Psychiatric Interviewing: The Art of

Understanding: A Practical Guide for –

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 References

Chapter 15 Understanding and Effectively Engaging People With Difficult Personality Disorders
Introduction to Object Relations and Self Psychology

The Four Developmental Stages of the Self and Their Clinical Applications

Concluding Comments: on the Utility of Mirrors

References

Part III Mastering Complex Interviewing Tasks Demanded in

Everyday Clinical Practice

Chapter 16 The Mental Status

Introduction

The Impact Status

The Mental Status

References

Chapter 17 Exploring Suicidal Ideation

Introduction

Section 1: Risk Factors, Warning Signs, and Protective Factors: Their Role in the Clinical Formulation of Risk

Section 2: the Elicitation of Suicidal Ideation, Planning, Behaviors, and Intent

Concluding Comments

References

Chapter 18 Exploring Violent and Homicidal Ideation

Introduction

Part 1: Risk Factors for Violence

Part 2: Clinical Formulation of Risk – the Tetrad of Lethality

Part 3: the Art of Eliciting Violent and Homicidal Ideation

Conclusion

Transitional Directions to Part IV: Advanced Interviewing and Specialized Topics

References

Part IV Specialized Topics and Advanced Interviewing

To the Reader

Chapter 19 Transforming Anger, Confrontation, and Other Points of Disengagement

Introduction

Part 1: Points of Disengagement – Core Definitions

Part 2: Points of Disengagement – Developing A Contemporary Language for Their Navigation

Part 3: Effectively Navigating Common MADs and PDQs

References

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Chapter 20 Culturally Adaptive Interviewing
Introduction: A Reason to Be

Part 1: Definitions, Attitudes, and Goals – in Search of Culturally Adaptive Interviewing

Part 2: the Mystery of Cultural Identity – Unpacking Assumptions

Part 3: Developing and Utilizing Cultural Literacy to Engage Patients and to Better Understand the Complexity of Their
Problems

Part 4: Cultural Disconnects – How to Prevent Them Before They Occur, Recognize Them as They Occur, and Transform
Them Once They Occur

Part 5: Practical Tips for Exploring Religion, Spirituality, and Framework for Meaning

Conclusion and Final Clinical Illustration

References

Chapter 21 Vantage Points

Exploration of the Attentional Vantage Points

Exploration of the Conceptual Vantage Points

References

Chapter 22 Motivational Interviewing (MI)

Introduction

Motivational Interviewing

The Bridge to Improving Medication Interest and Use

References

Chapter 23 Medication Interest Model (MIM)

Introduction

Part 1: “Nonadherence” – More Than Meets the Eye

Part 2: The MIM – Development and Roots

Part 3: The Spirit of the MIM

Part 4: The Choice Triad – The Foundation of the MIM

Part 5: Practical Interviewing Techniques and Strategies for Enhancing Medication Interest and Use

Conclusion to the Book

References

Appendix I An Introduction to the Facilic Schematic System – A Shorthand for Supervisors and
Supervisees (Interactive Computer Module)
Background and Foundation

Making a Longitudinal Facilic Map: Tricks of the Trade

Making a Cross-Sectional Map

Interactive Exercises for Consolidating the Understanding and Use of Facilic Shorthand

References

Appendix II Annotated Initial Interview (Direct Transcript)

9
Appendix III The Written Document/Electronic Health Record (EHR): Effective Strategies
Appendix IIIA Practical Tips for Creating a Good EHR/EMR Document

Appendix IIIB Prompts and Quality Assurance Guidelines for the Written Document

Appendix IIIC Sample Written Assessment

Appendix IIID Sample Initial Clinical Assessment Form

Appendix IV Supplemental Articles From the Psychiatric Clinics of North America

Group A: Articles for Clinicians and Trainees

Group B: Articles for Faculty and Interviewing Mentors

Glossary of Interview Supervision Terms

Index

10
Praise for Psychiatric Interviewing, 3rd Edition

Advance Praise for the Third Edition

“Readers of this book, whether beginning students or wizened clinicians with decades of
experience, will find much that is innovative. . . . . I had the pleasure of running across Shea's
interviewing strategy for uncovering suicidal ideation, behaviors, and intent (the Chronological
Assessment of Suicide Events – CASE Approach) years ago. . . . . In this book readers will find a
remarkably compelling and practical introduction to the effective use of the CASE Approach. Shea's
subsequent video demonstrations of the CASE Approach are, in my opinion, unparalleled in the
history of mental health training. I have never seen such great teaching videos on eliciting suicidal
ideation. They are a treasure, and I believe that many lives will be saved by those lucky enough to
view them.”

From the Foreword by Jan Fawcett, M.D.

Professor of Psychiatry, University of New Mexico

Recipient of Lifetime Achievement Awards

from both the American Association of Suicidology

and the American Foundation for Suicide Prevention

“Dr. Shea has done the impossible – written a text that works for bachelors, masters, and doctoral
level social workers. Throughout the text, Shea integrates cultural humility, the client perspective,
clinical wisdom, and the best that research has to offer. His writing is authoritative yet accessible.
The accompanying videos are the most amazing instructional videos I've ever seen – they include
mini-lectures, video of an actual client interview, and wondrously realistic role-plays (which invite
you into the mind of a master) and speak directly to the content in the text. Instructors will treasure
the text because it covers everything that needs to be covered and is presented in a way that
inspires the reader to learn the material. I hate to say it, but a medical doctor has written the best
social work interviewing text on the market. I hope this text gets adopted in every school of social
work.”

Jonathan B Singer, Ph.D., LCSW Associate Professor

School of Social Work, Loyola University Chicago

Founder and host, Social Work Podcast

“Insightful, wonderfully practical, and surprisingly comprehensive, Shea's chapter on culturally

sensitive interviewing in Psychiatric Interviewing: the Art of Understanding, 3rd Edition sets a new
bar on effective literature on multiculturalism. Shea not only eloquently delineates important cross-

11
cultural principles for students – while modeling numerous immediately useful questions and
strategies – he provides examples of clinician/client dialogue in which the student can actually see
the interviewer gracefully transforming awkward cultural disconnects. I've never seen anything quite
like it in the clinical literature. Simply superb! PS: Year after year my master level counseling
students have raved – and I mean raved – about Shea's textbook, and this Third Edition looks to be
even better! I know of no book that better prepares a student for actual clinical practice.”

Dottie R. Morris, Ph.D.

Chief Officer of Diversity and Multiculturalism, Keene State College

Former Director of Student Affairs for the Clinical Mental Health Counseling
Program at Antioch University New England

“In this highly readable and engaging book, psychiatric nursing students learn the principles and
techniques of conducting fluid and individualized assessments. We have been using the second
edition of this book for over a decade at our school, and it has been an indispensable resource for
both our faculty and our students. This 3rd Edition has been revised and expanded including
fascinating new chapters on topics such as wellness, motivational interviewing, cultural diversity and
how to collaboratively talk with patients about their medications. Many of the chapters are enriched
with engrossing video demonstrations (be sure to watch the video on eliciting suicidal ideation, it
brings the practical art of suicide assessment alive). I can't recommend this book enough. It will
infuse passion and curiosity in your students. It will be a resource they will return to for learning for
years to come.”

Palmira Brouwer R.N. BscN, MA (psychology)

Faculty Department of Psychiatric Nursing

Douglas College, B.C. Canada

“Both of the previous editions of Dr. Shea's book have anchored Bryn Mawr's advanced clinical
social work practice curriculum for a generation of our master's degree students. This third edition is
a masterful integration of text and video instruction. Indeed, it represents a pedagogical leap, in
which Dr. Shea brings the beginning and advanced student into the mysteries of the first encounter
with his characteristic warmth, compassion, and wisdom that has so enthralled our students over
the years. Only now, we can see it, not only in engaging text, but in amazingly effective video
instruction and interview demonstrations, that bring to life the clinical encounter. Shea models for
students the core interviewing skills, the advanced practice competencies, and the guiding ethical
behaviors that are the foundations of all helping professions. With the publication of this book, I
personally believe that Dr. Shea has cemented his standing as one of the most influential mental
health educators of the 21st Century.”

James A. Martin, Ph.D., LICSW

Colonel, U.S. Army (Retired)

Professor of Social Work and Social Research

Bryn Mawr College, Bryn Mawr, PA.

12
Here is a book I would enthusiastically recommend to all graduate students in psychology on the art
of clinical interviewing and to all faculty who teach such courses. Shea's book provides a highly
satisfying introduction to the core principles of clinical interviewing but much more. It also, with a
refreshingly informal writing style, provides a sophisticated journey into advanced interviewing
techniques and strategies as needed in the real world of clinical practice. Even the most
experienced clinician will enjoy and learn much from this text. I don't believe I've ever seen an
author capture the pain of patients dealing with serious disorders such as major depression,
schizophrenia, and bipolar disorder with such sensitivity and compassion, while transforming this
understanding into easily learned questions and techniques for use in actual practice. Combine this
sensitive and comprehensive approach with Shea's skillful use of advanced technology (over 7
hours of streaming video modules and interviewing demonstrations) and you have a book, whose
shelf-life will be measured not in years, but decades.”

Lawrence A. Welkowitz, Ph.D.

Co-Editor of Asperger's Syndrome: Intervening in Clinics, Schools

and Communities
Principle Investigator: Use of iPad Assisted Learning for Autism

Interviewing skills are not only indispensable, they are the rate-limiting factor in providing quality
care. In the 3rd Edition of Dr. Shea's classic text, we now have an indispensable book to match the
training needs of our psychiatric residents (indeed, of our trainees in any mental health discipline).
As a forensic specialist, let me focus on Shea's chapters devoted to exploring suicidal ideation and
violent ideation. Using Shea's interviewing principles, especially the Chronological Assessment of
Suicide Events (CASE Approach), clinicians will be able to render the best possible care, often
exceeding the standard of care. The skills delineated within these chapters should, in my opinion,
be taught in all psychiatric residency programs. Every resident should buy and read this entire book
before taking his or her first night of call. Every resident. In fact, I recommend reading it twice. I
almost forgot to mention, Shea's extraordinary streaming videos will thrust this book to the forefront
of web-based learning. Trust me on this point. They're fabulous.

James L. Knoll, IV, M.D.

Professor of Psychiatry

Director of Forensic Psychiatry

SUNY Upstate Medical University

“While reading the pages of this wonderful book, I kept wishing I could have held this book in my
hands when I was a psychiatric resident. Dr. Shea's stand-out chapters on personality dysfunction
(from DSM-5 differential diagnosis to the effective application of object relations and self
psychology) are suffused with an understanding of the pain experienced by patients with personality
disorders, and the confusion and intensity they can stir-up in the interviewer. Using Shea's
techniques, clinicians will feel competent at steering through the most turbulent and treacherous of
interpersonal eddies in order to connect with and help these patients. Readers of this highly
engaging, ground-breaking book, and viewers of its over 7 hours of stunning videos, will be able to
become the clinicians their patients deserve, the ones they were meant to be.”

13
Laura Miller, M.D.

Professor of Psychiatry, Loyola University Stritch School of Medicine

Medical Director of Women’s Mental Health at Edward Hines Jr. VA Hospital

“This book is a gift – an extraordinary gift – to the field of clinical social work. Its sophisticated yet
delightfully readable text and its brilliantly conceived and executed streaming video, combine to
create the single most practical and enjoyable clinical textbook that I've ever read. Unlike other
books that focus only on what needs to be addressed, Dr. Shea teaches the how and he does so
with unmatched insight, clarifying intensity, a self-effacing humor, a contagious warmth, and a
genuine sense of mission. The wealth of comprehensive topics explored, ranging from DSM-5
differential diagnosis to uncovering domestic violence and suicide, sensitively exploring psychotic
process, and advanced diversity counseling, make this more than a book or a course – it is a virtual
traineeship. It provides social workers and other mental health professional with an opportunity to
learn from one of the greatest innovators in the history of clinical interviewing. You'll never have a
book that you highlight more. In fact, it's probably simpler to highlight what you don't want to
emphasize. You'll save ink.”

Amanda Rowan, Licensed Clinical Social Worker

Founder, Executive Director, Therapist Development Center

Praise for Previous Editions of Psychiatric Interviewing:

the Art of Understanding
Praise From the Reviewers
10 out of 10 rating on Doody's Score for, “Is this a worthwhile contribution to the field?”

“Using a rich palette of information from various fields, including psychoanalysis, behavioral
psychology, and sociology, the author writes about the entire interview, and reveals the rich
interaction that begins even before the first words are spoken. . . . . It is no surprise that this book
has been well received by major psychiatric journals. However, it is always a pleasant surprise to
find an engaging book that is both theoretically sound and clinically indispensable.”
Doody's Book Reviewer

“This is a book I wish I could have written. . . . . can be read with interest by expert and novice
alike.”

Clinical Psychology Review

Arthur Weins, Ph.D.

“Rich in information, wisdom, humor, and charm, this book teaches not only interviewing skills but
also the attitudes and behaviors that underpin the therapeutic personality and process.”
American Journal of Psychiatry

“Provides a well-balanced synthesis of many approaches from various schools of psychiatry,

psychology, and counseling. . . . enjoyable and stimulating to read. . . . . written with eloquence and
humor.”
British Journal of Psychiatry

14
“Intensely practical, with a riveting chapter on the assessment of risk for suicide and homicide. . . . .
Reviewers have a way of telling you that a good book is essential for every psychiatric library. This
time it really is true.”
Canadian Journal of Psychiatry

Both previous editions chosen for the Brandon/Hill List

as one of the most important psychiatric books
for medical libraries to procure!

“Shea's book, which is now in its second edition, is a valuable counter-weight to the ‘one size fits all’
approach to interviewing and eliciting data. It is an invaluable book for those training in psychiatry or
other mental health professions and indeed for practicing clinicians.”
Australian and New Zealand Journal of Psychiatry

“Rich with sensitive observations and practical suggestions and enlivened by frequent examples of
diagnostic interviewing.”
Transactional Analysis Journal

“A marvelous text on an aspect of psychiatry that often does not receive as much attention as it
deserves.”
Hospital and Community Psychiatry

Praise From the Experts and Faculty for Previous Editions

“Year in and year out, one of the most popular, if not most popular, required textbooks for our
master level students in counseling. Superbly practical yet filled with a sense of compassion.”

Judi Durham, A.P.R.N., M.A., C.S.

Senior Associate Faculty

Antioch University New England

“For mental health professionals this book is a must read. The writing style is fluid, fast paced, and
stimulating. I recommend it without hesitation to all nurses and nursing students.”

Joan Kyes, M.S.N.

Author of Psychiatric Concepts in Nursing

“Practical, sensitive, and comprehensive. . . . . The chapter on handling resistance and awkward
questions provides a wealth of practical suggestions for students in mental health from social work
to psychiatry.”

Carol Anderson, M.S.W., Ph.D.

Author of Mastering Resistance – A Practical Guide to Family Therapy

“This beautiful and immensely useful book is a great gift. It should stand as the best starting clinical
text for all mental health professionals. . . . . I predict that beginning clinicians, and many
experienced ones, too, will return to this book the way people return to the books they find deepest

15
and most evocative, reading a few pages at a time, to be savored and enjoyed, so its wisdom enters
our bones.”

Leston Havens, M.D. from the Foreword to the 2nd Edition

Professor of Psychiatry, Harvard Medical School

“A highly crafted book on interviewing which impressed me with the remarkable ways in which it is
truly comprehensive. The chapter on personality assessment is a rich blend of gathering valid
diagnostic data while simultaneously attending to the patient's feelings and needs. It is a remarkable
introduction to the assessment and diagnosis of personality disorders.”

Juan Mezzich, M.D., Ph.D.

Former Secretary General

World Health Organization, Psychiatric Division

“Dr. Shea deserves congratulations for writing an engaging book on a fascinating, but difficult
subject. The text demonstrates the creativity and flexibility Dr. Shea values as integral to the
process of interviewing. There is much here for the beginning clinician from a variety of disciplines,
but the rewards for the more experienced interviewer are equally apparent. This book is not just
informative, it challenges the reader to reflect on his or her own interviewing style and technique.”

Miles K. Crowder, M.D.

Coordinator for the Psychiatric Residency Training

Vanderbilt University

“This book is rich with case presentations, vivid clinical dialogues, theoretical eclecticism, personal
wit, clinical acumen, and undeniable readability. I can't think of any other book that my graduate
students enjoy as much, or talk about with more enthusiasm. In my view Psychiatric Interviewing:
the Art of Understanding, 2nd Edition is unequivocally the best beginning text for mental health
professionals, no matter what their discipline.”

David Jobes, Ph.D.

Author of Managing Suicidal Risk, 2nd Edition

Past President of the American Association of Suicidology

“A rare model of painstaking scholarship and pragmatic understanding.”

Stanley D. Imber, Ph.D.

Professor of Psychiatry and Psychology, University of Pittsburgh

“The mental health counselor rarely finds psychiatric literature that bridges the traditional differences
of theoretical orientation and practice. Dr. Shea has carefully and sensitively responded to the
needs of all mental health professionals, providing careful examination of psychopathology,
diagnosis and resistance that is refreshing for the non-psychiatrically trained mental health

16
counselor.”

Arthur C. Mace, M.A., N.C.C.

Clinical Director, Fayetteville County Mental Health Center

17
Copyright

© 2017, Elsevier Inc. All rights reserved.

First edition 1988
Second edition 1998

No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher's permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).

ISBN: 978-1-4377-1698-6
E-ISBN: 978-1-4377-3782-0
Inkling ISBN: 978-0-323-32901-9

Dr. Shea retains copyright of chapter opener images.

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their
own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

Printed in the USA

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Content Strategist: Charlotta Kryhl

Content Development Specialist: Sharon Nash
Project Manager: Julie Taylor
Design: Miles Hitchen
Illustration Manager: Brett MacNaughton
Marketing Manager: Rachael Pignotti

18
19
Dedication

To the memory of my father who showed me the door of creativity,

In fondest memory of my mother who urged me

to open it,

And to Susan, Brenden, and Ryan who were waiting

on the other side.

and

To Juan Mezzich, MD, PhD

my first and most important mentor,

whose unending support and pioneering work

towards Person-Centered Psychiatry and Medicine

will leave a legacy of healing and hope

for untold numbers of people

for many decades to come.

20
Foreword
It has been my privilege to train and supervise young mental health professionals from many
disciplines for over 50 years. I can say that doing so has been one of the great joys of my life. I can
also safely say that you are holding in your hands one of the most remarkable books I have had the
pleasure to read in all of those years. Enormously practical, elegant in execution and delightfully
fun to read, every page holds clinical wisdom.
Shea has an almost uncanny ability to genuinely perceive the complexities of clinical
interviewing, while creating frameworks that illuminate, clarify, and simplify those complexities so
that young clinicians can actually apply them. And he accomplishes this challenging task with a
self-effacing humor and a refreshing sense of compassion that combine to shed a vibrant brilliance
on our art. I can think of no better first book for any trainee in mental health, for it is not only, in my
opinion, an unsurpassed book about how to interview, it is a book about why we interview. It is a
book that captures the wonderment of our work and the soul of our mission.
It is also my opinion, that you are holding in your hands the textbook of tomorrow, today. Shea's
graceful integration of over 7.5 hours of streaming video throughout the text provides every
psychiatric resident and graduate student the chance to see a truly talented interviewer at work
undertaking tasks as complex as exploring sensitive and taboo topics to uncovering suicidal
ideation and intent. If this were not enough, the viewer also gets the chance to watch and hear Shea,
one of the most dynamic speakers in our field today, discuss these interview excerpts, powerfully
consolidating what the student has just read in the text while providing new nuances and insights
not even mentioned in the text. It is a stunning wedding of innovative educational theory with
today's revolutionary technology. As the student enters their clinical rotations, and ultimately, as
they leave their residency and graduate programs to secure their first jobs, they can return to these
videos, stream them on their laptops, tablets, and smart phones, wherever they are and whenever
they choose. The video illustrations of the book will always be available to them in the palm of their
hands.
Readers of this book, whether beginning students or wizened clinicians with decades of
experience, will find much that is innovative. Indeed, Shea's innovations, in my opinion, have been
pivotal in shaping how interviewing is both done and taught across disciplines. I had the pleasure
of running across Shea's interviewing strategy for uncovering suicidal ideation, behaviors, and
intent (the Chronological Assessment of Suicide Events – CASE Approach) years ago and promptly
invited him to write an article about it in the Psychiatric Annals.
As the years have passed, the CASE Approach has become one of the most respected approaches
for eliciting suicidal ideation in the world, as reflected by its being chosen as a recommended
strategy by the Zero Suicide Initiative and its selection for the Best Practices Registry from the
Suicide Prevention and Resource Center (SPRC). In this book readers will find a remarkably
compelling and practical introduction to the effective use of the CASE Approach. Shea's subsequent
video demonstrations of the CASE Approach are, in my opinion, unparalleled in the history of
mental health training. I have never seen such great teaching videos on eliciting suicidal ideation.
They are a treasure, and I believe that many lives will be saved by those lucky enough to view
them.
I was pleased to see that Shea's numerous other innovations are equally expertly reviewed and
updated in this edition. His internationally respected supervision system for helping trainees to
create fluid and naturalistic interviews, known in the clinical interviewing literature as the study of
facilics, is beautifully updated in this edition, including an interactive web program. An entire
chapter has been dedicated to the topic of “validity techniques,” a field of study first delineated by
Shea years ago for helping patients to share sensitive and taboo material such as incest, domestic
violence, and substance abuse. And, as a bonus, for any clinicians who prescribe medications, there

21
is a chapter on Shea's Medication Interest Model (MIM) as the model is applied to psychiatric
medications. If not familiar with the MIM, it is a collaborative model of talking with patients about
their medications. In this chapter, the reader will find over 40 specific interviewing techniques that
help patients make wise decisions about whether or not medications are a good choice for them and
can help clinicians to effectively motivate patient interest in using those medications once chosen. I
have been intimately involved in the study and use of medications for decades, and I was fascinated
by the principles and techniques delineated in this chapter. I have a feeling that the MIM will
someday be as important in the field of improving medication adherence as the CASE Approach
has become to uncovering suicidal ideation.
On a final note, Shea is not only a great innovator – he is a wonderful explicator of the ideas and
concepts of others. In short, he is a natural born teacher. His eloquent mastery of language and his
well-timed wit brings the work of others to life for readers. Two examples will demonstrate my
point. Shea has had nothing to do with the development of motivational interviewing (Chapter 22),
yet his chapter on motivational interviewing is a remarkably succinct and penetrating introduction
to its use. I would recommend it to anyone as a first introduction to the subject. Likewise, Shea's
introduction to object relations and self psychology (Chapter 15) is a wonderful monograph on the
topic. He brings to life some of the traditionally most difficult concepts in the field of
psychodynamic therapy. I feel quite confident that his chapter will delight and fascinate new
trainees, who I find have a genuine hunger for learning more about psychodynamic thought. Such
students will be hard pressed to find a more practical and compelling introduction to the topic.
In closing, I have always been a believer that every minute counts in this life. I believe that if one
values every moment, one essentially stretches life. I close with this thought because I realize that
time is at a great premium in our contemporary lives. I just want to reassure any faculty that require
this book, and any students that read it, that every minute spent in its pages will be worth it. Every
minute will count. And every minute will not only benefit you but all the future patients that your
caring will touch.
Jan Fawcett M.D.

22
Foreword to the 2nd Edition
This beautiful and immensely useful book is a great gift. It should stand as the best starting clinical
text for all mental health professionals, because the ultimate success of our clinical interventions is
determined directly by the information we must sensitively garner from the interview. Einstein
remarked that in early sciences, examples serve better than concepts; indeed, they form the earliest
concepts. Shea introduces the beginning clinician to the work by means of concrete situations and
particular examples of actual clinical dialogue. There could be no sounder starting point. Later, I
predict, beginning clinicians, and many experienced ones, too, will return to this book the way
people return to the books that they find deepest and most evocative, reading a few pages at a time,
to be savored and enjoyed, so its wisdom enters their bones.
The book starts where all interviewers start, in the dark, knowing that they must gently feel their
way. This is a necessity not only because valid psychological data are extremely difficult to secure
but also because our first job is to establish an effective relationship to carry on the work. In other
words, Shea takes the interview with deep seriousness, which is the same as taking the relationship
seriously and the importance of uncovering valid findings.
On the other hand, in a particularly refreshing light, Shea does not take himself too seriously. He
draws our attention to his own mistakes, reflecting on them with a gentle humor, demonstrating
directly what can be learned from them. No better model for learning could be demonstrated for the
beginning, and often frightened student, allowing the student immediately to feel more at home
both with himself or herself and with the author. Moreover, Shea knows that an interview and a
relationship can be at cross purposes, so he doesn't want patients to feel that they are “being
interviewed,” but rather that they are “talking with someone.” He states his goal early, “to gather
the necessary clinical information efficiently while powerfully engaging the patient.”
The focus is on assessment, not ongoing psychotherapy, but there is much here for all
psychotherapists. For instance, throughout the book Shea emphasizes the point that a well-crafted
initial interview, although it is not psychotherapy, is always therapeutic. He proceeds to
demonstrate with practical illustrations, including an entire transcript of one of his own interviews,
exactly how to accomplish this complex task.
With “facilics,” his innovative set of principles for studying and understanding the methods by
which clinicians structure interviews and manage their time, he provides a wonderfully practical
method for gracefully navigating the tight time constraints of modern clinical practice. He manages
to artfully wed the process of data gathering with compassionate listening. He furthers this
integrative task by highlighting the many practical interviewing techniques that other authors have
developed from a myriad of disciplines, including analytic, interpersonal, self-psychological,
cognitive–behavioral, and existential schools of thought. In short, this is a sophisticated, deeply
informed work, the hands-on emphasis of which does not belie a profound understanding.
Too often, clinical discussions have a pretentious, high theoretical cast, whether of putative brain
processes or unconscious ones. In our mission to help others, unlike theoretical physicists, it is not
our main goal to penetrate the secrets of nature and society. Rather, in clinical care, we are more like
engineers whose task is to construct the practical bridges and strong foundations that foster the
healing process. We need to get from A to B, from meeting to connecting, from guessing to
surmising, from sensing to feeling deeply. Shea breaks down the steps, makes the distinctions, and
lets us build our own working methods from the various examples he provides. We are to practice
techniques and create new ones, until a wide range of possible actions becomes second nature to us
all.
This is where clinical work must begin. We could not be in better hands.
Leston Havens M.D.

23
24
Preface

The purpose of life is to serve and to show compassion and the will to help others. Only then have
we ourselves become true human beings.
Albert Schweitzer

It is with great pleasure and excitement that I sit down to write the preface for the 3rd edition of this
book. Much has changed in our field since the publication of the 2nd edition 18 years ago – some
good, some not so good. My pleasure arises, to a great extent, from the fact that the cornerstone
principles of the first two editions – sensitivity and compassion – still resonate in our field today;
indeed, in the age of managed care, increasing time pressures, and the advent of the electronic
health record, they may play an even more important role as guideposts than ever before. Put more
bluntly, many extraneous factors have been introduced into the environment of everyday clinical
care that, in my opinion, make it harder to be a sensitive listener today than has been the case in all
previous generations.
In this regard, the one over-arching goal of this textbook is to prepare the trainee to function effectively, and
with compassion, in the hectic worlds of community mental health centers, inpatient units, emergency rooms,
university counseling centers, and private practices. To accomplish this task, today's students require
the acquisition of a series of advancing interviewing skills that must be developed sequentially
throughout the years of their residency and graduate training (indeed, as an ongoing education
throughout the rest of their careers). In these pages I have made my best effort to address these
progressive steps in a fashion that makes their acquisition both more pleasant and more effective. I
have tried to create a book that, in essence, grows with the trainee through the years of their
residency or graduate program and beyond.
Moreover, in an exciting fashion, the field of clinical interviewing has exploded with innovations
since the 2nd edition of this book, from the widespread acceptance of motivational interviewing to
the numerous advances made with regard to culturally adaptive interviewing and the increased
emphasis on wellness interviewing. Towards capturing this excitement, I have tried to keep intact
whatever elements of the 2nd edition reader feedback has suggested were most effective, while
approaching the topics of each chapter with the same informal writing style that readers seemed to
enjoy so much in the previous editions. As they say, don't fix what isn't broken. In addition, as with
the 2nd edition, I have given careful attention to presenting the complexities and nuances of each
topic with the in-depth sophistication they warrant when training psychiatric residents and
graduate students in clinical psychology, psychiatric social work, psychiatric nursing, and
counseling.
Concerning the sequential skills that new trainees must master, first and foremost, trainees – no
matter what their disciplines – must, in their initial course on clinical interviewing, acquire a set of
core interviewing skills of a surprisingly complex nature. More specifically, the trainees must
acquire and practice skills ranging from topics as diverse as conveying empathy, nurturing
engagement, and sensitively structuring interviews, to effectively uncovering client wellness and
strengths, as well as delicately uncovering the truth about sensitive and taboo topics. All of these
skills must be learned while simultaneously addressing the interplay between these skills and the
complex context of cultural diversity, nonverbal communication, and the interface between the
interview and collaborative treatment planning. No small task for an introductory course! Part I of
this text – “Clinical Interviewing: the Principles Behind the Art” – was designed to meet this
daunting task head-on with individual chapters addressing all of these topics.
And, here is where things get really exciting. As I mentioned earlier, many things have changed
since the 2nd edition of this book. A truly great advance has been the ability to stream video through
the web. This has revolutionized how we can go about the process of training clinicians in
interviewing (as well as psychotherapy). Throughout Part I (as well as Parts II and III) more than 7.5

25
hours of streaming video have been integrated directly into the text of the book. Now readers become
viewers. After learning about specific techniques, with the mere click of a link, the reader of the
accompanying e-book can view streaming video in which I am not only consolidating and
elaborating on what was just read, but I am demonstrating the exact same interviewing techniques
with annotated video. Moreover, as Jan Fawcett noted in his Foreword to the 3rd edition: “As the
student enters their clinical rotations, and ultimately, as they leave their residency and graduate
programs to secure their first jobs, they can return to these videos, stream them on their laptops,
tablets, and smart phones wherever they are and whenever they choose. The video illustrations of
the book will always be available to them in the palm of their hands.”
In Step 2 of their maturation as clinical interviewers, after acquiring their core interviewing skills,
the trainee will encounter a new, and particularly challenging set of skills to master. Specifically the
graduate student or psychiatric resident must learn how to adapt their newly acquired core
interviewing skills for use in the real world of community mental health centers, inpatient units,
college counseling centers, private practices, and emergency departments. In these settings, the
trainees, during their clinical rotations and internships (and subsequently in their years of
employment) will encounter patients suffering from a variety of painful disorders ranging from
major depressive disorders, substance use disorders, post-traumatic stress disorder (PTSD), and
obsessive–compulsive disorder, to bipolar disorder and schizophrenia.
This requires that a clinical interviewer understand the phenomenology and exquisite pain with
which these psychopathological symptoms present themselves to each unique patient (as well as
the pain of the family members who love the patient). Moreover, it is not enough to have an
introduction to this phenomenology. One must understand, in a particularly sophisticated fashion,
the person beneath these symptoms and be able to sensitively explore the experience and meaning
of these symptoms, for they are manifested uniquely by each person and the cultural context that
shapes that person.
Part II of this textbook – “The Interview and Psychopathology: From Differential Diagnosis to
Understanding” – attempts to address these critical concerns. The major diagnostic categories are
approached with chapters dedicated not only to sensitively performing a differential diagnosis (in
which I provide numerous sample questions and illustrative interview excerpts) but with separate
chapters that illustrate various questions and strategies that will take the reader into an even deeper
understanding of the pain and symptoms of the person before them. You will note that careful
attention is given to cultural and familial factors so that clinicians – who are interviewing a patient
who comes from a different culture than the interviewer's culture – will not mistake cultural
differences as psychopathology or, on the other side of the coin, miss disorders that are unique to
the patient's cultural heritage.
Note that the 3rd edition of this book is specifically designed to allow faculty to literally create the
textbook that he or she feels is best suited for the course being taught. Thus some faculty will feel
that there is time within their trainees' first course – on core interviewing skills – to assign these
chapters on the interface between the clinical interview and psychopathology. Other faculty may
decide these chapters are best suited for a separate course on psychopathology. Still others may
decide that one or two of the chapters are invaluable in the first course on clinical interviewing so as
to ensure that the students immediately understand that their core interviewing skill will be
implemented with patients in great pain and with varying disorders.
The third graduated step in the trainee's development of interviewing skills is challenging,
indeed, sometimes legitimately intimidating. The student must learn how to sensitively elicit
suicidal ideation and intent as well as violent ideation and intent. Many trainees also find the
mental status to be confusing and awkward to implement gracefully. These specific tasks are of
such importance that separate chapters are dedicated to each of them in Part III of the book –
“Mastering Complex Interviewing Tasks Demanded in Everyday Practice.”
The expanded chapter on suicide assessment in this 3rd edition includes some of my very favorite
pages in the book, which I hope you will enjoy as well. It is an introduction to the interviewing
strategy for uncovering suicidal ideation, planning, intent, and actions known in the clinical
literature as the Chronological Assessment of Suicide Events (the CASE Approach). It has been one
of my greatest satisfactions to see the interest and adoption – both nationally and internationally –
of the CASE Approach, which was first delineated in the 2nd edition of the book. In this expanded

26
chapter, I have an opportunity to not only describe the updated version of the CASE Approach (for
we are always improving it) but to demonstrate, via streaming video, the interview strategy in its
entirety, dissecting its nuanced variations as the clinical risk of suicide presents in varying degrees
of severity.
Finally, in a trainee's fourth evolution in clinical interviewing skills, during his or her graduate
program or psychiatric residency, the trainee will need to learn advanced skill sets, which are
addressed in Part IV, “Advanced Interviewing and Specialized Topics.” As noted earlier in this
Preface, I have tried to create a book that will grow with the psychiatric resident or graduate
student as they progress through their training, while providing a reference that they will pull off
the shelf in their subsequent careers as a mental health professional.
The bonus chapters in Part IV are essentially designed as independent monographs regarding
each of these topics. I would like to draw the reader's attention to two of these advanced chapters
that I think, paradoxically, despite their advanced nature in the sense of requiring a pretty good
observing ego to employ their techniques, faculty might find very enticing to include as closing
bonus chapters in an introductory course on clinical interviewing. Students really appreciate the
usefulness of the topics.
The chapter, “Transforming Anger, Confrontation, and Other Points of Disengagement” covers
all of the types of awkward moments that beginning clinicians dread such as patients confronting
them on their inexperience, asking personal questions such as, “Do you believe in God?” or “Have
you ever had an affair?”, or a delusional patient asking, “Do you believe me?” I tried to provide an
easily understood framework for handling such questions as well as providing the beginning
student with possible answers and illustrative dialogue of clinicians responding gracefully to such
moments.
I also think that faculty may find that some of their beginning students will be ready to enjoy the
sophisticated introduction to culturally adaptive interviewing to be seen in the chapter, “Culturally
Adaptive Interviewing: The Challenging Art of Exploring Culture, Worldview, and Spirituality.” I
have attempted to create a comprehensive “monograph” that will allow a student – through the
reading of a single chapter – to come away with a sound introduction to this fascinating, and
critically important, area. I have tried to not only describe what needs to be done during culturally
competent interviewing, but I have also tried to give compelling examples of dialogue that
demonstrate culturally adaptive interviewing.
Two truly advanced topics, dear to my heart and closely related to each other, also appear as
bonus chapters. In this 3rd edition, I finally had a chance to do something that I have wanted to do
for years – attempt to provide, in a single chapter, a reasonably sound introduction to the highly
innovative work of Miller and Rollnick – Motivational Interviewing (MI). As one would expect in
this book, I focus on how the principles of MI can be employed in the initial interview.
It was also a pleasure to be able to introduce to all mental health providers, especially all those
who prescribe medications (from psychiatrists to psychiatric nurse clinicians, psychiatric physician
assistants, and psychiatric clinical pharmacists) the collaborative and motivational model known as
the Medication Interest Model (MIM), which addresses how we can go about the complex process
of talking with our patients about the possible use of medications in a truly collaborative fashion.
The MIM was first introduced for use in general medicine in my book Improving Medication
Adherence: How to Talk with Patients About Their Medications as applied to medications being used to
treat all disease states from diabetes, hypertension, and congestive heart failure to depression and
PTSD. In our bonus chapter in Part IV of this book, I have been able to create a fast-reading
monograph on how the collaborative interviewing principles and techniques of the MIM can be
specifically applied with patients considering psychiatric medications. I hope this monograph on
the psychiatric application of the MIM will help many clinicians to help many patients for many
decades to come.
For faculty readers some particularly rich new material has been added in the Appendices. In
Appendix IVB the reader will find four popular, unabridged articles from the Psychiatric Clinics of
North America describing innovative educational strategies and approaches. The articles examine
challenges such as designing effective interviewing training programs for psychiatric residents and
graduate students and teaching clinical interviewing skills using role-playing from conveying
empathy to eliciting suicidal ideation and intent. Separate articles describe, in detail, the real-world

27
application of educational advances such as macrotraining and scripted group role-playing (SGRP).
In addition, over the years I have been repeatedly asked by faculty and interviewing mentors
whether there was a readily available resource for quickly teaching both trainees and instructors the
schematics to be used in facilic supervision. With the production of this book, readers can now
enjoy an easy to use interactive computer module online to do so whenever they choose.
I hope that the reader enjoys this book as much as I enjoyed expanding, revising, and adding
video to it. In the final analysis, interviewing should be fun. I think it is important to emphasize that
this book does not pretend to show the “correct” way of interviewing, because there is no correct
way. Instead, I offer suggestions that will provide the reader with the principles to develop his or
her own creative style of interviewing, always flexibly matching the interview to the needs of the
patient, not to the dictates of a school of thought.
In closing, this is a book about knowledge – knowledge applied to the art of healing. In the last
analysis, as students of this art, it will always remain our great privilege to ensure that the
knowledge of our minds is guided by the compassion of our hearts and the wisdom of our souls. As
Albert Schweitzer so elegantly stated in our epigram, it is through this art and through our desire to
help others that we ultimately find ourselves.
Shawn Christopher Shea M.D.

July 24, 2016

28
A Few Stylistic Notes From the Author
Please note that the names of all the patients have been changed. In addition, at times,
distinguishing characteristics or facts have been altered to further protect their identity without
altering the clinical essence of our interaction.
Also note that, historically, various names have been used to refer to the people we are helping in
our therapeutic work including client, patient, consumer, and various other descriptors. To me
there are pros and cons to each of these, and I could genuinely make convincing arguments for the
use of any of them. I originally began the manuscript by randomly switching such descriptors, but I
found that readers then tried to ascribe reasons to why I used each in a particular passage (there
were no reasons for I was doing so randomly!).
It became evident that to avoid this type of misunderstanding and for the sake of consistency and
ease of reading, I should choose one of them. I chose to use the word “patient” for many readers –
at some point in their careers – will be working with people in settings such as hospital units or
emergency rooms where, indeed, the term “patient” is viewed as normative. This is not to suggest
that the word “patient” is superior or correct, it is merely a way of securing consistency in the text.
With regard to gender identifying words in the text, I also take that topic seriously, for I recognize
that language counts. For instance, some experts prefer the word Latino, others the word Latino/a,
and still others the word Latina/o (which is my personal preference). I can't pass judgment on any
of these descriptors as long as the writers are trying their best to be cognizant of the importance of
gender in their writing. I can't assure my readers that we will always agree on my choices, but I can
assure the reader that I made my choices with a genuine spirit of addressing gender fairly and in a
fashion consistent with the highest current values of our society.

29
Acknowledgments
I would like to begin by expressing my deep gratitude, once again, to all those who helped with the
first and second editions of this book.
With regards to the third edition, many colleagues, clinicians, and patients have coalesced over
the years into wonderfully evanescent teams of people whose knowledge, experiences, and bits of
self have found themselves into the pages of this book. I can't thank enough all of the clinicians –
whom I have had the pleasure to meet during my clinical interviewing workshops – who have
shared their interviewing tips with me and, oftentimes, subsequently made contributions to the
“Interviewing Tip of the Month” on our website for the Training Institute for Suicide Assessment
and Clinical Interviewing (www.sucideassessment.com). Your enthusiasm for clinical interviewing,
as well as your clinical wisdom, help to animate the pages of this book.
Regarding my years at Dartmouth spent developing the Dartmouth Interviewing Mentorship
Program for the Department of Psychiatry, a special thanks goes to the core members of the so-
called “Phantom Gate Club” – Ron Green, MD, Bruce Baker, PhD, Christine Barney, MD, Stephen
Cole, PhD and Mark Reed, MD. Your feedback, creative ideas, interviewing expertise, and
friendship are reflected throughout the chapters in this third edition.
A special thanks to three wonderful clinicians who provided outstanding input on the chapter
entitled, “Culturally Adaptive Interviewing: The Challenging Art of Exploring Culture, Worldview,
and Spirituality”. Dottie Morris, PhD provided a detailed review of the entire chapter, supplying
her insights from her years of work in the field of diversity and multiculturation. I would also like
to thank Edward Hamaty, DO for his sensitive review of the section exploring the needs of the
LGBT community as well as his cherished friendship since our meeting at Lee Hospital for a
summer work program way back in 1970. And thanks to Patsy “PJ” Taucer, M.Ed, a Certified
Medical Interpreter, for her hands-on input on the effective role of interpretation. Couldn't have
done it without you guys.
With regards to the ongoing development and support of the Chronological Assessment of
Suicide Events (CASE Approach) special thanks goes to the never-ending, always appreciated,
support of Skip Simpson, JD, as well as his deeply appreciated friendship. Thanks “Skipper”. More
than anyone, you have taught me the meaning of mission. In addition, both Tom Ellis, PhD and
David Jobes, PhD have been staunch advocates of the CASE Approach from its very inception. A
very special thanks goes to Donna Amundson, L.C.S.W., whose support, input on training
techniques, and unwavering efforts in training clinicians in the CASE Approach has undoubtedly
saved many lives. Her selfless efforts are a part of the soul of the CASE Approach and always will
be.
Moving on to production support, I want to give much deserved recognition and thanks to the
team at Elsevier. In all of my years, this team has been the most talented, professional, and mission-
oriented publication team that I have ever encountered. As our “little project” grew and grew, they
provided their unequivocal support and patience at every step. I can't thank my editor, Charlotta
Kryhl enough. Lotta's encouraging phone-calls with me and her work behind the scenes is the only
reason this book appears in its present innovative format and with its many hours of integrated
video. Thanks goes to Sharon Nash, content development specialist, who, with skill and savvy, has
steadfastly kept us all on track and schedule, no mean accomplishment with regards to myself I
might add. Thanks to Julie Taylor and her entire staff for the best production and “look” I have ever
had in a book. Finally, Marcela Holmes, my copyeditor. I may be biased, but she's got to be one of
the best in the business and has been a joy with whom to work. The book is a much better read for
her efforts. Hopefully I'll someday join you all for a round of bitters in a London pub – on me of
course.
I would also like to add something about the publisher itself, Elsevier. From the very start they

30
have been believers in the mission of this book. Their genuine belief in its mission was most
strikingly reflected in their choosing a remarkably low price for the book – without any hesitation
on their part – in an effort to make sure the book would get into the hands of the clinicians who can
transform its words into healing and hope. What an extraordinarily refreshing attitude in a world
so often consumed by greed and self-interest. Kudos to a great company. Many lives will be
changed because of your integrity.
As I come to the production team of our integrated video, I feel a sense of great gratitude and
warmth. Jeff Kolter of Jeff Kolter Productions is a remarkable human being, who put over 500 hours
into the project, a large amount of this time for gratis because of his belief in its mission. He is
responsible for all videography as well as all post-production and editing. My work with Jeff has
been some of the most enjoyable collaboration of my life. He brought the didactics and patient
interviews to life. And what a gorgeous green screen! Jeff, I'll always remember our times in your
studio and dinners at the Co-op. Many thanks to others involved in producing our integrated video
including Xavier Brown and Susan Shea for their creative input, support, and recommendations. A
special thanks also goes to both my wonderful role-players and, especially, to my patient for her
permission to use the video of her interview with myself.
Another artist warranting much thanks is Debi Stevens. Debi provided the lovely, and sometimes
haunting, artwork that forms the facing pages of the many new chapters that appeared in the third
edition. Debi, I'll fondly remember our hours at Brewbaker's Café brainstorming and reviewing
your remarkable creations.
A thanks goes to the delightful staff of the Susan Colgate Cleveland Library/Learning Center at
the Colby-Sawyer College in New London, New Hampshire for their support over the last three
years of the project. In particular, I would like to thank Noelle Bassi, Beth Krajewski, Erica Webb,
and Kelli Bogan for all of their support as I busily wrote and edited the last half of the book in your
beautiful library. You made “the trip” a fun one.
As my acknowledgments draw to a close, I have saved some of the most important for last. I
would like to thank Jan Fawcett, MD, for his supportive phone calls and his much appreciated
comments and suggestions for the mood disorder chapters in particular. But, most of all, I would
like to thank Jan for his truly lovely Foreword. It has been an honor to get to know you better. I
believe that anyone who has met you, comes to know that you are not only a gifted clinician and
innovator, but a truly good human being. The world is a softer place because you are in it. Many
thanks.
Finally, an enormous amount of gratitude to my wife and the Co-Director of the Training
Institute for Suicide Assessment and Clinical Interviewing (TISA). Susan, thanks so much for all of
your outstanding editorial suggestions on the text as well as the remarkable creative inputs you had
on this project. Moreover, for your support over the six years of this project - that required much
sacrifice on your part – I will forever be grateful. You are not only the love of my life, you are the
keeper of my soul.
Shawn Christopher Shea MD

31
Video Table of Contents
The Delicate Dance: Engagement and Empathy

1.1 Introduction to Integrated Video Package

1.2 Effectively Using Empathic Statements

Beyond Empathy: Cornerstone Concepts and Techniques for Enhancing Engagement

2.1 Conveying Empathy with Fact-Finding Questions

The Dynamic Structure of the Interview: Core Tasks, Strategies, and the Continuum of Open-
Endedness

3.1 Macrostructure of the Interview: The Graceful Unfolding of the

Introduction, Opening, and Body of the Interview
Facilics: The Art of Transforming Interviews into Conversations

4.1 Creating Graceful Transitions Using Natural Gates

Validity Techniques for Exploring Sensitive Material and Uncovering the Truth

5.1 Validity Techniques: Effective Use

5.2 Validity Techniques Illustrated: Complete Interview with Ben

without Didactics and without Labels for Interviewing
Techniques

5.3 Validity Techniques Illustrated: Complete Interview with Ben

without Didactics but with Labels for Interviewing Techniques

5.4 Interviewing Techniques for Uncovering Malingering

Mood Disorders: How to Sensitively Arrive at a Differential Diagnosis

9.1 Sensitively Uncovering the Symptoms of Major Depressive

Disorder

9.2 Sensitively Exploring the Diagnostic Criteria for Other

32
 Psychiatric Disorders such as Panic Disorder, Generalized
Anxiety Disorder, and Adult Attention-Deficit Disorder
Personality Disorders: How to Sensitively Arrive at a Differential Diagnosis

14.1 Sensitively Uncovering Criteria for Antisocial Personality

Disorder
The Mental Status: How to Perform and Document It Effectively

16.1 Principles and Components of the Mental Status

16.2 The Formal Cognitive Mental Status Examination: The Art of

Sensitively Uncovering Cognitive Deficits
Exploring Suicidal Ideation: The Delicate Art of Suicide Assessment

17.1 The Delicate Art of Uncovering Suicidal Ideation and Intent –

Part 1: Core Principles and Theory

17.2 The Delicate Art of Uncovering Suicidal Ideation and Intent –

Part 2: From Theory to Practice (Annotated Video Clips)

17.3 The Delicate Art of Uncovering Suicidal Ideation and Intent –

Part 3: Flexibly Utilizing the CASE Approach with Patients with
High Lethality (Annotated Video Clips)

17.4 CASE Approach Illustrated: Complete Interview with Amy #1

without Didactics and without Labels for Interviewing
Techniques

17.5 CASE Approach Illustrated: Complete Interview with Amy #1

without Didactics but with Labels for Interviewing Techniques

17.6 CASE Approach Illustrated: Complete Interviews with Amy #2

and with Amy #3 without Didactics and without Labels for
Interviewing Techniques

33
PA R T I
Clinical Interviewing: The Principles Behind the
Art
OUTLINE
Chapter 1 The Delicate Dance Engagement and Empathy
Chapter 2 Beyond Empathy Cornerstone Concepts and Techniques for Enhancing Engagement
Chapter 3 The Dynamic Structure of the Interview Core Tasks, Strategies, and the Continuum of
Open-Endedness
Chapter 4 Facilics The Art of Transforming Interviews into Conversations
Chapter 5 Validity Techniques for Exploring Sensitive Material and Uncovering the Truth
Chapter 6 Understanding the Person Beneath the Diagnosis The Search for Uniqueness,
Wellness, and Cultural Context
Chapter 7 Assessment Perspectives and the Human Matrix Bridges to Effective Treatment
Planning in the Initial Interview
Chapter 8 Nonverbal Behavior The Interview as Mime

34
CHAPTER 1

The Delicate Dance

Engagement and Empathy

When a doctor tells me that he adheres strictly to this or that method, I have my doubts
about his therapeutic effect. … I treat every patient as individually as possible, because the
solution of the problem is always an individual one …

Carl G. Jung

Memories, Dreams, Reflections

In the following pages, we will begin a study of the interviewing process. We will be examining

35
Another random document with
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN