Therapeutic Interviewing

Essential Skills and Contexts of Counseling

Michael D. Reiter

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000538571
• Edition: 2
• Topic: Psicologia
• Subtopic: Consulenza psicoterapeutica

This newly updated introductory textbook is designed to help students of psychotherapy and counseling at all levels build the foundational strategies, skills, and tools essential for engaging clients in a therapeutic interview, developing a specialist understanding of the varying formats and diverse settings in which these interviews occur.

In this second edition, Michael D. Reiter interweaves a new framework, the Issue Cycle, to help students build, from start to finish, a foundational template for engaging clients regardless of therapeutic model. With every chapter being revised, as well as including a new chapter on the ethical relationship that occurs in psychotherapy, the book begins with laying down the context of therapy, such as its definitions, motivations, and ethics, before moving on to developing students skills of therapy, including conversing, reflecting, goal-setting, terminating sessions, and how to avoid being an ineffective therapist. In Parts 3 and 4, chapters cover the contexts of clients and therapy, such as working with children, families, and groups, and includes a special revised focus on multicultural interviewing and effective online counseling. Including several interactive elements, such as case scenarios and application exercises, an instructor's manual with a sample syllabus, essay questions and more, students can uniquely see theory in action.

Practical and accessible, this textbook shall be essential reading for students of psychotherapy and counseling, as well as training family therapists, social workers, and other mental health professionals who work directly with those dealing with psychological, behavioral, and emotional difficulties.

Part I The Context of the Therapy Relationship

1 Therapeutic Interviewing: Defining Therapy, Therapeutic Relationships, & The Interview

DOI: 10.4324/9781003195832-1

You are reading this book because you’re interested in becoming a helping professional. Sitting across from a client and knowing what to say, what not to say, how to sit, how to react, what strategies to use, and a host of other decisions in order to help a person who has come to therapy for some problem(s) occurring in their life is an extremely challenging situation. Likely, you’ve had the experience of helping out friends and family members when they’ve had problems, and there is something about this field that calls to you. Yet, the skills that you used to do that may not be the same for the psychotherapy context. Having a real client sit across from you changes the rules of the game. The conversation becomes different based on the change of roles and rules inherent to such relationships. The person who is good in the friend-to-friend interview will have many more decisions to consider for how to talk with clients. In many ways, your previous learnings of how to have conversations in non-therapeutic contexts can actually hamper and limit you in the psychotherapy context.

This book explores the dynamics, skills, and processes of one specific type of interview--the therapeutic interview. There is no one right way of conducting a therapy session, which is both freedom and restriction. However, sometimes, especially for novice therapists, a blank canvas can be overwhelming. This book can be considered a first step in helping you navigate the therapeutic landscape. The book highlights some of the core foundational skills that most therapeutic interviewers use, while also highlighting some potential pitfalls in the process.

Dynamics of Interviews

A therapy session is an interview, yet it is distinct from other types of interviews such as employment, survey, recruitment, performance, and research interviews. The purpose of the interview is based upon what type of interview it is, the context of that interview, and the goals of each person in that interaction. In any type of interview, two people (or more) mutually engage in a discourse where each is contributing to the conversation. Although we might have the perception that one person (the interviewer) is the owner of the interview, this is not quite the case. Interviews are transactions, where each person is both sender and receiver of communication. Each contributes to the overall output of the transaction. Therapy is another context where this mutual transaction occurs. Lipchik and de Shazer (2017) stated, “The therapeutic interview is an interactional process between a client who is seeking help and a therapist who is expected to provide it” (p. 54).

Interviews are a unique form of human communication and are distinct in their structure, process, and guidelines. They are not the same as regular conversations.

Conversations can range from extremely casual and meaningless (small talk with strangers) to extremely serious (conversations with significant others about important issues in one's life). Regular conversations also usually involve more equity in who talks, how much each person talks, what is talked about, and the purpose of the conversation. Therapy conversations are much more focused with more of the talk and the personalness of the talk being weighted more to one person—the client.

Self-Reflection 1.1

Think about your perceptions of the differences between a normal conversation and an interview. What do you think are the main differences between the two? When would you engage in one rather than the other? What are your perceptions of the differences between the individuals involved? What roles might each of them play and how would that change their behavior during the transaction?

Most interviews, regardless of the context, are a one-time occurrence. However, therapy, more than any other context of interviewing, has interconnected interviews. After an initial interview, the beginning of therapy interviews for second and subsequent sessions will follow-up on the first interview. The conclusion of therapeutic interviews is also different from most other interviews as they tend to ask something of the interviewee, such as some type of homework or other such action that will take what was discussed during the interview and put it into practice to better the person's life. Thus, unlike most other interviews, the goal of the therapeutic interview is change.

All interviews are rule-governed. The more formal guidelines of therapy interviews are set by licensing and credentialing bodies. We call these guidelines ethics (see Chapter 4). Therapists can then use these ethical codes to help them make decisions about their conduct with clients, colleagues, and the general public. Other rules of interviews are more covert and are based on the context of that interaction. For instance, you will likely engage with clients differently if you are meeting with them in your office, in their home, in the school, in a residential setting, or online.

Exercise 1.1 Observing Rule-Based Interviews

Watch an interview conducted between two people. This might be on the television or on YouTube or other such platform. Shows such as 20/20, Howard Stern, or other talk shows usually have some type of interview during the show. Have a notepad and a pen and pay attention to all of the overt and covert rules of conduct during the interview. Some of the things to pay attention to are: who speaks first; last; who is the primary person to ask questions; who speaks longer; how much people can interrupt each other; what type of physical proximity is acceptable; how emotional people can get; etc. Then watch an interview that is occurring in a different context and conduct the same type of observation. What differences do you notice?

People are not born good interviewers. As in all skill development, the old cliché holds that practice, practice, practice is what is important. Therapeutic interviews are unique because it takes an integration of theory and practice. While you may be good when having conversations with friends, family, or in work/school situations, the therapeutic interview is unique. It will take you learning the concepts and putting in time and effort to become good at them. As Gladwell (2008) explained, regardless of field, experts have put in countless hours at their craft (or perhaps not countless, as they average about 10,000 hours of doing the skill). If this is your first endeavor into therapeutic interviewing, you are starting at 0. Patience and practice over repeated therapeutic encounters will help move you to continually improve your craft as a therapist.

The Therapeutic Interview

The therapeutic interview occurs within a unique context of human interaction. It is perhaps one of the most sensitive of all types of interviews because it primarily deals with extremely personal issues of peoples’ lives, such as their hopes, fears, feelings, and pain. At its simplest, the therapeutic interview focuses on change for one member of the duo. However, there is an imbalance in the amount of personal information disclosed, where one person (the client) discloses the majority of the personal information, while the other person (the therapeutic interviewer) discloses a minimal amount of personal information. Although this is the same for many types of interviews, the intensity of the material discussed is usually much deeper and more personal in the therapy interview. There is also an imbalance, where the majority, if not just about all of the focus, is on the client. In most non-therapy relationships, there is equal reciprocity in the amount of time spent talking and the level of personal disclosure. The type of information one person discloses to another is expected to promote similar self-disclosure from the other. Think about the most recent person you met. You were likely to self-disclose your name, school you are going to, major, favorite band, etc., and then expected them to give you the same information back. Yet in the therapeutic interview, there is usually an extreme imbalance of self-disclosure in the relationship context.

The therapeutic interviewer is highly trained in setting a context for conversations that helps open up possibilities for the client. Therapists, having received training in various areas of helping, have expertise in developing conversations for change possibilities. This will be something that will be invaluable for you when clients want to know if you have personal experience with their problem. For instance, someone may come in complaining about the behavior of their child and want to know if you have children. As a therapeutic interviewer, you aren’t there to tell them how to live their life, especially based on how you are living yours. How they should live their life is not your expertise. Your expertise is in helping to create a conversational space that opens up pathways of difference.

What is it that defines an interview as being therapeutic? Therapy is based on an encounter between two or more people where one of these individuals uses verbal and nonverbal skills, such as empathic understanding, to connect with the other person and help move the other person toward desired goals. This empathic understanding connects the two people in a relationship. It is this relationship that is the most fundamental aspect of psychotherapy (Horvath, 2018). Second, the therapeutic interview is a business relationship where the two parties contract with one another for the desired outcome of one person changing some aspect of their situation. Lastly, therapy is based on the therapist having some model of how problems form and how they are resolved (Figure 1.1).

Figure 1.1 Psychotherapy is predicated on the combination of the therapeutic relationship, a focus on change, and the therapist's theoretical orientation.

Although this explanation of what psychotherapy entails gives a very general overview of the field, many people have debates as to what a therapist should be skilled at, how they should work with clients, what the therapeutic goals should be, and how therapist and client should get there. This book provides you with a foundational knowledge of how to conduct a therapy interview, regardless of theory. However, your theoretical orientation impacts the way in which you conduct sessions. Thus, you should take the material presented in this book and evaluate how it makes sense based on your theoretical orientation, the client you are working with, and the context you are working in. The next section of this chapter explores some of the ways in which psychotherapy has been understood.

Exercise 1.2

Watch several interviews conducted on television, or if you can, check out counseling videos from your public or university library. What positive and negative skills do you notice the interviewer displaying? What impact do you notice the interviewer having on the interviewee?

Self-Reflection 1.2

How do you define therapy? What does therapy mean to you? What do you think the main ingredients of counseling are and what are they not? Where did your ideas of therapy come from? What assumptions do you have about what happens between therapist and client?

Defining Therapy

The process in which the therapeutic interview is housed has been called many things over the past century, including psychotherapy, therapy, counseling, and helping. It is practiced by a variety of individuals including psychiatrists, psychologists, family therapists, mental health counselors, clinical social workers, pastoral counselors, professional counselors, and other individuals involved in the mental health service industry. Regardless of the title of the person conducting the therapeutic interview, there are distinct skills needed for working with other individuals. These skills are then used in a context defined by the theory of the therapist, why the client came to therapy, and where the therapy is taking place. The theory addresses what type of relationship to establish with the client, how much self-disclosure, confrontation, and support the therapist should give the client, and what the focus of therapy will be. The theory also informs with whom to meet, how often, and what goals will be addressed. Regardless of theory, a thorough understanding of psychotherapy is needed to place the skills of therapeutic interviewing into a framework of meaning.

Therapy's main purpose is change. Therapists use all of their skills and knowledge to assist clients in moving in a direction of change (be it behavioral, emotional, psychological or relational). The intent of this change is for it to be lasting, so that the client doesn’t have to keep coming back to therapy. Therapists attempt, over time, to get the client to eliminate or reduce a complaint situation. The time necessary to do this might be one session or may take hundreds of sessions over several years. Regardless of the presenting complaint, your job as a therapist is to get your client to fire you as quickly as possible! (But to fire you because you did such a great job that their complaint is no longer a complaint.)

One thing that many novice therapists struggle with is the notion that the therapeutic interview is based within a contractual agreement between therapist and client where the therapist has agreed to utilize their skills and resources to work for the client. The struggle is that the “work” in therapy cannot be one-sided in either direction. Both therapist and client must use the therapeutic interview to try to reach the treatment goals. If only the therapist is working, little to no change will happen for the client as the therapist cannot control the client. If only the client is working, change may occur, however, it will probably not be as effective as if both parties are equally trying to complete the business transaction. Change that would probably have happened without the therapist's interventions wastes the client's time and money. Lambert (2001) discussed this type of variance of change (where the client changes because of things occurring outside of the therapy or personal traits) as extra-therapeutic factors. These account for approximately 40% of change for clients. Although this may make it se...