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Clinical Interviewing Skills

1) Interviewing a person with a persistent headaches and problem sleeping, how to structure an interview?
2) Composing the questions, what are 5 examples of open-ended questions and 5 examples of closed-ended questions to obtain the information during the interview?
3) Develop hypothetical examples of at least 5 techniques (paraphrasing, summaries, or reflections) that could be used during the interview.
4) What are the possible opening techniques to be utilized to build rapport with the person interviewed?
5) What types of question we want to avoid during the interview?
6) Explain how one's own beliefs could affect the interview? How beliefs can influence by one's own cultural, gender, sexual orientation, or ethnicity?
7) What are steps to take to limit the impact of one's own beliefs on the interview?

Solution Preview

Below is a list of things that we practice when conducting a clinical/diagnostic interview. I tried to keep it in point form but I elaborated on each one to highlight why is it important.

Clinical/Diagnostic Interviewing Skills
Things to take note of:
• The purpose of the interview is to collect information that will help you understand the presenting problem, formulate your hypothesis and help you with diagnosis and treatment plan for this client.
• You are an investigator, the client is the expert about this problem and your job is to guide the client to reveal clues that will help you gain a clearer picture of this problem
• Note if the client is referred by another person/agency or is self-referred
• If referred by someone else, you may already have some background information on the problem as assessed by another clinician or medical examiner
• Do not take all the information and existing diagnoses at face-value. They still need to be investigated. Although it is important to understand the history (previous diagnoses if any, medications, family history, medical reports, current diagnosis etc.) of the client from these reports, it is extremely important not to form judgements or allow these pieces of information to sway your investigation process. This may lead to confirmatory bias during the interview (considering information that supports your pre-conceived notions and dismissing information that does not support them).
Steps to conducting Interviews:
• Read any background information about the client to guide your interview process
• Establishing 2-way conversation by building rapport with client. Establishing good rapport with the client increases compliance and allows the client to share freely. This can be done in several ways:
1. Establish their preferred name and introduce yourself
2. Ice-breaker conversations : non-threatening topics, humour
3. Be professional, polite, respectful (tone of voice, choice of words) and empathetic
4. Not speaking too fast or too slow, checking for understanding especially if the client is from a different country, cultural background, have a developmental or learning disorder or may not speak the same language.
5. Understanding that the client may be stressed, on medication, sleep-deprived, have a pre-existing disorder/disability, may not be motivated to participate or may not be functioning at their peak. Thus, it is important to allow time to process questions, repeat if necessary and always check for understanding.
6. Establishing confidentiality clause with the client and establishing boundaries
7. Practice active listening skills: Appropriate body language, non-judgemental comments, paraphrasing what the client has shared, showing interest, smiling, complementing and encouraging the client
8. Building on client's ideas and asking appropriate follow-up questions to allow conversation to flow and to encourage client to elaborate
9. Do not stick to an interview checklist and aim to follow through with each question in a robotic manner. The interview should ideally build on in a conversational manner and allow some flexibility in questioning without going too far off tangent.
10. Pay attention to non-verbal cues of your client to determine comfort level. Adjust topics, type of questions (open-ended vs close-ended) and distance between you and the client accordingly.
11. Establish purpose of the meeting, the procedures if any and briefly explain what to expect from this session (e.g. "I would like for us to get to know each other a little more today. I have some questions to ask you but I prefer to keep this as a 2-way conversation so please feel free to stop and ask me any questions at any point during this session. If you feel uncomfortable answering any questions, do not hesitate to let me know. If you do not understand anything I ask you, please feel free to ask"). Knowing what to expect next can lower anxiety for clients.
12. It is important to know when to interrupt a client during the interview session. Interrupting them can disrupt the flow of the conversation, result in loss of important information and may hinder rapport between the clinician and client. However, it may be important to interrupt the conversation if the conversation is going off tangent or you need the client to elaborate further on a point that they have made. Wait for a natural pause when they are talking and interrupt gently. Always show that you have been listening by summarizing what has been shared.

• Begin Interview with open-ended questioning and follow-up with a mixture of open and close-ended questions. Monitor client's responses to the different approach of questionings and adapt accordingly. If client hesitates to elaborate, use appropriate prompts but do not ask leading questions.
• Determining the orientation of the client is an important first step. Orientation includes questions pertaining to name, day/date, time, location, and personal information such as address, phone number etc. This establishes ...

Solution Summary

Clinical interviews is an essential step to diagnosis. This article gives a step-by-step guide to the important aspects of clinical interviews, examples of questions and types of biases that a clinician needs to be aware of.