Wk 3 Mental Status Exam Training, part 6. Interpersonal Issues

Definition of Interpersonal Issues

Interpersonal behavior refers to how a client interacts with others in their immediate environment (e.g., therapists, family members, or partners in couples therapy).
Several key interpersonal behaviors are covered, including:
- Contempt - Definition: A passive-aggressive style of relating to others.
- Signs:
  - Eye rolling
  - Sarcastic imitation of vocal tone
- Example:
  - A client describes an argument with their mother while mocking her tone and rolling their eyes.
  - Research connection: John Gottman found that contempt is the strongest predictor of divorce.
- Defensive - Definition: Reacting hostilely to input from others due to feeling threatened or attacked.
- Example:
  - A client brags about writing a Nobel Prize-winning book.
  - When asked about the book’s content, the client accuses the interviewer of trying to steal their idea. “why don’t u think I could win it” “client feels attacked and response in a hostile manner”
- Dismissive - Definition: Reacting to input by disregarding or rejecting it, without necessarily feeling threatened.
- Example:
  - A client is told that their drinking might be affecting their ability to keep a job.
  - Instead of considering the suggestion, they shrug it off and blame their boss for wanting to fire them anyway.Guarded
- Hypervigilant Definition: Excessive awareness of the environment, often due to heightened anxiety or fear.
- Possible causes: Trauma, PTSD.
- Example:
  - A client is obsessed with noise levels in their neighborhood.
  - Looking constantly around
  - They repeatedly mention how much they appreciate a neighbor being quieter and express distress over a lawnmower noise.
- Guarded Definition: Being overly cautious about sharing information due to lack of trust.
  - Possible causes: Trauma, paranoia.
  - Signs:
    - Minimal responses
    - Evasive communication
  - Example:
    - When asked about their week, a client gives vague, one-word answers like “the usual” and avoids elaboration. Closed or secretive..
- Oppositional/Defiant - Definition: Reacting to authority or requests with resistance, argumentation, or hostility.
- Behavioral Traits:
  - Frequently argues or refuses to comply with instructions.
  - May display frustration or anger in response to authority.
  - Often challenges rules or expectations.
- Example:
  - A client refuses to answer questions, saying, "I don’t have to tell you anything. You can’t make me."
  - They may also respond sarcastically or aggressively to perceived control.
- Suggestible - Definition: Easily influenced by others, sometimes excessively compliant.
- Behavioral Traits:
  - Changes opinions or behaviors based on external input.
  - Easily persuaded by authority figures or peers.
  - May struggle with independent decision-making.
- Example:
  - A client shifts their answers based on the interviewer’s tone, agreeing with contradicting statements.

1st example: Affect(full and congruent seems anxius and concerneed) and Mood, thought process(tangentional and distractble to thing in environment), speech reglar rate and rythm memory:unable to access Interpersonal: hypervigelent and dismissive and gaurded(turing away from interviewer

2nd example: mood(dysphoric) and affect, thought process, speech(appropriate not pressure, memeroy/conciuos(unable to access), mootor(relaxed) interpersonal; defensive (clients reats with hostility and feels attacked

3rd- mood(dysphoric) and affect(full and congruent), thought process, speech(reg rate and rythem, motor(relaxed), memory(unable to assess), interpersonal: suggestible(easily influencced by interviewr persuattion

4th example: mood(dysphoric) and affect(full and congruent with dysphoric mood), thought process( logical , attention:rumentanting ans stating twice that s itlls all their fault), speech(reg rate amd rythm), motor, memory(unable to assess), interpersonal: dismissive and defensive