Structured and Semistructured Interviews

Structured and Semistructured Interviews

Diagnostic interviewing is one of cornerstones of modern clinical psychology. The earliest forms of interviewing typically involved a free-flowing, unstandardized format in which professionals relied on their clinical acumen to generate appropriate questions. As the field progressed, standardization of clinical diagnosis was emphasized, a concept marked by the publication of the first Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1952). Since that time, the DSM has gone through many revisions, and with its growth and development structured and semistructured interviews have also evolved, mirroring the DSM criteria.

The inherent nature of an unstructured interview leaves the type of questions and manner in which questions are asked to the discretion of the professional, which can be influenced by the professional's theoretical orientation, training, mood, and interaction with the patient. With the advent of structured interviews, several limitations of the unstructured interview were addressed. The structured interview provides a standardized method for asking and answering questions and recording and interpreting responses. As a consequence, variability and inconsistency across professionals are decreased (Rogers, 2001; Segal & Coolidge, 2003). Improvement of diagnostic consistency has helped make the structured interview a useful tool not only in clinical practice but also in clinical research and training of professionals (Rogers, 2001).

In the past few decades, there has been a proliferation of structured interviews, and a number of important differences between instruments have emerged. First, the structured interview can vary in the stringency of the user's ability to deviate from the interview protocol. The most strict is a fully structured interview, which requires that all questions be asked as written, allowing few or no deviations from the interview format. Alternatively, a semistructured interview is less strict, typically beginning with standard questions but allowing optional probes or follow-up questions from the interviewer. Second, structured interviews vary in the content and depth of coverage. For example, some instruments may include most clinical (Axis I) or personality (Axis II) disorders, whereas others focus on a specific subset of disorders, such as anxiety or mood disorders, but with greater depth. Structured interviews have also been developed to assess specific areas of clinical interest (e.g., malingering, the [Page 25]five-factor model of personality). Third, the ease of use for the interviewer, the level of training needed to administer the measure, and the psychometric properties also differ between the different structured interviews.

Although there are advantages of structured interviews, critics of these instruments point out that their use can damage rapport, particularly in the context of a therapeutic relationship (Rogers, 2001; Rubinson & Asnis, 1989). Furthermore, a structured interview is only as valid as the diagnostic criteria on which it is based. Many researchers have argued that the DSM criteria should not be the sole determinant of diagnoses or be used as a substitute for clinical expertise (First, Frances, & Pincus, 2004). A structured interview can also limit the depth and breadth of coverage of particular diagnostic or clinical issues (Rogers, 2001; Rubinson & Asnis, 1989). Although there are advantages and disadvantages of relying solely on a structured interview, the interviewer is not prohibited from following up with individualized or unstructured questions (i.e., before or after the structured interview is completed).

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