We begin to realize how much a clinician’s ability
to make sense of a patient’s verbalizations depends
on a shared background.
For example, some midwestern clinicians listen-
ing to Asian American patients may suddenly feel as
if they have lost their own frame of reference. But in
dealing with midwestern patients, how many times
will those same clinicians mistakenly assume that
their frames of reference are identical to those of
their patients? In other cases, gender differences can
sometimes produce nearly the same effects. Gender-
related factors can interact with a clinician’s values
and background. Then, everything from sheer igno-
rance to gender stereotypes can conspire to reduce
the validity of the assessment interview. The answer
seems to lie in making assessors more “gender
aware” (L. S. Brown, 1990; Good, Gilbert, &
Scher, 1990). How does one become more gender
aware? An expert in gender issues has made the fol-
lowing suggestions:
Clinicians seeking to enhance their gender
awareness might focus on three areas—
their knowledge, attitudes, and behaviors.
Knowledge is typically increased by read-
ing (such as research and conceptual arti-
cles and books) or attending a course or
seminar on gender issues. Attitudes are
enhanced through experiences with peo-
ple holding conceptions of gender that
differ from one’s own (such as people from
differing cultures, religions, or sexual
orientations), which serve to broaden our
understanding of gender issues. Behaviors
are improved through practice and feed-
back (with a supervisor that has expertise in
gender-related issues). (G. Good, personal
communication)The Patient’s Frame of Reference
If the clinician is going to be effective in achieving
the goals of the interview, it is essential that he or
she have an idea of how the patient views the first
meeting. Only with such awareness can the
patient’s verbalizations and behaviors be placed in
their proper context. By the same token, the estab-
lishment of rapport will be more difficult if the
clinician is not sensitive to the patient’s initial per-
ceptions and expectations. A patient may have an
entirely distorted notion of the clinic and even be
ashamed of having to seek help. Sometimes patients
have been pressured into seeking help. A spouse has
finally said,“Get help or we’re through!”A sorority
lays down an ultimatum that a member either“get
therapy”or leave the house. Some patients present
themselves at the clinic to placate employers. What-
ever the reason, it will inevitably color the nature of
interview behavior.
For many individuals, going to see a clinical
psychologist arouses feelings of inadequacy. Some
individuals will respond to this by“clamming up.”
Others will display a kind of bravado that says,
“See, I’m not weak at all!”Still others may become
competitive and imply that psychology is not all it’s
cracked up to be or suggest that it is really unlikely
that the clinician has much to offer. In contrast,
there are patients who start with a view of the cli-
nician as a kind of savior. Although it is often quite
reinforcing to be viewed as a miracle worker or a
great healer, remember that the patient will proba-
bly reconsider this evaluation later. For example, a
young inpatient diagnosed with borderline person-
ality disorder once informed the entire inpatient
unit that one of the authors was the best therapist
in the hospital and maybe one of the best in all of
clinical psychology. Imagine the author’s chagrin
when he witnessed, 4 days later, the same patient’s
announcement that the author was a horrible ther-
apist and an embarrassment to his profession.The Clinician’s Frame of Reference
In a sense, the general dictum here, as in any
endeavor, is“Be prepared.”This implies that the
clinician should have carefully gone over any exist-
ing records on the patient, checked the information
provided by the person who arranged the appoint-
ment, and so on. Such a posture will ensure that the
clinician knows as much as can be known at that
point about the patient. Such preparation may also
minimize spending interview time going over172 CHAPTER 6