Skills For Interviewing and Working Directly With Clients
Observation: watch the client and the interaction between the client and yourself. Take not on what is said nonverbal as well as verbal, look at what is not said and they rush on from. Look for discrepancies between verbal and non-verbal communication.
Paraphrasing: This is feedback – it is a shortened summary of what they just said. It isn’t parroting, it is abridging to show your understanding and can be used to seek further information through clarifying. “It sounds like….”. Clarifying is self disclosing and focusing discussion. Perception Checking is determining accuracy of hearing.
Cultural and Gender Issues:
- Not all cultures like to share their feelings, and some people as individuals may want to save face.
- Men may feel unmanly when expressing themselves.
- In general, when working with females, paraphrasing usually gets your more answers and works better, while when working with men asking questions. Don’t rely on this solely and try to incorporate both just notice the preference.
Summarising: This is like paraphrasing but it covers more content, like summarising the consultation with the client and used at the beginning to revisit past sessions as a recap.
Reflection of Feeling: The focus of this is on emotion, it is like an emotion paraphrase, “sounds like you are feeling anxious and worn down….”. It puts a name on the emotional tone and summarises how they are feeling. It should help a client identify how they feel.
- (name of client) sounds like you are feeling (name the emotion or feeling) at the moment because (name the context). Now clarify
Cues for Reflection:
- What is the client actually saying
- How is the client saying it: vocal pitch, speed, hesitations
- Non verbal cues: physical appearance, gestures, eye contact, facial expressions, body posture, movement.
Acknowledging or commenting on the clients behaviour and stating an obvious thing allows them to know you noticed, but reflecting goes past just acknowledging and moving on, it explores further information.
Change: It is very important that your client is ready to make the change otherwise it will not happen. Stages of change:
- Precontemplation >Contemplation> Determination > Action > Maintenance > Relaps.
- Precontemplation: the client has not considered changing
- Contemplation: the client is thinking about change
- Determination: The client wants to change and makes plans
- Action: the client begins to change by engaging actively in changing
- Maintenance: Client has achieved change and is maintaining it
- Relaps: can occur anywhere in the cycle and the client will fall back to a previous stage.
- A client in the Contemplation and Determination Stages are the easiest for a practitioner to help as they are ready for change.
Initial Therapy Consultation:
- introduce self
- familiarise client with clinic, bathrooms and water
- Begin establishing rapport
- Make sure client is comfortable
- Enquire about past client experiences
- Have they seen a practitioner before?
- If yes, how did they find the experience?
- If yes, what did they like or not like?
- Informed consent
- Confidentiality and limitations
- Payment clarification
- Risk of harm
- Session overview
- Describe a normal course of a session
- Tell client it may deviate depending on what is said, eg it may take more than one session or serious health issue may require immediate attention.
- Clients presenting problems
- Find out main reason for coming
- Start with open questions and move to closed questions as the interview proceeds
- Define The Problem
- Continue to gather data
- Assess the problem and see if there are success they have made
- Separate clients issues from each other for goal forming stage
- Explore for exceptions
- Find out when things have been better for client, if symptoms have been reduced at a certain point in time.
- Has cleitn intentionally mader the change or was it accidental?
- Use the information to help improve the chance of success
- Interview – clarify /goals/needs /scaling
- Clarifying goals: are they SMART? – Specific? Measureable? Actionable? Realistic? is the clients Timeframe realistic?
- Scaling: gauge how willing they are to change and how important it is for them to change
- Describe my limitations as a practitioner
- So they have realistic expectations and know that you cannot solve all problems
- Make them aware that everyone is different so the outcome can be different.
- Agree on a realistic goal/ prioritise
- Reflect on the situation and which treatment should be taken
- Ask if there was anything else that I should know or you would like to discus
- Assessment> present treatment plan.