Interviewing (psychology)

• TYPE OF PSYCHOLOGY: Behavioral medicine; Clinical; Consulting; Counseling; Educational; Family; Forensic; Health; Organizational; Psychotherapy; School; Social

An interview is a dynamic exchange between two or more individuals in which each person's responses influence the other. Interviewing is central across mental health settings and serves myriad purposes. An interview may be structured, semi-structured, or unstructured, depending on its objective. The interview’s context shapes its goals. Ethical clinical interviewing involves attending to the client’s well-being and pursuing the intended objectives of the interaction, or as some practitioners describe it, a conversation with a purpose.

Introduction

Clinical interviewing is the foundation for practically all work in the helping professions. Several distinct advantages contribute to the widespread use of clinical interviewing. Interviews facilitate the development of a therapeutic rapport and are inexpensive, portable, flexible, and multidimensional, tapping into verbal and nonverbal behaviors. Increasingly, clinical interviews are conducted via telepsychology platforms, which require adaptations to rapport-building, confidentiality, and engagement strategies.

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 differs from a typical conversation partner and the flow of the discourse is usually more goal-oriented than a typical conversation.

Besides having a purpose, some other points 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 participants' will rather than a pre-established start and end time in a pre-determined place. By contrast, interviews typically involve efforts to achieve a specific purpose or intended goal. In addition, interviews usually integrate an awareness of defined roles between participants, such as between interviewer and interviewee. Establishing defined roles in the clinical interview is essential 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 clinician build a relationship in which the client can trust the interviewer, a process called building rapport. Along with the goal of rapport-building, most interviews aim to collect 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 a 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 therapy.

Types of Interviews

There are two primary distinguishing factors that 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 interview.

Evidence-based assessment tools are common in clinical settings, and interviewers may incorporate a number of standardized screeners to enhance diagnostic accuracy and inform treatment planning. These include the Patient Health Questionnaire-9 (PHQ-9), a brief measure used to assess the severity of depressive symptoms; the Generalized Anxiety Disorder-7 (GAD-7), a screening tool for generalized anxiety symptoms; the Adult ADHD Self-Report Scale (ASRS), which evaluates symptoms consistent with adult Attention-Deficit/Hyperactivity Disorder; and the Adverse Childhood Experiences Questionnaire (ACE-Q), which screens for exposure to potentially traumatic early life events that may impact long-term physical and mental health. Each tool contributes valuable data to the overall clinical formulation and helps guide individualized treatment planning.

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 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 client's needs.

Some examples of clinical interviews include intake interviews, mental status interviews, case history interviews, diagnostic interviews, crisis 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 using the diagnostic standards from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR, 2022). The DSM-5-TR provides updated criteria, diagnostic specifiers, cultural formulation guidance, and prevalence information for mental health conditions.

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 and integrates trauma-informed care and safety planning. 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 issues and any medication the client takes regularly, as well as any substance use concerns. In addition to 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 allow clinicians to ask clients about their expectations for treatment, offer information about available options, and conduct initial risk and safety assessments.

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 and cognitive changes that may inform diagnosis under the DSM-5-TR.

Diagnostic Interview

Several features 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 "skip" the related questions if the broad criteria are not met. Criteria are frequently coded as present, subthreshold, or absent. Interviewers are encouraged to use structured diagnostic tools such as the Structured Clinical Interview for DSM-5-TR (SCID-5) or the Mini International Neuropsychiatric Interview (MINI) to increase diagnostic reliability and consistency. Culturally responsive diagnosis can be supported using the Cultural Formulation Interview (CFI) included in the DSM-5-TR.

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 wide 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. When possible, information from significant others or previous providers may be integrated to create a more comprehensive formulation.

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 those involved. Crisis interviewers work under the assumption that individuals in crisis cannot use previously developed coping mechanisms to manage their response to a traumatic event. Crisis interviewers work with clients to restabilize and seek new coping strategies. The trauma-informed approach includes validation of emotional distress, grounding techniques, safety planning, and referrals to longer-term care. The Columbia-Suicide Severity Rating Scale (C-SSRS) may be used to assess immediate risk of harm.

Termination Interview

In clinical terms, 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 accomplished in therapy. They can celebrate the progress made, discuss goals that were not 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. Clinicians may also assess readiness for termination, provide relapse prevention planning, and offer booster session options.

Interdisciplinary Collaboration in Interviews

Clinical interviewing may be part of an interdisciplinary process involving primary care providers, educators, social workers, legal professionals, or rehabilitation specialists, particularly in behavioral medicine, school, and forensic psychology. Interview documentation in this context is prepared with interdisciplinary utility in mind, using clear, jargon-free language and structured summaries when appropriate. Modern technologies like cloud-based electronic health records and artificial intelligence tools aid in the clinical interviewing processes and allow medical professionals to collaborate and update one another on patient status from anywhere.

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