Appendix

Suggested Diagnostic
Interview Format

DEMOGRAPHIC DATA

Name, age, gender, ethnic and racial background, religious orientation, relationship status, parental status, level of education attained, employment status, previous experience with psychotherapy, source of referral, informants other than client.

CURRENT PROBLEMS AND THEIR ONSET

Chief complaints and the client’s ideas about their origins; history of these problems; how they have been addressed so far, including medications; why therapy is being sought now.

PERSONAL HISTORY

Where born, reared, number of children in family and client’s place among them; major moves. Parents and siblings: Get objective data (whether alive, cause and time of death if not; age, health, occupation) and subjective data (personality, nature of relationship with patient). Psychological problems in family (diagnosed psychopathology and other conditions; e.g., substance use disorder, violence, boundary violations).

Infancy and Toddlerhood

Whether patient was wanted; family conditions after birth; anything unusual in developmental milestones; any early problems (eating, bowel control, talking, locomoting, bedwetting, night terrors, sleepwalking, nailbiting, etc.); earliest memories; family stories or jokes about the client; the story of the client’s name.

Latency

Separation problems, social problems, academic problems, behavioral problems, cruelty to animals; illnesses, losses, moves, or family stresses at this time; sexual, physical, or emotional abuse or witnessing of domestic violence.

Adolescence

Age of puberty, any physical problems with sexual maturation, family preparation for sexuality, first sexual experiences, sexual preference (masturbation fantasies if this is uncertain); school experience, academically and socially; patterns of self-destructiveness (eating disorders, drug use, questionable sexual judgment, excessive risk-taking, suicidal tendencies, antisocial patterns; social withdrawal); illnesses, losses, moves or family stresses at this time.

Adulthood

Work history; relationship history; adequacy of current intimate relationship; relationship to children; hobbies, talents, pleasures, areas of pride and satisfaction, aspirations (where does the person hope to be in 5 years, 10 years, etc.).

CURRENT PRESENTATION (MENTAL STATUS)

General appearance, affective state, mood, quality of speech, soundness of reality testing, estimated intelligence, adequacy of memory; assess reliability of information. Pursue further investigation into any of these areas that suggest problems; for example, if mood is depressed, assess suicide. If it feels difficult to get a linear history, assess for depersonalization, derealization, and other dissociative reactions.

Dreams: Are they remembered? Any recurrent? Example of a recent dream.

Substance use, prescribed or otherwise, including alcohol.

CONCLUDING TOPICS

Ask the patient if he or she can think of any important information that your questions have not touched on. Ask whether the patient is comfortable with you and whether he or she has anything to ask.

INFERENCES

Major recurring themes; attachment pattern; areas of developmental arrest and internal conflict; favored defenses; inferred unconscious fantasies, wishes, fears, beliefs; central identifications, counteridentifications, unmourned losses; self-cohesion and self-esteem.