Participants were recruited among training institutions for post-graduate psychotherapy training in Germany (for further information see Procedure). Figure 1 shows participant flow.

The final sample for analysis consisted of N = 233 psychotherapy trainees. The mean age was M = 31.05 years (SD = 5.72). On average, participants were enrolled for M = 3.05 (SD = 2.02) years into their current training program and had M = 3.96 (SD = 3.39) years of experience in working with patients, with six participants reporting no prior patient experience. For further participant information see Table 1.

At the beginning, the survey explained the term “structured diagnostic interview” and gave examples of common interview schedules (see Supplement 1). Subsequently, participants were asked about the context in which they learned or practiced SDIs, the total number of SDIs conducted, their familiarity with SDIs (1 = “not at all familiar” to 9 = “very familiar”), and their overall satisfaction with SDIs (0 = “not at all satisfied” to 100 = “totally satisfied”). The latter rating was adapted from the Interviewer Acceptance Questionnaire (Suppiger et al., 2009). Furthermore, participants rated their current frequency of use of different diagnostic information and methods to assess diagnoses during patient encounters (1 = “never” to 9 = “always”), and their estimated use of SDIs for diagnosing patients after completing training (1 = “never” to 9 = “always”).

The therapist version of the Patient Acceptance Questionnaire (PAQ, Bruchmüller et al., 2011; Suppiger et al., 2009) was included to measure participants’ estimation of patients’ SDI satisfaction and acceptance. First, participants estimated patients’ overall SDI satisfaction (0 = “not at all satisfied” to 100 = “totally satisfied”). Second, ten single items assessed participants’ estimate of patients’ acceptance. The single items include both positive (e.g., “In an SDI patients feel that the interviewer takes their problems seriously”) and negative statements (e.g., “Patients find SDIs exhausting”). Participants rated their endorsement of each item on a four-point scale (0 = “does not apply at all”, 1 = “somewhat applies”, 2 = “quite completely applies”, 3 = “completely applies”).

Additionally, participants rated their agreement to six positive and nine negative beliefs about SDIs (see Supplement 2). Eleven items (e.g., “SDIs help not to overlook anything”, “SDIs take too long”) were adapted from Bruchmüller et al. (2011). The first author formulated four additional items (e.g., “SDIs help to broaden one’s own diagnostic competence”, “Learning SDIs takes too much time”) based on feedback from participants of a psychotherapy training course. Participants rated their agreement to the presented beliefs on a nine-point scale (1 = “I totally disagree” to 9 = “I totally agree”). In addition, participants could provide further statements on SDIs.

Participants’ personality factors were measured using the German short version of the Big Five Inventory (BFI-K, Rammstedt & John, 2005). Based on the five-factor model of personality, the BFI-K contains the scales extraversion, agreeableness, conscientiousness, neuroticism, and openness. It consists of 21 items which participants rate on a five-point scale (1 = “strongly disagree” to 5 = “strongly agree”). The BFI-K has sufficient validity and reliability across different samples (Kovaleva et al., 2013; Rammstedt & John, 2005).

Finally, participants’ demographic information, including age, gender, previous study courses, and information on their current training program were assessed. Additionally, participants rated their adherence to different psychotherapeutic orientations (psychodynamic/ analytic, cognitive/ behavioral, and systemic psychotherapy) on a nine-point scale (1 = “not at all” to 9 = “very strongly”). These orientations were chosen because they are offered by state-approved post-graduate training institutes in Germany.

The survey included two instructed response items to check for careless responding. In the first item, participants were instructed to choose the option “slight agreement” on a five-point rating scale (“strong disagreement”, “slight disagreement”, “neutral”, “slight agreement”, “strong agreement”). The second item used a multiple-choice format with four options numbered 1 to 4, where participants were instructed to choose “Option 4”.

The data were collected between February and June 2023. The online survey was created using SoSci Survey (Leiner, 2024) and was made available on http://www.soscisurvey.de. The link to the survey was sent via e-mail to 172 state-approved training institutions for post-graduate psychotherapy training in Germany from all four major psychotherapeutic orientations (behavioral, psychodynamic, psychoanalytic, and systemic psychotherapy). Institutions were contacted either directly through the contact information on their website or through a mailing list. Contact persons were asked to disseminate the information and link to the survey among the institutions’ current psychotherapy trainees. Upon accessing the link, participants received participant information and actively consented to survey participation. Participants could enter a personal e-mail address for a chance to win one of five 20€ online vouchers after survey completion. E-mail addresses were saved separately from participants’ survey data to ensure anonymity.

All analyses were performed using IBM SPSS Statistics (Version 28). The main analyses were preregistered at AsPredicted (https://aspredicted.org/N3F_9T3). Secondary analyses as well as descriptive analyses regarding a further student sample, as described in the pre-registration, will not be reported in the present manuscript. Due to the composition of the sample and the results of the correlational analyses, the pre-registered test of regression and mediation models concerning personality factors and adherence to orientation were not computed. Only the results from exploratory correlational analyses are reported (see Results).

Significance level was set at α = .05 for all analyses. A two-tailed test of correlation between SDI familiarity and overall SDI satisfaction was computed. Additionally, a multiple linear regression model of overall SDI satisfaction on the agreement to 15 beliefs about SDIs was computed. All predictors were entered in a single step. A priori power analysis using G*Power (Faul et al., 2009) indicated that a minimum of N = 143 participants was needed for the regression analysis to detect a medium effect with power = .80. Small to moderate intercorrelations were observed between predictors, but mean VIF = 1.75 indicated no multicollinearity (see Supplement 3). Exploratory correlations between overall SDI satisfaction, the BFI-K subscales (Rammstedt & John, 2005), and the ratings of adherence to psychotherapeutic orientations were computed. Due to the negatively skewed distribution for the cognitive/behavioral and the positively skewed distribution of the psychoanalytic/psychodynamic orientation ratings, non-parametric Kendall’s Tau C correlations are reported.

The answers to the open question about further beliefs about SDIs were categorized by the first author. First, specific entries were categorized into positive and negative arguments. Second, specific topics were identified. The most frequent topics for both positive and negative arguments, along with examples of participant entries are reported.

Participants commonly reported treatment of outpatients (70%) as a context for SDI encounters, followed by courses during their master’s program and training (67.4%), treatment of inpatients (50.6%), and research (28.3%). The estimated number of SDIs conducted by psychotherapy trainees ranged from zero to 200 interviews. Most trainees (42.1%) conducted 10 or fewer SDIs, with 13 participants reporting that they had never conducted an SDI before. The majority (66.5%) of participants stated that conducting SDIs was mandatory during their training program.

On average, trainees reported a medium level of overall SDI satisfaction (M = 60.43, SD = 20.83, range: 0 – 100) and endorsed a moderate level of SDI familiarity (M = 6.03, SD = 1.78, range: 1 – 9). A moderate positive correlation between overall SDI satisfaction and SDI familiarity was observed, r(231) = .41, p < .001.

Concerning estimated SDI use after training (M = 5.79, SD = 1.81, range: 1 – 9), 2.6% of trainees stated that they would “never”, while 6.4% stated that they would “always” use an SDI for diagnosing patients. For diagnosing patients, trainees with patient experience (n = 227) reported to use clinical history taking most frequently, followed by questionnaires, classification systems, and SDIs (see Figure 2).

Psychotherapy trainees estimated a medium level of overall SDI satisfaction among patients (M = 55.60, SD = 20.62, range: 0 – 95). The positive statements with the highest mean agreement ratings were the statement: “During an SDI, patients feel that the interviewer takes their problems seriously” (M = 1.82, SD = 0.86) and the statement: “After an SDI, patients think that the interviewer asked for enough detail to get an appropriate understanding of their situation” (M = 1.82, SD = 0.87). In contrast, psychotherapy trainees tended to only partially agree or disagree with the statement: “Patients have the feeling that they understand themselves and their problems better after an SDI” (M = 0.84, SD = 0.77). Among the negative items, the estimation that patients find SDIs exhausting received the highest mean agreement (M = 1.50, SD = 0.80). Descriptive statistics on all PAQ items are shown in Supplement 4.

The regression model of overall SDI satisfaction on beliefs about SDIs was significant, F(15, 217) = 17.01, p < .001. The whole model explained 54% of variance. Descriptive and regression statistics for all beliefs are shown in Table 2. Two of the positive beliefs (“SDIs are reliable sources of information”, “SDIs are efficient”) positively predicted overall SDI satisfaction, whereas two of the negative beliefs (“SDIs disturb the relationship to patients”, “SDIs are too confusing”) negatively predicted overall SDI satisfaction.

Participants entered 31 further arguments for and against SDIs. Among the positive arguments, the identified topics were: benefit for patients and the therapeutic relationship (e.g., “the diagnosis [using an SDI] induces confidence that the therapist relies on scientific evidence, and not arbitrary; the patient can rely on the result”), and benefit for determining accurate diagnoses (e.g., “in particular cases [the SDI] uncovered symptoms in the past”). Among the negative arguments, the most common topics included: weakness of the interview itself (e.g., “structured interviews are too undynamic”), lack of benefit for determining a diagnosis (e.g., “[…] the interview only showed that there is psychological distress, it was not helpful diagnostically”), detrimental effect on patients and the therapeutic relationship (e.g., “SDIs can irritate patients ([they create the] impression that one’s very sick if one has to answer such different questions)”), high effort (e.g., “SDI require a lot of time/resources, that, to my experience, are not available in the daily clinic routine”), and lack of appropriate compensation (e.g., “structured interviews are not sufficiently rewarded during training (neither monetary, nor for the progress of training), which can be frustrating”).

The exploratory correlational analysis included only participants that reported experience in working with patients (n = 227). A small negative relationship was found between psychotherapy trainees’ overall SDI satisfaction and the adherence to a psychoanalytic/psychodynamic orientation, τ_c = -.14, p = .005. In contrast, a small positive relationship was found between psychotherapy trainees’ overall SDI satisfaction and the adherence to a cognitive/behavioral orientation, τ_c = .11, p = .005. No relationships were found between overall SDI satisfaction and any personality factor. Full results of the correlational analyses are reported in Supplement 5.

The present study has limitations that need to be considered. First, the cross-sectional design does not allow for conclusions regarding possible long-term effects of SDI training (e.g., on actual SDI use after training). Second, certain survey items might have been insufficient. Even though most SDI beliefs were endorsed previously (Bruchmüller et al., 2011), the additional arguments reported by participants suggest that there are more issues relevant to SDI satisfaction. Single items of adherence to psychotherapeutic orientations were used as ecological and integrative measures but may have failed to capture all aspects relevant to orientation adherence. Trainees that are at an early stage of training might have had more difficulties providing accurate answers due to little experience. Third, correlational and exploratory analyses somewhat limit the conclusions that can be drawn. However, the present study has important implications for clinical practice and future research despite this methodological limitation, as it is the first to provide evidence on SDI beliefs and satisfaction among trainees. Finally, as most participants were psychologists in CBT training, the present results may not generalize to trainees with other training orientations and professional backgrounds. Yet, importantly, the present sample is still representative of the current trainee population in Germany, as most psychologists choose a post-graduate training in CBT (Rabe-Menssen et al., 2021).

The present study is the first to provide evidence for the impact of beliefs about SDIs on psychotherapy trainees’ overall SDI satisfaction. The results imply that training programs need to increase their efforts to implement SDI training and provide opportunities for SDI application in different settings to strengthen trainees’ SDI familiarity. While considering trainees’ needs and concerns (e.g., time constraints, limited compensation), programs need to inform trainees about the evidence on SDIs that highlight diagnostic advantages and common misconceptions, especially regarding their impact on the therapeutic relationship (Neuschwander et al., 2017; Suppiger et al., 2009). Longitudinal studies are needed to determine the impact of SDI training experiences on practitioners’ SDI use following training. In addition to overall SDI satisfaction, it would be informative to assess trainees’ immediate response to individual SDIs, thus allowing for direct comparisons to previous studies on interviewer satisfaction (Neuschwander et al., 2017; Suppiger et al., 2009). This approach would also enable tracking changes in SDI satisfaction and help determine the number of conducted SDIs required for sufficient experience to benefit from SDIs’ advantages. When investigating relations of SDI endorsement and evaluations with individual characteristics of trainees, research might focus more on specific behaviors and skills, as they are possibly more relevant than personality factors, and can be directly addressed and monitored during training. Finally, future evaluations of SDI satisfaction should include trainees with different professional backgrounds and orientations to account for a wider trainee population.