Observational Techniques in Clinical Settings

Introduction

This entry is written from a learning perspective that emphasizes the need to objectively evaluate behaviour as part of clinical assessment. Two practical and cost-effective techniques for obtaining behavioural samples (specimens) are discussed. The first method entails home tape recording of representative interactions. Methods of incorporating these data into treatment are discussed in addition to their assessment uses. Actigraphy is the second objective method. Behavioural measurements of waist and/or wrist activity every minute of the day and night for one, two, or more weeks can be very informative. Evidence demonstrating the desirability of obtaining behavioural measurements from children suspected of having ADHD is presented. The broader implications of these data are discussed.

Observation in Clinical Settings

A clinician's approach to assessment is driven either explicitly or implicitly by their theoretical orientation. I declare my theoretical orientation to contextualize this entry. I understand normal and abnormal behaviour from a parallel distributed processing (PDP) connectionist neural network (CNN) approach to learning and memory that includes both cognition and affect. Tryon (1995) has given introductory details of this position, and reasons for holding it. McLeod, Plunkett, and Rolls (1998) provide coverage that is more complete. I refer to all PDP CNN models as neural network learning theory (NNLT) because they are brain-inspired memory systems that learn from experience. Memories are learned and learning implies memory; otherwise learning would not be cumulative. Consequently, one can speak of learning and memory as interdependent facets of a single learning-memory process. This general approach to learning is a superset of operant and respondent conditioning that includes all forms of cognitive and emotional processing at both cortical and subcortical levels. The relevant contribution of this theoretical orientation to this entry is that experience drives the learning-memory process. Therefore, it is important for clinicians to learn as much as possible about the past and present experiences of their clients. Direct access to prior experience is not possible and therefore clinicians must rely on interview data from the client and others. We will discuss ways to make direct contact with current events.

People mainly seek professional help for behavioural and psychological problems when faced with a behavioural and/or psychological excess or deficit that persists beyond an acceptable time in themselves, their spouse, parent, child, or other family member. The clinician should first determine the frequency, intensity, and duration of these excesses and/or deficits. The clinician should then determine what triggers these excesses or deficits – what discriminative stimuli set the occasion for these excesses or deficits. The clinician also needs to determine if any social and/or other consequences currently maintain these excesses or deficits.

Clinicians can readily observe how the client behaves in session with them and with their spouse, children, and/or other family members if a joint session is held. While such observations may suggest clinical hypotheses, they constitute a small behavioural sample and are restricted to an office setting, which differs in important ways from the natural settings one wishes to generalize to. Clinicians can interview the client and other family members about behaviour that occurs outside the office but the results are frequently biased by the client's perspective. Research on eyewitness credibility clearly demonstrates that people make poor observers (Loftus & Hoffman, 1989). Psychologically distressed persons engaged in family strife are even more likely to bias reports of their behaviour and the behaviour of others. In short, one can expect widely discrepant and strongly held views of the same events across [Page 639]respondents. Clinicians are frequently hard pressed to know where the truth resides. Behavioural observation is one method for obtaining the desired information. Tryon (1998) has discussed this technology. There are several reasons why clinicians do not use behavioural observation. They mainly concern difficulty and expense not covered by insurance. Observers need to be found, trained, and paid for their work which increases costs. Insurance companies may not reimburse these expenses. Observers need to visit the home and/or school, which raise logistical as well as privacy issues. More time is required to decode and analyse these data which further increases expense. The home tape recording method described in the next section is a compromise solution that offers most of the benefits of behavioural observation but is much more economical and far less invasive. It also provides opportunities for clinical intervention that might not otherwise be available.

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