Social Class Factors Impinging the Interview

Most of the techniques recommended for conducting a sound general clinical interview (empathic listening, a nonjudgmental attitude, sensitive interventions, nondirectiveness versus judicious directiveness) are equally applicable to a cross-cultural setting. However, as was pointed out earlier, there are issues of attitude set and language that are encountered in a cross-cultural (including "cross socioeconomic class") interview that must be navigated as well. During the main body of the interview other types of issues arise. These issues generally have to do with determining whether an observation should be considered pathological or whether it is culturally determined. This chapter assumes that there exist social class and cultural differences between clinician and patient. A word of explanation is needed. It is assumed that in most countries of the world, certainly in the United States, there exist different social and economic classes in the population and that clinicians because of their usually greater education, the socialization that accompanies it, and perhaps their own class origins may find themselves interacting with patients from a distinct social class. (It also occurs that some clinicians find themselves working with patients from a higher social class, but in this discussion the emphasis is on working with lower socioeconomic status persons.) Furthermore, many countries, even fairly homogenous ones, have groups of individuals of distinct ethnic/national origin. Certainly this is the case in the United States. Similarly, the clinician may be a member of this group but because of acculturation may now have moved apart from involvement (and understanding) of the group's customs, beliefs, and so on. This dissonance arising from class or cultural differences between clinicians and because of their presumably somewhat greater education and the socialization that accompanied it and perhaps class origins may find themselves interacting with patients from a distinct social class. Awareness of the degree of this sociocultural distance is important and may only be determined as the interview progresses. For example, the cultural distance between an American clinician and a foreign-born patient may be somewhat neutralized if they are from similar social classes (i.e., health professionals).

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