Clinical Interview

A clinical interview involves counselors asking individuals questions to gather pertinent information. In interviewing, therapists attempt to help individuals feel comfortable so that candid and relevant information is revealed. Clinical interviewing occurs throughout the counseling process but is typically a major component of the initial session.

An initial interview focuses on gathering information. Therapists generally gather demographic information (e.g., marital status, race or ethnicity, and employment) and information about current problems (e.g., frequency of problem, degree problem affects functioning, and previous attempts to solve problems). Additional questions are asked about social support, medical history, and current medications. Furthermore, therapists may ask questions regarding suicide, substance use, and issues of violence. The information gathered during the initial clinical interview influences the treatment plan, so honest communication is essential to permit accurate assessment.

The initial interview and other interviewing assessments conducted during the counseling process can be useful in assessing client issues. The effectiveness of clinical interviewing is more dependent on counselors’ communication skills than are more formal assessment techniques. Depending on the type of information sought, therapists may use formal assessments and behavioral observations to supplement the clinical interview. These techniques help gather information in a systematic manner; however, many counselors believe there is no substitute for the wealth of information typically gained during the clinical interview.

Types of Clinical Interviews

There are three types of clinical interviews: structured, unstructured, and semistructured. The type of interview used varies according to the setting and the theoretical or professional orientation of the therapist. A structured interview requires that the same questions be asked of each client in an identical manner. An unstructured interview allows the counselor to determine the questions and topics covered during the interview. A semistructured interview combines these formats. Specific questions are always asked, but these are coupled with opportunities to explore unique client circumstances.

There are advantages and disadvantages to each interview format. The questions asked in a structured interview have been researched to determine if they are reliable and whether they elicit useful and valid information. Consquently, the structured interview provides more consistent information. However, a structured interview may not be appropriate for clients with less common problems or clients from diverse cultures. Although the unstructured interview can be adjusted for individual clients, its effectiveness depends on the clinician’s interviewing skills and ability to interpret the clients’ answers.

Commonly used structured interviews are the Composite International Diagnostic Interviews: Authorized Core Version 1.0 (CIDI-CORE) and the Diagnostic Interview Schedule (DIS). Some typical semistructured interviews are the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for Axis 1 DSM-IV Disorders (SCID-I).

Interviewing Techniques

Effective clinicians exhibit interpersonal warmth, refined skills, and attentiveness. They use open-ended questions that allow clients to elaborate on their thoughts and feelings and answer questions in “their own words.” An example of a closed-ended question is, “Do you drink alcohol?” whereas an open-ended question might be, “Why don’t you tell me about your drinking?”

The clinical interviewing process as an assessment technique continues well after the first session. Clinical interviewing also is used to monitor problem resolution, interpersonal development, daily functioning, and client progress. Clinical interviewing may also be used to evaluate the counseling process by asking clients questions concerning the degree to which counseling was helpful.

References:

  1. Morrison, J. (1995). The first interview. New York: Guilford Press.
  2. Okun, B. F. (2001). Effective helping: Interviewing and counseling techniques (6th ed.). Pacific Grove, CA: Brooks/Cole.

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