PRAGMATICS OF THE INTERVIEW electric cords.

• The interviewer encounters quite a few

decisions long before the client arrives for Confidentiality
the interview. Many of these decisions
• there are some situations that require the
involve the setting in which the interview
psychologist to break confidentiality.
will take place and the professional
These situations are typically defined by
behaviors the interviewer plans to use
state law and often involve the
during the interview itself.
psychologist discovering during a session
Note Taking that the client intends to seriously harm
someone (self or others) or that ongoing
• There are good reasons for taking notes.
child abuse is occurring.
Written notes are certainly more reliable
• interviewers should routinely explain
than the interviewer’s memory. Many
policies regarding confidentiality as early
clients will expect the interviewer to take
as possible. Such explanations should be
notes and may feel as though their words
consistent with state law and professional
will soon be forgotten if the interviewer is
ethics and provided in writing, with ample
not taking notes.
opportunity for oral discussion offered as
• It is likely that the effect of note taking is
well.
highly dependent on the particular
situation, including exactly how a client
interprets the use of any particular mode
TYPES OF INTERVIEWS
of note taking and exactly how an
interviewer uses that mode. • different forms according to the demands
of the situation, which may depend on the
setting, the client’s presenting problem,
Audio and Video Recordings and the issues the interview is intended to
address. In actual practice, there are
• Clinical psychologists may prefer to audio-
countless unique, idiosyncratic varieties of
or video-record the session. recording a
interviews, but most fall into a few broad
client’s interview requires that the
categories: intake interviews, diagnostic
interviewer obtain written permission
interviews, mental status exams, and crisis
from the client.
interviews.

The Interview Room

Intake Interviews
• the most preferred offices were the ones
• interview determines whether the client
that were orderly rather than messy, and
needs treatment; if so, what form of
“soft” (with comfortable seats, decorative
treatment is needed (inpatient,
rugs, muted lighting, art, and plants)
outpatient, specialized provider, etc.); and
rather than “hard” (sparsely furnished,
whether the current facility can provide
institutional, or overly modern).
that treatment or the client should be
Additionally, more spacious, uncluttered
referred to a more suitable facility.
offices were rated more positively than
• typically involve detailed questioning
offices that were cramped and featured
about the presenting complaint.
disordered piles of papers and tangles of
 • Follow-up questions are also pre-defined,
with a limited range of allowable probes
Diagnostic Interviews
to clarify patient responses, which are also
• to diagnose specified.
• interviewer is able to confidently and • Example: "Have you been feeling restless
accurately assign Diagnostic and Statistical or slowed down?"
Manual of Mental Disorders (DSM) "Are you experiencing any feelings of
diagnoses to the client’s problems. worthlessness or excessive or
• some clinical psychologists prefer inappropriate guilt?"
structured interviews, while others prefer
unstructured interviews.

Unstructured Interview

• unstructured interview, in contrast,

Structured Interviews
involves no predetermined or planned
• A structured interview is a predetermined, questions. In unstructured interviews,
planned sequence of questions that an interviewers improvise: They determine
interviewer asks a client. Structured their questions on the spot, seeking
interviews are constructed for particular information that they decide is relevant
purposes, usually diagnostic. during the course of the interview.
• Structured interviews tend to be highly • In actual practice, quite a few clinical
reliable, in that two interviewers using the psychologists blend these approaches to
same structured interview will come to conduct an interview that may be labeled
the same diagnostic conclusions as a partially structured or semistructured
• produce a diagnosis based explicitly on interview
DSM criteria, reducing reliance on • The interviewer starts with broad, open-
subjective factors such as the ended questions and allows the
interviewer’s clinical judgment and conversation to flow more naturally.
inference, which can be biased or • The interviewer uses their clinical
otherwise flawed. judgment and experience to guide the
• The interviewer reads questions from a interview.
standardized manual verbatim. • Follow-up questions are based on the
• Questions are pre-determined and cover patient's responses, with the ability to
specific diagnostic criteria for Major explore topics in greater depth as needed.
Depressive Disorder (MDD) and other • The interviewer might cover the same
related disorders (e.g., anxiety disorders, general areas as a structured interview
other mood disorders). (mood, sleep, appetite, etc.) but has the
• The interviewer uses specific rating scales freedom to adjust the order, wording, and
(e.g., "In the past two weeks, have you felt depth of questions based on the patient's
sad or down most of the day, nearly every individual presentation.
day?" – patient response might be rated • Tell me about what brings you in today."
as "absent," "mild," "moderate," or (This allows the patient to share their
"severe"). primary concerns in their own words.)
 • "How have you been feeling lately?" (This but also to provide immediate and
can lead to a discussion of mood, energy effective intervention for that problem
levels, and other symptoms.) • can be conducted in person but also take
place often on the telephone via suicide
hotlines, crisis lines, and similar services.
Mental Status Exam • When interviewing an actively suicidal
person, five specific issues should be
• The mental status exam is employed most
assessed (adapted from Sommers-
often in medical settings. Its primary
Flanagan & Sommers-Flanagan, 2009):
purpose is to quickly assess how the client
is functioning at the time of the
evaluation.
• Instead, its yield is usually a brief
paragraph that captures the psychological
and cognitive processes of an individual
“right now”—like a psychological snapshot
• The format of the mental status exam is
not completely standardized, so it may be
administered differently by various health
professionals.
• Categories: Appearance,
Behavior/psychomotor activity, Attitude
toward interviewer, Affect and mood, CULTURAL COMPONENTS
Speech and thought, Perceptual
Appreciating the Cultural Context - Behaviors,
disturbances, Orientation to person, place,
thoughts, or emotions that might be viewed as
and time, Memory and intelligence,
abnormal or pathological by some cultural
Reliability, judgment, and insight
standards may in fact be normal according to
• The mental status exam is not intended as
others, and interviewers should be careful not to
a meticulous, comprehensive diagnostic
overpathologize by imposing their own cultural
tool. Instead, it is intended for brief,
values.
flexible administration, primarily in
hospitals and medical centers, requiring • Clinical psychologists should make efforts,
no manual or other accompanying in interviews and other interactions with
materials. clients, to appreciate clients from a
perspective that takes into account the
clients’ own cultures. Clinical psychologists
Crisis Interviews also make adaptations to cultural
expectations or norms when conducting
• a special type of clinical interview and can
the interview, such as perhaps including a
be uniquely challenging for the
bit more small talk with a member of a
interviewer.
culture where its absence is likely to
• designed not only to assess a problem
hinder rapport, or consulting with
demanding urgent attention (most often,
professionals who know the culture well
clients actively considering suicide or
another act of harm toward self or others)
Acknowledging Cultural Differences - Open,
respectful discussion of cultural variables can
enhance rapport, increase the client’s willingness
to share information, and help the interviewer
gain a more accurate understanding of the client’s
issues (Sommers-Flanagan & Sommers-Flanagan,
2009).

• Without it, the interview process—and

the assessment process more broadly—
can prove invalid and can lead to culturally
insensitive treatment (Ridley, Tracy, Pruitt-
Stephens, Wimsatt, & Beard, 2008).