Clinical interview
In the early 20th century, renowned psychologist Jean Piaget was the first clinician to use the terms “clinical” and “interview” together to represent the assessment procedure that is so common today. The clinical interview is an incredibly flexible and effective tool for gathering information. Maybe just as important, it is usually the first meaningful contact a therapist has with their client. Here is what you need to know about this essential assessment tool.
Summary
- The clinical interview, first conceptualized by Jean Piaget, is a fundamental tool in therapy used to gather client information for diagnosis and establish a therapeutic relationship.
- There are three main types of clinical interviews: unstructured (informal and conversational), semi-structured (guided with room for flexibility), and structured (standardized for diagnostic accuracy).
- Unstructured clinical interviews typically cover identifying information, education and work history, social and relationship background, presenting problems, family history, mental and physical health history, substance use, and behavioral observations.
- Structured clinical interviews, like the SCID-5, follow strict guidelines for diagnosing mental disorders, while semi-structured interviews, such as the mental status exam, offer more flexibility while maintaining a standardized approach.
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What is a clinical interview?
The clinical interview has two primary purposes:
- Gather client information to develop a diagnostic impression.
- Establish rapport and form the basis for the therapeutic relationship.
Clinical interviews can be either structured, unstructured, or semi-structured, depending on the therapist’s needs. Although unstructured interviews are almost always conducted during the intake, semi-structured and structured clinical interviews can take place at any point in the therapeutic process. Let’s take a closer look at the three types of clinical interviews.
Unstructured clinical interviews
Unstructured interviews are by far the most common type of clinical interview. Unstructured interviews do not follow a formal set of questions (although you may have your own format for conducting them). Instead, it is more of a conversation between the therapist and the client. However, there is a clear goal. You want to leave an unstructured interview with an initial belief about a client’s diagnosis (and other problems) and start to create the foundation for your therapeutic relationship.
That being said, every clinical interview needs to start with a “getting to know you” phase. You don’t want to begin your relationship with a client by making them feel uneasy right off the bat. You want the client to feel comfortable and establish some rapport before diving into more sensitive topics.
Components of an unstructured clinical interview
What information you want to gather in an interview is up to you. However, it is recommended that you cover the following areas:
Identifying information: Includes name, date of birth, identifying pronouns, etc. Many therapists don’t go over this information in an interview but instead rely on intake paperwork. However, because this is basic information that the client provides to almost everyone, it can be a non-threatening way to start an interview.
Pro Tip: Go over the identifying information in the intake paperwork before meeting with the client and create some follow-up questions that may build rapport. For example, you might mention that you see by their birthdate that they are the same astrological sign as your mother.
Education and work history: Similarly, these are often rudimentary questions that don’t bring up much drama but give you a glimpse into how the client has functioned in work and school environments.
Social and relationship history: Information about past and present relationships gives you a window into the client’s social functioning, usually an essential pillar of mental health. For instance, therapists can explore friendships, romantic relationships, and how the client gets along with work or school colleagues.
Presenting problem: “What brings you into therapy today?” Some therapists ask this question right away but it is usually recommended that you start with a lighter topic to build rapport. But make no mistake, this is the most essential part of the clinical interview. This is why the client is seeking therapy and it needs to be a focus of your treatment.
Family history: Discussing family tends to bring up strong emotions. If family history isn’t the reason for a client seeking therapy, you can be almost sure it has something to do with it. In general, family issues have a strong impact on mental health.
Physical and mental health history: You probably want to save this area until later in the interview. This category contains questions about abuse, trauma, illness, and suicidality, all of which can be highly sensitive topics. It is also essential to get information about past therapy and hospitalizations, both physical and psychiatric.
Drug/alcohol and prescription medication history: This group of questions often flows naturally after you discuss a client’s psychiatric history. Questions about drug and alcohol use are similarly delicate and require a sympathetic hand.
Behavioral observations: While these are not questions for the client, an important aspect of the unstructured clinical interview is what you notice about the client’s behavior. The tone, mannerisms, and body language of the client can provide a wealth of clinical data.
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Semi-structured interviews
Semi-structured clinical interviews are those that have a set format but allow for follow-up and further discussion. They are less conversational than an unstructured interview but still provide the opportunity to establish rapport with the client.
Therapists often develop their own semi-structured interview by taking components of the unstructured interview and molding them into a set template. Therefore, they go through the same format every time they conduct a clinical interview during intake.
The most famous semi-structured interview for mental health is the mental status exam. The mental status exam is given less frequently in outpatient therapy but is popular in institutional and agency settings. Although the questions in a mental status exam are determined beforehand, the clinician has some latitude in exploring areas brought up by the client’s answers.
Structured clinical interviews
Structured clinical interviews are the least flexible type of clinical interview. The interview questions are developed based on research findings and are manualized. As such, all clinicians need to ask the same exact questions in the same format. Therapists may clarify answers but the follow-up is usually minimal. Developing rapport, however, is secondary to the focus of the interview.
Moreover, the questions in the interview are designed for a particular purpose. For example, one of the most popular structured interviews is the SCID-5. The questions in the SCID were developed to provide specific diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). A structured interview is often used when the assessment of a diagnosis is confusing and more accuracy is needed.
Note: Some clinicians may use a structured clinical interview more as a guide, making it semi-structured. However, if you don’t strictly follow the instructions of a structured interview, you are threatening its psychometric properties (i.e., reliability and validity).
The clinical interview is the most popular assessment tool in mental health. Whether it is structured, semi-structured, or unstructured, the clinical interview provides therapists with a breadth of information that fuels the purpose and direction of treatment.
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Resources
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References
Biography. (2021, November 12). Jean Piaget. https://www.biography.com/scientists/jean-piaget
Luvira, V., Nonjui, P., Butsathon, N., Deenok, P., & Aunruean, W. (2023). Family Background Issues as Predictors of Mental Health Problems for University Students. Healthcare, 11(3), 316. https://doi.org/10.3390/healthcare11030316
Sommers-Flanagan, J., Johnson, V. I., & Rides At The Door, M. (2020). Clinical interviewing. In M. Sellbom & J. A. Suhr (Eds.), The Cambridge handbook of clinical assessment and diagnosis (pp. 113–122). Cambridge University Press. https://doi.org/10.1017/9781108235433.010
Sommers-Flanagan, J. & Sommers-Flanagan, R. (2024). Clinical interviewing. (7th ed). John Wiley & Sons, Inc. https://www.wiley.com/en-us/Clinical+Interviewing%2C+7th+Edition-p-9781119981985#evaluation-copy-section
Webber, M., & Fendt-Newlin, M. (2017). A review of social participation interventions for people with mental health problems. Social psychiatry and psychiatric epidemiology, 52(4), 369–380. https://doi.org/10.1007/s00127-017-1372-2
