Definition:

Interviewing is a Structured manipulation to influence the mental processes of the patient

toward therapeutic gain.
The very act of verbalizing has certain releasing values for the person. It provides a kind of
emotional catharsis in which the individual discharges quantities of pent-up tensions and
feelings. The benefits of “talking things over” with a sympathetic person and of “getting off
one’s chest” burdensome thoughts and painful feelings are well known. Irrespective of any
advice received, the mere ventilation of attitudes and emotions helps the individual to evaluate
the situation better and to approach problems in a more constructive manner.

Objectives of interview:
1. The purpose of the clinical interview is to gain sufficient information from the
informant or informants to formulate a diagnosis, assess the individual's strengths and
liabilities, assess the developmental and contextual factors that influence the presenting
concerns, and to allow planning for any interventions to follow.

2. The interview is used primarily to gather information for clinical evaluation or

psychotherapeutic treatment, it can also serve the purpose of preparing the
patient for therapy, and less frequently the interview process itself provides some relief
from psychological distress.

3. Gathering Information for Assessment and Treatment

4. Establishing Rapport for Assessment and Treatment

INTERVIEWING TECHNIQUES:
I. Opening the Interview
II. Maintaining the Flow of Verbalizations
The encouragement of verbalizations is a prime task during interviewing. This is done by
listening attentively to the patient, signalling that the therapist is following what is being said by
nodding of the head, by controlled facial expressions, by such utterances, as “yes,” “I see,” and
“mm hmm,” and by carefully selected questions that indicate interest and understanding. As
long as a patient continues on an important trend, fulfilling the specific goal toward which
therapy is directed at the time, one does not interrupt. However, when there are too prolonged
pauses, where the patient shifts concentration from the pertinent focus, or where one wishes to
reflect feeling or to make interpretations, the therapist makes added verbal comments. There are
some patients who need little encouragement apart from a few non-verbal interpolations. There
are other patients with whom the therapist will have to manifest much more activity, perhaps
even after every sentence.

a. Managing pauses
b. Managing silence

III. Directing the Flow of Verbalizations: The Principle of Selective Focusing

In general, the process of selective focusing consists of initially identifying an important theme
in the patient’s verbalizations, of guiding this theme into a goal-directed channel, and of
circumscribing the area of subject coverage.

a. Identifying an important theme

If one has followed the suggestions outlined in opening the interview—namely, not interfering
with the thought content of the patient—the therapist will become aware of certain immediate
preoccupations. Irrespective of how unimportant the therapist considers these to be, it is urgent
to heed them carefully. They may be far removed from the material that the therapist wants to
discuss, but to neglect or circumvent them, or to substitute other topics, constitutes a fatal error
in interviewing.

b. Reading between the lines

There are many times that patients will say with conviction things that they do not entirely
believe. Early defenses to avoid hurt and censure continue to operate in adult life toward
masking true meanings. This unconscious duplicity is reinforced in the here-and-now by many
aspects of contemporary society that endorse deceit in social communication. We become so
concerned with the consequences of our behavior (e.g., the effect of what we say on persons
whose esteem we seek to sustain) that we exploit counterfeit tactics to please rather than to
voice our genuine convictions. While such inauthenticity sometimes has certain immediate
practical advantages, we pay a penalty for this indulgence in the currency of fear, hopelessness,
guilt feelings, and a diffuse sense of outrage. The shaping of our behavior according to such a
spurious design often causes us to live a good deal of the time outside of ourselves.

c. Guiding the theme into a goal-directed channel

While the dominant theme may be the vehicle of the interview, it is essential to direct the theme
toward a fruitful goal. Of their own accord patients may not be interested in moving toward this
goal. They may even resist violently attempts to shift the topic of discussion away from the goal
that is dominant in their mind. It will be necessary, therefore, to accept the patient’s choice of
topic and then try, in as subtle a way as possible, to influence the content of thought toward an
important objective.
IV. Inculcating Insight
a. Accenting
Accenting is also useful in getting patients to accept certain facts about themselves and their
situation. These may have escaped verbalization for the following reasons: (1) a lack of
incentive to reveal facts, (2) a conscious fear of such revelations, (3) unconscious fear of the
factual implications, (4) a confusion as to which facts are important, and (5) complete ignorance
of what the facts are, due to repression. Pointed questions help their patients break through
resistances. Repetition serves the added purposes of questioning the validity of the patient’s
comments and of obtaining more information about specific topics

b. Summarizing
Patients often ramble in their verbal accounts. They may become so engrossed in detail that
they lose sight of the interrelationship of the various topics discussed. They may fail to connect
casual happenings with basic themes. A rapid summarization from time to time, therefore, is
helpful in pulling together material that seems to be uncoordinated. It is useful also as a
measure preliminary to a pertinent question intended for purposes of focusing.

c. Restating
Recasting certain statements of the patient into different words brings out related aspects of the
material that may have escaped attention. It also explicates what may be difficult for the patient
to verbalize. Repetitive reformulations emphasize important trends in the patient’s mind and
help to rephrase his or her problems in more cogent terms.

d. Reflecting
Reading between the lines of what the patient says, the therapist becomes attuned to feelings
affiliated with verbalizations and to emotional undercurrents of the content of thought, as well
as to attitudes that have not been expressed. The therapist reflects these back to the patient,
putting them into terms that the patient will be able to accept without stirring up too much
anxiety. For instance, a patient launches into great praise of her employer and the possessions
of the employer: Cadillac car, country estate, and important friends. The therapist senses
jealousy and restrained contempt in the patient’s tone and reflects these feelings by saying, “Yet
some of the things your employer does may irritate you.’’ The patient responds by cautiously
criticizing, then openly attacking her employer. The exposure of the patient’s feelings and
acceptance of these by the therapist relieve guilt and encourage a deeper exploration of
emotions and conflicts.

e. Establishing connections
Due to the factor of repression even obvious connections between symptoms, feelings, and
inner conflicts may not be seen by the patient. The relationship of daily happenings in the
patient’s life with tension and anxiety states that are constantly being mobilized also continues
to remain vague. The patient will, therefore, require help from the therapist who establishes the
associations for him or her

f. Maintaining tension in the interview

The maintenance of a certain amount of tension in the interview is essential in getting patients
to think things through for themselves. Tension acts as a driving force by creating in the patient
an incentive for change through active participation in the therapeutic process. On the other
hand, a relaxed, tensionless state tends to diminish activity. Tension may be created in a number
of ways, particularly by focusing on provocative topics, by asking challenging questions related
to painful or avoided subjects, by giving patients interpretations of their disturbed attitudes or
behavior, and by the strategic use of silence.

g. Extending measured support

Measured support is given the patient whenever the ego resources crumble and the patient show
symptoms of collapse. This temporary prop may help the patient retain the insights he or she
has developed, since it prevents the ego from employing repressive and regressive defenses
elaborated to preserve its integrity. An ego threatened by too great anxiety may protect itself by
repudiating the insights it should integrate. Among the measures practiced to give the patient
support are reassurance, avoidance of conflictual topics, and direct advice and guidance.
Reassuring comments, for example, may involve statements such as, “In spite of all your
difficulties, you have achieved a good deal in life.” Following this, one may enumerate positive
achievements of the patient or the patient may be told, “All people make mistakes and go
through periods of misery.” Such techniques must be employed sparingly and only where
absolutely necessary, in reconstructive therapy.

h. Confrontation
Patients may be confronted with certain contradictions in their behavior, queries being made as
to why they react the way they do. This will impose pressure on them, to which they will
respond variantly: defensively with rationalizations, angrily with rage, indifferently with
detachment, tremulously with anxiety, or with a host of other responses fashioned by their
feelings toward the therapist, how they imagine the therapist regards them and their foibles, and
what the exposure does to their self-image. The way confrontations are communicated—the
wording, tone, and facial expression of the therapist—will influence the quality and intensity of
the patient’s responses. Some highly challenging confrontations may be made, and they will be
accepted if presented in a kindly, non-condemning, firm, but understanding manner that
conveys a non-judgmental and non-punitive intent. On the other hand, confrontations posed
accusingly or demeaningly, or before a good working relationship has been established, may be
resisted violently.
I. Making interpretations
The making of interpretations, especially in reconstructive therapy, is an important step in
promoting insight since it constitutes a frontal attack on existing blocks in patients and enables
them to come to grips with anxiety. Anxiety is at the root of practically all psychopathologic
problems. Defenses against anxiety cripple the adjustment capacities of the person, causing one
to react in an inappropriate way to casual happenings. Interpretations directed at bringing
patients to an awareness of their anxiety show them how they are responding to this emotion
and the defenses that they utilize in warding it off. Interpretations also help to dissolve
resistances that constantly interfere with patients’ capacities to think for themselves.
Interpreting blocks that prevent patients from becoming aware of their problems is a prime task
in interviewing.

V. Terminating the Interview

The proper termination of the interview is extremely important. There are some therapists who
mismanage this phase of the interview due to a fear that they may offend the patient. Thus they
are unable to interrupt a patient at the end of a session for many minutes after the interview time
has terminated. The invasion of the next patient’s hour complicates the schedule of the therapist
and often creates resentment in the succeeding patients.
No matter how lenient the therapist may be in other respects, strict adherence to a time schedule
is important. If at least 5 minutes’ interval between patients is allowed, the therapist will be able
to extend several minutes’ time to a patient who is upset or to one who is dealing with highly
charged material. The only exceptions to a rigid time schedule are treatment sessions with very
sick patients. Here, at least 15 minutes of leeway between sessions should be arranged in
advance to allow for an extension of the interview if necessary.

TYPES OF INTERVIEW
There are many different forms of interviews conducted by psychologists. Some interviews are
conducted prior to admission to a clinic or hospital, some are conducted to determine if a
patient is in danger of injuring themselves or someone else, some are conducted to determine a
diagnosis. Whereas some Interviews are highly structured with specific questions asked for all
patients, others are unstructured and spontaneous.

Some important forms of interview are:

● The intake / admission interview
● The case history interview
● Mental status examination interview
● The crisis interviews
● Diagnostic interview
THE INTAKE/ADMISSION INTERVIEW
According to Watson; “This type of interview is usually concerned with clarification of the
patient's percentage complaints, the steps he has taken previously to resolve his difficulties and
his expectances in regard to what may be done for him".
The purpose of the initial intake interview or admission interview is to develop a better
understanding of the patient's symptoms or concerns in order to recommend the most
appropriate treatment or intervention plan. Whether the interview is conducted for admission to
a hospital, an outpatient clinic, a private practice, or some other setting the initial interview
attempts to evaluate the patient's situation as efficiently as possible.
Ordinarily a psychiatric social worker conducts this interview; however, upon occasion, the
psychologist, one of the physician, or a psychiatric nurse may serve as intake interviewer.
The basic question to be dealt with is "Why is the patient here? i.e., what doe she says is the
matter with him? Important but secondary questions involve information about previous
hospitalization, the name of his doctors, what the patient expect from treatment, his availability
for treatment, and the like. Although typically brief, the intake or admission interview is
extremely important in conserving the time of other professional staff members and in sparing
the clinic or hospital for occasional embarrassing or awkward situations. The patient may in
some instances desire treatment which a particular clinic may not be prepared to give.
Certain hospitals, for example, do not handle alcoholic or narcotic addiction cases; thus the
patient can be at once referred to an appropriate institution, saving time for the examining
psychiatrist, psychologist, the various attendants, and for the patient himself. Similarly, the
awkward consequences of an overly casual admission procedure can be avoided by a well-
planned interview. Hospital staff members can relate many anecdotes of relative's who were
mistaken for the patient himself, of surgical patient who were given diagnostic psychiatric
interview, or of salesman who were escorted to a room and confronted with a personality test.
A careful intake interview will guard against such mistakes. It should be noted that every
patient will not be able to state coherently what the nature of his trouble may be. But even the
unclear replies can be highly revealing, and the astute intake interviewer can report significant
observation of the patient's behavior which he may not reveal again for some time or which
may be missed by later examiners. Ordinarily, the diagnostic and treatment session which come
at some time after the intake interview are carried out by another, different staff person. This
does not mean however, that therapy begins later.
CASE HISTORY INTERVIEW
In many hospitals and clinics the intake or admission interview is followed immediately by the
personal and social history interview. The same person usually a psychiatric social worker,
commonly conduct both interviews, often in one sitting. Sources of information other then the
patient himself are, of course, utilized when completing a personal and social history report.
Frequently, the patient does not remember or cannot for other reasons communicate material
which may have a bearing upon his problem. Thus, information from friends, relatives, hospital,
military, and other records are also used for the history. But whatever the source of information,
the purposes of the social and personal history report is to gather information which will be
helpful in diagnosing and treating the patient's disorder. Frequent job changes, for example,
may be evidence of general instability. The adult schizophrenic who showed marked apathy and
withdrawal symptoms as a preschool child is probably more severely afflicted than patients
whom symptoms appeared more recently. Neurotic symptoms which appear after the divorce of
parents may have different etiology than similar symptoms which appear after the head injury.
In most instances a standardized form or social history guide of some sort is used. Certain
obvious information may not be recorded because the form does not call for it or details which
are unimportant for a particular case may be set down in time wasting abundance. Obviously,
the common sense of the interviewer is the answer to such problems. The typical information
obtained in a personal and social history includes material on the patient's early life, with
particular attention paid to family relationship and general environment. Also included are data
on the patient's educational and vocational history, neuropathic traits, his habits, and
recreations, as well as other material. Obviously much of this information can be obtained only
by direct questioning. Some patients are threatened by situations which require specific
answers, and they may show panic reactions of varying degree. Others will lie, perhaps because
they cannot remember and do not wish to say so, but more often because painful memories are
awakened of jail sentences, of divorce, of previous hospitalization, or the like. Most patients, of
course, are truthful, but only in their cultural fashion. It is this area that the skill of the
interviewer is brought out. While much of the information requested is factual, the manner in
which the patient communicates his facts may be quite misleading. The fact that an occasional
patient will lie about his personal social history, even about trivial matters, is sometimes
irritating or disheartening to the newcomer to the interviewing situation. Such falsification is
not a reflection upon the interviewer's skill or comportment but rather upon the reason why the
patients being interviewed. He is a patient. He may be confused, a psychopath, or something
else; but he is sick. This may seem like unnecessary emphasis; yet every clinician should be
prepared to ward off feelings of indignation or humiliation which may arise when he learns that
virtually every fact he so laboriously recorded, from age and address to family history and
vocation, is false. This happens with extreme rarity, of course; but it happens to almost every
clinician sooner or later. When it does, and if one is taken in, a little self-directed humor helps
restore a sense of proportion. Then a firm resolution to check other information sources can turn
the experiences to one's advantage.

MENTAL STATUS EXAMINATION INTERVIEW

Often a mental status examination interview is conducted to screen the patient's level of
psychological functioning and the presence or absence of abnormal mental phenomena such as
delusions, delirium, or dementia. Mental status exams include a brief evaluation and
observation of the patient's appearance and manner, speech characteristics, mood, thought
processes, insight, judgment, attention, concentration, memory, and orientation. Results from
the mental status examination provide preliminary information about the likely psychiatric
diagnosis experienced by the patient as well as offering some direction for further assessment
and intervention (e.g. referred to a specialist, admission to psychiatric unit, and evaluation for
medical problems that impact psychological functioning). For instance, mental status interviews
typically include questions and tasks to determine orientation to time (e.g., "what day is it?
What month is it?),place (e.g., Where are you now? Which hospital are you in?"), and person
("who am I who is the president of United States?"). Also, the mental status interview asses
short term memory (e.g. "I am going to name three objects I'd like you to try and remember:
dog, pencil, and vase") and attention-concentration (e.g., "count down by 7s starting at 100. For
example 100, 93, and so forth").While there is some mental status examination that are
structured resulting in scores that can be compared to national norms, most are unstructured and
do not offer a scoring or norming option. During the examination the interviewer notes any
unusual behavior or answers to questions that might be indicative or psychiatric disturbance.
For example, being unaware of the month, year, or the name of the current president of the
United States usually indicate mental problems. This can result in bias based on the
interviewer's clinical judgment during and evaluation.

THE CRISIS INTERVIEW

A crisis interview occurs when the patient is in the middle of a significant and often traumatic
or life-threatening crisis. The psychologists or the mental health professionals (e.g., a trained
volunteer) might encounter such a situation while working at a suicide or poison control
hotline, an emergency room, a community mental health clinic, a student health service on
campus, or in many other settings. The nature of the emergency dictates a rapid, "get to the
point" style of interview as well as quick decision-making in the context of a calming style. For
example, it may be critical to determine whether the person is at significant risk of hurting him-
or herself or others. Or it may be important to determine whether the alcohol, drugs, or any
other substances are used, so as to make sure that the clinician interviews the person in a
calming and clear-headed manner while asking critical questions in order to deal with the
situation effectively. The interviewer may need to be more directive (e.g., encouraging the
person to phone the police, unload gun, provide instructions to induce vomiting, or step away
from a tall building or bridge); break confidentiality if the person (or someone else, such as a
child) is in serious and immediate danger; or enlist the help of others (e.g., police department,
ambulance).

THE DIAGNOSTIC INTERVIEW

The purpose of the screening or diagnostic interview is to assist the clinician in his attempt to
understand the patient. If the level of diagnostic understanding required is merely a separation
of the fit from the unfit, as in military neuro-psychiatric examinations, the interview task is one
of screening. That is, after a brief interview the interviewee be adjusted fit for specific duties,
such as a regular military assignment, or he may be referred for prolonged observation and
extended psychological testing. Occasionally, limit trial duty may be recommended as an
alternative to regular duty of psychological observation. Upon other occasions the diagnostic
task is highly specific, and a detailed level of understanding is required. This may involve a
diagnostic label as categorized as "paranoid schizophrenia" and a description of personality
dynamic. In the latter case primary dependence is not placed upon the interview alone, for
psychological tests play a most important role in such detailed diagnostic procedures. In the
diagnostic interview, while the examination progresses; the interviewer observes the
interviewee’s behavior as well as noticing the content of his answers. Thus thighs pressed
together, a mincing walk, and fluttery feminine gestures in a male should lead the interviewer to
suspect and investigate the possibility of homosexuality. The bubbling, enthusiastic replies and
exaggerated gestures in another interview should lead the interviewer to hypothesize tentatively
a manic condition and seek further evidence. Ordinarily, brief neuro psychiatric interviews are
not oriented towards future psychotherapeutic activity because most of the interviews have no
need of therapy. However, it is not difficult to adopt the procedure of the brief interviews so
that those who seem in need of treatment are rendered more receptive to the idea. Thus this kind
of interview is used to describe whether an individual needs help or not.

STRUCTURE OF INTERVIEW :
There are 3 main structures:
1) A fully structured interview - all questions are delivered to each respondent consistently,
regardless of their responses.
2) A semi-structured interview - there are some set questions that are delivered to all
respondents. However, other questions vary depending on earlier responses.
3) An un-structured interview - an exploratory interview with few or no set questions. Clearly
more planning is needed in structured interviews than unstructured interviews, which

CHARACTERISTICS OF STRUCTURED AND UNSTRUCTURED INTERVIEW

UNSTRUCTURED CLINICAL INTERVIEW
The unstructured clinical interview is a ubiquitous, time-honoured, and significant contributor
to the diagnostic and treatment processes in clinical psychology. In a sense, it is like a free-
flowing conversation between the clinician and respondent, and there are no a priori parameters
for the specific topics and relative depth of conversation.
This unstructured approach provides ample opportunities for gathering general client
information and a relatively rich description of the client’s experience (rather than an
exclusively stringent focus on the client’s problems or symptoms). The flow, sequence, and
content of this type of interview are largely determined by the clinician’s theoretical model
(e.g., psychodynamic, cognitive-behavioral, existential/humanistic, etc.), view of
psychopathology, training, knowledge base, intuitions, and interpersonal style, as well as by the
nature of the client’s responses. With the unstructured approach, clinicians are entirely
responsible for determining the specific questions that are critical to successfully completing
the diagnostic process. However, a clear advantage of this relatively unstructured approach is
that it provides extensive opportunities for empathizing with the client and developing a strong
therapeutic relationship.
Another advantage associated with the unstructured clinical interview is its inherent flexibility
with respect to topics of discussion, with no a priori guidelines limiting the boundaries of
exploration. The lack of structure in this approach can be a serious disadvantage, however, as
the clinician may not gather all the information needed for an accurate diagnosis and useful
case conceptualization.

STRUCTURED CLINICAL INTERVIEW

On the other end of the spectrum, structured interviews conform to a standardized list of
questions (including follow-up questions), a uniform sequence of questioning, and systematized
ratings of the client’s responses. The most common types of structured interview are those that
focus on the psychiatric diagnostic process.
In structured diagnostic interviews, the standardized questions are designed to measure the
specific criteria for mental disorders as defined in the DSM. These essential elements of
structured diagnostic interviews serve several important purposes. Most notably, their use
increases the coverage of many mental disorders that otherwise might be overlooked in a less
standardized approach, enhances the diagnostician’s ability to accurately determine whether
particular symptoms are present or absent, and reduces variability among interviewers. Taken
together, these elements serve to increase reliability, or replicability, of diagnosis. This is highly
valued because diagnostic reliability is a prerequisite of diagnostic validity.
There are two types of structured interview: fully structured and semi structured. In a fully
structured interview, questions are asked verbatim to the respondent in a specific predetermined
order, the wording of probes used to follow up on initial questions is specified, and interviewers
are not to deviate from this format. In contrast, in a semi structured interview, although initial
questions for each symptom are specified and are typically asked verbatim to the respondent,
the interviewer has considerable latitude to follow up on responses. The interviewer can modify
or augment the standard inquiries with individualized and contextualized probes to rate specific
psychiatric symptoms more accurately. The amount of structure provided in an interview
clearly impacts the extent of clinical experience and judgment needed to administer the
interview appropriately: Semi structured interviews require clinically experienced examiners to
administer the interview and to make diagnoses, whereas fully structured interviews can often
be administered by no clinicians who receive training on the specific instrument. This latter
difference makes fully structured interviews popular and economical, especially in large-scale
research studies in which an accurate diagnosis is essential Structured and semi structured
interviews have been created to assist with the differential diagnosis of all major clinical and
personality disorders in the DSM system, as they are specifically designed to assess the formal
diagnostic criteria specified in the manual. Other structured interviews are narrower in focus,
designed to assess a specific problem or form of psychopathology in great depth (e.g., eating
disorders, substance abuse, borderline personality disorder features, gambling, autism spectrum
disorder). In addition to the purpose of DSM differential diagnosis, structured interviews have
been developed to assess one’s competency to stand trial or one’s personality traits according to
the five-factor model of personality.

INTERVIEWING SKILLS :
Open-Ended Questions, Clarification, Reflection, Facilitation And Confrontation, Silences
In Interviews, Verbal And Non-Verbal Components.

QUESTIONS
There can be a range of question types during the interview. Be aware that the
questions you select will greatly influence the direction of the interview. You may need to
ask a question in more than one way in order to elicit the information you are after.
Open ended questions
• Useful when the interview is exploratory, or when the emphasis is on discovering
the respondent’s perspective on events.
• Can motivate by allowing free association, giving recognition, allowing the
interviewer to be a sympathetic listener, and avoiding more specific questions that
might alert the respondent to ego-threatening information.
• Disadvantage is that they are liable to a larger proportion of irrelevant information
than narrower questions, and some detail may be missing.
• Useful in understanding the chronological order of events, and assessing the
vocabulary of the respondent.

Types of Open-Ended Questions

Open-ended questions are likely to feature the typical "who, what, where, when, why, and how"
These questions draw out different kinds of responses that can be useful for a therapist.

● Who: Elicits insight into relationships

● What: Most often leads to facts
● Where: Enables discussion about the place the environment took place
● When: Brings about the timing of a problem, including what happened immediately
before and after it
 ● Why: Most often brings about reasons
● How: Enables a person to talk about feelings and/or processes

The proper tone of voice is important when asking any question, specifically when asking
"why" questions. Starting a question with "why" can seem accusatory and cause a person to
respond defensively. Using a non-judgemental tone can prevent this response.

Close-Ended Questions
• More readily used when the objectives of the interview are known.
• Useful for more reluctant respondents (whether for reasons of motivation or
language), or for those giving information not particularly important to them.
• usually preceded by open questions which provide a sense of the context in which
the questions are being asked
Clarification
Clarification can be an important tool when clients are extremely emotional and may not be
thinking clearly enough to present details in a coherent manner. It can also be useful when first
meeting with a client and the psychologist is collecting a detailed life history. Normally,
clarification is intended to gain some understanding of specific facts and circumstances in
which a detailed description is necessary.
When using clarification, the psychologist has the client clarify vague or ambiguous thoughts,
feelings or behaviors by asking the client to restate what s/he has just said or by stating to the
client what the counselor has understood the client to have said. Clarification, therefore, can be
either a paraphrase of the client's most recent statement or a question to the client about the
content of what has just been said. Clarification is differentiated from a probe by the fact that it
is a request for the client to make clearer what has already been said, whereas a probe requests
information that has not yet been stated. Clarification can be differentiated from a paraphrase
by its purpose: to gain clarity about vague or ambiguous material, whereas a simple paraphrase
intends to communicate to the speaker that the counselor is listening, has understood what has
been just said, and involves an invitation to continue speaking without interruption.

Reflection
Reflecting is the process of paraphrasing and restating both the feelings and words of the
speaker. The purposes of reflecting are:

● To allow the speaker to 'hear' their own thoughts and to focus on what they say and feel.
● To show the speaker that you are trying to perceive the world as they see it and that you are
doing your best to understand their messages.
● To encourage them to continue talking.
Reflecting does not involve you asking questions, introducing a new topic or leading the
conversation in another direction. Speakers are helped through reflecting as it not only allows
them to feel understood, but it also gives them the opportunity to focus their ideas. This in turn
helps them to direct their thoughts and further encourages them to continue speaking.

Example:
Interviewer: “You’re feeling pretty overwhelmed by all the things that are going on right now.”
Helps respondents:
 Feel understood
 Express more feelings
 Manage feelings
 Discriminate among various feelings

Confrontation:

The term confrontation means challenging another person over a discrepancy or disagreement.
However, confrontation as a skill is an attempt by the psychologist to gently bring about
awareness in the client of something that they may have overlooked or avoided.

There are three steps to confrontation. The first step involves the identification of mixed or
incongruent messages (expressed through the client’s words or non-verbals). The second step
requires is to bring about awareness of these incongruities and assist the client to work through
these. Finally, step three involves evaluating the effectiveness of the intervention evidenced by
the client’s change and growth.

Example:

C: I only drink a couple of times a day.

T: let's be honest. You drink every morning and every night after work. Wouldn't you say you
were dependent on alcohol?

● therapist points our discrepancies between what is observed and what is stated
● can be used to clarify therapist's perception or when statements are inconsistent
● often used with substance abusers, with character disorders
● to break denial and/or rigid defenses
● often increases anxiety and avoidance
● can be constructive or destructive
● most beneficial when it is factual content and not hostile
 ● focus on material that client should be addressing but isn't

Paraphrasing
To paraphrase, the interviewer chooses the most important details of what the client has just
said and reflects them back to the client in the interviewer’s own words. Paraphrases can be just
a few words or one or two brief sentences.
Helps respondents:
● To convey that you are understanding him/her
● Help the respondent by simplifying, focusing and crystallizing what
● they said
● May encourage the client to elaborate
● Provide a check on the accuracy of your perceptions

Summarising
Summaries are brief statements of longer excerpts from the interview. In
summarising, the interviewer attends to verbal and non-verbal comments
from the client over a period of time, and then pulls together key parts of the
extended communication, restating them for the client as accurately as possible.
A collection of two or more paraphrases or reflections that condenses the client’s messages or
the session
● To tie together multiple elements of client messages
● To identify a common theme or pattern
● To interrupt excessive rambling
● To start a session
● To end a session
● To pace a session
● To review progress
● To serve as a transition when changing topics

Reframing (Cognitive reframing):

C: I realize now he'll never change. I have to accept that.

T: How could you take advantage of the situation so that it can benefit you?
 o either client or therapist restates beliefs, attitudes, feelings
o in a manner more closely tied to reality
o provides fresh perspective on a situation
o serves to undercut negative self-statements and irrational thoughts that accompany
maladaptive behavior
o can promote new ways of thinking and new insights can lead to behavioral change

MANAGING SILENCE

The significance of silence, when it occurs, must be appraised. Is it a defense? Is it an attack? Is

it a pause in which creative cogitation is being executed. A common response to interpretation
is silence, which may indicate that the interpretation is correct and startles the patient while he
or she attempts to integrate it, or is incorrect, the patient responding with varied resistances or
attempting to test its validity.

Silence may reflect a fear of revealing oneself or of releasing anxiety as one approaches
repressed conflictual foci. It may be a self-defeating masochistic maneuver or a hostile act
against the therapist.

If silence is perceived as a hindrance to the interview, it is dealt with in the same way as any
other resistance. If it appears to be a transient phenomenon, it may be purposefully ignored. It is
then handled by confrontation, by counter silence or other tactics. Fortunately, long periods of
silence are rare in good therapy. Should it continue, the therapist may try the following in order.

1. Say “mm hmm” or “I see” and then wait for a moment.

2. Repeat and emphasize the last word or the last few words that the patient said.
3. Repeat and emphasize the entire last sentence or recast it as a question.
4. If this is unsuccessful, summarize or rephrase the last thoughts of the patient.
5. Say, “and” or “but” with a questioning emphasis as if something else is to follow.
6. If the patient still remains silent, the therapist may say, “You find it difficult to talk” or “It’s
hard to talk.” This focuses the patient’s attention on his or her block.
7. In the event of no reply, the following remark may be made: “I wonder why you are silent?”
8. This may be succeeded by, “There are reasons why you are silent.”
9. Thereafter the therapist may remark, “Perhaps you do not know what to say?”
10. Then, “Maybe you’re trying to figure out what to say next?”
11. This may be followed by, “Perhaps you are upset?”
12. If still no response is forthcoming, a direct attack on the resistance may be made with,
“Perhaps you are afraid to say what is on your mind?”
13. The next comment might be, “Perhaps you are afraid of my reaction, if you say what is on
your mind?”
14. Finally, if silence continues, the therapist may remark, “I wonder if you are thinking about
me?”
15. In the extremely rare instances where the patient continues to remain mute, the therapist
should respect the patient’s silence and sit it out with him. Under no circumstances should one
evidence anger with the patient by scolding or rejecting him.

Verbal Communications
A common language is essential for the conduct of the interview. Problems arise where the
therapist and the patient do not understand or speak the same language.
Problems may also develop where there is a marked disparity in education, cultural
background, and socioeconomic level or where the patient comes from an area of the country in
which a local dialect contains unusual colloquialisms. Here the flexibility of the therapist will
be put to test, for it is the therapist who will have to make the adjustment, not the patient. This
will necessitate an inquiry, from time to time, into the meanings of the words and concepts used
by the patient, with adoption of these in the vocabulary of the therapist.
The use of vocabulary similar to that employed by the patient helps interviewing. Many patients
lack the sophistication necessary for the understanding of complex psychologic ideas. It is
essential to recast these into simple words and phrases that are readily comprehensible to
patients. Even well-educated persons may not grasp the meaning of certain interpretations and
comments of the therapist, although these apparently have been clearly stated. A definition of
terms may be essential. Additionally, after the therapist has offered clarifications and
interpretations, it may be necessary to check the patients’ understanding by asking them to
formulate what has been said, in their own words. In the event there is a lack of understanding,
a reformulation may be made by the therapist, and another check then executed of the patient’s
comprehension.
The therapist should judiciously watch the personal need to impress the patient with complex
words and high-sounding phrases. The use of language that is as unadorned and straightforward
as possible will guarantee best results in interviewing.
Nonverbal Communications
Nonverbal communications during interviewing reveal aspects of the self that evade verbal
expression. The patient is as much aware of the therapist’s moods through the latter’s non-
verbal behavior as the therapist is of the patient’s emotions. Thus, the patient often picks up
attitudes of disinterest and annoyance expressed by the therapist through facial expressions,
mannerisms, and behavior that verbal pronouncements of interest and concern. Since
individuals project themselves into every situation with their total personality, one may gain
important clues to so me of their underlying turmoil and their less conscious attitudes by
observing their behavior in the therapeutic setting. Their gait, posture, facial expression,
gestures, and mannerisms all reveal patterns, defenses, and facades that are either part of their
habitual character structure or specifically reflect the role that they are playing with the
therapist. One must make these observations casually so as not to give patients the impression
that they are being watched like a specimen under a microscope.
It is usually easy to discern tension and anxiety in the patient by noting muscular spasms, which
communicate themselves in gait peculiarities, fidgetiness while sitting in the chair, wringing of
the hands, picking of the skin and lips, flushing, and lapses of attention conveyed by facial
blankness. Anger is apparent in a stiffening of posture, clenching of the fists, tapping of the toes
and grimness in facial expression. Enthusiasm and excitement are similarly evidenced by
appropriate behavioral attitudes.
A check of one’s own non-verbal manifestations may be necessary periodically to ascertain that
one is not conveying disapproval, boredom, and irritation to the patient. Ideally, the therapist’s
facial expression should be pleasant, relaxed, and noncritical. Inappropriate scowling, frowning,
and angry expressions are destructive to good therapy, as are continued acts of yawning, skin
picking, wriggling in one’s chair, and tapping of the extremities.
Head nodding is advantageously employed as a sign that the therapist is paying rapt attention
and is, following the associations of the patient. This is often accompanied by such
vocalizations as “uh huh,” “mm hmm,” “yes,” and “I see.” Head shaking is used only
occasionally as a sign of sympathetic understanding when the patient discusses personal
suffering, or when the therapist wishes to communicate disapproval over what is going on. In
the latter case it may be accompanied by a slight frown and the expostulations “mm mm”! or
“hmm”! sharply expressed. A smiling facial expression is often employed to indicate
acceptance and approval.
Subvocal utterances are also tremendously important during interviewing. How the patient says
things may be as important as what he or she says. Inflections, intonations, accents, emphases,
pauses, gaps in statements, slurring of speech, and varied sound expostulations may reveal to
the therapist emotionally charged areas that the patient cannot put into words. By the same
token, subvocal expressions and intonations influence the patient significantly. Frank (1961)
cites a number of studies that illustrate this fact dramatically. For instance, during non-directive
therapy it was possible to show that approbatory sounds and gestures at selected statements
increased these categories from 1 percent in the second hour to 45 percent in the eighth hour.
On the other hand, disapprobatory expressions reduced other categories from the 45 percent
present in the second hour to 5 percent during the eighth hour. The therapist must, therefore,
judiciously observe the manner in which remarks are presented to the patient to avoid an
untoward effect. Voice training for therapists, where there are problems in articulation, may be
invaluable.
Silence may also be an important non-verbal tactic, applied when the patient is pondering or
groping for solutions. It may also be employed as a way of stimulating tension to activate
thinking and problem solving in the patient. It can, however, be overdone, and particularly in
short-term therapy it should be used with discretion.