- Introduction
“It is clear that the clinician must cultivate skills in several core areas in order to effectively utilize the interviewing process, and the interviewing of children demands additional competencies unique to this group.” (Young and al., 2010).
This chapter aims to present the basic competencies that are essential in the clinical work with children. It also provides a guideline of the interview with children, and underlines that the clinician should possess an extensive knowledge of child development, diagnosis, and multicultural psychology.
The chapter, written by Christopher Young, Julie Davidson and Alan Gross, comes from a book entitled “Handbook of clinical psychology competencies”.
- Summary
This chapter of handbook provides tools to work with children, and more precisely to lead interviews with them. It is intended to be very practical and put the emphasis on differences between adults and children that have to be taken into consideration to work effectively.
The clinical interview is one of the most important tools of the clinician, and therefore, it’s important to develop this skill to make it as effective as possible. According to the authors, the principal goal of the clinical interview is the acquisition of necessary information for case conceptualization, diagnosis, and responding to the referral. But, when interviewing children, the psychologist may encounter some specific difficulties. To overcome them, here are some skills to work on.
First, according to the authors, some competencies are important in every child interview. The first competence emphasized in the text is the importance of acquiring knowledge of children’s developmental trajectories. Indeed, being aware of what can be considered as normal behavior at a certain age is crucial in order to spot “atypical” behavior. This aspect is linked to having knowledge in terms of diagnosis of developmental disorders and child psychopathology. In this aim, they also discuss diagnosis of developmental disorders, and about the importance of being familiar with the most current diagnostic criteria.
In a second time, the authors put emphasis on cultural considerations when you meet a child (that goes for all patients). Indeed, the clinician must also be aware of the differences between his culture and his patient’s. With an understanding of the influence of culture on symptom presentation and psychosocial environment, they can minimize cultural barriers. Furthermore, he must take into consideration his own biases and stereotypes about the patient’s culture.
Moreover, according to the authors, we have to take into account the language specificities of children and sometimes the language disorders. Indeed, we need to adapt our vocabulary to the child’s age and developmental level. Open-ended questions are very important to use among children because they do not influence him by creating suggestions or false memories. Unfortunately, it is not always possible to do it, because of the context.
The authors then raise an important point of interviewing children : the place of parents and teachers. During the child’s development, social and family contexts are very important. It is therefore important to take them into consideration. From the author’s point of view, exchange with the parents or the teachers is a good way to obtain information. Meeting with the parents is very important in order to determine the child’s interests and to determine the possibility of an individual interview with him. It can also provide topics for initiating dialogue.
To end this part, the authors also discuss the physical environment in which the interviews take place. Allowing the child to explore the room before the interview is a good way to establish a warm social climate.
After listing general competencies needed in almost every child interview, the authors explain, in a second part, other competencies related to the context, or particular situations.
First, suicidal ideas and self injuries are considerable issues among children. Different warning signs, like psychological problems, substance abuse or suicide history can be considered. Faced with this, clinicians sometimes have to conduct a special interview with suicidal risk assessment. This kind of interview is precisely structured and at the end, the parents, or the legal guardian should be aware of the situation. The best in this case is to let the child speak directly to the parent. Unfortunately, it’s not always possible and when it’s not, clinicians have to be very careful not to break the therapeutic alliance while talking to parents.
Another situation that requires specific competencies is when the child tends to be “difficult”, or reluctant to speak and collaborate with the psychologist. It can be due to different reasons. One of them is related to the bad communication between parents and children, and leads to misunderstandings about the purpose of a therapeutic work. The child may have the impression that he has to go to the psychologist because his parents decide in this way, without personally understanding why. Before meeting children, it can be useful for clinicians to ask the parents to what extent the child knows where he or she is coming, and why.
Then, clinicians may also face situations in which children are concerned by maltreatment or abuse. These cases are sensitive, because of the topic of course, but also because the author(s) is, or are, often part of the close family. It can even be those who bring the child to the interview. To address this issue, psychologists should be careful of the wording of the questions, by using more open-ended questions, for example. And when they have enough information, they should be ready to write allegations if necessary.
Finally, clinicians can meet children in a legal procedure, most of the time when they are victims. In this case, the main goal of the interview is to determine how the child is and what are the consequences for him. The notion of truth is more pregnant than in a classic clinical interview, that’s why the clinician has to be very cautious while wording questions and be as little suggestive as possible.
- Critical evaluation
This chapter provides a good foundation for working with children. The structure of the chapter makes it easy to find the information of interest, and the topics covered are diverse. They also cover some less common situations in which the clinician can encounter difficulties, that’s why we think this chapter is very interesting for young psychologists who want to work with children and who do not have yet any experience with them. However, it seems to us that some of the most important topics are not addressed or not sufficiently addressed by the authors.
In fact, working with children today is mainly based on specific mediations. The medium of drawing, for example, is essential with children, allowing them to express themselves in a less inhibited way than verbal production. The authors only mention it once, as a tool for building a relationship with the child. But if drawings do indeed allow children to feel more at ease, they are also important sources of information about their psychological functioning, their cognitive development or their family functioning, when the drawing is discussed with the children. According to Woolford and al. (2015), studies have “consistently shown that drawing increases the amount of information that children of all ages verbally report about emotional and event-based experiences.”
Drawings are also often used in projective tests, tools that are widely used with children and not mentioned by Young and al. Another critic that can be made is that the tests cited by the authors are exclusively tests for categorical diagnosis. While diagnosis may be useful in some situations, in order to redirect the child to more appropriate facilities, we believe it does not give much information on how the child perceives his environment, and what disturbs him.
The authors also affirm that the use of toys is counterproductive because it does not match the expectations the child can have towards the adult : “In other words, playing toys with the child may be less effective in cultivating a positive therapeutic relationship than merely talking with the child in a manner that affirms the value of beliefs and experiences (Gurland & Grolnick, 2008).” (Young and al., 2010). However, the study they cited wasn’t about playing with children. In the study, the children were shown a videotape in which an adult is alone and either playing with a toy or reading a newspaper, therefore the adult and the child do not interact with one another. And therefore, it doesn’t seem really correct to conclude that playing with children is counterproductive in the aim to establish a rapport with them.
Finally, we can also add that this article does not present a lot of examples. The chapter is part of a handbook, which means it aims to educate and give clues to the clinicians who are working with children. That is why we think that readers need examples and clinical cases that they can use in order to illustrate the competencies that are presented.
- Conclusion
Clinical interview is an important tool for the clinician, and it requires a lot of different competencies. This chapter presents the main competencies that all clinicians should have and improve when they do clinical interviews among children, such as knowledge of children’s developmental trajectories, their language specificities and the place of the parents and the teachers.
This chapter also discusses related-context competencies that are essential when the clinician intervenes in particular or difficult situations. He needs to have practical knowledge and theoretical bases about suicidal ideas, maltreatment or abuse and reluctance of the child that can be quite common.
Although this chapter does present the main competencies needed in the work with children, it does not talk about mediation at all, which is a great tool widely used by clinicians. We also think there is a lack of clinical examples and that it misses some important themes such as drawing, which is commonly used to help children to express themselves.
We still liked to read this chapter, because clinical interviews with children is a topic that we have not covered much in our formation, although many clinicians will be confronted with children in their practice. It also brought us to think about the impact of screens in the life of the children, because we noticed it’s something that the authors did not mention. Moreover, we found that chapter accessible to many because it uses quite comprehensive vocabulary with straightforward ideas.
5. Words we have learned
Breadth (p 209) : largeur, ampleur
Warrant (p 210) : justifier, assurer
Straightforward (p 210) : simple, direct, évident
Proficiencies (p 210) : compétences, aptitudes
Reluctant (p 215) : réticent
To entail (p 223) : impliquer
6. Key words :
| Contextual Competencies | Compétences contextuelles |
| General Competencies | Compétences générales |
| Clinical Interview | Entretien clinique |
| Children | Enfants |
| Handbook | Manuel |
7. Bibliography
Gurland, S. T., & Grolnick, W. S. (2008). Building rapport with children: Effects of adults’ expected, actual, and perceived behavior. Journal of Social and Clinical Psychology, 27, 226–253.
Young, J. & Davidson, Julie & Gross, Alan. (2010). Clinical Interviewing with Children. Dans P. Friman & K. Freeman, Handbook of Clinical Psychology Competencies. DOI : 10.1007/978-0-387-09757-2_8.
Woolford, J., Patterson, T., Macleod, E., Hobbs, L., & Hayne, H. (2015). Drawing helps children to talk about their presenting problems during a mental health assessment. Clinical child psychology and psychiatry, 20(1), 68–83. https://doi.org/10.1177/1359104513496261
By Ewen Stanguennec, Philomène Voisin, Thanh-Ngoc Hoang, Lola Troublé (M2 PCPI)
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