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Clinical Interviewing


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Table of Contents

Preface xiii About The Authors xxi Part One: Foundations of Clinical Interviewing 1 Chapter 1: An Introduction to The Clinical Interview 3 Learning Objectives 3 Chapter Orientation 3 Welcome to The Journey 3 What Is a Clinical Interview? 5 Clinical Interviewing versus Counseling and Psychotherapy 7 A Learning Model for Clinical Interviewing 13 Multicultural Competencies 17 Multicultural Humility 25 Summary 28 Suggested Readings and Resources 29 Chapter 2: Preparation 31 Learning Objectives 31 Chapter Orientation 31 The Physical Setting 31 Professional and Ethical Issues 38 Multicultural Preparation 55 Stress Management and Self-Care 65 Summary 68 Suggested Readings and Resources 68 Chapter 3: An Overview of the Interview Process 71 Learning Objectives 71 Chapter Orientation 71 Stages of a Clinical Interview 71 The Introduction 73 The Opening 84 The Body 90 The Closing 95 Ending The Session (Termination) 104 Summary 107 Suggested Readings and Resources 109 Part Two: Listening and Relationship Development 111 Chapter 4: Nondirective Listening Skills 113 Learning Objectives 113 Chapter Orientation 113 Listening Skills 113 Adopting a Therapeutic Attitude 114 Why Nondirective Listening Is Also Directive 123 The Listening Continuum in Three Parts 125 Nondirective Listening Behaviors: Skills for Encouraging Client Talk 126 Ethical and Multicultural Considerations 142 Not Knowing What to Say 145 Summary 146 Suggested Readings and Resources 147 Chapter 5: Directive Listening Skills 149 Learning Objectives 149 Chapter Orientation 149 Directive Listening Behaviors: Skills for Encouraging Insight 150 Ethical and Multicultural Considerations When Using Directive Listening Skills 175 Summary 178 Suggested Readings and Resources 179 Chapter 6: Skills for Directing Clients Toward Action 181 Learning Objectives 181 Chapter Orientation 181 Readiness to Change 181 Skills for Encouraging Action: Using Questions 184 Using Educational and Directive Techniques 192 Ethical and Multicultural Considerations When Encouraging Client Action 204 Summary 215 Suggested Readings and Resources 216 Chapter 7: Evidence-Based Relationships 217 Learning Objectives 217 Chapter Orientation 217 The Great Psychotherapy Debate 217 Carl Rogers's Core Conditions 218 Other Evidence-Based Relationship Concepts 233 Evidence-Based Multicultural Relationships 250 Summary 253 Suggested Readings and Resources 254 Part Three: Structuring and Assessment 255 Chapter 8: Intake Interviewing and Report Writing 257 Learning Objectives 257 Chapter Orientation 257 What's an Intake Interview? 257 Identifying, Evaluating, and Exploring Client Problems and Goals 259 Obtaining Background and Historical Information 267 Assessment of Current Functioning 276 Brief Intake Interviewing 280 The Intake Report 282 Do's and Don'ts of Intake Interviews with Diverse Clients 298 Summary 300 Suggested Readings and Resources 301 Chapter 9: The Mental Status Examination 303 Learning Objectives 303 Chapter Orientation 303 What Is a Mental Status Examination? 303 Individual and Cultural Considerations 305 The Generic Mental Status Examination 308 When to Use Mental Status Examinations 340 Summary 342 Suggested Readings and Resources 342 Chapter 10: Suicide Assessment 345 Learning Objectives 345 Chapter Orientation 345 Facing The Suicide Situation 345 Suicide Risk Factors, Protective Factors, and Warning Signs 348 Building a Theoretical and Research-Based Foundation 356 Suicide Assessment Interviewing 360 Suicide Interventions 380 Ethical and Professional Issues 385 Summary 389 Suggested Readings and Resources 390 Chapter 11: Diagnosis and Treatment Planning 393 Learning Objectives 393 Chapter Orientation 393 Modern Diagnostic Classification Systems 393 Defining Mental Disorders 396 Diagnostic Interviewing 404 The Science of Clinical Interviewing: Diagnostic Reliability and Validity 406 Less Structured Diagnostic Clinical Interviews 409 Treatment Planning 415 Case Formulation and Treatment Planning: A Cognitive-Behavioral Example 423 Additional Cultural Modifications and Adaptations 427 Summary 428 Suggested Readings and Resources 430 Part Four: Special Populations and Situations 431 Chapter 12: Challenging Clients and Demanding Situations 433 Learning Objectives 433 Chapter Orientation 433 Challenging Clients 433 Motivational Interviewing and Other Strategies for Working Through Resistance 436 Assessment and Prediction of Violence and Dangerousness 451 Demanding Situations: Crisis and Trauma 456 Cultural Competencies in Disaster Mental Health 468 Summary 470 Suggested Readings and Resources 471 Chapter 13: Interviewing Young Clients 473 Learning Objectives 473 Chapter Orientation 473 Considerations in Working with Young Clients 473 The Introduction 475 The Opening 479 The Body of the Interview 490 Closing and Termination 503 Culture in Young Client Interviews 506 Summary 508 Suggested Readings and Resources 508 Chapter 14: Interviewing Couples and Families 511 Learning Objectives 511 Chapter Orientation 511 Challenges and Ironies of Interviewing Couples and Families 511 The Introduction 514 The Opening 522 The Body 528 Closing and Termination 540 Special Considerations 541 Diversity Issues 546 Summary 549 Suggested Readings and Resources 550 Chapter 15: Electronic and Telephonic Interviewing 553 Learning Objectives 533 Chapter Orientation 553 Technology as an Extension of the Self 554 Definition of Terms and Communication Modalities 557 Non-FtF Assessment and Intervention Research 561 Ethical and Practical Issues: Problems and Solutions 565 Conducting Online or Non-FtF Interviews 573 Multicultural Issues: Culture and Online Culture 575 Summary 576 Suggested Online Training Resources 577 Appendix: Extended Mental Status Examination Interview Protocol 579 References 589 Author Index 639 Subject Index 655

About the Author

JOHN SOMMERS-FLANAGAN, PHD, is a clinical psychologist and professor of counselor education at the University of Montana. He is a long-time member of both the American Counseling Association (ACA) and the American Psychological Association (APA). RITA SOMMERS-FLANAGAN, PHD, is professor emeritus at the University of Montana. As a clinical psychologist, she has worked with youth, families, couples, and women for many years.


"I'm a huge admirer of the authors' excellent work. This book reflects their considerable clinical experience and provides great content, engaging writing, and enduring wisdom." John C. Norcross, Ph.D., ABPP, Distinguished Professor of Psychology, University of Scranton "The most recent edition of Clinical Interviewing is simply outstanding. It not only provides a complete skeletal outline of the interview process in sequential fashion, but fleshes out numerous suggestions, examples, and guidelines in conducting successful and therapeutic interviews. Well-grounded in the theory, research and practice of clinical relationships, John and Rita Sommers-Flanagan bring to life for readers the real clinical challenges confronting beginning mental health trainees and professionals. Not only do the authors provide a clear and conceptual description of the interview process from beginning to end, but they identify important areas of required mastery (suicide assessment, mental status exams, diagnosis and treatment electronic interviewing, and work with special populations). Especially impressive is the authors' ability to integrate cultural competence and cultural humility in the interview process. Few texts on interview skills cover so thoroughly the need to attend to cultural dimensions of work with diverse clients. This is an awesome book written in an engaging and interesting manner. I plan to use this text in my own course on advanced professional issues. Kudos to the authors for producing such a valuable text." Derald Wing Sue, Ph.D., Professor of Psychology and Education, Teachers College, Columbia University "This 6th edition of Clinical Interviewing is everything we've come to expect from the Sommers-Flanagan team, and more! Readers will find all the essential information needed to conduct a clinical interview, presented in a clear, straightforward, and engaging style. The infusion of multicultural sensitivity and humility prepares the budding clinician not only for contemporary practice, but well into the future. Notable strengths of the book are its careful attention to ethical practice and counselor self-care. The case studies obviously are grounded in the authors' extensive experience and bring to life the complexities of clinical interviewing. This is a `must-have' resource that belongs on the bookshelf of every mental health counselor trainee and practitioner." Barbara Herlihy, PhD. NCC, LPC-S, University Research Professor, Counselor Education Program, University of New Orleans

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