Shauna Thompson (10017221) APSY660: Self-Evaluation of Clinical Interview Assignment

For this assignment I chose to interview my partners friend Lesley, who is a single mother, and her 18-year old son Daniel, who is in high school. I am not familiar with the details of their personal lives, and I have not known them for very long. Prior to beginning the interviews I asked each of them if any topics of conversation were off-limits (i.e. they were unwilling to discuss in an interview). Lesley asked that we not discuss the history and involvement of Daniels father in his life, so I did not cover that in the interview. I chose to interview them separately because I thought I might get more realistic responses (particularly from Daniel), and both of them would be more comfortable talking with me (not to mention avoiding later conflict if they were honest in front of one another). The settings were not ideal (e.g. I would have preferred to do the interview with Lesley at the kitchen table or somewhere we would be seated at the same level, but that was the only space available at the time). Prior to the interviews I asked both Lesley and Daniel to complete a questionnaire from Appendix A in our Sattler and Hoge (2006) course text. They indicated that they were comfortable informing on themselves and declined the use of pseudonyms. In the interest of confidentiality their last names were not used in our discussions. Both clients completed questionnaires were quite unremarkable, and I chose the referral question at random after neither client brought forward any specific concern to discuss. Neither reported any unusual mood/emotional concerns, other than the normal teenage irritability and parent-teen disagreements. I did not include their completed questionnaires in my submission because all relevant content was discussed in the interview, and I wanted to preserve confidentiality as much as possible. I felt my rapport with both Lesley and Daniel was good throughout the process. I believe I was able to set them at ease from the beginning of the interview. I discussed confidentiality, and also explained that because Daniel was 18 years old he would be treated like an adult (i.e. I would not report the contents of our conversation directly to his mother). I provided opportunity for questions at the beginning and the end of our interview, and felt that I gave enough time for each of them to respond to my questions as they were able. I was also able to sit comfortably with them in silence at times when they were not able to immediately provide an answer. I thought it was important to note to both of them that I would support Daniel in bringing any potential problems forward if we deemed
Page | 1

Shauna Thompson (10017221) APSY660: Self-Evaluation of Clinical Interview Assignment

it necessary to so, whether to his mother or another adult who could help him (though at the time I did not anticipate any real problems being brought forward). I felt that during the interviews I was well attuned to both clients, and that both interviews were appropriately comprehensive. Daniel had asked if he could leave the dogs out to play so he wouldnt be nervous, and despite their potential for distraction I think we managed them quite well, and they allowed him an outlet to reorganize himself at times. Both conversations felt to me as though they flowed quite naturally from topic-to-topic, even when the topics themselves were difficult (e.g. suicide/self-harm). Though I was very surprised by Daniels disclosure of suicide attempts and self-harm I felt that I reacted appropriately and was able to encourage him to be open and honest in his discussion with me. There were some areas of interest/concern noted in the interview process, particularly in the interview with Daniel. I Daniel said that he enjoyed school he had some academic concerns in the areas of attention and concentration, slipping grades, and an ability to focus and follow instructions at times. He related the cause of these difficulties primarily to his emotional concerns. Emotional concerns he disclosed included his (previously undisclosed) history of self-harm and attempted suicide, a long history of feeling emotionally overwhelmed by the emotions of others, and his history of coping by bearing through and isolating himself. He also mentioned a new stress recently involving constraints on the relationship with his girlfriend, and trouble between himself and his girlfriends mother. Somatic complaints included the recent development of chest pains (currently being addressed/investigated by his physician), and headaches that occur when he is feeling particularly emotionally overwhelmed. The disclosures of suicide and self-harm were particularly surprising for me during our interview as I had no idea he had those themes in his past. I was concerned when he stated that he had never told anyone else besides his girlfriend, and also by the disclosure that he felt they identified with one another quite significantly because of these events. I felt the need to spend more time on this area of discussion, but as I was limited to 90 (videotape) minutes I tried to cover the topic well enough initially (for the sake of the video evaluation) to be able to put it off until the end of our taped interview. When our taping ended I had further discussion with Daniel
Page | 2

Shauna Thompson (10017221) APSY660: Self-Evaluation of Clinical Interview Assignment

about his current self-disclosed level of risk for suicide and self-harm (low to none), and I also discussed the possibility of bringing the problems he was (is) having to his mother (with my support). He agreed only to think about it and we planned to meet at a local coffee shop in one week to see how he is feeling about the matter. I also contracted with him that if he was feeling especially overwhelmed, at risk, or just needed friendly adult support that he could contact me directly, and I left him with my telephone number programmed into his cell phone. I also let him know that if his girlfriend needed someone to talk to (again, not a professional, but a friendly adult) that she could also call me for support. Of course in the event that she does contact me I will respond appropriately to any possibility of harm, and in any discussion I would tell her of my responsibility to do so. Daniel noted that he has always been susceptible to feeling emotionally overwhelmed by the emotions and strong feelings of others, and that he usually deals with his feelings by keeping them inside. It is not clear that depression is currently an issue, but further investigation is warranted regarding the possible presence of a depressive disorder and/or an anxiety disorder, as well as additional follow-up regarding the previous history of self-harm and suicide. If this were not done by me personally then I would offer Daniel referral to a counsellor. With regard to gathering information specific to the fictional referral question (i.e. depression), I did not find the information from Daniel and Lesley to distinctly show a depressive symptom pattern, or point clearly to the presence of a depressive disorder. Lesley reported concern for Daniels self-esteem and emotionality, but no other depressive symptoms. Daniel identified no problems in eating or sleeping, no detachment from areas of interest (friends/hobbies), no concerns with fatigue, low energy, or decisiveness, and he was able to identify hopes and dreams for the future. He did however identify a diminished ability to concentrate and focus at times, emotionality, a history of self-harm, recurrent (past) thoughts about suicide ideation, and multiple suicide attempts. Though it did not appear from the interview that Daniel would qualify for a diagnosis of depression in further assessment I would want to use an assessment tool to formally evaluate for the presence or absence of a disorder of depression or anxiety. While anxiety wasnt part of the initial referral question, some of Daniels comments about reactions to emotional overwhelm, as well as his
Page | 3

Shauna Thompson (10017221) APSY660: Self-Evaluation of Clinical Interview Assignment

description of the chest pains he is experiencing led me to question the possible presence of an anxiety disorder. I would start with the BASC-2 parent (mother), teacher (math teacher) and self-reports, as they would provide information on both anxiety and depression. I might also use a self-report scale such as the BDI-II, or the Reynolds Adolescent Depression Scale Second Edition that is mentioned in the text for further corroboration. I would not suggest the evaluation of any academic areas in this case. Overall I felt that both interviews went well. Im not sure of the recommended time that should be set aside for these types of interviews in a clinic-type setting, but I had been planning for one hour to interview the parent, one hour for the student if there were no significant problems, and up to 90 minutes if there were significant problems. I felt that I was able to manage time well in both interviews. My strengths in the interview were my ability to help the clients feel at ease during the interview, my use of reflective statements and questioning, and my ability to monitor the clients mood and energy level and respond appropriately. I had a difficult time moving on to other topics of conversation once suicide and self-harm came up, and I felt myself wanting to counsel Daniel as opposed to just assessing his current state and situation. As well, I felt like I had trouble keeping the interview moving forward at points because Daniel really wanted to talk about the relationship between himself and his girlfriends mother, as well as his fears or concerns about upcoming changes in family rules regarding the amount of time he and his girlfriend are permitted to spend together. Though I was able to redirect him I wonder if I can find a way to help him be heard as much as he needs in order for him to be ready to move on. Lastly, I was quite unprepared for there to be any real troubles discussed during our interview. I think it will be important in the future to go into interviews with openness to the fact that I dont really know whats there, and a curious and professional attitude toward discovering each persons story. I will certainly be working on these things in the future.

Page | 4