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Structured Clinical Diagnostic Interview
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Guidelines for Asking Questions
you know, you help your clients correct faulty ideas and logic mainly through
questions. Ideally with the anxiety-disordered client, he or she learns to pose
your questions to themselves. The following is a checklist for asking questions.
Think of an anxiety-disordered child or adult you are treating and see if you
need to fine tune your questions in the next session.
♦ Six-Point Checklist for Asking Questions
Here is a six-point checklist:
1. Did your questions help the client to focus on the specifics?
do you need to try the "close your eyes technique"?
What do you think would happen if you confronted your boss about changing your
---Client: Oh, probably nothing would happen.
you be more specific? What exactly do you think would happen?
he probably would just shrug it off and say, "Well, it's just the way it
---Therapist: Can you be even more specific? Maybe think about it
for a moment? Can you close your eyes and imagine it?
---Client: Well, I
imagine he might be taken back at first. But then he would probably ask me why
I brought it up; then I really think that he wouldn't carry it any further.
---Therapist: Can you imagine it again?
---Client: I can see him act another
way. He's very mad at me.
---Therapist: How you are reacting to him?
Well, I'm getting uptight and I can't talk. I want to leave.
That's what I was wondering about. To be even more specific, what would be the
worst thing about the situation? Your feeling? The way you would act? Or the reaction
of your boss?
Here I used questions to get the client to specify what
exactly he was afraid of in the situation.
♦ 2. Were your questions
specific, direct, and concrete enough?
Although an open-ended question
such as "How have you been feeling?" is useful for obtaining general
information, questions that get particular types of information are usually more
helpful: for instance, "How anxious were you when you asked for the date?"
Such questions enhance the client's observing self in the session and, thus, improve
communication, provide structure, and facilitate relief of symptoms. When one
client said his anxiety concerns the "meaning of life," I ask the client
"What specifically concerns you about the meaning of life?" What at
first appeared to be a client's existential or preoccupation with vague philosophical
concepts was traced to a specific fear of cancer.
♦ 3. Did your questions grow out of your
conceptualization of the client's problem?
your last session with your anxious client. For example, if your strategy
for a battered wife is for her to see the possible course of action, "I could
call the police," was your question geared to having the client think along
the lines of "What could you do?"
♦ 4. Were your questions
timed to foster rapport and problem-solving?
As you know, poorly timed
questions can increase your client's anxiety. As would, for example, asking a
client to cognitively "rehearse" a fearful event before you have established
trust with him. Were questions geared to enhance trust, like "Do you feel
nothing will happen if you tried what we discussed?," asked early in treatment?
♦ 5. Did you ask questions too rapidly for the child's level
The result I find, especially with a child is they feel cross-examined
and become defensive. To avoid this, I find I need to take added time with a child
to think about the information I have before I phrase my next question. I need
to constantly be vigilant to avoid the common error of formulating a new question
instead of listening to the client's answer.
♦ 6. Were your questions
in-depth enough or were you aiding your client in avoidance of the issues?
As you know, your client usually has more information than he is aware of. You
may stop asking questions before the client gets to the real cause of the anxiety.
To avoid this, I ask "Can you think of anything else?" I find often
a client's most helpful reconceptualizations come after his immediate responses.
I then repeat, "Take a couple of minutes and see if you can think of anything
else." By simply repeating this question, it often brings up new material.
In the following clinical example, I use questions to elicit information and to
open up a client's closed logic.
---Client: I don't think I'll ever be
able to get a job.
---Therapist: How often do you have this thought?
---Therapist: And what do you base this thought on?
I just feel it. There's no use.
---Therapist: Do you think feelings are always
---Client: No. I guess not always.
---Therapist: Your feelings
are often wrong and just reflecting what you're thinking. What are the advantages
of this type of thinking?
---Client: Well, I don't have to go for the interview.
I don't have to think about it.
---Therapist: Those are real benefits. What
disadvantages are there?
---Client: Well, I'll never get what I want. I may
be making a mountain out of a molehill.
---Therapist: On balance, is this
thinking helpful to you?
---Client: I suppose not.
do you think you could do about this type of thinking if it's getting in your
---Client: Well, maybe look at it more closely.
Peer-Reviewed Journal Article References:
Powell, D. M., Stanley, D. J., & Brown, K. N. (2018). Meta-analysis of the relation between interview anxiety and interview performance. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 50(4), 195–207.
Recklitis, C. J., Blackmon, J. E., & Chang, G. (2017). Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview. Psychological Assessment, 29(10), 1189–1200.
Vrshek-Schallhorn, S., Wolitzky-Taylor, K., Doane, L. D., Epstein, A., Sumner, J. A., Mineka, S., Zinbarg, R. E., Craske, M. G., Isaia, A., Hammen, C., & Adam, E. K. (2014). Validating new summary indices for the Childhood Trauma Interview: Associations with first onsets of major depressive disorder and anxiety disorders. Psychological Assessment, 26(3), 730–740.
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