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Clinical Interview

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DOI: 10.1002/9781118625392.wbecp117

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Clinical Interview
John Sommers-Flanagan,1 Waganesh
Abeje Zeleke,2 and Meredith H. E.
Hood1
1 The
University of Montana, U.S.A. and 2 Duquesne
University, U.S.A.
The clinical interview has been referred to as
the foundation of all mental health treatment
and as arguably the most valuable skill among
psychologists and other mental health prac-
titioners. Professionals from several different
disciplines (i.e., psychologists, psychiatrists,
counselors, and social workers) utilize clinical
interviewing procedures. As a consequence,
clinical interviewing has been defined in
many ways by many authors (Jones, 2010;
J. Sommers-Flanagan & Sommers-Flanagan,
2014).
At its core, the clinical interview involves
a professional relationship between a mental
health provider and a patient or client. Whether
patients are voluntary or mandated, usual and
customary ethical practice requires that pro-
fessional clinical interviewers provide both
written and oral informed consent. Informed
consent is used not only to obtain consent for
treatment, but also to educate patients about
what to expect during the clinical interview.
Caveats and Variations
The definition and practice of clinical inter-
viewing varies based on a variety of factors,
including professional discipline. For example,
psychologists and psychiatrists aligned with
the medical model consider the clinical inter-
view as primarily a method for investigating
patient symptoms and establishing a psy-
chiatric diagnosis. In such cases, the clinical
interview may be referred to as a diagnostic
or psychiatric interview and strong efforts
are made to structure the interview in ways
The Encyclopedia of Clinical Psychology, First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118625392.wbecp117
that result in reliable, objective, and valid
psychiatric diagnosis.
Mental health practitioners from other
professional disciplines or those who hold
postmodern or social justice theoretical per-
spectives, often view the clinical interview as
a subjective, relational process. As an example,
Murphy and Dillon (2011) described the
clinical interview, in part, as a “conversa-
tion characterized by respect and mutuality, by
immediacy and warm presence, and by empha-
sis on strengths and potential” (p. 3). Although
some mental health practitioners probably
adhere to a strict, objective diagnostic clinical
interviewing procedure whereas others discard
the diagnostic lens for a relational or postmod-
ern approach, it is likely that most professionals
in clinical practice pursue both diagnostic and
relational goals during clinical interviews.
Traditionally, clinical interviews have a pre-
determined duration of 50 min, but many
variations exist. For example, although
unusual, some practitioners have written
about conducting open-ended interview ses-
sions (Glasser, 2000). Generally the clinical
interview is considered synonymous with
the initial interview or intake interview, but
the term also can refer to any clearly defined
assessment or therapeutic contact between
a professional and a patient. For the most
part, the clinical interview has become an
umbrella term referring to a wide range of
interviewing procedures including, but not
limited to, psychosocial history, mental status
examination, suicide assessment interviews,
and diagnostic or psychiatric interviews. In
all cases the clinical interview is a rich and
complex interpersonal interaction between
mental health professional and patient.
The Goals of Clinical Interviewing
Perhaps the clearest way to define a clinical
interview is to describe its purpose or goals.
2 CLINICAL INTERVIEW
Generally, there are four possible goals of a
clinical interview. These include: (a) the goal
of establishing (and maintaining) a working
relationship or therapeutic alliance between
clinical interviewer and patient; research has
suggested the relationship between interviewer
and patient is multidimensional, including
agreement on mutual goals, engagement in
mutual tasks, and development of a relational
bond (Bordin, 1979; Norcross & Lambert,
2011); (b) the goal of obtaining assessment
information or data about patients; in situa-
tions where the goal of the clinical interview
is to formulate a psychiatric diagnosis, the
process is typically referred to as a diagnostic
interview; (c) the goal of developing a case
formulation and treatment plan (although this
goal includes gathering assessment informa-
tion, it also moves beyond problem definition
or diagnosis and involves the introduction of
a treatment plan to a patient); (d) the goal of
providing, as appropriate and as needed, a spe-
cific educational or therapeutic intervention,
or referral for a specific intervention; this
intervention is tailored to the patient’s particu-
lar problem or problem situation (as defined in
items b and c).
All clinical interviews implicitly address the
first two primary goals (i.e., relationship devel-
opment and assessment or evaluation). Some
clinical interviews also include, to some extent,
case formulation or psychological intervention.
A single clinical interview can simultaneously
address all of the aforementioned goals. For
example, in a crisis situation, a mental health
professional might conduct a clinical interview
designed to quickly establish rapport or an
alliance, gather assessment data, formulate
and discuss an initial treatment plan, and
implement an intervention or make a referral.
A Brief History of the Clinical
Interview
The term “interview” was first used in the
1500s to refer to a formal conference or
face-to-face meeting. The term “clinical” has
origins from around 1780 and is linked to an
objective or coldly dispassionate approach to
bedside observations and treatment of hospital
patients. Although difficult to determine the
precise origin of the joining of clinical and
interview in modern use, it appears that Jean
Piaget (1896–1980) was the first psychologist
to use a variant of the term clinical interview.
In 1920, as Piaget was working to develop a
standardized French version of an English rea-
soning test with Theodore Simon in the Binet
laboratory in Paris, he became more inter-
ested in the fundamental nature of children’s
thinking than in the ranking of children’s intel-
lectual ability on a standardized test. Realizing
that existing psychological research meth-
ods were inadequate for studying cognitive
development, he began using an interviewing
approach that had much in common with
psychiatric diagnostic interviews. He referred
to his process as the “semiclinical interview”
(Elkind, 1964). Piaget’s semiclinical inter-
view combined standard and nonstandard
questioning as a means for exploring the
richness of children’s thought.
Similar to Piaget’s initial efforts to com-
bine a rigorously standardized protocol with
spontaneous or unplanned questioning, the
definition and implementation of the clinical
interview has historically and presently been
characterized by tension between a highly
structured or protocol-driven interaction ver-
sus an unstructured or free-response process.
In a report on structured clinical interviews,
Abt (1949) provided an early articulation of
this dialectical tension inherent to the clinical
interview, noting that researchers did not want
to lose the rich, projective, and idiosyncratic
material obtained in a clinical interview, but
also needed reliable interviewing procedures
that were quantifiable.
Abt’s comments captured the qualitative
vs. quantitative nature of most historical and
contemporary controversies concerning the
clinical interview. On the one side, adherents to
the medical model view the clinical interview
as a scientific assessment endeavor, emphasiz-
ing its quantitative nature and psychometrics
(e.g., reliability and validity). On the other

side, many practitioners view the clinical
interview as a means for obtaining qualitative
and idiosyncratic data about patients, using
both the process and the data obtained to
strengthen the therapeutic relationship and
move toward a culturally and individually
tailored intervention. Since the 1940s the clin-
ical interview has been considered as either a
method for gathering facts about symptoms
that align with a scientifically valid diagnosis
or a relational experience designed to under-
stand the subjective world of another. There
are some who contend that the clinical inter-
view can and should be both a scientific and
relational process (J. Sommers-Flanagan &
Sommers-Flanagan, 2014).
The Structure or Process of a
Clinical Interview
All clinical interviews have an inherent internal
structure that includes a beginning, middle,
and end. This pattern or process of a clinical
interview has been written about extensively.
Various authors have identified interview
stages or phases and specific tasks that clinical
interviewers should accomplish in a particular
sequence. Many of these stages or phases are
theoretically based, but Shea (1998) described
a general atheoretical interview structure that
includes the following stages: (a) the intro-
duction; (b) the opening; (c) the body; (d) the
closing; and (e) termination. In Shea’s model,
there are interviewer–patient interactions and
interviewer tasks that signal the beginning and
ending of each stage. These interactions and
tasks are described next.
The Introduction
This interviewing stage begins at first contact
between clinician and patient; it ends when
the clinician begins to specifically ask about
“the reasons the patient has sought help”
(p. 58). Tasks common to the introduction
may include scheduling, formal introductions
(including the clinician’s description of his or
her professional credentials), seating, clinician
expressions of concern, clinician reassurance
CLINICAL INTERVIEW 3
regarding initial patient fear or reluctance,
conversation or small-talk, explanations of
confidentiality, purpose of the interview,
checking with patients on expectations com-
bined with a brief description of how clinician
and patient will work together, time limits,
and a discussion of theoretical orientation (as
needed).
The Opening
The opening begins when the clinician initially
and formally asks questions about the patient’s
current concerns. This period ends when the
interviewer stops asking general questions
and begins focusing in on specific topics. In
Shea’s (1998) model, the opening is minimally
directive and lasts about 5–8 min. Interviewer
tasks include an opening question, use of
basic attending or nondirective listening skills
(e.g., paraphrase, reflection of feeling), and,
based on the patient’s opening response, an
initial evaluation of patient problems, person-
ality, and current functioning. In psychiatric
terminology, the focus during this period is on
eliciting and then listening to and analyzing the
patient’s chief complaint. The chief complaint
is defined as the patient’s primary reason for
seeking therapy.
Many clinicians develop and use a stan-
dard opening statement or question. A
common prototype is: “Tell me what brings
you to counseling (or therapy) at this time”
(J. Sommers-Flanagan & Sommers-Flanagan,
2014, p. 184). Other authors have recom-
mended many other possible formal openings,
including: (a) What brings you here today?
(b) How can I be of help? (c) What are some
of the stresses you have been coping with
recently? and (d) Anything you would like to
tell me about yourself or your situation, I’d be
very glad to hear.
The Body
The body of an initial interview primarily
involves information gathering, but it can
also include the implementation of a specific
therapy intervention or technique. Overall, the
4 CLINICAL INTERVIEW
quality and quantity of information gathered or
intervention applied depends almost entirely
on the interview’s purpose and the clinician’s
theoretical orientation. For example, if the
interview’s purpose is to establish a working
psychiatric diagnosis, the clinician will be ask-
ing specific questions about patient symptoms.
In contrast, if the purpose of the interview
is to establish rapport and initiate a working
alliance, then the interviewer is likely to use
more nondirective listening skills designed to
show empathic understanding of the patient’s
situation, concerns, and emotions.
Tasks associated with the body of the clin-
ical interview include transitioning from less
directive to more directive interviewing, gath-
ering information pertaining to the patient’s
problem, focusing on patient symptoms and
characteristics associated with possible psy-
chiatric diagnoses, describing an initial case
formulation, and applying interventions as
appropriate.
The Closing
The closing signals the end of information
gathering (diagnosis) or intervention (treat-
ment). At this time most clinicians stop
gathering new information and avoid applying
new interventions. Instead, the discussion
turns to planning for the future. This future
focus may include coping strategies for the
week ahead (assuming there will be a session
the next week) or a discussion about what to
talk about during the next session. The closing
generally occurs about 5–10 min before the
interview is over. Tasks associated with the
closing stage include providing reassurance,
summarization, articulating a case formula-
tion, instilling hope, guiding and empowering
patients, and tying up loose ends.
Termination
Termination of the interview involves and
requires close time management. This is partly
because it is not unusual for both clinical
interviewers and patients to want to extend
the session beyond prearranged boundaries.
The clinical interviewing task is so immense
that it often feels as if more time is needed to
develop a deeper understanding of patients
and their problem(s). Additionally, patients
may be feeling enjoyment or gratification over
being listened to so closely and consequently
want to linger.
Statements made by patients immediately
before the session is scheduled to end or as they
walk out of the office are commonly referred
to as doorknob statements. Doorknob state-
ments sometimes represent patients’ efforts to
extend the session. For example, patients may
suddenly begin discussing abuse experiences
or suicidal impulses at the end of the session.
Doorknob statements are one example of the
challenges of ending clinical interviews in a
timely fashion. Tasks associated with the ter-
mination stage include watching the clock or
time management, observing for and handling
doorknob statements, offering reminders of
appointment times or homework, and offering
well wishes until the next meeting.
Levels of Interviewing Structure
Unstructured, Semistructured,
and Structured Clinical Interviews
The term structure is not only used to describe
an interview’s internal process or sequence,
but also to describe the directiveness of the
approach used during a clinical interview.
In this regard, the interpersonal process that
constitutes the clinical interview may be rel-
atively unstructured (patient directed) or
highly structured (clinician directed). The
level of structure of a given clinical interview
depends on a variety of contextual factors
(e.g., interview goal, theoretical orientation,
treatment setting, or practitioner preference).
Clinical interviews are typically categorized as
unstructured, semistructured, or structured.
Unstructured Clinical Interviews
In an unstructured clinical interview, inter-
viewers provide little direction, allowing
patients to take the lead and speak freely
about topics they choose. An unstructured

interview may intermittently include open or
projective questions posed by the interviewer,
followed by patient responses. During unstruc-
tured interviews, clinicians focus on tracking
patients, usually using a variety of nondirective
listening skills, instead of using questions and
other directive interviewing approaches to lead
patients (Meier & Davis, 2011). For example,
in an initial psychoanalytic clinical interview,
the clinician might use free association, dream
analysis, and/or free recall of childhood events
as a means of collecting assessment infor-
mation. From the psychoanalytic perspective
a less structured or unstructured process is
viewed as helpful in stimulating a transference
reaction. Psychoanalytically oriented clinicians
use their observations of transference reactions
as a source of assessment and treatment plan-
ning data. Depending on the psychoanalytic
or psychodynamic model being employed, the
clinician may or may not provide an explicit
treatment formulation during an initial session
and may or may not use trial interpretations
designed to elicit assessment data and initiate
the treatment or intervention process.
Semistructured Clinical Interviews
In keeping with Piaget’s initial development
of the semiclinical interview, a semistructured
interview typically includes a predetermined
set of questions followed by either unplanned
questioning or a free response or exploration
period. Semistructured interviews come in
many forms and fulfill many different pur-
poses. For example, for diagnostic purposes,
the Hamilton Rating Scale for Depression
(HRSD) can be used to guide a semistructured
interview. Specifically, the HRSD includes 21
depression-related items that can be imbedded
into an interview (in any order) and results
in a score from 0 (no depressive symptoms)
to 66 (extreme depressive symptoms). In con-
trast, the Relationship Anecdotes Paradigm
(RAP) interview is a semistructured inter-
view approach designed to elicit numerous
relationship narratives that contribute to a psy-
chodynamic treatment formulation and plan.
Overall, semistructured clinical interviews
CLINICAL INTERVIEW 5
provide clinicians with structure and focus,
but also allow flexibility in how the interview
is conducted.
Structured Clinical Interviews
In contrast to unstructured and semistructured
interviews, a structured clinical interview is a
tightly managed protocol or process wherein
clinicians ask a systematic series of prede-
termined questions, including follow-up
questions. In this approach there is little or
no opportunity for unplanned or spontaneous
questioning by clinicians and little or no
spontaneous exploration of diverse topics by
patients. The purpose of a structured clinical
interview is nearly always diagnostic. Training
and supervision to conduct structured diag-
nostic interviews is often required to ensure
diagnostic reliability. Examples of structured
diagnostic interviews include the Structured
Clinical Interview for DSM-IV Axis I Disorders
(SCID-I), the Child Assessment Schedule, the
Mini-Mental State Exam (MMSE), the Anxiety
Disorders Interview Schedule for DSM-IV
(ADIS-IV), and the Alcohol Use Disorder and
Associated Disabilities Interview Schedule–IV
(AUDADIS-IV). These examples provide a
sense of the range and specificity of published
structured diagnostic interviews.
The SCID-I is perhaps the most commonly
used structured interview prototype. The
SCID-I comes in two forms: (a) the Clini-
cian Version for DSM-IV Axis I Disorders
(SCID-CV); and (b) the Research Version for
DSM-IV axis I disorders (SCID-RV). In addi-
tion, there is also a SCID protocol for determin-
ing DSM-IV Axis II disorders (the SCID-II).
The SCID user’s guide describes the SCID as a
“semistructured interview.” However, in prac-
tice, the SCID is nearly completely structured.
For example, the only protocol deviations for
clinicians are that in addition to questions that
are “to be asked verbatim,” there are also “par-
enthetical questions” to be asked as needed, and
sections where clinicians are prompted to use
the patient’s “own words” when constructing
required or parenthetical questions.
6 CLINICAL INTERVIEW
The SCID’s development and evolution
is informative regarding controversies and
conflicts between clinical interviewing research
and clinical interviewing practice. In an effort
to provide a reliable and valid approach to
establishing psychiatric diagnoses, the National
Institute for Mental Health funded the SCID’s
development in the mid 1980s. Initially, the
SCID was designed as a clinical interview
protocol to meet the needs of both clinicians
and researchers. However, researchers found
the initial version too limited in scope and
detail, whereas clinicians found the initial
version too cumbersome and detailed for
routine clinical practice. As a consequence,
separate clinician and research versions of
the SCID for DSM-IV Axis I disorders were
developed. Even as a simplified protocol, the
SCID-CV takes approximately 45–90 min to
administer depending on a variety of factors
and is not routinely used among independent
practitioners.
Despite its extensive structure, in the end,
SCID-CV-generated diagnoses are based on
clinical judgment. The SCID-CV User’s Guide
specifically articulates this aspect, noting that
when the clinician’s judgment conflicts with
either the patient’s report or admission of
symptoms, the final diagnostic decision should
be based on clinician judgment. This is a good
example of how even the most structured
diagnostic protocols retain clinician subjec-
tivity. It also illustrates that clinicians and
patients can and will disagree about the pres-
ence and absence of symptoms and diagnoses
and that when such conflicts occur, clinical
interviews based on the medical model place
final authoritative diagnostic decisions in the
hands of the clinician. In contrast, postmod-
ern approaches, including person-centered,
solution-focused, and narrative theoretical
perspectives, place a strong emphasis on the
“patient as the best expert” on his or her
condition or situation.
Contemporary Developments
in Clinical Interviewing Research
and Practice
In the past three decades, there has been
extensive research and practice using clinical
interviewing procedures across a wide range
of settings and clinical populations. As a
consequence, the diverse range of clinical
interviewing processes and protocols now
available to clinicians is rather daunting.
Not only can clinical interviews be brief or
extensive, as well as structured, semistruc-
tured, or unstructured, but they may also
focus on the full range of diagnostic condi-
tions (e.g., dementia, dissociation, trauma,
depression, anxiety, premenstrual dysphoria)
and be applied to populations across the life
span (e.g., children, adolescents, adults, cou-
ples, parents/caregivers, the elderly). At this
point it might be best to acknowledge that
contemporary clinical interviewing research
and practice is diverse; there is no single,
agreed-upon approach to all clinical inter-
views. Instead, contemporary specification
and diverse application suggests a state of the
clinical interview that echoes Gordon Paul’s
(1969) famous statement about psychotherapy.
It is no longer a matter of asking which form
of the clinical interview is most reliable, valid,
and useful; instead, the appropriate question
is now: “What clinical interview procedure, by
whom, is likely to be most effective with this
individual patient with that specific problem
and under which set of circumstances?”
The Clinical Interview as a
Relational Act: Building
the Therapeutic Relationship
It has been well documented that the therapeu-
tic relationship is not only the cornerstone of
the clinical interview, but also one of the most
robust predictors of positive psychotherapy
outcomes. However, developing a positive
therapeutic relationship with patients is a com-
plex and interactive process, often involving
a reciprocal dynamic between therapeutic

relationship variables and treatment methods
or techniques. This complex clinical reality led
Norcross and Lambert (2011) to claim that
“treatment methods are relational acts” (p. 5).
Furthermore, the proliferation of empirically
validated time-limited treatments has made
it increasingly important to identify more
precisely how clinicians can efficiently and
authentically develop an empathic and positive
relationship with patients during a clinical
interview.
Research suggests that it is particularly
important for mental health clinicians to
clarify the nature and expectations of ther-
apy at the onset of the working relationship.
Often, patients do not have a well-defined
understanding of the clinical interview or psy-
chotherapy process when initiating treatment.
Receiving information regarding the basics
of psychotherapy tends to enhance patient’s
investment in the process and increases their
motivation to change. In particular, Tryon and
Winograd (2011) recommended emphasizing
to patients the importance of their mutual
contribution to efficacious therapy outcomes.
Similarly, successful clinical interviewers
engage in collaborative goal setting and treat-
ment planning with patients. It is essential that
patients and therapists have a mutual under-
standing of the patient’s primary concerns and
what he or she hopes to change as a function
of treatment. Furthermore, it is imperative that
both parties agree on how to work together
to achieve mutually agreed-upon goals. When
the therapist and patient possess a cooperative
stance towards treatment and desired out-
comes, their relationship gains meaning and a
positive working alliance develops.
Interactive feedback between patient and
therapist can strengthen therapeutic rela-
tionships. This may involve bi-directional
feedback—feedback from clinician to patient
and from patient to clinician. For example,
during the intake it can be beneficial for ther-
apists to ask patients if they would like to hear
a summary of the therapist’s observations. In
particular, providing patients with interpre-
tive feedback pertaining to their repeating
CLINICAL INTERVIEW 7
interpersonal relationship patterns is linked to
positive treatment outcomes (Shedler, 2010).
Similarly, it is also important to invite patients
to provide feedback to therapists regarding
their comfort with the process and to sys-
tematically check in with patients regarding
whether there are salient issues that the clini-
cian may be missing (Lambert & Shimokawa,
2011).
The Science of Clinical Interviewing
Like all approaches to psychological assess-
ment and intervention, the clinical interview
has been the focus of substantial scientific
research. Although used for both assessment
and intervention purposes, the single clinical
interview primarily has been evaluated as
an assessment procedure. The main general
question has been: Is the clinical interview a
reliable and valid assessment procedure?
The scientific consensus is that psychiatric
diagnostic reliability greatly improved with the
1980 publication of DSM-III and subsequent
development of structured or semistructured
clinical interviewing protocols such as the
SCID-I. Despite this progress, problems
with interrater reliability and validity persist.
Typically researchers have reported kappa
coefficients (a measure of reliability) for the
SCID-I ranging from −0.03 to 1.00 (with a
recent study using DSM-IV criteria ranging
from 0.61 to 0.83; Lobbestael, Leurgans, &
Arntz, 2011). For the SCID-II, kappa coeffi-
cients have ranged from 0.43 to 1.00 (and 0.77
to 0.94 in a more recent study using DSM-IV;
Lobbestael et al., 2011). It should be noted that
these research studies have used highly trained
interviewers and that there is little scientific
evidence demonstrating that independent
clinicians would obtain similar reliability using
the SCID or other structured diagnostic assess-
ment interviews. Finally, as implied previously,
critics who view clinical interviewing from
alternative theoretical perspectives often ques-
tion whether psychiatric diagnosis is a valid or
helpful approach to treating patient problems
or alleviating human suffering.
8 CLINICAL INTERVIEW
Overall, scientific support of structured
or semistructured clinical interviews as a
reliable and valid diagnostic procedure is
limited. Given this state of the science, it
has been proposed that practicing clinicians
maintain a balanced approach to conducting
diagnostic clinical interviews. In an effort to
maintain a positive working relationship while
simultaneously obtaining potential useful
diagnostic information, a five-part model has
been described: (a) clinicians open diagnos-
tic interviews with a warm and interactive
explanation and discussion of what the patient
should expect; (b) an extensive review of the
patient’s chief complaint or presenting problem
and associated goals are obtained; (c) a brief
review of the patient’s relevant personal history
or at least a history of the problem is con-
ducted; (d) as appropriate, a brief mental status
examination is conducted; and (e) a review
of the patient’s current situation, including
social supports, coping skills, physical health,
and personal strengths is obtained. As needed,
a structured or semistructured interview
protocol can be inserted into this diagnostic
interviewing process.
Multicultural Adaptations
Early research on psychotherapy with diverse
patients indicated that following an initial clin-
ical interview, most culturally diverse patients
did not return for a second session. This find-
ing, as well as other multicultural research,
motivated researchers and practitioners to
search for and identify possible cultural adap-
tations that might help clinical interviewers
establish more positive connections with
diverse patients during the initial interview.
Although the complexities of research with
diverse populations in clinical settings limit
the strength of conclusions that can be made, a
number of general guidelines for multicultural
adaptations are available (Griner & Smith,
2006). These include: (a) the use of initial small
talk and self-disclosure with some cultural
groups, (b) whenever needed or possible,
conducting an initial interview in the patient’s
native language, (c) seeking professional con-
sultations with professionals familiar with the
patient’s culture, (d) providing extra services
(e.g., childcare) that help increase patient
retention, (d) oral administration of written
materials to patients with limited literacy, (f)
cultural sensitivity training for all professional
staff, and (g) explicitly incorporating cultural
content and cultural values into the interview
process, especially with patients who are not
acculturated to the United States culture.
Future Directions
To the extent that human interaction remains a
popular means for obtaining information and
making inferences about individual patients,
the clinical interview in psychology, psychiatry,
counseling, and social work will likely remain
one of the most fundamental components of
mental health training and practice.
For the historical observer, it should not be
surprising that clinical interviewing processes
and procedures have included both quanti-
tative and structured approaches as well as
qualitative and unstructured approaches. It is
likely that the future of clinical interviewing
will continue to include efforts to emphasize
both of these diametrically opposed inter-
viewing perspectives. Hopefully, knowledge
from future research and practice will help
refine clinical interviewing guidelines so that
individual clinicians gain in their awareness
of when to apply less structured procedures,
more structured procedures, and cultural
adaptations in ways that enhance the reliability
and validity of interviewing as an assessment
process and the effectiveness of the clinical
interview as a mechanism for building a strong
therapeutic relationship that contributes to
positive treatment outcomes.
SEE ALSO: Approaches to Diagnostic Validity;
DSM-IV; Informed Consent, Psychotherapy; Med-
ical Model of Mental Disorders; Mental Status
Exam; Structured Clinical Interview for the DSM
(SCID); Structured versus Semistructured versus
Unstructured Interviews; Therapeutic/Working
Alliance
 CLINICAL INTERVIEW 9

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