Observation and evaluation of thought is usually broken into two broad categories: thought process and thought content. Thought process refers to how clients express themselves. In other words, does thinking proceed in a systematic, organized, and logical manner? Can clients “get to the point” when expressing themselves? In many cases, it is useful to obtain a verbatim sample of client speech to capture psychopathological processes. The following sample was taken from a client’s letter to his therapist, who was relocating to seek further professional education.
Dear Bill: My success ?nally came around and I ?nally made plenty of good common sense with my attitude and I hope your sister will come along just ?ne really now and learn maybe at her elementary school whatever she may ask will not really develop to bad a complication of any kind I don’t know for sure whether you’re married or not yet but I hope you come along just ?ne with yourself and your plans on being a doctor somewhere or whatever or however too maybe well now so. I suppose I’ll be at one of those inside sanitariums where it’ll work out . . . and it’ll come around okay really, Bye for now.
The client who wrote this letter clearly had a thinking process dysfunction. His thinking is disorganized and minimally coherent. Initially, his communication is characterized by a loosening of association; then, after writing the word doctor, the client decompensates into complete incoherence .
There are many ways to describe speech or thought processes. Some of the most common thought process descriptors are listed and de?ned in Table 8.2. When describing client speech and thought process, a mental status examiner might state: The client’s speech was loud and pressured. Her communication was sometimes incoherent; she exhibited ?ight of ideas and neologisms.