purposes of the interview. However, it is important
to remember that a considerable amount of research
on interviewing has been carried out. Practically,
this means that novices do not need to rely solely
on the slow and sometimes painful accumulation of
experience to polish their skill. They can profit
from the study of a considerable body of research
on interviewing that provides a scientific founda-
tion for their art (Garb, 1998).
Interviewing Essentials and Techniques
Many factors influence the productivity and utility
of data obtained from interviews. Some involve the
physical setting. Others are related to the nature of
the patient. A mute or uncommunicative patient
may not cooperate regardless of the level of the
interviewer’s skills. Few interviewers are effectiveBOX6-1 Computer Interviewing: Are Clinicians Necessary?In recent years, use ofcomputer interviewinghas been
growing. Computers have been used to take psychiatric
histories, cover assessment of specific problems, do
behavioral assessments, and assist in the diagnosis of
mental disorders (First, 1994; Greist, 1998; Kobak, Greist,
Jefferson, & Katzelnick, 1996). These uses of the com-
puter are said to have several advantages (Erdman,
Klein, & Greist, 1985; First, 1994; Greist, 1998). For
example, the computer always asks all the questions
assigned, reliability is 100%, and for some patients at
least, it is less uncomfortable and embarrassing to deal
with an inanimate object than a live clinician. At the same
time, computers are impersonal and, some might even
say, dehumanizing. Then, too, only structured interviews
can be employed; interviewer flexibility is not possible
(First, 1994). For example, it is not possible to ask addi-
tional questions aimed at clarification when an intervie-
wee’s response is unclear. Also, the wording and order of
questions cannot be tailored to meet the special needs of
individual patients. Still, computer interviews have been
shown to be useful in identifying target symptoms in cli-
ents (Farrell, Complair, & McCullough, 1987).
There are computerized versions of diagnostic
interviews as well. For example, the Computerized
Diagnostic Interview Schedule Revised (Blouin, 1991),
or CDISR, can be administered by a personal computer,
and it assesses the presence and severity of symptoms
related to more than 30 Axis I mental disorder diag-
noses (e.g., major depression, alcohol dependence,
panic disorder). Studies comparing computer-
administered and interviewer-administered versions of
the DIS have been supportive (Blouin, Perez, & Blouin,
1988; Greist et al., 1987).
Finally, it is interesting to note that the use of
computer-assisted interviews has been taken a step
further. Recently, Baer et al. (1995) reported prelimi-
nary data on a fully automated telephone screening
system that uses computerized digital voice recordings
and touch-tone responses to assess communityresidents for symptoms of depression. In this study, a
screening test was offered to community residents.
When the toll-free number was called, a series of
questions about a variety of depressive symptoms was
administered to each caller. Callers answered the
questions by selecting specified numbers on the
telephone keypad, and there was an option to have
the question repeated. All text was narrated by a
professional actress and actor. Immediate feedback
regarding the level of depression (no depression,
minimal or mild depression, severe or extreme depres-
sion) was provided to each caller. Toll-free telephone
numbers of selected health care professionals were
provided to all callers whose responses indicated at
least minimal levels of depression.
Do these new computer applications mean the
clinician will soon be obsolete? First (1994), for one,
thinks not. Although he acknowledges the various
advantages of computer-assisted interview assess-
ments, he cites several reasons the computer cannot
currently replace the clinician:
■ Many nonverbal cues (e.g., facial expressions and
vocal inflections) are not currently amenable to
computer-based assessment.
■ We do not currently have computer-based tech-
nology that can process unrestricted language
(i.e., free-form patient responses that are typed or
submitted in response to computer queries).
■ Only clinicians can encode and process informa-
tion relevant to the course of a mental disorder or
temporal sequencing of symptoms.
■ Only clinicians are able toapply“clinical judgment”—
the implicit threshold of clinical significance.
However, it is important to note that technologi-
cal advances may someday make several of First’s
points moot, and as we will discuss in Chapter 10,
clinical judgment has its limitations as well.166 CHAPTER 6