(For Epucerevrl Pyrroses OnLy TEACHING DIAGNOSTIC AND CLINICAL INTERVIEWING Bonnie A. Rudolph, Ph.D, his chapter describes a method of teaching assessment interviewing, based on twenty years of experience condmcting and teaching such interviews. It describes the history, training contests and contents, and a metatheoretieal model of teacbing diagnostic interviewing, The chapter also proposes a format of training and describes six diagnostic interviewing competencies Diagnostic interviewing is one of the most frequently practiced profe sional mental health activities. Counselors, psychologists, social workers, psychi atric nurses, and psychiatrists all utilize the fiest clinical interview to assess client needs and problems, identify strengths and weaknesses, suggest diagnoses, make referrals, plan treatment, form relationships, and make other interventions, St= dents from these professions are trained in the clinical interview using a variety of methods based on differing philosophical, pedagogical, and therapeutic ori- entations (Boorzin & Ruggil, 1988; Garb, 1989). Furthermore, there has been insufficient study of the processes of the first clinical interview and its outcomes (Rudolph et al., 1993). A review of the literature on evaluating, the diagnostic nelson et al, (1998) recommenced some strat gies to strengthen interview by first interview investigations. The thrust of this chapter, however, is to hefp teach students clinical interviewing, To serve a diverse audience of trainers and trainces, a generic modet that applies to different educational settings and theoretical orientations ix offered This model uses the concepts of goals, tasks, and bond suggested by Bordin (1979) as well as a developmental (phases) view of the assessment interview and training (Laolph, 2004). 8 fandamental premise of die madet is chat given he variety of clients, assessment approaches, contexts, and purposes of clinical in= terviews, students should learit (0 utilize « discerning Aexibility, an abiding re spect for the person, and an appreciation for the many factors that influence the outcome of his firse awessment interview: Below, relevant history, a Contest of training, and the diversity of content of diagnostic interviewing are introduced4 Chapter 1 HISTORICAL INFLUENCES Most training Iiterature, the bulk of which comes from counseling psychology, has focused on intervention rather than assessment and has gradually moved over the past twenty-five years from an ill-defined and unstructured to a more clearly delineated approach (Baker & Daniels, 1989). Rogers (1957), Carkhoff (1969), and ethers popularized a didactic and experiential approach to training, intervention skills; however, within this person-centered approach, assessment training was not emphasized. Ivy (1971) further systensatized interview training with his nticrocounseling program, as did Hill (1986) with her response-mode categories. In addition, the move to “manualized” therapies within clinical psy- chology and psychiatry has made training more systematic within specific ther- apeutic approaches (e.g., Klerman et al., 1984; Serupp & Binder, 1984). Within mental health fields, efforts to identify professional comperencies have also sup- ported greater delineation of educational/training outcomes (Bourg et al., 1987; Coursey et al., 2000). However, with a few exceptions (Rosenberg, 1999; Bogels et al., 1995; Spitzer & Williams, 1986), the training literature on assess- ment interviewing has lagged behind this trend to greater specificity. Hence, trainers of the clinical and diagnostic interview have had to apply general ther- apy training principles as wells as concepts from their specific therapy ap- proaches, many of which are untested or unsupported, when teaching the as sessmient interview. Acknowledging the variety in theories of therapy, professional associations have suggested broad ability categories such as knowl- edge, skills, and attitudes (American Psychological Association, APA, 1998; American Counseling Association, 1995). However, the specification of these categories is left to each theoretical school or training program. Most recently, APA (2002) has moved to use the terms knowledge, skills, and competencies. Responding to these trends and recognizing the need to document training outcomes, one professional psychology program faculty in the mid-'90s focused on evaluating the assessment competency within its trainees (Rudolph et al., 1998). Over several years, the faculty developed a set of inventories to measure this competency, That process led to the identification of and agreement upon “floor-level” criteria for determining competency in assessment/diagnostic inter viewing that could apply to the various therapeutic approaches of faculty and stu- dents, as well as to the range of clients and contexts where trainees were situated. Such agreement is noteworthy given the number of faculty (n = 32) and the di- verse therapy orientations they espoused. These criteria are: To structure the interv To forge a working alliance To facilitate interviewee participation and disclosure To collect data and pursue the inquiry To conduct the interview professionally ww een ae‘Teaching Dieguostic and Clinical imerviewing 5 These and subsequent activities resulted in the development of the generic clin- ical interviewing teaching model described in this chapter TRAINING CONTEXT AND CONTENT As this chapter is designed to serve trainers of various professional disciplines, some basic assumptions concerning the training context should be noted. My first assumption is that the training is occurring within an organized curricu- jum and program of study with an articulated training mission. The second as sumption is that the trainees have at least a college education and are pursuing graduate studies with high motivation to provide good clinical/counseling ser~ vices. The third assumption is that the learning outcomes of the training in clinical/diagnostic interviewing are clarified for students before training be- gins. That is, students should know the expected educational outcomes of sc cessfully completing the training. The final assumption is that the trainer is an experienced assessnient interviewer who is open to continuous learning, com- mitted to self-reflection and collaborative learning processes, and operating within an adequately supportive educational environment. Faculty and stu- dents interacting in contexts where chese assumptions are not met are encour aged to consider their situations and advocate for better training to best utilize his chapter. Obviously, explicating assumptions about the qualities of the training con- text is an easier task than clarifying the “content” of what is taught concerning dinical interviewing. Different theories of therapy require specialized “knowl- edge bases” and suggest different assessment interview tasks, processes, antd skits. Some models emphasize inquiry, others listening and sensitive reflection, yet others decision making and problem identification. The chapters that follow in this text explicate approaches of different therapeutic orientation toward the concent and process of the clinical or diagnostic interview, while the beginning of this chapter describes a generic approach to teaching clinical interviewing Although metatheoretical, the following model contains certain values and con- tent thar may be more or less compatible with different theoretical and peda gogic orientations, Thus I recommend the reader “keep the meat and throw oue the bones” in applying the model to his or her own unique training situation, A MODEL OF TEACHING CLINICAL OR DIAGNOSTIC INTERVIEWING The purpose of the model is to create a training environment in which all the participants learn, experiment, self-reflect, and collaborate inn waique ways to achieve assessment-interviewing competence, The three concepts of goals,