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CONTENTS
Cover
Title Page
Copyright
Dedication
Preface
Language Choices
What's New in the Sixth Edition?
Access to Videos and Additional Content
Using the Online Instructor's Manual and Ancillary Materials
Acknowledgments
About the Authors
Part One: Foundations of Clinical Interviewing
Chapter 1: An Introduction to the Clinical Interview
Learning Objectives
Chapter Orientation
Welcome to the Journey - Video 1.1
What Is a Clinical Interview? - Video 1.2
Clinical Interviewing versus Counseling and Psychotherapy - Video
1.3
A Learning Model for Clinical Interviewing - Video 1.4
Multicultural Competencies - Video 1.5
Multicultural Humility - Video 1.6
Summary
Suggested Readings and Resources
Chapter 2: Preparation
Learning Objectives
Chapter Orientation
The Physical Setting - Video 2.1
Professional and Ethical Issues - Video 2.2
Multicultural Preparation - Video 2.3
Stress Management and Self-Care - Video 2.4
Summary
Suggested Readings and Resources
Chapter 3: An Overview of the Interview Process
Learning Objectives
Chapter Orientation
Stages of a Clinical Interview - Video 3.1
The Introduction - Video 3.2
The Opening - Video 3.3
The Body - Video 3.4
The Closing - Video 3.5
Ending the Session (Termination) - Video 3.6
Summary
Suggested Readings and Resources
Part Two: Listening and Relationship Development
Chapter 4: Nondirective Listening Skills
Learning Objectives
Chapter Orientation
Listening Skills - Video 4.1
Adopting a Therapeutic Attitude - Video 4.2
Why Nondirective Listening Is Also Directive - Video 4.3
The Listening Continuum in Three Parts - Video 4.4
Nondirective Listening Behaviors: Skills for Encouraging Client Talk
- Video 4.5
Ethical and Multicultural Considerations - Video 4.6
Not Knowing What to Say
Summary
Suggested Readings and Resources
Chapter 5: Directive Listening Skills
Learning Objectives
Chapter Orientation
Directive Listening Behaviors: Skills for Encouraging Insight - Video
5.1
Questions - Video 5.2
Ethical and Multicultural Considerations When Using Directive
Listening Skills - Video 5.3
Summary
Suggested Readings and Resources
Chapter 6: Skills for Directing Clients Toward Action
Learning Objectives
Chapter Orientation
Readiness to Change - Video 6.1
Skills for Encouraging Action: Using Questions - Video 6.2
Using Educational and Directive Techniques - Video 6.3
Ethical and Multicultural Considerations When Encouraging Client
Action - Video 6.4
Summary
Suggested Readings and Resources
Chapter 7: Evidence-Based Relationships
Learning Objectives
Chapter Orientation
The Great Psychotherapy Debate
Carl Rogers's Core Conditions - Video 7.1
Other Evidence-Based Relationship Concepts - Video 7.2
Evidence-Based Multicultural Relationships - Video 7.3
Summary
Suggested Readings and Resources
Part Three: Structuring and Assessment
Chapter 8: Intake Interviewing and Report Writing
Learning Objectives
Chapter Orientation
What's an Intake Interview? - Video 8.1
Three Overarching Objectives - Video 8.2
Factors Affecting Intake Interview Procedures - Video 8.3
Identifying, Evaluating, and Exploring Client Problems and Goals
Obtaining Background and Historical Information
Assessment of Current Functioning
Brief Intake Interviewing - Video 8.4
The Intake Report - Video 8.5
Do's and Don'ts of Intake Interviews With Diverse Clients - Video
8.6
Summary
Suggested Readings and Resources
Chapter 9: The Mental Status Examination
Learning Objectives
Chapter Orientation
What Is a Mental Status Examination? - Video 9.1
Individual and Cultural Considerations - Video 9.2
The Generic Mental Status Examination - Video 9.3
When to Use Mental Status Examinations - Video 9.4
Summary
Suggested Readings and Resources
Chapter 10: Suicide Assessment
Learning Objectives
Chapter Orientation
Facing the Suicide Situation - Video 10.1
Suicide Risk Factors, Protective Factors, and Warning Signs - Video
10.2
Building a Theoretical and Research-Based Foundation - Video
10.3
Suicide Assessment Interviewing - Video 10.4
Suicide Interventions - Video 10.5
Ethical and Professional Issues - Video 10.6
Summary
Suggested Readings and Resources
Chapter 11: Diagnosis and Treatment Planning
Learning Objectives
Chapter Orientation
Modern Diagnostic Classification Systems - Video 11.1
Defining Mental Disorders - Video 11.2
Diagnostic Interviewing - Video 11.3
The Science of Clinical Interviewing: Diagnostic Reliability and
Validity
Less Structured Diagnostic Clinical Interviews - Video 11.4
Treatment Planning - Video 11.5
Case Formulation and Treatment Planning: A Cognitive-Behavioral
Example - Video 11.6
Additional Cultural Modifications and Adaptations - Video 11.7
Summary
Suggested Readings and Resources
Part Four: Special Populations and Situations
Chapter 12: Challenging Clients and Demanding Situations
Learning Objectives
Chapter Orientation
Challenging Clients - Video 12.1
Motivational Interviewing and Other Strategies for Working Through
Resistance - Video 12.2
Assessment and Prediction of Violence and Dangerousness - Video
12.3
Demanding Situations: Crisis and Trauma - Video 12.4
Cultural Competencies in Disaster Mental Health - Video 12.5
Summary
Suggested Readings and Resources
Chapter 13: Interviewing Young Clients
Learning Objectives
Chapter Orientation
Considerations in Working With Young Clients - Video 13.1
The Introduction - Video 13.2
The Opening - Video 13.3
The Body of the Interview - Video 13.4
Closing and Termination - Video 13.5
Culture in Young Client Interviews - Video 13.6
Summary
Suggested Readings and Resources
Chapter 14: Interviewing Couples and Families
Learning Objectives
Chapter Orientation
Challenges and Ironies of Interviewing Couples and Families -
Video 14.1
The Introduction - Video 14.2
The Opening - Video 14.3
The Body - Video 14.4
Closing and Termination - Video 14.5
Special Considerations - Video 14.6
Diversity Issues - Video 14.7
Summary
Suggested Readings and Resources
Chapter 15: Electronic and Telephonic Interviewing
Learning Objectives
Chapter Orientation
Technology as an Extension of the Self - Video 15.1
Definition of Terms and Communication Modalities - Video 15.2
Non-FtF Assessment and Intervention Research - Video 15.3
Ethical and Practical Issues: Problems and Solutions - Video 15.4
Conducting Online or Non-FtF Interviews - Video 15.5
Multicultural Issues: Culture and Online Culture - Video 15.6
Summary
Suggested Online Training Resources
Appendix: Extended Mental Status Examination Interview Protocol
Preparation
MSE Categories
Evaluating and Communicating Results
References
Author Index
Subject Index
End User License Agreement

List of Tables
Table 2.2
Table 3.1
Table 3.2
Table 3.3
Table 3.4
Table 3.5
Table 3.6
Table 4.1
Table 4.2
Table 5.1
Table 5.2
Table 5.3
Table 6.1
Table 8.1
Table 8.2
Table 9.1
Table 9.2
Table 9.3
Table 9.4
Table 10.1
Table 10.2
Table 10.3
Table 11.1
Table 12.1
Table 12.2
Clinical Interviewing
Sixth Edition

John Sommers-Flanagan
Rita Sommers-Flanagan
Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
Published simultaneously in Canada.
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Library of Congress Cataloging-in-Publication Data
Names: Sommers-Flanagan, John, 1957- author. | Sommers-Flanagan, Rita, 1953-author.
Title: Clinical interviewing / John Sommers-Flanagan, Rita Sommers-Flanagan.
Description: Sixth edition. | Hoboken, New Jersey : John Wiley & Sons, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016013760 (print) | LCCN 2016014706 (ebook) | ISBN 9781119215585 (paperback) |
ISBN 9781119215608 (pdf) | ISBN 9781119215615 (epub)
Subjects: LCSH: Interviewing in mental health. | Interviewing in psychiatry. | BISAC: PSYCHOLOGY /
Psychotherapy / General.
Classification: LCC RC480.7 .S66 2017 (print) | LCC RC480.7 (ebook) | DDC 616.89–dc23
LC record available at http://lccn.loc.gov/2016013760
Cover design by Wiley
Cover image: © Melamory/Shutterstock
This is for the many and diverse students who are choosing to dedicate
their lives to helping others. May your skills develop throughout your
lifetime, and may they always be used for improving the lives of
individuals, couples, and families.
PREFACE
Clinical interviewing is the cornerstone of virtually all mental health work. It
involves integrating varying degrees of psychological or psychiatric
assessment and treatment. The first edition of this text was published in 1993.
We remain in awe of the continuing evolution and broad practical application
of clinical interviews in mental health settings.

Language Choices
We live in a postmodern world in which language is frequently used to
construct and frame arguments. The words we choose cannot help but
influence the message. Because language can be used to manipulate (as in
advertising and politics), we want to explain some of our language choices so
that you can have insight into our biases and perspectives.

Patients or Clients or Visitor


Clinical interviewing is a cross-disciplinary phenomenon. While revising this
text, we sought feedback from physicians, psychologists, social workers, and
professional counselors. Not surprisingly, physicians and psychologists
suggested that we stick with the term patient, whereas social workers and
counselors expressed strong preferences for client. As a third option, in the
Mandarin Chinese translation of this text, the term used was visitor.
After briefly grappling with this dilemma, we decided to primarily use the word
client in this text, except for cases in which patient is used in previously
quoted material. Just as Carl Rogers drifted in his terminology from patient to
client to person, we find ourselves moving away from some parts and pieces
of the medical model. This doesn't mean we don't respect the medical model,
but that we're intentionally choosing to use more inclusive language that
emphasizes wellness.

Sex and Gender


Sensitivity to multiple gender perspectives has complicated how gender is
referred to in conversation and in writing. Consistent with tradition and
contemporary perspectives, when possible, we used plural language (i.e.,
them, their, they). When speaking in the singular (as in case examples), we
use him or her, based on the identified gender of the person in the case. As
appropriate, we occasionally use the plural they when describing individuals
whom we know or suspect wouldn't ascribe to a binary gender designation.

Interviewer, Psychotherapist, Counselor, Therapist, Clinician, or


Practitioner
Sometimes it feels as though there are far too many choices in life. Because
this text was written for aspiring mental health professionals across several
disciplines, we've chosen not to rein in our choices. Consequently, we
alternate in a random and whimsical way from therapist to clinician to
interviewer to counselor to psychotherapist, and occasionally we throw in
practitioner. Our hope is for everyone to feel included.

What's New in the Sixth Edition?


The sixth edition has new content and new citations, and is consistent with
cutting-edge clinical interviewing research and practice. It's also 15% leaner
than its predecessor. This trimming was in response to reviewer feedback.
The outcome is increased clarity and instructional efficiency.

Cultural Content
Because culture and diversity are ubiquitous, we have integrated culture and
diversity throughout the text. Instead of finding multicultural content primarily
in one chapter, you'll find it everywhere. In addition:
The multicultural competencies are reworked to integrate the latest
research and policy.
Cultural humility, a new cultural orientation concept, is featured.
More case examples reflect cultural diversity, including LGBTQ-related
issues.

Essential Skills, Reorganization, and Advanced Skills


This text has always taken a unique approach to bridging foundational
clinical/counseling skills with advanced interviewing and assessment. From
our perspective, advanced assessment interviewing should always rest on a
foundation of basic skills, and students should explicitly learn how the two are
integrated. To help meet this instructional goal, we have made two
organizational changes in this edition.
1. The former Chapter 6, An Overview of the Interview Process, has been
moved to Chapter 3. This gives students an earlier view of the big
interviewing picture.
2. We have divided the former Chapter 4, Directives: Questions and Action
Skills, into two chapters. The result: expanded skills coverage in Chapter
5, Directive Listening Skills, and Chapter 6, Skills for Directing Clients
Toward Action. This change strengthens and deepens coverage of specific
clinical skills that facilitate client insight and action.

Definitions and Clarity


The definition of clinical interviewing has been reworked and moved to the
very beginning of Chapter 1. There's also a new and informative discussion of
the difference between clinical interviewing and counseling or psychotherapy.

Case Examples to Facilitate Learning


There are more short case examples than ever. These concrete examples
help students “see” and apply interviewing skills and concepts.

Learning Objectives
Every chapter has reformulated and rewritten learning objectives to facilitate
active learning.

Ethics
Ethical issues are more prominent and integrated throughout the text. New
and updated discussions on clinician values, person-first versus disability-first
language, and clinician social behavior are featured.

Neuroscience
As appropriate, neuroscience concepts are discussed to help readers make
deeper links between what might be happening in the brain and clinical
interviewer and client behaviors.

Technology
Chapter 15 includes updated information on technology-based interviewing.
There's also a new section in Chapter 2 on using technology for note taking.

Clinician Stress Management and Self-Care


We have included more information and resources pertaining to the
importance of clinician self-care.

Suicide Assessment
Consistent with contemporary research and practice, the suicide assessment
chapter de-emphasizes suicide risk factors as a means for suicide prediction.
Instead, there's a stronger emphasis on clinician-client relational factors as
foundational to suicide prevention. In particular, methods for talking with
clients about suicide ideation, previous attempts, and other suicide-related
issues are clearer than anything we've seen in the literature.

Diagnosis and Treatment Planning


ICD-10-CM and DSM-5 are fully integrated into the diagnosis and treatment
planning material. In addition, the treatment planning section features new
evidence-based information on how to match client factors with treatment
strategies and techniques. This information will help clinicians develop
evidence-based treatment plans.

Couple and Family Interviewing


New content and case examples consistent with emotionally focused couple
therapy and the Gottman approach are provided.

All Chapters
Every chapter has been revised and edited using feedback from dozens of
graduate students and professors from various mental health disciplines
throughout the United States. In addition, every chapter also has new citations
and is updated to be consistent with the latest trends in clinical interviewing
research and practice.

Access to Videos and Additional Content


This edition comes with access to additional features via the enhanced ebook
version, which contains dynamic content to further enrich your understanding
of the text. Follow the instructions on the registration card at the back of the
book for access details. Th is interactive e-text features the following
interactivities:

Videos
Each chapter contains an extensive set of new videos introduced by us and
featuring counselors and clients demonstrating the techniques described in
the text. We've provided them to help you “see” and apply interviewing
techniques in different environments.

Practice Questions
At the end of each chapter, you will have the option to test your understanding
of key concepts by going through the set of practice questions supplied. Each
of these are tied back to the Learning Objectives listed at the start of each
chapter.

Using the Online Instructor's Manual and Ancillary


Materials
This text has an online instructor's manual and ancillary materials to help
make teaching clinical interviewing more pleasant and efficient. Through your
John Wiley & Sons sales representative or via the Wiley website, adopting this
text gives you access to the following instructional support:
An online instructor's manual, with supplementary lecture ideas,
discussion questions, and classroom demonstrations and activities
A test bank with more than 40 test items for each chapter
A downloadable set of generic PowerPoint slides geared to the textbook
chapters

Acknowledgments
Even on our bad days, we're aware of our good fortune as authors,
professors, and therapists. We not only get to hang out with each other and
write books but also get to publish with John Wiley & Sons. That's pretty close
to being born on third base.
This is where we're supposed to thank, acknowledge, and honor everyone
who made this book possible. But because this is the sixth edition of Clinical
Interviewing, by now we're indebted to nearly everyone we've ever known. So
we begin with a general thanks to the many people who have lightened our
burdens, provided input and guidance, and offered emotional support.
More specifically, we want to thank our Wiley editors, Tisha Rossi and Rachel
Livsey. You've both been steady, responsive, and immensely helpful. Thanks
also to Stacey Wriston, Mary Cassells, Melissa Mayer, and other members of
the Wiley publishing team. We've never had a question unanswered or a
request denied.
In addition to our remarkable Wiley team, the following list includes individuals
who have contributed to this or other editions in one significant way or
another. You all rock.
Roberto Abreu, MS, EdS, University of Kentucky
Amber Bach-Gorman, MS, North Dakota State University
Carolyn A. Berger, PhD, Nova Southeastern University
Rochelle Cade, PhD, Mississippi College
Sarah E. Campbell, PhD, Messiah College
Anthony Correro, MS, Marquette University
Carlos M. Del Rio, PhD, Southern Illinois University Carbondale
Christine Fiore, PhD, University of Montana
Kerrie (Kardatzke) Fuenfhausen, PhD, Lenoir-Rhyne University
Kristopher M. Goodrich, PhD, University of New Mexico
Jo Hittner, PhD, Winona State University
Keely J. Hope, PhD, Eastern Washington University
David Jobes, PhD, Catholic University of America
Kimberly Johnson, EdD, DeVry University Online
Charles Luke, PhD, Tennessee Tech University
Melissa Mariani, PhD, Florida Atlantic University
Doreen S. Marshall, PhD, Argosy University-Atlanta
John R. Means, PhD, University of Montana
Scott T. Meier, PhD, University at Buffalo
Teah L. Moore, PhD, Fort Valley State University
Shawn Patrick, EdD, California State University San Bernardino
Jennifer Pereira, PhD, Argosy University, Tampa
Gregory Sandman, MSEd, University of Wyoming
Kendra A. Surmitis, MA, College of William & Mary
Jacqueline Swank, PhD, University of Florida
Christopher S. Taylor, MA, Capella University
John G. Watkins, PhD, University of Montana
Wesley B. Webber, MA, University of Alabama
Ariel Winston, PhD, Professional School Counselor
Janet P. Wollersheim, PhD, University of Montana
Carlos Zalaquett, PhD, University of South Florida
Obviously, that's quite a list. We hope all that help translates into this being
quite the book!
ABOUT THE AUTHORS
John Sommers-Flanagan, PhD, is a clinical psychologist and professor of
counselor education at the University of Montana. John is the author or
coauthor of more than 60 professional publications and a longtime member of
both the American Counseling Association (ACA) and the American
Psychological Association (APA). He regularly presents professional
workshops at the national conferences of both organizations, as well as at
regional, national, and international continuing education gatherings. Having
recently published chapters on clinical interviewing in the APA Handbook of
Clinical Psychology, The Encyclopedia of Clinical Psychology, and the SAGE
Encyclopedia of Abnormal and Clinical Psychology, John is a leading authority
on the topic of clinical interviewing.

Photo courtesy of Todd Johnson, University of Montana.


Rita Sommers-Flanagan, PhD, is professor emeritus at the University of
Montana. Her diverse interests include professional ethics, women's issues,
and spirituality and its connections to science and human well-being. She is
the author or coauthor of more than 40 articles and book chapters, and most
recently contributed a chapter titled “Boundaries, Multiple Roles, and
Professional Relationships” to the APA Handbook on Ethics in Psychology.
She is also a published poet, essayist, and clinical psychologist, and has
worked with youth, families, couples, and women for many years.
John and Rita live and work in Montana. In their spare time, they write,
irrigate, create art, garden, and restore old buildings on the family ranch. They
hope to eventually establish a Stillwater River retreat center for writers,
therapists, and peacekeepers.
PART ONE
FOUNDATIONS OF CLINICAL INTERVIEWING
CHAPTER 1
AN INTRODUCTION TO THE CLINICAL INTERVIEW

Learning Objectives
After reading this chapter, you will be able to:
Define clinical interviewing
Identify differences (and similarities) between clinical
interviewing and counseling or psychotherapy
Describe a model for learning how to conduct clinical interviews
Apply four essential multicultural competencies
Describe multicultural humility and why stereotyping is natural,
but inadvisable
Chapter Orientation
Clinical interview is a common phrase used to identify an initial and
sometimes ongoing contact between a professional clinician and client.
Depending on many factors, this contact includes varying proportions of
psychological assessment and biopsychosocial intervention. For many
different mental health–related disciplines, clinical interviewing is the
headwaters from which all treatment flows. This chapter focuses on the
definition of clinical interviewing, a model for learning how to conduct clinical
interviews, and multicultural competencies necessary for mental health
professionals.

Welcome to the Journey - Video 1.1

We took for granted that honesty and kindness were basic responsibilities
of a modern doctor. We were confident that in such a situation we would
act compassionately.
—Atul Gawande, Being Mortal, 2014, p. 3
Imagine you're sitting face-to-face with your first client. You've carefully
chosen your clothing. You intentionally arranged the seating, set up the video
camera, and completed the introductory paperwork. In the opening moments
of your session, you're doing your best to communicate warmth and
helpfulness through your body posture and facial expressions. Now, imagine
that your client
Immediately offends you with language, gestures, or hateful beliefs
Refuses to talk
Talks so much you can't get a word in
Asks to leave early
Starts crying
Says you can never understand because of your racial or ethnic
differences
Suddenly gets angry (or scared) and storms out
These are all possible client behaviors in a first clinical interview. If one of
these scenarios occurs, how will you respond? What will you say? What will
you do?
Every client presents different challenges. Your goals are to establish rapport
with each client, build a working alliance, gather information, instill hope,
maintain a helpful yet nonjudgmental attitude, develop a case formulation,
and, if appropriate, provide clear and helpful professional interventions. Then
you must gracefully end the interview on time. And sometimes you'll need to
do all this with clients who don't trust you or who don't want to work with you.
These are no small tasks—which is why it's so important for you to remember
to be patient with yourself. Conducting clinical interviews well is an advanced
skill. No one is immediately perfect at clinical interviewing or anything else.
Becoming a mental health professional requires persistence and an interest in
developing your intellect, interpersonal maturity, a balanced emotional life,
counseling/psychotherapy skills, compassion, authenticity, and courage. Due
to the ever-evolving nature of this business, you'll need to be a lifelong learner
to stay current and skilled in mental health work. But rest assured, this is an
exciting and fulfilling professional path (Norcross & Karpiak, 2012; Rehfuss,
Gambrell, & Meyer, 2012). As Norcross (2000) stated:
The vast majority of mental health professionals are satisfied with their
career choices and would select their vocations again if they knew what
they know now. Most of our colleagues feel enriched, nourished, and
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