Structured versus
,
Semistructured versus
Unstructured Interviews
Anne E. Mueller and Daniel L. Segal
University of Colorado at Colorado Springs, U.S.A.
Among mental health professionals, the clinical
interview is the most commonly used method
for evaluating, or assessing, clients (Segal &
Hersen, 2010). The purpose of the clinical
interview is to develop rapport with the client
while obtaining a comprehensive understand-
ing of the client’s symptoms, including relevant
biographical and historical information. This
information is used to make an accurate psy-
chiatric diagnosis, which typically guides the
treatment process. Clinical interviews vary
tremendously in terms of their degree of struc-
ture, ranging from completely unstructured to
entirely structured. This entry reviews three
types of clinical diagnostic interview (unstruc-
tured, semistructured, and fully structured
interviews) and discusses the advantages and
limitations of each.
The Unstructured Interview
The unstructured clinical interview is a ubiqui-
tous, time-honored, and significant contributor
to the diagnostic and treatment processes in
clinical psychology. In a sense, it is like a
free-flowing conversation between the clini-
cian and respondent, and there are no a priori
parameters for the specific topics and rela-
tive depth of conversation. This unstructured
approach provides ample opportunities for
gathering general client information and a
relatively rich description of the client’s expe-
rience (rather than an exclusively stringent
focus on the client’s problems or symp-
toms). The flow, sequence, and content of
this type of interview are largely determined
The Encyclopedia of Clinical Psychology, First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118625392.wbecp069
by the clinician’s theoretical model (e.g.
psychodynamic, cognitive-behavioral, existen-
tial/humanistic, etc.), view of psychopathology,
training, knowledge base, intuitions, and inter-
personal style, as well as by the nature of
the client’s responses. With the unstructured
approach, clinicians are entirely responsible
for determining the specific questions that are
critical to successfully completing the diag-
nostic process. However, a clear advantage
of this relatively unstructured approach is
that it provides extensive opportunities for
empathizing with the client and developing
a strong therapeutic relationship. Another
advantage associated with the unstructured
clinical interview is its inherent flexibility with
respect to topics of discussion, with no a priori
guidelines limiting the boundaries of explo-
ration. The lack of structure in this approach
can be a serious disadvantage, however, as the
clinician may not gather all the information
needed for an accurate diagnosis and useful
case conceptualization.
The Structured Interview
On the other end of the spectrum, structured
interviews conform to a standardized list of
questions (including follow-up questions), a
uniform sequence of questioning, and sys-
tematized ratings of the client’s responses.
The most common types of structured inter-
view are those that focus on the psychiatric
diagnostic process. In structured diagnostic
interviews, the standardized questions are
designed to measure the specific criteria for
mental disorders as defined in the DSM. These
essential elements of structured diagnostic
interviews serve several important purposes.
Most notably, their use increases the cover-
age of many mental disorders that otherwise
might be overlooked in a less standardized
approach, enhances the diagnostician’s ability
to accurately determine whether particular
2 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
symptoms are present or absent, and reduces
variability among interviewers. Taken together,
these elements serve to increase reliability, or
replicability, of diagnosis. This is highly valued
because diagnostic reliability is a prerequisite of
diagnostic validity (discussed further below).
There are two types of structured inter-
view: fully structured and semistructured. In
a fully structured interview, questions are
asked verbatim to the respondent in a spe-
cific predetermined order, the wording of
probes used to follow up on initial ques-
tions is specified, and interviewers are not
to deviate from this format. In contrast, in
a semistructured interview, although initial
questions for each symptom are specified and
are typically asked verbatim to the respondent,
the interviewer has considerable latitude to
follow up on responses. The interviewer can
modify or augment the standard inquiries
with individualized and contextualized probes
to more accurately rate specific psychiatric
symptoms. The amount of structure provided
in an interview clearly impacts the extent
of clinical experience and judgment needed
to administer the interview appropriately:
Semistructured interviews require clinically
experienced examiners to administer the inter-
view and to make diagnoses, whereas fully
structured interviews can often be adminis-
tered by nonclinicians who receive training on
the specific instrument. This latter difference
makes fully structured interviews popular and
economical, especially in large-scale research
studies in which an accurate diagnosis is essen-
tial (e.g., population-based epidemiological
studies to determine the prevalence and inci-
dence of various mental disorders in specific
populations).
Structured and semistructured interviews
have been created to assist with the differential
diagnosis of all major clinical and person-
ality disorders in the DSM system, as they
are specifically designed to assess the formal
diagnostic criteria specified in the manual.
Other structured interviews are narrower in
focus, designed to assess a specific problem or
form of psychopathology in great depth (e.g.,
eating disorders, substance abuse, borderline
personality disorder features, gambling, autism
spectrum disorder). In addition to the purpose
of DSM differential diagnosis, structured
interviews have been developed to assess one’s
competency to stand trial or one’s personality
traits according to the five-factor model of
personality.
Structured and semistructured interviews
have many different uses or applications,
including research, clinical practice, and clin-
ical training. The research domain is the most
common application in which structured and
semistructured interviews are used. Such inter-
views may be used to formally select research
participants based on particular diagnostic
criteria so that etiology, comorbidity, and
treatment approaches can be explored for a
particular diagnosis or group of diagnoses.
Sound empirical research on mental disorders
requires that individuals assigned a diagnosis
truly meet full criteria for that diagnosis, and
thus structured and semistructured interviews
help researchers achieve this need. Structured
interviews also provide a standardized method
for assessing change in psychopathology or
diagnosis over time, which may be especially
relevant in longitudinal studies.
The next most common application for
structured and semistructured interviews is in
clinical settings, where administration of an
interview is used as part of a comprehensive
and standardized intake evaluation. Routine
administration of a structured or semistruc-
tured interview is increasingly common in
psychology training clinics, but doing so
requires considerable training for clinicians
and time for full administration. A variation
on this theme is that sections of a structured or
semistructured interview may be administered
subsequent to a traditional unstructured clin-
ical interview to confirm specific diagnoses.
Finally, use of structured or semistructured
interviews for training mental health profes-
sionals is an increasingly popular and ideal
application because interviewers have the
opportunity to learn (through repeated admin-
istrations) specific questions and follow-up
 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
probes used to elicit information and eval-
uate specific diagnostic criteria provided by
the DSM. Modeling the questions, sequence,
and flow from a structured or semistructured
interview can be an invaluable source of
training for beginning clinicians.
In the mental health field, all diagnos-
tic assessments have relative strengths and
weaknesses, and structured and semistruc-
tured diagnostic interviews are no exception.
Perhaps the most important advantage of
structured and semistructured interviews
centers on their ability to increase diagnos-
tic reliability (which refers to consistency or
agreement about diagnoses assigned by differ-
ent raters). By systemizing and standardizing
the questions interviewers ask and the way
answers to those questions are recorded and
interpreted, structured and semistructured
interviews decrease the amount of information
variance in diagnostic evaluations. That is,
these interviews decrease the chances that
two different interviewers will elicit different
information from the same client, which may
result in different diagnoses and subsequent
treatment. Thus, interrater reliability, or the
likelihood that two different interviewers
examining the same individual will arrive at
the same diagnosis, is greatly increased.
In addition, structured and semistructured
interviews increase the likelihood that the
diagnosis is reliable across time and across
different sources of information. In many
clinical and research settings, individuals are
in fact assessed on different occasions. Using
a structured or semistructured interview for
multiple assessments helps ensure that changes
in a client’s presentation are due to changes
in symptoms rather than variance in inter-
view questions. Likewise, in many settings,
clinicians conduct collateral interviews with
significant people in the client’s life to glean
a broader picture of the client’s symptoms,
problems, and experiences. Using a struc-
tured or semistructured interview for both a
client and a collateral source greatly increases
the chances that discrepancies between the
client and collateral informant reflect veridical
3
differences, rather than consequences of
different interviewing techniques.
Validity of psychiatric diagnosis refers to the
meaningfulness or accuracy of the diagnosis.
Because reliability is a required prerequisite for
validity, by virtue of the fact that structured
and semistructured interviews greatly increase
reliability of diagnosis, they also increase the
likelihood that the diagnosis is valid. Struc-
tured interviews also improve the validity
of diagnoses in other ways. The systematic
construction of structured and semistructured
interviews lends more methodological validity
to these types of assessment as compared to
unstructured approaches. Because structured
and semistructured interviews are designed to
thoroughly and accurately assess well-defined
diagnostic criteria, they are often better assess-
ments of those criteria than unstructured
interviews. Clinicians who use unstructured
interviews may diagnose too quickly, narrow
their diagnostic options prematurely, and miss
comorbid diagnoses. Indeed, it is not uncom-
mon for trainee clinicians or MA/PhD level
students in practicum performing an unstruc-
tured clinical interview to gather information
about the presence or absence of only a few
common mental disorders about which they
are most conversant. Because structured and
semistructured interviews require clinicians to
assess all of the specified criteria for a broad
range of mental disorders, they offer a more
thorough and valid assessment of many dis-
orders compared to unstructured interviews.
Coverage of other disorders may be neglected
during an unstructured interview if the inter-
viewer is unfamiliar with the specific criteria
of some disorders. Because they incorporate
systematic ratings, structured and semistruc-
tured interviews easily provide information
that allows for the determination of the level of
severity and the level of impairment associated
with a particular diagnosis.
A final advantage of structured and semi-
structured interviews is their utility as
training tools for trainee mental health pro-
fessionals and experienced clinicians who
desire to enhance their diagnostic skills.
4 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
Use of such interviews in the training con-
text helps clinicians to develop or enhance
their understanding of the flow, format, and
questions inherent in a comprehensive diag-
nostic interview. Structured interviews can also
be a useful means of training those who make
preliminary mental health assessments—for
example, intake staff at psychiatric hospitals
or mental health clinics—so that clients are
thoroughly and accurately evaluated in prepa-
ration for treatment planning. In the case of
nonclinician interviewers, fully structured
interviews are advisable because they mini-
mize the amount of clinical judgment needed
for accurate administration. Use of these
trained paraprofessionals can make large-scale
research studies cost effective.
The most common criticism of structured
and semistructured interviews is that their
use may damage the rapport or bond between
clinician and client. There is a danger that inter-
viewers may get so concerned with the protocol
of their interview that they fail to demonstrate
the warmth, empathy, and genuine regard nec-
essary to form a therapeutic alliance. However,
proponents of structured interviews note that
the problem of rapport-building during a struc-
tured interview can be overcome with training,
experience, and flexibility. Interviewers must
be aware of the potential negative effects of
structured interviews on rapport building and
make the nurturance of the therapeutic alliance
a prominent goal during an interview, even
when they are also focused on following the
protocol. It behooves those who use structured
and semistructured interviews to engage their
respondents in a meaningful way during the
interview and to avoid a rote-like interviewing
style that may serve to alienate. On the other
hand, not all clients have a negative perception
of a structured interview that must be inten-
tionally overcome. Some clients may prefer the
structured approach to assessment because it
is perceived as thorough and detailed, and in
these cases rapport is easily attained.
Another disadvantage of structured and
semistructured diagnostic interviews is
that they are limited by the validity of the
classification system itself. Because structured
interviews used for diagnosis are inherently
tied to specific diagnostic systems (e.g., the
DSM), they are only as valid as the systems
upon which they are based. One should recog-
nize that DSM diagnostic criteria were devel-
oped to operationalize diagnostic constructs
(e.g., panic disorder, depression, schizophre-
nia) but there is no absolute basis on which cri-
teria were created and no definitive gold stan-
dard for diagnosis (Segal & Coolidge, 2001).
Mental disorders are social constructions that
have evolved over time. Furthermore, the cri-
teria for many mental disorders in the DSM are
impacted by cultural and subcultural variations
in the respondent, as well as by the age of the
respondent. Thus, the accuracy of certain crite-
ria may fluctuate across various editions of the
DSM, thus requiring structured and semistruc-
tured interviews to be continually updated with
newer versions of the DSM. With many signifi-
cant changes in diagnostic criteria coming with
the publication of DSM-5, all of the current
structured and semistructured interviews will
have to be revised in the coming years.
A final criticism of structured and semistruc-
tured interviews centers on the fact that no
one structured interview can be all things in
all situations, covering all disorders and even-
tualities. For example, if a structured interview
has been designed to cover an entire diagnostic
system (like the DSM that identifies over sev-
eral hundred specific disorders), then inquiries
about each disorder must be limited to a few
inclusion criteria. In this case, the fidelity of
the official diagnostic criteria has been com-
promised for the sake of a comprehensive
interview. If the fidelity of the criteria is not
compromised, then the structured interview
becomes unwieldy in terms of time and effort
required for its full administration. Most struc-
tured and semistructured interviews attempt
some kind of compromise between these two
points of tension.
As can be seen, there are meaningful advan-
tages and disadvantages of all forms of clinical
interview. Users of such instruments must
make a choice about which is most useful in
 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
a given situation. It is especially important
to carefully contemplate what is needed in a
particular clinical or research situation before
choosing a structured or semistructured inter-
view. These interviews can be invaluable tools
in both clinical and research work; however,
it is essential that one does not make use of
such tools without accounting for some of
the problems inherent in their use. In certain
situations, unstructured interviews may meet
the objectives of a particular clinical inquiry
more efficiently than a structured interview. In
other cases, greater assurances that diagnoses
assigned are valid and meaningful would take
priority, such as in clinical research or in the
delivery of clearly defined psychotherapeutic
intervention protocols.
Specific Diagnostic Instruments
Fully structured and semistructured diagnostic
interviews can be divided into those that focus
on either clinical disorders or personality dis-
orders.
Diagnostic Instruments Focused
on Clinical Disorders
Anxiety Disorders Interview Schedule
for DSM-IV. The Anxiety Disorders Inter-
view Schedule for DSM-IV (ADIS-IV; Brown,
DiNardo, & Barlow, 1994) is a semistructured
clinician-administered interview designed to
measure current episodes of anxiety disorders
as defined by the DSM-IV. It provides differ-
ential diagnosis among anxiety disorders and
includes sections on mood, somatoform, and
substance-use disorders, as anxiety disorders
are frequently comorbid with such conditions.
Administration typically takes between 45 and
60 min.
Diagnostic Interview Schedule for DSM-IV.
The Diagnostic Interview Schedule for DSM-IV
(DIS-IV; Robins et al., 2000) is designed to
ascertain the presence or absence of the most
common mental disorders in the DSM. It is
unique among the multidisorder diagnos-
tic interviews in that it is a fully structured
interview specifically designed for use by non-
clinician interviewers, whereas all of the other
5
interviews are semistructured. By definition, a
fully structured interview clearly specifies all
questions and probes and does not permit devi-
ations. Due to complex scoring algorithms, the
DIS-IV is typically computer-scored. Adminis-
tration usually takes between 90 and 150 min.
Schedule for Affective Disorders and Schizo-
phrenia. The Schedule for Affective Disorders
and Schizophrenia (SADS; Endicott & Spitzer,
1978) is a semistructured diagnostic inter-
view designed to evaluate a range of Axis I
clinical disorders, with a focus on mood and
psychotic disorders. Ancillary coverage is pro-
vided for anxiety symptoms, substance abuse,
psychosocial treatment history, and antiso-
cial personality features. The SADS provides
in-depth but focused coverage of the mood
and psychotic disorders and also supplies
meaningful distinctions of impairment in the
clinical range for these disorders. The SADS
can be used to make many DSM-IV diagnoses
but it is not completely aligned with the DSM
system, which represents a significant point of
concern. It usually takes between 90 and 150
min to administer the SADS.
Structured Clinical Interview for DSM-IV
Axis I Disorders. The Structured Clini-
cal Interview for DSM-IV Axis I Disorders
(SCID-I; First, Spitzer, Gibbon, & Williams,
1997) is a flexible, semistructured diagnostic
interview designed for use by trained clinicians
to diagnose many adult DSM-IV Axis I clinical
disorders. The SCID-I has widespread popular-
ity as an instrument to obtain reliable and valid
psychiatric diagnoses for clinical, research,
and training purposes, and it has been used in
more than 1,000 studies. Full administration
typically takes between 45 and 90 min.
Diagnostic Instruments Focused
on Personality Disorders
Diagnostic Interview for DSM-IV Person-
ality Disorders. The Diagnostic Interview
for DSM-IV Personality Disorders (DIPD-IV;
Zanarini, Frankenburg, Sickel, & Yong, 1996)
is a semistructured interview designed to
assess the presence or absence of the 10
standard DSM-IV personality disorders as
6 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
well as depressive personality disorder and
passive-aggressive personality disorder in the
DSM-IV appendix. It typically takes about 90
min to administer the DIPD-IV.
International Personality Disorder Examina-
tion. The International Personality Disorder
Examination (IPDE; Loranger, 1999) is an
extensive, semistructured diagnostic interview
administered by experienced clinicians to eval-
uate personality disorders for both the DSM-IV
and ICD-10 classification systems. The IPDE
was designed as a standardized assessment
instrument to measure personality disorders
on a worldwide basis. As such, the IPDE is the
only personality disorder interview based on
worldwide field trials. The IPDE manual con-
tains the interview questions to assess either
the 11 DSM-IV or the 10 ICD-10 personality
disorders. The two IPDE modules (DSM-IV
and ICD-10) contain both a self-administered
screening questionnaire and a semistructured
interview booklet with scoring materials.
Because of the instrument’s ties to the DSM-IV
and ICD-10 classification systems and adop-
tion by the World Health Organization, the
IPDE is widely used for international and
cross-cultural investigations of personality dis-
orders. Administration typically takes about 15
min for the self-administered screen followed
by 90 min for the full interview.
Structured Clinical Interview for DSM-IV
Axis II Personality Disorders. To comple-
ment the Axis I version of the SCID, a version
focusing on Axis II personality disorders
according to DSM-IV has been developed, and
it is called the Structured Clinical Interview
for DSM-IV Axis II Personality Disorders
(SCID-II; First, Gibbon, Spitzer, Williams, &
Benjamin, 1997). The SCID-II has a similar
semistructured format as the SCID Axis I ver-
sion but it covers the 10 standard DSM-IV Axis
II personality disorders, as well as depressive
personality disorder and passive-aggressive
personality disorder. For comprehensive
assessment, the SCID-II may be easily used in
conjunction with the Axis I SCID that would
be administered prior to personality disorder
assessment. Administration typically takes
about 20 min for the self-administered screen
followed by 60 min for the interview portion.
Structured Interview for DSM-IV Personal-
ity. The Structured Interview for DSM-IV
Personality (SIDP-IV; Pfohl, Blum, & Zimmer-
man, 1997) is a comprehensive semistructured
diagnostic interview for DSM-IV personality
disorders. It covers 14 DSM-IV personality
diagnoses, including the 10 standard per-
sonality disorders, self-defeating personality
disorder, depressive personality disorder,
negativistic personality disorder, and mixed
personality disorder. Full administration
typically takes between 60 and 90 min.
It is apparent that structured and semistruc-
tured diagnostic interviews have greatly
facilitated both the objective measurement
of psychiatric symptoms and the accurate
diagnosis of mental disorders in a diverse
range of clinical and research settings. The
unstructured clinical interview is an acceptable
and common alternative to a more structured
interview, especially in situations in which
depth and flexibility are needed. The field’s
recent emphasis on empirically supported psy-
chotherapeutic interventions and processes has
necessitated refinement and use of clinically
relevant, standardized, objective, and validated
assessment procedures. Indeed, structured and
semistructured diagnostic interviews play an
important role in the advancement of the sci-
ence of clinical psychology, and it is expected
that they will continue to evolve as the field of
clinical psychology similarly matures.
SEE ALSO: Clinical Interview; DSM-IV; Evidence-
Based Assessment; Personality Disorders; Struc-
tured Clinical Interview for the DSM (SCID)
References
Brown, T. A., DiNardo, P. A., & Barlow, D. H.
(1994). Anxiety Disorders Interview Schedule for
DSM-IV (ADIS-IV). Albany, NY: Graywind
Publications.
Endicott, J., & Spitzer, R. L. (1978). A diagnostic
interview: “The Schedule for Affective Disorders
and Schizophrenia.” Archives of General
Psychiatry, 35, 837–844.
 STRUCTURED VERSUS SEMISTRUCTURED VERSUS UNSTRUCTURED INTERVIEWS
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J.
B. W., & Benjamin, L. S. (1997). Structured
Clinical Interview for DSM-IV Axis II Personality
Disorders (SCID-II). Washington, DC: American
Psychiatric Press.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,
J. B. W. (1997). Structured Clinical Interview for
DSM-IV Axis I Disorders – Clinician Version
(SCID-CV). Washington, DC: American
Psychiatric Press.
Loranger, A. W. (1999). International Personality
Disorder Examination (IPDE). Odessa, FL:
Psychological Assessment Resources.
Pfohl, B., Blum, N., & Zimmerman, M.
(1997). Structured Interview for DSM-IV
Personality. Washington, DC: American
Psychiatric Press.
Robins, L. N., Cottler, L. B., Bucholz, K. K.,
Compton, W. M., North, C. S., & Rourke, K.
(2000). Diagnostic Interview Schedule for DSM-IV
View publication stats
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(DIS-IV). St. Louis, MO: Washington University
School of Medicine.
Segal, D. L., & Coolidge, F. L. (2001). Diagnosis and
classification. In M. Hersen & V. B. Van Hasselt
(Eds.), Advanced abnormal psychology (2nd ed.,
pp. 5–22). New York: Kluwer Academic/Plenum.
Segal, D.L., & Hersen, M. (Eds.). (2010). Diagnostic
interviewing (4th ed.). New York: Springer.
Zanarini, M. C., Frankenburg, F.R., Sickel, A.E., &
Yong, L. (1996). The Diagnostic Interview for
DSM-IV Personality Disorders (DIPD-IV).
Belmont, MA: McLean Hospital.
Further Reading
Hunsley, J., & Mash, E. J. (Eds.). (2008). A guide to
assessments that work. New York: Oxford
University Press.
Rogers, R. (2001). Handbook of diagnostic and
structured interviewing. New York: Guilford
Press.