Fall 2025 SOWK 581 Week 02 - The Clinical Interview Process

Fall 2025 SOWK 581 Week 02 - The Clinical Interview Process

title: Fall 2025 SOWK 581 Week 02 - The Clinical Interview Process date: location: Heritage University tags:

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Week two is focused on the clinical interview process. Class is synchronous, with our in-person session taking place (09/06/25). You will read Cooper and Granucci Lesser (2022) Chapter 02 where you look at the therapeutic process as a whole divided into stages of treatment and what that looks like. I also ask you to read two journal articles about the DSM and ask you to start exploring your copy of this reference book. There are forums for you to consider diverse perspectives on the DSM and the content in the textbook. During the in-person class session we will be defining clinical practice and our role within the process practice. The agenda is as follows:

• Defining clinical practice and our roles
• Overview of the clinical interview process
• What happens in the beginning stage of treatment
• Transference and countertransference
• Practice exercise with motivational interviewing
• Middle and end of treatment

The learning objectives for this week include:

• Be exposed to different perspectives on DSM and the medical model.
• Students will be able to analyze the concept of impostor syndrome and its impact on new clinicians.
• Students will be able to analyze the concept of impostor syndrome and its impact on new clinicians.
• Define the concepts of transference and countertransference.
• Understand the stages of the change model and relate it to the therapeutic process treatment.
• Explain some of the considerations in the different phases of the treatment process.
• Experience a conversation that is not motivational interviewing, and one that is more in line with the principles of motivational interviewing.

Week 02 Plan

Agenda

• Defining clinical practice and our roles
• Overview of the clinical interview process
• What happens in the beginning stage of treatment
• Transference and countertransference
• Practice exercise with motivational interviewing
• Middle and end of treatment

Learning Objectives

• Students will be able to analyze the concept of impostor syndrome and its impact on new clinicians.
• Define the concepts of transference and countertransference.
• Understand the stages of the change model and relate it to the therapeutic process treatment.
• Explain some of the considerations in the different phases of the treatment process.
• Experience a conversation that is not motivational interviewing, and one that is more in line with the principles of motivational interviewing.

Core Tasks of Psychotherapy

I want to start off our class today talking about psychotherapy and the clinical process. Cooper and Cranucci Lesser (2022) provide seven core tasks that we engage in:

• Develop a therapeutic alliance: Rapport primary indicator for change
• Educate clients: Importance of psychoeducation. We are helping them understand the world, themselves, and the change process.
• Nurture clients’ hope: When clients feel like they can change, they do make change. Significant protective factor for clients.
• Facilitate development of coping skills: We teach them to manage their symptoms.
• Help clients reconsider their beliefs about self/world: We address thinking distortions.
• Nurture clients’ sense of mastery: We help them have confidence for making changes outside of the sessions.
• Conduct relapse prevention: The goal is that that they will end services and no longer need us. Skills to keep this going.

[Small Group Activity] Talk to a partner about:

• How would you define some of these tasks?
• Why are they important?
• What might their implementation look like?

[Whole Group Activity] Debrief discussion

Imposter Syndrome

Imposter syndrome can include a pervasive feelings of fear and doubt can lead to stress, anxiety, and a lack of self-confidence. The phenomenon is present when individuals don’t believe in their accomplishments and are afraid of being exposed as a “fraud” despite having competence and evidence of success (Bravata et al., 2020).

Apgar & Zerrusen (2024) Provide some recommendations for social work education to address

• Recognize and address the phenomenon with self and future clients
• Explore and address feelings of grief and shame before entering the workforce.
• Develop healthy boundaries to develop stress management and prevent burnout.
• Engage in mentorship to gain insight and develop skills and confidence
• Peer support where one can be honest about experiences and feelings of inadequacy

Considering Our Thoughts

It is very normal to feel like an imposter, especially as you are still learning and growing phase of your career. But it also vital that you recognize that sometimes we misalign these thoughts and increase our feelings like a fraud or like we won’t be able to do the work with our clients.

Cognitive Distortions and Definitions

The following are some cognitive distortions

• Negative Filter, Selective Abstraction, Ignoring the Evidence: Pays attention only to information that confirms negative beliefs. Ignores disconfirming or positive information about the self.
• Emotional Reasoning (False Alarms): Misinterpret physiological or emotional experiences as evidence of danger or doom. Leads to avoidance behaviors.
• Arbitrary inference: Persons come to a conclusion with no evidence and/or in the face of contradicting evidence.
• Overgeneralization: Taking a small piece of isolated evidence and then using it to make conclusions about a broad range of life domains.
• Magnification or minimization: Exaggerating failures or defects or minimizing accomplishments/attributes
• Personalization: Taking too much responsibility for events or circumstances beyond one’s control or unrelated to the person.
• All-or-Nothing Thinking: Perfectionistic thinking. Viewing the self, other, and world through an absolutistic lens (i.e., all good or all bad).
• Mind Reading or Fortune Telling (Catastrophizing): Assuming one knows what is going to happen or what another person is thinking without evidence.

-> Based on: Beck (2020), Greenberger and Padesky (2015), Wright et al. (2017) but taken from: Mancini (2021, see pp. 276-277).

[Individual Activity] Give handout, Considering Our Thoughts, and provide 5 minutes to start writing and thinking about this. Encourage to spend time away from class also doing this. Use it as a reminder.

• Print 14 copies of W-02 - Considering Our Thoughts W-02 - Considering Our Thoughts.pdf

Overview of Clinical Interview Process

I want to start off by thinking in a broad overview of the clinical interview process. I appreciate the textbook author using the framing beginning, middle, and end. Depending on when you took your BASW practice classes, if you used the Hepworth et al. textbook they frame it.

Phase 1: Exploration, Engagement, Assessment, and Planning Phase II: Implementation and Goal Attainment Phase III: Evaluation and Termination

Or if you used the Kirst-Ashman and Hull generalist practice model:

Engagement Assessment Planning Implementation Evaluation Termination Follow up

One of the things that I think is interesting in how the Cooper and Granucci Lesser (2022) make the connection to the stages of change (which they describe as a Transtheoretical Model)

The stages of change model uses interventions from several theoretical models and is therefore called transtheoretical. (p. 24)

The Beginning of Treatment:

• Pre-contemplation
• Contemplation*

The Middle of Treatment

• Contemplation (this is where they put it)
• Preparation
• Action

The Ending of Treatment

• Maintenance
• Termination

Beginning Stages of Treatment

I think something important for us consider at the start of treatment is the referral source.

Mandated vs Voluntary

[Whole Class Discussion] What should we be thinking about if a client is mandated verses voluntary.

Beginning stages of treatment (2 of 3)

Your textbook goes through and discusses what the start of the treatment usually includes. There are opportunities for introductions, potentially having clients ask personal questions, working to understand the your own and the clients self-awareness, and sharing about confidentiality that happen in the first session. Also during the first session is when you start doing your assessment and understand why the client is here.

[Whole class/Small Group Activity] Talk about each of these as described below:

• The first meeting (elicit experiences with the first meeting a client)
• Confidentiality (have one person share how they describe confidentiality, then everybody do with a partner)
• Introductions (brainstorm what should be described in our introduction, and then everybody do it with a partner)
• Answering personal questions (how do we handle this, any examples people have?)

Beginning stages of treatment (3 of 3)

Self-awareness is an umbrella term. Within the context of the clinical interview, we relate self awareness to an understanding of the multiple dimensions of the worker’s identity and how that interacts with the multiple dimensions of the client’s identity. (Cooper & Granucci Lesser, 2022 p. 19)

[Small Group Activity] With a partner, ask each other the same question a number of times; the same answer cannot be used twice. The questions they ask each other (changing roles) are “Who are you?” and “Who do you see?”

Activity reportedly taken from (Sommers-Flanagan & Sommers-Flanagan, 2017) described in Cooper and Granucci Lesser, (2022 p. 19).

Therapeutic relationship

I want to move into talking some about the therapeutic relationship. This goes through all three of the phases, but will look differently in each one.

Some of the things we think about are:

• Transference and countertransference (we will talk more about this in minute)
• Working alliance and the real relationship (how do we develop rapport, connection, and a working alliance)
• Resistance (What does it look like when we meet resistance, and what do we do)
• MI and Stages of change (we are going to do an activity giving a taste of MI)

Transference and Countertransference/Intersubjectivity

Transferance and Countertransference are important in understanding the therapeutic relationship. Lets start with defining them.

Transference: A client’s transferential responses may be evoked by the therapist.

Countertransference/Intersubjectivity: Considered to be both the result of the therapist’s unconscious processes and an appropriate reaction by the therapist to the patient. It is a reciprocal influence of the conscious and unconscious subjectivities in the therapeutic relationship.

[Whole Class Activity] What do you think these might look like. How do we handle it.

Motivational Interviewing (1 of 2) Persuasion Exercise

I want to have us experience a conversation that is not motivational interviewing, and one that is more in line with the principles of motivational interviewing. This comes from Miller Moyers (2020) and their train the trainer handouts.

Purpose: To provide an experiential contrast to motivational interviewing. In preparation for learning an interpersonal skill, trainees experience first-hand what happens when the opposite approach is taken. This exercise is designed to raise trainees’ awareness of common responses that are not reflective listening or motivational interviewing, and how they can obstruct motivation and change. Usually this exercise generates quite a bit of laughter.

Guidelines: Mention that this is not motivational interviewing. Your instructions should take no more than 3-4 minutes, and give instructions as if trainees do not already know what to do. When you start the first pair, use your watch to time 4-5 minutes, then stop the conversation and have them reverse roles. Again allow 4-5 minutes for the Helper to “help.” If time remains, have Speakers describe what they were experiencing during the conversation. We will then have a short debrief as a whole group.

Group Size: 3: Trainer plus 2 trainees add 1 as observer if needed Total Time: 15 minutes The session will automatically end after 15 minutes.

Trainer: You will work with a pair of trainees. Decide which will be Speaker and Helper first; they will then switch roles. Give instructions in your own words. If you have three trainees, assign one to simply observe on the first round, then they participate in the second round while another trainee observes.

Instructions for Speaker: “I would like you to talk about something you have been thinking about changing in your own life. It could be a habit, attitude or behavior, but it should be something you haven’t changed yet. Maybe it’s something that would be good for you, or that you think you should change. It should be something you feel comfortable sharing – not your deepest, darkest secret, okay? Any questions about that?”

Instructions for Helper: “Your task is to try as hard as you can to convince and persuade the Speaker to make the change that he or she is considering. Specifically, once you find out what the change is that the person is considering, do these five things:

1. Explain why the person should make this change.
2. Give at least three specific benefits that could result from making the change.
3. Tell the person how they could make the change.
4. Emphasize how important it is for them to make the change. This might include the negative consequences of not doing it.
5. Tell/persuade the person to do it. And if you encounter resistance, repeat the above, perhaps more emphatically.”

Trainees: When you are the Speaker, use one of your “a change I am considering making” topics. When you are the Helper, follow precisely the instructions given to you by the trainer. Do not use reflective listening. Within 4-5 minutes, try to fit in all five of the instructions.

Motivational Interviewing (2 of 2) A Taste of Motivational Interviewing

This example is meant to give you a taste of MI.

Purpose: This offers both Speaker and Interviewer an experience of an MI conversation. This can be done early in training, and it is not necessary to explain MI in advance or why these particular questions are used. This works well as a contrast after a Negative Practice exercise like #2.

Guidelines: Your instructions should take no more than 3-4 minutes, and give instructions as if trainees do not already know what to do. When you start the first pair, use your watch to time 6-7 minutes, then stop the conversation and have them reverse roles. Allow the next Interviewer 6-7 minutes to ask the questions and summarize. You may need to keep this conversation on track if the Interviewer or Speaker wander away from the structure. The “how important” question often needs a bit of guidance, particularly in relation to asking the follow-up question. If needed, after the four questions have been asked, remind the Interviewer to offer a short summary of the Speaker’s motivations for change. Then, if needed, guide the Interviewer to the fifth question. You will continue as Trainer with Exercise #4 – Debrief by Evoking.

Group Size: 3-4: Trainer plus 2 trainees add 1 as observer if needed Total Time: 20 minutes The session will automatically end after 20 minutes.

Trainer: You will work with a pair of trainees. Decide who will be Speaker and Interviewer first; they will then switch roles. Give instructions in your own words. If you have three trainees, assign one to simply observe on the first round, then they participate in the second round while another trainee observes.

Instructions for Speaker: “I would like you to talk about a change that you are considering, something you are thinking about changing in your life, but have not definitely decided. It will be something you feel two ways about. It might be a change that would be “good for you,” that you “should” make for some reason, but haven’t done yet. Tell the interviewer about this change you are considering.

Instructions for Interviewer: Don’t try to persuade or fix anything. Don’t offer advice. Instead ask these four questions one at a time, and listen carefully to what the person says:

1. Why would you want to make this change?
2. If you did decide to make this change, how might you go about it in order to succeed?
3. What are the three best reasons for you to do it?
4. How important would you say it is for you to make this change, on a scale from 0 to 10, where 0 is not at all important, and 10 is extremely important? [Follow-up question: And why are you at _____ rather than a lower number or 0?] After you have listened carefully to the answers to these questions, give back a short summary of what you heard, of the person’s motivations for change. Then ask one more question:
5. So what do you think you’ll do? and listen with interest to the answer.

Trainees: When you are the Speaker, use one of your “a change I am considering making” topics. When you are the Interviewer, follow precisely the instructions given to you by the trainer. You may offer a reflective listening response, if appropriate, after the Speaker answers a question. To give the trainer something to do, wander off the assigned task once.

MI Strategies: OARS

OARS represents communication strategies that can help a practitioner elicit change talk from the client/patient. It is an essential part of MI to enhance motivation. OARS stands for the following:

1. O pen-Ended Questions
2. Personal A ffirmations
3. Listen & Engage in R eflections
4. Provide S ummaries

OPEN-ENDED QUESTIONS

• Open the door and encourage the client to talk: “Can you tell me what you like about using?”
• Do not invite a short answer: “What makes you think it might be time for a change?”
• Leave broad latitude for how to respond: “Can you tell me more about how this began?”

PERSONAL AFFIRMATIONS

• Commenting positively on an attribute: “You’re a strong person, a real survivor.”
• A statement of appreciation: “I appreciate your openness and honesty today.”
• Catch the person doing something right: “Thank you for coming in today!”
• A compliment: “I like the way you said that.”
• An expression of hope, caring, or support: “I hope this weekend goes well for you!”

LISTEN & ENGAGE IN REFLECTIONS

• Are statements rather than questions:
  • Question: “Do you mean that you’re wondering if it’s possible for you to cut down?”
  • Reflection: “You’re wondering if it’s possible for you to cut down.”
• Make a guess about the client’s meaning (rather than asking)
• Yield more information and better understanding
• Often a question can be turned into a reflection
• Helps the client/patient continue exploring
• In general, a reflection should not be longer than the patient/client’s statement

PROVIDE SUMMARIES

1. Collect material that has been offered: “So far, you’ve expressed concern about your children, saving money, and providing a stable living environment for your family.”
2. Link to something just said with something discussed earlier: “That sounds a bit like what you told me earlier about feeling lonely.”
3. Draw together what happened and transition to a new task: “Before I provide you with some referral recommendations, let me summarize what you’ve told me so far, and see if I’ve missed anything important….Is there anything else that you would like to add before we move on?”

If I have too much time, teach about OARS, demonstrate it, and have people practice

Taken from: https://rutgerstraining.sph.rutgers.edu/Fiveminutes/download/mi_strategies_cheat_sheet.pdf Photo by Jake Lorefice on Unsplash

The Middle Stage of Treatment

This is where the core tasks of psychotherapy really happen that we talked about.

It is important to remember that what is crucial during this stage of therapy is that the client experience safety within the therapeutic relationship so as to be able to overcome the anxiety associated with change and take the necessary steps toward mastery.

(Cooper & Granucci Lesser, 2022 p. 29)

The ending phase

Ends without plan In long-term treatment, termination is not necessarily agreed on beforehand but is an outgrowth of the therapeutic process that has reached an end. (Cooper & Granucci Lesser, 2022 p. 31)