Parents, teachers, and mental health professionals often overuse the word attitude. When someone claims a student or client has an "attitude problem" or a "bad attitude," it can be difficult to determine precisely what is being communicated.
In the mental health field, "attitude toward the interviewer" refers to how clients behave in relation to the interviewer; that is, attitude is defined as behavior that occurs in an interpersonal context. Observation of concrete physical characteristics and physical movement provides a foundation for evaluating client attitude toward the interviewer. Additionally, observations regarding client responsiveness to interviewer questions, including nonverbal factors such as voice tone, eye contact, and body posture, as well as verbal factors such as response latency and directiveness or evasiveness of response, all help interviewers determine their client's attitude.
This portion of the mental status exam benefits from the emotional subjectivity discussed earlier. Interviewers must allow themselves to respond honestly to clients and then scrutinize their own reactions for clues to clients' attitudes. Such judgments are based on the interviewer's internal cognitive and emotional processes and, consequently, are subject to personal bias. For example, a male interviewer may infer seductiveness from the behavior of an attractive female because of his wish that she behave seductively, rather than any actual seductive behavior. Furthermore, what is considered seductive by the examiner may not be considered seductive by the client. Differences may be based on individual or cultural background. It is the interviewer's professional responsibility to avoid overinterpreting client behavior by attributing it to a general client attitude or, in some cases, a personality trait. When making judgments or attributions about client behavior, you should recall the criteria for disordered behavior presented in Chapter 6 and ask yourself:
Is the behavior unusual or statistically infrequent?
Is the behavior disturbing to the client or to others in the client's environment at home or work?
Is the behavior maladaptive; that is, does it contribute to the client's difficulty?
Is the client's behavior justifiable based on present environmental or cultural factors?
There are many ways a client can relate to an interviewer. Words commonly used to describe client attitude toward the interview or interviewer are listed in Table 8.1.
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