Interviewing (psychology)

Type of Psychology: Behavioral medicine; Clinical; Consulting; Counseling; Educational; Family; Forensic; Health; Organizational; Psychotherapy; School; Social

An interview involves communication between at least two persons. Each contributor impacts and is impacted by the responses of the other. The practice of interviewing is central to the work done in many mental health settings. Interviews may be conducted for a variety of intended purposes and can be structured, semi-structured, or unstructured to best serve the purpose of the interview. The goals of a particular interview relate to the context in which that interview is conducted. Ethical clinical interviewing encompasses care for the client while working to achieve the goals of the interview. Some practitioners refer to interviewing as a conversation with a purpose.

Introduction

Clinical interviewing is the foundation for practically all work conducted in the helping professions. There are a number of distinct advantages that contribute to the widespread use of clinical interviewing. Interviews are inexpensive to conduct, are multidimensional in that they tap into both verbal and nonverbal behaviors, are both portable and flexible, and facilitate the development of a therapeutic rapport.

Due to these advantages, the clinical interview has become the most widely used method of preliminary clinical assessment and provides a basic context for almost all other psychological assessments and treatments. The concept that interviews are a “conversation with a purpose” is an important starting point. The interviewer is purposeful and accepts responsibility for keeping the interview on track and moving toward the goal. In this sense, the interviewer's awareness is different than a typical conversation partner and the flow of the discourse is usually more goal-oriented than a typical conversation.

Besides having a purpose, there are some other points that distinguish interviews from conversations. For example, a conversation usually happens without a central theme, the participants' roles are typically not defined, and the conversation begins and ends according to the will of the participants rather than a pre-established start and end time in a pre-determined place. By contrast, interviews typically incorporate some efforts directed at achieving a specific purpose or intended goal. In addition, interviews usually integrate an awareness of defined roles between participants, i.e., interviewer and interviewee. The establishment of defined roles in the clinical interview is an essential step in crafting an effective therapeutic alliance between the client and the practitioner.

Rapport

A clinical interview incorporates an alliance between the interviewer and the interviewee to facilitate the goal of data collection. The practitioner's ability to gather information about the client requires that the client and the clinician are able to build a relationship in which the client is able to trust the interviewer. The process of establishing this relationship is referred to as building a rapport. Along with the goal of rapport-building, most interviews have in common the goal of collecting information about the interviewee's current situation, beliefs, feelings, and/or attitudes as skillfully as possible.

Building rapport is essential for conducting a clinical interview. Rapport refers to the relationship between patient and clinician. It includes a positive atmosphere along with mutual understanding of the purpose of the interview. A strong rapport can provide the clinician with leverage by which to achieve the goals of the interview. Although a comfortable atmosphere will not guarantee a productive interview (a warm, yet poorly prepared interviewer may make the interviewee feel at home but may not reach established goals), lack of attention to atmosphere and warmth can inhibit the development of trust. Clinicians from nearly every theoretical orientation agree that developing trust and rapport as a means of building a positive, collaborative alliance with clients is essential in the early stages of a therapy.

Types of Interviews

There are two primary distinguishing factors which shape every interview. First, every interview is shaped by its purpose. Next, the interview is shaped by its relative degree of structure. Some interview purposes are best served by a structured interview; others will be more effectively served by semi-structured or unstructured interviews. A structured interview requires the interviewer to use a pre-determined series of questions or prompts to elicit information from the interviewee. A semi-structured interview is more flexible, allowing the interviewer to use variable means to collect data from the interviewee, shifting questions and prompts according to what works best in a given situation. An unstructured interview may be focused on a particular theme but allows for the questions and prompts to be spontaneously developed during the course of the interview. In addition to purpose and degree of structure, interviews have other shaping characteristics. For example, interviews can be more or less formal. Some interviews are more or less focused on information seeking versus information giving. Interviews may incorporate a focus on the past, present, or future. Further, interviews are shaped by the developmental status of the client. It is also important to note that the focus of a series of interviews with one client may shift according to the stage of treatment or other factors pertaining to the needs of the client.

Some examples of clinical interviews include these: intake interviews, mental status interviews, case history interviews, diagnostic interviews, and termination interviews. The purpose of an intake interview is to report the circumstances which led the client to seek help. A mental-status interview evaluates the appearance, mood, speech and thoughts of the interviewee. A diagnostic interview evaluates criteria for clinical diagnosis. The goal of a case history interview is to determine the antecedents to the client's current state. A crisis interview occurs in relation to a traumatic event. Termination interviews prepare interviewees for conclusion of services. It is important to be aware that more than one of the following forms of interviews may be administered to the same client. For example, a client may complete an intake interview when first admitted for treatment. The client may later be provided a mental status examination, a case history interview, and a diagnostic interview in preparation for treatment or at intervals throughout treatment to evaluate treatment effectiveness. At the successful completion of treatment, the client might also be provided a termination interview. With this in mind, a brief typology of interviews typically used in psychotherapy follows.

Intake Interviews

The primary purpose of an intake interview is to gather information related to the immediate concerns that prompted the client to seek treatment. For example, during an intake, the interviewer may ask about when the presenting problem became a complaint and who defined it as such. The interviewer may probe to see what the client believes about the origin of the problem or symptoms. An intake interview might also include questions about any action the client has already taken to solve the problem. The interviewer may assess any biases or distorted thinking the client has about the problem. The interviewer may inquire about medical problems and any medication the client takes regularly as well as any substance abuse concerns. In addition to the primary purpose of collecting information, the intake interview allows the clinician to assess whether they possess the necessary competencies to work with the client, given their presenting concerns. The intake interview can also provide clinicians an opportunity to ask clients about their expectations for treatment and to offer information about available options.

Mental Status Interview

A mental status exam (MSE) provides information that forms the basis for understanding and conceptualizing the client's concerns. Several areas are addressed in a mental status interview or exam. In an MSE, the interviewer assesses the interviewee's appearance, behavior, psychomotor activity, and speech. Reports from an MSE typically include information regarding whether the client is alert, oriented to place and time, and dressed appropriately for the weather. The interviewer also assesses the interviewee's affect and mood along with the interviewee's attitude toward the interviewer. Other areas of consideration are the interviewee's attention, concentration, memory, cognition, reliability, judgment, and capacity for insight. Among other things, a mental status interview is an opportunity to evaluate and document client perceptual disturbances.

Diagnostic Interview

There are several features which distinguish a diagnostic interview from other forms of interviewing. The purpose or goal of a diagnostic interview is to arrive at a clinical diagnosis using specific diagnostic criteria. The interviewer typically uses standard, structured questions to determine whether diagnostic criteria are met. Most diagnostic interviews use an initial question based on broad criteria. This question is designed to let the interviewer to “skip” the related questions if the broad criteria are not met. Criteria are frequently coded as present, subthreshold, or absent.

Case History Interview

A case history interview aims to collect a detailed personal and social history that is as complete as possible. The goal is to provide a broad historical and developmental context in which the client and problem are situated. Related to this goal, case history interviews typically collect a broad range of information. Case history interviews may include family/parental, environmental, religious/spiritual, educational, sexual, medical, and/or psychopathological concerns. The interviewer is attentive to concrete facts such as dates, times, and events as well as the client's relevant thoughts and feelings.

Crisis Interview

The purpose of a crisis interview is to assist the client or the family with an immediate crisis. The first goal in a crisis interview is always to identify the problem and assess the safety of the individual(s) involved. Crisis interviewers work under the assumption that individuals in crisis are unable to use previously developed coping mechanisms to manage their response to a traumatic event. Crisis interviewers work with clients to re-stabilize and seek new coping strategies. Work done with clients in a crisis interview is not meant to be long term, so interviewers typically provide referrals for longer term treatment.

Termination Interview

In clinical terms, the word termination refers to the last phase of therapy. Though often underappreciated, termination can be an important piece of the therapeutic puzzle. For some clients, termination can be profoundly healing, meaningful, and transformative. Frequently, clients have come to therapy with concerns that include an element of loss. In the termination phase, therapy provides a venue through which clients can examine how they experience, process and cope with feelings associated with loss. When it is time for clients to begin termination, clinicians and clients can collaboratively evaluate the work that has been accomplished in therapy. They can celebrate the progress that has been made, have a conversation about goals that weren't reached and explore any disappointments with the process. For many clients, reminiscing and building an overview of therapy is gratifying because it helps the client put therapy into perspective.

Bibliography

Drill, Rebecca, et al. "Assessment of Clinical Information: Comparison of the Validity of a Structured Clinical Interview (the SCID) and the Clinical Diagnostic Interview." Journal of Nervous and Mental Disease 203.6 (2015): 459–62. Print.

Fowler, J. C., and J. C. Perry. "Clinical Tasks of the Dynamic Interview." Psychiatry68.4 (2005): 316–36. Print.

Jones, K. D. “The Unstructured Clinical Interview.”Journal of Counseling and Development 88.2 (2010): 220–26. Print.

MacKinnon, Roger A., Robert Michels, and Peter J. Buckley. The Psychiatric Interview in Clinical Practice. 3rd ed. Arlington: Amer. Psychiatric Assn., 2016. Print.

McConaughy, S. H. Clinical Interviews for Children and Adolescents: Assessment to Intervention. New York: Guilford, 2005. Print.

McDowell, T. "Practice Evaluation as a Collaborative Process: A Client's and a Clinician's Perceptions of Helpful and Unhelpful Moments in a Clinical Interview." Smith College Studies in Social Work 70.2 (2000): 375. Print.

Norcross, J. C., and M. J. Lambert. “Psychotherapy Relationships That Work II.”Psychotherapy 48.1 (2011): 4–8. Print.

Prout, T. P. D. Essential Interviewing and Counseling Skills: An Integrated Approach to Practice. New York: Springer, 2014. Print.

Sommers-Flanagan, John, and Rita Sommers-Flanagan. Clinical Interviewing. 5th ed. Hoboken: Wiley, 2015. Print.

Stuart, A. L., et al. “Comparison of Self-Report and Structured Clinical Interview in The Identification of Depression.”Comprehensive Psychiatry 55.4 (2014): 866–69. Print.

Vanderploeg, R. D., S. Groer, and H. G. Belanger. “Initial Developmental Process of a VA Semistructured Clinical Interview for TBI Identification.” Journal of Rehabilitation Research and Development 49.4 (2012) 545–56. Print.

Wright, K. M., et al. “Structured Clinical Interview Guide for Postdeployment Psychological Screening Programs”. Military Medicine173.5 (2008): 411–21. Print.