design to address the validity issue; however, this speaks
more to the stability or reliability of interview scores
than to the validity of the measure. Of course, we
would expect that a valid measure would also be reli-
able. But the test–retest design does not directly address
the validity question.
These points are well taken. We must realize
that no infallible criterion measure exists for com-
parison purposes. In these situations, we conduct
multiple validity studies using a variety of criterion
measures. Our confidence in the validity of our
structured interview will increase as a function of
the number of times we find that scores from our
measure are highly associated with scores from
alternative measures of the same or similar con-
structs and are not significantly related to scores
from measures of constructs that, theoretically,
should be unrelated to the diagnosis in question.
Suggestions for Improving Reliability and Validity
The following suggestions summarize some of the
previous discussion; they should help improve both
the reliability and validity of interviews.
- Whenever possible, use a structured interview.
A wide variety of structured interviews exist for
conducting intake-admission, case-history,
mental status examination, crisis, and diagnostic
interviews. - If a structured interview does not exist for your
purpose, consider developing one. Generate a
standard set of questions to be used, develop a
set of guidelines to score respondents’answers,
administer this interview to a representative
sample of subjects, and use the feedback from
subjects and interviewers to modify the inter-
view. If nothing else, completing this process
will help you better understand what it is that
you are attempting to assess and will help you
become a better interviewer. - Whether you are using a structured interview
or not, certain interviewing skills are essential:
establishing rapport, being an effective com-
municator, being a good listener, knowing
when and how to ask additional questions, and
being a good observer of nonverbal behavior.- Be aware of the patient’s motives and expec-
tancies with regard to the interview. For
example, how strong are his or her needs for
approval or social desirability? - Be aware of your own expectations, biases, and
cultural values. Periodically, have someone else
assess the reliability of the interviews you
administer and score.
The Art and Science of Interviewing
Becoming a skilled interviewer requires practice.
Without the opportunity to conduct real inter-
views, to make mistakes, or to discuss techniques
and strategies with more experienced interviewers,
a simple awareness of scientific investigations of
interviewing will not confer great skill. What,
then, are the functions of research on interviewing?
A major one is to make clinicians more humble
regarding their“intuitive skills.”Research suggests,
for example, that prior expectancies can color the
interviewer’s observations, that implicit theories of
personality and psychopathology can influence
the focus of an interview, and that the match or
mismatch of interviewer and interviewee in terms
of race, age, and gender may influence the course
and outcome of the interview. Thus, a number of
influences on the interview process have been
identified.
Furthermore, if we never test our hypotheses, if
we never assess the validity of our diagnoses, if we
never check our reliability against someone else, or
if we never measure the efficacy of a specific inter-
view technique, then we can easily develop an
ill-placed confidence that will ultimately be hard
on our patients. It may be true, as some cynics
argue, that 10 studies, all purporting to show that
“mm-hmm”is no more effective than a nod of the
head in expressing interviewer interest, still fail to
disprove that in one specific or unique clinical
interaction there may indeed be a difference. But188 CHAPTER 6