Intentional Interviewing Summary

Intentional Interviewing Developing Competence in the Counseling Interview Adapted From: Intentional Interviewing and Counseling: Facilitating Client Development in A Multicultural Environment by Allen E. Ivey and Mary Bradford Ivey, 5 th Ed., 2003 and lecture notes from Clinical Interviewing GPY 510 Professor Meredith Drew, Centenary College Spring Semester 2007.

Stipulation
Info only, not to be used in lieu of a professional license. While this material may be helpful; to some it is review and to others it is new. Please use this responsibly and in conjunction with the Ivey’s text as well as class work and a professional license.
If you are a pastor, I hope that reading this material might help you with pastoral care but it is in no way meant to supplant training, proper education and licensure.
Sincerely, BW

Some Key Points to Consider
Interviewing : information gathering and advice giving.
Counseling : focus on normal developmental concerns.
Psychotherapy : treatment of deep seated issues.
Intentional Competence : when using a specific skill in an interview, you can predict what the client is likely to say next. But clients differ, thus with intentional competence you can change style and skills to keep things going smoothly.
Micro Skills : single communication skills units of the interview; for ex: questions, interpreting, summarizing.
Basic Listening Sequence (BLS): used in problem definition leading to good interviewing technique: questioning, encouraging, paraphrasing, reflection of feelings, summarization.

Ethics & Multiculturalism
United Church of Christ Still Speaking Initiative.
No matter who you are or where you are on life's journey, you are welcome here.
What We Believe relates to counseling:
We believe that each person is unique and valuable.
We are a people of possibility.
We believe in the power of peace.
We believe that God calls us to be servants in the service of others.
We believe that each person is on a spiritual journey.

Ethics & Multiculturalism: Some Firsts in the United Church of Christ.
1620: Pilgrims seek spiritual freedom; Mayflower leaves Europe.
1630: An early experiment in democracy by Congregationalists.
1700: An early stand against slavery; Rev. Samuel Sewell writes 1 st anti-slavery pamphlet “The selling of Joseph.”
1846: First integrated anti-slavery society…Amistad freedom supporters.
1785: First ordained African American pastor.
1798: 'Christians' seek liberty of conscience oppose authoritarian church government.
1853: First woman pastor. Antoinette Brown is the first woman since New Testament times ordained as a Christian minister.
1897: Social Gospel movement denounces economic oppression.
1957: Spiritual and ethnic traditions unite, embraces a rich variety of spiritual traditions and embraces believers of African, Asian, Pacific, Latin American, Native American and European descent.
1972: Ordination of first openly gay minister.
1995: Singing a new song, the only hymnal released by a Christian church that honors in equal measure both male and female images of God.

Counseling Cautions! Boundaries Melt Down Diagnosing Triangulation Joi de Vivre

Suicide & Duty To Warn
Suicide : Our Nation loses 30,000 lives to this tragedy each year, another 650,000 receive emergency care after attempting to take their own lives. If a suicide act is immanent, assure that Rescue/911 has been called and that client has been transported to ER.
Duty to warn : refers to the responsibility of a counselor or therapist to breach confidentiality if a client or other identifiable person is in clear or imminent danger. In situations where there is clear evidence of danger to the client or other persons, the counselor must determine the degree of seriousness of the threat and notify the person in danger and others who are in a position to protect that person from harm (Herlihy & Sheeley, 1988; Pate, 1992). Also see: Tarasoff v. Regents of the University of California (1976). Three parts: harm to self, harm to others, abuse from others.

The Theory...

Narrative Theory ACTION A new theory to help clients generate new meaning through story-telling RE-STORY POSITIVE ASSET STORY

Story
By developing good listening skills you will learn how clients make sense of their world; they tell stories about their lives, problems, challenges and issues. By being intentional about your skills you will help them tell their stories in their own way.

Positive Asset
It is not enough to just listen even though that is a critical skill; it is vital that positive strengths and assets are uncovered by the client with your help. Without a Positive Asset Search , Counseling can degenerate into a depressive litany of negative stories, whining and complaining.
Develop respect for your clients and empower them by suggesting ways to build on their strengths.

Re-Story
By understanding client stories and strengths, you will help them re-story; generate new ways to talk about themselves.
An effective listener often helps clients find the strength and power to develop their own new stories.
Focusing, confrontation and influencing skills are used to facilitate this as is the 5-stage interview.

Action
Something must change in terms of the clients thoughts, feeling, and behaviors outside of the interview in order to consider the counseling effective.
Effective counseling strategies helps clients bring new ways of being and thinking into action.
You will learn to use influencing skills to help effect change.

In a Nutshell
Ethics & Multicultural Competence
Attending Behavior 3V’s+B
Client Observation Skills
Basic Listening Sequence
Open/Closed Questions
Encouraging, Paraphrasing, Summarizing
Reflection of Feeling
5-Stage Interview Structure
Confrontation
Focusing
Reflection of Meaning
Influencing Skills & Strategies Story Re-Story Action

Attending Behavior - (3V’s + B)

Attending Behavior
This is basic to communication.
Attending behavior encourages clients to talk, tell their stories and reduce counselor talk time.
The reduced attending behavior used intentionally can help clients move away from less productive or destructive topics.
Can be used to model good communication skills for clients who need them.
Added counselor benefits:
Communicates to your clients that you are interested in them.
Become aware of your client’s pattern of attending.
You can modify your pattern of attending to establish rapport with many individuals.
When counselor is lost or confused…attend!

Attending Behavior: 3 V’s + B
Visual eye contact: if you are going to talk to people look at them.
Vocal Qualities: vocal tone and speech rate indicate clearly how you feel about another person.
Verbal Tracking: the client comes to you with a topic of concern, don’t change the subject, stick with the client’s story…keep on track!
Attentive & Authentic Body Language: face your client squarely, lean forward, have an expressive face and use facilitative, encouraging gestures.

Client Observation Skills- Why, What, How, With Whom?

Client Observation Skills-Why?
The self-aware interviewer is constantly aware of the client and of the here-and-now interaction in the session. The client tells us about their world using verbal and non-verbal means. Observations skills are critical tools to determine how the client interprets their world.

Client Observation Skills-What?
Skills focus on 3 areas:
Nonverbal Behavior : eye contact patterns, body language, Leaning forward, crossing arms, facial cues, large scale movements.
Verbal Behavior : note verbal tracking patterns, topic change- when & who initiates the change?, “I” or “other” statements, do negative statements become more positive?
Discrepancies : incongruities, mixed messages contradiction, & conflict manifest in interviews. Effective interviewers can notice discrepancies and feed them back to the client to benefit the client.

Client Observation Skills-How?
Simple observation of the interview is basic. What you see, hear and feel from the client’s world? Note your impact on the client: how does what you say change or relate to the client's behavior? Use this skill to moderate your Microskill or interview technique.

Client Observation Skills-With Whom?
Observation skills are essential with all clients. Note individual and cultural differences in verbal & non-verbal behavior. Always remember that some individuals and some cultures may have a different meaning for a movement or use of language than your own personal meaning. Use caution when interpreting non-verbal behavior.

Attending Skills- the Basic Listening Sequence (BLS) B.L.S.

Attending Skills -BLS
The BLS (Basic Listening Sequence).
These skills are basic to empathic understanding and they help you communicate to your clients that you are listening to them.
Questioning.
Client Observation Skills.
Encouraging.
Paraphrasing.
Reflection of Feelings.
Summarization.

Questions

Questions
Closed Questions.
Can be answered in a few words ex: intake or interrogation.
Questions begin with words such as “is, are, do, when.”
Focus the interview and help gather specific information.
Puts the burden of guiding the talk on the interviewer.
Open Questions .
Cannot be answered in a few words.
Questions begin with “what, how, why, could.”
Encourages others to talk and provide you with.
maximum information.

Closed-question Example
Counselor: hi Kelly what’s happening with you today?
Kelly: I’m having problems with Peter again.
Counselor: Is he arguing with you again? Closed question, counselor defines the issue.
Kelly: (hesitates) Not really, he’s difficult to work with. Kelly is discouraged.
Counselor: Is he getting his work in on time? Counselor tries to Rx the problem using closed questions.
Kelly: No, that’s not the issue, he’s even early.
Counselor: Does he do a good job? Counselor is grilling Kelly.
Kelly: No, I can’t criticize what he does.
Counselor: Ahh, then it’s you with the problem! Let me share with you some ideas that might help you. Counselor running low on questions begins to look for a person to blame.

Open-question Example
Counselor: hi Kelly what’s happening with you today?
Kelly: I’m having problems with Peter again.
Counselor: More problems? Could you share with me what’s been happening lately? This open question begins with could.
Kelly: Peter has been doing something new, he goes off in a corner with Daniel and they start laughing. He’s ignoring most of our staff. In the middle of all this he still gets his work done. But he is impossible to deal with and it’s tearing me apart . we are hearing Kelly's story.
Counselor: I hear you! Peter is getting more difficult and seems to affect your team as well, it’s stressing you out and you look upset. Is that how you are feeling about things? counselor summarizes and acknowledges Kelly's emotions, the closed question at the end is a check out.

The Encourager
Variety of means to keep your clients talking to help them explore their thoughts and feelings.
Non-Verbal.
Eye contact, smile, head nod, open hand gestures.
Verbal .
Phrases such as: “Uh-Huh”, and simple repetition of a key word the client has uttered.
Restatement.
An extended encourager that repeats two or more exact words used by the client.

Paraphrase
You feedback to the client the essence of what has just been said.
You use some of your own words and the key important words the client used.
Note-Paraphrasing is NOT Parroting!

Sample Client Statement
Client Statement: “I’m really concerned about my wife. She has this feeling that she has to get out of the house, see the world, get a job. I’m the breadwinner and I think I have a good income. The children view Yolanda as a perfect mother, and I do too. But last night, we really saw the problem differently and had a terrible argument.”
Counselor Response : provide the following: key word encourager, restatement encourager, paraphrase with check-out.

Counselor response
Key Word Encouragers : Breadwinner, terrible argument, perfect mother.
Restatement Encouragers : You’re really concerned about your wife, you see yourself as the breadwinner, you had a terrible argument.
Paraphrase with Check-Out : You’re concerned about your picture perfect wife who wants to work even though you have a good income, and you’ve had a terrible argument, is that how you see it?

Reflection of Feelings
This involves observing three things:
Observing emotions.
Naming emotions.
Repeating emotions back to the client.

Reflection of Feelings: Observing Emotions
The counselor must learn to recognize key emotional words expressed by the client.
Examples: It really hurt…you felt angry…you are worried.
This task begins early in the session and as you move along you can help the client discuss & sort through the conflicting emotions that surface.
Use a “check out” to ensure that you stay with your client.
For example: “You are hurting about the situation, but I also sense some disappointment. Is that part of what you feel too?”

Reflection of Feelings: Naming & Repeating Emotions
The first task in reflection of feelings is to recognize key emotional words expressed by the client (basic skill).
The next step is to name and repeat the key words back to the client. This is usually done with a paraphrase (basic skill).
Later in the interview you can explore unspoken feelings which your client might not be fully aware of. Unspoken feelings are often expressed non-verbally: facial expression, eyes, body. After the client’s story is told more completely through your listening, you can help the client bring to the surface and sort through conflicting and unspoken feelings (advanced skill).

Always start with actual expressed feelings using the clients actual emotional words…later move to an exploration of unspoken feelings.
A tool to help with identifying “feeling” words is to consider examples from this group: sad, mad, glad, scared.
A tool to help with identifying deeper and more complex feelings is to explore such indicators as puzzled, frustrated, ambivalent, confused. Also be aware that anger hides a lot of deeper conflicts and emotions.

Reflection of Feelings: Example
My dad drank a lot when I was growing up, it didn’t bother me so much until now. I was just home and it really hurts to see what Dad’s doing to my mum. She’s awful quiet. ( looks down, brows furrowed, body tense ) Why she takes so much I don’t understand. ( looks at you with puzzled expression ) One night mum and I were drinking tea and he came in, stumbled over the doorstep and got angry. He went to hit her and I stopped him; I was so angry I almost hit him myself. ( anger flashes in his eyes ) I worry about mum. (slight tinge of fear seems to mix with anger in his eyes and you notice his body tensing)

Paraphrase : I hear you saying…
Reflection of feeling : You feel…
Deeper conflicts and emotions …I hear that your dad has been drinking for years.(paraphrase) And I hear many different feelings-anger, sadness, confusion-I also sense that you care a lot for your mum and dad. Am I close to what you are feeling about the total situation? (check out with broader reflection of feeling summarizes implicit feelings and encourages the client to think more broadly)

Summarization

Summarization
Similar to paraphrases but are used to clarify and distill what the client has said over a longer period of time. Can be used to begin/end an interview, as a transition to a new topic or to clarify a complex issue.
This technique helps the client and counselor organize their thinking about what is happening during the interview.
The counselor attends to verbal & nonverbal comments from the client made over a period of time, then selects key concepts and dimensions, restating them for the client as accurately as possible. A check-out at the end is part of a summarization.

Summarization…some Ex’s
Beginning of session : “Last time we talked about your feelings toward your mother-in-law and we discussed the argument you had with her…you saw yourself as guilty and anxious…we also discussed a plan of action for the week. How did that go?
Midway : So far I’ve seen that the plan didn’t work very well, you felt guilty when you saw the idea as manipulative. But one idea did work. You were able to talk with her about her garden, it was the first time you were able to talk with her without an argument. You visualize the possibility of following up next week. Is that about it?
End : We've reviewed your feelings toward your mother-in-law in more detail. Some of the following things seem to stand out: first, our plan didn’t work completely, but you were able to talk about one thing without yelling. We also identified some behaviors on your part that could be changed. They include eye contact, relaxing, changing the topic… I also like your idea at the end of talking with her about these issues. Does that sum it up?

Goals of the BLS
The goal of the Basic Listening Sequence is to elicit from the client three things:
An overall summary of the issue: use the “Open Question” here and/or use your attending skills.
“ Could you tell me your story?” At the close of each section of your interview, summarize your client’s main facts and feelings.

Goals of the BLS
The key facts of a situation: use what questions, encouragers and paraphrase to draw out the client’s thoughts about what happened.
The central emotions and feelings : use reflection of feelings and encouragers that focus on emotional words.
“ Could you share your feelings about that issue?”

Expected Consequences of Skill Usage

Ethics & Multicultural Competence
Interviewers who intentionally base their behavior on an ethical approach with an awareness of the many issues of diversity have a solid foundation for a lifetime of personal and professional growth.
Your clients will appreciate, respect and learn from your increasing knowledge in ethics and multi-cultural competence.

Attending Behavior
Clients will talk more freely and respond openly, particularly around topics to which attention is given.
Anticipate fewer eye contact breaks, a smoother vocal tone, a more complete story (with fewer topic jumps) and more comfortable body language.

Basic Listening Sequence
The client’s story, problem, or concern will be presented with the basics of the client’s thoughts and feelings, and the facts and behaviors related to the issues presented.

Open & Closed Questions
Clients will answer open questions in more detail. Clients will give shorter answers to to closed questions providing specific information. Effective questions-open or closed-may encourage more talk regardless.

Client Observation Skills
The interviewer is able to observe verbal and non-verbal behavior in self and in clients and use these observations as a foundation for use of the various Microskills and strategies. The client in turn will respond to the interviewer. The smoothly flowing interview will often demonstrate movement symmetry and complimentarity. Through the observation of discrepancies and conflict the interviewer will be able to provide appropriate helping leads and interventions

Encouraging
Clients will elaborate on the topic, particularly when encouragers are used in a questioning tone of voice.

Empathy

Empathic Understanding Our minds are merging, our minds are one, I feel what you feel, I know what you know...

Empathy
Carl Rogers - empathy is vital in order to understand the client’s world as he/she sees it and experiences it .
Empathy Defined - you experience the world as if you were the client, but with the awareness that the client remains separate from you.
Empathy is most often expressed by the counselor through paraphrasing and reflection of feeling…but other skills may be used.

Three Types of Empathy
Subtractive Empathy : Counselor responses sometimes give back less than or distorts what the client says-inappropriate use of listening or influencing skills.
Basic/Interchangeable Empathy : the counselor responses are roughly interchangeable with what the client says. Accurate use of the BLS=basic empathy.
Additive Empathy : Counselor adds something beyond what the client has said. Adding a link to something that the client has said earlier or frame of reference that helps clients see new perspectives. Skilled use of listening and influencing skills enable the counselor to become additive. Be genuine even though you disagree; respect is huge!

Client
I don’t know what to do. I’ve gone over this problem again and again. My husband just doesn’t seem to understand that I don’t really care any longer. He just keeps trying in the same boring way-but it doesn’t seem worth bothering with him anymore.
Empathy Level 1 2 3 4 5 Subtractive Interchangeable Additive

Levels of Empathic Understanding Level-1 Counselor Subtractive That’s not a very nice way to talk; you should consider his feelings too! Level-2 Counselor Slightly Subtractive Seems like you’ve just about given up on him. You don’t want to try anymore. Level-3 Counselor Basic/Interchangeable You’re discouraged and confused, you’ve worked over your issues with him but he doesn’t seem to understand. You don’t really care . Level-4 Counselor Slightly Additive You’ve gone over the problem with him again and again to the point that you don’t really care right now. You’ve tried hard. What does this mean to you? Level-5 Counselor Additive Any clue about what an additive response might be?

Additive Response Empathy Level-5 Counselor
I sense your hurt and confusion and that right now you really don’t care anymore. Given what you’ve told me, your thoughts and feelings make a lot of sense to me. At the same time, you’ve had a reason for trying so hard. You’ve talked about some deep feelings of caring for him in the past. How do you put that together right now with what you are feeling?

Initiating the session : establish rapport (3 V’s + B) and structure the interview. Have a basic plan!
Gathering information : the BLS and positive asset search, draw out stories, concerns, problems or issues.
Mutual goal setting : why are we here? what does the client want to have happen?
Working : getting into it, how are we going to solve this? explore alternatives, confront client incongruities & conflict, and restorying.
Terminating : do you have enough skills and understanding? Empower the client- to generalize and act on new stories.

Positive Asset Search Initiating the Session Gathering Data Mutual Goal Setting Working Terminating

Positive Asset Search
During counseling it is very important to give attention to client strengths. The positive asset search should especially be part of the data gathering aspect of the interview and systematically included later in the session as well as woven throughout the session.
Seek to draw out client stories, problems or concerns within a positive framework of strength and possibility…one way to communicate respect to clients is to tell them stories of strength and say good things about themselves.
CLIENTS GROW FROM STRENGTH!

Confrontation But…But…But

Confrontation
All counseling skills are concerned with facilitating change, but it is the skill of confrontation that acts as a lever for the activation of human potential.
Confrontation is not a direct harsh challenge. It is not going against the client, but with the client…a gentle skill that involves listening carefully and respectfully and seeking to help the client examine self or situation more fully.
Confrontation is a supportive challenge!

Confrontation
moving a client from inaction to action involves three major steps :
Identify conflicts via mixed messages, discrepancies and incongruences (client observation skills).
Point out the issues clearly to clients and work through the conflict to resolution (questioning, observation, reflective listening, & feedback).
Evaluate effectiveness of the intervention on client change & growth (see Confrontation Impact Scale).

Confrontation Impact Scale C.I.S.
The confrontation impact scale has been modified from but is based on pioneering principles developed by Elizabeth Kübler-Ross’s work on death and dying.
Clients often resist and sabotage change.
The C.I.S. is a general model to help the counselor assess effectiveness of confrontation and gauge the change process.

Confrontation Impact Scale 1-5
Denial : deny that an incongruity or mixed message exists. “I’m not angry about the divorce, these things happen. I do feel sad and hurt but definitely not angry.”

Partial Examination : the person works on part of the discrepancy and not the other parts of the mixed message. “I’m hurt, maybe I should be angry but I can’t feel it.”

Acceptance & Recognition but No Change : Client engages the confrontation but doesn’t make a resolution. Client needs to examine incongruity, stuckness & mixed messages. “I do have mixed feelings…I hurt, but I’m really angry at what’s been done to me.”

Generation of a new solution (early transcendence): client moves beyond recognition of the incongruity, puts things together in a new and productive way. “yes, I’ve got it, I’ve avoided my deep feelings of anger and I think it’s getting in my way. I hurt, and If I am going to move on, I have to allow myself to feel that angry part too.”

Transcendence-Development of new, larger, and more inclusive constructs, patterns or behaviors “I like the plan we’ve worked out. You helped me see that mixed feelings and thoughts are part of every relationship. I can move on now!”
transcendence

Focusing

Focusing
Client stories and issues have many dimensions. It is tempting to accept problems as presented and oversimplify the complexity of life!
Focusing can help a confused client focus zero in on important dimensions.

Focusing: 7 types of focuses:
Focus on the client : “ Teri, you were saying last time that you are concerned about your future…”
Focus on the main theme or problem : “ Tell me more about your getting fired . What happened specifically?”
Focus on others : “So you didn’t get along with the sales manager , I’d like to know more about him …”
Focus on Family : “How supportive has your family been?”
Focus on mutual issues or groups: “ We will work on this. How can you and I (our group) work together more effectively?”
Focus on Interviewer : “ My experience with difficult supervisors was…”
Focus on cultural/environmental/contextual issues : “It’s a time of high unemployment …what issues will be important for you as a woman seeking a job”?

Focusing: 2 additional strategies Family Genogram Community Genogram Hometown & Church Home-Dad ran a store, we lived in back Two-room rural school Grandma’s Farm, dad’s home

Meaning organizes life experience and serves as a metaphor from which clients generate words, sentences, and behaviors. Clients faced with complex life decisions may make them on the basis of meaning, values and reasons rather than on objective facts or feelings.
Ask the client questions that help them explore meaning: What does this mean to you, What sense do you make of it, Why is that important to you, what values underlie your actions, what was you intention when you did that…

Meanings are reflected through the following process:
Begin with a sentence stem like the following: ‘You mean…” “Could it mean that you…” “Sounds like you value…”
Use the client’s own words that describe the most important aspect of the meaning so you stay in the client’s frame of reference.
Add a paraphrase of the client’s longer statements capturing the essence of what has been said.
Close with a check-out such as “Is that close…” or “Am I hearing you correctly…”

Influencing Skills

Interpersonal Influence Continuum Low Moderate High The Moderate Triad The amount of influence observed over client talk by different skills. Encouraging/Restating Reflection of feeling Paraphrasing Reflection of Meaning Open Questions Closed Questions Focusing Information/Instruction/Advice Self-Disclosure Feedback Interpretation/Reframe Logical Consequences Directive Confrontation

Influencing Skills: 6 Strategies for Change
Interpretation/reframe: re-story, guide the client to look at the problem from a new perspective with a new frame of reference.
Logical consequences: look at the possible results of alternative actions, anticipation of rewards/punishments.
Self-disclosure: interview shares brief story, thoughts or experiences-I,me,my + verb (think, feel, have experienced) be genuine and cautious.
Feedback: see/hear ourselves as others see/hear us, be touched as others touch us. Focus on strengths, be concrete & specific, lean & precise, nonjudgmental, use check-out. Not - “you did a good job” but -I saw you relax and become more joyful as you became more assertive.”
Information/advice/opinion/instruction/suggestions: attend to client, be clear, specific & concrete and use check-out.
Directive: involve client as co-participant in strategy, use 3V’s + B, be clear & concrete, use check-out.

Thank You very Much!!!!

Intentional Interviewing Summary

by Bernd Weishaupt

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