Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. PART THREE SPECIAL PROBLEMS IN INTERVIEWING EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 171 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 12 CROSS-CULTURAL INTERVIEWING WHILE CULTURAL COMPETENCE has many definitions, in this chapter we use the definition that has been most widely accepted in social work and other counseling professions (Sue and Sue 2008). According to this definition, cultural competence is comprised of three components: 1. Culturally competent self-awareness/attitudes: awareness of biases, assumptions, and personal values that may negatively influence interactions with, and perceptions of, diverse clients. 2. Culturally competent knowledge: an understanding of the worldview and the social and political context in which the culturally diverse client lives. 3. Culturally competent skills: culturally informed skill in the use of interview responses and treatment modalities. In the remainder of this chapter, these three elements will be discussed as they apply to the social work interview with racial/ethnic, sexual minority, and elderly clients (Sue and Sue 2008). The topic of religion and spirituality is discussed as it applies to the older adult. For an extended discussion of this topic, Edward Canda and Leola Dryud Furman’s book Spiritual Diversity in Social Work Practice: The Heart of Helping is highly recommended. RACIAL/ETHNIC MINORITY DIFFERENCES Population projections for the United States indicate a decline in the proportion of non-Hispanic Whites and an increase in Asian Americans, Hispanic/Latino Americans, and African Americans in the next forty years. Immigration and fertility trends (decreasing births among non-Hispanic Whites and increases among other groups) are the forces expected to lead to greater diversity in the U.S. population by 2050 (Cheeseman Day 2010). In a national survey of licensed social workers, 41 percent reported that more than half of their caseload were ethnic minority clients (National Association of Social Workers Center for Workforce Studies 2006). Given the growing population of African Americans, Hispanic/Latino Americans, and Asian American groups, it is likely that the composition of racial/ethnic minorities in worker caseloads will increase in the near future. The social work labor force, on the other hand, is overwhelmingly White, suggesting that a racial/ethnic minority client is likely to be seen by a White social work interviewer (National Association of Social Workers Center for Workforce Studies 2006). Given this probability, it is surprising how little empirical information is available about White social work attitudes or feelings toward racial/ethnic minority groups. A single randomly selected sample of White social work practitioners from a single state chapter of the National Association of Social Workers (NASW) found that the majority endorsed positive attitudes toward racial/ethnic minorities (Green, Kiernan-Stern, and Baskind 2005). While this result is reassuring, it measured only self-reported attitudes, not White respondents’ unconscious attitudes toward people of color. In the following section we discuss the issues that may arise when the White interviewer interacting with an African American client holds unconscious racial biases. The focus is on the White interviewer/African American client dyad because that is the topic of the majority of the research. The dynamics that are identified, however, should generalize to an interview in which there is a White practitioner and another racial/ethnic minority group member. SELF-AWARENESS: RACIAL/ETHNIC MINORITY DIFFERENCES Implicit attitudes are “actions or judgments that are under the control of automatically activated evaluation, without the performer’s awareness of that causation” (Greenwald, McGhee, and Schwartz 1998, 1464). In this section, we discuss implicit attitudes toward members of racial/ethnic minority groups that reflect stereotypes or characteristics at the individual or collective level that are related to membership in a social category (Boysen 2010). A stereotype about African American males is that EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 172 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. they are aggressive or hostile. Repeated exposure to this stereotype over time and from many sources may result in its automatic (e.g., involuntary) retrieval in the presence of an African American male. This is an example of implicit bias (Wilson, Lindsey, and Schooler 2000). Explicit and implicit attitudes coexist in memory and may not be consistent. An individual may form an explicit evaluation of an individual that is independent of, or does not agree with, his implicit evaluation. These different levels of attitude (Dovidio et al. 2002) may influence different types of responses. Explicit attitudes affect deliberate responses for which the individual has the motivation and opportunity to weigh the costs of one response over another. Implicit attitudes influence automatic responses that are more difficult to control or for which motivation to control is absent because these responses are judged to be irrelevant to the task (Wilson et al. 2000). The label “dual attitudes” represents the simultaneous existence of explicit and implicit attitudes in memory. The concept of implicit bias is reflected in research on “aversive racism.” Because of the significant influence of race relations between Whites and African Americans on American society, the majority of the research on this concept is focused on White attitudes toward African Americans, though it can be generalized to attitudes between Whites and other groups. Changing social norms in the United States, influenced by the Civil Rights Act and other legislation that made discrimination illegal, contributed to a decline in blatant racial prejudice. Instead, many Whites are aversive racists: their explicit attitudes reflect support for equal rights, while their implicit attitudes reflect racial bias (Dovidio et al. 2002). In several studies that examined interracial interactions, White participants’ explicit attitudes toward African Americans were expressed in verbal behavior, while their implicit attitudes were reflected in nonverbal behaviors such as visual contact (eye contact indicates attraction, liking) and blinking (blinking rates are responses to tension). Whites who held less biased explicit attitudes but biased implicit attitudes displayed friendly verbal behavior while simultaneously displaying negativity in their nonverbal behavior. The White participants with these dual attitudes evaluated the interaction favorably because they were aware only of their verbal behaviors. However, from the perspective of the African American participant, the nonverbal behavior was weighed more heavily than the verbal behavior, resulting in feelings of uneasiness. To the extent that African American individuals are sensitive to rejection or dislike in interacting with Whites, they may conclude that these conflicting messages are indicative of deceitfulness and manipulation (Dovidio et al. 2002). Implicit racial bias can also influence the interview in the form of micro-aggressions. The term micro-aggression as used here refers to subtle, unintentional behaviors or verbal comments that convey rudeness or insensitivity or demean a person because of his or her membership in a racial/ethnic minority or sexual minority group (Sue and Sue 2008). Stereotyping the client (“I know that African American people are very religious”) and minimizing the influence of racial/cultural issues (“I am not sure we need to talk about race to understand your depression”) are two examples of racial micro-aggressions. African American clients’ perceptions of racial micro-aggressions by White counselors have been negatively related to the quality of the therapeutic relationship and to avoidance of future contact (Constantine 2007). It may be particularly difficult for the African American client to cope with racial insults in a context such as the counseling interview that is assumed to focus on fostering growth and development. Implicit racial bias can also interfere with the expression of empathy. Empathy is defined as the act of perceiving, understanding, and responding to the ideas and emotions of others (Barker 2003; Gerdes and Segal 2011). At its most basic level, empathy is manifested as “affective sharing,” which is an automatic and involuntary process. When we listen to another person describe feelings and observe her facial expressions, gestures, and vocal tone, neural networks are stimulated in our brain through “shared representations” that stimulate us to adopt their postures, facial expressions, and voice tone, as well as experience similar emotions (Gerdes and Segal 2011; Preston and de Waal 2002). Neuro-imaging studies have found that implicit racial prejudice decreases affective responding for the targets of prejudice, potentially interfering with the ability of the interviewer to respond empathetically to a client of another race (Chiao and Mathur 2010; Gutsell and Inzlicht 2010). REDUCING IMPLICIT BIAS EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 173 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. While implicit bias is automatic, that does not suggest that it is inevitable or unchangeable (Macrae and Bodenhausen 2000; Stampley and Slaght 2004). Perspective-taking, or assuming the perspective of the individual who is the object of prejudice, is a strategy for reducing implicit bias toward members of an “out-group” (Galinsky and Moscowitz 2000; Todd et al. 2011). In several studies, perspective-taking decreased implicit racial/ethnic bias as measured in attitudes and nonverbal behaviors. While the dynamics underlying this effect are not established, one suggestion is that in taking the perspective of the out-group member, one experiences a connection between the self and that individual. Since most people’s evaluation of themselves is positive, this evaluation is connected in the perceiver’s mind to the object of bias, who is then regarded more positively. Perspective-taking can also enhance the development of affective-sharing and empathy in the interview. Perspective-taking requires an intense concentration on the client’s use of words and content, gestures, and facial expressions. Through focused listening and close observation, the worker may begin to mimic the client’s facial expressions and posture. As a result of this matching of expressions and gestures, the worker also experiences the emotions of the client and is able to share the client’s feelings or affect, contributing to the development of empathy (Gerdes and Segal 2011). CULTURAL COUNTER-TRANSFERENCE Cultural counter-transference refers to culturally based and conditioned stereotypes, values, and attitudes that distort the interviewer’s perceptions of the client who is a member of another group. For example, an interviewer whose family endorsed the work ethic may assume that “anyone can pull themselves up by their bootstraps,” leading to a distorted view of an African American client whose skills do not match the available jobs in an area. The following questions can be helpful in revealing the influence of one’s own cultural assumptions on the interview: 1. Are you using yourself or your family as the standard to view the client or the client situation? 2. What self-reflection process do you use to recognize your emotional reactions (thoughts and feelings) to clients? 3. Are you identifying your needs rather than the client’s needs and priorities? 4. Are your unresolved personal issues or conflicts interfering with your understanding or perception of the clients’ situations? (Stampley and Slaght 2004, 345) KNOWLEDGE: RACIAL/ETHNIC MINORITY DIFFERENCES The culturally competent interviewer is aware of the complex issues in developing knowledge that can be applied to the racial/ethnic minority client in the interview. On one level, knowledge of what the majority of members of a racial/ethnic group believe may offer some general information, but it cannot be assumed that all individuals in the group reflect these beliefs. There are generally more differences within a racial/ethnic group than between racial/ethnic groups. For example, while many Asian Americans may be characterized as displaying filial piety, strong identification with the family, and emotional restraint, an individual Asian American client may diverge from the group in being expressive and more interested in job mobility than parental caregiving (Kim, Atkinson, and Umemoto 2001). Further, enculturation and acculturation may influence core cultural beliefs. Acculturation refers to the process of learning about and adopting the values, beliefs, attitudes, and behaviors or “worldview” of the White majority culture (Hwang 2006). Enculturation refers to the degree to which the individual maintains the beliefs of his or her own indigenous heritage (Kohatsu, Concepcion, and Perez 2010). Each individual processes acculturation and enculturation differently (Kohatsu et al. 2010). Thus an adolescent Asian American female may reject the emphasis that her family places on harmonious relationships by disobeying her mother (acculturation) but maintaining the Asian belief in the value of education by studying hard in school (enculturation). Each individual has a unique cultural identity that is composed of his or her core beliefs. Some of these beliefs may resemble the majority beliefs of their group, while others are a reflection of individual racial/ethnic identity, gender, age, socioeconomic status, sexual orientation, acculturation and enculturation, and national origin (Hwang 2006). Cultural beliefs influence the interview when they cause misunderstanding and miscommunication. Dimensions of cultural knowledge that are likely EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 174 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. to disrupt the interview process include differences in communication and the expression of distress and cultural beliefs about the client-worker relationship (Hwang 2006; Hwang et al. 2008). Cultural values such as emotional restraint may characterize some Asian cultures. Asian immigrants may be uncomfortable expressing their feelings to the interviewer who is a stranger because of their belief that such behavior will reflect negatively on their own character and the reputation of their family (Hwang 2006). The observation of client discomfort in the interview can be used to form hypotheses that can be tested by asking the client if talking to a stranger is uncomfortable. In acknowledging client discomfort, the worker defuses tension and increases the likelihood of developing a therapeutic relationship. The individual’s cultural background may also influence the expression of distress. Asian American, Hispanic/Latino American, and African American clients may somatize or express psychological distress through physical symptoms. One explanation is that in some cultures, emotional distress is interpreted as a sign of mental illness, laziness, or weakness. Physical symptoms, by contrast, are not stigmatized and elicit support and empathy. The latter is a culturally congruent form of distress, while the former is not. Thus somatization may protect an individual from shame and worry and reduce feelings of lack of control (Hwang et al. 2008). A Hispanic/Latino woman is talking to a worker in an outpatient mental health center: INTERVIEWEE: I have no energy at all, and I am headachy. . . . I cannot sleep or eat. . . . This just began about three months ago. INTERVIEWER: Is there anything that changed at all in that time? No, just that I have been going to church more often to pray for my parents in Mexico, who are sick. INTERVIEWER: Do you see any connection between these physical symptoms and the situation with your parents? INTERVIEWEE: No, not at all. What are you saying? I am not crazy! INTERVIEWEE: In this vignette the worker was not aware of the influence of culture in the meaning that the client attributed to her problem. Her comments are interpreted by the client as critical. The worker who is aware of this cultural influence can use the client’s vocabulary to protect the client from the experience of stigma, establish trust, and begin to engage the client in the therapeutic relationship (Aklin and Turner 2006; Comas-Diaz 2006). The interviewee’s cultural background may also influence his or her expectations of the client-worker relationship. Asian American and Hispanic/Latino American clients may expect the worker to conform to cultural etiquette by engaging with them informally in a discussion of their background, migration history, and family before beginning the formal part of the interview. The practitioner may also be asked to disclose some personal history. During this small talk, the interviewee has an opportunity to evaluate the practitioner and assess whether he or she is trustworthy. Flexibility in responding to these expectations may enhance the likelihood of developing a working relationship with these clients (Comas-Diaz 2006; Hwang 2006). In addition to acquiring knowledge of differing cultural beliefs, the interviewer needs to acknowledge the influence of historical and sociopolitical realities on the interaction. Individuals who are members of racial/ethnic groups are likely to have experienced racism and discrimination throughout their lives. Among racial/ethnic minority groups, African Americans in particular have had a long history of prejudice, segregation, and discrimination in the United States. Research on utilization of the mental health system indicates that African Americans significantly underuse services (Aklin and Turner 2006). Negative stereotypes among some Whites, including beliefs that African American individuals have an inferior mental capacity and that their personality structures deviate from that of Whites, may contribute to this underutilization (Aklin and Turner 2006). The influence of the sociopolitical context on the interview is manifested in the form of mistrust among some African American clients when they first encounter a White interviewer. For example, White interviewers may notice that African American clients are monitoring their level of disclosure by sharing no or little information. This behavior may indicate the African American client’s ambivalence about the “safety” of opening up to a White worker (Ward 2005). If the worker notices indications of mistrust (e.g., lack of self-disclosure, emotional withdrawal from the interview interaction), it is EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 175 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. advisable to candidly broach the subject of distrust and racism with the client by saying, “I know this is a difficult topic to discuss, but I was wondering what it is like for you to talk to a White interviewer. I ask because I want to be as helpful to you as possible.” Some clients may prefer not to discuss racial/ethnic differences with the interviewer, even when these issues have some salience to them. If this is the case, the interviewer can respond as openly and nondefensively as they would in any similar situation in which there is a miscommunication (Cardemil and Battle 2003). SKILLS: RACIAL/ETHNIC MINORITY DIFFERENCES GENERAL INTERVIEWING SKILLS White interviewees and racial/ethnic minority clients are likely to differ in their rules for nonverbal communication (Hill 2009; Sue and Sue 2008). For example, in Japanese culture a smile may indicate embarrassment and apprehension. An interviewer may misinterpret the smile of a Japanese client who is recalling a frightening experience (Sue and Sue 2008). The rules that regulate nonverbal behavior are typically out of our conscious awareness. When an individual’s rules for nonverbal behavior are not followed in an interaction, intense discomfort is aroused. While the source of this discomfort may be difficult to articulate, there is likely to be a “sense” that something is not right (Hill 2009). The interviewer is obligated to adapt her own rules for nonverbal behavior to the client’s when a difference exists. A recommendation is to ask for feedback if the client appears to be experiencing discomfort (Hill 2009). Research suggests that racial/ethnic minority clients respond more positively to interviewing techniques that focus on problem solving than to other techniques (Chang 2009; Sue and Sue 2008). Asking probing questions about clients’ thoughts and behaviors, offering advice and suggestions, and using skills training are examples of problem-solving techniques that are associated with positive interview outcomes among racial/ethnic minority clients. The reasons for this finding are not clear. Generally, cultural variations in the structure and process of relationships, degree of stigma regarding help-seeking for psychological distress, and norms for expressive communication may be contributing factors (Hwang 2006). When a racial/ethnic minority client is unfamiliar with, and skeptical about, the benefits of counseling, client engagement may be facilitated with culturally congruent information or advice that the client may regard as new learning or new ideas. This “gift” demonstrates the benefit of counseling to the client, motivating his future involvement in the interview (Kim et al. 2003). Among African American interviewees who approach the interview with a history of White mistreatment, self-disclosure or advice may indirectly reveal some of the interviewer’s personal thoughts and feelings to the client to reduce mistrust. African American clients who have been the targets of racial discrimination are unlikely to self-disclose until they can judge the interviewer’s trustworthiness (Ward 2005). The willingness of the interviewer to self-disclose indirectly through advice or interpretation or directly through the sharing of personal information may reduce to some extent the difference in power and privilege perceived by the ethnic minority client in relation to the interviewer (Cardemil and Battle 2003; Sue and Sue 2008). This is turn may contribute to the beginning of a feeling of trust and a lowering of the interviewee’s defenses. Because of the continuing influence of implicit racial bias in the interviewer and the current and past sociopolitical environment, the possibility of tension and conflict in the relationship between the White interviewer and the racial/ethnic minority client is high. An open conversation early in the interview about roles and expectations and requests for client feedback about techniques are helpful. Providing an open opportunity for the client to provide feedback about concerns may encourage racial/ethnic minority interviewees to disclose areas of need that are not being addressed. Simple acts of courtesy such as returning phone calls promptly, starting interviews on time, attentive listening, and expressing interest are particularly salient with clients who may be sensitive to indications of disrespect from White interviewers (Chang 2009). SKILLS IN THE INTERPRETED INTERVIEW EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 176 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Because of the influx of immigrants to the United States in the past few decades, it is likely that the worker will encounter clients who are members of racial/ethnic minorities who speak only their native language or have limited English proficiency. Statistics indicate that the immigrant population in the United States increased by 8.8 million between 2000 and 2010, a 28 percent increase. The majority of these immigrants arrived from Latin America, Asia, and Africa (Wilson and Singer 2011). When the provider is not fluent in the client’s native language, it is advisable to hire a professional interpreter. Using an interpreter who is a member of the client’s community is less desirable for a number of reasons. Clients speaking through an interpreter from their own community may decline to reveal personal information because they are concerned that it will be shared throughout the community. Further, it is best to avoid asking a family member to interpret unless the client requests it. Even when the client requests a family interpreter, it is important for the worker to ensure that the interpreter is serving the client’s welfare. It is possible for an interpreter to distort the interviewee’s statements to protect the honor of the family or to serve the family’s best interests. For example, if an interviewee says that his father beats him, the interpreter who is a relative may change the meaning of the message to protect the father or the family. Children, in particular, should not be used as interpreters. In the presence of a child interpreter, a family member may be reluctant to express distress or may omit information that may be judged to be too intimate, embarrassing, or disturbing. A child interpreter may also be exposed to information that is inappropriate. For example, a child is likely to be extremely distressed if asked to translate the results of a medical test that indicate a poor or terminal prognosis for the parent. In addition, the child may feel responsible for the outcome of the interview and may even be blamed by the family if the outcome is negative. The professional interviewer should speak as if he is talking directly to the interviewee. All translating should be done in the first person (e.g., “I went to work” vs. “She went to work”); this tactic may decrease the sense of distance or loss of connection between the interviewer and the interviewee when communication is mediated by a third person. The interpreter should accurately convey the communication of each participant, including the level of expressiveness of the participants’ statements. It is not appropriate for the interpreter to advise, counsel, or coach the client. The role of the interpreter is to be neutral in facilitating accurate communication. In an interpreted interview, the participants should be seated so that the interviewer and interviewee are positioned close to each other to facilitate eye contact, with the interpreter sitting slightly to the side of and behind the client. Confidentiality should be addressed by the interpreter at the beginning of the interview, particularly if the interpreter is a member of the client’s ethnic community (Aronson Fontes 2008). SEXUAL ORIENTATION DIFFERENCES The American Psychological Association (2011) defines sexual orientation as “the sex of those to whom one is sexually and romantically attracted.” Sexual orientation includes categories of same-sex attraction (gay men or lesbians), opposite-sex attraction (heterosexuals), or attraction to both sexes (bisexual). A recent estimate of the sexual orientation of the U.S. population ages 18 to 44 found that 3 percent of males and 5 percent of females self-identified as homosexual, bisexual, or “something else” (U.S. Census Bureau 2012). While public opinion polls in the United States indicate rising acceptance of homosexuality (PEW Research Center for the People and the Press 2011), lesbians, gays, and bisexuals (LGB) continue to experience discrimination, rejection, ostracism, and criminal victimization (Herek and Garnets 2007). While the convention is to refer to lesbian, gay, bisexual, and transgendered individuals with the acronym LGBT, we use LGB in this book because the paucity of literature and research makes it difficult to discuss transgendered individuals knowledgeably. SELF-AWARENESS: SEXUAL ORIENTATION DIFFERENCES Social work practitioners have been socialized in a society that reflects heterosexism. Heterosexism is an ideological system that “denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship, or community” (Herek 1995, 321). Because of the pervasive nature of EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 177 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. heterosexism in the culture, it is likely that social work practitioners have internalized biased attitudes toward LGB persons. Until approximately thirty years ago, homosexuality was classified as a mental illness by both the psychiatric and psychological professions. In 1973, the American Psychiatric Association removed homosexuality as a category of mental illness, and in 1975, the American Psychological Association (APA) issued a policy statement affirming that homosexuality implied no impairment in psychological functioning (Herek 2007). The National Association of Social Workers (NASW) also opposes discrimination based on sexual orientation (NASW 2009). The current view in medicine, psychology, and social work is that homosexuality is a normal expression of sexuality and is no more likely to be associated with psychopathology than is heterosexuality. However, there is evidence that some clinicians continue to equate homosexuality with pathology. The most extreme expression of this belief is in the recommendation that LGB clients accept conversion therapy to change their sexual orientation. There is no research that supports the effectiveness of conversion therapy, and there is a large amount of evidence that it is harmful. Consistent with these findings, the NASW and other mental health organizations regard conversion therapy as unethical (APA 2011; NASW 2000). The influence of more subtle stereotypes about LGB individuals may be found in the interviewer’s assumptions about parenthood and relationships. Reservations about LGB people as role models for children may be expressed in an interviewer’s reluctance to place a child for adoption with a gay or lesbian couple. Stereotypes may also be expressed in the assumption that opposite-sex relationships are more significant than same-sex relationships. For example, the LGB client may notice that the interviewer’s inquiries about a partner are superficial and lack depth. This may convey a message that the interviewer lacks understanding of, and respect for, LGB attachments (Eubanks-Carter, Burckell, and Goldfried 2005). Subtle sexual prejudice may also be expressed in the interviewer’s avoidance of LGB issues or in an overemphasis on the topic of sexual orientation when the client’s presenting problem is unrelated to sexual orientation. A White gay man in his 60s is talking to a social worker on a medical surgical ward on which his long-time partner is hospitalized: INTERVIEWER: What is it that you are concerned about? The nurse on the floor told me that you asked to talk to me. INTERVIEWEE: Well, I am Jack’s partner, but because we are not married or related, I am having trouble seeing him in the hospital. INTERVIEWER: Uh [shifting in her chair]. Well . . . those are the regulations. Maybe we should talk about the plan for discharge. In this exchange, the interviewer lost her focus after the client disclosed that he was gay by mentioning his relationship with Jack. She then minimized his concerns by focusing on the “regulations” and changed the subject. This type of interaction communicates bias and will discourage the client from future contact. These negative attitudes and behaviors may undermine the creation of an environment in which the client feels safe and secure enough to form a therapeutic relationship with the interviewer. In a recent study of LGB clients’ perceptions of therapist characteristics, the negative attitudes described here were classified as undesirable qualities in a prospective therapist (Burckell and Goldfried 2006). If the interviewer becomes aware of communicating bias in an interview with a sexual minority client, the recommended approach is to avoid defensiveness, ask for clarification, and remain open and receptive to client feedback. The creation of an environment in which the client feels respected, supported, and valued can facilitate an open discussion of these misstatements (Shelton and Delgado-Romero 2011). KNOWLEDGE: SEXUAL ORIENTATION DIFFERENCES To offer effective services, the interviewer requires knowledge of issues and concerns that are specific to the LGB interviewee. Two of these issues are sexual stigma and sexual minority identity development, or “coming out.” Sexual stigma is a specific type of stigma characterized by the EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 178 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. attribution of an inferior status toward any form of nonheterosexual behavior, relationship, or identity (Herek, Gillis, and Cogan 2009). Sexual stigma may be expressed in harassment, rejection, hostility, ostracism, name-calling, and criminal victimization. Several studies have found that LGB individuals experience poorer mental and physical health than their heterosexual peers because of greater exposure to stigma-related stressors (Mays and Cochran 2001; Meyer, Schwartz, and Frost 2008). Another source of stress for LGB individuals is the formation of an LGB sexual identity, or “coming out.” The majority of LGB individuals begin the process of identity development in late childhood with a realization of same-sex attraction and then the formation of a lesbian, gay, or bisexual identity in midadolescence, followed by a first same-sex sexual experience about a year later and then disclosure of sexual orientation to others when they are in their early 20s (Calzo et al. 2011; Floyd and Stein 2002). If the individual is an early developer, the age of onset of these milestones is in middle childhood, with disclosure by age 18. Peers and parents may suspect that an individual who exhibits cross-gender appearance, behaviors, or traits is lesbian, gay, or bisexual in the absence of disclosure. Because the adolescent is vulnerable and lacks both internal and external resources for coping with extreme stress, parental rejection or peer harassment related to sexual orientation may be extremely injurious. For example, LGB adolescents who experience high levels of parental rejection have increased odds of suicide attempts, depression, substance abuse, and unprotected sex in adulthood (Ryan et al. 2009). School-based bullying and harassment, particularly of gay men with cross-gender traits, is associated with suicidal behavior in adolescence (Bontempo and D’Augelli 2002; Friedman et al. 2006). On the other hand, supportive friends and family acceptance of sexual orientation during adolescence and young adulthood are associated with less psychological distress and a more integrated sexual identity (Pachankis and Goldfried 2004; Rosario, Schrimshaw, and Hunter 2008). Interviewers should be knowledgeable about these unique stressors experienced by LGB interviewees to guide the interaction toward salient content and to effectively communicate empathy. However, interviewers should keep the heterogeneity of the LGB population in mind to individualize their assessments and interventions. SKILLS: SEXUAL ORIENTATION DIFFERENCES Prior to an interview, the clinician should consciously counter any assumptions about the sexual orientation of the interviewee. In particular, it is important not to assume that all interviewees are heterosexuals. Even when clients are in a relationship with an opposite-sex partner, they may still identify as gay, lesbian, or bisexual (Lyons et al. 2010). To avoid sending a message that the LGB interviewee is not welcome, the interviewer should avoid asking questions about an opposite-sex romantic partner or a spouse. Instead, the interviewer should use more inclusive language, such as asking about whether the individual is in a relationship or has a partner. This communicates respect. Gay, lesbian, or bisexual clients may respond positively to selective disclosure of professional credentials and personal information including sexual orientation in the first interview. It has been hypothesized that self-disclosure of professional and personal information equalizes power in the relationship (Borden et al. 2010). Further, similarity in sexual orientation may enhance the perception of the counselor as attractive, credible, and expert at contributing, at least initially, to the development of rapport. However, sexual orientation is not the most important criterion that nonheterosexuals seek in a counselor (Saulnier 2002). A competent heterosexual interviewer can also be effective. In common with others, LGB interviewees respond positively to warmth, friendliness, respect, empathy, and acceptance (Burckell and Goldfried 2006). Because discrimination and prejudice related to sexual stigma can be stressful for LGB interviewees and impact their sense of safety, it is extremely important to create a sense of security in the therapeutic environment (APA 2011). The communication of LGB-affirming attitudes, including an understanding of the impact of sexual stigma on the interviewee, support for the client’s adoption of an LGB identity, and an understanding of when sexual orientation is salient, may facilitate a sense of trust and agreement on goals, contributing to the formation of a therapeutic alliance (Burckell and Gold-fried 2006). Even when the client’s primary problem is not sexual orientation, displaying affirming and validating attitudes toward LGB issues is perceived as helpful (Burckell and Goldfried 2006). The interviewer should be familiar with and be able to share information about community resources EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 179 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. available to LGB clients such as gay-straight alliances in the public schools, leisure and support groups, and community agencies that offer LGB-affirming health and mental health services (Pachankis and Goldfried 2004). Integration in the LGB community can be a protective factor because the individual can access group resources in responding to sexual stigma, in addition to their personal coping resources (Herek and Garnets 2007). In child care settings specifically, the interviewer’s understanding of the issues of confidentiality in regard to sexual orientation are important. Adolescents in care may be concerned about being “outed” because they have experienced or anticipate stigma or rejection from foster parents, foster youth, and child welfare professionals (Ragg, Patrick, and Ziefert 2006). They may also be concerned that if they disclose their sexual orientation to the worker, the worker will reveal this information to others, “outing” them to the child welfare system. Because of these issues, the interviewer will be most helpful by focusing on confidentiality and its limits in the opening of the interview. The interviewer can also convey support by respecting the youth’s concerns and not documenting sexual orientation in the case record. Advocacy in setting and upholding agency standards that respect sexual orientation may also reduce the exposure to sexual stigma in the system (Ragg et al. 2006). ELDERLY CLIENT DIFFERENCES We are concerned at this point with a special adaptation of the interview associated with a special identified group of interviewees: the elderly. Almost everything we discussed in the text regarding therapeutic relationships, the interviewing process, interviewing techniques—everything we identified as indicative of competent, effective interviewing—is as applicable for interviewing the elderly as it is for cross-cultural clients. Our focus here is to identify the particular interviewing adaptation uniquely associated with interviewing the elderly. The population of the United States will grow increasingly older over the next decades. Between 2010 and 2050, the elderly population will grow by 45 percent. Most of the increase is due to the graying of the baby boomer generation, who began to turn 65 in 2011. The population will become more ethnically diverse as the aggregate ethnic minority population becomes the majority by 2042. These population projections have implications for social work. The numbers of elderly individuals living in the community who can benefit from social and health services will grow, resulting in a need for social work professionals (Vincent and Velkoff 2010). SELF-AWARENESS: ELDERLY CLIENT DIFFERENCES In preparation for an interview with an elderly interviewee, the interviewer is obligated to engage in some introspective exploration of attitudes toward the elderly. In a youth-oriented society, exposure to ageism is endemic. Some stereotypical attitudes and feelings about the elderly are that they are unattractive, rigid, dependent, unproductive, and grumpy. Generally, social workers, along with other human service personnel, are reluctant to select a career in gerontology. There may be a perception that work with the elderly is not valued and that there is little to be accomplished from a clinical perspective (Lagana and Shanks 2002). Ageism among social workers may be expressed through biased assessments and in overprotective and paternalistic attitudes (Alley, Cherry, and Erdman 2009; Kane 2004). Workers may be uncomfortable with elderly clients for a variety of reasons. The focus of the interview with an elder on death and loss may provoke workers’ fears about their own mortality and decline. The younger interviewer may unconsciously assume the role of a child and relate to the older client as a parent, protecting the client as he had cared for his own parents or trying to resolve regrets about the parent-child relationship in the work with the interviewee (Atkins and Loewenthal 2004). Elderly clients may present a challenge to younger workers because they are perceived as belonging to a different time and place. There are differences in language, values, attitudes, and exposure to historical events. This lack of shared experiences may result in difficulty on the part of the younger worker in feeling empathy for the older client (Atkins and Loewenthal 2004). Many interviewers are members of the generation sandwiched between two dependent groups: young children and elderly parents. Some may actually be in the process of having to divide and devote EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 180 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. limited time, energy, and resources to two competing obligations. Even those not currently in this position may anxiously anticipate the problem. Despite their most altruistic feelings and sense of obligation, they might resent the requirements that the situation demands (Richardson and Barusch 2006). Interviewers may not be oblivious to intergenerational competition for resources. The very substantial allocations for meeting the increasing needs of the elderly through Social Security, Medicare, Medicaid, outlays for nursing homes, prescription drugs, and so on means that less is available for support of programs in which the younger generation have a primary interest, such as education, health care of children, financial supports for low-income families, unemployment benefits, and so forth. Without being aware of them, these feelings may affect the attitudes toward the elderly that determine interview interaction. Becoming aware is a precondition for control to prevent or ameliorate negative-oriented relationships. KNOWLEDGE: ELDERLY CLIENT DIFFERENCES SENSORY LOSS AND INTERVIEW COMPANIONS The elderly client may exhibit normal age-related vision and hearing loss. Impaired vision is likely to affect the ability to see objects that are closer and to see in the absence of bright lighting. Prescription glasses can correct for these problems. Hearing loss is the most frequent sensory loss among older adults, affecting the ability to hear high-frequency sounds in men and low-frequency sounds in women. Hearing loss more than vision loss will affect interview interaction (U.S. Census Bureau 2011). It may be difficult to determine whether an older adult has a hearing problem. Few older adults with hearing loss wear hearing aids, and among those who do, the hearing aid may not be visible. In the harried pace of the medical setting, providers have assumed that problems in communicating with the older hearing-impaired patient indicated disorientation or cognitive impairment (O’Halloran, Worrall, and Hickson 2011). Indicators of a hearing impairment include frequent requests to repeat information, a facial expression of strained listening, and a gaze intent on the speaker’s face and lips. Elderly interviewees may present other problems for the interviewer in communication. Some have dental problems that make them difficult to understand. Strokes leave some with impaired speech. Their voices may be weak and tremulous. And some clients for whom English is not a first language may be difficult to understand due to accents or limited vocabulary. It is not uncommon for the elderly client to bring a family member to the interview to help with communication. A companion may compensate for a client’s sensory or cognitive deficits by transmitting information about the client to the interviewer and facilitating the client’s understanding of the interviewer’s communication. If tasks are assigned for between interviews, the companion can provide support to the client in implementation. Companions also encourage elderly relatives to ask questions or clarify concerns in the interview, leading to a better understanding of the information transmitted. As long as the companion does not dominate the interviewee, her presence can have positive effects (Wolff and Roter 2011). DEPRESSION Many problems that are specific to aging as a phase of the life cycle can be of concern for interview interaction. As individuals age, retirement, widowhood, and limited mobility result in a decrease in the size of the social network, in the closeness of relationships, and in the composition of the network as the number of nonfamily network members declines (Cornwell, Laumann, and Schumm 2008; Gellis 2010). Perceived social isolation or loneliness is more common among the elderly over age 75 and is associated with poorer physical and psychological health (O’Luanaigh and Lawlor 2008). The social, economic, and physical challenges of aging may increase the rates of depression, particularly among the low-income elderly. Among the factors contributing to depression in this population are grief over the loss of a spouse, multiple chronic health conditions, impairments in Activities of Daily Living (ADLs, such as bathing, dressing, and using the toilet), financial concerns, and unmet needs for community supports (Choi and Kimbell 2006). EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 181 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Elderly individuals may not seek treatment for depression for a variety of reasons. The elderly have a lack of objective knowledge about the symptoms of depression and report psychological distress in somatic terms. It is not uncommon for the elderly to assume that depression is a normal part of aging. Among the low-income elderly, multiple psychosocial concerns may leave little energy or motivation to prioritize depression as a problem (Proctor et al. 2008). COGNITIVE AND PHYSICAL IMPAIRMENTS Elderly individuals with cognitive and mobility limitations frequently need assistance with ADLs and Instrumental Activities of Daily Living (IADLs, such as shopping, managing money, and doing laundry). Home and Community Based Services (HCBS) provides assistance to these elders with daily activities so they can remain in their homes. HCBS include personal care, chore assistance, transportation, congregate meals, respite care, and adult day care (Kassner 2011). In 2009, about 5.2 million adults aged 65 or older and 1.7 million adults aged 85 or older needed assistance with ADLs and IADLs. Those with long-term care needs comprised 14 percent of the population aged 65 and older and 38 percent of the population aged 85 and older (Kassner 2011). Poorer elders have a greater likelihood of functional impairment, possibly because health issues contributed to lost wages and lower earning potential during middle and later adulthood (Kassner 2011). The family provides the majority of personal care and chores services to the community-dwelling elderly. About three-fourths of community-dwelling disabled older adults rely exclusively on the family for assistance. Another third supplement family care with paid services (out of pocket, private insurance, or publicly supported programs). HCBC is primarily funded by Medicaid, the public health insurance program for the poor. Strict income and categorical restrictions (type of population served) limit eligibility for Medicaid coverage of HCBS to the poorest and sickest of the elderly population (Kassner 2011). In the absence of Medicaid coverage, families and older adults either pay out of pocket or use private long-term-care insurance to pay for services (Kassner 2011). Because of the level of expense involved, both of these options are practical only for the most affluent. Research indicates that home- and community-based services are underutilized by older adults and their families. Among the reasons for lack of use provided by caregivers of older adults is “no need for the service.” In this case, perception of need may be influenced by a lack of knowledge about the care recipient’s health care condition and the potential benefits of long-term care in providing support for disabled individuals. A second reason endorsed by caregivers, “no awareness of the service,” may indicate a lack of knowledge about the formal service delivery system (Casado, van Vulpen, and Davis 2010). Other reasons for underutilization of HCBS include high cost and reluctance to allow strangers in the house (Casado et al. 2010). SPIRITUAL AND RELIGIOUS BELIEFS Physical and cognitive impairment, loss of autonomy, and increasing awareness of mortality may contribute to a concern with religion and spiritual beliefs in the elderly. Generally, spirituality has been defined as a sense of transcendence or a connection with a larger power or purpose, while religion is a formal institutionalized pattern of beliefs and practices (Nelson-Becker 2004). Religion and spirituality have been related to indicators of mental health in older adults. Religious institutions may prohibit unhealthy practices such as use of alcohol, nicotine, and drugs; positive interactions with a religious community may provide social support, and religious/spiritual beliefs may facilitate positive reinterpretations of stressful events (Baetz and Toews 2009; Greenfield, Vaillant, and Marks 2009). Thus religion/spirituality can be a resource for coping among the elderly (Nelson-Becker 2004). SKILLS: ELDERLY CLIENT DIFFERENCES The interviewer should be sensitive to the elderly client’s level of stamina and stop the interview if the client seems to be fatigued. Adequate lighting and comfortable chairs communicate thoughtfulness. When the client is hearing impaired, the worker should begin the interview by asking the client, “How can I best communicate with you?” In general, the hard-of-hearing client will require a room with low or no background noise and slow enunciation to facilitate lipreading. Checking in with the client EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 182 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. periodically to determine whether there is any miscommunication or if communication is satisfactory is helpful (Iezzoni et al. 2001). In developing a relationship with an elderly client, the worker should initially demonstrate respect for the client through the use of formal surnames and courtesy, such as greeting the client with a smile and a handshake (Sung and Dunkle 2009). The elderly individual may be slow to engage with the worker because of concerns about stigma and a tendency to minimize or dismiss feelings of psychological distress. It may be helpful to offer support and reassurance to the client by normalizing these reactions and recognizing their strength in coming to the appointment. The level of directiveness in work with elderly clients is determined by an assessment of their personal and social resources and the severity of the problem. If the client has many internal and external supports and a problem that is less severe, the interview can be a collaborative one (Richarson and Barusch 2006). Research suggests that client-identified problems are more likely to be resolved, possibly because the client is more motivated to work on issues that cause them anxiety or worry (Enguidanos et al. 2011). Integration of questions about religion/spirituality in the interview is recommended to offer clients an opportunity to explore these issues. A general question like “While many people value religion or spirituality, others do not. What are your beliefs?” may be followed by queries exploring how the client coped with past or current problems and the influence of their beliefs (religious or not) on their coping (Nelson-Becker 2004). Reminiscence or recalling past life events enhance a feeling of competence by reviewing how one coped with past difficulties and achieved important goals. Identification of previous coping successes may be applied in the interview to address current problems (Bohlmeijer et al. 2007). Educating the client by sharing information about the benefits of community resources for the caregiver or care recipient, as well as knowledge about what resources are available, who is entitled to receive them, and how to apply them, may facilitate the ability to make an informed decision about utilization (Casado et al. 2010). A more directive interviewing approach is necessary with clients whose decisional capacity is impaired and whose behavior poses a danger to themselves or others. In balancing beneficence with self-determination, the practitioner will pressure the client to accept interventions only when lower levels of directiveness fail (Healy 2003). The concept of cultural competence includes cultural self-awareness, knowledge, and skills. These components of cultural competence are discussed as they relate to racial/ethnic minorities, sexual minorities, and the elderly. Implicit racism—conscious beliefs about racial equality that exist simultaneously with unconscious racial bias—may contribute to confusion and mistrust between African American and White communicators. Dimensions of cultural knowledge that are likely to disrupt the interview process include differences in the expression of psychological distress and cultural expectations regarding the formality of the relationship. The influence of past experiences with racial prejudice and discrimination may be a barrier to developing trust early in the interaction with an African American client when the worker is White. Interviewing skills should be adapted for differing cultural rules about nonverbal behavior, the intervention modality, and client expectations of the interviewer. When the provider and client speak different languages, it is advisable to hire a professional interpreter. While currently homosexuality is viewed by social work, psychology, and psychiatry as a normal expression of sexuality, some practitioners, including social workers, express a bias toward LGB clients in recommending that they accept conversion therapy to change their sexual orientation. There is no research to support the effectiveness of conversion therapy, and its practice is considered unethical by NASW. LGB clients are exposed to unique stressors. Sexual stigma or the attribution of an inferior status to nonheterosexual relationships and behaviors is expressed in harassment, ostracism, name calling, and criminal victimization. Exposure to sexual stigma has been associated with poorer mental health among LGB individuals. Another source of stress for LGB individuals is the formation of an LGB sexual identity, or “coming out.” Beginning in late childhood and ending in young adulthood, the coming-out process may provoke parental rejection and school-based harassment. The odds of suicidal ideation and behavior are higher among those LGB adolescents who come out in a negatively charged environment. EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 183 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Interviewers are cautioned to avoid the assumption that all of their clients are heterosexual. The use of inclusive language on intake forms and in the interview (e.g., instead of questions about marital status, substitute questions about an intimate relationship or a relationship with a partner) sends a welcoming message to the LGB client. Because of exposure to discrimination and prejudice related to sexual stigma, it is important to create a sense of psychological safety by communicating gay-affirming attitudes. Ageism is expressed in negative stereotypes about the elderly, such as that they are rigid, dependent, grumpy, and unattractive. Social workers are not attracted to work with the elderly because it is considered low-status and ungratifying. Younger workers may be uncomfortable with the topic of death and loss and may feel awkward in a relationship with a client who is the age of their parents. Social work with the elderly requires knowledge of the sensory losses associated with normal aging. Because of financial, social, and physical losses, the low-income elderly, in particular, are vulnerable to depression. The poorer elderly are also more likely to be dependent in the performance of daily activities necessary to remain in their homes. They rely on their families exclusively for caregiving. Home- and community-based services are rarely used by these families because of a lack of awareness and knowledge. In regard to interviewing skills, the interviewer can accommodate hearing loss by speaking slowly to facilitate lipreading and by choosing a room that is low in background noise. If a client has strong internal and external resources, the interview can be a collaborative one. The uses of a problem-solving approach and reminiscence are effective with elderly clients. The extent to which the client does or does not value religious/spiritual beliefs is suggested to identify coping resources. Education of the client and caregiver about community resources is suggested to increase their awareness and knowledge about services. A more directive approach is recommended for clients who lack decision-making capacity and who present a danger to themselves or others. EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 184 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 13 PROBLEMATIC INTERVIEWS CROSS-CULTURAL INTERVIEWS pose special problems in adapting the interview to cultural differences between participants. Some interviewees pose problems of adaptation because of special difficulties they bring to the interview situation. For reasons of space limitations, we have selected two special interviewee groups for more elaborate discussion: the involuntary adult client and the sexually abused child. The involuntary client constitutes a fairly large interviewee subset. Interviewing children who may have been sexually abused is a task frequently assigned to social workers because the law often requires that other professionals—medical personnel, educators, and police—report any suspicions of abuse to social agencies. INVOLUNTARY INTERVIEWEES People come to an agency interview with various levels of commitment to the experience. Some make a completely voluntary decision to participate, whereas others come involuntarily. The levels of voluntarism are in the nature of a continuum rather than a dichotomy, running from eager to get help to willing to tolerate service to ambivalence, reluctance, resistance, opposition, and hostility to use of the service. Involuntary interviewees are those required by court order to seek agency help and those who have been pressured to use the service. Such interviewees include alcohol and drug abusers, those on probation or parole, and clients who have neglected or physically, emotionally, or sexually abused their children. Correctional programs, schools, substance abuse programs, and outpatient and inpatient mental health, child protection, and domestic abuse agencies refer these clients. Juvenile courts may refer adolescent offenders. Such clients often make contact because not coming would result in the imposition of even more punitive conditions, such as activation of a suspended prison sentence, termination of parental rights, or return to a correctional facility. Another group of interviewees also come to the agency in opposition to a self-determined preference. They would rather not be there if they had the choice. Such interviewees come as a consequence of social, psychological, or professional pressures and stipulations. Unless they come, a wife threatens divorce, an employer threatens job termination, a father threatens disinheritance, a child will not be returned from foster care, or an adolescent will not be allowed to return to school. Their acquiescence to agency contact is not legally mandated, but they are coerced into coming as a condition of restoration or preservation of a valued personal aspect of his or her life. This group of interviewees has been termed nonvoluntary clients. Coerced nonvoluntary clients and mandated involuntary clients are different. Mandated clients are impelled by a legal decision requiring their participation. Coerced clients are propelled by social and emotional pressures from spouses, parents, doctors, clergy, and/or school administrators who are strongly recommending their participation. Because the mandated client is an extreme instance of the involuntary client, much of what we say here is applicable to others in the coerced non-voluntary client group. Our concern here is not with resistance as it is classically defined—namely, unconscious or preconscious defenses by the ego against communications that might create anxiety, guilt, shame, and the like. Resistance on the part of the mandated client is a defense against externally imposed threats. Resistance here means anything the interviewee does to impede the objectives of the interview. Our concern here is with conscious, deliberate, openly acknowledged efforts to oppose unwanted interactions or intrusions, to subvert the efforts of the worker to conduct an interview, and to reject the role of being a client of the agency. More recently the term reactance has been applied to such behavior so as not to confuse it with what has been identified as classical resistance. The voluntary client comes to the interview having resolved any ambivalence about accepting the EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 185 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. influence of the interviewer. The involuntary client comes resisting the interviewer’s interventions. As Hutchison (1987) notes, the involuntary client is forced to recognize the formal authority of the interviewer as agency representative but has not accepted the interviewer’s psychological authority. Mandated clients challenge professional authority and test its limits (Gitterman 1989). Social work interviewers are uneasy about working with involuntary and nonvoluntary clients. They feel rejected and inadequate because their usually effective interviewing skills often fail to work. They resent having to expend time on those who refuse help when they might use the time to help those who would gratify them by responding positively. Interviewers rarely encounter the kind of naked opposition that such clients sometimes display, so they have little experience in dealing with it. It is easy to be intimidated by this kind of interviewee. The seemingly incompatible demands of the community—that the agency be both helpful and controlling—become highly visible in an interview with the involuntary client. The interviewer is faced with both an ethical and a pragmatic question. The ethical question involves the morality of acting as an agent of social control on behalf of the legal system, which has denied the client the right of self-determination in the decision to contact the agency. In cooperating with the legal system, is the worker colluding in the unethical denial of the client’s right to self-determination? However, refusing to accept the referral that puts the worker in the dual role of helper and controller involves the unethical rejection of the clients’ beneficent entitlement to the right for service even though the client doesn’t recognize the need. There is the additional pragmatic consideration as to whether the worker can actually be of help in those situations. Workers’ skepticism is based on the fact that, unlike some medical procedures, any kind of counseling requires active participation by the interviewee. Another prerequisite for effective helping is that the interviewee recognize that a problem exists. In the case of the involuntary client, this is often not the case. Other people are discomfited by the interviewee’s behavior; the client is not. The interviewee attributes the problem to someone else. Involuntary clients are frequently in denial about the existence, significance, and/or consequences of their problems. GETTING STARTED There have been efforts to identify the stages toward acceptance of involvement in a process of change (Prochaska, DiClemente, and Norcross 1992). Initially the interviewee is in a reactive stance—not only uninvolved and unengaged but in opposition to being involved and engaged. The initial stage of change requires some level of acceptance, however minimal, in order to approve participation. Unless that happens, nothing further can happen, which makes the success or failure of the initial interviews crucial. In an effort to achieve this initial stage, the interviewer, as always, must start from where the interviewee is—where she is coming from. The interviewer accepts the fact that the interviewee is not unmotivated but rather differently motivated. The interviewer tries to understand the situation from the interviewee’s perspective, from the interviewee’s point of view. The referring agency has robbed these clients of some measure of autonomy by requiring them to do something they would rather not do. Like any mature adult, they react to such demeaning infringement on their freedom with anger and hostility. What appears to be deviant, illogical, and self-damaging to others may be defined differently by interviewees. Even if clients’ behaviors are problematic to others, the behaviors are giving the clients some measure of satisfaction (e.g., the euphoria of getting “high,” the release of rage in the physical abuse of a child), and they are not sure they want to give them up. Becoming involved means clients have to acknowledge failure and engage in an unfamiliar process requiring a sacrifice of autonomy and a grant of some controls to others. They have to disclose much of their intimate life to others with no certainty as to how those people will use the information. In addition, they are not sure how the whole experience will be helpful to them. In the initial interview, the interviewee is in what has been termed the stage of precontemplation —denying that he has a problem and feeling coerced into the referral to the agency (Prohaska et al. 1992). The interviewer faces the problem of converting an authority without the power to influence into an authority with freely granted power to influence. The worker has the authority—granted to the agency by the community and delegated by the agency to the worker—to schedule an interview with EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 186 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. the client. However, initially the worker has no power to influence. In response to authority, mandated clients are physically present, but they may still refuse to cooperate and block any effort by the worker to involve them in the interaction. Authority does not guarantee the worker the power to make interviewees do anything they choose not to do. Only as workers induce clients to mitigate their opposition can interviewers attain any power to influence. Involuntary/nonvoluntary clients use a variety of evasive and diversionary tactics to avoid serious discussion of their problems. The overtalkative, rambling interviewee’s resistance may be equally effective but less apparent than that of the openly taciturn interviewee. Interventions by the interviewer are met with vague, uncommunicative responses; brief, uninformative answers; evasive comments; inattention; irrelevant diversions; and persistent silence. Verbosity and small talk are oppositional behaviors, frustrating productive interviewing. Although some clients openly acknowledge that they “wouldn’t have come if I hadn’t been told I had to” or “didn’t ask to come or want to come,” others are covert resisters. They go through the motions; they are overly compliant or excessively agreeable, defensively avoidant or uncooperatively taciturn. The problem is to get beyond these tactics and influence interviewees to change their motivation to some degree from opposition to acceptance of the interview. Interviewees must additionally accept the role as interviewee and the obligation to participate in the tasks that the role requires. With effort, interviewers can aid interviewees to accept responsibility for the situation and acknowledge that they have a problem that they need to address. The objective is to help the involuntary/nonvoluntary interviewee see the need for the service, perceive the service as appropriate, and believe the service can help her with her problem (Altman 2003). In responding to the interviewee’s oppositional behavior, the interviewer manifests all the facilitating attitudes that counter the attitudes that fuel such behavior. When the worker is accepting, empathetic, respectful, interested, and individualizing and maximizes, to the extent possible, the interviewee’s entitlement to autonomy, it makes it difficult for the interviewee to maintain a negative stance. It is hard to fight with someone who does not want to fight with you, who listens acceptingly to what you have to say, and who does not challenge or threaten you. The facilitating approach demonstrates to interviewees how they will be treated if they decide to become involved with the agency. The interviewer disarms the client’s motivation to continue to be negative and enhances the client’s motivation to cooperate. Faced with persistent negativity, the interviewer might wedge the door open by asking neutral questions about the interviewee’s life and general situation that have little to do with the substance of the referral. The interviewer needs to be alert to any intimation, however slight or oblique, that some aspect of opposition is moderating and encourage it. A significant aspect in helping the interviewee move from uninvolvement to beginning involvement is to help the interviewee accept responsibility for the behavior that needs changing. Involuntary interviewees may present themselves as blameless. They deny responsibility and give excuses: “I was drunk”; “I was sick”; “I was very upset”; “Nobody told me”; “They provoked me”; “My friends forced me.” Rather than seeing themselves as needing help, coerced interviewees see themselves as a victim of other people’s manipulations. A correctional social worker says: When we interview guys in prison, our first job is to get them into prison. Now that sounds paradoxical, but while these guys are in prison physically, emotionally they are not. Many of them are convinced they shouldn’t be there, they have been railroaded, it was these other guys, and so on. So our first job is to get them to accept that they are there for a reason and they are responsible for that reason. Involuntary clients often use silence as an impregnable defense in opposing the interview and as an aggression against the interviewer. The interviewer needs to respond. Brianna is a 16-year-old adolescent who has dropped out of high school and was ordered by the juvenile court to see a social worker. Brianna enters the interview room, does not acknowledge the social worker’s greeting, and sits down with her face averted. INTERVIEWER: I know you are seeing me because the court ordered you to, and I can imagine you’re not too happy about the whole thing. BRIANNA: [Silence] EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 187 INTERVIEWER: Could you tell me how you feel about this? [Silence] INTERVIEWER: Could you tell me what you’re thinking about now? I’d very much like to hear. BRIANNA: Nothing. INTERVIEWER: Is there anything you would like to talk about? BRIANNA: [Silence] INTERVIEWER: I would like to help you in any way I can, and I think I can be of some help. But you would have to tell me what you might want me to help you to change. BRIANNA: [Silence] Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. BRIANNA: Saying something like “Sometimes I guess you feel like talking, but other times, like now, I guess you don’t” tends to suggest that the interviewee’s resistant behavior is not a fixed personality attribute but a response to this situation. Interviewers who disclose that they have reacted similarly on occasion sometimes find that doing so helps to dissolve some of the opposition: “Your silence reminds me of the times I felt forced to go to confession but did not want to confess anything to anybody.” Initially, the worker needs to deal directly and explicitly with the resentment of the coerced client. The worker does this by openly recognizing the circumstances that brought the interviewee to the interview and the negative feelings this likely has evoked and by expressing empathy with the feelings: I know that you have been required by the court to meet with me. I can understand that since this is something you yourself did not freely decide to do, you might have some strong feelings about this. People don’t like to be told what to do, and I can’t blame them. I am interested in learning from you how you feel about this. Rather than countering the opposition directly, the interviewer goes with it, joining the interviewee by affirming the interviewee’s entitlement to opposition. Accepting and empathizing with the interviewee’s oppositional statements can help to defuse them. Working with the opposition rather than adversatively rejecting it allies the interviewer with the interviewee. Starting with attention to the interviewee’s opposition is starting where the client is. Interviewees who come because they are forced to are highly likely to have negative feelings about coming. Consequently, the risk is low in suggesting that the interviewee share any feelings of anger: “Since everyone is different, I don’t know for sure that you feel this way, but I can imagine that you might be angry about having to meet with me.” Although accepting and responding empathetically to hostile, even insulting, responses from an interviewee who feels imposed on, the worker should not apologize because the interviewee has been required to come. The worker should be explicit in making the conditions of the contact clear: It’s very clear that you are really angry about this. And I can imagine that if I were in your shoes, I would feel the same way. But the court has made contact with us a condition of your continuing in the community. And we work along with the court in implementing the requirement. If you fail to maintain contact, we would have to notify the court, and you would have to serve your prison time. We can depersonalize the issues by referring to the court order and agency rules that constrain the behavior of the interviewer as well as the interviewee: I can understand that, given where you are coming from, the requirement that you meet with me may seem like an oppressive imposition. But both you and I are stuck with that. Now, given the reality that we have to meet, how do you want to use the time? Is there anything you would like to talk about? Anything with which you think we can be of some help? It’s your choice. It’s up to you. I can only help you if you help me to help you. The social worker should describe the terms of the mandate to the client, including the client’s behavior under question, the sources of the sanction for the agency’s involvement, what happens if the client resists participation, and the threshold at which coercive action will be undertaken. The interviewer should present this information in a straightforward, nonconfrontational manner. Interviewers are genuine in accepting that they have authority vis-à-vis the interviewee. Workers can express this authority in the contact with the involuntary client in such a way that the client perceives it as an expression of caring. Interviewers can merely point out that their authority in this instance is designed to help the involuntary client to refrain from engaging in self-damaging behavior. The interviewer acts in the guise of a surrogate supportive superego. Aware that the interviewee probably associates the interviewer with the punitive court, the worker EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 188 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. should be clear and explicit that the agency is not the court, that the interviewer is not an employee of the court, and that agency treatment is not punishment. INITIATING CHANGE Throughout the interview, the worker tries to maximize the interviewee’s scope of self-determination. By mandating the contact the court has limited the interviewee’s right in one respect: the client’s right to refuse contact with the agency. Within the limits of the agency contact, the worker has discretion to provide a variety of options. In consultation with interviewees and in response to their preferences, interviewers determine what part of the general situation the client wants to deal with, the specifics of scheduling, how the interviewer chooses to deal with the subproblem they have selected for consideration, and the like. We can also suggest autonomy by asking interviewees how they would like to be addressed. In line with self-determination, we recognize that interviewees have the right to refuse contact with the agency and accept the consequences that result from such a refusal. We are all familiar with the concept of informed consent. Similarly, we need to help the interviewee with a decision of informed opposition. Do interviewees clearly know and understand what will happen if they choose to continue to reject contact with the agency? The worker has to be clear about the consequences of this. The interviewer attempts to engage the interviewee in a collaborative discussion of aspects of his life that are problematic or dissatisfying for him and for which he might want help—and for which the agency is ready to offer help. The collaborative, joint participatory nature of the interaction is, once again, a demonstration of respect for the interviewee’s autonomy. And, once again, involvement in such a discussion requires the client to enact the role of interviewee and the tasks inherent to the role. When the legal system refers interviewees, they are likely to want to change something, if only to get the legal system off their back. Individuals who have been convicted of a crime, who are alcoholics or drug abusers, or who neglect or abuse their children are sufficiently attuned to their environment to know that their behavior carries a stigma. People like to live in harmony with others and experience pleasure rather than pain in relationships, parenthood, and on the job. Interviewees are aware of the personal negative consequences of their behavior. Some component of interviewees’ ambivalence about their situation does press for change. Interviewers ally themselves with this positive component. Mandated clients often have a strong motive for cooperating in the interview. For some, cooperation may result in the end of probation, the return of a driver’s license, or regaining custody of their children. Interviewers can use such motives to obtain interviewees’ active participation. INTERVIEWEE: It’s hell being without a driver’s license. It’s more than inconvenient; it’s embarrassing. What would you like to do to get it back? INTERVIEWEE: Well, you tell me. I think I might be ready to listen. INTERVIEWER: That’s very good. Let’s talk about that. INTERVIEWER: We might exploit conflicts in the clients’ value system that might induce change. The worker reports: He said that she knew that saying he was a real loser made him mad, but she kept saying it over and over again, and this time he couldn’t control himself and he hit her. So she made him do it. I pointed out that he had said that he hated to come here because it was a violation of his autonomy, his independence. And here his wife was violating his independence. She made him do what he said he didn’t want to do. She was controlling him. Where was his autonomy? If possible, an effort is made to translate any concerns the interviewee expresses so that they are related to the requirements that brought them to the agency. For instance, while Ms. S. does not acknowledge that her hoarding poses a safety hazard for her child, she wants a homemaker to help her clean the house for the holidays. She might agree to a contract that states that she will clean the house with the assistance of a homemaker by Thanksgiving so it is no longer a safety hazard for her child (Rooney 2009). MODELING EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 189 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. In her behavior the interviewer is modeling pro-social approaches to interpersonal interaction. If a positive relationship is established between interviewer and interviewee, the interviewee may be prompted to emulate such pro-social behaviors in identification with the interviewer. In modeling where she is coming from, the interviewer expresses where to find appropriate support for responsible parenting, marital harmony, and so on. Interviewers support, praise, and reinforce both interviewees’ recognition of the harm done as a result of the actions in question and expressions of interest in programs that deal with those actions. On the other hand, the interviewer might challenge with care expressions in support of sexist or racist ideas (i.e., “She should have been home with the kids; that’s where she belongs”). Throughout, an effort must be made to align interviewees’ expressed interests, motivations, and needs with what is being required of them. The better the congruence and fit between the interviewees’ perspective and the agency demands, the greater the likelihood that some degree of interview success will be achieved (Altman 2003; Rooney 2008). The small forward steps in the change process for moving from rejection toward the beginning of participation are addressed in the literature on motivational interviewing (Miller and Rollnick 2002) and solution-focused interviewing (De Jong and Berg 2001). The model for motivational change follows from the “transtheoretical” formulation proposed by Prochaska and colleagues (1992), and it is often cited in the involuntary client literature (Rooney 2009; Trotter 2007). The stages of change are represented in a continuum from “precontemplation,” where no problem is acknowledged, to some awareness of the problem, to ultimate acceptance of the need for change. The interventions that are likely to affect progress through the continuum can only be implemented in the context of a positive relationship. However, studies concerning interviews with involuntary or nonvoluntary interviewees indicate some pervasive modification to the interviewer’s role (Skeem et al. 2007). In addition to the usual elements that characterize the positive relationship, there is an element of firmness. The necessity for reconciling the dual help-control nature of involuntary or nonvoluntary interaction requires that an element of authority be embedded in the positive relationship configuration of acceptance, trust, caring, and respect. TERMINATION AND EVALUATION Toward the end of the interview, the interviewer tries to evaluate, support, and strengthen the level of self-attribution the interviewee might feel toward changes in behavior that comply with requirements for change. In line with this, the interviewer might explore with the interviewee those elements in her support system that would undermine efforts toward change. The level of effectiveness of interventions with involuntary or nonvoluntary interviewees has been the subject of research. In a summary of an earlier review of the literature on outcomes, Rooney (1994, 89) notes that “a review of the effectiveness literature suggest(s) that legally mandated clients can have more successful results than we had earlier thought to be the case. However, these more positive results contain the caution that coerced intervention often produces time limited benefits that do not last beyond the use of external pressures.” A reasonable summary of more recent reviews (Chovanec 2009; Rooney 2009; Snyder and Anderson 2009; Trotter 2007) would suggest that following the prescriptions generally recommended in the literature would achieve a limited measure of success. Box 13.1 provides several suggestions for interviewing the involuntary client. THE CHILD SEXUAL ABUSE INTERVIEW The child sexual abuse interview is, once again, a problematic interview. The interviewee is a child; the content of the interview is of a highly sensitive, personal nature; and a high level of responsibility is involved because of the possibility that it might result in legal action. The interviewer might be asked to testify about the interview. ... BOX 13.1 INTERVIEWING THE INVOLUNTARY CLIENT EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 190 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 1. Be aware of your attitudes toward this group of interviewees. 2. Understand your relationship with and obligations to the referring agency. 3. Know the requirements and limits of the mandate imposed on the interviewee by the referring agency. 4. As in all interviews, but of particular importance here, manifest the basic attitudes and approaches that make for establishing a positive relationship. 5. Warmth and respect communicate an empathetic understanding of the negative, oppositional, and resentful feelings that such interviewees generally bring to the interview; roll with the resistance. 6. Make it clear to the client that you must act in accordance with the limitations and consequences of the mandate imposed on the interviewer-interviewee relationship. 7. Seek to respect and extend the negotiable freedoms of choice available to the interviewee within the limitations of the mandate. 8. Actively explore with interviewees what help they might be interested in accepting from the agency in working on any problem of concern to them; make a deal. 9. Attempt throughout to act not as an adversary but as an ally seeking to formulate a service the agency can provide and the interviewee is interested in accepting. 10. Communicate a sense of hope that although the initial contact is imposed, such relationships can effect positive change. ... The child abuse interview does not usually originate with any action on the part of the child. It originates from a variety of sources. Professionals, including doctors, teachers, and dentists, are required by law to report any suspicion of child abuse. Family members and neighbors in contact with the child might be aware of activities and behaviors that suggest child sexual abuse. A report is made to child protective services, and a worker is assigned to investigate the allegations. Then an interview with the child is scheduled. The investigative interviews conducted by social workers in such cases are of prime importance because, unlike other types of physical abuse, objectively discoverable evidence and witnesses seldom exist. Sgroi, Porter, and Blick (1982, 48) reported, “In most child sexual abuse cases, there will be little or no physical evidence and few if any physical findings to support the allegation.” Sexually transmitted diseases and/or pregnancy resulting from sexual abuse are rare. Vaginal or anal injury as a result of penile or digital penetration is somewhat more frequent but still absent in most cases. Validation of a report of sexual abuse rests primarily on the information provided by the child victim and obtained by the social worker in the interview. If, as is often the case, the incident results in legal action against the alleged perpetrator, the defense attorney is likely to be rigorous in reviewing the social worker’s report of the interview for flaws and errors. Consequently, the interviewer has to conduct the interview in a manner that does not leave it open to a negatively contested challenge. In the not so distant past, social work child sexual abuse interviews have been subject to criticism. Myers (1993, 26), who edited a book on such reports, notes that “poor interviewing, particularly excessive use of leading questions, contributes significantly to skepticism about professional competence” (Ceci and Bruck 1995; Wood and Garven 2000). Having scheduled an interview with the child, the social worker may be accompanied by a police officer because of the legal implications involved in such an interview. The family is notified about the scheduled interview, and the parents’ presence may be permitted. Obviously, the parent permitted in the interview should not be the suspected perpetrator. The worker must instruct the parent sitting in to be unobtrusive. In 2011, failure to notify parents of an interview conducted with a child at school resulted in a lawsuit, Camreta v. Greene, that involved Child Protective Services and was heard by the U.S. Supreme Court. Interview location should provide privacy, minimizing external influences and distractions. The interview should be held in a neutral and psychologically comfortable place. Workers should avoid interviewing suspected abuse victims at home, where the abuse might have occurred, because it is associated with the perpetrator and the hurt. The room should have available nonverbal sources of communication, including playthings such as crayons, paints, and anatomically correct dolls. Anatomically correct dolls with a detachable penis, EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 11/15/2018 10:56 AM via MACEWAN UNIVERSITY AN: 611679 ; Kadushin, Alfred, Kadushin, Goldie.; The Social Work Interview Account: s4934679 191 Copyright © 2013. Columbia University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. pubic hair, mouth, rectum, and vagina that can be opened to reenact insertion have enabled children to demonstrate experiences they might find otherwise difficult to verbalize (Everson and Boat 1994; Shamroy 1987). Such dolls communicate permission to discuss sexual matters and enable the social worker to identify the words the child is using for genitalia. These interviews may be audiotaped or, even better, videotaped. This may obviate the necessity of subjecting the child to multiple interviews and makes available a record to confirm that the interview was neutrally nondirective. Audiotapes or videotapes capture the details of the child’s account without the distractions occasioned by note taking. The record they provide can reduce the number of times the child must be subjected to anxiety-provoking interviews. The disadvantage of tapes is that they provide evidence of any errors in directivity and suggestibility that the interviewer might have made. On the other hand, a taped interview can be used to counter any subsequent attempt by the child to retract the statements because of pressure by the perpetrator. THE INTERVIEW As always, the interview starts with some information as to how it is to be conducted and with efforts to develop a relationship with the child. Because of the legal implications of the child sexual abuse interview, the interviewer needs to be honest with the child about the limits of confidentiality. The interviewer will have to share information obtained from the child with the court and the parents. Workers should explicitly instruct children that they do not have to answer questions, they should feel free to answer questions in any way they want, and they may disagree with or correct the interviewer’s reflections or summaries of what they have said. The interview may start with a general introduction: I am _____. I am a social worker. I am here to help children with any problems, any difficulties they may have, including any problems you may have. If the child seems receptive, the intervi...
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