BEHAVIOURAL ASSESSMENT

 Behavioral assessment chiefly emphasizes empirically based methods that focus on

designated observable behaviors, as far as possible avoiding any need for inference.
 Behavioral assessment usually begins with a detailed examination of specific
environmental influences on the client’s behavior. In the typical outpatient setting, the
behaviorally oriented clinical interview is usually the starting point.
 Guided by learning concepts such as conditioning and reinforcement, the therapist
inquires about the situations in which the problem behavior occurs, about possible
pairings of stimuli within those situations, and about the possible reinforcing or
punishing consequences of the problem behavior. Questions like “how,” “when,”
“where,” and “what” are typical features of assessment interviews in behavior
therapy, consistent with the focus on the specifics of behavior in situations.
 Behavioral therapists carefully examine the nature of their clients’ problems and the
critical factors that influence them. In concert with factors that exist “within” a
person, such as patterns of psychophysiological, cognitive, or affective responding,
contextual factors in the environment are seen as major determinants of behavior.
 Thus, in contrast with more traditional views of personality and psychopathology,
individual behavior is not viewed as inherently stable across different life situations.
Furthermore, a client’s overt responses to assessment instruments are of interest in
their own right, and must be sampled as extensively and accurately as possible.
 In contrast with traditional approaches, a primary function of behavioral assessment
includes selection of appropriate treatment techniques and evaluation of treatment
progress and outcome. Assessment itself can be viewed as the first stage of behavior
therapy. However, behavioral assessment is hardly a static or even well-defined
enterprise.
 Early approaches to behavioral assessment were idiographic, tailored to the unique
features of each client. Consistent with the emphasis upon conditioning and learning
principles, assessment focused on specific behavior in specific surroundings. During
this early period, researchers developed such behaviorally focused assessment devices
as behavioral avoidance tests, such as those used by Lang and Lazovik (1963) to
assess fear of snakes.
  Behavioral assessment continued to expand during the 1970s. This decade has been
called the “honeymoon” period in the development of behavioral assessment, because
it was marked by great optimism and conceptual confidence.
 However, during the late 1970s behavioral assessment entered a self-critical phase
that Nelson (1983) referred to as the “period of disillusionment.” The idiographic
emphasis of the early behavioral assessment techniques represented a potential
strength, but was taken too far. If assessments are truly unique to each case, then
generalizations across clients with similar features are impossible.
 Lack of standardization of materials and procedures makes cross-study comparisons
impossible, while normative data, or norms, provide useful standards for decisions
about who needs therapy and can help therapists set treatment goals.
 Similar concerns were expressed about concepts of situational specificity. It is
advantageous to start with the idea that behavior may be situation-specific.
 The chief focus is upon the construct validity of an assessment procedure—the degree
to which conclusions drawn from the results of the assessment are indeed true to the
targeted construct.

FUNCTIONAL ANALYSIS

 The overarching goal of behavioral assessment as an essential component of behavior

therapy is to integrate assessment information into a clinical formulation to guide
treatment interventions. The clinical formulation that results from a behavioral
assessment is most often referred to as the functional analysis, a phrase that signals
behavior therapists’ interest in identifying the potentially controllable discriminative
stimuli, behavioral contingencies, and reinforcers influencing the client’s problem
behavior.
 Identifying the antecedent conditions and consequences of a particular behavior
could show that it occurs more frequently at some times of day, when particular
people are present, or when certain consequences occur.
 Typical behavioral interventions to address problem behavior of this kind include
overcorrection and differential reinforcement of other behavior. In
overcorrection, the client is asked to remedy the damage done by the behavior,
actually going beyond what would be minimally required, contingent upon the
 occurrence of the inappropriate behavior. In this example, overcorrection could mean
requiring the clients to clean their teeth with antiseptic toothpaste and to have their
hands treated with antibacterial medication.
 Differential reinforcement of other behavior (DRO) involves delivering positive
reinforcement contingent upon a client’s having spent at least a certain minimal
interval of time not engaging in hand-biting. Without a functional analysis of the
problem behavior, overcorrection and DRO could have been implemented as
potentially suitable behavioral interventions. However, a functional analysis might
reveal that another, quite different approach is more fitting.
 There are five main functions: 1. Description of the problem 2. Identification of
controlling variables 3. Evaluation of adaptive significance 4. Selection of treatment
5. Evaluation of outcome.
1. Description of the problem - The most obvious first step in behavioral
assessment is to obtain a clear description of specific problems that the client
would like to change. The characteristic frequency, duration, and intensity of the
problem are then delineated in order to determine the severity of the problem.
2. Identification of controlling variables - Once a specific problem (or set of
problems) is identified, the next step is to examine the types of antecedent and
consequent stimuli that could be maintaining it. This is the essence of functional
analysis—identifying important relationships between the environment and the
behavior that are potentially controllable. Associated with reinforcement
contingencies. They must be evaluated as part of any comprehensive behavioral
assessment and that they must be considered as part of any comprehensive
behavioral intervention. Kanfer and Saslow (1969) proposed a conceptual model,
the S-O-R-C-K model, which helps guide clinicians through the stages of
behavioral assessment. S refers to stimuli, antecedent events or discriminative
stimuli that function to cue the problem behavior. O refers to the organism, or
characteristics of the individual that cannot be directly observed but may play a
role in perpetuation of the problem (for example, a biological predisposition to
behave impulsively or to entertain dysfunctional thoughts that precipitate
depressive feelings). R refers to responses or behaviors identified by the client as
problematic. C refers to the immediate consequences of the behavior, and K to
contingencies or current schedules of reinforcement.
 3. Evaluation of adaptive significance - In order to evaluate this important issue,
the clinician might use criteria such as comparison of the problem with some
“normal” standard; danger to self or others; and impairment of social,
occupational, or personal functioning.
4. Selection of treatment - Nelson and Hayes (1979) have suggested the following
criteria for selecting among various treatment targets: Dangerousness to self or
others Behaviors that are highly irritating to others Behaviors that are easiest to
change (in order to increase the client’s feelings of hopefulness and sense of
personal efficacy) Behaviors at the beginning of a chain of linked behaviors.
5. Evaluation of treatment progress and outcome - The final assessment function
involves evaluation of treatment progress and outcome. According to Barlow,
Hayes, and Nelson (1984), evaluation of treatment effects can be addressed by
three different questions: 1. Is the treatment being implemented successfully? 2. Is
the treatment effective in alleviating the client’s presenting problems? 3. What are
the implications of the treatment effects for clinical science?

BEHAVIOURAL ASSESSMENT METHODS

BEHAVIOURAL INTERVIEWS

Among behavior therapists, the behavioral interview is almost universally employed to gather
information concerning problem behavior. The therapist’s general goals are to establish a
warm, supportive, and trusting relationship with the client, and to achieve detailed
information about the nature, development, and current context of the client’s stated
problems.

Establishing a good relationship. Although behavior therapy is generally time-limited and

problem-focused, this does not preclude the necessity of establishing good rapport with
clients. General characteristics of successful therapists have been detailed elsewhere (e.g.,
Egan, 1982). Good relationship-building skills involve the ability to show respect and caring
to the client, the ability to listen carefully and to be empathically responsive to the client’s
distress, and the ability to present oneself as genuine. These therapist skills are probably
necessary to the success of all forms of psychotherapy.

Achieving adequate information. The information-gathering procedure has been likened to

a funnel (Hawkins, 1979) in that, initially, a wide range of life events are discussed,
narrowing to more specific information as the interview progresses. The therapist attempts to
obtain a picture of the entire person in his or her social milieu. The following areas are
usually assessed:

Psychosocial adjustment, reflecting the number, type, and severity of emotional or

behavioral problems, at the present time and in the past, and the quality of the client’s social
relationships. Past history is usually explored although not in detail as psychodynamic
practitioners.

Academic and vocational adjustment. General information about the client’s history of
academic and vocational achievement is also obtained, including present level of vocational
success and satisfaction and relevant information about school achievement.

Medical history and status. Pertinent medical information is obtained, such as the client’s
history of serious illnesses and past inpatient or outpatient treatments.

Assets. The client’s personal strengths or assets are carefully assessed. These might include
quality of the client’s social support system etc.

Motivation. Clinicians ask how the client has tried to handle the problem in the past, and
how well these efforts have succeeded.

Witt and Elliott (1983) provided this somewhat similar outline of expected accomplishments
for any behavioral interview:

1. Initially, provide the client with an overview of what needs to be accomplished and why a
clear and detailed specification of the problem behavior is important.

2. Identify the target behavior(s) and articulate them in precise behavioral terms.

3. Identify the problem frequency, duration, and intensity (“How many times has it occurred
today,” “How long has it been going on,” etc.).

4. Identify conditions in which the problem occurs in terms of its antecedents, behaviors, and
consequences.

5. Identify the desired level of performance and consider an estimate of how realistic this is
and possible deadlines.

6. Identify the client’s strengths.

7. Identify the procedures for measuring relevant behaviors: What will be recorded, who will
record it, how will it be recorded, when and where will it be recorded?
8. Identify how the effectiveness of the program will be evaluated.

9. After completing discussion of the preceding areas, summarize it to ensure that the client
understands and agrees

STRUCTURED INTERVIEWS

Structured interviews and rating scales were originally designed to provide differential
diagnoses of clients’ presenting problems, and to assess the severity of symptoms associated
with diagnostic categories. Specific to particular problem areas. Questions refer to the
duration, content, course, and severity of specific symptoms.

Structured interviews have several advantages. They are reliable, inexpensive, fairly easy to
administer, and they allow modest flexibility in interview content. However, they have
important disadvantages as well, particularly for behaviorally oriented clinicians. Structured
interviews require lengthy administration times (e.g., the SADS takes between 1.5 and 2
hours to administer). Moreover, some instruments do not provide information about
contextual factors related to problem behavior. Finally, the validity of many structured
interview formats has not been adequately established.

BEHAVIOURAL QUESTIONNAIRES

Self-report checklists and questionnaires are used during the initial stages of therapy to
identify the range and intensity of the client’s presenting problems. Behavioral self-report
questionnaires have focused on observable phenomena such as the frequency and type of
undesirable behaviors. Behavioral questionnaires are highly problem-focused. For example,
the Wolpe and Lang (1969) Fear Survey Schedule consists of 72 items on which clients
rate the degree of fear corresponding to different situations or objects. More recently, in line
with the “cognitive revolution” in behavioral therapy, questionnaires have been designed to
assess the type and frequency of maladaptive thoughts. Beck Depression Inventory-II, clients
assess the frequency of self-critical and suicidal thoughts.

Self-report questionnaires are advantageous because they cover a wide range of clinical
disorders, and are easily administered, quick, and inexpensive. Because of these practical
virtues, they are frequently used in screening, and in evaluations of treatment progress and
outcome. An example of a specific self-report questionnaire to assess a focused problem area
is the Revised Children’s Manifest Anxiety Scale. Potential limitations of self-report
questionnaires have included the possibility of distortion, bias, or misinterpretation in the
client’s responses; lack of attention to situational specificity; and in many cases, questionable
validity. For these reasons, data derived from self-report questionnaires should always be
supplemented with other sources of information about the client’s problem.

BEHAVIOURS RATING SCALES

Typical behavior rating scales are multifaceted, assessing a wide range of behaviors on
several different dimensions. Examples includes Child Behavior Checklist (CBCL) and
Conners’ Rating Scales-Revised.Ratings are usually made by teachers and parents, conferring
the advantages of assessing behavior across situations with independent informants.
However, these ratings tend to be impressionistic, global ratings that may be subject to
various forms of bias.

ANALOGUE TECHNIQUES

Analogue techniques involve asking the client to respond to contrived situations in the clinic
or laboratory that are similar to real-life problem situations. A range of media and techniques
have been used, including paper-and-pencil responses to written scripts, asking the client to
attend to audiotaped or videotaped situations, asking the client to enact problematic social
interactions in the consulting room, or asking the client to assume various roles of persons
involved in troubling social exchanges.

For example, Goldsmith and McFall (1975) assessed interpersonal skills of adults by asking
them to respond to a contrived script, and Lang and Lazovik (1963) have assessed
avoidance behavior in phobias by devising behavioral avoidance tests. Analogue techniques
may be very useful in generating hypotheses about the nature of the client’s problems.

The degree of correspondence between contrived stimuli and real-life problems they
represent may not be great and has rarely been tested by clinicians.

DISADVANTAGES: 1. it is tough to create a contrieved stimuli as similar to that of real life

stimuli

2. additional information is required to be collected to clarify the real picture

SELF MONITORING

Self-monitoring involves recording aspects of one’s own behavior for use in treatment. Self
monitoring is especially helpful in the case of low frequency events, which would be difficult
to observe independently. If the presenting problem involves some sort of “private event,”
such as cravings or dysfunctional thoughts, self-monitoring is one of the only means available
for assessment.

A variety of assessment tools have been used, including written diaries, mechanical counters,
timing devices, and computers.

The advantages of self-monitoring are many: 1. It can be can be carried out anywhere. 2. It
permits sampling of low-frequency private events, such as illicit drug use or sexual behavior.
3. It promotes insight into how one’s own behavior is related to situational and other factors.
4. It can be reactive, in that self-monitoring may in itself promote positive change.

Potential drawbacks of self-monitoring include noncompliance, reactivity, and inaccuracy.

In trying to circumvent noncompliance, it is important that the therapist selects a recording
method appropriate to client’s problem, trains the client in self-monitoring techniques, then
follows up with phone or mail contacts. The reactivity problem is more difficult to deal
with. When individuals self-record their own behavior, it tends to change in frequency. When
independent checks of self-monitored data have been conducted, many investigators have
reported poor accuracy. Thus, the assessment function of self-monitoring is hampered by
problems of reactivity and inaccuracy, particularly in situations where pretreatment baseline
data must be obtained.

DIRECT OBSERVATION

Direct observation of problem behaviors in natural settings (such as homes, schools, or

residential treatment facilities) played an important role in the initial development of
behavioral assessment and continues to be one of its hallmarks. The greatest advantage of in
vivo observation is that problem behavior can be observed in its customary situational
context, leading directly to hypotheses about possible controlling variables.

The many potential limitations of in vivo observation includes:

1. Reactivity. Perhaps the greatest drawback of observational methods is reactivity to
the presence of the observer. People tend to behave differently when they know that
they are being observed by others.
2. Reliability of observations. Achieving acceptable interrater reliability requires
intensive training. Diverse factors have been found to affect reliability, including the
complexity of social behaviors and interactions under observation, observers’
awareness that a reliability assessment is being conducted, observer fatigue, and the
tendency for observers to “drift” from the original coding criteria over time.
3. Validity of observations. Validity is influenced by many factors, including the
comprehensiveness of the coding system, the number of observations conducted, the
nature of the validation criterion and the extent to which different situations relevant
to the problem behavior are adequately sampled.
4. Cost-efficiency. Direct observation is expensive and time-consuming.