closed-ended questions often suggest the answer the interviewer expects or prefers. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

The Benefits of Using Closed-Ended Questions • Such questions are essential when agency routine

The Benefits of Using Closed-Ended Questions • Such questions are essential when agency routine or necessity requires that the clinician get a great deal of information in a very short time to determine immediate eligibility for needed services. • Closed-ended questions can be imperative in establishing clear assessment or understanding. • A series of organizing closed-ended questions often provide much needed structure and calming. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Tried-and-True Questions • These questions just seem to get easily and directly at the

Tried-and-True Questions • These questions just seem to get easily and directly at the things we need to know to assess, plan, and act wisely in our clinical roles. • Please see pp. 158 -159 for several examples of these questions. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Problematic Types of Questions • “Why” questions can be problematic because they often sound

Problematic Types of Questions • “Why” questions can be problematic because they often sound judgmental – and they often are. • Our authors have found that “why” questions rarely work. • Pseudoquestions are often clinician directives or commands disguised as questions. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Problematic Types of Questions continued • Double questions occur when we ask the client

Problematic Types of Questions continued • Double questions occur when we ask the client to respond to more than one question at a time. • Tangential questions veer from the main topic, taking side roads without good reason. • Ratatat questions barrage the client with one rapid-fire question after another. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Prompts • Prompts are brief responses by the clinician that encourage the client to

Prompts • Prompts are brief responses by the clinician that encourage the client to continue with the story or to add to what has been said. – Prompts are meant to be minimal and to signal the clinician’s close following of the story and interest in details. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Silence • If the clinician is too quick or too active in ending a

Silence • If the clinician is too quick or too active in ending a silence, clients may be conditioned to sit and wait for the clinician to direct the process. • Chan & Lee (2004) note that “in most cultures throughout the world, individuals start talking when they have to: Americans, instead, tend to stop talking when they have to” (p. 272). © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Reflection • Reflection can be used as a probe to encourage the client to

Reflection • Reflection can be used as a probe to encourage the client to explore a specific area further. • In the dot-dot reflection technique, the clinician simply repeats back the last thing said and hangs it, unfinished, in midair for the client to complete. – Dot-dot is a very useful technique in any conversation when the client loses track for a moment. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Reflection continued • Underlining is a special form of reflection in which the clinician

Reflection continued • Underlining is a special form of reflection in which the clinician underscores important content or experience by the strategic use of verbal or nonverbal emphasis. • In summarizing, the clinician pulls together the major ideas, themes, or patterns that have just been discussed and reflects them to the client. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Refocusing • Refocusing involves returning the client to a desired topic by gently inserting

Refocusing • Refocusing involves returning the client to a desired topic by gently inserting it into the conversation again. – in fast-paced managed care environments, the need for highly focused interviewing assumes increasing importance. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Initiating New Topics • It is important to know when to follow and just

Initiating New Topics • It is important to know when to follow and just accompany the client on the journey unfolding. • It is also important to know when to introduce and explore new areas. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Sensitive Timing • Timing has to do with what and how much to ask,

Sensitive Timing • Timing has to do with what and how much to ask, when to ask it, and whom to ask. • In order to develop a timing instinct, you have to notice how different people react to exploration and notice which interviewer behaviors seem to broaden or deepen the conversation. • Clinicians should watch what evolves once exploration begins. • It is important to respect a client’s need to ebb and flow and to remember that no one is “ON” all the time in clinical work – neither the clinician nor the client. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

The State of the Clinical Relationship • In a good working alliance, all that

The State of the Clinical Relationship • In a good working alliance, all that may be required for exploration is a supportive, empathic environment and some initial broad questions that set the framework of the meetings. • However, people new to each other have to feel each other out, testing for comfort and safety. • No conversation just rolls along without stumbling blocks. • The ongoing work of a good relationship is first to acknowledge stumbling points and then to sort through them together. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

The Client’s Readiness to Explore Charged Areas • The clinician’s overriding intent is to

The Client’s Readiness to Explore Charged Areas • The clinician’s overriding intent is to do nothing to harm or needlessly intrude on the client. • Clinicians should be thinking about what is in the client’s best interest at any given moment. • Our authors prefer the gradual introduction of deeper-level exploration, carefully monitoring and often discussing the client’s reactions to advancing exploration. • Coping levels and resources (or lack of them) give us important clues as to client readiness and capacity to continue exploring. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

The Client’s Cognitive Capacity and Expressive Style • The kind of exploration and elaboration

The Client’s Cognitive Capacity and Expressive Style • The kind of exploration and elaboration attempted depends on the client’s intelligence, educational level, and cognitive capacities, including the accuracy of perception, reality testing, judgment, logic, abstract and concrete thinking, use of fantasy, insight, and general quickness of mind. • Our authors generally try to avoid jargon and esoteric language and attempt to keep language immediate, simple, encouraging, and respectful of each client’s style. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

The Client’s Cognitive Capacity and Expressive Style continued • Using a client’s metaphor creates

The Client’s Cognitive Capacity and Expressive Style continued • Using a client’s metaphor creates a sense of close following and respect for the way the client frames the world. – A metaphor is a word or phrase that stands for another similar concept. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Informed and Respectful Process • Educational and class differences can negatively affect the language

Informed and Respectful Process • Educational and class differences can negatively affect the language that clinicians use with and about clients. • Clinicians may also make mistaken assumptions about groups of people and not explore things as frankly as they should. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Maintaining the Not-Knowing Position • A not-knowing perspective has two important aspects: – (1)

Maintaining the Not-Knowing Position • A not-knowing perspective has two important aspects: – (1) it is okay not to know, and – (2) clients often know more than we do about the realities of their experience. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Maintaining the Not-Knowing Position continued • Being comfortable with not knowing is absolutely essential

Maintaining the Not-Knowing Position continued • Being comfortable with not knowing is absolutely essential for eliciting the client’s story. – Saying “I don’t understand” is often more useful than saying “I understand” or “Yes, I know. ” • It is important to remember that clients are, and will, always remain, the expert on their own lives. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Sustaining Techniques to Cushion Intensive Exploration • Sustaining techniques offer clients support as they

Sustaining Techniques to Cushion Intensive Exploration • Sustaining techniques offer clients support as they open their stories to deeper exploration and elaboration. • Checking-in is a sustaining technique in which the clinician is really asking how things feel or seem to the client after a period of exploring. – Check-ins emphasize to the clinician the importance of the client’s feelings, observations, and participation generally. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Sustaining Techniques to Cushion Intensive Exploration continued • Several other sustaining techniques include: –

Sustaining Techniques to Cushion Intensive Exploration continued • Several other sustaining techniques include: – Crediting client strengths, – Slowdowns, and – Validation of the difficulty of disclosure. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Appreciating and Using Resistance • Clients showing resistance are signaling a need for caution

Appreciating and Using Resistance • Clients showing resistance are signaling a need for caution and a wish to protect the known in the face of the unknown. • In psychodynamic theory, the term resistance refers to the unconscious defenses against the emergence of painful or forbidden material. • Resistance to clinician questions should not be seen as a negative trait of the client. • When the client balks at further elaboration, the clinician can honor and reframe the balking as sensible. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.

Enough is Enough • Sometimes when clients balk, it may be wise to go

Enough is Enough • Sometimes when clients balk, it may be wise to go down another path or to try exploring with different words on another day or when they signal readiness by introducing a topic similar to the one refused earlier. • Interns and new employees are especially vulnerable to pressure from supervisors and consultants to go after information that may be impossible or unwise to obtain. • It is good to recognize when enough is enough and to let go and move on unless there is imminent risk of harm to the client or to others. © 2011 Brooks/Cole Publishing | Cengage Learning, Inc.