Clinical Psychology

patient may arrive at different diagnostic formula-
tions. Research on the reliability of diagnoses using
unstructured clinical interviews has not supported
this approach (e.g., Matarazzo, 1983; Ward, Beck,
Mendelson, Mock, & Erbauch, 1962).
Fortunately, things have changed. Researchers
have developed structured diagnostic interviews that

can be used by clinical psychologists in their research

or clinical work. A structured diagnostic interview

consists of a standard set of questions and follow-up

probes that are asked in a specified sequence. The

use of structured diagnostic interviews ensures that

all patients or subjects are asked the same questions.

This makes it more likely that two clinicians who

BOX6-3 Clinical Psychologist Perspective: Thomas A. Widiger, Ph.D. (Continued)

Oneofthemajorinnovationsofthethirdedi-

tion of the American Psychiatric Association’s (1980)

Diagnostic and Statistical Manual of Mental Disor-

ders (DSM-III)was the provision of relatively specific

and explicit criteria sets to facilitate the obtainment

of reliable clinical diagnoses. Prior toDSM-III,clinical

diagnoses were so unreliable that there was no

doubt that they lacked validity. If two clinicians

provided different diagnoses, it is highly unlikely

that both of them were correct. The relatively spe-

cific and explicit criteria sets inDSM-IIIhave led to

the obtainment of reliable diagnoses within

research, which has in turn led to highly informative

(and replicated) researchconcerning etiology,

pathology, and treatment.

However, research has also indicated that unre-

liable diagnoses continue to be provided within

applied clinical settings, largely because of the fail-

ure to conduct systematic and comprehensive

assessments of the diagnostic criteria sets. There will

be instances in which there are valid reasons for not

adhering to theDSM,but any such deviation should

at least be acknowledged and documented.

Unstructured clinical assessments in routine clinical

practice do tend to be unsystematic, idiosyncratic,

and unreliable. As a result, they fail to correlate

meaningfully with external validators (that is, with

valid indicators of etiology, pathology, and treat-

ment); they often correlate with indicators of gen-

der, ethnic, and other biased expectations or

assumptions; and they often lack credibility when

critiqued by an external review.

Semi-structured clinical interviews offer many

advantages and benefits. They ensure that the inter-

view will be systematic, comprehensive, and replicable.

They minimize the occurrence of idiosyncratic biases

and assumptions. They provide inquiries and probes

that have been shown empirically to generate useful

information. Reliable and valid diagnoses within clini-

cal practice will be obtained if the interview is

systematic, comprehensive, and objective. Semi-

structured interviews should be used in forensic, dis-

ability, and other formal assessments and should be

part of initial intake assessments (along with self-

report screening inventories). This is not to say that

semi-structured interviews do not have limitations.

They can be problematic to establishing rapport,

and they will at times be superficial and inappropri-

ately constraining. However, semi-structured inter-

viewing can be incorporated into a clinical practice

without suffering serious costs. Most graduate pro-

grams in clinical psychology devote a year of training

to assessment. In the early years of the profession,

none of this time appeared to be given to the impor-

tance of objective, systematic, and comprehensive

clinical interviewing. However, this does appear to be

changing. I do expect the assessment training of grad-

uate students in clinical psychology in the future to

give more attention to the value and techniques of

semi-structured clinical interviews.

Thomas A. Widiger

Psychology Dept., Univ. of Kentucky

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