Tag Archives: assessment

Opportunities for Graduate Students and Professors as We Revise Our Clinical Interviewing Textbook

Revising textbooks is a joy and a burden. When I’m first forced to face the revision process, I feel unfairly burdened. I think things like, “I thought we wrote a perfect book that would last forever. How could anyone think it needs revision?” To say that I lack the necessary enthusiasm is an understatement. I lack any enthusiasm.

However, once I dive back into the text, it’s like visiting an old friend. And in this case, the good news is that it’s like visiting an old friend whom I like very much.

Rita and I started working on the first edition of Clinical Interviewing way back in 1990. Yep. It’s a very old friend.

During the next 6-8 months, we’ll be working on the 6th edition revision. If you’re a graduate student or faculty in Counselor Education, Psychology, or Social Work, we’re looking for your help. But, as before, we really only want your help if it will be meaningful to you. If you think that might be the case, read on:

You’re invited to help in one of four ways:

1. You can choose one or more of the chapters from the fifth edition, read it (them), and offer feedback and advice on changes you think would improve the text. We can take up to three reviewers for each chapter, but more than that will overwhelm us.

2. You can provide us with feedback and recommendations for DVD content that will help in the teaching and learning of basic and advanced counseling and interviewing assessment skills. This is very important because having excellent video content facilitates learning and is one of our big goals.

3. You can provide expert analysis of specific literature related to basic counseling skills and/or advanced interviewing assessment strategies. For example, if you’re on the cutting edge of administering mental status exams (or want to be), we can work together to read and select new literature that will help us update that chapter.

4. You can develop and write up specific classroom activities that help students learn basic and more advanced interviewing skills. If your contribution in this area is original, we’ll work with you to organize your learning activity so that it can be included as a short publication in our electronic instructor’s manual.

5. If you’re an expert in a particular area and want to send us citations of your published work, we’ll review your work and consider including those citations in the 6th edition, as appropriate.

If any of these opportunities sound good to you, or, if you have other ideas, questions, or comments about our revision process, please email me directly at: john.sf@mso.umt.edu.

Thanks for considering these opportunities to contribute to the Clinical Interviewing 6th edition!

Sincerely yours,

John SF

P.S.: In case you don’t know much about this text and the accompanying DVD, here’s what a couple reviewers said:

“A superb synthesis and presentation of the key concepts any beginning student absolutely needs to know about clinical interviewing. John and Rita Sommers-Flanagan make an eloquent case that connecting with the client on a human level is the superordinate task, without which little else of value can be achieved. Replete with relevant clinical examples, helpful how-to hints, as well as pearls of clinical wisdom, this comprehensive yet accessible text is highly recommended.”—Victor Yalom, Ph.D., Founder and CEO, Psychotherapy.net

About the DVD:
“Indispensable interviewing skills imparted by two master teachers in an engaging, multimedia presentation. Following the maxim of ‘show and tell,’ the Sommers-Flanagans provide evidence-based, culture-sensitive relational skills tailored to individual clients. An instructional gem!”
John C. Norcross, PhD, ABPP, Distinguished Professor of Psychology, University of Scranton; Editor, Psychotherapy Relationships That Work

The Art and Science of Clinical Interviewing (in Chicago)

In about 10 days I’ll be on my way to Chicago to video-record five short lectures on Clinical Interviewing. Alexander Street Press is producing this video project and Dr. Sharon Dermer of Governor’s State University is hosting. The project is titled “Great Teachers, Great Courses.” [This is pretty cool and my thanks to JC for getting me included.]

I’ll be recording the morning of Tuesday, May 19, which happens to be just before Debbie Joffe Ellis, who just happens to be the wife of the late Albert Ellis. She asked to switch times with me and so I obliged, noting in an email to Dr. Dermer:

Sure. I can do morning. Besides, if I said no I would end up with the Ghost of Albert Ellis’s scratchy voice in the back of my head saying things like, “What the Holy Hell is wrong with you?”

I’d just as soon avoid that.

All this is my slightly braggy way of explaining why I’ll be writing about five upcoming blogs on Clinical Interviewing. Here we go.

What is a Clinical Interview?

Definitions can be slippery. This is especially true when our intention is to define something related to human interaction.

One of my favorite descriptions of clinical interviewing is scheduled for inclusion in the forthcoming “Handbook of Clinical Psychology.” Mostly I suppose I like this description because I wrote it (smiley face). Here it is:

In one form or another, the clinical interview is unarguably the headwaters from which all mental health interventions flow. This remarkable statement has two primary implications. First, although clinical psychologists often disagree about many important matters, the status of clinical interviewing as a fundamental procedure is more or less universal. Second, as a universal procedure, the clinical interview is naturally flexible. This is essential because otherwise achieving agreement regarding its significance amongst any group of psychologists would not be possible. (page numbers tbd)

When it comes to formal definitions, it’s clear that clinical interviewing has been defined in many ways by many authors. Some authors appear to prefer a narrow definition:

An interview is a controlled situation in which one person, the interviewer, asks a series of questions of another person, the respondent. (Keats, 2000, p. 1)

Others are more ambiguous:

An interview is an interaction between at least two persons. Each participant contributes to the process, and each influences the responses of the other. However, this characterization falls short of defining the process. Ordinary conversation is interactional, but surely interviewing goes beyond that. (Trull & Prinstein, 2013, p. 165)

Others emphasize the development of a positive and respectful relationship:

. . . we mean a conversation characterized by respect and mutuality, by immediacy and warm presence, and by emphasis on strengths and potential. Because clinical interviewing is essentially relational, it requires ongoing attention to how things are said and done, as well as to what is said and done. The emphasis on the relationship is at the heart of the “different kind of talking” that is the clinical interview. (Murphy & Dillon, 2011, p. 3)

From my perspective, the BIG goals of this “different kind of talking” can be broken into two main parts: (1) ASSESSMENT and (2) HELPING That said, I’m likely to further break these two main parts into four interrelated and overlapping parts that may or may not be formally including in a single clinical interview:

1. Establishing a therapeutic relationship
2. Collecting assessment information
3. Developing a case formulation or treatment plan
4. Providing a specific educational or psychotherapeutic intervention

What are the Goals of a Clinical Interview?

[In the following two paragraphs I’m including a more wordy and erudite way of saying the preceding . . . which is one of the things that we academics are wont to do. I should note these paragraphs are excerpted from my entry in the Encyclopedia of Clinical Psychology (2015). This piece, very recently published, is cleverly titled, “The Clinical Interview” and coauthored with Drs. Waganesh Abeje Zeleke, and Meredith H. E. Hood.]

Perhaps the clearest way to define a clinical interview is to describe its purpose or goals. Generally, there are four possible goals of a clinical interview. These include: (a) the goal of establishing (and maintaining) a working relationship or therapeutic alliance between clinical interviewer and patient; research has suggested the relationship between interviewer and patient is multidimensional, including agreement on mutual goals, engagement in mutual tasks, and development of a relational bond (Bordin, 1979; Norcross & Lambert, 2011); (b) the goal of obtaining assessment information or data about patients; in situations where the goal of the clinical interview is to formulate a psychiatric diagnosis, the process is typically referred to as a diagnostic interview; (c) the goal of developing a case formulation and treatment plan (although this goal includes gathering assessment information, it also moves beyond problem definition or diagnosis and involves the introduction of a treatment plan to a patient); (d) the goal of providing, as appropriate and as needed, a specific educational or therapeutic intervention, or referral for a specific intervention; this intervention is tailored to the patient’s particular problem or problem situation (as defined in items b and c).

All clinical interviews implicitly address the first two primary goals (i.e., relationship development and assessment or evaluation). Some clinical interviews also include, to some extent, case formulation or psychological intervention. A single clinical interview can simultaneously address all of the aforementioned goals. For example, in a crisis situation, a mental health professional might conduct a clinical interview designed to quickly establish rapport or an alliance, gather assessment data, formulate and discuss an initial treatment plan, and implement an intervention or make a referral.

What Happens During a Clinical Interview?

The range of interactions that can happen during a clinical interview is staggering. This could partly explain why we (foolishly) wrote a textbook on this topic that’s 598 pages long and includes an instructional DVD.

My son-in-law says one good way to get a flavor for any book is to put together the first and last words. In this case, our Clinical Interviewing text reads (not including the front or back matter), “This . . . culture.” To give you a further taste of “This . . . Clinical Interviewing . . . culture,” here’s a modified excerpt from the text:

Imagine sitting face-to-face with your first client. You carefully chose your clothing. You intentionally arranged the seating, set up the video camera, and completed the introductory paperwork. You’re doing your best to communicate warmth and helpfulness through your body posture and facial expressions. Now, imagine that your client:

  • Refuses to talk.
  • Talks so much you can’t get a word in.
  • Asks to leave early.
  • Starts crying.
  • Tells you that you’ll never understand because of your racial or ethnic differences.
  • Suddenly gets angry (or scared) and storms out.

Any and all of these responses are possible in an initial clinical interview. If one of these scenarios plays out, how will you respond? What will you say? What will you do?

From the first client forward, every client you meet will be different. Your challenge or mission (if you choose to accept it) is to make human contact with each client, to establish rapport, to build a working alliance, to gather information, to instill hope, and, if appropriate, to provide clear and helpful professional interventions. To top it off, you must gracefully end the interview on time and sometimes you’ll need to do all this with clients who don’t trust you or don’t want to work with you. (pp. 3-4)

In my opening Great Teachers, Great Courses lecture I’ll be focusing on the definition of the clinical interview and then limit myself to describing and demonstrating about 18 different interviewing “behaviors” or responses that clinicians who conduct clinical interviewing have at their disposal. These behaviors are named and organized into three categories. And so to help myself stop writing this blog and get back to work, I’ll wait and write about them later.

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Webinar Tomorrow: Diagnosis and Assessment of Oppositional Defiant Disorder and Conduct Disorder

Tomorrow at noon Mountain Time, Western Montana Addiction Services is sponsoring a one-hour webinar on the diagnosis and assessment of oppositional defiant disorder and conduct disorder. I’ll be the presenter. If you’re interested in tuning in, you’ll need to email Erin Wenner at: ewenner@wmmhc.org to get instructions on how to gain access. This month I’ll be focusing on very basic diagnosis and assessment issues related to ODD and CD. Next month on June 10th at noon, I’ll be focusing counseling or treatment issues.

Powerpoint Slides from the ACES Clinical Interviewing Presentation in Denver

This post includes a link to the powerpoiint slides for our presentation at the Association for Counselor Education and Supervision in Denver, CO. For this we offer a BIG THANKS to Sidney Shaw, Ed.D. who presented on our behalf so we could be in Erie, PA for the birth of our new granddaughter, Nora Flanagan Bodnar. Thanks Sidney!!

ACES clinical interview

Guidelines for Violence Risk Assessment

Predicting violence is notoriously very difficult. Nevertheless, sometimes counselors, social workers, psychologists and psychiatrists are faced with situations where they need to make estimates or predictions of violence potential. The material below is a short preview from Clinical Interviewing, 5th edition. http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=dp_ob_title_bk

Research findings imply that therapists who hope to conduct accurate violence assessments should know actuarial violence prediction risk factors. However, as is often the case, scientific research doesn’t always parallel real-life situations faced by therapists. For example, while much of the actuarial violence research has been conducted on forensic or prison populations—with the designated outcome measure being violent recidivism—therapists typically face situations in schools, residential treatment centers, and private practice (Juhnke, Granello, & Granello, 2011). Consequently, although actuarial violence prediction risk factors may be helpful, they probably don’t generalize well to situations where a counselor is making a judgment about whether there’s duty to protect (and therefore warn) a shop teacher about a boy (who has never been incarcerated) who reports vivid images of slitting his shop teacher’s throat.

Given these limits, it’s best for us to call clinical interview-based assessments in school and agency settings violence assessment, rather than violence prediction. This distinction helps clarify the fact that what most clinicians do in general practice settings, including public and private schools, falls far short of scientific, actuarial-based violence prediction.

A Reasonable Approach to Violence Risk Assessment

Predicting violence is a challenging proposition. Despite the many shifting variables that change based on the specifics of any given situation and despite the low base rate, and therefore inherent unpredictability of violent behavior, this section provides general guidelines that may be helpful should you find yourself in a situation where violence assessment is necessary. Of course, in addition to this guide you should always pursue consultation and supervision support when working with potentially violent clients.

Table 12.2 includes a general guide to violence assessment. It doesn’t include common actuarial risk factors from two common instruments, the Violent Rate Appraisal Guide (Harris, Rice, & Quinsey, 1993) or the Psychopathy Checklist-Revised (Hare et al., 1990; Harpur, Hakstian, & Hare, 1988). If you find yourself intrigued with violence risk assessment you may want to explore a career in forensic psychology.

Table 12.2. A General Guide to Violence Assessment
The following checklist is offered as a general guide to conducting violence assessment. It should not be used as a substitute for actuarial prediction.
____1.  Ask direct and indirect questions about violent behavior history. Be especially alert to physical aggression and cruelty. If the violent behavior that’s being threatened is similar to a past violent behavior the risk of violence may be higher.

_____2. Because potentially violent individuals aren’t always honest about their violence history, you may need to ask collateral informants—someone other than the client—about the client’s history of violent behavior (assuming you have a release of information signed or have determined you have an ethical-legal responsibility to protect someone from harm).

____3.  You should listen for details that might help you identify potential victims. If the details are not forthcoming, you may need to ask specific questions in an effort to obtain those details. Identification of a specific victim increases violence risk (and provides you with information about whom you should warn).

____4. As clients talk about violent urges, you should listen for specifics about the plan. As needed, you may, through curious and indirect questioning, make efforts to further assess the specificity of the client’s violence plan. More specific plans are associated with increased violence risk.

____5. If clients don’t tell you about his or her access to a weapon or means for committing his or her planned violent act, you should ask. Similar to suicidal situations, access to lethal means increases violence risk.

____6. Historical information is doubly important. Generally speaking, the sooner violent behavior patterns began, the more likely they are to continue and clients raised in chaotic and violent environments (including gang involvement) are at higher risk for violence.

____7. Diagnostic information may be helpful. When looking at DSM diagnoses, the best violence predictors include items from list B** of the **DSM’s Antisocial Personality diagnostic criteria (see DSM-IV-TR**).

____8. Evaluate current cognitions. If clients have low expectations of being caught or of having consequences, risk may be higher.

____9. Consider substance use. Positive attitudes towards substance use and substance use when carrying weapons confer greater risk.

____10. Notice your intuition. Intuition isn’t a great predictor of anything, but if you have images of violence linked to a particular client, it’s reasonable to err on the conservative side and begin the process of warning potential victims.

**This information may change in the DSM-5

Practicing Humility When Conducting Mental Status Examinations

Perhaps more than any other assessment task, conducting a balanced mental status examination requires that professionals resist the natural temptation to make sweeping judgments about clients on the basis of appearance, specific behaviors, or single symptoms. For example, in a recently published book titled The mental status examination and brief social history in clinical psychology, Smith {{5681 III 2011;}} stated:

A Fu-Manchu mustache suggests the wearer doesn’t mind being thought of as “bad,” whereas a handlebar mustache tells you the person may be somewhat of a dandy or narcissist. (p. 4)

After reading the preceding excerpt, I decided to conduct a small research study by surveying men in Montana with Fu-Manchu mustaches. Whenever I saw men sporting a Fu-Manchu, I asked them to rate (on a seven-point Likert scale) whether they minded being thought of as “bad.” In contrast to Smith’s (2011) observations, I found that most men with Fu-Manchu’s actually thought they looked good and reported wearing the mustache in an effort to look attractive. Of course I didn’t really conduct this survey, but the fact that I thought about doing it and imagined the results carries approximately the same validity as the wild assumption that a mental status examiner can quickly “get into the head of” all clients with Fu-Manchu (or handlebar) mustaches and interpret their underlying personal beliefs or intentions, or even worse, extrapolate from a physical feature to a personality disorder diagnosis.

Although I’m poking fun at the sweeping generalizations that Smith (2011) made in his text, my intent is to point out how easy it is to grow overconfident when conducting MSEs. Like Smith, I’ve sometimes found myself making wild and highly personalized assumptions about the psychopathological meaning of very specific behaviors (some years ago I had my own personal theory about “tanning” behaviors being linked to narcissism).

The key to dealing with this natural tendency towards overconfidence is to use Stanley Sue’s (2006) concept of scientific mindedness. A single symptom should be viewed as a sign that the sensitive and ethical mental status examiner considers a hypothesis to explore. Another example from Smith (2011) may be helpful as another caution of the dangers of over-interpreting single symptoms. He stated: “If the person is unshaven, this may be a sign of depression, alcoholism, or other poor ability at social adaptation” (p. 4).

Smith may be correct in his hypotheses about unshaven clients. In fact, if a research study were conducted on diagnoses or symptoms commonly associated with unshaven-ness, it might show a small correlation with depressive symptoms, partly because poor hygiene can be a feature of some depressive disorders. However, in the absence of additional confirming evidence, an unshaven client is just an unshaven client. And when it comes to social adaptation, I should note that I know many young men (as well as a variety of movie stars) who consider the unshaven look as either desirable, sexy, or both. This could lead to an equally likely hypothesis that an unshaven client is particularly cool or has an especially high level of social adaptation.

In your own MSE work I encourage you to adopt the following three guidelines to help you avoid what might be called the overconfident clinician syndrome:

  1. When you spot a single symptom or client feature of particular interest, you should begin the scientific mindedness process.
  2. Remember that hypotheses are hypotheses and not conclusions; this is why hypotheses require additional supporting evidence.
  3. Don’t make wild inferential leaps without first consulting with colleagues and/or supervisors; it’s often easier to become overconfident and subsequently make inappropriate judgments when working in isolation.

Keep these preceding guidelines in minds as you conduct mental status examinations. You can find my DVD with a clip of a mental status exam at: http://www.amazon.com/Clinical-Interviewing-Skills-John-Sommers-Flanagan/dp/1118390121

Teaching Counseling and Psychotherapy Theories: Reflections on Week 1

Teaching Counseling and Psychotherapy Theories – Week 1

This past Monday evening in Missoula, Montana I met with my 80+ counseling and psychotherapy theories students for our first 3-hour class of the semester. Some student might have thought they’d get out early on the first day of the semester . . . but such was not the case. We had a nice evening together (my opinion). Although it was smoky outside (too many forest fires nearby) in the classroom the air was clear and the thinking sharp. Every year it feels humbling when I meet a new group of students in the fall and recognize their dedication and intelligence, not to mention the compassion for and interest in helping others that’s an intrinsic requirement of taking a class that’s all about counseling and psychotherapy theories and practice.

This group was especially generous – laughing heartily at my stories and gently confronting me when I misspoke and suggested I might spontaneously lie to protect my client’s confidentiality. One of my favorite moments was when, as we were talking about strategies for protecting client confidentiality in a public situation where someone might ask, “How do you know ______?” Several students shared excellent strategies (far better than my ‘spontaneous lying’ idea). One in particular said, “I just don’t respond to the question and make some comment like ‘Oh yeah, you know she’s really good at soccer’ and then hardly anyone follows that up by asking me how I know that person a second time.” Somewhat surprisingly, I was able to use that particular line several times later in class whenever students asked me questions I couldn’t answer. You should try it. Here’s how it works: Somebody asks you something you can’t or don’t want to answer, just say, “Hey, you know she’s really good at soccer.” It’s pretty much guaranteed you won’t have to answer the question.

As a method of providing a little extra intellectual stimulation, below I’m including two activities that go along with the content of Counseling and Psychotherapy Theories in Context and Practice. Have fun and good luck in your personal quest for better understanding of yourself and others . . . a particular quest that never really ends.

Activity 1: Creating and Testing Personal Hypotheses

One of our graduate students told us his “personal theory” of why some people become good cooks and other people develop poor cooking skills. He said:

I’m a bad cook because my mom was a good cook. I never had any reason to learn to cook because my mom did it all for us. But my girlfriend is a really good cook. I think that’s because her mom was a bad cook and so she had more reason to learn to cook for herself.

Although you can probably see a number of flaws with the reasoning underlying this “theory,” most of us carry these sorts of ideas around with us all the time. Let’s briefly analyze and test our student’s theory and then move on to identifying some of yours.

First, we should ask: Is this student’s statement really a theory? The answer is “No.” The reason this isn’t a theory is because it’s too narrow and not very elaborate. Theories don’t just predict behavior, they also provide detailed explanations for why particular behaviors occur.

As described in the text, a theory involves a gathering together and organizing of knowledge about a particular object or phenomenon. Also, theories are used to generate hypotheses about human thinking, emotions, and behavior.  Although our student has developed an interesting hypothesis about one factor that contributed to why he and his girlfriend have poor and good cooking skills, he really doesn’t have an overarching theory for generating the hypothesis . . . but he could develop one. Perhaps his bigger theory is about how individuals compensate for their caregivers strengths and weaknesses. He would need to work on describing, explaining, and predicting how this process works, but his idea has potential.

Theorists work both deductively (from the theory to the hypothesis) and inductively (from the specific hypothesis or observation to the bigger theory). Our student appears to be operating inductively. He observed himself and he observed his girlfriend and he developed an interesting hypothesis.

It’s possible and reasonable for people to systematically test their personal theories or hypotheses. Most likely, if we asked our student to test his hypothesis, he would do so in a biased way. He would likely notice when his hypothesis is true and ignore or completely overlook evidence opposing his hypothesis. Social psychology has shown that humans just seem to operate that way . . . we look for evidence to support our ideas and ignore evidence that contradicts our ideas (see Snyder & Swann, 1978).

With all this in mind, take a few minutes to write down some of your personal hypotheses about human behavior. Pick anything that you tend to think is true about humans (e.g., women have greater pain tolerance than men; individuals from larger families have better social skills; pet owners have trouble relating to people) and describe it below.

Hypothesis 1:

 

Hypothesis 2:

 

Hypothesis 3:

 

After you’ve established a few hypotheses, think about whether they might fit together into an overarching theory—or are they just a few random and unconnected ideas about human behavior? Then, either way, think about how you might test the validity of your hypotheses. Also, think about how you could or would avoid being systematically biased toward validating your own hypotheses?

Activity #2: A Psychological Assessment Critique

Years ago, Rita had a cartoon on her office door that had two guys in their scientific lab coats in conversation. One of the guys was asking the other one something like: “Would you like me to come up with evidence to destroy this scientific argument or evidence to support it?”

The big point of the cartoon is that even science is subjective. Because science is subjective, it’s important to be able to criticize research in general and or own research in particular. For this activity, we’d like you to list five shortcomings or problems with measuring counseling and psychotherapy outcomes. For example, let’s pretend you’ve just conducted 10 sessions of therapy with a client. You’re interested in measuring your effectiveness and so you had your client complete a self-report questionnaire on depression at the beginning and again at the end of the therapy. Using a seven-point Likert scale, the client rated him/herself on 20 depression symptoms. If you used this scale or questionnaire, what might be the shortcomings or problems associated with this measurement system?

1.

 

2.

 

3.

 

4.

 

5.

 

At the end of this blog I’ve listed what I think are five of the most common problems with self-report outcomes measures. When you’re finished listing your five ideas, check out and compare your five ideas with my five ideas.

What are the Most Common Measurement Problems when Using Self-Report Measures in Therapy Outcomes Studies?

John’s Answers

  1. How do we know participants are giving us honest feedback about their feelings, beliefs, and response to the intervention? (Sometimes people lie, other times they deceive themselves, other times they automatically or intentionally respond in a socially desirable manner).
  2. How do we know participants are motivated to answer surveys, questionnaires, or interview questions with due diligence? (This variability in participant motivation can translate into a hasty response set or compulsive over-reflection on each item). It also results in a less than 100% response rate when surveys are administered.
  3. How do we know if participants are capable of defining or understanding what’s helpful for them? (Respondents may not have clear ways to distinguish whether what they received was helpful or they may not understand the question or they may misinterpret the question; even if they can make internal, individual distinctions of what’s helpful, how can we know how that compares with another person’s internal and individual standard for helpfulness)?
  4. How can we ever know if one person’s rating of a “5” on a 1-7 Likert (pronounced lick-ert) is ever really equivalent to someone else’s rating of a “5”? (For example, one of us has an issue with ever giving anyone or anything a perfect “7” or worthless “1” when completing seven-point Likert-type questionnaires and so his (or her) responses may not be comparable to people who don’t have such issues).
  5. Given that mood is highly variable and yet powerfully influential, how can we be sure that we’re not measuring, at least in part, something related to the respondent’s current mood, instead of current attitude or anything close to a behavioral inclination?

 

Two Sample Mental Status Examination Reports

JSF Dance Party

This is a photo of me checking my mental status.

Generally, mental status examinations (MSEs) can have a more neurological focus or a more psychiatric focus. The following two fictional reports are samples of psychiatric-oriented MSEs. These sample reports can be helpful if you’re learning to conduct Mental Status Examinations and write MSE reports. They’re excerpted from the text, Clinical Interviewing (6th edition; 2017, John Wiley & Sons). Clinical Interviewing has a chapter devoted to the MSE, as well as chapters on suicide assessment interviewing and diagnostic interviewing (and many others chapter on other important topics). You can take a look at the book (and some darn good reviews) on Amazon: https://www.amazon.com/gp/product/1119215587/ref=dbs_a_def_rwt_bibl_vppi_i0

If you’d like to see a short video-clip MSE example, you can go to: http://www.youtube.com/watch?v=1lu50uciF5Y

Sample Mental Status Examination Reports

A good report is brief, clear, concise, and addresses the areas below:

1.  Appearance

2.  Behavior/psychomotor activity

3.  Attitude toward examiner (interviewer)

4.  Affect and mood

5.  Speech and thought

6.  Perceptual disturbances

7.  Orientation and consciousness

8.  Memory and intelligence

9.  Reliability, judgment, and insight

The following reports are provided as samples.

Mental Status Report 1

Gary Sparrow, a 48-year-old white male, was disheveled and unkempt on presentation to the hospital emergency room. He was wearing dirty khaki pants, an unbuttoned golf shirt, and white shoes and appeared slightly younger than his stated age. During the interview, he was agitated and restless, frequently changing seats. He was impatient and sometimes rude in his interactions with this examiner. Mr. Sparrow reported that today was the best day of his life, because he had decided to join the professional golf circuit. His affect was labile, but appropriate to the content of his speech (i.e., he became tearful when reporting he had “bogeyed number 15”). His speech was loud, pressured, and overelaborative. He exhibited loosening of associations and flight of ideas; he intermittently and unpredictably shifted the topic of conversation from golf, to the mating habits of geese, to the likelihood of extraterrestrial life. Mr. Sparrow described grandiose delusions regarding his sexual and athletic performance. He reported auditory hallucinations (God had told him to quit his job and become a professional golfer) and was preoccupied with his athletic and sexual accomplishments. He was oriented to time and place, but claimed he was the illegitimate son of Jack Nicklaus. He denied suicidal and homicidal ideation. He refused to participate in intellectual- or memory-related portions of the examination. Mr. Sparrow was unreliable and exhibited poor judgment. Insight was absent.

Mental Status Report 2

Ms. Rosa Jackson, a 67-year-old African American female, was evaluated during routine rounds at the Cedar Springs Nursing Home. She was about 5’ tall, wore a floral print summer dress, held tight to a matching purse, and appeared approximately her stated age. Her grooming was adequate and she was cooperative with the examination. She reported her mood as “desperate” because she had recently misplaced her glasses. Her affect was characterized by intermittent anxiety, generally associated with having misplaced items or with difficulty answering the examiner’s questions. Her speech was slow, halting, and soft. She repeatedly became concerned with her personal items, clothing, and general appearance, wondering where her scarf “ran off to” and occasionally inquiring as to whether her appearance was acceptable (e.g., “Do I look okay? You know, I have lots of visitors coming by later.”). Ms. Jackson was oriented to person and place, but indicated the date as January 9, 1981 (today is July 8, 2009). She was unable to calculate serial sevens and after recalling zero of three items, became briefly anxious and concerned, stating “Oh my, I guess you pulled another one over me, didn’t you, sonny?” She quickly recovered her pleasant style, stating “And you’re such a gem for coming to visit me again.” Her proverb interpretations were concrete. Judgment, reliability, and insight were significantly impaired.

 

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