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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

CLINICIAN'S THESAURUS, 7TH EDITION

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

CLINICIAN'S THESAURUS 7th Edition The Guide to Conducting Interviews and Writing Psychological Reports EDWARD L. ZUCKERMAN, P h D THE GUILFORD PRESS New York London

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

© 2010 Edward L. Zuckerman Published by The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012www. guilford. com All rights reserved Except as noted, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce Form 1, Form 2, and the Feedback Solicitation Form. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video-or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. Library of Congress Cataloging-in-Publication Data Zuckerman, Edward L. Clinician's thesaurus: the guide to conducting interviews and writing psychological reports / Edward L. Zuckerman. —7th ed. p. cm. Includes bibliographical references and index. ISBN 978-1-60623-874-5 (pbk. : alk. paper) 1. Interviewing in psychiatry. 2. Mental status examination. 3. Neuropsychological report writing. 4. Psychiatric records— Terminology. I. Title. RC480. 7. Z83 2010 616. 89001′4—dc22 2010016504

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

v About the Author Edward L. Zuckerman received his Ph D in clinical psychology from the University of Pittsburgh and continued there as an adjunct teacher of personality psychology and human sexuality for 14 years. He taught abnormal psychology at Carnegie Mellon University for 9 years and now consults to the Social Security Disability Determination Division. He was in the independent general practice of clinical psychology for more than 15 years and has worked in state hospitals and community mental health centers. He lives on a small farm in Pennsylvania with his wife and their horses, chickens, dogs, cats, geese, and ducks.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

vii Contents Acknowledgments and an Invitation xvii Getting Oriented to the Clinician's Thesaurus 1 What Is the Clinician's Thesaurus and What Does It Do?, 1 How This Book Is Organized, 2Understanding the Style and Format of the Chapters, 3A Functional Guide to Report Construction, 7Further Guidelines and Advice on Report Writing, 13Some Ways to Use the Clinician's Thesaurus, 16A Cautionary Note and Disclaimer, 17 PART I. Conducting a Mental Health Evaluation 1. Beginning and Ending the Interview 21 1. 1. Structuring the Interview, 21 1. 2. Introducing Yourself and Noting Possible Communication Difficulties, 21 1. 3. Assessing the Client's Understanding of the Interview Situation, 22 1. 4. Obtaining Informed Consent, 23 1. 5. Other Points for All Interviews, 23 1. 6. Eliciting the Chief Concern/Complaint/Issue, 24 1. 7. Eliciting the Client's Understanding of the Problem, 24 1. 8. Dimensionalizing the Concern/Problem, 24 1. 9. Ending the Interview, 25 2. Mental Status Evaluation Questions/Tasks 26 2. 1. Introduction to the Mental Status Questions, 26 2. 2. Background Information Related to Mental Status, 27 2. 3. Rancho Los Amigos Cognitive Scale, 27 2. 4. Glasgow Coma Scale, 28 2. 5. Orientation, 28 2. 6. Attention, 30 2. 7. Concentration, 30 2. 8. Comprehension of Language, 31 2. 9. Eye-Hand Coordination/Perceptual-Motor Integration/ Dyspraxia/ Constructional Ability, 31 2. 10. Memory, 32 2. 11. Fund of Information, 34 2. 12. Opposites, 35 2. 13. Differences, 36 2. 14. Similarities/Analogies, 36 2. 15. Absurdities, 36 2. 16. Calculation Abilities, 37 2. 17. Abstract Reasoning/Proverbs, 38

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

viii Contents 2. 18. Paired Proverbs, 38 2. 19. Practical Reasoning, 39 2. 20. Social Judgment, 39 2. 21. Decision Making, 40 2. 22. Self-Image, 40 2. 23. Insight into Disorder, 40 2. 24. Strengths and Coping, 41 2. 25. Mental Status Evaluation Checklist, 41 3. Questions about Signs, Symptoms, and Other Behavior Patterns 44 3. 1. Introduction to the Questions about Signs, Symptoms, and Behavior Patterns, 44 3. 2. Abuse (Nonsexual)/Neglect of Spouse/Elder, 45 3. 3. Abuse (Nonsexual)/Neglect of Child, 46 3. 4. Abuse (Sexual) of Child or Adult, 46 3. 5. Affect/Mood, 47 3. 6. Anxiety, 48 3. 7. Body Dysmorphic Disorder, 48 3. 8. Compliance-Noncompliance with Treatment, 48 3. 9. Compulsions, 49 3. 10. Delusions, 50 3. 11. Depression, 51 3. 12. Dissociative Experiences, 53 3. 13. Eating Disorders, 54 3. 14. Gay and Lesbian Identity Formation, 56 3. 15. Hallucinations, 56 3. 16. Illusions, 58 3. 17. Impulse Control, 58 3. 18. Mania, 58 3. 19. Obsessions, 59 3. 20. Organicity/Cognitive Disorders, 60 3. 21. Pain, Chronic, 60 3. 22. Paranoia, 61 3. 23. Phobias, 62 3. 24. Self-Injury, 62 3. 25. Sexual History, 63 3. 26. Sexual Identity/Transgender Issues, 65 3. 27. Sleep, 66 3. 28. Substance Abuse: Drugs and Alcohol, 67 3. 29. Substance Use: Tobacco and Caffeine, 75 3. 30. Suicide and Self-Destructive Behavior, 76 3. 31. Violence, 78 PART II. Standard Terms and Statements for Wording Psychological Reports A. Introducing the Report 4. Beginning the Report: Preliminary Information 83 4. 1. Heading and Dates for the Report, 83 4. 2. Sources of Information for the Report, 83 4. 3. Identifying Information about the Client, 84 4. 4. Self-Sufficiency in Appearing for Examination, 85 4. 5. Consent Statements, 86 4. 6. Reliability/Validity Statements, 87 4. 7. Confidentiality Notices, 89 4. 8. Ethical Considerations in Report Writing, 91

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Contents ix 5. Referral Reasons 92 5. 1. Statement of Referral Reason, 92 5. 2. Common Referral Reasons for Children at Home, 93 5. 3. Common Referral Reasons for Children at School, 93 5. 4. Common Referral Reasons for Children at Both Home and School, 95 6. Background Information and History 97 6. 1. History/Course of the Present/Chief Complaint/Concern/ Problem/Illness, 97 6. 2. Medical History and Other Findings, 98 6. 3. Personal, Family, and Social Histories, and Current Social Situation, 99 6. 4. Adjustment History, 102 6. 5. Social History for a Disability Examination, 103 6. 6. Family Genogram/Family Tree/Pedigree, 104 B. The Person in the Evaluation 7. Behavioral Observations 107 7. 1. Appearance, 107 7. 2. Clothing/Attire, 110 7. 3. Movement/Activity, 111 7. 4. Speech Behavior, 114 7. 5. Other Behavioral Observations, 117 8. Responses to Aspects of the Examination 118 8. 1. Reaction to the Context of the Evaluation, 118 8. 2. Attention/Concentration/Effort, 120 8. 3. Response to the Methods of Evaluation/Tests/Questions, 121 8. 4. Persistence/Motivation, 122 8. 5. Relationship with the Examiner, 123 8. 6. Response to Success/Failure/Feedback, 125 9. Presentation of Self 127 9. 1. Dependency-Surgency, 127 9. 2. Presence/Style, 127 9. 3. Self-Image/Self-Esteem, 128 9. 4. Social Sophistication/Manners, 128 9. 5. Warmth-Coldness, 129 9. 6. Other Aspects of Self-Presentation, 129 10. Emotional/Affective Symptoms and Disorders 132 10. 1. General Aspects of Mood and Affects, 132 10. 2. Anger, 133 10. 3. Anxiety/Fear, 134 10. 4. Bipolar I Disorder, 136 10. 5. Bipolar II Disorder, 136 10. 6. Cyclothymia, 137 10. 7. Depression, 137 10. 8. Guilt/Shame, 142 10. 9. Mania, 143 10. 10. Panic, 144 10. 11. Seasonal Affective Disorder, 144 10. 12. Sexuality, 145 10. 13. Other Affects/Emotional Reactions, 145

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

x Contents 11. Cognition and Mental Status 146 11. 1. No Pathological Findings: Summary Statements, 146 11. 2. Arithmetic, 147 11. 3. Attention, 147 11. 4. Concentration/Task Persistence, 147 11. 5. Consciousness Levels, 148 11. 6. Decision Making, 148 11. 7. Dementia, 149 11. 8. Information, 149 11. 9. Insight, 150 11. 10. Intelligence, Development, and Cognition: Assessment, 151 11. 11. Intelligence Scores: Classifications, 152 11. 12. Memory, 153 11. 13. Moral/Social Judgment and Knowledge, 156 11. 14. Motivation for Change: Summary Statements, 157 11. 15. Orientation, 157 11. 16. Reality Testing, 157 11. 17. Reasoning/Abstract Thinking/Concept Formation, 158 11. 18. Social Maturity, 159 11. 19. Stream of Thought, 159 11. 20. Test Judgment: Summary Statements, 162 11. 21. Other Summary Statements for Mental Status, 162 12. Abnormal Signs, Symptoms, and Syndromes 163 12. 1. Abuse, 163 12. 2. AIDS Dementia Complex, 164 12. 3. Attention-Deficit/Hyperactivity Disorder, 164 12. 4. Autism Spectrum Disorders, 168 12. 5. Battered-Woman Syndrome, 169 12. 6. Body Dysmorphic Disorder, 170 12. 7. Chronic Fatigue Syndrome, 171 12. 8. Compulsions, 171 12. 9. Conduct Disorder, 172 12. 10. Delusions, 173 12. 11. Denial, 174 12. 12. Depersonalization and Derealization, 175 12. 13. Dual Diagnoses, 175 12. 14. Eating Disorders, 175 12. 15. Fetal Alcohol Syndrome, 178 12. 16. Gambling, 178 12. 17. Hallucinations, 179 12. 18. Illusions, 180 12. 19. Impulse-Control Disorders, 180 12. 20. Malingering, 182 12. 21. Obsessions, 183 12. 22. Oppositional Defiant Disorder, 184 12. 23. Pain Disorder/Chronic Pain Syndrome, 184 12. 24. Paranoia, 185 12. 25. Phobias, 185 12. 26. Postconcussive Syndrome, 186 12. 27. Posttraumatic Stress Disorder, 186 12. 28. Premenstrual Dysphoric Disorder, 187 12. 29. Rape Trauma Syndrome, 189 12. 30. Reactive Attachment Disorder, 190 12. 31. Schizophrenia, 191 12. 32. School Refusal/Avoidance/“Phobia, ” 192 12. 33. Self-Injurious Behavior, 193 12. 34. Sexual Abuse, Child, 193

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Contents xi 12. 35. Sexual Impulsivity/“Addiction”/“Compulsion, ” 194 12. 36. Side Effects of Psychotropic Medications/Adverse Drug Reactions, 195 12. 37. Sleep Disturbances, 196 12. 38. Stalking, 198 12. 39. Substance Use, Abuse, and Dependence, 198 12. 40. Suicide, 202 12. 41. Violent Behaviors, 207 13. Personality Patterns 209 13. 1. Models of Personality Diagnosis, 209 13. 2. Assessment Methods, 211 13. 3. Cognitive or Thinking Styles, 212 13. 4. A and B Personality Types, 212 13. 5. “Addictive” Personality, 214 13. 6. Aggressive Personality, 214 13. 7. Antisocial Personality, 214 13. 8. Authoritarian Personality, 216 13. 9. Avoidant Personality, 217 13. 10. Borderline Personality, 218 13. 11. Codependent Personality, 219 13. 12. Compulsive Personality, 221 13. 13. Dependent Personality, 222 13. 14. Dissociative Identity Disorder, 224 13. 15. Histrionic Personality, 225 13. 16. Hypochondriacal Personality, 226 13. 17. Narcissistic Personality, 227 13. 18. “Nervous” Personality, 228 13. 19. Normal/Healthy Personality, 229 13. 20. Obsessive Personality, 230 13. 21. Paranoid Personality, 231 13. 22. Passive- Aggressive Personality, 232 13. 23. Sadistic Personality, 233 13. 24. Schizoid Personality, 234 13. 25. Schizotypal Personality, 235 13. 26. Self-Defeating Personality, 235 C. The Person in the Environment 14. Activities of Daily Living 239 14. 1. Assessment, 239 14. 2. Assistance Level Required/Degree of Independence, 239 14. 3. Child Care, 240 14. 4. Chores/House Care/Domestic Skills, 240 14. 5. Cooking, 240 14. 6. Financial Skills, 240 14. 7. Hazard Recognition and Coping, 241 14. 8. Living Situation/Level of Support Needed, 242 14. 9. Quality of Performance, 242 14. 10. Self-Care Skills, 242 14. 11. Shopping, 243 14. 12. Transportation, 243 14. 13. Caregiver Burden, 243 14. 14. Summary Statements, 243 15. Social/Community Functioning 245 15. 1. General Lifestyle, 245 15. 2. Involvement in Social/Community Activities, 246 15. 3. Problems/Conflicts in Community Relating, 246

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

xii Contents 16. Couple and Family Relationships 247 16. 1. Systemic Family Constructs, 247 16. 2. Assessment of Families at Intake, 248 16. 3. Family Interviewing Method, 249 16. 4. Child Rearing/Raising: Aspects, 250 16. 5. Couple Relationships: Aspects, 251 16. 6. Summary Statement, 251 17. Vocational/Academic Skills 252 17. 1. Basic Work Skills, 252 17. 2. History of Work, 255 17. 3. Language Skills: Reading and Writing Ability, 256 17. 4. Math Ability, 257 17. 5. Special Considerations for Disability Reports, 257 17. 6. Vocational Competence/Recommendations, 257 18. Recreational Functioning 260 18. 1. Entertainment: TV/Radio/Music, 260 18. 2. Hobbies, 260 18. 3. Sports, 260 18. 4. Reading Materials, 261 18. 5. Participation/Performance Quality, 261 19. Other Specialized Evaluations 262 19. 1. Coping Ability/Stress Tolerance, 262 19. 2. Culturally Sensitive Formulations, 262 19. 3. Developmental Stages, 264 19. 4. Financial Competence/Competence to Manage Funds, 264 19. 5. Homosexual Identity: Stages of Formation, 265 19. 6. Impairment's Effects on a Person, 266 19. 7. Puberty, 266 19. 8. The Refugee Process, 267 19. 9. Religious and Spiritual Concerns, 268 19. 10. Testamentary Competence/Competence to Make a Will, 269 D. Completing the Report 20. Summary of Findings and Conclusions 273 20. 1. Overview, 273 20. 2. Beginning the Summary, 273 20. 3. Summary of Previous Information, 273 20. 4. Relevant Findings and/or Conclusions, 274 20. 5. Diagnostic Statement, 274 20. 6. Consultations and Further Evaluations, 274 20. 7. Summarizing Treatment, 274 21. Diagnostic Statement/Impression 276 21. 1. Qualifiers for Diagnosis, 276 21. 2. ICD Versions, 276 21. 3. DSM-IV-TR, 277 21. 4. Anxiety Disorders, 277 21. 5. Mood Disorders, 278 21. 6. Stress and Adjustment Disorders, 282 21. 7. Personality Disorders, 283 21. 8. Impulse-Control Disorders Not Elsewhere Classified, 284 21. 9. Childhood Disorders, 284 21. 10. Eating and Elimination Disorders, 288

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Contents xiii 21. 11. “Organic” Cognitive Conditions, 289 21. 12. Substance-Related Disorders, 291 21. 13. Psychotic Disorders, 295 21. 14. Sleep Disorders, 296 21. 15. Somatoform Disorders, 298 21. 16. Psychological Factors Affecting a Medical Condition, 298 21. 17. Dissociative Disorders, 299 21. 18. Sexual Dysfunctions and Disorders, 299 21. 19. Factitious Disorders, 301 21. 20. Medication-Induced Movement Disorders, 302 21. 21. V Codes, Etc., 302 21. 22. Axis IV: Psychosocial and Environmental Problems, 305 21. 23. Axis V: Global Assessment of Functioning Scale, 305 22. Recommendations 307 22. 1. Need for Treatment, 307 22. 2. Treatments of Choice, 308 22. 3. Treatment Options/Case Disposition, 309 22. 4. Types of Therapies/Services, 309 23. Prognostic Statements 312 23. 1. General Prognostic Statement, 312 23. 2. Other Statements, 313 24. Closing Statements 314 24. 1. Value of the Information, 314 24. 2. Thanking the Referrer, 314 24. 3. Continued Availability, 314 24. 4. Signature, Etc., 315 24. 5. Disclaimer, 315 PART III. Useful Resources 25. Treatment Planning and Treatment Plan Formats 319 25. 1. The Flow and Nature of Treatment Planning, 319 25. 2. Some Advice on Writing Treatment Plans, 319 25. 3. Various Formats for Treatment Plans, 320 25. 4. A Treatment Plan Format for Case Conceptualization, 324 25. 5. Treatment Plan Components for Clients with Substance Abuse, 333 25. 6. Treatment Plan Components for Crisis Interventions, 335 25. 7. Checklist of Strengths, 335 25. 8. Outcome Measures/Goal Achievements, 336 26. Formats for Reports, Evaluations, and Summaries 338 26. 1. A Standard Format for Reports of Evaluations, 338 26. 2. Format for Psychodynamic Evaluations: Developmental Model, 339 26. 3. The Psychodynamic Diagnostic Manual, 340 26. 4. Themes for Evaluations from an Existential Perspective, 340 26. 5. Adlerian Evaluations, 340 26. 6. Transactional Analysis, 341 26. 7. Nursing Diagnoses and Treatment Planning, 342 26. 8. Vocational and Nonclinical Personality Evaluations, 342 26. 9. Formats for Therapy Notes, 343 27. Treatments for Specific Disorders and Concerns 345 27. 1. Abuse/Aggression/Violence/Impulsive Behaviors, 345 27. 2. Anorexia Nervosa and Bulimia Nervosa, 345

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

xiv Contents 27. 3. Antisocial Personality Disorder, 346 27. 4. Anxiety Disorders, 346 27. 5. Asperger Syndrome, 346 27. 6. Attention-Deficit/Hyperactivity Disorder, 346 27. 7. Bipolar I Disorder, 346 27. 8. Body Dysmorphic Disorder, 346 27. 9. Borderline Personality Disorder, 347 27. 10. Dementia, 347 27. 11. Dissociative Identity Disorder, 347 27. 12. Dual Diagnosis, 347 27. 13. Gambling, Pathological, 347 27. 14. Hypochondriacal Personality, 347 27. 15. Obsessive-Compulsive Disorders, 348 27. 16. Pain, Chronic, 348 27. 17. Phobias, 348 27. 18. Posttraumatic Stress Disorder, 348 27. 19. Religious and Spiritual Concerns, 348 27. 20. Schizophrenia and Psychosis, 349 27. 21. Sleep Disturbances, 349 27. 22. Stalking, 349 27. 23. Substance Abuse, 349 27. 24. Types of Therapies, 350 28. Listing of Common Psychiatric and Psychoactive Drugs 351 28. 1. List of Medications by Trade and Generic Names, 351 28. 2. Finding Street Drugs' Names, 357 28. 3. Results of Medication Treatment: Descriptors, 357 28. 4. Drug Resources for the Clinician, 357 29. Psychiatric Masquerade of Medical Conditions 359 29. 1. Introduction, 359 29. 2. Anxiety, 360 29. 3. Sexual Dysfunction, 360 29. 4. Depression, 360 29. 5. Mania, 361 29. 6. Organic Brain Syndrome/Dementia, 361 29. 7. Psychosis, 363 29. 8. Medication-Induced Psychiatric Conditions, 364 Appendices A. Abbreviations in Common Use 367 A. 1. Clinicians/Mental Health Professionals, 367 A. 2. Treatment, 368 A. 3. Diagnoses and Conditions, 368 A. 4. Relations, 369 A. 5. General Aids to Recording, 369 A. 6. Legal Terms, 370 A. 7. Medication Regimens, 370 A. 8. Educational Services, 370 B. Annotated Readings in Assessment, Interviewing, and Report Writing 371 Assessment, 371 Interviewing, 372Report Writing, 372

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Contents xv Feedback Solicitation Form 374 About the Clinician's Electronic Thesaurus, Version 7. 0 375 Additional Productivity Features, 375 Hardware Requirements, 376Software Requirements, 376 References 377 Index 387

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

xvii Acknowledgments and an Invitation I must first express my continuing appreciation to my editors at The Guilford Press, without whom this work would be much less clear, organized, and precise. I am very grateful for their expertise, experience, and enormous efforts. Anna Brackett's organizational skill, Marie Sprayberry's atten-tion to detail and thoroughness, and, especially, Barbara Watkins's wisdom and grace have turned this collection of words into a highly useful tool. With appreciation for their expertise and generosity, I am happy to give credit here to the following professionals for their contributions. Dolores Arnold, MEd, NCC, of Lawton, OKJudy Bomze of Wynnewood, PARenee F. Bova-Collis of Richmond, V A Richard L. Bruner, Psy D, of Hightstown, NJJeffry Burkard of Colvis, CAKathryn Elkins of Victoria, Australia Joe Elwart, Psy D, of Royal Oak, MIPatricia Hurzeler, MS, APRN, CS, of Bloomfield, CTMustaq Khan, Ph D, of London, Ontario, Canada Dorothy H. Knight of Jacksonville, ILBryan Lindberg of Portsmouth, RISusan G. Mikesell, Ph D, of Washington, DCIlene D. Miner, CSW, ACSW, of New York, NYRobert W. Moffie, Ph D, of Los Angeles, CAFay Murakawa, Ph D, of Los Angeles, CAMichael Newberry, MD, of Palm Bay, FLJames L. Pointer, Ph D, of Montgomery, ALJoseph Regan, Ph D, of Toronto, Ontario, Canada Daniel L. Segal, Ph D, of Colorado Springs, COJudith Shea, MA, of Lawrence, MAJanet L. Smigel, RN, CDHenry T. Stein, Ph D, of San Francisco, CAFrank O. Volle, Ph D, of Darien, CTMarcia L. Whisman, MSW, ACSW, of St. Louis, MOLeslie J. Wrixon, Psy D, of Cambridge, MANora F. Young of Sedro Wolley, WA I must also clearly acknowledge my debt to many other colleagues, from whose clearest thinking and best writing I have borrowed liberally to fill these pages. More than 250 of you have furnished

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

xviii Acknowledgments and an Invitation the more than 60,000 reports from which I have culled the thousands of unduplicated wordings incorporated here. Although you are too numerous to credit individually, please accept my grati-tude and appreciation. While I have borrowed many of the words and phrases, I alone must assume responsibility for the content and organization of the Clinician's Thesaurus, whatever its merits or limitations. Now, you are invited to contribute. What is missing from this book? What would you have put in or taken out? What have I gotten wrong? Please let me know by mail or e-mail, and—if your sugges-tions are adopted into the next edition—three good things will happen: 1. You will get a free copy of the next edition. 2. Your contribution will be fully acknowledged here. 3. You will receive my (and our fellow clinicians') sincere appreciation for adding to our knowl-edge, and for making our work easier. Send mail to P. O. Box 222, Armbrust, PA 15616, and e-mail to edwardzuckerman@gmail. com. * * * The following copyright holders have generously given permission to quote or adapt material from these copyrighted works: “Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions” by R. G. Tedeschi and R. P. Kilmer, 2005, Professional Psychology, Research and Practice, 36(3), 230-237. Copyright 2005 by the American Psychological Association. “Assessment of Coma and Impaired Consciousness” by G. Teasdale and B. Jenvet, 1974, Lancet, 2(7872), 81-83. Copyright 1974 by The Lancet Ltd. “A Brief Reminder about Documenting the Psychological Consultation” by R. A. Rivas-Vasquez, M. A. Blais, G. J. Rey, and A. A. Rivas-Vasquez, 2001, Professional Psychology: Research and Practice, 32(2), 194-199. Copy-right 2001 by the American Psychological Association. “Detecting Physical Illness in Patients with Mental Disorders” by R. S. Hoffman and L. M. Koran, 1984, Psycho-somatics, 25, 654-660. Copyright 1984 by the American Psychiatric Press. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. ) by the American Psychiatric Association, 2000 (Washington, DC: Author). Copyright 2000 by the American Psychiatric Association. “Enhancing Motivation for Treatment of Addictive Behavior: Guidelines for the Psychotherapist” by A. T. Horvath, 1993, Psychotherapy, 30(3), 473-480. Copyright 1993 by the Division of Psychotherapy (29) of the American Psychological Association. Handbook of Psychiatric Emergencies (4th ed. ) by A. E. Slaby, J. Liev, and L. R. Tancredi, 1994 (Norwalk, CT: Appleton & Lange). Copyright 1994 by Appleton & Lange. “Levels of Cognitive Functioning” by C. Hagen, D. Malkmus, and P. Durham, 1979, in Rehabilitation of Head Injured Adults: Comprehensive Physical Management (Downey, CA: Los Amigos Research and Education Insti-tute, Inc., Rancho Los Amigos National Rehabilitation Center). Copyright 1974 by Los Amigos Research and Education Institute, Inc. “Narcissism Looming Larger as Root of Personality Woes” by D. Goleman, 1988, November 1, The New York Times, pp. C1, C16. Copyright 1988 by The New York Times. “Neuropsychological Aspects of AIDS Dementia Complex: What Clinicians Need to Know” by D. U. Green-wood, 1991, Professional Psychology: Research and Practice, 22(5), 407-409. Copyright 1991 by the American Psychological Association. The Paper Office (4th ed. ) by E. L. Zuckerman, 2008 (New York: Guilford Press). Copyright 2008 by Edward L. Zuckerman. “Psychological Stages of the Refugee Process: A Model for Therapeutic Interventions” by C. Gonsalves, 1992, Professional Psychology: Research and Practice, 23(5), 382-389. Copyright 1992 by the American Psychologi-cal Association. Report Writing in Psychology and Psychiatry by J. T. Huber, 1961 (New York: Harper). Copyright 1961 by Jack T. Huber (by permission of Harper Collins Publishers, Inc. ). “Shame and Guilt: Definitions, Processes, and Treatment Issues with AODA Clients” by R. T. Potter-Effron, 1989, in R. T. Potter-Effron and P. S. Potter-Effron (Eds. ), The Treatment of Shame and Guilt in Alcoholism Counseling (New York: Haworth Press). Copyright 1989 by The Haworth Press.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

CLINICIAN'S THESAURUS, 7TH EDITION

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

1 Getting Oriented to the Clinician's Thesaurus What Is the Clinician's Thesaurus and What Does It Do? This book is more than a giant collection of synonyms; it is a treasury of the terms, standard phras-ings, common concepts, and practical information clinicians use in their daily work. In breadth and in depth, this book covers the language of American mental health. It is organized to help you, first, collect the client information you need; second, organize those findings into a high-quality report; third, find the most precise terms to express your findings; and fourth, develop appropriate diagnoses, treatment plans, and recommendations. If you write mental health evaluations and intakes, psychosocial narratives, testing-based reports, progress notes, managed care treatment plans, closing summaries of treatments, and the like, the Clinician's Thesaurus will ease your workload as it sharpens your writing because it does the follow-ing: Presents dozens of related terms to enhance the clarity, precision, and vividness of your reports. Offers behavioral descriptions for a range of psychopathology to help you document your observations, formulations, and conclusions. Suggests phrasings that can individualize and personalize a report or description. Stimulates your recall of a client's characteristics (we all can recall more when we prompt our memories by reading related terms). Suggests “summary statements” where only a brief indication is needed, such as when cogni- tive functioning is within normal limits. Contains extensive cross-references and a helpful index for ease in locating materials and ideas. Replaces the drudgery of narrative reporting with playfulness, spontaneity, and serendipity. (I know this is a big promise, but when you skim the book you will find both the familiar and the novel. ) In addition, because of its format and structure, the Clinician's Thesaurus can help you do these things:

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2 Getting Oriented to the Clinician's Thesaurus Structure an interview or assessment to ensure that you have not missed any important aspect. Organize your thoughts when writing or dictating a report to ensure that you have addressed all the issues of relevance for that client. Access the knowledge base you have built from your training and experience for use in treat- ment planning or other clinical decisions you have to make. Revise, elaborate on, or tighten up a report you have drafted. The wide diversity of terms offered allows you to refresh and vary your writing, even about a familiar topic or point. Learn, do, or teach report writing (see below). The Clinician's Thesaurus can be thought of as an enormous checklist. It is designed to approximate your internal checklist—the one on which you draw to conduct interviews, understand and respond to questions, and construct your reports. However, because it is far easier to work from an external checklist, it converts the demanding free-recall task into a much simpler recognition task. You just have to read, weigh, and select the best wording for the task at hand. How This Book Is Organized The Clinician's Thesaurus is organized in the same sequence of actions you would take to approach a client, assess the client's functioning, and then construct the report. Part I covers conducting a men-tal health evaluation. Part II offers ways to begin, develop, and end the report; it includes all of the standard topics addressed in mental health reports, presented in the sequence they are addressed in a typical report. Part III offers treatment plan formats, alternative report formats, and other useful resources. Part I offers a guide for interviewing, plus hundreds of questions and aids for eliciting specific kinds of client information. Chapter 1 provides pointers for conducting a valid and ethical interview and guidance for beginning and ending the interview. Chapter 2 covers all the traditional aspects addressed in a Mental Status Evaluation (MSE). It offers common questions (and many variations on them) for examining cognitive function-ing. Chapter 3 offers hundreds of questions designed to elicit information about all kinds of signs, symptoms, and behavior patterns, including ones that are particularly difficult to address in the interview context (such as paranoia, dissociative experiences, and sexual history). Part II of this book is designed to guide your writing of a report. It is organized in the sequence of the traditional evaluation report. (For more on this format and on constructing reports, see below. ) The chapters offer a range of descriptors and phrases by topic area. Almost any report can be shaped from the terms and areas covered. Useful clinical tips and common wording pitfalls also appear throughout the text. Chapters 4-6 cover introducing the report: preliminary information; the reasons for the referral; and background information. Chapters 7-13 address the person in the evaluation: behavioral observations; responses to aspects of the examination; presentation of self; emotions/affects; cognition and mental sta-tus; abnormal symptoms; and personality patterns. Chapters 14-19 cover the person in the environment: Activities of Daily Living (ADLs);

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 3 social/community functioning; couple and family relationships; vocational and academic performance; recreational functioning; and other dimensions clinicians are often asked to evaluate. Chapters 20-24 cover completing the report: summaries, diagnostic statements, recommen-dations, prognoses, and professional closings. Part III of this book offers useful clinical resources. These include the following: Formats for treatment plans. Formats for writing a wide range of reports and summaries. A brief list of treatment manuals for specific disorders and other treatment resources. A list of common psychotropic medications, by trade and generic names. Cues for recognizing the psychiatric presentation (“masquerade”) of medical conditions. In addition, there are Appendices containing useful abbreviations and an annotated list of readings in assessment, interviewing, and report writing. Understanding the Style and Format of the Chapters As just described, the three main parts of this book cover, respectively: questions for broad aspects of an evaluation (in Part I), wording for areas of a report (in Part II), and clinical resources (in Part III). The chapters within each part are then subdivided into more specific topics. For example, Chap-ter 10, “Emotional/Affective Symptoms and Disorders,” has 13 main sections—each addressing a specific affective symptom or disorder, ranging from anger to depression to panic. Each of these main topics has its own section number (e. g., the third section in Chapter 10, “Anxiety/Fear,” is numbered 10. 3). Cross-references throughout the book are to these chapter and section numbers. To find terms and descriptors for an anxious client, you could turn to the book's table of contents, find Chapter 10, see that Section 10. 3 is “Anxiety/Fear,” and then turn to that section for a full range of terms relating to anxiety and fear grouped by manifestation. You could also look up “anxi-ety” in the index and find other related sections. Of course, not all section topics within a chapter will need to be covered in every report. The sec-tion topics represent a range of possible options across different types of clients and different types of reports. Select from these topics and terms those relevant to the particular client and type of report you are writing. Types of Information in the Chapter Sections Most of this book consists of lists and groupings of the standard terms used in North American mental health. Other kinds of useful information also appear throughout the chapters: Introductory and explanatory comments. Cross-references to related sections of the book. Practice tips, reminders, and cautions. References to the standard works in the field or area. Descriptors, terms, and phrases for wording reports. Sample “summary statements. ” Sample evaluation questions and tasks (primarily in Chapters 1, 2, and 3).

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

4 Getting Oriented to the Clinician's Thesaurus Figure 1 (see below) offers a quick visual guide to identifying these various types of information within the chapter format. It also illustrates many of the formats and typographic conventions described below. (Note that the figure represents a composite of several pages, so as to illustrate a wider range of formats. Some content has been omitted in this composite. ) It is from the descriptors that you may select the ones most appropriate for incorporation into your reports. The format for these is explained below. The descriptors and phrasings offered in this book are standard American English usage and are the conventional language of the mental health field. Because the terms offered are only rarely defined here, you may find useful a specialized psychiatric dictionary (e. g., Campbell, 2009; Sted-man's Medical Dictionary, 2006; Stedman's Psychiatry Words, 2007). As you will see in Figure 1 and throughout the book, the descriptors and terms may appear in different formats, such as in a paragraph, in a list, or as columns of words across the page. Some formats indicate that the terms have been ordered according to degree of meaning. Understanding the arrangements gives you further information about those terms. These formats are explained below. Because so much valuable information is now available on the Internet, dozens of websites have been incorporated into this edition. Most of these web addresses can be easily typed into any web browser. Alternatively, entering the first few terms of the address into a search engine (like Google. com) will produce a collection of sites, including the one you seek. Formats for Descriptors and Terms The terms and descriptors offered in the Clinician's Thesaurus are always shown in the following font, suitable to set them off from other kinds of text. They may be arranged in one of four ways, from an unordered grouping of related words to increasingly ordered arrangements: 1. Unordered groups of similar but not synonymous words and phrases in a line or para-graph. Example: Presentable, acceptable, suitable, appearance and dress appropriate for age and occupa-tion, businesslike, professional appearance, nothing was attention-drawing, mod-estly attired. These words are often used as alternatives for each other. They are presented in a line or paragraph with no ordering principle. In the example above, the terms and phrases are all similar descriptors for “appropriateness” of clothing/attire. 2. An ordered spectrum of words and phrases, indicated by a double-arrow graphic (↔), in a line or paragraph. Example: (↔ by degree) Awkward, clumsy, “klutzy,” often injures self, “accident-prone,” inaccurate/ ineffective movements, jerky, uncoordinated, <normal>, purposeful, smooth, dex-trous, graceful, agile, nimble. In the example above, a client's movement or activity is characterized along a spectrum of ability from uncoordinated (“awkward”) to highly coordinated (“nimble”). The arrowheads (<>) enclosing the word “normal” indicate that it is the midpoint of the spectrum. 3. Columns of words ordered by degree (↔) across the page. Example: Qualities of Clothing (↔ by degree) filthy rumpled needing repair plain neat stylish grimy disheveled threadbare out of date careful dresser fashionabledirty neglected seedy old-fashioned clothes-conscious elegant

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 5 FIGURE 1. Reduced composite page illustrating various formats and typographic conventions.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

6 Getting Oriented to the Clinician's Thesaurus The word columns above are sequenced along a spectrum of degree of the trait—in this example, from “filthy” to “stylish. ” Each individual column contains one or more unordered alternative terms with slightly different shades of meaning. However, when a word is a stan-dard term used by clinicians for a cluster, it is presented at the top of the column in bold-face. In the example above, the three words in the first column all indicate the same relative degree of “Qualities of Clothing,” but have different nuances. “Filthy” is a standard term for this degree in quality. 4. Lines or paragraphs sequenced by degree (↔) and staggered downward across the page. Example: Unable to recognize the purposes of the interview/the report to be made... Indifferent, bland, detached, distant, uninvolved, uncaring... Dependent, sought/required much support/reassurance/guidance... Anxiety appropriate/proportionate to the interview situation... Understood the social graces/norms/expectations/conventions... In the example above, each level represents a degree of the quality along an ordered spec-trum. The words or phrases at each level are rough synonyms. In the example above, the quality of a client's response to the evaluation ranges from “Unable to recognize the pur-poses... ” to “Understood... ” Typographic Conventions for Descriptors and Terms Double arrow (↔): Indicates that the terms or phrases are ordered along a spectrum of degree for the trait, quality, or behavior. Slash mark (/) : Indicates that an alternative word or words immediately follow. Example: Understood the social graces/norms/expectations/conventions... Here the terms “social graces,” “norms,” “expectations,” and “conventions” are alternative descriptions, each of which can be used with the term “Understood” to indicate a quality of client response to the evaluation. Quotation marks (“ ”) : Indicate that a word is slang or inappropriate in a professional report. Example: Awkward, clumsy, “klutzy,” often injures self, “accident-prone,”... Slang and similar inappropriate words are frequently offered by persons being evaluated. They are placed in the Clinician's Thesaurus under appropriate headings to assist the clini-cian unfamiliar with such phrasings in understanding their meanings. For example, the de-scriptors for uncoordinated movement in the example above include “klutzy” and “accident-prone. ” Their placement indicates their meaning, but the quotation marks should alert you not to use the terms in your report. Check mark (ü): Indicates comments, advice, cautions, and clinical tips. These range from brief comments to tables of information; they are useful in understanding the client or phe-nomena, but are not to be borrowed for the report. Example: Note: ü If the client is incapable of providing this information, a family member or other informant should be sought. Braces ({ }) : Indicate words or phrases that are obsolete, obscure, or only of historical inter-est. Example: (↔ by degree) Gregarious, likeable, dramatic, entertaining, pleasant, vivacious, seductive, cracks jokes, prankish, naive, infantile, silly, { w i t z e l s u c h t }.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 7 The descriptors above constitute a spectrum of terms relating to mania. The word “ w i t z e l-s u c h t ” is now considered an obsolete description, and so it appears in braces. (Small capital letters in this case indicate the word's non-English origin. ) Underlining and capitalization of the initial letters of a phrase : Indicate a commonly used acronym. For example, Activities of Daily Living are often referred to as ADLs. (Note that this convention is also used in a couple of chapter titles and elsewhere in text proper. ) Special headings : Most wordings apply to both adults and children. However, words used only in the evaluation of children are listed at the end of each area where they apply, and are indicated by the heading “For a Child. ” Similarly, other uses are indicated, such as “For a Disability Report. ” Finally, in some instances sample sentences are provided to indicate how you might sum up a situation; these are indicated by the heading “Summary Statements. ” Typographic Conventions for Descriptors and Terms at a Glance Convention Meaning ↔ Ordered spectrum of meaning / Alternative word or words immediately following “ ” Slang or inappropriate for professional report < > Midpoint in a spectrum ü Comments, advice, cautions, clinical tips { } Obsolete, obscure; historical interest only Capitals Underlined Indicates the acronym, as in Activities of Daily Living (ADL) Notes on Grammar For compactness and simplicity, adjectives, adverbs, verbs, and nouns are sometimes mixed in a list-ing. Just modify the word to suit the sentence you have in mind. The pronoun forms used throughout this book are intended to lessen the sexist associations and implications whose harmful effects are well documented in this field. The book uses combinations such as “her/him” and “he/she” in varying order, or alternates in turn between “he” and “she,” to avoid furthering gender associations. When pronouns of a single gender are employed, that phras-ing should not be taken to imply any association of gender with behavior. A Functional Guide to Report Construction The Nature of Reports, the Steps of Their Construction, and the Corresponding Portions of the Clinician's Thesaurus The purpose of a report is to communicate the results of your assessments (and, for therapy sum-maries, interventions) to someone who has a need for this information. To accomplish this purpose, you, the writer, must simultaneously attend to two tasks: 1. Create a coherent, integrated narrative. What you have to say should be relevant, should be important, and should fit within a familiar professional structure. 2. Focus the narrative on the needs of the reader. That reader may be a referrer, a supervisor, the client's next therapist, a court or lawyer, a teacher or school system, a physician, another professional, or the person examined and his/her family. Each will understand your words from her/his background and experience.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

8 Getting Oriented to the Clinician's Thesaurus Keeping these two tasks in mind is essential to producing reports that communicate well and are useful. The next few pages move from looking at the most general to the most specific aspects of a report's narrative. You will see how the flow of information is organized to produce a report whose ideas are of value to the report's reader(s), and whose expression is precise, tailored to the individual, and meaningful. Report construction begins when you begin to collect relevant information about the client. You must then organize the information you have collected. In general, the sequence of topics in a report begins with old information, such as the client's history and the referral reasons. It proceeds to the new information you have gathered in the interview or assessment. It then presents the new understanding you have formed of the client, based on both the old and the new information. This integrated picture finally leads to new planning, which involves the generation of appropriate and effective interventions. This stepwise process corresponds to the main components of a traditional evaluation report, as seen below: The process of constructing a report The main components of an evaluation report Subdivisions of Part II of the Clinician's Thesaurus Old information Introducing the report A New information— personal The person in the evaluation B (New information—test results) (Standardized samples of behavior) (Not covered in this book) New information—social The person in the environment C New understandings and plans Completing the report D The model above is an extremely general version of the logic of constructing reports. (Readers are referred to Braaten, 2007, for detailed guidance on how to report test results for children and adolescents. ) Each of the four main components of a report covered in this book includes a range of specific issues or concerns that you can address, as shown in Table 1. Of course, no single report will include all of these. Rather, you must use the report's purpose combined with your clinical judg-ment to select those issues of most use to the reader of the report. Now let us look more closely at these concerns (and their parallel chapters and sections of the Cli-nician's Thesaurus ), so as to understand the nature of the clinical work involved in each. What is a clinician doing when he/she considers each area of personal and social functioning? What are the questions implicitly or explicitly asked by the report's reader that will help her/him to do what is best for the client? The chapters and sections of Part II of the Clinician's Thesaurus are designed to offer ways of framing the answers. The following discussion is intended to guide you in framing the questions. A. Introducing the Report BEGINNING THE REPORT : PRELIMINAR y INFORMATION (CHAPTER 4) The beginning of a report covers old information: facts and issues before this evaluation took place. Don't include every piece of historical information you may have. Rather, include only the informa-tion relevant to the goals of the report. Use the information to clarify why you are doing an evalua-tion or writing a summary. Reports usually begin with identifying information (the client's identity, age, marital status, etc. ). In addition, important aspects of your meeting with the client, such as the client's competence and consent to participate in the interview, are customarily included here although they are not histori-cal. This is done to avoid interrupting the later flow of clinical information.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 9 TABLE 1. Generalized Format for an Evaluation Report Components of a report Chapters/sections of the Clinician's Thesaurus A. Introducing the report (old information) Preliminary information Chapter 4 Could include these:Headings and dates Section 4. 1 Sources of your information about the client Section 4. 2 Identifying information about the client Section 4. 3 Self-sufficiency in appearing for the examination Section 4. 4 Statements of consent to be evaluated Section 4. 5 Reliability of the client/validity of the information Section 4. 6 Confidentiality notices about the report Section 4. 7 Referral reasons Chapter 5 Could include these:Nature of the problem(s) faced by the client or the referrer Section 5. 1 Who referred the client, for what services, and for what purpose(s) Sections 5. 2 to 5. 4 Background information and history Chapter 6 Could include these:History of the presenting problem or chief concern Section 6. 1 Medical, family, social, adjustment histories Sections 6. 2 to 6. 5 Using a genogram Section 6. 6 B. The person in the evaluation (new information—personal) Could include these:Behavioral observations Chapter 7 Responses to aspects of the examination Chapter 8 Presentation of self Chapter 9 Emotional/affective symptoms and disorders Chapter 10 Cognition and mental status Chapter 11 Abnormal signs, symptoms, and syndromes Chapter 12 Personality patterns Chapter 13 C. The person in the environment (new information—social) Could include these: Activities of Daily Living Chapter 14 Social/community functioning Chapter 15 Couple and family relationships Chapter 16 Vocational/academic skills Chapter 17 Recreational functioning Chapter 18 Other specialized evaluations Chapter 19 D. Completing the report New understandings Could include these: Summary of findings and conclusions Chapter 20 Possible psychiatric masquerade of medical conditions Chapter 29 Diagnostic statement/impression Chapter 21 New plans Could include these:Recommendations Chapter 22 Prognostic statements Chapter 23 Detailed treatment plan Chapter 25 Closing statements Chapter 24

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

10 Getting Oriented to the Clinician's Thesaurus Who are you? When, where, and from whom did you get this information? Who is the client? How well does the client understand the interview process and outcomes? (See Chapter 1, especially Sec-tions 1. 3 and 1. 4, for assistance with explaining the purposes, consequences, and confidentiality of the interview to the client. ) Were there any limitations on the interview? How reliable was the client? REFERRAL REASONS (CHAPTER 5) What is the nature of the problem(s) faced by the client or the referrer? Who referred the client, when, for what services, and for what purpose(s)? The greater the precision of this goal, the easier the report is to write, because you will always be returning to it. Spend as much time as necessary to refine your understanding of the referrer's needs. BACk GROUND INFORMATION AND HISTOR y (CHAPTER 6) What led up to this evaluation? What do you know about this person's previous functioning and the context in which he/she has lived? B. The Person in the Evaluation The goal of the next main component of the report is to state how this person is doing in her/his life at present or in the recent past. This component, like the one that follows it, consists of new information—that is, information about the client's functioning in contact with you (during the assess-ment or therapeutic interviews). What did you observe of this person's appearance, behavior, ways of relating to you, cognitive func-tioning, emotional reactions, symptoms, and personality? Your findings might be either test data for a psychological evaluation, or things you learned about the client's dynamics, personality, or functioning during therapy sessions you are now reviewing. For each of the first three areas covered below, the central question is this: What do these observ-able behaviors indicate or illustrate about important aspects of the client's mental state and inter-personal functioning? Information irrelevant to these aspects should be excluded. BEHAVIORAL OBSERVATIONS (CHAPTER 7) In what ways might the client's appearance, clothing, movement, speech, etc., indicate phenomena of clinical interest? RESPONSES TO ASPECTS OF THE Ex AMINATION (CHAPTER 8) How did the client relate to you and your questions or materials? How much effort and persistence did he/she demonstrate? How did the client respond to difficulties, failure, frustration, success, or feedback? PRESENTATION OF SELF (CHAPTER 9) How friendly or forthcoming was the client? How self-confident? How dependent or indepen-dent? How knowledgeable about socially appropriate behaviors? How warm or cold? How socially skilled? The next four areas covered below are those usually seen as the most psychological: emotions; thinking; other signs, symptoms, and syndromes; and personality patterns.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 11 EMOTIONAL/AFFECTIVE Sy MPTOMS AND DISORDERS (CHAPTER 10) What were the client's mood and affects? How did these change during the interview, in response to topics discussed or for other reasons? Did the client display or recount anger, anxiety/fear, depres-sion, mania, guilt/shame, or other feelings? COGNITION AND MENTAL STATUS (CHAPTER 11) How well was the client able to think, to process information, to come to conclusions, to make deci-sions, and to take actions? Could she/he recall and integrate relevant information and exclude the irrelevant? Did she/he understand the world, her-/himself, and what was happening in common ways? Did he or she organize thoughts and words normally and communicate effectively? What evi-dence did you see of judgment, insight, and higher-level functioning? (See Chapter 2 for questions to evaluate all aspects of cognitive functioning. ) ABNORMAL SIGNS, Sy MPTOMS, AND Sy NDROMES (CHAPTER 12) What other symptomatic behaviors (i. e., not purely emotional/affective or purely cognitive) have you been alerted to, observed, and investigated, and want to tell the reader about? How severe are these? How limiting? (See Chapter 3 for questions to evaluate abnormal and symptomatic behaviors. ) PERSONALITy P ATTERNS (CHAPTER 13) What enduring and cross-situational patterns of attending, thinking, feeling, and acting did you observe? What evidence did you see of traits or patterns of the better-known personality disorders and character patterns (e. g., aggressive, authoritarian, codependent, sadistic, self-defeating, etc. )? C. The Person in the Environment The third main component of the report continues with new information. Its purpose is to describe how this person functions in the larger world of everyday activities, close and formal relationships, and similar areas. The central question to be answered is this: How successful or impaired is this person in each area? ACTIVITIES OF D AILy LIVING (CHAPTER 14) Can this person take care of him-/herself? How well accomplished are the daily tasks of self-care, cooking, cleaning, child care, shopping, and getting around? SOCIAL/COMMUNITy FUNCTIONING (CHAPTER 15) What has the client or others told you about social and community relationships? How skilled and involved is the client? How much conflict and failure does she/he experience? COUPLE AND F AMIL y RELATIONSHIPS (CHAPTER 16) What did the client or others tell you about more intimate and persistent relationships with the members of his/her family of origin, spouse/partner, and/or children? How effective or limited is this person in these areas? If you evaluated family members, how competent were they? What were their structural and systemic patterns? VOCATIONAL/A CADEMIC Sk ILLS (CHAPTER 17) What do you know of the client's academic and vocational adjustments and accomplishments? What are her/his current reading, mathematical, and vocational skill levels? What kinds of problems or conflicts have occurred?

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

12 Getting Oriented to the Clinician's Thesaurus RECREATIONAL FUNCTIONING (CHAPTER 18) How does this person spend his/her free time? What activities are engaged in, and at what level of performance or intensity? How satisfying are they? OTHER SPECIALIz ED EVALUATIONS (CHAPTER 19) You may be asked to evaluate the client's competence to manage his/her finances, make a will, cope with stress, or adapt to being a refugee, among other things. Or you may be asked to describe her/his spiritual or religious concerns, problems, and issues. D. Completing the Report The last main component of the report covers new understandings and the resulting new plans. Groth-Marnat (2009) says that a good report should not only integrate old information, but provide a new and unique perspective on a person. This is a daunting task. It requires an organization of the data around topics of interest, but there are a very large number of topics or ideas on which you can focus. If a report is to have value, it will be in the integration of the information and the formulation of accurate diagnoses, well-considered recommendations, and achievable plans for treatment. New Understandings SUMMAR y OF FINDINGS AND CONCLUSIONS (CHAPTER 20) Offer an integration of history, findings, and/or observations, and your understanding of the cli-ent's functioning in the areas most relevant to the referrer's or reader's needs. Condense this infor-mation into a paragraph: the relevant demographic information, referral reason, history, and your major findings most relevant to the referral question, treatment history, or any other purpose of the report. Additional issues may need to be addressed at this point in some reports. For example, what addi-tional information do you need and from whom? Also, might the psychological symptoms presented be due to a medical condition? (See Chapter 29, “Psychiatric Masquerade of Medical Conditions. ”) For testing reports, findings can be organized by topic (integrating the results of different tests, such as cognitive functioning, emotional controls, interpersonal relations, etc., depending on the referral questions). A statement about the probable reliability of the findings is also needed (see Chapter 4, Section 4. 6, “Reliability/Validity Statements”). DIAGNOSTIC STATEMENT/IMPRESSION (CHAPTER 21) A diagnosis is professional shorthand that integrates many kinds of data. Generally you should include all five axes of a DSM diagnosis and any “rule-outs. ” Placing it here orients the reader to the recommendations and treatment planning that follow. ICD-9-CM is replacing DSM-IV-TR for some purposes; both are offered in Chapter 21. New Plans The last few elements of the report involve using your fuller and newer understanding of the client (generated above) to do new planning for services that are in the client's best long-term interest: rec-ommendations and treatment planning (for more detail on the latter, see Chapter 25, “Treatment Planning and Treatment Plan Formats”). RECOMMENDATIONS (CHAPTER 22) Are any further evaluations needed to clarify diagnoses or other points? What levels and areas of current functioning indicate the need for treatment? What supports might the client need? What

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 13 kinds of treatment would best restore functioning? How motivated is the client for treatment? In general terms, what intensity of treatment, approaches, and methods would be best? (For creating a detailed treatment plan, again see Chapter 25. For a list of common psychiatric medications, see Chapter 28, “Listing of Common Psychiatric and Psychoactive Drugs. ”) PROGNOSTIC STATEMENTS (CHAPTER 23) What course do you expect for this client if she/he does not receive the recommended treatments and services? What course do you expect for this client if she/he does receive the recommended treatments and services? CLOSING STATEMENTS (CHAPTER 24) Thank the referrer, indicate your continued availability (if so), and sign the report. Do not be afraid to do outlines and drafts (Ownby, 1997). You might start with summaries of the old and newly acquired information. You can then create a longitudinal picture: In your initial review of the client's life's trajectory, how do his/her background and history fit with the current findings (of a single slice of time) and lead to your prognosis and treatment recommendations? A later review should edit the materials into a tight narrative that clearly links the pieces of evidence to the conclusions drawn from it. Finally, use your understanding of the referral reasons or the readers' needs to pare down the report to focus only on answers to these needs. Attributions References to professionals may be phrased as follows: The clinician, therapist, psychologist, social worker, psychiatrist, nurse, counselor, behavior specialist, consultant, evaluator, interviewer, writer, undersigned, author, reporter, corre-spondent. The professional can be said to do the following: Report, offer, observe, note, document, record, state, summarize, etc. References to the client may be phrased as follows: The client, patient, claimant, {examinee}, resident, {subject}, individual, person, citizen, con-sumer, man, woman, child, student, etc. The client can be said to do the following during an interview: Say, state, report, note, speak of, describe, indicate, mention, tell me, concede, present, dis-close, elaborate, maintain, offer, deny, disavow, disclaim, exhibit, evidence, register, reveal, etc. Or, for more legalistic language, you can use these terms: Allege, submit, claim, contend, aver, opine, certify, etc. The use of first names, given names, or nicknames is unprofessional except for children. For adults, Mr. or Ms. (yes, even for married women who use their husbands' surnames) is the professional stan-dard. Use “Dr. ” and other titles only where necessary to prevent misunderstanding or where they are relevant to the purpose of the report. Further Guidelines and Advice on Report Writing Unlike reports of the past, which emphasized precise diagnosis and understanding of etiol- ogy, current models focus more on descriptions of the person and his/her specific behaviors.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

14 Getting Oriented to the Clinician's Thesaurus Current report models have shifted away from a focus on symptoms, maladjustments, and areas needing change; they now emphasize assessing strengths and coping mechanisms. Use headings and subheadings to help the reader follow your thinking and understand when you change levels of analysis. Evaluation reports that need to include test results require that the results be both clearly available (usually by being set into tables) and integrated into the picture of the client being developed in the progress of the report. For a report of test results, Lichtenberger et al. (2004) summarize three common ways to organize the paragraphs of data: (1) these can move from one domain of functioning to another, with headings like “Intelligence,” “Adap-tive Functioning,” and “Academic Achievement”; (2) they can report abilities under headings such as “Memory,” “Judgment,” and “Expressive Language”; and (3) they can report results test by test. In my opinion, these are most appropriate only for hasty and simple reports, because the goal of a good evaluation is the integration of test data into functioning and the understanding of the whole person. Another useful guideline for reports of test data is to move from the more global tests and findings to the more specific instruments and findings (Lichtenberger et al., 2004). For example, you might have IQs precede subtest scores, give Minnesota Multiphasic Personality Inventory-2 validity scores before two-point interpreta-tions, and only then present the findings from the Rotter Incomplete Sentences Blank. Simi-larly, they suggest moving from the more standardized test results to the less formal, such as the facts of your or others' observations. Because of concerns with test security and copyrights, do not repeat the questions from standardized tests or the mental status questions in your reports, but only the responses you received. (Or refer to the question indirectly—e. g., the Wechsler “Brooks” proverb. ) As to writing style, Ownby (1997) calls for a “professional style,” by which he means avoiding jargon, using shorter words with precise meanings, writing short paragraphs focused on a single concept, and employing a variety of sentence lengths and structure to maintain read-ers' interest. Take into account how the intended readers of your report will interpret it. Consider their level of psychological sophistication, their theoretical or professional orientation, their deci-sions and options, and their relationship with you. Although reports are typically written at the writer's reading level (graduate school) and are addressed to peers, reports are now widely made available to parents, less trained or differently trained professionals, and clients. Therefore, they should be phrased for readers with 12th-grade or lower reading levels (Har-vey, 1997). Use the readability tests of your word processor to check. It is preferable to use lower reading levels (as long as meaning is not lost), use shorter sentences, reduce acronyms, and omit passive voice. Brenner (2003) argues for reports that (1) are written for the con-sumer, (2) eliminate jargon, (3) fully respond to the referral questions, (4) individualize and tailor all findings, (5) emphasize strengths, and (6) make concrete recommendations. Segal and Hutchings (2007) offer a thorough checklist for making certain that an intake report is complete, well written, and professional. Only those details that are relevant and have meaning for the point/purpose of the report should be given. Do not report as facts what you have only been told. Instead, specify where the information came from. (For various phrasings, see “Attributions,” above. )Remember to report negative (absent) as well as positive (present) findings. Avoid the unclarified use of acronyms, abbreviations, and names for local service providers and programs if the report is addressed to or might be used by those unfamiliar with such

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 15 references. Instead, use the local language and then describe the program in general terms— for example, “TSI, a transitional community residential services provider” or “7 West, the alcohol detoxification ward. ” Where you are concerned about confidentiality and yet know you will be releasing the report to readers with whom you wish to maintain the subject's anonymity, you might use this method: Write the subject's name at the top of page 1 only, and use the subject's first (for a child) or last (for an adult) initial in all subsequent references to the subject. This way, you will have only one occurrence of the name to remove. (See also Section 4. 7, “Confidentiality Notices. ”) For the prevention of tampering with and loss of the pages of a report, they can be numbered as “Page 1 of 6,” “Page 2 of 6,” etc. Make sure your statements are consistent. Don't make different judgments in the narrative and on a check-off form. Don't state different conclusions based on different data. Be neat and legible. Use correct spelling and grammar, and use a dictionary or spelling checker. Get feedback on your reports, no matter how intimidating this may seem. Ask peers and report recipients for their input. It is customary to write intake reports and similar contemporaneous evaluations (e. g., prog- ress notes) in the present tense, and to use the past tense for events and experiences reported from the past (as in closing summaries and histories) and also for mental status results. Use careful phrasings with attributions in the present tense for past material that is controversial, potentially untrue, or slanderous, and for which you have no confirming evidence beyond the client's report. For example, phrasings like “The client describes her parents as being severely alcoholic” or “He reports having been sexually abused by a priest” are preferable to “Her parents were alcoholics” or “He was sexually abused by a priest. ” Sattler and Hoge's (2005) advice on writing reports is worthwhile: Prefer the specific to the general, the definite to the vague, the concrete to the abstract. Do not take shortcuts at the cost of clarity. Avoid fancy words. Omit needless words. Make every word tell. Express coordinate ideas in similar form. The content, not the style, should protect the report from monotony. Use a clear order of presentation so that your ideas can be followed. Avoid the use of qualifiers. “Rather,” “somewhat,” “possible,” “may”—these are the leeches that infest the pond of prose, sucking the blood of words. Put statements in positive form. Make definite assertions; avoid tame, colorless, hesitating, noncommittal language. Do not overstate. Avoid overgeneralization, overinterpretations, and “Barnum statements”— those so general as to be universally applicable. Esser (1974) points out these common problems with reports: Failure to answer referral questions or provide desired information. Making the report too long or too short. The report should be the shortest way to convey the essential information. Balance brevity and thoroughness.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

16 Getting Oriented to the Clinician's Thesaurus Telling the referrer what he/she already knows, or, conversely, failing to use referrer-provided information. Providing just pure data: findings without interpretations, judgments, or impressions. The presence of contradictions in the report. Reluctance to provide realistic or negative findings. Making unrealistic plans for the client. Failure to back up recommendations and plans with facts and reasons. Failure to consider alternative recommendations, courses of action, and objectives. Giving a summary that isn't one: It fails to bring together the information and to create a composite picture from it. Zimmerman and Woo-Sam (1973) offer other points: State the information simply and concisely. If you cite an authority, make certain she/he is qualified and neutral. Do not go beyond your data. Identify the substantiated bases of your cause-effect conclusions, and beware of fads in these interpretations. Some Ways to Use the Clinician's Thesaurus When you Interview You can use Part I of this book to guide your interview. You might simply read some of the mental status or symptom questions to the client; you might copy out a few to ask; or you might use them to refresh your memory of the questions appropriate to the referral's concerns. In contrast to struc-tured interviews, these chapters offer many questions for each area; if a particular question does not result in a satisfactory response, you will have many similar ones to use. When you Write or Dictate a Report As described earlier, Part II of this book is organized in the same sequence as the “classic” mental health report. If you are constructing other kinds of reports, you will find that you can select relevant sections to fit your needs and requirements for contents and structure. Each chapter is independent and can be seen as a module to be put to different uses. The individual chapter titles correspond to the major headings of standard reports, such as “Behavioral Observations,” “Mental Status,” or “Diagnostic Summary. ” Within each chapter, the numbered sections cover the aspects that are typi-cally evaluated in that area. Paging through the major numbered sections within each chapter will remind you to address each relevant area in your report. If you need to do a very comprehensive evaluation, you can use all the numbered headings within each chapter as a checklist to make certain you haven't overlooked any important point. The chapters in Part II contain specific words and phrases that reflect numerous ranges of mean-ing. From these, you can select the best descriptors for your patient in these areas. You can turn to a specific chapter and its numbered sections to focus on a particular topic for writing a more fine-grained description. As you use the Clinician's Thesaurus, you may find it worthwhile to highlight in color, underline, or box the words or phrases that best suit your writing style and are most relevant to your practice and

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Getting Oriented to the Clinician's Thesaurus 17 setting. You may find it practical to use the black thumb tabs on the edge of each page to access sections of the book more quickly. When you Teach As a teacher, you simply cannot offer your students more than a fraction of the behaviors a clinician must understand. When you focus on a few diagnoses or processes, students may miss the breadth they will need. If you discuss theory, your students may miss the concrete; if you offer cases, they may learn only a few examples and not the larger picture of the disorder. As a teacher, I have struggled with these choices myself. This book provides another option: All the aspects of each syndrome and pattern are in the Clinician's Thesaurus. The whole language of the mental health field is in here. When students need to interview, the questions here will enable them to follow up (almost) any referral question. When they sit down to write up their findings, all the language options are here. They and you can concentrate on the higher-level functions— weighing, winnowing, and integrat-ing—not on reinventing the standard language. Students love this book because it both reduces their anxiety and makes them more competent. When they see that (almost) everything they will need is in this one book, they breathe a sigh of relief. The book does not replace their clinical education, but it does assist the process. It is equiva-lent to giving a calculator to a math student: The student can concentrate on the nature of the problem, not the details of the calculation. When you Supervise Less skilled professionals or students may sometimes fail to think deeply or may write glib reports. The usual supervisor's response to this situation is to interview the students, trying to pull from them observations of the patients that they probably never made because they lacked the terms for labeling the phenomena of interest. When you supervise, try this instead: Refer such students to the appropriate sections of the Clini-cian's Thesaurus and ask them to find, say, three or more words to describe the cognitive aspects of a patient's depression. Not only does this make the supervision problem into a game instead of a contest over who is smarter, but also it puts the burden of discrimination on the students, where it belongs. Moreover, this process of weighing the alternatives trains a kind of clinical judgment that I find almost impossible to teach in other ways. The Clinician's Thesaurus is not a “cheat sheet” or a crutch. Reports written by clinicians using it are not “canned. ” Few individuals have thousands and thousands of words and statements in mind to choose from, and there is no limitation on entering new ones into the book. It does not write reports for anyone; students still have to learn the words' meanings and evaluate their appropriate-ness for each client. A Cautionary Note and Disclaimer The entries of this book are presented simply as sample questions and lists of terms that have been used in the field. Their presence here does not imply any endorsement by the author or publisher. These wordings are offered without any warranty, implied or explicit, that they constitute the only or the best way to practice as a professional or clinician. When individuals use any of the words, phrases, descriptors, sentences, or procedures described in this book, they must assume the full responsibility for all the consequences— clinical, legal, ethical, and financial. The author and publisher cannot, do not, and will not assume any responsibility for the use or implementation of the book's contents in practice or with any person, patient, client, or

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

18 Getting Oriented to the Clinician's Thesaurus student. The author and publisher shall not be liable in the event of incidental or consequential damages in connection with or arising out of any use by purchasers or users of the materials in this book. By employing this book, users signify their acceptance of the limits of the work and their acceptance of complete personal responsibility for all such uses. The author and publisher presume (1) that the users of this book are qualified by education and/or training to employ it ethically and legally, and (2) that users will not exceed the limits of document-able competence in their disciplines as indicated by their codes of ethical practice. If more than the material presented here is needed to manage a case in any regard, readers are directed to engage the services of a competent professional consultant.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Part I Conducting a Mental Health Evaluation Part I's Chapters: Page 1. Beginning and Ending the Interview 21 2. Mental Status Evaluation Questions/Tasks 26 3. Questions about Signs, Symptoms, 44 and Other Behavior Patterns

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

21 1 Beginning and Ending the Interview 1. 1. Structuring the Interview There are dozens of specialized interview methods (see Hersen & Turner, 2003) and numerous structured interviews, which should be used to increase reliability and validity over more open-ended approaches. An excellent guide for a clinician seeking this direction is Rogers (2001). The format below addresses some points crucial to beginning all interviews, whether structured or unstructured. Because a client may not understand a question's goal, or the answer may not be as informative as you hoped, Chapters 2 (“M ental Status Evaluation Questions/Tasks”) and 3 (“Ques-tions about Signs, Symptoms, and Behavior Patterns”) offer multiple questions under each topic so that you can ask a second or third question. 1. 2. Introducing yourself and Noting Possible Communication Difficulties When you are interviewing clients for treatment, bear in mind that “When clients present for an evaluation, they are often in a great deal of emotional pain. They are often demoralized and hope-less because their efforts to address their problems have failed or had only limited impact. They can benefit by simply having an opportunity to share their story [sic] with a compassionate and attentive listener” (Segal & Hutchings, 2007, p. 115). Make eye contact and introduce yourself to each client as follows: “Hello, I'm [Title] [Name]. And you are... ?” This format avoids breaching confidentiality by calling out a name. If the area is crowded, you can announce your name and ask, “Who is here to see me at this time?” With each client, be alert to the client's possible limitations of hearing and vision, and inquire if you have any reason to suspect a disability. Ask about any need for glasses/contact lenses or hearing aids if not worn, and comment in your report on the effects on the client's performance. Ask the client for suggestions to improve conditions, such as minimizing the background noise or changing the lighting. Don't cover your mouth; be sure to speak clearly. When you are interview-ing hearing- impaired clients or users of American Sign L anguage (who call themselves deaf), it is legally required by the A mericans with Disabilities Act of 1980 (amended in 1990 and 2008), as well as clinically preferable, to obtain the services of a certified interpreter. Do not force clients to read or write in a language structure other than ASL or to lip-read. There are far too many examples of BEGIN/ENDING INTERVIEW

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

22 CONDUCTING A MENTAL HEALTH EVALUATION BEGIN/ENDING INTERVIEWhearing- impaired people being misdiagnosed as mentally retarded or psychotic for any examiner to be complacent about this. 1 Assess and report, with your conclusions, the presence of any of the following: Visual impairment: Near-/farsightedness, astigmatism, cataracts, hemianopsia, blindness, etc. ; totally/partially/not compensated for with glasses. Hearing impairment: Total/partial deafness in left/right/both ears, necessitating hearing aids/ lip reading/signing/total communication/American Sign Language; understands amplified/ simplified/repeated conversational speech. Limitations of movement (especially hands if you are doing testing) and ability to sit for peri-ods of time. Impaired speech. (See Section 7. 4, “Speech Behavior. ”)Unfamiliarity with the English language, English as a second language, non-native speaker. Use of or need for an interpreter (in the case of a client with either a hearing impairment or an English-language difficulty). Literacy: Able/unable to read aloud/understand/rephrase a paragraph from a newspaper or com-mon magazine, national news magazine; look up a location on a map; fill out a job applica-tion; understand the instructions for a prescribed medication; follow a recipe; etc. [Avoid using “grade-level” terms, because they are misleading and functionally irrelevant. ] It may be hard for clinicians to understand that up to half their clients, depending on the set-ü ting, may lack basic literacy. However, because illiteracy is socially negative, few clients will acknowledge it when asked. Appropriate evaluation should be routine. Administering an instru-ment called the Rapid Estimate of Adult Literacy in Medicine (Davis et al., 1993) may be more relevant than having a client read aloud and summarize the content of a few paragraphs from a magazine. Low literacy and its resulting misunderstanding and low compliance should not be mistaken for resistance or low intelligence. Lastly, consider all the known variables that affect interpersonal communication, such as age, gen-der, ethnic, socioeconomic, and “racial” differences; language use and style of communication; the demand characteristics of the interview situation; the unstated expectations of each person about the nature and purposes of the interview; and others for your particular situation. 1. 3. Assessing the Client's Understanding of the Interview Situation Ask early, especially if the client seems reluctant to raise the subject: “What have you been told about this interview/our meeting?” “What do you expect to happen here?”“What did you think and feel before you came in here/met me?” “Because I have spoken with /read reports from /know you from , I already know some things about you/why you have come here/why we are talking. However, I'd like to hear from you why you have come to see me/come here. ” “I'd like to talk with you for a few minutes in order to . ” 1I am grateful to Ilene D. Miner, CSW, ACSW, of New York, NY, for this information.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

1. Beginning and Ending the Interview 23BEGIN/ENDING INTERVIEW 1. 4. Obtaining Informed Consent See Section 4. 5, “Consent Statements. ” You must obtain fully informed, cognitively competent, and voluntary consent to the interview or evaluation. Explain the purposes of the interview. Attend to the client's and examiner's perceived expectations of the referring agent; what information is to be gathered, by what means; what is then to be done; and, if a report is written or made, who will see it (e. g., Social S ecurity Disability, workers' com-pensation, courts, and other agencies or parties to whom it may be forwarded without the client's additional authorization under the terms of the H ealth Insurance P ortability and Accountability Act of 1996). As you explain each relevant aspect, ask the client: “Would that be all right with you?”Once some private fact is revealed, it cannot be ignored, so you must fully explain the likely con-sequences of your evaluation and subsequent report and then offer the client the opportunity not to participate and let him/her know he/she can stop participating at any point. I usually use state-ments such as “Consider what will be in your long-term best interests” or “If you have any reserva-tions let us discuss them before we proceed any further. ” Do encourage questions if you detect or suspect any reluctance. Of course, issues may arise as you proceed, in which case you might say something like “You can stop me at any time during our interview if you don't understand me or need to question what I am asking you to do. ” For situations in which you are a consultant, you should explain that your interview will not be for treatment, you will not be their doctor or refer the client to other therapists, nothing is off the record, and the client may choose not to answer any of your questions. When the assessment's purpose is to help the client qualify for some special educational service, get hired, or receive financial support, make it clear that your findings and report may not support this goal—and that even when they do, the final decision will be made by the relevant agency, not by you. On a more positive note, you can explain that even if the goal is not achieved, the results may provide useful information to the client about further activities or interventions. Lastly, explain and have the client sign an authorization to release records for the evaluation. It may incorporate the points made above with a statement such as this: “I fully understand that no specific outcomes can be guaranteed as a result of this evaluation. ” 1. 5. Other Points for All Interviews Ask everyone about the following: Current medications prescribed, taken: Name(s), dosage(s), frequency. All forms of abuse (see Sections 3. 2 to 3. 4). Major losses and grieving. All substances used (see Sections 3. 28 and 3. 29). Suicidal (see Section 3. 30) and homicidal (see Section 3. 31) ideation and impulse control (see Sec-tion 3. 17). Raise any other issues that would arise because of the nature of your setting, population, providers, location, and other factors, and that would be unfamiliar to the average person.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

24 CONDUCTING A MENTAL HEALTH EVALUATION BEGIN/ENDING INTERVIEW 1. 6. Eliciting the Chief Concern/Complaint/Issue See Section 6. 1 for more on addressing the Chief Concern. “Would you please tell me why you are here/came to see me/are being evaluated?” “What brings you to the hospital/the clinic/my office?”“What concerns you most?”“What has been going on?”“What has happened to you?”“What do you hope to have happen/come from our meeting?” 1. 7. Eliciting the Client's Understanding of the Problem See also Section 19. 2, “Culturally Sensitive Formulations. ” Some initial questions to elicit the client's understanding of the presenting problem (based on simi-lar questions by Reimer et al., 1984) are as follows: “What do you think caused your problem?” “Do you have an idea of why it started when it did?”“How severe is your problem/disorder/complaint/sickness?”“How long do you expect it to last?”“What other problems has your problem/disorder/complaint/sickness caused you?”“What do you fear about your problem/disorder/complaint/sickness?”“What kind of treatment do you think you should receive?”“What results do you hope to receive from this assessment/treatment?” 1. 8. Dimensionalizing the Concern/Problem “For how long has this been happening?” (Duration) “How often does this happen?” (Frequency) “When it happens, how strong is it when it starts, at its worst, etc. ?”(Intensity) “Think back to the last time this happened and tell me: “What led up to its happening?” (Antecedents, cues, controlling stimuli, latency, sequences, progression, chains) “What were you thinking and feeling?” (Expectations, beliefs, meanings, affects) “Who else was around, and what did they think and feel?”(Social support, persons who defined prob-lem) “What happened next/afterward?” (Sequences, reinforcers, consequences) “How typical was this occasion?” (Development of the problem, intensity) “Was the first time it happened different?” (Client's understanding of development) “What could have made a difference in this incident?”(Expectations of outcome, changeability, treatment, treaters, understandings of cau-sation) Note: ü The causative factors for a problem may not be the same as the factors maintaining it.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

1. Beginning and Ending the Interview 25BEGIN/ENDING INTERVIEW 1. 9. Ending the Interview It is best to develop a standard set of closing statements for your interview. These will ensure that potentially important information is not lost, that consistency across clients and occasions is main-tained for reliability and validity, and that important legal or patient care issues are discussed. “Is there anything else that you want to add/tell me/want me to know/understand?” “Is there anything important/relevant/that matters that we have not covered?” “Do you have any questions about what we have done today/about this evaluation/about the report I will be writing?” “Do you have any questions about what the next step will be/what happens next?” “The next step is that will contact you about by mail/phone, in days. ” “You will need to make an appointment with to . ”“I appreciate your taking the time to come to this interview and the efforts you made to provide the information I needed. ” “Thank you for your time and efforts in coming here and talking to me. ”“I expect that you will receive some benefit from all of this. ” Or “Although you will not benefit directly from what we have done today, you will be assisting in the training of professionals who will/in the collection of research data that will help others in your situation. ”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

262 Mental Status Evaluation Questions/Tasks The questions in this chapter are about cognitive functions. Questions about symptoms and abnor-mal behaviors are in Chapter 3. 2. 1. Introduction to the Mental Status Questions Over the years, clinicians have formulated questions for assessing mental status (especially cogni-tive function) and passed them down to their students. But with empirical examination, most of these have been found to lack reliability, validity, or both, and the whole area of interpreting the patient's responses is unstandardized. Therefore, for higher reliability, a number of standard brief mental status tests and short batteries are available, such as the classic Mini-Mental Status Examina-tion by Folstein et al. (1975) (available at www. 3parinc. com), and the Global Deterioration Scale by Reisberg et al. (1982). More recent screening tools include the Saint Louis University Mental Status Exam (available at aging. slu. edu) and the Montreal Cognitive Assessment (available at www. moctest. org). Both have sensitivity superior to that of Folstein et al. 's MMSE, especially for the detection of mild cognitive impairment/mild dementia (Smith et al., 2007) and for cognitive dysfunction in Par-kinson's disease (Gill et al., 2008). The Cambridge Cognitive Examination— Revised also appears to be highly discriminating for mild cognitive impairment (Heinik & Solomesh, 2007). The NEPSY-II (Korkman et al., 2007) assesses children ages 3-16 in six domains. You could, of course, use the questions from the age- appropriate sections of the Stanford-Binet, or the Wechsler subtests of Information, Arithmetic, Comprehension, Similarities, or Digit Span, for the advantage of precise scoring and interpretation of the responses. Even with these tests, however, norming and validity may still be less than desired for the important consequences that flow from MSEs. The questions offered below may be suitable alternatives for clients who have recently been for-mally tested on the instruments cited above, or they may be used for other reasons. These questions are appropriately used only as screening devices; unusual responses must be investigated further with standardized tests, and patterns of unusual responses must be investigated with neuropsycho-logical, neurological, or other appropriate scientific methods. No assertion or implication of any kind of validity is made or should be inferred about the use of the questions presented here. As far as I know, no research has been conducted on them, and no published norms are available to guide clinicians in interpreting the responses obtained to the MENTAL STATUS QUESTIONS

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 27MENTAL STATUS QUESTIONSquestions asked. The internal “norms” of experienced and well- trained professionals are the only basis for evaluating such responses. Although you will find guidance in almost any psychiatry text, the best books for learning to do MSEs are Trzepacz and Baker (1993) and Morrison (2008). The latter has a simple but excellent eight-page outline that integrates the process of data gathering and the formal structure of the interview. Rogers (2001) offers reviews of MSEs and structured interviews. Also, bear in mind that your observations and conclusions about the client's thought processes (“symptoms”) are entirely inferred from your observations (“signs”), as you have no direct access to these processes. Verbal and behavioral expressions can be affected by conditions such as sensory limitations, learning disorders, illiteracy, pain or other distractions, language limitations, or even dental problems. 1 The numbered sections below cover areas of mental functioning in rough order of increasing com-plexity and demand on the client's cognitive abilities. For each subsection that asks about a specific cognitive function, such as memory, similarities, or social judgment, a cross- reference is included to the appropriate section of Chapter 11, “Cognition and Mental Status. ” There you will find the terms for describing the cognitive function. 2. 2. Background Information Related to Mental Status See also Chapter 6, “Background Information and History. ” Note: ü If the client is incapable of providing this information, a family member or other infor-mant should be sought and identified in your report. “How far did you go in school/How many grades did you finish in school/Did you finish high school?” “In school, were you ever left behind a year/not promoted to the next grade/did you have to take a grade over again?” “Were you ever in any kind of special classes/special education/classes for students with learn-ing disabilities/mental retardation/social and emotional disturbances or disabilities?” 2. 3. Rancho Los Amigos Cognitive Scale This scale can be used to assess the level of function in carrying out purposeful behavior. Adapted from Hagen, Malkmus, and Durham (1979). Used by permission. See also the Rancho Los Amigos Scale on Levels of Coma (copyright 1997; see www. waiting. com/rancholosamigos. html; a more detailed version can be found at www. northeastcenter. com/rancho_los_amigos_revised. htm). Level I No response to pain, touch, sound, or sight. Level II Generalized reflex response to pain. Level III Localized response. Blinks to strong light, turns toward/away from sound. Responds to physical discomfort. Inconsistent response to commands. Level IV Confused-agitated. Alert, very active, aggressive, or bizarre behaviors. Performs motor activities, but behavior is nonpurposeful. Extremely short attention span. 1Thanks to Joe Elwart, Psy D, of Royal Oak, MI.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

28 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONSLevel V Confused-nonagitated. Gross attention to environment. Highly distractible; requires continual redirection. Difficulty learning new tasks. Agitated by too much stimulation. May engage in social conversation, but with inappropriate verbalizations. Level VI Confused-appropriate. Inconsistent orientation to time and place. Retention span/recent memory impaired. Begins to recall past. Consistently follows simple directions. Goal-directed behavior with assistance. Level VII Automatic-appropriate. Performs daily routine in highly familiar environment in a nonconfused but mechanical, robot-like manner. Skills noticeably deteriorate in unfamiliar environment. Lacks realistic planning for own future. Level VIII Purposeful-appropriate. 2. 4. Glasgow Coma Scale This scale can be used for more precise numerical rating of core mental functioning, particularly after brain trauma. It is for an older child (age 4 and up) or adult and is adapted from Teasdale and Jenvet (1974). It is used by permission. The GCS can also be found online (www. northeastcenter. com/glasgow_coma_scale. htm), as can a version for infants and younger children (www. northeastcenter. com/modified-glasgow-coma-scale-for-infants-and-children. htm). Eyes: Open: Spontaneously 4 To verbal command 3To pain 2 No response 1 Best motor response: To verbal command: Obeys 6 To painful stimulus: Localizes pain 5 Flexion-withdrawal 4 Flexion-abnormal 3 Extension 2 No response 1 Best verbal response: Oriented and converses 5 Disoriented and converses 4 Inappropriate words 3 Incomprehensible sounds 2 No response 1 Total (3-15): Generally, ratings of 12 or above indicate mild injuries, and ratings of 8 or less indicate severe ü injuries. 2. 5. Orientation See Section 11. 15, “Orientation,” for descriptors. To assess and document disorientation and confusion after Traumatic Brain Injury more for-mally, the Galveston Orientation and Amnesia Test (available at www. utmb. edu/psychology/adultre-

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 29MENTAL STATUS QUESTIONShab/goat. htm) has been widely used. However, for those whose difficulties have other causes, the 10-item Orientation Log may be more appropriate (see tbims. org/combi/olog). To Person “Who are you?” “What is your name?” [Pay attention to nicknames, childhood versions of name, hesitations, aliases. ] “Are you married?”“What kind of work do/did you do?” For a Child: “What school do you go to?” “What grade are you in now?”“What is the name of your teacher?” To Place “Where are we/you?” (Setting, address/building, city, state/province. )“Where do you live?” (Setting, address/building, city, state/province. )“How far is this place from where you live?” To Time Observe whether the client wears a watch and, if so, whether the time indicated is correct and the client can read the time correctly. If the client wears no watch and indicates not knowing the time, ask for a guess or an approximation. “What time is it? Is that a. m. or p. m. ? Is it day or night?” “How old are you?” “When is your birthday?” “What day is today? Which day of the week is today? What month is it now? What is today's date?” “What season is it? What year is it?”“When did you first come here? How long have you been here? Have you ever been here before?” (If yes:) “How long were you here then?” To Situation “Who am I?”“What am I doing here?”“What is the purpose of our talking?”“Why are you here?” To Familiar Objects Hold up your hand and ask, “Is this my right or left hand?” “Please name the fingers of my hand. ” Hold up/point to a pencil, a watch, and eyeglasses, and ask the client to name each object, its uses, and its parts. To Other People “What is your mother's/father's/spouse's name?”“What is your child's name/are your children's names?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

30 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONS“What is my name?” “What is my title/job?”“When was the last time we met?”“What are the names of some staff members?” [Ask about their titles, functions, etc., as well. ] “What are the names of some other persons here/patients?” 2. 6. Attention (↔ by degree) See Section 11. 3, “Attention,” for descriptors. For attention span questions, see Sections 2. 7, “Concentration,” and 2. 10, “Memory. ” The questions and tasks below, arranged in order of increasing difficulty, cover active information processing about a single or particular stimulus with filtering out of irrelevant stimuli. “Please say the alphabet as fast as possible. ” (Note the time taken; normal speed is 3-10 sec-onds. ) “Spell 'earth'/'house. '” “And now please spell it backward. ” “Repeat your Social Security number backward, please. ” [You may need to clarify this by add-ing “One number at a time, from the end. ” Note time needed and accuracy. ] “Tap a pencil on the table each and every time I say the letter C. ” (Present a series of random letters at the rate of about one each second, with the letter C randomly distributed but occurring about every three to eight letters. ) [Normal performance is making one or two errors (not noticing a C) in 45 seconds/45 letters. ] Digit span, forward and reverse: In other words, ask client to listen to, repeat, then repeat in reverse an arbitrary series of single digits you say first. (See Section 2. 10, “Memory. ”) Name three objects and have the client repeat them. Record the trials until the client is able to repeat all of them accurately. [This can also be used for delayed recall. ] (See Section 2. 10. ) “Count and then tell me the number of taps I have made. ” (Tap the underside of the table, or in some other manner make several trials of 3-15 sounds out of the client's sight. ) 2. 7. Concentration (↔ by degree) See Section 11. 4, “Concentration/Task Persistence,” for descriptors. The questions and tasks here cover the maintenance of/holding of attention, or the performance of linked mental acts that require the excluding of irrelevant stimuli. “Please spell your last name. ” “Now please spell it backward. ” “Name the days of the week backward, starting with Sunday. ”“Please name the months of the year. ” “Now please say them backward. ”“Say the alphabet backward as fast as you can. ”Ask the client to write a fairly long and complex sentence from your dictation. Ask the client to tell you when a minute has passed while you talk/don't talk to him/her, and record the time taken. Ask the client to point to/underline each A in a written list presented on a full page of letters: for example, B, F, H, K, A, X, E, P, A, etc. Have the client do mental arithmetic problems. (See Section 2. 16, “Calculation Abilities,” for examples— including the famous “serial sevens. ”)

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 31MENTAL STATUS QUESTIONS2. 8. Comprehension of Language Receptive Receptive language abilities can be assessed by the responses to simple questions such as “Is my aunt's brother a man or a woman?” or “The lion killed the tiger. Which one is dead?” Next in com-plexity are the client's responses to a series of commands such as these: “Close your eyes. Open them. Raise an arm. Raise your left arm. ” “Show me how you brush your teeth/comb your hair. ”“Put your right hand on your left knee three times, and then touch your left ear with your right hand. ” “If today is Tuesday, raise one arm; otherwise, raise both. ” (A three-stage command:) “Pick up that paper, fold it in half, and put it on the floor. ”“Please read and obey this sentence. ” (Presented on a card: “Close your eyes for 5 seconds. ”) Fluency “Please tell me as many words as you can think of that begin with the letter F. Don't give me names/proper nouns or repeat yourself, and keep going until I stop you. ” (Stop the client after 30 seconds, and perhaps repeat with the letters A, P, or S. Score is the total number of words meeting the criteria on each trial. ) Expressive Ask the client to read and explain some sentences from a magazine or newspaper. Show her/him a photograph (e. g., in a magazine) and ask for the name(s) of the item(s) depicted. Ask her/him to describe a picture that portrays several actions. 2. 9. Eye-Hand Coordination/Perceptual-Motor Integration/ Dyspraxia/Constructional Ability Ask the client to: Pick up a dime with each hand from the tabletop. Spin a paper clip on the tabletop, using each hand. Touch each thumb to each finger as you name them (not in order). Ask the client to: Copy a design of two overlapping pentagons from an illustration on a card. Draw a house/a tree/a person/a person of the opposite sex/yourself. [These are known as the House-Tree-Person and Human Figure Drawing tests. ] Ask the client to draw, from your dictation: a diamond the outlines of a cross a smoking pipe the edges of a transparent cube Ask the client to draw a clock face and then indicate the present time as he/she estimates it to be, or “twenty after six. ” [This is known as the Clock Test. See Juby, 1999; Heinik & Shaikewitz, 2009. ]

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

32 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONS2. 10. Memory See Section 11. 12, “Memory,” for descriptors. If possible, it is probably best to use the Wechsler Memory Scale—IV (Wechsler, 2009) or a similar validated test for accurate and precise evaluation. Introductory Questions “Has your memory been good?” “Have you had any difficulty concentrating or remembering what you read/watch on television/ recipes/telephone numbers/appointment times?” “Have you recently gotten lost/forgotten an important event/forgotten something you were cooking/left some appliance on too long?” “Have you had any difficulty recalling people's names or where you know them from?”“Have other people said to you that your memory is not as good as it was?” Immediate Memory/Memory Span Immediate memory covers a period of about 10-30 seconds in the experimental laboratory, or what was just said, done, or learned during the evaluation in the clinic. “Digit span,” both forward and reverse, is a common but complex task requiring perhaps more concentration than immediate memory. 2 Begin by telling the client: “I am going to say some numbers one at a time. When I finish, please repeat them back to me. Ready?” Start with two digits (“1, 7,” not “17, 36,” etc. ). When the client repeats these correctly on a first or second attempt (with different digits), increase the length of the list by one digit until the client fails both trials/number sequences offered. Write the numbers down as you say them. Speak at a consistent rate of one digit per second; do not emphasize ending numbers with ü changes in your voice; and avoid consecutive numbers and easily recognizable dates or familiar sequences, or use your own Social Security number or telephone number. Then say: “Now I am going to say some more numbers, but this time I want you to repeat them backward. For example, if I said '6, 2,' what would you say?” The score is the maximum number of correctly recalled digits in correct order on either trial. ü “Five forward with one mistake” is four forward. Education (but not age) affects digit span, so be careful with interpretations. Normal digit span ü in adults is five to eight digits forward and four to six backward. A difference of three or more between forward and backward may reflect concentration deficits. Norms are available in the manuals for the Wechsler tests (Wechsler, 2003, 2008, 2009). Short-Term Retention Short-term retention covers a period from a few minutes up to 1-2 hours. Name (for auditory retention) or point to (for visual retention) three related items (e. g., Broad-way-New York City-taxi; book-pen-tablet; scissors-stapler-pad, apple-peach-pear). Tell the client that you will ask him/her about them later, and then ask for recall after 5 minutes 2I am grateful to James L. Pointer, Ph D, of Montgomery, AL, for this clarification.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 33MENTAL STATUS QUESTIONSof interspersed activities. The score is the number recalled out of three without and then with prompting. Offer four items from four categories (e. g., house, table, pencil, dictionary) and record the num-ber of trials taken to learn the list. Ask for recall in 5 and 10 minutes. If the items are not recalled, prompt with category descriptions (e. g., a building, a piece of furniture, a writing tool, a kind of book). If they are still not recalled, ask the client to select the words from a list of four similar items (e. g., for pencil offer pen, crayon, pencil, paintbrush). Give the client three colors or shapes to remember, and ask her/him to recall them in 5 min-utes. Tell the client your name and ask him/her to remember it because you will ask for it later. Ask in 5-10 minutes. If it is not correctly recalled, reinform and teach; then ask again every 5 or 10 minutes more, and note the number of trials to mastery or your abandoning the test. Ask the client to read a narrative paragraph from a magazine or newspaper, and to produce the gist of the story upon completion without being able to refer to the source. Ask about events at the beginning of the interview. (For example, were any other people pres-ent? What was asked first and next? Which history items were sought?) Recent Memory Recent memory covers a period from a few hours up to 1-4 days, and also today's events. Ask about yesterday's meals/television programs/activities/companions (but only if these can be verified). Ask about the route taken/distance to this office, your name (if not overused in the interview), events in the recent news. Ask, “What clothes did you wear yesterday?” Recent Past Memory Recent past memory refers to the last few weeks and months. Ask the following questions only if the answers can be verified: “What did you do last weekend?” “Where and when did you take your last vacation?”“What presents did you get on your last birthday/Christmas?”“What were you doing on the most recent national holiday (July 4th, Labor Day, Christmas)?”“Name any other doctors you have seen/any hospitalizations/tests received, when the present illness began/you first felt troubled/ill. ” Remote Memory Remote memory extends from approximately 6 months ago up to all of the client's lifetime, includ-ing the premorbid period (before symptom onset). Ask about the following: Childhood events (in their correct sequence), places lived, schools attended, names of friends. “Where were you born?” “What is your birth date?”“Your first memory?”“What was the name of your elementary/grade/high school?”“Please tell me the names of some of your friends in school. ” Life history: parents' full names, siblings' names and birth order, family deaths, first job, date(s) of marriage, names/birth dates/ages of children. More difficult alternatives: siblings' birthdays, dates of hospitalizations, names of doctors, school teachers' names, “How you dressed up for Halloween. ”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

34 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONSActivities on holidays about a year ago or on other dates that stand out. Local historical events. Historical events: Attack on Pearl Harbor (Dec. 7, 1941); Sputnik (1957); first men on the moon (July 20, 1969); name of the U. S. president who resigned (Nixon, Aug. 9, 1974); U. S. presi-dents during wars (WW II—F. D. Roosevelt; Korean War— Truman, Eisenhower; Vietnam— Johnson, Nixon; Iraq and Afghanistan—G. W. Bush, Obama); Challenger disaster (Jan. 28, 1986); collapse of Berlin Wall (Nov. 9, 1989); Oklahoma City bombing (Apr. 19, 1995); World Trade Center/Pentagon attacks (Sept. 11, 2001); etc. 2. 11. Fund of Information See Section 11. 8, “Information,” for descriptors. Basic Orientation Information “What is your birth date? Social Security number?”“What is your phone number? Area code?”“What is your address? Zip code?”“What is your height? Weight? Shoe size? Dress/suit size?” “Tell me the time. ” “What time will it be in an hour and a quarter?” “How long will it be until Christmas?”“How many days are there in a month/year?”“Name the days of the week/months of the year. ” “Where are we?” [Ask for state, county, city, hospital/building, floor, office. ] “Name the local sports teams. ”“What is the capital of this state?”“Which states border this one?”“Name the five largest U. S. cities. ”“How far is it from here to (one of the large cities named above)?”“How far is it from New York City to San Francisco?”“In which country is Rome/Paris/London/Moscow?”“Name three countries in the Middle East/Europe/South America. ”“What is the current population of this city/state/the United States (about 308 million in 2010), the world (about 6. 8 billion in 2010)?” Information about People “Who is the current president? And before him? And before him? Name the presidents back-ward, starting with the current one. ” (U. S. presidents since 1901 in reverse order: Obama, G. W. Bush, Clinton, G. H. W. Bush, Reagan, Carter, Ford, Nixon, Johnson, Kennedy, Eisen-hower, Truman, F. D. Roosevelt, Hoover, Coolidge, Harding, Wilson, Taft, T. Roosevelt. ) [Note: The failure to recall most of these is not pathognomonic. ] “Where does the president live?” (In the White House; Washington, D. C. )“Who was the first president of the United States?”“Who is the governor of this state/mayor of this city?”“Who is... ?” [Name several present or past entertainers and/or sports figures that the cli-ent would seem likely to know. ] “What was/is Booker T. Washington/Thomas Edison/Jonas Salk/Albert Einstein/Steve Jobs/Bill Gates famous for?” “Who invented the airplane?” (The Wright brothers, Wilbur and Orville. )“What does a pharmacist do?”“Who is/was John F. Kennedy/Martin Luther King, Jr. /Fidel Castro?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 35MENTAL STATUS QUESTIONSFor a Child: “Who is Mickey Mouse/Mr. Rogers/Big Bird/Ronald Mc Donald/Barney/Harry Potter/Sponge-Bob?” “What are your teachers' names?” The names in several of these questions can of course be varied depending on a client's age, gen-der, place of residence, and ethnicity, as well as on the current popularity or importance of various figures. Information about Things “Name five foods. ” “Name five animals. ”Ask about local geography: rivers, mountains, streets, downtown, parks, highways, stores, malls, schools. “How many sides does a pentagon have?” (Five. )“Name three animals beginning with C. ”“Name three cities beginning with D. ”“How many ounces in a pound?” (16. )“What are houses made of?”“Which is the longest river in the United States?” (The Mississippi. )“In what direction does the sun set?” (The west. )“Please identify these. ” [Show some coins and bills of common U. S. currency. ]“Who/whose face is on a penny/nickel/dime/dollar bill/five-dollar bill?” (Lincoln/Jefferson/F. D. Roosevelt/Washington/Lincoln. ) “At what temperature does water freeze?” (32 degrees Fahrenheit or 0 degrees Celsius. )“From what do we get gasoline?” (Oil, crude oil. ) Information about Events “What do we celebrate on the 4th of July/Christmas/Thanksgiving Day/Labor Day/Memorial Day/Easter/Passover/Ramadan/Kwanzaa?” “Who won the last Super Bowl/World Series?”“Please name some events/big stories that are currently in the news/that you have read about in the papers or seen on the TV news. ” “What has happened recently in (specify a place)?”“What did (person's name) do recently? What happened to (person's name) recently?”“In about what years did the United States fight in World War II/Korea/Vietnam/the Persian Gulf/ Afghanistan/Iraq?” (1941-1945, 1950-1953, 1965-1975, 1990-1991, 2001-?, and 2003-?, respectively. ) “Why did we fight that war?” (For those over 75 years of age:) “What was the date of the attack on Pearl Harbor?” (Dec. 7, 1941. ) (For those over 55 years of age:) “What was the date President John F. Kennedy was assassi-nated?” (Nov. 22, 1963. ) What was the date of the attacks on the World Trade Center and the Pentagon? (Sept. 11, 2001. ) 2. 12. Opposites “Please tell me the opposite of each of these words. ” Hard fast large out high child

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

36 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONS2. 13. Differences Use the format “What is the difference between a and a ?” or “In what ways are a and a different or not the same?” lie-mistake midget-child kite-airplane duck-pigeon orange-baseball water-land boy-girl hand-foot tongue-nose Ask: “Which of these is the different one and why?” Desk, apple, chair, lamp. (Apple is not furniture, not artificial, is edible. ) Pottery, statue, painting, poem. (Poem is not tangible; statue does not begin with P, etc. ) 2. 14. Similarities/Analogies Use the format “In what ways are a and a the same or similar?” Pairs of words, grouped by difficulty, are listed below. Easy (because there is a commonly available word for an abstract commonality, but these still have concrete and functional levels) yellow-green dollar-dime apple-orange scissors-saw joy-anger violin-piano cat-lion ship-airplane Moderately Difficult (because a word for an abstract commonality is not so easily available) truck/car-bus bus-airplane duck-chicken elbow-knee sun-moon barn-house socks-shoes watch-clock Difficult (because the commonality is quite abstract and difficult to find) theater-church wings-legs work-play prison-zoo mountain-lake telephone-radio steam-fog ruler-thermometer Question any vague responses until you obtain a clear estimate of the level of comprehension ü and abstraction involved. For example, “bus-airplane” can be interpreted on a spectrum of increasing abstraction: “Both have wheels/People ride in both/Both are means of transporta-tion/Both are technological artifacts. ” In ambiguous cases, ask the client: ü “Please tell me more about that. ” If necessary, add: “What type/ class of things do they belong to?” 2. 15. Absurdities You can, of course, use Verbal Absurdities from the Stanford-Binet Intelligence Scales, Fifth Edition (Roid, 2003), or you might select from your experience examples tailored for the particular person being examined. Ask the client: “What is wrong with/is foolish/doesn't make sense about this?” “The doctor rushed into the emergency room, got out the bandages, and after eating a sand-wich, bandaged the bleeding man. ”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 37MENTAL STATUS QUESTIONS“Bill's ears were so big he had to pull his sweaters on over his feet. ” “An airplane pilot ran out of gas halfway across the ocean, so to be safe, he turned around, flew back, and landed where he took off. ” “A man was in two auto accidents. The first accident killed him, but the second time he got well very quickly. ” Only if you believe it useful, ask about absurdities/contradictions/paradoxes in everyday life: “Please give me an example of 'Catch-22. '”“Prevention is more effective than treatment, yet is underfunded. ” 2. 16. Calculation Abilities See Section 11. 2, “Arithmetic,” for descriptors. The questions below require attention, concentration, memory, and education. On all math prob-lems, make note of the actual answers given; the effort required/given; time needed; accuracy/changed performance when given a prompt, on the next correct answer in a sequence, or when given paper and pencil to perform the calculations; etc. Also note self- corrections, use of fingers to count upon, requests for paper and pencil, complaints, excuses, etc. Basic Examples of Arithmetic Questions (↔ by degree) “How much is 2 + 2? And 4 + 4? and 8 + 8?” [Continue in this sequence and note the limits of skill. More difficult versions are 3 + 3's and 7 + 7's. ] One-step: “3 + 4 = ?” “6 + 4 = ?” Two-step: “7 + 5-3 = ?” “8 + 4 + 9 = ?” “4 + 6 + 3 = ?”“Which is larger: 1⁄3 or 1/2?” Verbally Presented Arithmetic Problems (↔ by degree) “How many quarters are there in $1. 75?” (7)“If pens are priced at 2 for 18 cents, how much would half a dozen cost?” ($0. 54)“How much is left when you subtract $5. 50 from $14. 00?” ($8. 50)“How many nickels are there in a dollar?” (20)“How many nickels are there in $1. 95?” (39) Serial Subtractions/“Serial Sevens” See Section 11. 4, “Concentration/Task Persistence,” for descriptors. “Starting with 100, subtract 7, and then subtract 7 from that, and continue subtracting 7. ” Normal performance is 1 minute or less in subtracting to 2 with two or fewer errors, not includ-ü ing spontaneous self-corrections. In reporting responses to this, it is clearer to the reader if you underline the errors, as in this set of responses: 93, 84, 77, 70, 62. Attend not only to accuracy but to speed and persistence. Simpler Alternatives to “Serial Sevens” Simpler alternatives to “serial sevens” include counting from 1 to 20 by twos, or counting to 39 by threes and subtracting “serial fives” from 100. More difficult are “serial fours” from 50, and “serial threes” from 31. For those for whom “serial sevens” is too easy, “serial thirteens” from 100 may be suitable.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

38 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONS2. 17. Abstract Reasoning/Proverbs See Section 11. 17, “Reasoning/Abstract Thinking/Concept Formation,” for descriptors. Our interpretation of our clients' interpretation of proverbs should be circumspect and informed (see Gibbs & Beitel, 1995). The selection of which proverbs to offer depends on your initial assess-ment of the client's deficits and diagnosis. Some are more difficult to interpret satisfactorily, while others reveal coping strategies, the intensity of the cognitive dysfunction, or personalization. Ask, “What do people mean when they say ?”, followed by a prov-erb such as the following: “All that glitters is not gold”/“You can't judge a book by its cover. ” (Appearances can be deceiving. ) Make hay while the sun shines”/“Strike while the iron is hot. ” (Using an opportunity, tak-ing initiative. ) “Don't cry over spilled milk. ” (Mature resignation and priorities. )“The grass is always greener on the other side of the fence. ” (Optimism, pessimism, envy, regret, dissatisfaction. ) “Every cloud has a silver lining. ” (Optimism, hopefulness, trust, patience. )“Rome wasn't built in a day”/“Great oaks from little acorns grow. ” (Patience, frustration tolerance, deferral/delay of gratification. ) “People who live in glass houses shouldn't throw stones. ” (Arrogance vs. tolerance, humil-ity, guilt, impulse control. ) (Or more casually: What goes around comes around. ) “Birds of a feather flock together”/“Like father, like son”/“The apple doesn't fall far from the tree. ” (The effects of history, genetics, or learning. ) “Don't count your chickens before they are hatched”/“A bird in the hand is worth two in the bush. ” (Caution, realistic hopes/plans. ) “The squeaking wheel gets the grease. ” (Excessive modesty vs. attention-seeking behavior, self-assertion. ) “When the cat's away, the mice will play. ” (Control and rebellion. )“A rolling stone gathers no moss. ” (Either positive or negative interpretations of stones/ moss/rolling. ) An alternative is to ask, ü “Do you have a favorite Bible story?” If so, “Tell me the story. ” Then ask, “Why is it your favorite?” 2. 18. Paired Proverbs These proverbs can be used to further evaluate the client's abstraction abilities. Present one on the left and then the paired one on the right. Ask the client, “What do people mean when they say... ” before each proverb. Note when and how the client recognizes the conflicts presented by the pairs. Does she/he fail ü to notice the conflicts; seem to notice but then ignore the conflict; make some joke; comment on human nature, proverbs in general, the examiner, or the examiner's questions; try to resolve the conflict at a higher level of abstraction; offer other conflicting proverbs? “Don't change horses in midstream. ” and “If at first you don't succeed, try, try again. ” “A bird in the hand is worth two in the bush. ”and “Nothing ventured, nothing gained. ” “Look before you leap. ” and “He who hesitates is lost. ” “Out of sight, out of mind. ” and “Absence makes the heart grow fonder. ” “A stitch in time saves nine. ” and “Don't cross a bridge until you come to it. ”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 39MENTAL STATUS QUESTIONS“Haste makes waste. ” and “Strike while the iron is hot”/ “Make hay while the sun shines. ” “Do unto others as you would have them do unto you. ”and “To each his own”/ “Different strokes for dif-ferent folks. ” 2. 19. Practical Reasoning General Questions “Why do we refrigerate many foods?” “Why do we have newspapers?”“Why should people make a will?”“Who picked out the clothes you are wearing?” Hazard Recognition (↔ by degree) “What should you do before crossing the street?” “Why shouldn't people smoke in bed?” “What should you do when paper in a wastebasket catches fire?”“What should you do if food catches on fire when you are cooking at the stove?” “What should you do when you cut your finger?” “What should you do if you smell gas in your house/come home to find that a broken pipe has flooded the kitchen?” 2. 20. Social Judgment See also Section 2. 19, above; see Sections 11. 13, 11. 16, and 11. 20 for descriptors. The questions below require increasing social understanding (↔ by degree). “What should you do if you lose/find a library book?”“What should you do if you see a purse or a wallet on the sidewalk/in the street?”“Why should people go to school?”“What should you do if you are stopped by the police?”“What would you do if you found that you had locked your keys in your car?” “Why do we have to put stamps on letters we mail?” “Why do people have to have license plates on their cars?” “Please tell me of a situation/incident in which you made a bad/foolish/mistaken choice. ” “Have you ever been taken advantage of/been a victim?”“Have you ever made any bad loans?” “What should you do if someone is very critical of a job you have done?” “What would you do if someone threatened/tried to hurt you?”“Please tell me the name of a close friend of yours/someone you would confide in/talk with if you had a personal problem/talk over a serious problem with. ” “How would you spend $10,000 if it were given to you/if you won the lottery?” “Who is or was the most important person in the world/history? Why?” “What is the role of a free press in a democracy?”“Why do we vote by secret ballot?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

40 CONDUCTING A MENTAL HEALTH EVALUATION MENTAL STATUS QUESTIONS“Why do people feel so strongly about the subject of abortion?” “What do you think are the major differences between the Republican and Democratic par-ties?” For a Child: “If you could be any animal, which would you choose and why?” “If you could have anything you wished for, what three things would you wish for?”“If you could live anywhere in the world, where would you want to live?”“What would you do if another student pushed/hit/teased you?” “Do you think you have enough friends?”“What would you do if someone you didn't know offered you a ride home from school/offered you a video game/wanted to show you a puppy or kitten?” 3 “If you could change anything about yourself, what would you change?” 2. 21. Decision Making See Section 11. 6, “Decision Making,” for descriptors. “Are you satisfied with the decisions you make?” “Do you have a hard time coming to some decisions? Which are hardest? Why?”“Do you decide too quickly or take too long to make a decision?”“Have other people ever said you were indecisive/wishy-washy? Do you agree?” 2. 22. Self-Image For descriptors, see Section 9. 3, “Self-Image/Self-Esteem. ” “Which three words best describe you?”“What are your strengths as a person?”“How would you describe yourself?” “What was the most important thing that ever happened in your life?” “What would be written on your tombstone/in your obituary if you were to die today?”“Has life been fair to you?”“Please tell me about the turning points in your life. ” 2. 23. Insight into Disorder For descriptors of responses, see Section 11. 9, “Insight. ” “What kind of place is this? What goes on here?”“Why are you here? What causes you to be here?”“Why are you talking to me?” “Do you think there is something wrong with you?” (If so:) “What? Do you think you are ill?” “What do you think has caused your troubles/pain/confusion/being disabled/being hospital-ized?” “How well is your mind working?”“What are your major problems?” 3Some of these questions are from Judy Bomze of Wynnewood, PA.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

2. Mental Status Evaluation Questions/Tasks 41MENTAL STATUS QUESTIONS“What is your diagnosis?” “What does that mean?” “Did you ever have a nervous breakdown/bad nerves/something wrong with your mind?” “Do you think you need treatment?” “Why did/do you need to take medicines?” “What role or part do you think/believe you have played in this problem/your problems?”4 “What do you need to do to stay well. ” “What are your suggestions for your treatment?”“What changes would help you most?” “How would you describe your childhood/family/earlier life?” 2. 24. Strengths and Coping This list is adapted from Tedeschi and Kilmer (2005). Self-Efficacy “How sure are you that things will work out for you when you have to try something new and challenging/someone counts on you to do something important/you're faced with a prob-lem in an important relationship?” Social Support “How much can you count on your friends and family when you need them?”“Do you have someone who really 'gets' you and understands how you feel?”“Other than your family/folks, do you feel as though there are adults and people who care about you and will help you?” Coping Strategies “What do you tend to do when you're faced with a problem or stressful situation? How do you handle it?” “What do you do when you are stressed?/When you are upset, what do you usually do?”“What gets you through? What do you do then?” 2. 25. Mental Status Evaluation Checklist In any evaluation of mental status, always consider variables that may be affecting the client's ü performance, such as current medications and illnesses, limitations of communication, and oth-ers. (See Section 1. 2, “Introducing Yourself and Noting Possible Communication Difficulties. ”) The checklist presented on the next two pages (Form 1) is adapted from my book The Paper Office (Zuckerman, 2008). The form is concise and helpful for recording the results of an MSE. You may photocopy and adapt it for your work with clients without obtaining written permission, but you may not use it for teaching, writing, or any commercial venture without such permission. 4This way to assess the client's degree of taking responsibility or blaming comes from Michael Newberry, MD, of Palm Bay, FL.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

42[Use the top of this page for your letterhead. ] Mental Status Evaluation Checklist Directions: Rate current observed performance, not reported, historical, or projected. Circle the most appropriate descriptive terms in part C, and feel free to write in others. If an aspect of mental status was not assessed, cross out the heading. Write additional observations, clarifications, and quotations in part D. Client: Date: Evaluator: Highest grade completed GED? Special education for ? Primary occupation: Other: A. Informed consent was obtained about:  The recipient(s) of this report  Confidentiality  Competency  HIPAA  Other: B. Evaluation methods 1. The information and assessments below are based on my observation of this client during:  Intake interview  Psychotherapy  Formal mental status testing  Group therapy  Other: 2. We interacted for a total of minutes. 3. Setting of the contact:  Professional office  Hospital room  Clinic  School  Home  Work  Jail/prison  Other: C. Mental status descriptors (Circle all appropriate items) 1. Appearance and self-care Stature Average Small Tall (For age, if a child) Weight Average weight Overweight Obese Underweight # pounds: Clothing Neat/clean Careless/inappropriate Meticulous Disheveled Dirty Appropriate for age, occasion, weather Seductive Inappropriate Bizarre Grooming Normal Meticulous Neglected Bizarre Cosmetic use Appropriate Inappropriate for age Excessive None Posture/gait Normal Tense Rigid Stooped Slumped Bizarre Other: Motor activity Not remarkable Slowed Repetitive Restless Agitated Tremor Other notable aspects: 2. Sensorium Attention Normal Unaware Inattentive Distractible Vigilant Concentration Normal Scattered Variable Preoccupied Confused Anxiety interferes Focuses on irrelevancies Orientation ×5 Time Person Place Situation Object Recall/memory Normal Defective in: Immediate/short-term Recent Remote Amnesia Confabulation (cont. ) FORM 1. Mental Status Evaluation Checklist. From Zuckerman (2008). Copyright 2008 by Edward L. Zuckerman. Adapted by permission in Clinician's Thesaurus, 7th ed., by Edward L. Zuckerman. Permission to photocopy this form is granted to purchasers of this book for personal use only (see copyright page for details). MENTAL STATUS QUESTIONS

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

43 Mental Status Evaluation Checklist (p. 2 of 2) 3. Relating Eye contact Normal Fleeting Avoided None Staring Facial expression Responsive Constricted Tense Anxious Sad Depressed Angry Attitude toward examiner Cooperative Dependent Dramatic Passive Uninterested Silly Resistant Critical Hostile Sarcastic Irritable Threatening Suspicious Guarded Defensive Manipulative Argumentative 4. Affect and mood Affect Appropriate Labile Restricted Blunted Flat Other: Mood Euthymic Irritable Pessimistic Depressed Hypomanic Euphoric Other: 5. Thought and language Speech flow Normal Mute Loud Blocked Paucity Pressured Flight of ideas Thought content Congruent mood and circumstances Incongruent Personalizations Persecutions Indecisions Suspicions Delusions Ideas of reference Ideas of influence Illusions Preoccupations Phobias Somatic Suicide Homicidal Guilt Religion Other: Hallucinations Auditory Visual Other: Content: Organization Normal Logical Goal-directed Circumstantial Loose Perseverations 6. Executive functions Fund of knowledge Average Abov e average Impoverished by: Intelligence Average Below average Above average Needs investigation Abstraction Normal Concrete Functional Popular Abstract Overly abstract Judgment Normal Common-sensical Fair Poor Dangerous Reality testing Realistic Adequate Distorted Variable Unaware Insight Uses connections Gaps Flashes of Unaware Nil Denial Decision making Normal Only simple Impulsive Vacillates Confused Paralyzed 7. Stress Stressors Money Housing Family conflict Work Grief/losses Illness Transitions Coping ability Normal Resilient Exhausted Overwhelmed Deficient supports Deficient skills Growing Skill deficits None Education Communication Interpersonal Decision making Self-control Responsibility Self-care Activities of daily living Supports Usual Family Friends Church Service system Other: Needed: 8. Social functioning Social maturity Responsible Irresponsible Self-centered Impulsive Isolates Social judgment Normal “Street-smart” Naive Heedless Victimized Impropriety D. Other aspects of mental status This is a strictly confidential patient medical record. R edisclosure or transfer is expressly prohibited by law. This report reflects the patient's condition at the time of consultation or evaluation. It does not necessarily reflect the patient's diagnosis or condition at any subsequent time. MENTAL STATUS QUESTIONS

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443 Questions about Signs, Symptoms, and Other Behavior Patterns Questions here do not address cognitive functioning or mental status; those are covered in Chapter 2, “Mental Status Evaluation Questions/Tasks. ” For interviewing and evaluating couples or fami-lies, see Chapter 16, “Couple and Family Relationships. ” 3. 1. Introduction to the Questions about Signs, Symptoms, and Behavior Patterns The questions in this chapter address two kinds of phenomena: (1) signs and symptoms (such as anxiety, hallucinations, and mania) and the disorders with which they are associated; and (2) behav-iors that are considered the province of the clinician but are not psychopathological (such as gay and lesbian identity formation, affects, and compliance with treatment). These questions are generally open-ended and address the issues from several directions. This allows you to ask a second or third question about the same phenomenon, to get a fuller sense of it or allow the client to offer more information. Some of the phenomena covered in this chapter are of great clinical importance, but formulating nonleading or nontransparent questions about them is most difficult. Examples of these include dissociative experiences, delusions, and sexual identity; this chapter provides questions that will make it far easier for you to address such topics. The chapter also includes full sets of questions for taking a sexual history and for assessing substance use of all kinds. Finally, most of the symptom sections here are cross- referenced to sections in Chapter 10, “Emotional/Affective Symptoms and Disorders,” or Chapter 12, “Abnormal Signs, Symptoms, and Syndromes. ” In those chapters you will find the terms for describing your findings. If you are engaged in screening persons for the presence of psychopathology, an efficient strategy is first to use a symptom checklist and then use an interview to follow up on what the screening checklist has found. There are hundreds of well- validated checklists for any kind of symptomatic behavior, and they are time-and effort- efficient. Expensive interview time should be reserved for in-depth evaluations of the severity, impact, development, dynamics, and duration of the psychopa-thology. As an interviewer, you might also use the referral question or historical records to select which topics to address with a client. Sy MPTOM QUESTIONS

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 45Sy MPTOM QUESTIONSThe questions about nonsexual and sexual abuse, substance use and abuse, suicide, and impulse control/violence are considered essential to the assessment of risk; ask them of every client you interview. 3. 2. Abuse (Nonsexual)/Neglect of Spouse/Elder See also Sections 3. 17, “Impulse Control,” and 3. 31, “Violence. ” See Sections 12. 1, “Abuse,” and 12. 5, “Battered-Woman Syndrome,” for descriptors. For nonsexual abuse/neglect of a child, see Section 3. 3, just below. It is a good idea to have a list of shelters and support programs ready, should you find evidence ü of abuse. Opening Questions Inquire of all patients about physical and sexual abuse, threats, fights, arguments. “How are things at home?” “Are you alone at home a lot?”“Are you afraid of anyone at home?” Neglect/abuse may show as weight loss, dehydration, withdrawal, etc. ü Battering by Partner These questions are based on similar questions by Ni Carthy and Davidson (1989). “Has your partner ever1 hit, punched, slapped, kicked, pushed, or bitten you/your children/ anyone else at home?” “Have you had bruises from being hit, held, or squeezed?”“Have you ever had to stay in bed or been too weak to work after being hurt?”“Have you ever seen a doctor because of injuries from your partner?” Emotional/Psychological/Financial Abuse “Has your partner... 'tracked' all of your time?”controlled all the money in the household and forced you to account for everything you spent?” repeatedly accused you of being unfaithful when you weren't?”bragged to you about his/her affairs with others?” interfered with your relationships with family and friends?” prevented you from working or attending school?”humiliated you, called you names, or made painful fun of you in front of others?” gotten very angry or frightened you when drinking or using drugs?” threatened to hurt you or the children?”threatened to use a weapon against you or the children?”repeatedly threatened to leave you?”punished the children or pets when he/she was angry at you?”destroyed personal property or sentimental items?”forced you to have sex against your will?” 1You can use “ever” for emphasis or to reduce denial.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

46 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSA simple mnemonic for domestic abuse questions is Sherin et al. 's (1998): HITS: Hurt? I nsulted? Threatened with harm? Screamed at? 3. 3. Abuse (Nonsexual)/Neglect of Child See also Section 3. 2, above, and Section 3. 4, “Abuse (Sexual) of Child or Adult,” below. For DSM-IV-TR/ICD-9-CM diagnoses, see V codes in Section 21. 21. You must know your local legal definition of abuse and the threshold criteria for your legal ü responsibility to report abuse and to whom. Also, since a confession cannot be unsaid, you must advise a client of this before exploring any situations in which abuse may have occurred. If you have suspicions about injuries or risks, obtain experienced psychological, medical, and legal consultation immediately. You can usually call your local child protection agency on its hotline and discuss a case, using “hypotheticals” to help clarify your understanding, obligations, and options without breaking confidentiality. For more, see Section 3. 9, “The Duty to Protect (and Warn),” in The Paper Office (Zuckerman, 2008). Opening Questions2 for a Child “Are you a happy kid or not so happy?” “How do you get along with your father/mother/caregiver?”“Are your parents strict?”“What happens when you get into trouble?”“Are you afraid of anyone at home?”“Do you have problems with a teacher/babysitter/minister/coach?” 3. 4. Abuse (Sexual) of Child or Adult See also Sections 3. 2 and 3. 3, above. The relevant DSM-IV-TR and ICD-9-CM codes are complex. (See Section 21. 21, “V Codes, Etc. ”) This is a specialty area; if you are not experienced and trained, get consultations or refer clients ü before going very far into the topic, in order to avoid contaminating the memories or interpreta-tions. The note under Section 3. 3 also applies here. Initial Inquiry Sometimes, in the right context, a gentle inquiry like “What has happened to you?” will open ü the door to these issues. This is preferable to “What is your problem?”, as sexual abuse may not be seen as a “problem. ” 3 For a Child: “What do you call your private parts? What do you call the other sex's private parts?” “Who has touched your private parts?” [Note: Do not add “when you didn't want them to,” as that may not have been true or may as yet be unrecognized. ] “How did that make you feel?”“Whom did you tell? What did they do about it?”Ask other “who, when, where, why” questions. 2This stepwise approach and wording are suggested by Nora F. Young of Sedro Wolley, WA. 3This sensitive approach is recommended by Nora F. Young of Sedro Wolley, WA.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 47Sy MPTOM QUESTIONSFor an Adult: “Have you ever been forced into sexual acts as a child or adult?” “Has any partner ever insisted on sex when you didn't want to?”“Was your first experience with sex by choice, or were you forced?” Sexual Victimization “Did anyone ever touch you sexually when you didn't want them to?”“Have you ever had a sexual experience with anyone who was also a relative of yours?”“Have you ever been forced to have any kind of sex with anyone?” (If so:) “What happened? With whom?”“Where? When?”“How many times did it happen?”“Whom did you tell?” (If no one:) “Why not?”“What did you do about this?”“How did this affect you, etc. ?” Consider your legal and professional obligations under mandated reporting and duty to protect. Sexual Offenses “Have you ever forced anyone to have any kind of sex with you?”“What happened? With whom? Where? When?” (Continue with the questions under “Sexual Vic-timization,” above. ) “Have you had any kind of sex with anyone who was under 18 years of age?” Activities of Daily Living See Chapter 14 for descriptors from which you can fashion questions shaped to the goal of the evaluation. 3. 5. Affect/Mood See Sections 10. 3, “Anxiety/Fear,” and 10. 7, “Depression,” for descriptors. “How would you describe your mood today?”“Are you happy, sad, or what right now?”“Using a scale where plus 10 is as happy as you have ever been, 1 is not depressed at all, and minus 10 is as depressed as you have ever been, please rate your mood today. ” [Less edu-cated persons may need a scale from 0 to 10. ] “What is your usual mood like?” (If negative, ask:) “When was it last good?”“When are/were you happiest?” “In the last month, how many times have you cried/yelled/been afraid?” “How long does it take you to get over a bad mood/upset?” “What was your mood like during your childhood/adolescence/earlier life?” “Were there ever times when you couldn't control your feelings?”“When do you swear? What do you swear at? What do you say?” Alcohol Use/Abuse See Section 3. 28, “Substance Abuse: Drugs and Alcohol. ” Anger See Sections 3. 17, “Impulse Control,” and 3. 31, “Violence,” for questions, and Section 10. 2, “Anger,” for descriptors.

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

48 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSAnorexia Nervosa See Section 3. 13, “Eating Disorders. ” 3. 6. Anxiety See Section 10. 3, “Anxiety/Fear,” for descriptors; see Section 29. 2, “Anxiety,” for possible medical causes. For social anxiety/social phobia, see Section 3. 23, “Phobias. ” “Is there something you are very concerned about/afraid of happening?” “What do you worry about?”“How does the future look to you?” “When you get frightened, what happens to you?” “Do you ever have times of great fear or anxiety/panic attacks?” [If so, inquire about cues/trig-gers, frequency, duration, whether observed by others, specific physiological symptoms, the sequence of the symptoms, etc. ] “Are there any distressing memories that keep coming back to you?”“Is there any situation you avoid because it really upsets/scares you?” 3. 7. Body Dysmorphic Disorder See Section 12. 6, “Body Dysmorphic Disorder,” for descriptors. “Are you unhappy with the way you look?” (If yes:) “What are you concerned about?”“Is there some part of your body that you consider quite unattractive, ugly, or deformed?”“When you think about your appearance, do you become depressed? Anxious?”“When you tell others about this defect, do they tell you there is nothing wrong?”“How much time each day do you spend checking in a mirror, touching the area/picking at the defect, seeking reassurance from others, camouflaging the defect, or exercising/dieting/tan-ning/weightlifting?” “How much does thinking about this defect interfere with your concentration, schooling/work, or daily activities such as shopping?” “Do you avoid some relationships because of this defect?”“Have you spoken to a dermatologist/plastic surgeon/dentist/other professional to correct something about your appearance?” “Have you had surgery or treatment for this defect without any relief?” Because of embarrassment, such symptoms will not often be reported without inquiry, so ask about BDD when the presentation includes referential thinking, social anxiety, depression/suicidal ide-ation, being housebound, and/or a history of unnecessary surgery or dermatological treatment. Bulimia Nervosa See Section 3. 13, “Eating Disorders. ” Child Behavior Disorders See Chapter 6, “Background Information and History,” and Sections 5. 2-5. 4 (covering typical problems of children). 3. 8. Compliance-Noncompliance with Treatment The relevant DSM-IV-TR and ICD-9-CM code is V15. 81, Noncompliance With Treatment (DSM) or Noncompliance with medical treatment (ICD).

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 49Sy MPTOM QUESTIONS“What medications do you take every day? What medications should you be taking?” “What problems have you had in getting treatment/finding an understanding doctor/taking the medicine as it was prescribed/keeping scheduled medical appointments?” “Have you ever stopped taking medications prescribed for you before they ran out/because of some reason?” (If so:) “What was the reason?” “Is there anything that makes you reluctant to take medications/get the treatments prescribed for you?” 3. 9. Compulsions See also Section 3. 19, “Obsessions”; see Section 12. 8, “Compulsions,” for descriptors. The questions below are based in part on similar questions by Goodman et al. (1989). Initial Inquiries “Are you a person who is especially careful about safety?”“Is there anything in your house/at work that you have to check on frequently?”“Do you ever have to do the same thing over and over, or in a certain way?”“Do you have any habits/frequent actions/behaviors that you must/feel compelled to do in a particular way or very often?” “Are there some things you must do in order to fall asleep/to get ready to go out?” Cleaning/Contamination “Are there any actions you have to do before or while you eat/go to the bathroom?”“Do you have to be very careful about dirt/germs/disease?”“How many times a day do you wash your hands?”“Do you find that you need to change your clothing more than once a day?” Checking/Doubting “Do you find yourself checking and rechecking locks/doors/windows/lights/appliances?”“Do you need to go back repeatedly to see that everyone is OK and you did not accidentally harm anyone?” “Do you have to recheck to make certain you did not make a mistake?”“Do you have to tap or touch anything several times?” Hoarding/Collecting “Do you find that you have a lot of items that you don't need but just can't discard?” Arranging/Organizing “Do you feel you have to arrange your clothes or personal items in a certain way, or you will feel very nervous?” “Do you get upset when anything is not very tidy/disorganized/out of place/unsymmetrical/out of order?” Repeating/Counting “Are there any words or phrases you feel you have to say in a certain way or at certain times?”“Do you find you have to count any items over and over?”“Do you rewrite even simple lists over and over?”“Do you find that the reassurances of others don't help you relax?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

50 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSClient Awareness of Excess/Irrationality “Do you feel uncomfortable until these actions are done, even though you may know that they are unimportant/unnecessary/ineffective?” “Do these actions seem reasonable to you or more than you should be doing? Do you spend more time on these than you would like to?” “How does doing these things affect your life/routines/job/relationships/family members?” “How much control do you feel you have over these actions? Do you resist them or yield to them?” Conduct Disorder in Children See Sections 5. 2-5. 4 (covering typical problems of children). See Section 12. 9, “Conduct Disorder,” for descriptors. 3. 10. Delusions See also Section 3. 22, “Paranoia”; see Section 12. 10, “Delusions,” for descriptors. Mind Control “Did anyone ever try to read your mind/use unusual means to force thoughts into your mind/ try to take some of your thoughts away/stop or block your thoughts?” Grandeur/Special Abilities Note the person's reports of a large number of cars or other possessions, exaggerated abili-ü ties, titles/degrees/education/high positions, dramatic or unlikely consumption of alcohol or drugs, or history of unlikely or criminal activities. “What is unusual about you?” “Are you an especially gifted person?”“Do you have great wealth/unusual strengths/special powers/impressive sexual qualities?”“Are you able to influence others/read people's minds/put thoughts into their minds?”“Have you ever received personal messages from heaven/God/someone unusual?”“Have you been in communication with aliens/dead people/God/Christ/the Devil/the Blessed Virgin/any Biblical persons?” “Do you think you are immortal/cannot be harmed/hurt/killed?” Imposter “Are you a fake?” [Separate a delusion from beliefs of inadequacy based on low self-esteem— the “imposter phenomenon. ”] “Do you think people recognize who you really are?”“Are you concerned about being discovered/identified/exposed?”“What is your real rank?” Monomania Is this person preoccupied with certain ideas, themes, events, or persons? Does all his/her conversa-tion return to a single overvalued topic/false idea? Nihilism “Do you think everything is lost/hopeless/pointless?” “Do you think that tomorrow will never come? Do you think that time has stopped?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 51Sy MPTOM QUESTIONS“Do you think that things outside no longer exist?” “Do you suspect that nothing is real?”“Do you still have all the parts of your body?” Persecution See Section 3. 22, “Paranoia. ” Reference “Do people do things/do things happen that only you really understand/have special meanings for you/are designed to convey or tell you something no one else is to know?” “Are things on the TV/the radio/in the papers especially meaningful to you/contain special mes-sages just for you?” “Have you ever been forewarned/known that something would happen before it did?” Somatic/Hypochondriacal “How is your health? How often are you ill? How often do you see a physician? Do you have many illnesses/medical or health problems?” “Do you have a lot of pain or unusual pains?”“Which medicines do you take regularly? Which medicines/herbals/supplements do you take regularly that don't need a prescription?” “Is there some illness you are worried about getting, or some illness you already have, that concerns you?” “How often do you think about it?”“How does it make you feel when you think about it?”“What do you do about it?”“Do you think you might/do have some serious disease that hasn't been diagnosed cor-rectly?” “Do you think you have a serious disease, but haven't been able to find a doctor to treat it?” Self-Deprecation See Sections 3. 11, “Depression,” and 10. 7, “Depression. ” Depersonalization and Derealization See Section 3. 12, below. 3. 11. Depression See Section 10. 7, “Depression,” for descriptors; see Section 29. 4, “Depression,” for possible medical causes. Screening Questions “In the past 2 weeks, how often have you... felt blue or down in the dumps?” felt slowed down or had lower energy?”blamed yourself too much or felt worthless?”eaten more than usual or less than your usual amount?”not been able to get to sleep or stay asleep?”had trouble concentrating or making decisions?”felt very pessimistic or hopeless about the future?”

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52 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSSomatic/Vegetative Symptoms “Has your health changed recently?” “Has your appetite or eating habits or your interest in food changed recently?”“How is your sleep?” (If a client replies with anything but “Fine” or “No problem” ask:) “On how many nights in a week do you have trouble with sleep?” (See Section 3. 27, “Sleep,” for more questions. ) “Have your bowel or bladder habits changed?”“Has your interest in sex changed?” [Libido is desire, not performance. ] Affective Symptoms “How are your spirits generally?”“When was the last time you felt really down?”“Do you ever get pretty discouraged/depressed/blue? Are you blue/feeling low now?”“When you get sad or down, how long does it last?”“Have you had a time when you felt very tired or very irritable?”“Have you suffered some personal losses recently?”“Do you think you are more depressed in the winter than the summer, or only in one season?” (See Section 10. 11, “Seasonal Affective Disorder. ”) Social Functioning See also Chapter 15, “Social/Community Functioning,” and Chapter 18, “Recreational Functioning. ” “Do you find yourself avoiding being with people?” “Do you go out less than you used to?”“Have you given up any friendships/any social activities?” Self-Deprecation “Are you hard on yourself?”“Have you been harder on yourself lately?” “Do you think you are worthless/ugly/giving off bad odors?” “Are there times when you call yourself names?” (If so:) “Which?”“Do you think you are a wicked person/have sinned/have done something unforgivable?” (If so:) “Why?” Suicidal Ideation See also Section 3. 30, “Suicide and Self-Destructive Behavior”; see Section 12. 40, “Suicide,” for descriptors. “When people are depressed, they sometimes think about dying. Have you had thoughts like that?” “Have you ever thought of hurting yourself?”“What do you see for yourself in the future?”“Do you think you will get well/over this problem?” (If so:) “How long will it take?” Optimism-Pessimism “What is the worst thing that ever happened to you?”“What is the best thing that ever happened to you?”“If you could have three wishes come true, what would you wish for?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 53Sy MPTOM QUESTIONSAnhedonia “What do you do to enjoy yourself/have a good time/for fun?” “Has your interest in this/these things changed?” Assessment Scales A great deal of information about psychological tests is available online at no cost. A prime resource is the website generously maintained by W. E. Benet, Ph D, Psy D (www. assessmentpsychology. com/tests. htm; for specific depression tests, see www. assessmentpsychology. com/onlinetests. htm). Commonly used scales for depression that are now available for free include the Hamilton R at-ing Scale for Depression (Hamilton, 1960), at healthnet. umassmed. edu/mhealth/hamd. pdf ; the Zung Depression Rating Scale (Zung, 1965), at healthnet. umassmed. edu/mhealth/Zung Self Rated Depres-sion Scale. pdf ; the Center for Epidemiologic Studies Depression Scale (Radloff, 1977), at counsel-lingresource. com/quizzes/cesd/index. html ; the Geriatric Depression Rating Scale, at counsellingresource. com/quizzes/geriatric- depression/index. html ; the Goldberg Depression Questionnaire, at counsellingre-source. com/quizzes/goldberg- depression/index. html ; the Q uick Inventory of Depressive S ymptomatol-ogy— Self Report, at counsellingresource. com/quizzes/qids- depression/index. html ; and the E dinburgh Postnatal Depression Scale, at health. utah. gov/rhp/pdf/epds. pdf. 3. 12. Dissociative Experiences See Section 12. 12, “Depersonalization and Derealization,” for descriptors. For standardized evaluation, you can use Ross et al. 's (Ross, 1997; Ross et al., 1990) Dissociative Dis-orders Interview Schedule, or Bernstein and Putnam's (1986) Dissociative E xperiences Scale which is available and can be scored online ( counsellingresource. com/quizzes/des/index. html ). An updated version of the DES, DES-II, can be downloaded as a pdf (see www. neurotransmitter. net/dissociation-scales. html ). Dissociative Experiences “Have you ever walked in your sleep?” “Did you have imaginary playmates as a child?”“Have you ever remembered a past event so vividly that it seemed you were actually reexperi-encing it?” “Have you ever suddenly realized that... you don't remember earlier parts of the trip you are on?”you are in a place and have no recall of how you got there?”you are wearing clothes you would not have chosen?”some of your personal possessions were missing?”you have items you don't recall getting or buying?” “Have you ever been greeted by people who call you by another name and really seem to know you?” “Have you ever been unable to recall major events in your life?”“Have you ever been unable to decide whether you actually did something or just imagined doing it?” Depersonalization “Are you aware of any significant change in yourself?”“Do you feel normal/all right/natural/real?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

54 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONS“Are you always certain who you are?” “Did you ever feel detached/divorced from yourself?”“Did you ever act in so strange a way you considered the possibility that you might be two dif-ferent people?” “Did you ever feel that you have lost your identity/like you were someone else?”“Do you ever wonder who you really are?”“Did you ever feel that you were becoming someone or something different?” “Have you ever suddenly realized that you don't recognize your face/body in a mirror?” “Did you ever feel that your self/body was different/changed/unreal/strange?”“Have you ever felt that your body doesn't belong to your self?”“Have there been times you felt your mind and body were not together/linked?”“Do you ever feel like you were/your mind was outside/watching/apart from your body?”“Do you ever feel like someone else is moving your legs as you walk/ever feel like a robot?” Derealization “Did you ever get so involved in a daydream that you couldn't tell if it were real or not?”“Do people, trees, houses, etc., look as they usually do/always did to you?”“Did you ever feel like you weren't really present?”“Did you ever feel you were detached/alienated/estranged from yourself or your surroundings/ everything around you?” “Have you ever been in a familiar place but found it strange/peculiar/weird/unfamiliar/some-how changed?” “Did you ever feel that things around you/the world were/was very strange/remote/unreal/ changing?” “Do things seem natural and real to you, or does it seem like things are make-believe?” “Did things or objects ever seem to be alive?” Drug Abuse See Section 3. 28, “Substance Abuse: Drugs and Alcohol. ” Always ask every client ü about past and present use of medications/street drugs/other chemi-cals, and especially alcohol (Ramsey et al., 2005). 3. 13. Eating Disorders See Section 12. 14, “Eating Disorders,” for descriptors. Evaluate weight, fat percentage, and proportion. Also evaluate self-efficacy, preoccupation, or ü hypervigilance around eating; terror over weight gain; body image; odd eating behaviors; etc. To evaluate anorexia nervosa, see Garner and Garfinkel (1979) for the 40-item Eating Attitudes Test (see also www. medal. org). Opening Questions “What is your present weight? The most you ever weighed? Your lowest weight as an adult?” “Have you gained or lost weight in the last year or two?” (If so:) “How much?” “What have you eaten in the last 24 hours?” [Explore for patterns, typicality, rationales, etc. ] “Do you think your eating habits are unusual?” “Is your life a series of diets?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

3. Symptom Questions 55Sy MPTOM QUESTIONS“Do you have 'food binges' where you eat a large amount of food in a short time period?” “If you have binged, was it on high-calorie foods such as sweets, desserts, or salty or fatty foods?” “Have you stopped a binge by vomiting, purging, or sleeping, or because of pain?” A British mnemonic for eating disorders is SCOFF: “Do you make yourself Sick because you feel uncomfortably full?” (Purging. )“Do you worry that you have lost Control over how much you eat?”Have you recently lost more than One stone in a 3-month period?” (One stone is 14 pounds. An American version might be F for Fifteen pounds, making the acronym SCFFF. ) “Do you believe yourself to be Fat when others say you are too thin?”“Would you say that Food dominates your life?” The authors (Morgan et al., 1999) suggest scoring 1 point for every “yes,” and believe that a score of 2 indicates a likely case of Anorexia Nervosa or Bulimia Nervosa. Thoughts and Feelings about Weight “How often do you think about your weight/eating/dieting?” “How do you feel about your current weight?” [Note any disparity between client's statements and your judgments of appearance. ] “Do you feel you are too fat?” (If yes:) “How long have you felt that way?”“Are you afraid of being/becoming overweight?”“How much control over your eating do you feel you have?”“Is your eating out of your control?”“Do you avoid certain foods (foods with sugar, fat, salt, cholesterol, etc. )”?“How would your life be different if you lost/gained the weight you want to?” History of Food Restriction “What kinds of diets have you tried?” [Take a diet history: dates; losses; time to regaining; kinds of restrictions used; weight at initiation, at termination, and at next diet; etc. ] “Have you ever gotten so upset or desperate about your weight that you have done something drastic?” “Have you ever: gone on eating binges, vomited after you've eaten, fasted for long periods, used diet pills/cathartics/laxatives/diuretics/overexercising to lose weight, lost a great deal of weight, or felt guilty after eating?” Alternative Questions “Do you eat when you're not hungry? Do you eat to escape from worries or troubles?”“Is your life dominated by thoughts of food?”“Do you look forward with pleasure to the times when you can eat alone?” (If so:) “Do you plan these occasions?” “Do you have a fear of becoming fat or losing control of your eating?”“Do you feel guilt or remorse after overeating?”“Do you eat sensibly when others are present and then binge when you are alone?” “Is your life a series of diets?” “Do you resent being told to 'use your willpower' to stop overeating?”

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56 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONS3. 14. Gay and Lesbian Identity Formation See also Section 19. 5, “Homosexual Identity: Stages of Formation,” and the “Sexual Adjustment” heading under Section 6. 4, “Adjustment History. ” Homosexuality is of course not pathological, but the strong social pressures and prejudices against it are stressors, and so it may require additional efforts for homosexual persons to form an adaptive identity. The questions in this section cover normative homosexual identity development. 4 General Questions “Did you ever have a sense of not belonging or of feeling sexually different from most peo-ple?” “Do you know any gay men? Any lesbians?” (If so:) “What are they like?” “What images of gay men and lesbians do you have?” “Have you ever thought you might be gay?” (If so:) “When did you first think this?” “What was it like to consider this idea/recognize such feelings?” Attraction “Do you find yourself attracted to gay/lesbian relationships or to specific gays/lesbians?”“Have you ever acted on your feelings?” (If so:) “What did you do?”“Have you tried to ignore or change these thoughts and feelings and/or convince yourself that you may not be gay?” Understanding “Why do you think gay people are that way?” (Example: “They are born that way. ”)“Do you see yourself as gay and accept it without liking it?” Identity Activism “Tell me about the pressures from society you feel/are aware of. ” “Are you out (i. e., “out of the closet”—not concealing one's homosexuality) to friends/family/cowork-ers/the public?” “Are you considering coming out to them or others?” “Are you involved in any gay activities—social, political, or otherwise?” 3. 15. Hallucinations See Section 12. 17, “Hallucinations,” for descriptors; see Section 29. 7, “Psychosis,” for possible medical causes. Note: ü Look for behaviors that suggest hallucinating: return of gaze to a spot, sudden head turn-ing, staring at one place in room, eyes following something in motion, mumbling or conversing with no one else present, etc. If there is an indication of the presence of hallucinations, ask questions to discriminate those that are apparently due to entering or leaving sleep, delirium, alcohol or drug withdrawal or abuse, medications, etc. 4I am grateful to Leslie J. Wrixon, Psy D, of Cambridge, MA, for these questions and for guidance regarding the stages of identity development.

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3. Symptom Questions 57Sy MPTOM QUESTIONSGeneral Questions “Do you have a vivid imagination?” “Do you dream so vividly that you aren't sure it was a dream?”“Did you ever think/act in really strange/odd/peculiar ways?”“Have you had any uncanny/eerie/bizarre/unexplainable experiences?”“Has your mind ever played tricks on you?”“Did you ever see or hear things others did not?”“Have you had visions/seen apparitions?”(For any of these:) “Where did you first experience this?” Auditory “Were you ever surprised that you could hear some sounds other people couldn't hear (whispering voices, echoes, melodies, parts of conversations, people arguing/giving you orders, etc. )?” “Have you ever heard noises in your head that disturb you?”“Have you ever heard voices coming from inside your head?” (If yes:) “Was this like voices speaking your own thoughts or someone else speaking?”“Where do the voices come from?”“Whose voices? Men's or women's? How old were they?”“What did they say?”“When does this happen? How often do you hear them?”“When did this start?”“What brings these on?” Visual “Have you ever seen anything so unusual that other people didn't believe it?”“Did you ever have visions/see apparitions/ghosts?”“Did you ever see anything like in a dream when you were awake?”“Have you ever seen things that no one else saw?” (If so:) “What? What did you feel then?”“What do you call these experiences?”“What causes these things to happen?”“When was the first time this happened?” kinesthetic/Tactile/Haptic “Have you ever felt strange sensations (e. g., electricity)/odd feelings in your body/anything crawling on you (e. g., bugs)?” Gustatory “Have you ever felt strange tastes in your mouth (metal, electricity, poisons, etc. )?” Olfactory “Have you ever smelled strange odors that you could not account for (poisons, death, some-thing burning, sewage, odd smells from your own body, dead spirits, etc. )?” Other “What was the strangest experience you ever had?”“Did you ever visit another planet? Ever die and return to life?” (If so:) “How/why do you think these things come about?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

58 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSHomosexual Identity Development See Section 3. 14, “Gay and Lesbian Identity,” and Section 19. 5, “Homosexual Identity: Stages of Formation. ” 3. 16. Illusions See also the “Derealization”? heading under Section 3. 12, “Dissociative Experiences”; see Section 12. 18, “Illusions,” for descriptors. “Do you believe there is only one reality?” “Does the world ever look very different to you?” (If yes:) “In what way(s)?”“Do any things feel different, in some way, at certain times?”“Do things ever seem to change size/look smaller or larger?”“Do parts of your body ever seem to change in size or shape or texture?”“Do things sometimes seem nearer or farther away than they should?”“Does time ever seem to move very slowly or very fast?” 3. 17. Impulse Control See also Section 3. 31, “Violence,” for questions, and Sections 12. 19, “Impulse-Control Disorders,” and 12. 41, “Violent Behaviors,” for descriptors. “Do you find yourself suddenly doing things before you have thought about or decided to do them?” “Does money 'burn a hole in your pocket' until you spend it?” “Do you feel compelled/driven to do things you don't want to do?”“Do you feel unable to stop yourself from doing some things?” “Have you ever been involved in sexual behaviors you regretted?” “Do you ever steal/shoplift?”“Please tell me about all the times you have had contact with the police. ”“Have you ever been fired/evicted/arrested?” (If yes:) “Why did that happen?” “What do you usually do when you get very upset and angry?” “Do you have a bad temper/fly off the handle/flare up?”“Have you ever thrown/broken things? Ever hit/attacked anyone?”“Do you get involved in more fights than others in your neighborhood?”“Do you have a list of people you just don't talk to any more because you always get into argu-ments with them?” Insight See Section 2. 23, “Insight into Disorder”; see Section 11. 9, “Insight,” for descriptors. Irritability See Sections 3. 5, “Affect/Mood,” and 3. 11, “Depression. ” 3. 18. Mania See Section 10. 9, “Mania,” for descriptors; see Section 29. 5, “Mania,” for possible medical causes. “Was there ever a time when you... stayed very excited?” were too happy without any reason?”

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3. Symptom Questions 59Sy MPTOM QUESTIONSwere too full of energy?” talked too much and couldn't stop?”phoned or visited too much?”planned or started many things and couldn't finish any of them?”did without sleep for a day or two?”seemed to be oversexed?”were overworked/held several jobs at the same time?”spent money recklessly/spent money you didn't have/made extravagant gifts/gambled?” “Have you ever found yourself pacing and couldn't stop/stop for long?”“Was there ever a time when you were too impatient/irritable/couldn't concentrate/couldn't stop your mind's racing?” (If yes to any of the above:) “When did this start? How long did this last? What happened because of this?” “Were you ever treated for these conditions?” A large selection of screening tools and rating scales can be accessed at ü www2. massgeneral. org/ schoolpsychiatry/screeningtools_table. asp. Munchausen's Syndrome See Section 12. 20, “Malingering. ” Noncompliance See Section 3. 8, “Compliance-Noncompliance with Treatment. ” 3. 19. Obsessions See also Section 3. 9, “Compulsions”; see Section 12. 21, “Obsessions,” for descriptors. Differential diagnosis must distinguish obsessions from depressive ruminations, anxious wor-ü rying, and delusions. For standardized recording, you can use the Yale-Brown Obsessive-Com-pulsive Scale (Goodman et al., 1989; www. brainphysics. com/ybocs. php). It covers contents, distress, time spent, insight, indecisiveness, avoidance, and resisting thoughts. A children's version is also available. Initial Inquiries “Are there any thoughts you just seem unable to forget/get rid of/keep out of your mind/stop thinking about?” “What do these thoughts revolve around or continually come back to?” “Are there any phrases/names/dates/slogans/rhymes/titles/music that continually run through your mind/you can't seem to control?” “Are there any prayers/numbers/names/phrases you feel you have to repeat?” (If so:) “Which? When?” Thoughts “Is there any possibility that you keep thinking about/considering/mulling over/speculating about?” “Are there any everyday decisions you seem unable to make or take too much time to make?” “How often do you think about your health/how your body is working/whether you are sick?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf

60 CONDUCTING A MENTAL HEALTH EVALUATION Sy MPTOM QUESTIONSClient Awareness of Excess/Irrationality “Do you think about these things more than you should/would like to/more than a sensible number of times a day? Do they take up a long time each day?” “How does thinking these things affect your life/routines/job/relationships/family members?” “Do you feel uncomfortable until you think these thoughts, even though you may know them to be nonsensical/unimportant/ineffective?” “How much control do you feel you have over these thoughts? Do you resist them?”“How do you try to get these thoughts out of your head/make them stop?”“Where do you think these thoughts come from?” Contents of the Obsessions Somatic: Body parts, appearance, or illness. Contamination: Bodily waste, dirt, germs, animals, etc. Religious scrupulosity. Repetition, counting, arranging, checking, hoarding/collecting, etc. Sexual: “Perverse” or forbidden acts, incest, {homosexuality}, etc. Symmetry, precision, balance, arrangements. Violence: Self or other harm, horrific images, blurting out obscenities/insults, etc. 3. 20. Organicity/Cognitive Disorders See Chapter 11, “Cognition and Mental Status,” for descriptors; see Chapter 2, “Mental Status Evaluation Questions/Tasks,” for guidance in conducting an MSE. Ask for a history of: Sunstroke. Head injuries. Syphilis. Near-drowning. Major surgery. AIDS/AIDS-Related Complex. Electrocution. Apnea. High fevers/delirium. Poisonings. Vertigo/dizziness. Seizures/convulsions/fits. Exposure to toxic chemicals in the workplace/home/garden. Substance use/abuse, intravenous drugs, overdoses. (See Section 3. 28, “Substance Abuse: Drugs and Alcohol. ”) Periods of unconsciousness/being “knocked out”/having fainted/being in a coma. Episodes of alteration of levels of consciousness, “out cold,” “weirded out,” “falling out. ” Do a complete MSE, and consider neuropsychological testing and/or neurological evaluations. 3. 21. Pain, Chronic See Section 12. 23, “Pain Disorder/Chronic Pain Syndrome,” for descriptors. The usual medical interview asks these questions, using the mnemonic OPQRST: Onset: “What brings it on?” Palliative and Provocative: “What makes it better or worse?” (Time of day, cold, movement?)Quality or character: e. g., “Is it throbbing or steady?” “Dull or sharp?”Region and Radiation: e. g., “Is it located on one or both sides?” “Does it spread?”Severity: Use comparisons (toothache, wound from a... ) from the person's history. Timing and duration: “How often do you get it?” “How long does it last?”

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3. Symptom Questions 61Sy MPTOM QUESTIONSA good list is available at www. painassessmentresources. com/resources/index/html and then click on “Notes on psychological assessment tools. ” “Do you frequently have pain somewhere in your body?” (If so:) “Where?” “Has the pain affected your sleep?” (If so:) “How?”“Has the pain affected your eating? Has your weight changed?”“Has the pain changed your ability to think or concentrate?” (If so:) “Please explain. ”“Do you have to lie down and rest because of the pain, or does it force you to keep moving?”“Do you find that you are thinking about the pain a lot?” “Tell me about your activities in a 24-hour day, such as cooking, laundry, shopping, cleaning, reading, exercise, hobbies, etc. When do you wake up?” (And so on. ) “Does the pain affect your ability to take care of yourself/your day-to-day needs?” “What activities have you had to restrict or stop because of pain?”“Do you need to use any assistance device? Anything to walk with?” (If so:) “When did you start using it? Which physician gave it to you?” “How has the pain changed in the last year?” “What medications do you take for the pain?” [Ask for names, dosages, over-the-counter or physician source. ] “How does the medicine affect the pain?” “Do you get any side effects from these medications?” “What other treatments have you had? (Chiropractor, physical therapy, other?) How well did they work?” “Have you been treated in any pain management program or pain clinic?” (If so:) “When? Where? To what effect/with what result?” “Have you ever been referred to a psychologist or psychiatrist to help you to learn to cope with the pain?” [Ask for name, dates, location, phone number, dates of treatment. ] “Do doctors seem to have helped or failed you?” “Has some doctor said your pain was 'imaginary' or 'all in your head'?”“Do you truly believe your case is hopeless?” 3. 22. Paranoia See Section 12. 24, “Paranoia,” for descriptors. Being Monitored “When you get on a bus/eat in a restaurant/enter any public place, do people notice you/turn around to look at you?” “Have you ever been singled out for special attention/watched/spied on?”“Do people sometimes follow you for a while?” Suspicion “Would you say that you are more suspicious than other people, perhaps with good cause?”“Have you been attacked/been shot at?”“Would you feel safer if you carried a gun/knife/Mace or hired a bodyguard?” “Do you think there is someone or something out to get you?” “Do you think anyone is against you? Do you have enemies?”“Does any organization or group of people have it in for you? Is anyone plotting against you?” “Is there anything about you that has made other people jealous of you/prejudiced against you/ out to get or harm you/want to damage your property?”

Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf