Diagnostic Interviewing

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Structured and semistructured diagnostic interviews consist of a systematic series of specific questions to evaluate clients' diagnosis-related behavior patterns, thoughts, and feelings. Many published diagnostic interviewing procedures exist, most of which are based on the DSM-III-R or DSM-IV diagnostic criteria. The determination of an appropriate diagnostic label is the primary or exclusive goal of these procedures. Diagnostic interviews can be administered by counselors, social workers, psychologists, physicians, or technicians with specific training in administering a particular diagnostic interview (R. Rogers, 2001; Vacc & Juhnke, 1997). In some cases, the training required for an individual to administer a particular diagnostic interview is rather extensive (Kronenberger & Meyer, 1996). Specific diagnostic interviews are usually aimed at either adult or child client populations.

Adult Diagnostic Interviewing

Numerous adult diagnostic interviewing schedules exist. Some schedules are broad spectrum, in that they assess for a wide range of DSM-IV-TR disorders (e.g., Struc tured Clinical Interview for Axis I DSM-IV Disorders; First, Spitzer, Gibbon, & Williams, 1995). Other schedules are more specific and circumscribed in their goals; for example, some structured and semistructured interview schedules evaluate specifically for substance disorders (Psychiatric Research Interview for Substance and Mental Disorders; Hasin et al., 1998), anxiety disorders (Anxiety Disorders Interview Schedule; T. Brown, Atony, & Barlow, 1995), depressive disorders (Diagnostic Interview for Depressive Personality; Gunderson, Phillips, Triebwaser, & Hirschfeld, 1994), and more. Common adult diagnostic interviews are reviewed and described by Vacc and Juhnke (1997), Kronenberger and Meyer (1996), and R. Rogers, (2001).

Child Diagnostic Interviewing

There are also numerous child diagnostic interviewing schedules. Again, these can be classified as either broad spectrum (e.g., The Child Assessment Schedule; Hodges, 1985) or circumscribed (e.g., Anxiety Disorders Interview Schedule for Children; W. Silverman, 1987). Common diagnostic interviews for children and adolescents also are reviewed and briefly described in recent publications (Kronenberger & Meyer, 1996; R. Rogers, 2001; Vacc & Juhnke, 1997).

Advantages Associated with Structured Diagnostic Interviewing Advantages associated with structured diagnostic interviewing include the following:

1. Structured diagnostic interview schedules are standardized and straightforward to administer. Technicians can ask clients specific diagnostic-relevant questions.

2. Diagnostic interview schedules generally produce a DSM-III-R or DSM-IV-TR diagnosis, consequently relieving clinicians of subjectively weighing many alternative diagnoses.

3. Diagnostic interview schedules generally exhibit greater interrater reliability than clinical interviewers functioning without such schedules. This means that two interviewers using the same structured interview protocol come up with the same diagnosis for the same client more often than two interviewers who are relying on less structured diagnostic interview procedures.

4. Diagnostic interviews are well-suited for scientific research. It is imperative that researchers obtain valid and reliable diagnoses to effectively study the nature, course, prognosis, and treatment responsiveness of particular disorders.

Disadvantages Associated with Diagnostic Interviewing

There are also numerous disadvantages are associated with diagnostic interviewing:

1. Many diagnostic interviews require considerable time for administration. For example, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS or K-SADS; Puig-Antich, Chambers, & Tabrizi, 1983) may take one to four hours to administer, depending on whether both parent and child are interviewed. Most diagnostic interviews require training for therapists who use them, which makes them even more time-consuming.

2. Diagnostic interviews do not allow experienced diagnosticians to take shortcuts. This is cumbersome because experts in psychiatric diagnosis require far less information to accurately diagnose clients than beginning interviewers (Schmidt, Norman, & Boshuizen, 1990).

3. Some clinicians complain that diagnostic interviews are too structured and rigid, deemphasizing rapport-building and basic interpersonal communication between client and therapist (Bögels, 1994). Extensive structure and rigor may not be acceptable for practitioners who prefer relying on their intuition and relationship development for establishing treatment procedures.

4. Although structured diagnostic interviews have demonstrated reliability, some clinicians question their validity. For example, there are no interview schedules that assess for every DSM-IV-TR diagnostic label available. Diagnostic interviews must leave out important information about client personal history, personality style, and more (Bögels, 1994). Therefore, critics contend that two different interviewers may administer the same interview schedule and consistently come up with the same incorrect or inadequate diagnosis.

Because of the preceding disadvantages, formal diagnostic interviewing procedures are rarely used in actual clinical practice (Kronenberger & Meyer, 1996). Given their time-intensive requirements in combination with mental health provider needs for time-efficient evaluation and treatment, it is not surprising that diagnostic interviewing procedures are underutilized and sometimes unutilized in clinical practice. In reality, researchers and academicians studying the prevalence, course, prognosis, and treatment of mental disorders use these procedures almost exclusively.

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