The interview process between a clinician and his or her client seems to be the groundwork upon which treatment and healing begins. Dependent on the type of case and diagnosis is presented specific settings, techniques, and boundaries will be applied to produce the best results. Thus, it is imperative for a clinician to fully comprehend how what may appear insignificant in his or her opinion negatively can influence his or her client in the vastest way. A scenario of a 15-year-old Filipino female recently hospitalized for attempted suicide will be used as a theoretical case study and the methods in helping her will be examined. The primary goal of the scenario analysis is to evaluate, identify, and treat the young girl in regard to her exceptional set of circumstances, personal characteristics, and cultural divergence. Supplementary to the clinician’s initial objectives it is important that a stage is prepared for the client to feel compelled to communicate openly and receive guidance to heal.
Alexis Gomez was referred to me by a hospital social worker called to investigate her attempted suicide case. My services is requested to work closely with the young teenage girl in deciding the length of her therapy, whether or not she would require institutionalized care, and the state of her home environment. The first interview was thought best to be scheduled at one of my office’s located at a small community agency near the client’s home to provide a less sterile and clinical atmosphere. To gain a better perspective of the individual I was to meet so also to help form healthy expectations I reviewed the notes gathered by the hospital social worker detailing the young girl’s medical, family, and cultural background. Upon studying the information provided I learned Alexis came from an affluent two-parent household with two older siblings living in a quiet suburban town. She is an honor student enrolled in all AP courses at a Catholic school where she is involved in numerous athletic sports and is well-liked by her peers. Although Alexis’ family background reveals that in the Filipino culture family is highly valued above any other and is the fundamental societal unit she is struggling with relationship issues with her mother and siblings. In a traditional Filipino family the father is reported to encompass the role of provider and head of house while the mother takes on the responsibilities of the domestic and emotional development and values of the family (philippinecountry.com, 2006). The adolescent is remarked to have had a close personal relationship with her mother but lately has been feeling closed off and inadequate because of her mother’s constant mood changes usually directed at the young girl. As well, Alexis has stated briefly that she feels abandoned and alone because her adult siblings spend less quality time with her or at home because of work and personal relationships. Moreover, family tensions have been a cause for additional stress in the home environment between her parents, older brother, and the relationship the parents disapprove of leaving him to move out. Given that in the Filipino culture families are extraordinarily close parents occasionally find it difficult to allow their children to leave, especially their first born son, which many times results in adult children staying home as long as they please (philippinecountry.com, 2006). As I continued to peruse the reports, I found that Alexis’ desperate action was too fueled by her parent’s restrictive and smothering behavior limiting her social freedoms or relationships, pressure to excel in school seeing as education in the Filipino background is considered central to upward mobility and social standing (everyculture.com, n.d.), and bullying from jealous peers. The young girl appears to isolate herself even from those closest to her and exhibits signs of resentfulness and hostility that promote assumptions of past self-mutilation when looking over medical reports. Therefore, because I have more knowledge of the client’s identity, the family values and beliefs she has been raised with, and her presenting issues I will be able to create varying methods of gaining her trust in communication while recognizing she may be resistant to the idea of therapy, especially if she has been mandated to participate. First, I would be sure to speak to Alexis with a tone that expresses my mutual respect for her as a young adult by explaining the reason for the visit and reiterating my responsibility to the relationship in maintaining confidentiality, especially in regard to what is disclosed to her parents with her consent. Next in a focal but also nondirective manner I will ask what her expectations are of me and the session, what her interests are, and where would she like to begin without overwhelming her with countless other questions (Murphy & Dillon 2011). Throughout this brief introduction I want to offer my support unconditionally while being gentle but persistent if she has trouble speaking of the incident or other sensitive topics. I want her to know that I am simply here to listen without any judgment of what she has done or about her family that will reveal respect for her comfort level while still stressing my concern and readiness to listen (Smith, Barston, & Segal, 2011). As well through validation of feelings and a show of empathy an effective working relationship can be established. Accompanying my styles for personal communication and instituting a sense of trust in the relationship I might suggest keeping a journal or sharing art projects to help Alexis express herself more actively without shame or hesitance (kidshealth.org, n.d.). However, I need to remain conscious of some of the issues concerning self-disclosure and boundaries. As I state in the beginning of the interview that I am accountable to my client for releasing or not releasing information to her parents without consent, at the same time it is necessary to discuss with her the instances in which I would have to breach confidentiality. One instance would be to the Child Protective Agency who was also alerted by the hospital case worker about the attempted suicide who need confirmation on the adolescent’s well-being and living situation and the other to the parents if I feel Alexis poses a threat to herself or others. Likewise, relationship boundaries must be put in place so as not to confuse the young girl with disillusions of friendship outside of the therapeutic setting. Both issues also pertains to the family, they must understand I am here for Alexis’ benefit and will not disclose anything spoken at our meetings unless notified by her or Child Protection. After discussing expectations and privacy matters, I will focus on my attending behaviors and the client’s non-verbal communication that hopefully will encourage her to talk more freely demonstrating my interest in what she has to say. Engaging in Contrast Interviewing that is basically contrasting and comparing a positive and negative experience, detecting disruptions of eye contact with unsettling topics or dilation of pupils when speaking about something of interest, and observing body language or posture like personal space and moving forward when intent or backward when bored are just a few examples (University of Oklahoma, n.d.). In addition, vocal qualities or tones (verbal underlining or speech breaks), noticing a change of topic or selective attention, and practicing relaxation or silence when unsure of what to say next are other techniques for supporting my client. Regrettably, attending behaviors and non-verbal communications are not my only concerns to remain mindful of but the cultural sensitivities specific to Alexis and her family. Filipino societies do not tolerate disrespect of elders, parents, or older siblings and disobedience of the expectations of the home. Just as public challenges or reprimand are not looked upon lightly but are viewed as shaming the family. Because of her families values it will prove problematic for Alexis to discuss her struggles at home without feeling like is she is betraying her cultural lifestyle as well as dishonoring the family and their name. Equally challenging is trying to create a mode for the young girl to confide in her parents or my interference without them feeling as if their authority is being disrespected. Cross-cultural distrust can become similarly an issue with questions coming from a culturally different interviewer, which is considered particularly insolent. Consequently, it is beneficial I introduce resources that will permit Alexis to relate to individuals with analogous troubles such as groups for depressed teens, teens that cut themselves, multicultural peers, or victims of bullying. Unfortunately, because so many of the presenting issues stem from the familial environment individual therapy will not be enough and it will be essential to confer with Alexis the need for integrating family counseling once she believes she is ready to do so. Dual collaboration, cooperation, and contribution from all the parties involved will assist in Alexis’ recovery and prevent future destructive incidents. In the end the interview process should consist of understanding the nature of the client’s mental state, personal characteristics, and the cultural and social makeup of his or her home environment. With the inclusion of listening skills, empathy, attentiveness, boundaries, and patience the needs of the client along with the family unit can be met averting clinician-client mistrust.
Everyculture.com. (n.d.). Culture of the Philippines. Retrieved January 29, 2012 from http://www.everyculture.com/No-Sa/The-Philippines,html
Kidshealth.org. (n.d.). What do therapists do? Retrieved January 29, 2012 from http://kidshealth.org/teen/your_mind/mental_health/therapist.html# Murphy, B.C. & Dillon C. (2011). Interviewing in action in a multicultural world. (4th ed). Belmont, CA: Brooks/Cole, Cengage Learning.
Philippinecountry.com. (2006). Philippine Culture- Common family traits. Retrieved January 29, 2012 from http://www.philippinecountry.com/philippine_culture/common_ family_traits_html
Smith, M., Barston, S., & Segal, J. (2011). Teen Depression- Guide for parents and teachers. Retrieved January 29, 2012 from http://www.helpguide.org/mental/depression_teen.htm University of Oklahoma. (n.d.). Interviewing Notes- Attending behaviors: Basic to communication. Retrieved January 29, 2012 from http://www.faculty-staff.ou.edu/M/ Lawrence.J.Marshall-1/InterviewingNotes,html