The woman described that she had a very busy course load, had to work extra hours to support herself and then found herself working very hard to support a relationship with someone who was inattentive and needy due to substance abuse problems.
Throughout the interview I nodded and affirmed the woman's concerns and feelings, offering support and sympathy through eye contact. The interview concluded when I summarized the situation and affirmed that I had interpreted the situation correctly, and together with the interviewee decided that she needed to spend more time focusing on her own needs and break up with her partner. The client seemed satisfied with this conclusion, which she had come to already but just needed support and reaffirmation that she was making a good decision.
At one point during the interview in fact the client stated that she thought it was best that she terminated her relationship with her boyfriend, but had stated that she was uncertain whether this decision was well grounded. Thankfully during the course of the interview the woman was able to conclude with the interviewers support that she was on the right path, one that would lead to self-discovery and greater personal satisfaction and happiness.
What skills did you use and why?
Many interview skills were used during this interview. In particularly I worked to first establish rapport with the client by presenting a non-threatening and non-judgmental environment. I also listened carefully to the clients concerns all the while maintaining eye contact and nodding my understanding of the client's situation and particularly concerns.
During the interview I paraphrased the clients concerns and the facts gathered from the client to ensure that I was hearing what she had to say correctly. Paraphrasing is an ideal tool in any type of interview setting to ensure that the interviewer is accurately interpreting the messages given by the interviewee. Eye contact also helped build rapport and trust. In this case since trust was vital to the outcome of the interview process, establishing rapport was the first priority on the list. Establishing a safe and communicative environment enabled the client to fully unload her concerns and come to a supportive decision based on her wants, needs and desires.
One other primary skill used was active listening. This required that I dismiss any preconceived notions I had regarding the outcome of the interview ahead of time. This also required that throughout the interview I took care to listen to what the client had to say without making judgments regarding her statements until the interviewee had completely finished sharing her thoughts and experiences.
One of the biggest mistakes interviewers often make is judging the content of an interview without actually listening to what the interviewee has to offer. Such rash judgments are natural but can interfere with the interviewers ability to maintain an objective viewpoint. Many people have a tendency to start forming their responses before someone talking has actually finished speaking. This can actually impede the interview process and prevent the interviewer from hearing everything the interviewee has to share about the situation being evaluated. Thus active listening was vital to the success of this interview. To help facilitate active listening I chose to record the session so I could take notes at a later time. This also helped facilitate a more active listening environment.
Evaluate The Interview
This interview was very effective. In this instance the client came into the interview very anxious, confused and nervous. Up until the interview the client had not discussed this issue with any friends or family members. As such the client was not confident of the legitimacy of her worry or fear. Fortunately the client's anxiety and stress were alleviated early on in the interview as rapport was established between the client and the interviewee. During the interview through directed but also open ended questioning the interviewer was able to gather ample information regarding the interviewees background. From this probing the interviewer understood what factors contributed to the woman's confusion and hesitance to leave a situation that was clearly not benefiting her in any way.
The interview might have benefited however from a number of interventions. In this case the woman might be referred to additional support and counseling services to help her deal with other issues that arose during the interview process. Through the course of the interview it became apparent that multiple other situations or factors in the woman's personal life were 'out of control'. While the woman was not physically abused from her boyfriend, she clearly suffered much mental and emotional...
The interview revealed that this may be a result of a pattern of emotional abuse the woman had experienced throughout her life. During the interview the woman revealed that her father had left her when she was young. This may have contributed to her perception that she need a male figure to depend on and may have contributed to her dissatisfaction throughout her relationship. It may also have contributed to her attraction to someone she might otherwise have considered delinquent.
In the future it would be beneficial for the interviewer to have more resources readily available that he could refer clients to in similar situations. People undergoing emotional abuse often require additional support to prevent similar situations from re-occurring in the future. Many times they often also require continuing support to stand firm in their convictions. In this case while the woman said she was committed to getting on with her life and breaking up with her partner, there are no guarantees that she actually took this course of action. A follow up interview would help clarify whether she took the steps she indicated she would and help her deal with any emotional fall out that resulted from her interaction and break up with her boyfriend.
When is it appropriate to breech confidentiality? What are laws regarding this?
In certain instances it may be necessary to breech confidentiality. The laws governing this are very strict with the intent of protecting patients and clients in a confidential environment.
The American Psychological Association has established multiple ethical guidelines and laws to ensure the confidentiality of any individuals undergoing counseling interviews. State laws also govern what information must be kept confidential during an interview by counseling staff. Guidelines are established that ensure that the information an interviewee shares with a counselor is kept confidential and will not be shared without written consent of the interviewee, and that no record of counseling sessions will be kept without agreement by the interviewer.
Under certain circumstances it may be necessary to breech confidentiality, as when the patient consents to disbursement of information for further treatment or when legally authorized bodies need access to patient or client information on behalf of the client acting in the best interests of the client (except where prohibited by law) (APA, 1992).
In cases where the client or interviewee presents as a danger to themselves or to others including the interviewee it may be necessary to institute legal action that will breech confidentiality and assist the client (APA, 1992). In all cases even under legal directives where patient confidentiality must be breached the client has a right to disclosure and to know what legal authorities are accessing their information and what the intend to do with this information. In some cases with the informed consent of a client a counselor might share information with other professional associates to gain further insight and recommendation into the best course of action for assisting a client in a given situation.
In this particular case breech of confidentiality may have been warranted if during the course of the interview the woman had revealed that her life or the life of her family members were in danger as a result of her relationship with her boyfriend. It appeared however during the interview that the danger the boyfriend was incurring was emotional rather than physical or life threatening. If this had not been the case informed consent to have the boyfriend incarcerated or charged with abuse may have been appropriately suggested.
In most cases however federal and state laws are very strict governing breech of confidentiality, and in most cases informed consent will be necessary to release any confidential data unless a counselor is under subpoena by a court or other legal entity (APA, 2002).
With regard to medical information in particular there are a number of laws including HIPPA regulations that govern the disbursement of confidential information (APA, 2002). In most cases patients have 100% control over who their information may be shared with.
In cases where counseling is accompanied by medical care treatment patient information may need to be shared with insurers to ensure the patients financial needs are cared for appropriately. Then only the minimal amount of information necessary to ensure a claim is handled will be offered. Most patients will need to sign a consent form releasing information even to their insurer however under new regulations.
References
American Psychological Association. (1992). "Ethical Principles…
