Format Variables

Unstructured interviewing is a difficult skill to acquire. It is not surprising, therefore, that clinical training programs

(e.g., master's and doctoral programs of clinical psychology, counseling psychology, social work, and—less so—psychiatric residency programs) typically devote considerable attention to the development of such skills among their students. Interviewing is typically taught with an overt emphasis on the cultivation of listening skills (as opposed to questioning skills, per se), perhaps because it is not uncommon for the novice clinician to conduct interviews in an ineffectual manner that might charitably be described as a barrage of questions. The acquisition of solid unstructured interviewing skills typically requires considerable practice, in addition to a capacity on the part of the interviewer for critical self-reflection (in order to learn from one's inevitable interviewing missteps) and a recognition of the fact that the interview is based, ultimately, on a human relationship (Johnson, 1981). In an attempt to facilitate the training of interviewing skills, various clinical theorists have subdivided the interview into discrete phases, steps, or objectives.

Harry Stack Sullivan, a seminal figure in both the theory and practice of American psychiatry, was one of the first clinicians to give extensive attention to the interview process. In his still-influential book, The Clinical Interview (1954), he described four principal stages characteristic of the unstructured interview (along with the caveat that such stages be recognized as "hypothetical, fictional, abstract, and artificial"). These four stages Sullivan termed the inception, the reconnaissance, the detailed inquiry, and the termination. The inception includes the clinician's welcoming of the patient and the establishment of what is to be expected from the interview. The reconnaissance stage consists of questioning regarding the patient's history, social situation, and therapeutic needs. During the inquiry stage, the clinician begins to test various clinically relevant hypotheses, especially those germane to the patient's presenting set of problems. The fourth stage, termination, refers to the delicate process of ending the interview in mutually satisfactory fashion.

Asomewhat related, contemporary description of the unstructured interview process is to be found in Shea's (1988) proposed five-phase structural model. This model suggests a broad interview outline that may prove especially helpful for the beginning interviewer and that appears applicable to most forms of unstructured interviewing, regardless of the theoretical context within which the interview occurs. Phase one, the introduction, refers to the initial contact between patient and therapist. During this phase, the therapist may attempt to put the patient at east with conversational small talk and to educate the patient about the interview process itself. Phase two, the opening, entails the clinician's encouraging the patient to provide a first-person account of presenting problems, elicited by a statement such as "Tell me what brought you to therapy." Phase three is the body of the interview. During this phase, the interviewer works to gather relevant information based on material presented during the opening. Such information will subsequently be used by the clinician in the process of case conceptualization and treatment planning. During the closing phase, the interviewer begins the simultaneous process of summarizing material covered during the interview and communicating the clinician's own conceptualization of the manner in which the patient's problems may be optimally addressed—a process that often helps foster a sense of hopefulness in the patient (Frank & Frank, 1991). The final phase, termination, describes the formal cessation of the interview and the exiting of the patient. Shea's model nicely illustrates the point that although the interview format may remain unstructured (inasmuch as the questions and wording thereof are not planned prior to the session), the interviewer typically retains a general idea of the sequence and flow of the interview.

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