CHAPTER 3 The First Interview Bonnie A. Rudolph Texas A&M Intemational University because there are so many different factors to consider when therapists’ tasks within the first interview. Furthermore, I have al jance to psycho- :h positive therapy outcome ians and sophisticated therapy ance of certain thera-48 RUDOLPH performance has been reported by trainees (Rosenbaum, 1984), and al though a modest amount of ar ‘unnecessary anxiety due to lack of clear definition can and should be avoided (Smelson, from video and audio recordings of LIMITATIONS ‘The purpose of this chapter is to describe how the brief psychodynamic children. Although these therapeutic formats are important and increas ingly common in psychotherapy practice, they are not the focus of this chapter. Other limitations in application also apply. The tasks suggested here are appropriate interview is conducted also influences the appropriateness of the tasks described here. These tasks do not fit every tus exam or a fo- rensic ent treatments of these types of interviews “elsewhere (Meloy, 1989; Schwartz, 1989). requires important modifications in thera- pist tasks and interview processes. Increasingly psychotherapists are pro- viding services to patients who are hearing impaired, use sign language, of experience speech impediments. How the therapist conducts these first terviews is particularly important and warrants sensitive and thou! interview should also influence the tasks of the therapist. ‘ences between the patient and therapist in race, culture, social class, ‘Interview. One fundamental purpos interview tasks. However, certain categories 1g, FIRST INTERVIEW ‘the patient with a safe and trustworthy setting for selt-exploration. There- : nees, which could handicap or limit the cre setting for the patient, are discussed with sen: is clear that “one size does not tasks or factors are, with in “good” first psychotherapy iked to positive therapy outcomes. I return ‘some notable exceptions, exchanges should be comm ret jould be an ade- uate and comfortable seating arrangement that is consistent with the cul- aral background of the patient. The space of the room should be welcom- and convey a tone of sanctuary, again within the cultural context ticipants. he Person of the Psychotherapist, cus on the tasks of the first interview in this, h the importance ist enacts tasks is ss the erse the time and terrain of the first interview: the ther: and correct the course of the Journey. Therapist energy, atten50 RUDOLPH he journey as term therapy learning of brief therapy models. How: ever, he note ly, the trainee coming to learn brief therapy should have the knowledge and skills acquired from many years of experience with jot having become habituated to any of his or her "In some ways pist should be: and poi ‘calmness, ge possess a certain presence 1d by observers as ly, the word poise 3 FIST INTERVIEW 51 THE FIRST INTERVIEW: AN ABBREVIATED REVIEW The first interview of psychotherapy has been the topic of books (Benja- jons and dynamics (Luborsky, 198 1984), and creation, maintenan IDENTIFICATION OF FIRST INTERVIEW. THERAPIST TASKS therapy writers, 41946) and leading up to the more recent works of Strupp and Binder (1984); Luborsky (1984); Horowitz (1986); Pinsker, Rosenthal, and McCullough52 RUDOLPH 3. FIRST INTERVIEW 53 using response modes; and general books on interviewing (Hersen & Van Numer Bret "Hasselt, 1998), which cover basic processes but identified few specific ther- Dynamic Theorists apist tasks, Endorsing (8) a» A Plethora of Tasks Combination of the reviews of these thee areas resulted inf tasks noted by various psychodynamic and nondynamic writers and researchers of therapist actions or tasks in the first interview of brief psychotherapy. This “ist was then checked over for redundancies, commonalities, and unique- ness and a refined list of 173.tasks recommended by both Seana ‘dynamic brief theorists was generated, wer TEER, ve of which were previously used to asess ose oto in raining during and readers may contact me if ‘The sorting process primarily lew of brief psychodynamic psychotherapy, Fourteen different tasks were identified that were mentioned by at least 2 of the 20 Focusing tasks appear very importa Furthermore, the sixcategory system is consistent with dy- Revised Approach to Therapeutic Tasks: Therapeutic Clusters Interview Rating Scale developed by Bogels et al. category system of sorted tasks seemed unsatisfactory for the pur- Poses of this chapter because it was developed to evaluate graduate psy- \e counseling psychology literature for therapist shology trainee actions in first interviews conducted at various pré ‘tasks produced the work of Ivey (1992), which includes listings of counselor54 RUDOLPH \. Set The Stage & Structure the Interview ° é Problem Disclosure G 3. Deepen Exploration and Emotional Expression ‘that just about every therapist task coulk 2 ‘one of the five others. It seemed logical to conceptualize forge a therapeu . 4 Reneion an aig L a) S Clarify and Test the Focus [gover Labeler A N contribute to the therap. erations, the rationale was supported by ubiquity c E FAG. 21. Pest interview task clusters and Forging « Therapeutic Alliance psychother- ia ce are depicted in Fig. 31. The sixth the side in the figure. Elaboration of the Proposed Six Task Clusters ‘would include further describe this model of the 3 interview for brief therapy, each luster are listed. I begin with the beginning. Setting the Stoge ond Structuring the ter setting the stage and structuring the inte Therapists’ tasks to manage b isclosures, and passageoy RUDOLPH {3 FIRST INTERVIEW 57 surance coverage, and any cultural or lifestyle differences between thera- e Therapist conveys ‘= « Therapist attempts a variety of approaches to engage the reticent pa tent, + Therapist encourages patient to elaborate on important materia * Therapist invites patient reactions to inating and orienting phase of Bp stervicw + Therapist encourages allen OK HEN in interview. irst phase of the hypothesized that this category of therapist tasks is therapeutic be- (Strupp, 1973; Orlinsky therapist tasks make a metacommur fe, “You have val vork and you must actively participate in tlieinterview for our work to be success.” THeNestheraplePlackeRelp tc ‘The reduction of ambiguity for tasks engender is probably also therapeut developed a system tom ‘The tasks within this factor are therapeutic because they. convey to the » and comfortable in conducting ‘therapeutic relat ing patient engage- hances therapy success, ation of material and helpful expression of emotions. This therapeutic Is defined here as the category of therapist actions or tasks that Fompts and subsequently ks are more-advanced-than Cluster because they involve discerning which tons also belong here. "A representative sampling of therapist tasks for this cluster Include the following: further pursue, when, and in what manner, “Representative therapist tasks tichided within this cluster are the fol ing: + Therapist inquires as to théReasomtnepatientsoushrelpatetisstime,58 RUDOLPH + Phe hesapist asks about the patient's feelings and states of mind. ist asks the patient to SiSGHSS|iMPOHARERSISEORSHIGS in his ites observation of patient behavior and in +The therapist inquires inte ESTE GRSTASSUER, ‘therapist in the interview. «The therapist asks the patient to discuss his or her thoughts and fet ings about the interview process. «The therapist inquires into patient dreams, wishes, and fears. +The therapist asks the patient to report his or her earliest memory. «The therapist pursues important material and encourages the patient to elaborate + The therapist asks the regards himself or hers + The therapist promotes lscussion ofthe patient's needs trom the po nts perspective. quires into the way the patient relates to himself or her sal and self-talk. + The therapist inquires into change points in the patient's about how she or he evaluates or ‘These tasks are therapeutic precisely because they engage the patient in disclosure and discussion at a level and in a manner that is not usual in so (GialEROHARGES, Thus, patients have an opportunity to experience the mate- rial ina new way, which ma te alterations in perceptions and mean- ings and Teads to the fourth cluster of tasks described next. Reflection and Naming. ‘The therapeutic cluster of re ing is consistently emphasized by brief psychodynamic ws 1978; Luborsky, 1984). Most dynamic writers address the spectic therapist task of therapist offered interpretations. However, there are a wide range of therapist tasks within this category that contribute to the strength and in- fluence of this therapeutic factor. This task cluster refers to therapist ac tions or tasks that cast a new or dllfere J. Some representative therapist tasks within this cluster are listed following «+ The therapist GKCPSHUnERSHCAUn TON patenemateral + The therapist offers a process observation of patientnterviewibelravior 59 not made explicit by the patient. _ + The therapist bers patter inthe patient interpersonal AION [Bhips anci communicates this observation to the + The therapist repeats an expression ofthe patients, giving different em- phasis to thelpimasing, __ + The therapist links a patient reaction t | tons to other significant people in the patient's present or past. "+ The therapist examines the interaction between the patient and the _ therapist In the here and now of the session and does this out loud. _+ The therapist [RORFORISIa(BHERESECIENG® names the patient behav- for as defensive and communicates the negative consequences of the defense for patient progress). ‘The therapist edutates or advises a patient about a condition, treat- ment, process, or risk - This cluster of tasks has long been considered therapeutic because it in- olves the patient in perceiving his or her experience in a different way. :pist Suggests amelioration of a difficulty or problem in the pa- as the focus ar objective of the subsequent therapy. rapist with patient reac ie-y5 260 RUDOLPH «The therapist suggests a SOFSCORMEATEIANORSPINEME 2s the fo- cus for therapy. «The therapist suggests an oedipal conflict or derivative as the focus of therapy + The therapist (lita phaSeSih=ipalientsigoalfontherapyisuch that more clear, measurable, and motivating «The therapist suggests a symptom to lessen or eliminate as the focus of therapy work. + The therapist spaiicallyasis the patient tihesorshe fs{committed to, ‘WORRIRGTORTBNENGEATRE. Or conversely, the therapist inquires into doubts the patient may have about the focus of the subsequent therapy. + Thettherapist inquires into what will be different as a result of therapy. ++ The therapist inquires into how the patient's life would be if the prob: lem miraculously disappeared. 6 therapist tasks in this farranging +The therapist addkeses-te pallet by is oF her name, + The therapist MSGSMNeWOre Mean@FRIESEOERS OIE mutual etfort of both patient and therapist. '» The therapist attends to the _ + The therapist acknowledges the patient's feelings, + The therapist accurately paraphrases the ps Is ++ The therapist forecasts the work the two will do together in subsequent therapy. Forge a Therapeutic Alliance: The Megofactor Cluster. Many reviews of measures of the therapeutic alliance report a positive correlation be- tween high alliance scores and positive therapy outcomes (Crits-Chris- toph, 1991; Luborsky, 1984; Marmar, 1990). Forging a therapeutic alliance is important for all forms of therapy (Borden, 1979). For my purposes, this category of therapist tasks refers to_all deliberate therapist tasks that ‘Therefore, therapist tasks within tions to encourage and acknowledge patient to the work. therapist, and secking help volltionaly.. Drofessional helpers, tion. The therapist knows, in general terms, what to expect in vlew; the patient typlcally does not. The patent saa also often approach the interview with heightened anxiety. In effect, the patient is being socia izeainto the role of therapy patient or participant in what is often a highly charged and novel situation. For some patients these circumstances may make the lessons learned more potent, Even when the patient is not espe- RACTION OF THERAPEUTIC CLUSTERS ID PATIENT CONTRIBUTIONS ‘Sequencing of the task clusters is much less fixed than the ordering in 3.1 implies. Everything affects everything el st interview. Pa- ts greatly influence the processes and outcomes of first interviews as do psychotherapy as a whole. How much ini 1 the quality and type of their contributions naturally influence the thera- 's tasks and the sequence of their occurrence. Likewise, therapists mayRUDOLPH Oricing & Phase Selhe Stage and Stace “he nevi patients experience beginning therapy (Caty an Tes Phases of the First Interview ‘he Foous As for the idea of phases ex! than research supporting thi ‘Working to Understand Phase Continged therapeutic clusters and Intervi d research suggests (HEE PHASES) ut did not catego- lize a task-analysis64 RUDOLPH approach when creating thelr task categories. The clusters proposed here are based on such an approach and appear to have heuristic and research value. Three phases of the first interview for brief therapy have also been labeled and the meager research supporting phases and how they relate to clusters has been discussed CONCLUSION ‘This chapter has attempted to identi dynamic and brief therapy writers of vé sarily the same. The increase in therapy manuals and frequent supervision wise, have written about them I strength and value. Furthermor ciently present in the first i Obviously, detailed study of ‘A promising strategy might be to compare first-nterview tasks of experi- enced or expert therapists with novice or less experienced brief therapists. ‘One might expect that expert brief therapists would be more proficient at ‘moving through the sequence of therapist tasks and in deviating from it to best engage a particular patient than less experienced therapists. It may also be that expert ly adept at capitalizing on tasks that contribute to fers at once. By comparing ex- ierview, one could not only study the tasks performed but also sses of therapist task performance as well, Such task-analysis research may generate other tasks and clusters that are more valid or useful. Certainly, as new therapies develop and as new patient populations are served, other tasks may be identified. What is clear from the review conducted here is tha large number of firstinterview tasks that the brief ther: complish. The novice brief therapist need not be set adrift on an uncharted. investigate this sourse of abbreviated therapeutic work. The challenge, rather, is selecting shich tasks best fit the patient's needs, the training site's mission, and de- velopment of trainee skills. By considering the framework of six therapeutic clusters suggested here, as well as the three first interview phases, trainers rainees may be able to focus thelr efforts so that all parties enhance is chapter has focused on the what, in which therapist tasks are , the critical role of the patient and pat rs ‘acknowledged. Each patient brings unique strengths and weaknesses to the first visit. These patient qualities act as parameters within which the therapist must operate. However, if we conduct ourselves in his first interview with respect and compassion for the patient, an open nind, and respor ly sensitive behavior, then we have a human ty lead to reflection and growth for both participants. DC: American Psychiatrie Pres. 1987) Brie therapy: Shor tem psychodynamic intervention. Northvale, NE nee rand energy pyr. span (Peay The der Poca ss aa 3 2 gen nero Psa ren ea 0, nen aap re poche: ew York Grn min-A 09, Me hong ew nd et Bose: Howton Min PE Gail, Eo) 1) Hor of patra eas ca ‘New York: Wiley. me wea Lac, Neel, (908) Therapist vrs AB . rive. A Bern. Gare Hen scary ond ble change Ah 9p 2509) Ne 7, Bloom's single session psychotherapy: In B, Bloom, Panned shortterm ps raps clinica! handbook 2nd ed, pp. (2-89. Boston: Allyn & Bacon. poe 5M, van der Viuten, P., Blok, G., Kreutzkamp,R, Melle, R, & Shmict H. (1985) Assess: en and validation of diagnostic interviewing ki lof Psychopathology and Behavioral Assessment, 17, 217-20. ten, B,(1979). The enerallzablity ofthe payehoanaitic concept ofthe worklyg alliance. atherapy: Theory, Research, and Prutce, 16, 252-260 Hoyt, M, & Friedman, S. (Ed. (192) The first session in rie therapy. New York:66 RUDOLPH 7 Pinsker, H. Rosenthal, R, & McCullough L. (1891). Dynamle supportive paychotherapy. In P. Barber (Eds_), Handbook of shorterm dynamic psychotherapy (pp. hotherapy. In P. Cris H. Data, J, Jochem, J, Kadlee, M, G, Mann, N. J, & Whipple, K (1975). Pechatherapy ve _Si8bchator therapy. Cambridge, Ma: Harvard Univer Laborsy Ld Mark . P. In psychiatric diagnosis. mB ‘New Yorke Plenum,RUDOLPH CHAPTER 4 Assessing Patient Capacities for Therapy: Psychological-Mindedness and Quality of Object Relations Anthony S. Joyce University of Alberta Mary MC: Private Practice, Edmonto Canada In this chapter, we prox @ more glob Sand mai allow-tor the therapy QOR assessments hav the process utility regarding the Process developments over lures, PM and QOR, are presented in Gise is used to demonstrate the features Plications for the treatment process, PSYCHOLOGICAL MINDEDNESS Be Feaeve Presented at our Psychiatrie Treatment Cink: requesting ther toaddress iness and depression. She believed that the root of 6