It is often dif?cult to determine when a client is being untruthful during an interview.
Even experienced interviewers can be deceived by their clients . For example, in a case we worked with, a very depressed male client was admitted to a psychiatric hospital. When asked if he would like to participate in the hospital’s recreational program, the client replied, “I’m too depressed to move.” The next day, after being left unsupervised during the recreational outing, this same client managed to ?nd the energy to run away from the hospital without medical approval. His report regarding his inability to move had been extremely unreliable.
Reliability may be estimated based on a number of observable factors. Clients with good attention to detail and who spontaneously elaborate to your questions are likely to be reliable informants. In contrast, clients who answer questions in a vague or defensive manner have a greater probability of being unreliable. In some cases, you will The Mental Status Examination 235have a clear sense that clients are intentionally omitting or minimizing parts of their history.
When you suspect a client is unreliable, it is useful to contact family, employers, or other client associates to corroborate the client’s story. This step can be problematic, but it is often necessary. If no one is available with whom you can discuss the client’s story, it is advisable to proceed cautiously with your client’s care while observing his or her behavior closely. You should also note reservations about the client’s reliability in your mental status report.
People with good judgment are able to consistently make constructive and adaptive decisions that affect their lives in a positive way. In the clinical setting, a client’s judgment can be evaluated during an intake interview by exploring his or her activity, relationship, and vocational choices. Ask, for example, if your client regularly involves himself or herself in illegal activities or in relationships that seem destructive. Does he or she ?irt with danger by engaging in potentially life threatening activities? Obviously, consistent participation in illegal activities, destructive relationships, and life threatening 236 Structuring and Assessment Table 8.3. Sample Mental Status Exam Questions Used to Assess Intelligence Many questions used to assess intelligence during a mental status exam are taken from standardized tests or are otherwise copyrighted, and therefore it is inappropriate to reproduce them here. The following questions are similar in content to typical questions used by mental status examiners.