Tag Archives: BIOP

Observation Skills

(Pfäfflin & Adshead, 2004) suggest that from a neurobiological perspective the process of affect regulation inexorably links nonverbal and verbal representational domains in the human brain.  This relationship may serve to facilitate the transfer of implicit information in the right hemisphere to explicit or declarative systems in the left.  (Pfäfflin & Adshead, 2004, p. 136)  One might deduce that it would be subsequently impossible to separate verbal behavior from nonverbal behavior.  Recognizing this connection, in my opinion, is the key to improving our observational skills.  No action, verbal or nonverbal, should go un-scrutinized… every action (no matter how small) means something.

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Despite our recognition that nonverbal communication is as important, or more important, than verbal communication; “there is no dictionary of nonverbal communication.”  (Riggio & Feldman, 2005, p. xiii)  There is no standard by which we can judge the inherent meaning of an averted gaze.  Even basic facial expressions that convey emotion are subject to the trials of context and individual differences.  And so, we would be well served to recognize that individual and multicultural issues are paramount in the interpretation of behavior.  Furthermore, the interpretations of those expressions are governed by our own selective attention.  (Ivey, Ivey, & Zalaquett, 2010, p. 124)  “Be careful not to assign your own ideas about what is ‘standard’ and appropriate nonverbal communication.”  (Ivey et al., 2010, p. 125)

I would suggest that we be cognizant of the perceived deficits that our potential clients bring to the table, especially if they have a history of interpersonal problems.  We should approach our observations with a healthy scientific skepticism and mindful that we can not always trust what we see.  Furthermore, we would be well served to approach the perspectives of our clients with the same distance and objectivity.  Take the case a client whom demonstrates deficits in decoding facial expressions…

One can speculate that many interpersonal problems might result from a deficit in decoding facial expression… the most obvious problem is the difficulty in identifying the internal states of others: their desires, emotions, or intentions.  Such information is essential for the understanding of others, of the meaning of their behavior in general as well as during social interaction.  Relating to someone whose intentions and emotions are obscure is virtually impossible.  (Philippot, Douilliez, Pham, Foisy, & Kornreich, 2004, p. 18)

Furthermore, research suggests that both nonverbal and paralinguistic communication play an important role in the retrieval of knowledge in trans-active memory systems.  (Borman, Ilgen, & Klimoski, 2003, p. 348)  Almost invariably, it seems as though individuals will “look up and to their left” when they are retrieving information from long-term memory.  Although I do not recall the specific source, I recall that left handed people actually do the opposite (look up and to their right).  When interpreting the memory retrieval of our clients, we would be well served to know which hand they write with.

You mentioned note taking… which is important not only for our benefit of reviewing previous sessions, but for our ability to self access and determine if we have left a stone unturned.  Process notes really are an art, not a science.  In his blog, Bowden Mcelroy (2005) suggests a couple of different formats for process notes that you may find helpful in your practice.  He terms the first one ‘BIRP.’

B: Behavior. What did the client do?

I: Intervention. How did the therapist intervene?

R: What was the client’s Response to the intervention?

P: What is the Plan? Where does treatment go from here?

A second suggestion, one that is in relatively wide use in the field, is called ‘SOAP.’  (As a sidebar, this is also a great method for self-assessment) (Mcelroy, 2005)

S: Subjective: What did the client say?

O: Objective: What did the therapist observe?

A: Assessment (or, Analysis): What does the therapist think is going on?

P: As always, P stands for Plan.

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Borman, W. C., Ilgen, D. R., & Klimoski, R. J. (Eds.). (2003). Handbook of psychology (Vols. 1-12). Hoboken, NJ: John Wiley & Sons.

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

Mcelroy, B. (2005, Nov. 10). How to write counseling notes [Web log message]. Retrieved from http://mcelroycounseling.com/how-to-write-counseling-notes/

Pfäfflin, F., & Adshead, G. (Eds.). (2004). A matter of security: The application of attachment theory to forensic psychiatry and psychotherapy. New York, NY: Jessica Kingsley Publishers.

Philippot, P., Douilliez, C., Pham, T., Foisy, M., & Kornreich, C. (2004). Facial expression decoding deficits in clinical populations with interpersonal relationship dysfunctions. In R. E. Riggio & R. S. Feldman (Eds.), Applications of nonverbal communication (pp. 17-37). Mahwah, NJ: Lawrence Erlbaum Associates.

Riggio, R. E., & Feldman, R. S. (Eds.). (2005). Applications of nonverbal communication. Mahwah, NJ: Lawrence Erlbaum Associates.