Highly structured interviews have become the gold standard of diagnostic interviewing, primarily in research but are also increasingly used in the context of routine clinical assessment. Discussions of the foundations of psychiatric interview usually deal with efficacies (sensitivities, specificities) and reliabilities of particular interview approaches. They fail to address more overarching theoretical concerns such as; the adequate manner of obtaining the psycho-diagnostic information. There is an important gap in the psychiatric literature concerning the being and nature of symptoms/signs in psychiatry, and a lack of an adequate epistemiological approach to psycho-diagnostic interviewing that is both theoretically coherent and reflecting practical-clinical reality.

The aim of this presentation is to address the main theoretical and clinical aspects of diagnostic psychopathological interviewing.

For the sake of illustration, we will contrast two types of interviewing: 1) a fully-structured psychiatric interview, conducted by a “for-the-purpose” trained non-clinician and 2) a conversational, phenomenologically oriented, semi-structured interview conducted by an experienced, reliability-trained clinician. Various aspects of the psycho-diagnostic interview such as; individualizing the interview approach to the patient, the characterization of symptom/sign in psychiatry, the knowledge and experience of the interviewer and the implications of converting subjective experiences into words.

The theoretical and clinical aspects of the diagnostic psychopathological interview addressed here, imply that the fully-structured interview is not a suitable and theoretically coherent way of obtaining psycho-diagnostic information, and could result in misdiagnosing.