Behavior During Session and

Way of Reporting the Behavior

Muhammad Mustabeen
Reg No. L1F21MSSY0040
Subject: Psycho-diagnosis and Assessment

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 Behavioral
Observation
What is behavioral observation,
Components of behavioral observation,
Reporting, Disorder specific behavioral
observations during session
What is Behavioral Observation?
“Pay less attention to what they say, Just watch what they do.”
“Dale Cornegie”

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 Definition/Emphasis

“Behavioral observation focuses on clearly observable ways in which the client interacts
with his or her environment and during the session with the psychologist”
(Encyclopedia of Human Behavior)

Focusing more on “How the client said it”.

Observing that how the client “behaves” or “presents himself” initially.

Observing how that initial behavior changes over the time period.

Example: A client may be co-operative in initial interview but become angry after filling
out personality questionnaire or a client might seem relaxed at the beginning of cognitive
testing but become frustrated when the cognitive test items get harder.
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 Things We Should Remember!

Observation of these behaviors is not enough.

Taking notes of how the client behaved/presented is an
important aspect of assessment.
Can be used informally as a part of interview or in a testing
session or as a method as well.
During the initial interview, it is usually unstructured but
there are structured mental status observations as well like
Mini-Mental State Examination (Focus on cognitive
symptoms) or ABA (Applied Behavioral Analysis) tools.
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 Things We Should Remember! (Cont.)

Avoid developing a general impression (negative or

positive) of the client from first contact.

This general impression can lead towards biased

assessment of the client’s other behaviors and
characteristics.

Avoid the primacy and recency effect.

Consider the interpretations about the cause of

observed behaviors as merely hypothesis that are
subject to further confirmation (Suhr, 2015).
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 Things We Should Remember! (Cont.)

Example: How much foot shaking or leg shaking is too much for a client?

 It can vary culture to culture. It doesn’t indicate one specific thing. Foot shaking
might change in response to a question or a need for the client to have a restroom.

 Foot shaking can indicate nervousness, restlessness, pain, anger, urinary

urgency, impatience.

 So consider the interpretation of the cause of an observed behavior as merely a

hypothesis rather than a 100 percent fact until confirmed by a comprehensive
assessment (Suhr, 2015).

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Components of Behavioral Observation
“A self is a repertoire of behavior appropriate to a given set of contingencies”
“B.F Skinner”

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 1. Clothing

What to observe?

Is the client’s clothing appropriate to weather or

season?

Is it appropriate to the context (according to the

culture or not?

Research: Results of a study indicated that there is a

strong relationship between clothing style and mood of
a person. While negative emotions has a moderate
association with one’s clothes. (Moody et al., 2010)
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 2. Grooming and Hygiene

What to observe?

Is the client’s grooming and hygiene is

appropriate to the culture?
Is he or she caring for his/her fingernails?
Styling Hair, or shaving his moustaches or beard
Is he/she Maintaining good health?
Is he/she having a good sleep? (by appearance like yawning)
Is he or she taking care of his or her teeth?
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 2. Grooming and Hygiene (cont.)

Research: It is explored that difficulties in personal

hygiene and grooming leads towards difficulties in
recovery and the appropriate and timely
implementation of the intervention in patients
with depression. It suggests the provision of
intervention in initial sessions that help the patient
in developing personal hygiene so that speeding up
the recovery process (Stewart, 2022).

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 3. Gait & Posture

What to observe?

How does the client walk?

Does the client have a good balance? Is his walk slow or
fast?
How does the client stand or sit?
Unusual gestures or perseverative movements.
Does his sitting pattern changes over the time during
session? (like lengthy time sitting or unable to sit still)

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Different Sitting Positions

 Indication of frustration and stress.

 Indication of low confidence or insecurity.
 Indication of fear, anxiety or insecurity.
 Indication of uncomfortableness.
 Holding back a negative or anxious attitude
 Indication of submissiveness.
(Nierenberg, 1971).
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Different Sitting Positions (cont.)

 Person who takes things sensitively.  Person who loves to be in command.

 Who is defensive.  Indication of jealous streak in nature when it
 Or may be who is relaxed or comfortable. comes to relationships.

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Different Sitting Positions (cont.)

Clutching Armrests Sitting on the Edge

 Person who is sensitive.  Indication of nervousness or anxiety.
 Who always remain aware of his or her  Indication of restlessness.
surroundings.  Indication of curiosity.

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 4. Motor Movements

What to observe?
General motor activity

Speed of movements like restless or motor retardation.

Unusual body movements like tics

Any physical limitations like walk, stair climbing or

bathing or dressing etc.

Do these motoric behaviors change over the time?

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 5. Speech

What to observe?
Is the client’s speech rapid or slow?

Notably soft-spoken or loud

Evidence of slurring or misarticulation

Is the speech blunted or prosodic?

Any other unusual vocalizations like verbal tics,

grunts, whispering to self.

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 5. Speech (cont.)

Research: A study has explored the correlation between speech

features and the expressed emotions. Like speech rate varies in
four different emotions,
 Slightly faster in anger

 Faster or slower in happiness

 Slightly slower in sadness

 Much faster in fear

Similarly features like pitch and voice quality also varies in

different emotions (Khanna, 2011).

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 6. Facial Expressions

What to observe?
Does the client appear expressive with his or her face?

Limited or no facial expressions.

Frequently made facial expressions like wrinkled forehead

or grimace then relating it to the emotions or the mood.

Are these expressions congruent to what client is saying

or reporting about his or her mood like La Bella
Indifference in conversion disorder.

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 6. Facial Expressions (cont.)

Work of Paul Ekman

According to Paul Ekman,
 Basic human emotions are innate.

 Are shared by everyone.

 Accompanied across cultures.

 Have universal facial expressions.

 Ekman identified 6 basic emotions with universal expression

(Ekman,1979).

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6. Facial Expressions (cont.)
Universal Facial Expressions of Seven Emotions
(APA)

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 7. Eye Contact

What to observe?
Does the client,
Make eye contact with the therapist or the assessor?

Ever break his eye contact and in what context (like

any specific question)?

Considering the cultural context (like male and

female in a therapeutic relationship).

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 8. Level of Attention/Alertness/Arousal

What to observe?
Does the client,
Respond in a timely fashion to requests and
questions?

Appear awake and alert?

Yawn or even fall asleep?

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 9. Need for Repetition

What to observe?
Does the Interviewer,
Have to repeat questions?

Have to repeat instructions?

Does it occur immediately after asking the question or

after giving the instructions?

How much resistant or complaint he or she is in

responding?

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Reporting of Behavioral Observation
“You can listen to what people say, sure. But you will be far more effective if you listen to
what people do”
“Seth Godin”

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 Important Things to Report!

Willingness to share information. Crying spells (duration)

Was secretive Excitement
Anxious Grandiosity
Relaxed Blunted affect
Withdrawn Mute or talkative
Co-operative Abusive language
Timid Incoherent speech
Aggressive Restless or motor retardation
Complaint Reactions towards specific assessment
Orientation tasks.

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 Sample of Reporting Behavioral Observation

Mr. S arrived on time for sessions. His dressing was appropriate. He was alert,
oriented, co-operative and attentive throughout the interview and testing. He
asked minimal questions but answered the questions quickly and fluently. There
was no need to repeat the instructions and questions. His speech was congruent
with his level of education and his mood. His mood was euthymic and his facial
expressions were appropriate. He made good eye contact. He showed no unusual
motor movements and was able to sit still for long hours of testing. He yawned
frequently which indicated that he had not gotten appropriate sleep before the
session. He had difficulty in reading some of the fine print notes and was holding
the forms closer to his eyes rather than reading from the table top (Suhr, 2015).

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Disorder Specific Behavioral Observation
“We learn by observation, imitation and repetition”
“Denis Waitly”

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 ADHD

What to observe?
Difficulty sustaining attention.
Will not follow the instructions.
Avoiding tasks that require mental effort.
Fidgeting
Difficulty in remaining seated.
Impulsive
Irritability
Video: https://youtu.be/yRYl9Bf0yhs

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 Autism Spectrum Disorder

What to observe?
Deficits in social communication.
Social-emotional reciprocity.
Restricted and repetitive pattern of behavior.
Echolalia
Insistence on sameness
Hyper or hypo-reactivity to sensory input.

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 Conduct Disorder

What to observe?
Lack of guilt, empathy.
Physically aggressive.
Will not follow the instructions.
Deceitfulness.
Bullying and lying.
Violation of rules.
Video: https://youtu.be/TN7DIdQ493Q

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 Schizophrenia

What to observe?
Diminished emotional expression (blunted affect).
Anhedonia
Confusion
Social withdrawal
Bizarre behavior
Catatonic behavior
Disorganized speech.
Video: https://youtu.be/ieeNW29lB5k

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 Anxiety Disorders

What to observe?
Fear or anxiety.
Lack of eye contact.
Uneasiness or restlessness
Nervousness or tension.
Sitting on the edge of the chair.
Difficulty in concentrating.
Excessive reassurance (especially in children).
Video: https://youtu.be/XH2tF8oB3cw

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 Bipolar Disorder

What to observe?
Elevated, expansive or irritable mood.
Grandiosity
Will be very talkative.
Easily distractable.
Depressed or sad mood.
Loss of pleasure.
Difficulty in concentrating.
Video: https://youtu.be/zA-fqvC02oM

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Thank You!

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