More Help on Interviewing

Structuring the Assessment

It is a good idea to give a client some warning in advance of the time required, transportation and parking issues, things they might need like glasses, a list of medications needed, lunch..., as well as fees for the assessment, parking, or what ever.

Some starting questions are:

• do you know why you are here
• what do you know about the assessment process
• here's what we'll do and what happens next
• here's what I know
• anything I need to know about before we begin
• anything you want to make sure that I am aware of before we begin

Consent - explain this in detail and gather the required forms (one for consent to the evaluation, a second for contacting others for information, and a third for taping.

Interviewing

Balance

• Be non-confrontive but confrontive
  • "Was that what you expected to happen?"
  • "I'm struck that some people might say (mimic stern voice and face to distinguish between them and you), 'Oh you should have known that would happen.' What would you say to them?"
  • "Now, I have to ask this of everyone, but were there any concerns raised by anyone about substance abuse in this I should know about?"
• Columbo approach ("Now, let me make sure I got all this right...")
• Repeat questions in different ways later on
• Be wary of the highly detailed and dramatic account, the recount of a painful event without painful affect

Cool questions

• 3 strengths/reasons to hire you
• 3 weaknesses/things you'd change
• smartest/dumbest thing you ever did
• proverbs
• 3 wishes/invisible for a day
• what would be on your tombstone/obituary
• what role do you play in your difficulties
• what would you do if you won the lottery

Ending

• "Anything else you want me to know?"
• "Anything I forgot to ask?"

Topics and data to gather

Below are several areas and questions you can ask to learn more from clients.

Abuse

• ever been hit, punched, pushed, shoved, kicked, threatened by a loved one, or done this to a loved one
• ever felt controlled, constantly accused, humiliated, frightened by a loved one, or done this to a loved one
• ever had a loved one force you into having sex, destroy sentimental things to hurt you, brag about control or power over you, or done this to a loved one
• when did it start, how often is it, have you told anyone
• had sex as a minor with someone older, or been older and had sex with a minor

Attention/Concentration

• difficulty staying focused or on task, abandoned before completion
• hyper-focused, or difficulties tolerating abstractions
• difficulties being organized, losing things
• impulsive responding, shifting and fidgety in seat, responds before directions completed

Eating

• how much do you eat, is it healthy
• are you happy with your weight, (if no) what would you change
• are you happy with your body, (if no) what would you change
• do you have control over how much and when you eat
• do you ever binge
• ever eat and then throw up afterwards
• ever tried dieting and been unable to do it, is your life a series of diets

Medications

• what do you take and how often
• how often would you say you follow this routine
• what is it for
• does it help
• ever taken something else for the same problem

Pain

• have chronic pains
• interfere with sleep, concentration, daily activities
• what do you do, take medications, does this help
• what brings it on, what makes it better/worse, what side of the body
• how long does it last, how often does it happen

Sex

• where did you learn about sex
• when did you go through puberty
• were you ready for it
• how old were you on your first date
• how old were you when you had your first sexual experience
• was it voluntary, mixed with social pressure, alcohol, or drugs
• with the same or opposite sex
• have you ever had same-sex experiences
• ever felt you were sexually different
• ever felt you got into trouble because of your sex interests or life
• any sexual problems, when did they start, what have you done, and has it helped, does it impact your relationships
• thought about HIV risk (more questions if needed)
• how often are you having sex
• do you practice safe sex, how often (25%, 50%, 75%, 100%)

(Mood and Emotions)

General

• how do you feel today, is that typical
• (if bad) how long has it been since you felt good, how long does it take to "snap out of it"
• how would I know if you were happy, sad, and mad

Depression

• ever had days you couldn't get out of bed
• how does the future look to you
• changes in weight, appetite, sex, interest in pleasurable activities, energy level
• sleep problems, Difficulty Falling Asleep, Sleep Continuity Disturbance (difficulty staying asleep, going back to sleep after waking up), and Early Morning Awakening

Suicide

• thoughts of hurting yourself or others, (if yes) plan to do so, access to means to do so, would you do it, (if no) what would stop you
• thoughts that dying would be the only way to escape pain
• thoughts that dying would make others realize how bad things were, what would it do to them
• have you made a will, given away special things, checked on your life insurance, bought a gun

Anxiety

• ever been very afraid of something bad happening
• do you avoid any topic, place, or thing because it scares you

Obsessions and Compulsions

• do you ever have to do certain things a certain way or it's just not right
• do you ever have thoughts go through your head you just can't get rid of
• do you spend an excessive amount of time on them

Mania

• ever had some much energy you didn't need to sleep for a day or more
• ever had so much energy you couldn't sit still
• ever had an urge to do something that was completely irresistible
• gambled away a lot of money
• ever think about doing something and suddenly realize you just did it

Paranoia

• ever felt everyone was watching you
• ever felt you were being plotted against
• do people talk about you behind your back

PTSD

• Trauma or actual harm
• Recollection or recent dreams
• Avoidance of places and things, or Amnesia
• Unwanted memories, flashbacks, mental images
• Markedly diminished interests in life, or "emotional deadness"
• Autonomic overreactivity... Keep in mind this can apply to many traumatic experiences (war, rape, assault)

Substance Abuse

• substances
  • alcohol including beer, wine, and liquor (ask about each since some people won't add in the other substances unless asked)
  • marijuana (both alone and mixed with cocaine as a "primo")
  • cocaine (both snorting and smoking)
  • heroin (both smoking and injecting)
  • opium
  • amphetamines (speed, Ritalin)
  • barbiturates (uppers and downers, qualudes)
  • prescription drugs
  • hallucinogens (LSD, mushrooms, peyote, general stuff than made you see things)
  • inhalants (paint cans and thinners for example)
  • Rave and X

• CAGE (ever felt the need to Cut back, ever Annoyed at others' comments about your use, ever felt Guilty about your use, ever had a "morning Eye opener" to start the day)

• basic data
  • substance
  • first use and means
  • who introduced you to it
  • how much did you use at first
  • first intoxication
  • first period of regular use
  • why did it increase
  • average use in a week
  • most you would use in a week
  • current use
  • last use
  • is it a problem
  • mood before, during, after use
  • do you use after fights or disagreements
  • do you use with others or alone
  • any signs of withdrawal when you don't use
• addiction
  • tolerance (mixing substances, using one after the other to improve)
  • blackouts
  • craving
  • withdrawal
  • lots of time in affording or finding
  • accidents while using
• do you start and find you can't stop
• negative consequences of using
  • fights
  • relationship or job loss
  • DUI (what's the status of that now)
  • health problems (what's the status of that now)
  • history of sexual or physical abuse, victim or perpetrator, while under use
• family history (use, treatment, relatives you used with)
• treatment planning
  • efforts to cut back on their own, when and why
  • when, where, what type (detox, brief inpatient, 30 day inpatient), followed by what (brief outpatient, 3 month outpatient, halfway house)
  • how long lasted
  • what helped
  • how long sober
  • why relapsed (life stressors at the time, mental health issues like depression and bereavement
  • what do you need
  • longest time sober
  • shortest time sober
  • why
• are they/were they romantically involved with a user, what happened with that relationship

Thoughts and Experiences

• ever feel your thoughts are not your own
• ever felt god or the devil sent you a message
• ever see special meanings in things others don't see
• ever knew something was going to happen before it did
• ever see/hear things others didn't see/hear
• ever had a dream that was so real it was hard to tell it was a dream
• ever felt your mind was playing tricks on you
• ever had the sense others could read your thoughts
• ever felt you could hear a running conversation on your activities but didn't know where it was coming from
• ever heard voices tell you to do something, (if yes) what was it, did you want to do it, (if no) what did they say, (if yes) what happened then
• ever have strange physical sensations, like bugs crawling on your skin

Dissociation or Seizures

• ever feel someone else was using your body
• been told you spaced out but don't remember it
• suddenly weren't sure how you got where you were or were something you had come from