Interviewing Clients across Cultures: A Practitioner’s GuideRichard Balon, MD
Wayne State University, Detroit, MI, USA
By Lisa Aronson Fontes; New York, NY; The Guilford Press; 2008; ISBN 978-1606234051; pp 334; $24 (paperback); $38 (hardcover).
As our own culture and environment become truly multicultural, mental health practitioners frequently deal with patients of a cultural background different from their own. Cultural competence is more than an important clinical issue, the author of this volume psychotherapist, Lisa Aronson Fontes, states; it is also an ethical issue. We need to understand our patients’ various cultural backgrounds and the implications of what we say and do during our interactions with patients from various cultural backgrounds. The culturally competent clinical practice starts with interviewing the patient, which is what the book Interviewing Clients across Cultures aims to teach.
As the author points out, “this book has more to do with the process of cross-cultural interviewing than with its content” (p 1). This guides the book’s structure and helps to sharpen the focus of the entire volume. The first chapter, “A guide to interviewing across cultures,” points out that this book “is designed to help prevent uncomfortable misunderstanding from sabotaging your interview and to teach you how to overcome the barriers created by cultural differences.” The author also explains how interviews differ from other conversations and outlines the rest of the book. The following 11 chapters delve into various process aspects of interviewing in the multicultural framework.
Chapter 2, “Preparing for the interview,” discusses issues such as what information needs to be obtained before the interview, how to handle the initial paperwork, deciding whom to interview (family members or friends), how to create a welcoming setting for the interview, the need to respect values, and ways to avoid professional ethnocentrism. It also includes a discussion on assessing culture and acculturation, including the 5 general ways people handle acculturation challenges (traditionalism, transitional period, marginality, assimilation, and biculturalism). Chapter 3 “Biases and boundary issues,” focuses on biases (motivational, notational, cognitive, observational) and boundary issues that may distort the interview and the relationship with the interviewee. Some of boundary issues include “special connections” (in some cultures, eg, in Eastern Europe, official systems operate based on connections), ethnic matching, working with someone from the “same” culture, self-disclosure (eg, wearing religious symbols), and bribes and gifts. Chapter 4, “Setting the right tone: Building rapport and conveying respect,” concentrates on the early parts of the interview, discussing issues such as demeanor; note taking; conveying respect; counteracting shame; establishing the tone, speed, and volume of one’s voice (interviewers who speak in a dry, steady monotone may be perceived as unfriendly, cold, and intimidating; speakers of some guttural and tonal languages often are misperceived by English speakers as angry); setting the pace of the interview; addressing people appropriately (not using first names); whether and how to use professional titles; and how to “save” and not “lose” face. These are very useful tips. Similarly, chapter 5, “Beyond words: Nonverbal communication in interviews,” is useful and informative. It deals with risky gestures (eg, the A-OK sign, by making a circle with your fingers, is considered obscene in Brazil and Russia); pointing and beckoning (it is impolite to point with a finger in some Asian cultures); greetings; showing attentiveness; posture; gait; eye communication; expressing emotions, pain, and distress; touch; personal space; smiling; laughing; nonverbal signs of agreement and disagreement; and clothing. The discussion on touch is interesting. The author explains 5 levels of intimacy: functional-professional, social-polite, friendship-warmth, love-intimacy, and sexual arousal. She also brings up other interesting points, such as, many religiously observant people do not touch persons of the opposite sex who are not relatives, or patting children on the head is demeaning in many cultures.
Chapter 6, “Language competence: Building bridges with people who have a different native language,” discusses interviewing people whose native language is different from that used in the interview. In this situation, the author recommends an attitude of humility and support. She also provides advice for interviewing people who have limited English proficiency. This chapter also discusses bilingual people (there are “functional,” “compound,” and “coordinate” bilinguals). The chapter also reviews US guidelines and requirements regarding language competence, documents in diverse languages, and alternate forms of English. Chapter 7, “The interpreted interview,” provides advice on when to use an interpreter and how to find and prepare one, how to deal with an informal interpreter, and other aspects of the interpreted interview. Chapter 8, “Understanding and addressing reluctance to divulge information,” provides interesting and important information about airing secrets and conflicts, taboo topics (in the US workplace one, can talk about intimate issues such as health, relationships, etc., but not salaries). Chapter 9, “Interviewing culturally diverse children and adolescents,” reviews interviewing this special population. It is filled with fascinating details, such as terms adolescents use (“apple” = for native Americans, red outside, white inside; chocolate dipper = someone of a different race dating a black female; rice king = a non-Asian man dating Asian women).
Chapter 10, “Interview reports and documents,” and chapter 11, “Authority and trust issues for specific professions,” focus on various practical issues, such as how to write and present unbiased reports, and issues relevant to specific professions (social workers; medicine, nursing, and allied professions; mental health clinicians; law enforcement; educators; attorneys; researchers; women’s crisis workers; and others). The last chapter, “Common dilemmas and misunderstandings in cross-cultural interviews,” identifies common misunderstandings and ways to avoid them—eg, interrupting interviewees when you believe they are finished, but they are not, using English words in an offensive way; erroneous assumptions; or assuming you understand what the interviewee is saying. The book ends with a brief afterword.
This is a useful and informative book that has many practical features—eg, all chapters end with concluding observations, questions to think about and discuss, and recommended additional reading. It is filled with an incredible amount of information and is well written and easy to read. The reader may not agree with everything the author states and proposes, but I believe everybody will find something useful and informative. It could serve as a great reference book on culturally competent interviewing and as a teaching text in many professional training programs. I think that even busy clinicians will find this text interesting and will be able to use it in her or his practice. We all treat patients from different cultures, and this book could be a starting point for dialogues with our patients of different cultures.
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Annals of Clinical Psychiatry ©2010 American Academy of Clinical Psychiatrists