Gratification of Self. The clinical interview is not
the time or the place for clinicians to work out their
own problems. Sometimes a clinician is profes-
sionally insecure or inexperienced. Sometimes the
patient’s problems, experiences, or conversation
reminds clinicians of their own problems or threatens
their own values, attitudes, or adjustment. In one
way or another, however, clinicians must resist the
temptation to shift the focus to themselves. Rather,
their focus must remain on the patient. This is
obviously a matter of degree. None of us is so self-
controlled that our thoughts never wander or our
concentration never falters. However, the clinician–
patient roles are definite and should not be confused.
In some instances, the patient will ask personal
questions of the clinician. In general, clinicians should
avoid discussing their personal lives or opinions.
However, this advice must be tempered by awareness
of the reasons for the question. Thus, a breezy open-
ing question by a patient such as,“Say, what did you
think of that basketball game last night?”does not
have the same significance as the question,“Do you
think Freud was correct in his assessment of the
importance of penis envy in women?”When a ques-
tion seems to suggest something of importance about
the patient’s problems, it is usually best to deflect it or
to turn it around so that you can pursue your clinical
hypothesis. But if a question is trivial, innocent, or
otherwise basically inconsequential, a failure to
respond directly will probably be perceived as the
worst kind of evasion.
The Impact of the Clinician. Consider two
therapists working in the same clinic. One therapist
is a 50ish, matronly psychiatrist with a marked affin-
ity for print house dresses. Another is a clinical psy-
chologist—male, very youthful in appearance, quite
thin, carefully dressed, and seemingly quite unsure
of himself. It is inevitable that these two therapists
would be perceived differently by their patients.
Each of us has a characteristic impact on others,
both socially and professionally. As a result, the
same behavior in different clinicians is unlikely to
provoke the same response from a patient. The tall,
well-muscled, athletic therapist may somewhat
intimidate certain kinds of patients. The very
feminine female interviewer may elicit responses
in a client very different from those elicited by
her male counterpart. Therefore, it is important
for all clinicians to cultivate a degree of self-
insight or at least a mental set to consider the possi-
ble effects of their own impact before attaching
meaning to the behavior of their patients.The Clinician’s Values and Background. Nearly
everyone accepts the notion that one’s own values,
background, and biases will affect one’s perceptions.
Unfortunately, we are usually more skilled at vali-
dating this notion in others than in ourselves.
Therefore, clinicians must examine their own
experiences and seek the bases for their own
assumptions before making clinical judgments of
others. What to the clinician may appear to be
evidence of severe pathology may actually reflect
the patient’s culture. Take the following example:
A 48-year-old ethnic Chinese woman had
been receiving antipsychotic and antide-
pressant medication for psychotic depres-
sion. On this regimen, she had lost even
more weight and more hope and had
become more immobilized. A critical ele-
ment in this diagnosis of psychosis was the
woman’s belief that her deceased mother,
who had appeared in her dreams, had
traveled from the place of the dead to
induce the patient’s own death and to
bring her to the next world. This symptom
was interpreted not as a delusional belief
but as a culturally consistent belief in a
depressed woman who had recently begun
to see her deceased mother in her dreams
(a common harbinger of death in the
dreams of some Asian patients). This
patient responded well after the antipsy-
chotic medication was discontinued, the
antidepressant medication was reduced in
dosage, and weekly psychotherapy was
begun. (Westermeyer, 1987, pp. 471–472)
This case illustrates how all the behavioral cues
that clinicians typically rely on may lose their mean-
ing when applied to a patient from another culture.THE ASSESSMENT INTERVIEW 171