Interviewing Techniques

Interviewing is how the counselor learns what is actually going on, and the technique determines the answer. The same patient, asked differently, produces a different family history and a different account of what they are worried about. These are trainable, specific skills rather than personality traits, which is why they can be practiced and assessed.

• Open questions expand, closed questions confirm. Open questions ("Tell me about your mother's illness") produce narrative and unanticipated information. Closed questions ("Was she under 50?") pin down specifics. A useful interview opens wide and narrows, and one built entirely from closed questions yields only what the counselor already thought to ask.
• The funnel structure moves from broad to specific within each topic, and repeats the pattern for the next topic.
• Reflective listening restates what the patient said to confirm understanding and to signal attention. A simple reflection repeats the content; a complex reflection names the feeling or the implication underneath it and is what moves a conversation forward.
• Silence is a technique. After a difficult disclosure, three or four seconds of silence invites the patient to continue. Counselors fill silence out of discomfort, and doing so reliably ends the disclosure that was about to come.
• Empathic responses name and validate: "That sounds frightening" or "Many people in your position feel that way." Empathy is distinct from sympathy, which centers the counselor's own feeling about the patient's situation.
• Normalizing reduces isolation by stating that a reaction is common. It is only useful when it is true, and a false normalization is easy to detect.
• Avoid the multiple question. Asking three things at once means the patient answers one, usually the last, and the other two are lost.
• Avoid leading questions. "You are not planning to have more children, are you?" supplies the answer, and in family history taking, "No history of cancer, right?" reliably produces a false negative.
• Redirection is a skill, not a rudeness. Acknowledging then guiding ("That is helpful, and I want to make sure we get to the testing decision before we finish") keeps the session usable while respecting the patient.
• Nonverbal behavior carries a large share of the message on both sides. Position, eye contact, and whether the counselor is typing all signal availability. Nonverbal norms vary substantially across cultures, so direct eye contact is not a universal marker of engagement.
• Family history interviewing is a specific technique. Ask about relatives systematically rather than generally, ask ages at diagnosis rather than whether anyone had cancer, and ask about both maternal and paternal lines explicitly, because patients under-report the father's side.

• A counselor asks, "Is there any cancer in the family?" and the patient says no. Later, systematic questioning by relative reveals a paternal aunt with ovarian cancer at 52. The first question was closed and global, and the patient answered it honestly against her own understanding of what counted.
• A patient falls silent after being told her result is positive. The counselor waits rather than filling the pause. After several seconds the patient says, "I have to tell my sister," which is the actual issue and would not have surfaced if the counselor had kept talking.
• A patient says, "I suppose I just have to get on with it." A simple reflection would restate that. A complex reflection names what is underneath: "It sounds like you feel you do not have much choice in this." The patient then describes the pressure she is under.
• A patient recounts a long history about a distant relative. Rather than interrupting or letting the session dissolve, the counselor acknowledges its relevance and redirects to the decision that has to be made today, offering to return to the history if time allows.

• Do not build the interview from closed questions. You will only ever learn what you already suspected.
• Do not ask "any family history of X." Ask relative by relative with ages, because patients apply their own filter to the general question.
• Do not fill silence. It is the most commonly wasted tool in the session.
• Do not stack questions. Ask one, wait, then ask the next.
• Do not read nonverbal behavior through one cultural lens. Reduced eye contact may be respect rather than disengagement.