The Exciting New Preface from Clinical Interviewing (5th edition)


It’s hard to adequately express the excitement surrounding the upcoming publication of the DSM-5. Oops. I meant to write: “the 5th edition of Clinical Interviewing.” I knew there was a 5 in there somewhere.

To help the many world citizens eagerly anticipating this 5th edition, I’m including, hot off of my computer, the first part of the preface. I know . . . it really couldn’t get much more exciting than this.

Who knows, soon I might even be releasing the second part of the preface to this long-awaited masterpiece. [I hope you all can recognize the sarcasm I’m directing toward myself when you read this. It’s just that I’m working on the preface right now and I felt the need to post something on my blog . . . and these two things suddenly merged in space and time.]

Here it is.

Preface

Clinical interviewing is the cornerstone for virtually all mental health work. It involves integrating varying degrees of psychological or psychiatric assessment and treatment. The origins of clinical interviewing long precede the first edition of this text (published in 1993).

The term interview dates back to the 1500s, originally referring to a face-to-face meeting or formal conference. The term clinical originated around 1780; it was used to describe a dispassionate, supposedly objective bedside manner in the treatment of hospital patients. Although difficult to determine precisely when clinical and interview were joined in modern use, it appears that Jean Piaget used a variant of the term clinical interview in 1920 to describe his approach to exploring the nature and richness of children’s thinking. Piaget referred to his procedure as a semi-clinical interview (see Sommers-Flanagan, Zeleke, & Hood, in press).

Our initial exposure to clinical interviewing was in the early 1980s in a graduate course at the University of Montana. Our professor was highly observant and intuitive. We would huddle together around an old cassette player and listen to fresh new recordings of graduate students interviewing perfect strangers. Typically, after listening to about two sentences our professor would hit the pause button and prompt us: “Tell me about this person.”

We didn’t know anything, but would offer limited descriptions like “She sounds perky” or “He says he’s from West Virginia.” He would then regale us with predictions. “Listen to her voice,” he would say, “she’s had rough times.” “She’s depressed, she’s been traumatized, and she’s come to Montana to escape.”

The eerie thing about this process was that our professor was often correct in what seemed like wild predictions. These sessions taught us to respect the role of astute observations, experience, and intuition in clinical interviewing.

Good intuition is grounded on theoretical and practical knowledge, close observation, clinical experience, and scientific mindedness. Bad intuition involves personalized conclusions that typically end up being a disservice to clients. Upon reflection, perhaps one reason we ended up writing and revising this book is to provide a foundation for intuition. In fact, it’s interesting that we rarely mention intuition in this text. Although one of us likes to make wild predictions of the future (including predictions of the weather on a particular day in Missoula, Montana, about three months in advance), we still recognize our limitations and encourage you to learn the science of clinical interviewing before you start practicing the art.

Language Choices

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

Patients or Clients or Visitor

Clinical interviewing is a cross-disciplinary phenomenon. While revising this text we sought feedback from physicians, psychologists, social workers, and professional counselors. Not surprisingly, physicians and psychologists suggested we stick with the term patient, whereas social workers and counselors expressed strong preferences for client. As a third option, in the Mandarin Chinese translation of the second edition of this text, the term used was visitor.

After briefly grappling with this dilemma, we decided to primarily use the word client in this text, except for cases in which patient is used in previously quoted material. Just as Carl Rogers drifted in his terminology from patient to client to person, we find ourselves moving away from some parts and pieces of the medical model. This doesn’t mean we don’t respect the medical model, but that we’re intentionally choosing to use more inclusive language that emphasizes wellness. We unanimously voted against using visitor—although thinking about the challenges of translating this text to Mandarin made us smile.

Sex and Gender

Consistent with Alfred Adler, Betty Freidan, contemporary feminist theorists, and American Psychological Association (APA) style, we like to think of ourselves as promoting an egalitarian world. As a consequence, we’ve dealt with gender in one of two ways: (1) when appropriate, we use the plural clients and their when referring to case examples; and (2) when necessary, we alternate our use between she and he.

Interviewer, Psychotherapist, Counselor or Therapist

While working at a psychiatric hospital in 1980, John once noticed that if you break down the word therapist it could be transformed into the-rapist. Shocked by his linguistic discovery, he pointed it out to the hospital social worker, who quipped back, “That’s why I always call myself a counselor!”

This is a confusing issue and difficult choice. For the preceding four editions of this text we used the word interviewer because it fit so perfectly with the text’s title, Clinical Interviewing. However, we’ve started getting negative feedback about the term. One reviewer noted that he “hated it.” Others complained “It’s too formal” and “It’s just a weird term to use in a text that’s really about counseling and psychotherapy.”

Given the preceding story, you might think that we’d choose the term counselor, but instead we’ve decided that exclusively choosing counselor or psychotherapist might inadvertently align us with one professional discipline over another. The conclusion: Mostly we use therapist and occasionally we leave in the term interviewer and also allow ourselves the freedom to occasionally use counselor, psychotherapist, and clinician.

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