[humanser] Question about Recognizing and Reporting on Nonvisual Characteristics of Clients

[Sarah Meyer]

Good afternoon,
I haven’t posted to this Listserv in a while (grad school is great but
all-consuming, haha), but I hope you are all well.
I am writing to get some feedback on how blind practitioners have
addressed the visual appearance/physical characteristics of the mental
status exam. I am currently taking Appraisal Methods in Psychology,
and one of our assignments is to perform a full mental status exam on
someone and to write a paper/report including assessment and
recommendations.

According to one of the articles assigned for class, there are
physical characteristics and qualities that we aught to be able to
“see” and observe without the client even speaking a word, and these
are apparently important towards the assessment. I’m wondering how you
have handled these types of questions or elements, both in mental
status exams, and in writing objective/observational characteristics
in progress notes (It sounds weird to say, “It sounded as if client
was smiling” or “client sounded sad” when a sighted clinician could
say things like “Client was smiling” or “client maintained sad affect
for the duration of the session as evidenced by frowning and lowered
gaze.”). I realize that many of these characteristics are things we
could infer from other cues, but how do you report on nonvisual ways
of arriving at these conclusions? Here are questions I have based on
the articles I've been reading:

1.	Ethnicity. I realize that this information may be already available
if someone else performed the intake, or perhaps the client can tell
us themselves, but we can’t see if stated ethnicity matches apparent
ethnicity.
2.	Age: How can we identify if stated age matches apparent age without
saying something weird like, “client sounded young/childlike” or
“client sounded elderly”?
3.	Body build (slim, stocky, muscular, etc.), posture (erect,
slumped), walking and other movement quality (graceful, jerky,
limping?), physical abnormalities, scars, missing limbs, tattoos?
General nutrition?
4.	Hyperalertness, such as glancing around more than usual, as if with
suspicion? I imagine there are other clues to this, but how can a
mental status exam be complete without even talking about eye contact
or the client’s behaviors such as glances and focus?
5.	Clothing and accessories: How can we tell if a client is dressed
appropriately for climate and for our meeting with them? How can we
determine if clothing is dirty and tattered or clean and well-cared
for? Disheveled and wrinkled or in order? Casual or formal?
Contemporary or out-of-date? Unbuttoned or buttoned as should be?
Overly bright colors apparently can suggest mania; misbuttoned shirts
or coats could indicate dementia; and bizarre dress, such as an adult
dressed in a Boy Scout uniform, for instance, could indicate
psychosis. How do we obtain this important information?
6.	Hairstyle and color? Facial hair? Is it orderly or unkempt?
7.	Motor activity: Some things, like pacing and significant jiggling
of a leg, can be heard, but it is harder to tell if someone is sitting
on the edge of their seat, tense, or relaxed.
8.	Hands: are they folded or clenched in fists? Are nails dirty,
bitten, stained, or manicured? Is there a tremor? Is the client
picking at skin or clothing, or rubbing, touching, or scratching
anything inappropriately? Again, some things I can imagine being
audible, but how do you clarify what is happening without making the
client feel uncomfortable?
9.	Involuntary movements? I imagine that noticing movement of the
limbs would be easier to detect than involuntary facial movements.
10.	Mannerisms: Stereotypies, posturing, waxy flexibility, negativism,
and catalepsy? The article mentions these but says they are rare.
Still, how would you assess these?
11.	And of course, the infamous facial expression: eye contact,
patterns of gaze or focus, smiling/frowning, normal movements or are
they rigid or a fixed expression?
12.	How would you identify the following emotions or cues to emotions?
Anger: clenched jaw, knotted fists, flushing of face or neck, drumming
fingers, extended neck veins, fixed stare
Anxiety: jiggling foot, twisting fingers, affected casualness (such as
toothpicking)
Sadness: moistening of eyes, drooping shoulders, slowed movements
Shame: poor eye contact, blushing, shrugging

Thank you for your guidance! Have a great day,

-Sarah
	
-- 
Sarah K. Meyer
Graduate Student, Clinical Mental Health Counseling
Ball State University
sarah.meyer55 at gmail.com
(317)402-6632

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