of expression or slight changes in body position. Fur-
thermore, a fully transcribed interview will have to
be read in full later. The clinician must plow through
50 minutes of notes to extract the most important
material, which may have taken up only 10 minutes
of the interview.
With today’s technology, it is easy to audiotape
or videotape interviews. Under no circumstances
should this be done without the patient’s fully
informed consent. In the vast majority of cases, a
few minutes’explanation of the desirability of tap-
ing, with an accompanying assurance to the patient
that the tape will be kept confidential (or released
only to persons authorized by the patient), will
result in complete cooperation. Because today’s
world is awash with audio and video recording,
most patients are unlikely to object to it. By and
large, patients are not even upset by a microphone
or videorecorder that are in plain view. There may
be a few passing moments of self-consciousness, but
these quickly fade. Indeed, it may turn out that the
clinician is more threatened by the recording than
the patient, especially if the interview is likely to be
examined or evaluated by superiors or consultants.
In some instances, it is desirable to videotape
certain interviews. In the interests of research, of
training interviewers or therapists, or of feedback
to the patient as part of the therapeutic process,
videotaping sometimes has great value. Like audio
recording, it should be done openly, unobtrusively,
and with the patient’s informed consent.
Rapport
Perhaps the most essential ingredient of a good
interview is a relationship between the clinician
and the patient. The quality and nature of that rela-
tionship will vary, of course, depending on the pur-
pose of the interview. These differences will
undoubtedly affect the kind of relationship that
develops during the contact.
Definition and Functions. Rapportis the word
often used to characterize the relationship between
patient and clinician. Rapport involves a comfortable
atmosphere and a mutual understanding of the
purpose of the interview. Good rapport can be a
primary instrument by which the clinician achieves
the purposes of the interview. A cold, hostile, or
adversarial relationship is not likely to be construc-
tive. Although a positive atmosphere is certainly not
the sole ingredient for a productive interview (a
warm yet ill-prepared interviewer will not generate
the best of interviews), it is usually a necessary one.
Whatever skills the interviewer possesses will surely
be rendered more effective in proportion to the
interviewer’s capacity to establish a positive relation-
ship. Patients approach most interviews with some
degree of anxiety. They may be anxious lest they
are discovered to be“crazy”; they may be fearful
that what they state in the interview will be passed
along to employers. Whatever the specific nature of
these concerns, their presence is enough to reduce
the interviewer’s potential effectiveness.Characteristics. Good rapport can be achieved in
many ways—perhaps as many ways as there are
clinicians. However, no bag of“rapport tricks”is
likely to substitute for an attitude of acceptance,
understanding, and respect for the integrity of the
patient. Such an attitude does not require that
the clinician like every patient. It does not require
the clinician to befriend every patient. It does not
require the clinician to master an agreed-upon set
of behaviors guaranteed to produce instant rapport.
It does require that patients not be prejudged based
on the problems they seek help for. Attitudes of
understanding, sincerity, acceptance, and empathy
are not techniques; to regard them as such is to
miss their true import. To ask to be taught how
to appear sincere, accepting, and empathic is to
confess the absence of these qualities.
When patients realize that the clinician is trying
to understand their problems in order to help them,
then a broad range of interviewer behavior
becomes possible. Probing, confrontation, and
interviewer assertiveness may be acceptable once
rapport has been established. If the patient accepts
the clinician’s ultimate goal of helping, a state of
mutual liking is not necessary. The patient will rec-
ognize that the clinician is not seeking personal sat-
isfaction in the interview.168 CHAPTER 6