class 9_the adolescent interview_2

class 9_the adolescent interview_2 - CHAPTER 8 The...

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Unformatted text preview: CHAPTER 8 The Adolescent interview An adolescent is neither a smaii aduit nor a large child. By this age, toys and games have usualiy outlived their useful— ness in an interview situation; however, an initiai game of checkers or chess may help get some younger adolescents started. A snack or drink may also help facilitate dialogue (remember to ask parental permission first). Depending on an adolescent’s degree of maturity, most of the interview techniques that are used with adults can be applied to the adolescent inter~ view. Regardless of age, an informant can heip set the stage for the evaluation of a hospitalized patient. However, as with an adult outpatient, an adolescent office patient should usually be interviewed before information is obtained from the parents. At some point, you may want to follow up the individuai interviews of adolescent and parents with a family interview to learn how the parents and their chiid interact. As you will. note in. the interview presented in this chapter, the clinician spends much time trying to deveiop rapport. This is not unusual for an adoles- cent patient, who wili not uncommonly require more time to deveiop trust in the clinician than will typically be necessary for either an adult or a younger child. To conserve space, we have summarized some passages of dialogue. This interview takes place on an adolescent inpatient unit. (It is safe to assume that in this case it is not the patient who has initiated the evaluationm an issue that should be clarified at the beginning of any adolescent interview.) The interviewer has never met the patient before and does not have access to his prior history. Casey is dressed somewhat sioppiiy in baggy jeans, sweatshirt, and baseball cap turned backward. He lounges in his chair and pays as iittle attention as possible to the interviewer. 722 8. The Adolescent Interview 723 INTERVIEWER: Hello, my name is Mr. W I want to thank you for agreeing to be interviewed today Did your doctor tell you Why I wanted to meet with you? Ibis rather formal introduction may seem foreign to some Clinicians who treat adolescents. We feel it is important to find a middle ground between excessive formality and inappropriate familiarity. Adolescents need to feel that the adults in their world have the maturity and experience to handle their problems and to ensure their safety. Seductiveness, rampant informal ity, or attempts (usually unsuccessful) to dress or talle [the teenagers can repel an adolescent patient as surely as condescension or lacle of engagement can. CASEY: Yeah . . . INTERWEWER: And why was that? CASEY: I don’t remember. INTERVEEWER: Well, that’s OK. Let me try and explain. 1 work with Dr. 2., and I would like to get to know you a little better so i can help Dr. understand your problems better. is that all right with you? CASEY: [Long pause} Yeahhh . . . INTER‘V‘IEWER: Could you tell me why you came here? CASEY: idunno. [Silence] INTERVIE‘WER: What sort of problems were you having? CASEY: Nuthin’ . . . INTE‘RVIEWER: It sounds like you’re not too keen to talk. CASEY: [Frolonged silence} The interviewer 's good attempt at an open~enaea beginning has been consis~ tently rebufletl by a patient who is at best uninterested in talking If possible, the interview must now he salvaged by closed~enaetl questions, with careful attention to opportunities to form some sort of relationship with Casey. First, the interviewer presents some ground rules. INTERV’IEWER: Let’s talk a little bit about What we’re trying to do here. You’re here in the hospital when you don’t want to be, and we’re trying to learn what it Will take to get you out. Dr. Z. has already heard something from your folks about why you’re here; now we want to hear your side of it. 724 I. INTERVIEWING CHILDREN AND ADOLESCENTS Anything you say that will help us may get you out of here more quickly. Do you understand? CASEY: [Nods his head and steals a glance at the interviewer.] Uh-huh. INTERVIEWER: We also need to agree on this: i’m going to try to be sensitive to your feelings, but i will have to ask a lot of questions. lfI ask a question that you don’t feel you can answer truthfully, just ask me to talk about something else. But don’t just make something up. Any time you don’t tell the truth, it will confuse us. And you could be here longer. OK? CASEY: {Nodal INTERVIEWER: Still another thing: What you tell me I will treat as confidential. That means i won’t tell anyone, Without your permission. The only possi- ble exception, I think you’ll understand, is if you’re planning to harm yourself or someone else. Then I’d have to make sure you and others are protected. OK? CASEY: Sure. With these statements, the interviewer has emphasized three important points.- (I) a philosophy that the patient is not the entire problem, (2) the need for truth, and (3) the need for safety. These are fundamental to every adolescent interview,- they may have to he stated more than once. In addi- tion, the interviewer has addressed the adolescent’s need for assurance that his possibly embarrassing thoughts and feelings will not he divulged without his express consent. INTERWEWER: How old are you? CASEY: Fourteen. INTERWEWER: How long have you been in the hospital? CASEY: This is my second week, I think. INTERVEEWER: And you were an inpatient before at another hospital? CASEY: Yeah. INTERWEWER: HOW long were you an inpatient? CASEY: Nine days. Sofai; the interviewer has been asking simple questions that this recalcitrant patient can answer in a word or two. Ihe patient’s sloucheal posture, brief answers, and initial refusal to cooperate all signal the absence of rapport. 8. The Adolescent Interview 3'25 INTERVIEWR: Was it helpful to you? CASEY: No. I didn’t like it. E thought it was just torture. _ iNTERWEWER: Torture? By repeating a word oflered by the patient, the interviewer encourages an open-ended response. This technique is one of tine most useful for guiding the direction of an interview while encouraging verbal output. CASEY: Yeah. They treated me like a criminal. Almost exactly the same as in juveu nile hall. INTERVIEWiiR: Have you been to juvenile hall? A lapse: Instead of saying, “Tell me more, ” which wonld leeep the dialogue open—ended, the interviewer asks a yes-«no question. CASEY: I’ve seen it. Yes. IN'FBRVIEWER: From inside or outside? CASEY: From inside. INTERVIEWER: Boy, you’ve seen a lot of things? But you look kind of sad today. The interviewer focuses on affect by making a statement (“You look sad”) rather than by asking a question ("Do you feel sad?) The statement avoids argument and reinforces the use of words to communicate (especially appro priate for younger children). CASEY: wen . . . yeah‘ Just today. l’m getting into trouble with Cherub. She is just provoking me until I say something to her, and she doesn’t get into any trouble. They even notice it. I mean, she’s calling me all these names. INTERVIEW'ER: Do you feel they’re picking on you? CASEY: No, it‘s just really Cherub, and Johnny has done some stuff, too. He’s thrown my dominoes out the Window. I’ve seen him do that, and then he lies to me. And that makes me mad. ENTERVIEWER: I can understand that. Let me ask you this: Have you ever been in this place before? ' The interviewer wants to move ahead, but an abrupt subject change may not be the best way to proceed, especially with a yes—no question. CASEY: NO. INTERVIEVVER: How many times were you in juvenile hall? T25 25. h '. E. $1 ‘S s l. INTERVIE'WING CHILDREN AND ADOLESCENT§MM_ CASEY: i wasn’t in there. INTERWEW'ER: I thought you said you were? CASEY: i saw it. IN’i‘iaRmswaR: From the outside? CASEY: No, I was inside for a probation hearing. Interviewer and patient are sparring, testing each other’s veracity and trust— worthiness. The patient continues to he guarded, hut the interviewer responds with another attempt at open—ended questioning. INTERVIEWER: What were you doing on probation? CASEY: I robbed this lady’s house a couple of times. lwent with someone the first timeman older guy. We. took some Cigarettes and some iiquor and money. ENTERWEWER: Uh—huh. A barely uttered encouragement leeeps the ball rolling without getting in the way of the patient ’3 stream of thought. Adolescents often handle negative mood states (anger; anxiety, depression, guilt) through counterphohie acting out. Clinicians, like this interviewer; must be careful to responar with accep~ tance without appearing to condone the behavior in question. At the same time, they must dig beneath the behavior to search for its psychological underpinnings. CASEY: Well, it wasn’t much. She lives a few biocks away from me, and we just walked in. The back door was open. INTERVIEWde {Waits in siience for many seconds until the patient, feeling the need to fill the void, begins to speak again] CASEY: He . . . he was my homeboy, and {just went aiong. It was a couple of months ago, beginning of the sehooi year. He stole a car. I didn’t steal the car, but I was in it. Now he’s on probation. Hem— INTERWEWER: And when do you get ofl probation? To keep the focus on the patient, the interviewer interrupts, but uses the patient’s own word to make the transition. CASEY: I think it’s going to he 5 years. INTERVIEWER: And since then, have you been going to school regularly? CASEY: Yes. Sometimes I ditch, but I‘ve been going. Even if it’s a iot of buiishit. 8. The Adolescent Interview I _ ' T27 INTERVIEvnaR: Look, let’s change our focus a bit. Tell me if there was ever a time in your life when you weren’t getting into trouble. Were there happy times in “your life, or has your life been kind of shitty all along? This interviewer has obtained some information concerning Casey’s relation ship with his peersman important topic for any evaluation of a teenager. The interviewer next tries to ioole for any past history of untrouhled, positive family experiences. Although this transition is abrupt, it is announced (“let’s change ourfocns’i) to let the patient know that they will he pursuing a differ- ent coarse and that the interviewer is assuming more control of the process. The mild vulgarity (“shitty’Q may he an attempt to use language the patient will relate to. Of course, it is important to speak so that the teen will under- stand, hui an adult who tries to imitate teenager-5’ language too closely risks rejection. Clinicians sometimes feel that they must choose between relating to an adolescent patient as a peer and sounding like a censorious parent. In reality, a middle ground is almost always possible. CASEY: Depressing, because of what happened at school. It was really one teacher, one bad teacher who started the whole thing. INTERVIEWER: {Eh-huh. CASEY: This teacher—it was first gradcwpicked. on me, and I had her all the way through sixth grade. She was a jerk. She’d pick three people out of each class, all these people she didn’t like. Every time she came in, she’d. make them sit outside just because she didn’t like them. I was one of them. INTERWEWER: So it started in first grade, and it followed you because of that one teacher? CASEY: Yeah. ENTERVIEWER: And you couldn’t break the habit or change their minds? Several summary statements verifi) that the interviewer understands. CASEY: It wasn’t that. It was the teacher. She was real mean. I accidentally broke a pencil once, and she got real mad at me and sent the down to the office. She says, “The school pays good money for these pencils, and you go around breaking them. You’ve got to go to the office.” They did this stuff all the way through sixth grade. INTERWEW'ER: And then what happened? 728 I. [NTERVIEWING CHILDREN AND ADOLESCENTS Now the interview is moving along well, but the clinician'is still concerned at the relative lack of aflective material. I t is fairly usual for an adolescent topor- tray all the problems as emanating from without. Denial of responsibility sug— gests character. pathology in an adult, but may he normal for an adolescent. [The patient relates more material about his progress through school.] INTERWEWER: When you started thinking about grade school, it seemed to me that you started to cry a little bit. Was it a hard time for you? CASEY: I started to cry? What do you mean? I’m crying because of What’s going on in that other room. [tie gestures next door, Where loud voices can be heard] Some facts have emerged about Casey’s long-standing difiiculties in school, but only a little rapport has developed. When the interviewer attempts to focus on aflect, the patient shies away and returns to the present. INT‘ERVIEWER: You keep thinking about Cherub? Cassy: And how I’m getting in trouble for things that she did. INTERWEWER: That’s a pattern. People sort of pick on you, and you get into trou- ble. How come that happens to you? Here the interviewer attempts an interpretation in the form of a question. In general, we agree with the conventional wisdom that it is best to avoid early interpretations. Ihey are often wrong, and even when correct, they may pre- vent the revelation of more intimate material. In this case, however, the patient responds positively. CASEY: It‘s because they know I’ll get angry at them if they set me off, so they do. INT‘ERVIEWER: They try to set you off? ' CASEY: They get me in trouble by doing that. JN‘mRVIEWER: So when you get angry, what happens? Do you hit them? CASEY: No. Well, sometimes, but usually I start cussing at them and stuff. I did with Cherub and I got in troubie for it, even though Cherub was saying really disrespectful things, like “Oh, you have no friends." Stuff like that. She wasn’t getting into trouble with that, and I’m really angry because I got in trouble. INTERWEWERt You get into trouble; she didn’t. She got off free? 8. The Adolescent Interview The interviewer is still trying to establish rapport with statements and ques- tions that empathize with the patient’s feelings of being scapegoated. This is a strategy that can backfire in the long run, because the patient surely under— stands on some level that he contributes to his own troublesome interactions. However, in this diagnostic interview, the interviewer still wants to develop reliable, diagnostically useful information. The information needs to include not only the symptoms of the illness and the facts of thepast history, but also data about the patient’s capacity for insight and for forming therapeutic relationships. CASEY: Yeah. And she gets to leave the program today, and She barely goes to any of the groups. I go to the groups. 1 don‘t stay in my room and refuse to go to them. INTERWEWER: And she doesn’t have to? CASEY: No. Some meaningful facts have been obtained, and some degree of understand- ing of this adolescent boy’s minimal insight into his problems has been observed. The interview is proceeding smoothly, and much more information has been obtained from a reluctant patient than might be expected. By this time, the bridge to a dififerent subject has been reduced to a single word, “Now.” INTERWEWER: Now, how did you get yourself into the hospital here? CASEY: I got really angry at school and spit at one of the teachers, and they sus- pended me, and my mom said, “That’s it. You’re going to a hospital.” INTERVIEWER: Do you think it’s been helpful? CASEY: I don’t knew, really. I’m saying it’s been helpful because I want to get out of here, but I think it’s just been torture. INTERWEWER: Do you have to take any medicine? CASEY: 1 take lithium and Zoloft. INTERVIEW'ER: How do they make you feel? CASEY: Lithium makes me shake a lot, and Zoloft, i don’t know. INTERVIEWER: Do they help you control your temper? CASEY: Sometimes, yeah, but when Cherub does that kind of stufic to me, i still get angry. ' 7'29 130 I: I‘NTERVIEWING CHILDREN AND ADOLESCENTS INTERV’IEWER: When you’re mad and get into fights, have you ever hurt anybody? CASEY: Yeah. I don’t fist-fight or anything too often, though. INTERVIEWER: Give me an exampie of someone you hurt. CASEY: This one kid at school, 1' whacked him across the face and hurt him realky bad. I think I gave him a bioody nose, but that was all. INTERWEWER: Do you have friends in schooi? CASEY: At B—w High 1 was reaily popuiar, and I was hanging out with the popu— lar students there. Then I got put in Cm High, and 1' don‘t even know any— one there. INTERVIEWR: What’s (2— High? is that where the prohiem kids are? CASEY: No. It’s a really preppy school. INTERWEWER: is it a private schooi? CASEY: No. It seems really preppy, and I don’t reaiiy like it. INTERVEEWER: Why did you get put there? Because my mom felt that I was getting in too much trouble at B— High. IN'TERVIEWER: Tel}. me about your family—your mom and dad, Using a bridge supplied by the patient, the interviewer moves to another area. CASEY: They‘re OK, I guess. INTERWEWER: Do they work? CASEY: My dad does. He’s an. engineer. INTERVIEWER: And your mom. stays home? CASEY: Yeah. INTERWEWER: Have you ever heard them fight? CASEY: Yeah, I have, but they don’t do it too often. INTERVIEWR: So they get aiong pretty weii? CASEY: "Yeah. INTERWEWER: Any brothers and sisters? CASEY: I got a sister. 8. The Adolescent interview INTERWEWER: Tell me about her. CASEY: She’s 12. ENTERVIEWER: Does she look up to you—mtry to do What you do? CASEY: Not all the time. She doesn’t smoke or anything, and if I smoke, she doesn’t. I hope she doesn’t copy me. When talking about his sister and bisfamz'ly, Casey seems to soften, and even expresses the hope that the sister will not tales afi‘er him. This may be evi- dence of a capacity for empathy—a subject that is very important to evalw ate in any adolescent patient. INTERVIEWER: When did you start smoking? CASEY: This past summer. iN’I‘ERVIEWER: Did you start drinking then, too? CASEY: I drank a little bit. I drank a lot of wine and stuff below that, but that’s when I started drinking hard alcohol. lNTERViEWER: Did you ever have any problems from drinking? CASEY: What kind? [After further questioning about possible academic, medical, and personal problems from smoking and drinking, followed by some questions about street drugs, the interviewer learns where Casey was born and why the family moved to the current location. Casey also discloses some facts about his grandparents. ] INTERWEWER: Did you ever think about going back to D—m to live? CASEY: Yeah, i really want to go back to D—, but my mom says no. INTERVEBWER: [Softly] It could be like a new start. CASEY: Yeah. Everybody in my familywants to go back to 13— except for my dad. Ibis has been Casey’s first really enthusiastic response in the interview, anal the interviewer builds on it. It is especially vital with an adolescent patient to project the clinician is genuine fondness for the patient. Because of Casey’s initial hostility and resentment at hospitalization, it has taken much of the interview to get to this point. INTERWEWER: When your mom said no, did she mean she didn’t want to, or she didn’t want to because of your dad’s job? 737 732 I. WTERVIEWING CHILDREN AND ADOLESCENTS CASEY: She told me she did. She told me She’d like to move back to D”, but Dad’s got a good job. INTERWEWER: So when you were 5, your family moved to this area, or did you move around a iittle bit? CASEY: We moved here. INTERVIEWER: You’ve had the same house that you’ve always had Since you were 5? CASEY: Yeah. INTERVIEWER: Do you have any pets? CASEY: Yeah, I have two cats. INTERVIEWER: No dogs? CASEY: I want a dog. This is the second positive statement of the interview The interviewer uses it as a springboard to the discussion of other positive feelings. INTERVIEWER: You do? A dog would be good for you. What kind of dog would you have? ' CASEY: A golden retriever. INTEIWIEWER: Yeah, they’re great. Say, do you think things are better between you and your mom and dad since you’ve been in the hospital? CASEY: Yeah, and 1 haven’t gotten yelled at by my dad. INTERWEWER: Are you mad at your dad? CASEY: I get mad at him sometimes. INTERYIEWER: Does he get mad at you? Does he hit you? CASlZY: Yes. Weii, not hard. I INTERWEWER: When you were smaller, did he hit you? CASEY: No. Well, he spanked me. INTERWEWER: Did he—or anyonemreally abuse you? Beat you up? CASEY: No, nothing like that. INTERWEWER: Tell me a little bit about how a day is for you, when you’re not in here. You said you’re at C—— High. What time do you have to be there? CASEY: At 8:00. 8. The Adolescent interview 133 INTexmswss: How do you get there? CASEY: My mom drives me.- INTERWEWER: Are you in school. all day or half a day? CASEY: All day. INTEIWIEWER: And how do you get home? CASEY: My mom picks me up. Ihe interviewer now has a pretty good idea of Casey’s relationship with his family; it is much more positive than might be expected of a troubled teen- ager. Learning how other family members interact with teens, and how inde- pendent the teens have managed (or want) to become, can be a difiicult task for clinicians. Casey’s evidence will still have to be evaluated against that of his parents. INTERWEWER: What do you do after school? CASEY: 1 usually hang out with friends. With more time, the interviewer would want to ash Casey to elaborate on his activities with his friends. What do they do? Where do they do it? Who is involved? Why does he like/admire certain fiiends? Some interviewers ask, "What would your best friend say if I asked [him or her] about you?” Children and younger adolescents can he asked, “What would you like to change about yourself?“ (This is the equivalent of the classic question about “three wishes,” asked of even younger children.) All such information pro- vides a fuller picture of the more positive aspects of personality and interests, and the questions help cement the therapist—patient relationship by demon- strating an interest in the patient as a whole individual, much as do the questions about sports and hobbies that follow. IN'mRVIEWER: Do you have a lot of homework? CASEY: No. INTERWEWER: Are you on any kind of teams? Did you play soccer or anything like that? CASEY: I did, but don’t any more. INTERWEWER: Why not? CASEY: Because I don’t like soccer very much. INTEIiVIEWER: Do you have any hobbies? 734 ii lNTi’ERl/IEWING CHILDREN AND ADOLESCENTS CASEY: Yeah, I bowl. INTEIWJEWER: You bowl? What’s your score? CASEY: My highest score is 147. INTERVIEWiER: That’s pretty good. Better than me. What else? Does your family go camping or do anything like that? CASEY: No, we don’t go camping. INTERVIEWER: You’re from the East; you must like sn0w? CASEY: Yeah, I like snow. lN’I‘ERwEWER: Snowboarding? Do you have a skateboard? CASEY: {Shakes his head “no” to each question} i did, but someone stole it. lN’l’ERVIEWER: Do you spend time on a hike? CASEY: Sometimes. IN’FERVIEW'ER: Mostly you just hang out with your buddies smoking and drink ing? CASEY: Yeah. IN’l‘IiRVIEWER: Got a girlfriend? CASEY: No. IN'E‘ERVIEWER: Have you had any girlfriends? CASEY: I don’t think so. Well, kind of. When I was in BM Hospital. INTERVIE'W’ER: Have you ever been really close to any girl? CASEY: {Long pause} I don’t think I want to talk about that. INTERVIEwsR: OK. i’m-glad-you told me .- So E——~ Hospital was where you were an inpatient before? Casey has complied with om earlier request of the interviewer, who will mark the area of sexual knowledge and experience as important to revisit later. CASEY: Yeah. INTERWEWER: And what was that for? CASEY: It was a couple of months ago. That was because I got into a fight with my dad. INTERWHWER: Do you remember what you were mad about? 8. The Adolescent Interview CASEY: No, E don’t. ENTERVIEWER: Besides that time in the hospital and this one, have you been in other times, too? CASEY: No. INTHIWIEWER: Have you ever tried to hurt yourself or kill yourself? CASEY: No. And I know What you‘re going to aisle—I’ve never thought about it. Not seriously, anyway. INTERwEWER: Have you ever tried to hurt your parents or your sister with a knife or gun? CASEY: l frightened my mom with a knife, but I wasn’t going to hurt her. [Casey wipes his eyes] By now, the interviewer has addressed three areas that are vital to every patient assessment: sex, substance use, and suicidal ideas and violence. They have not been adequately evaluated yet (details of whatever suicidal thoughts Casey may have had should be explored in depth), but the inter- viewer feels that the patient is safe. And the ground has been prepared for further questioning later: iNTERVIEWfiR: You keep getting tearful. What are you sad about? CASEY: I don‘t know just what’s going on in there. [He points to the next room] INTERWEWER: You can’t let that go? CA5!in It’s hard to. I just get into trouble :1 lot when people do things to me. INTBRWEWER: You’re a nice kid, and you still get into trouble. CASEY: I get into trouble. I INTERVIEWER: You try hard, and they don’t appreciate you. CASEY: Yeah. INTERVtEWER: i don’t understand that. I don’t understand Why they don’t appre- ciate you. it’s just that your temper gets out of control. They trigger some" thing, and. boom, you’re gone. 15 that the problem? The interviewer now attempts again to form an alliance with the patient, and finally seems to he succeeding. The patient answers the next series of questions with more afiect and conviction. T35 736 l. INTERVIEWING CHlLDREN AND ADOLESCENTS CASEY: Sort of. INTERViEWER: Sort of. Have you ever broken things, put your fist through the wall? CASEY: l kicked a hole in the wall. INTERVIEWER: What else? Broken windows? CASEY: 1 broke my screen and jumped out the Window. INTERWEWER: You mean to get out of the house? [Casey nods “yes.”] Have you been involved in other stealing, besides breaking into that house those two times? CASEY: l shoplifted a couple of times. INTERWEWER: And the car? Stealing the car. CASEY: Yeah. INTERVIEW'ER: Do you know how to drive? CASEY: Yeah. ENTERVIEWER: Have you driven by yourself? CASEY: Only with my friends. INTERWEWER: Do you like it? Are you a good driver? CASEY: Yeah, I’m OK. iN’rsRWEWER: i’robabiy too fast. CASEY: I’m too scared to go fast. INTEIMEWER: I was going to ask you about that. Do you get scared? A good transition about his feelings. CASEY: Yeah. INTERVEEWER: What sorts of things scare you? CASEY: Sometimes I get scared when I have to go to sehooi. Some people, they came over and tried to beat me up and stuff, and they had a gun and stuff, and they were going to shoot me, and I get scared about that. INTERV’IEWER: Are these peopie in gangs? CASEY: Yeah. ENTERWEWER: Are you in one? 8. The Adolescent Interview CASEY: No, I’m not. INTERVIEWER: Now I need to ask you about some other feelings and experiences lots of people sometimes have. Do you ever get really scared, like when. you go to high places, in elevators, or in crowds? The interviewer signals another change of topic, and lets Casey [mow that these routine questions do not mean that be 1's suspected of having had such experiences. ' CASEY: No. Well, when I get into big crowds and tight places, that scares me. INTERWEWER: Does your heart pound and you sweat? CASEY: Yeah. INTERV’IEWER: You’ve had that? Tell me more. CASEY: Sometimes 1 just begin to shake when I get scared. Then I can’t breathe. 1 sweat a lot and my heart pounds. ENTERVIEWER: Does that happen very often? CASEY: No, only once in a. while when I’m in a panic. A bunch of guys are going to get me. INTERVlEWER: Is it only when someone’s trying to hurt you, or does it also hap- pen when you’re in tight places or crowds? CASEY: Urn, I guess just when I’m afraid of someone. INTERWEWER: Would you describe yourself as either especially neat or especially messy? CASEY: I’m in the middle. INTERVIEW'ER: But do you like everything in a Certain order? CASEY: No. INTERWEWER: What about voices? Do you ever hear voices that don’t seem real? CASEY: NO. INTERVIEWER: Do you ever see things other people don’t see? CASEY: No. INTERVIEWER: What about high moods? Like you feel really terrific, too good, and there's no reason for it? CASEY: No, unh-unh. 737 738 I. INTERVIEWING CHILDREN AND ADOLESCENTS INTERVIEWER: 0t been terribly overactive—maybe you didn‘t need to sleep much. for days on end? CASEY: No. INTERVIEWER: Or have you ever felt so bad you had thoughts about harming yourself, killing yourself, maybe? CASEY: Not really INTERWEWER: What does that mean? CASEY: You know, I guess lots of guys think about it. But I never wanted to or anything. INTERVIEWER: OK. How’s your appetite? CASEY: It’s good now. But sometimes it’s bad. INTERVIEWER: How long is it usually had? CASEY: I dunno. Just when i’m feeling lousy. Depressed, you know. iNTERVIEWER: I-iave you lost weight? CASEY: Fm not sure. I don’t think so. IN'I‘ERVIEWER: Are you about the right size, or are you small for your age? CASEY: I’m small for my age. INTERWEWER: How do you feel about that? CASEY: Bad and lonely, sometimes. But I do have some good friends. INTERWEWER: Do you talk to them about feeling lonely? CASEY: I talk to them. INTERVIEWER: \Wlien you’re feeling depressed, how long does that last? CASEY: I dunno—not long. Maybe a day or two. The moods of adolescents tend to he short-lived and labile. When ihisfaci‘ is not appreciated, youngpaiienis sometimes get treated with medications and other unnecessary therapies. Clinicians need to evaluate possible mood dis« orders carefully hut must keep in mind that young patients typically lack perspective as to changes in their own moods. Repeated interviews across time are essential. INTERVIEWER: Our time is almost up, and I would like to ask you just a few more 8. The Adolescent Interview 739 'questions. They may seem boring, but I would appreciate it if you would try to answer as best you can. OK? A complete, formal mental status exam (see Chapter I, Table 1.1) is not nec- £35de for every adolescent patient, any more than it isfor every adult. Com« pleteness is indicated whenever there is a question of severe mental pathol» ogj) (e.g., cognitive, psychotic, mood, or substance use disorders), or when, for legal or other purposes, the record needs to reflect a complete baseline evaluation. Of course, the behavioral aspects of mental status should he noted for every patient—general appearance and behavior,- mood; flow of t'houghtmfor these require no special set of questions. Questions necessary for much of the remainderwcontent of thought; insight and judgment; and aspects of the sensorium (memory attention span, fund of information)»~— will come up as other matters are pursued. Note that in pursuing a formal assessment of Casey ’5 mental status, this interviewer doesn’t make the comm mon mistake of describing the mental status tasks as “silly” or “dumb,” which would convey the impression that they are not important. CASEY: OK. IN’rERVIEWER: What’s the name of this hospital? CASEY: F— Hospital. INTERVIEWER: What day is it today? CASEY: Thursday. INTERVIEWER: Do you know the date? CASEY: It’s December. INTERWEWER: And the date? CASEY: I don’t remember. IN'I‘ERVIEWER: What year is it? CASEY: [He states it correctly} INTERWEWER: That’s good. Do you remember my name? Cassy: No. INTERWEWER: OK. What sort of work do I do? CASEY: You‘re the consultant. You’re supposed to help me get out of here. i 5 2'40 /. INTERVIEW/INC? CHILDREN AND ADOLESCENTS IN’I‘ERWEWER: Good. Here’s three words that I want you repeat back to me and then remember. Apple, clock, mustang. Can you repeat them for me right now? CASEY: Apple, clock, mustang. Before going ahead with the test ofshort-term memory, the interviewer ascer— tains that the patient has understood the items and that hts immediate recall is intact. The interviewer does not alert Casey that he will he asked to repeat these items a few minutes later; that would invite rehearsal. INTERWEWER: Good. Here’s a question: What’s the same about an apple and an orange? CASEY: I don’t know. Nothing. INTERVIEWER: Try to think about it a littie bit more. CASEY: You eat them. INTERVIEWER: Surei That’s good! Anything else? CASEY: No. INTERWEWER: How about a chair and a bed? What’s the same about them? CASEY: i can sleep in them both. INTERWEWER: {Chuckles} E guess so! Anything eise? CASEY: Well, they’re both furniture. IN'E‘ERWEWER: ExceHent! Here’s a saying: “Peopke who live in glass houses shouldn’t throw stones.” What does that mean to you? CASEY: Stones break giass. INTERVIEW'ER: Good. Anything etse? CASEY: No. INTERVIEWER: OK. Do you remember those three things I told you to remember? CASEY: I remember apple, but that’s ail. INTERWEWER: Are you sure? Try to recall the others. CASEY: I can’t. INtERWEWER: That’s OK. You’ve done fust fine. Now I want to go back to some- thing we tented about earlier—the ear theft. How Wouid you deai with this now, if you were with your friend and he wanted to do it? 8. The Adolescent Interview CASEY: You mean would I go along with it again? INTERVIEW’ER: [Node] CASEY: I dunno . . . I hope I’d.say “No,” but I dunno . . . INTERVIEWER: Why “hope”? CASEY: W611, it’s sure caused me a lot of trouble. INTERWEWER: OK. Well, I really appreciate the time you’ve spent with me. Thank you. Questions of the form “What would you do if. . . P” serve as a check. on judg— ment that may be somewhat more relevant to teenagers than asking them to state three wishes or to describe what they would do if they found a stamped letter. Such questions serve as a means of evaluating character and personal— ity, and as a check on the congruence of an adolescent’s values with those of mainstream adult society and culture. A similar sort of question, with many of the same advantages, takes the form “Tell me what you did in [a given sit uatlon]. ” This situation will usually describe an interpersonal problem the patient has already mentioned, though the interviewer may instead suggest a problem with a hypothetical relationship. Casey’s responses to the last two questions asked of him address both insight and judgment. 74‘? w-m~w«--u-w . mammammummmflfi. ...
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class 9_the adolescent interview_2 - CHAPTER 8 The...

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