F. Robert Wilson, Ph.D.
College of Education, Criminal Justice and Human Services |
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| Contact the Program Secretary |
F. Robert Wilson, Ph.D.
University of Cincinnati
October, 2005
Abstract
Ecologically grounded assessment is rooted in the Lewinian (1936) notion that behavior is a function of persons interacting within their environment. In conducting psychodiagnostic assessment, mental health counselors are urged to attend to the strengths and limitations of the person, the nutrients and toxins in the environment, and the pattern of interactions which describe the unfolding of the client's life.
Clinical Assessment: An Ecological View
Each time we greet a new client, we are faced with a puzzle: “Who are you?” The way we choose to go about answering this question will direct the course of our therapeutic relationship. Mental health counseling, arising as it does from the traditions of psychiatric and psychological science, has historically assumed that a client is a client because of problems arising from within and that therapy will involve marshalling the client's personal strengths to offset his or her personal limitations (Conyne & Cook, 2004; Wilson, 2004). Yet counseling as a whole also arises from another powerful tradition, the tradition of vocational and career counseling, which emphasizes the role of environment and the goodness-of-fit between the person and the environment in which he or she is seeking interpersonal effectiveness (Parsons, 1909). Lewin (1936) gave first voice to a synergistic, ecological model: a person's behavior is a function of the pattern of interactions one has within in one's environment, or B = f (P, E). From the ecological perspective, the question, “Who are you?” is a layered question. To truly answer it we must examine the individual's personal characteristics, the characteristics of his or her environment, and the pattern of interactions the person has within his or her environment which define the unfolding of his or her life.
An Ecological Framework for Assessing Health and Illness
Mental health is best studied by assessing the person-environment fit (Banning, 1989; Wilson, 2004). To assess this fit, the clinician must assess broadly, examining the client's intrapsychic sphere (particularly the constructs that form the basis of the client's intentions, plans, and actions), the client's ecological niche (particularly the people with whom the client interacts and the constructs that guide their intentions, plans, and actions), and the interactional sphere (the repeating patterns of interactions between the client and the client's niche mates) (Willi, 1999; Wilson, 2004). From the ecological perspective, health is construed as the degree to which one experiences interpersonal effectiveness within one's ecological niche (Lewin, 1936; Willi, 1999; Wilson, 2004).
The person. Historically, mental health assessment has assumed that intrapsychic factors were the most important determinant of a client's health, a view which could be modeled as B = f (P), Encyclopedic works such as Buros Mental Measurements Yearbook (Plake & Impara, 2001) or the Mariush (1999) review of key mental health instruments catalog a host of tools for assessing such intrapsychic features as cognitive capacity and attainment, mood and anxiety symptoms, and personality characteristics. Analysis of the person has been reified in the mental status examination (see Table 1).
Table 1 Elements of the Mental Status Examination
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• Appearance • Behavior, attitude, unusual features • Speech, language usage, unusual features • Mood; affective range, intensity, stability, congruence • Thought process • Thought content; perception • Cognitive function and capacity • Personality characteristics • Insight into own difficulties • Judgment; capacity for making good decisions |
The ecological view of health and illness recognizes that some problems, such as schizophrenia and mood disorders, may arise from malfunction in the biological substrata. Other problems, such as eating disorders and substance use disorders, arise from dysregulation of drive satisfaction and behavior. Still others, are rooted in life-long patterns of learning that lead to maladaptive personality traits. (McHugh, 2002). What these “problems of the person” have in common is context insensitivity. They are problems that arise regardless of the social context in which the person finds himself or herself.
The environment. Environmental assessment in mental health counseling has not kept pace. Historically, environmental assessment, grounded in the belief that behavior is a function of environmental forces, or as B = f (E), has been the province of sociology, community psychology, and social work. Even though the Axis IV of a DSM based multi-axial diagnosis (American Psychiatric Association, 2000) addresses psychosocial and environmental problems, the findings of this “environmental status examination” are often not given much weight in many clinician's diagnostic formulations and subsequent treatment plans. Ecologically grounded assessment, however, strives to obtain a comprehensive description of the daily contexts that make up an individual's life, including the objective qualities of the individual's ecological niche and his or her subjective perception of those qualities (Munger, 2000; Wilson, 2004). In parallel to the notion of context insensitivity mentioned above in the discussion of person based problems, some environments exert such potent toxic effects that people within the environment are negatively affected no matter how healthy they were when they entered the environment. Therefore, comprehensive evaluation of the environment includes both identification of nutrients (e.g., jobs, housing, food sources, health care facilities, education and training facilities, social services, recreation sites, and friendly, supportive people) and debilitating toxins (e.g., poor air, dangerous housing, dangerous work sites, predatory people, neighborhood strife, civil unrest). A guide for conducting an evaluation of environmental status has been drawn from the DSM-IV Axis IV problem focused list (American Psychiatric Association, 2000), Munger's list of core niche elements (2000), and Bronfenbrenner's (1979) hierarchy of ecological contexts
(see Table 2).
Table 2 Elements of the Environmental Status Examination
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Microsystem —primary, face-to-face contacts • Primary social group (family of origin, current family) • Social niche • Housing, neighborhood safety • Employment, vocation |
Exosystem —larger systems which affect the client • Educational opportunities • Medical care • Psychological, emotional care • Legal involvement |
Macrosystem —pervasive social forces • Cultural, ethnic considerations • Neighborhood and community characteristics • Socio-political policies |
The interaction between person and environment. One's personal characteristics and the characteristics of one's ecological niche are the building blocks for a life, yet how do they combine as a life unfolds? In ecological assessment, the interaction of the person with the elements and systems of the environment, B = f (P X E), is paramount (Bondurant-Utz, 1994; Horton & Bucy, 2000). Though not nearly so numerous, a variety of scales have been developed for assessing interactions among people. Notable examples include the FIRO scales (Schutz, 1958), the Interpersonal Checklist (Leary, 1957), the Inventory of Interpersonal Problems (Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988), and Hudson's series of instruments for assessing peer ( Hudson , 1993), sibling ( Hudson , 1997), and family ( Hudson , 1997) relationships. A rich description of the quality of a client's interactions within their ecosystem can be captured in genograms (Marlin, 1989) and ecomaps (WonderWare, 1995) by coding life-space patterns, what Lee (1985) described as the individual's “characteristic ways of negotiating time, space, people, and activity in their day-to-day lives” (p. 624). It is helpful to categorize client's relationship activities into a hierarchy of involvement ranging from little involvement and commitment (participating without interaction) to deep involvement and commitment (dyadic relationships with binding commitments) (as proposed by Willi, 1999 and listed in Table 3). Qualitative questions such as “What is a typical day like for you?”, “What is it like for you at work (or school)?”, “What is it like to live in your neighborhood?”, and “What has it been like for you when someone says, ‘I'll help you'?” should be a part of every clinician's standard interpersonal patterns evaluation.
Table 3 Hierarchy of Interpersonal Patterns
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• Simple forms of interactions (participating without interacting) • Nonreciprocal interaction • Brief contacts without commitment • Reciprocal relationships without responsibility • Relationships with minimal personal closeness • Dyadic relationships with binding commitments |
Problem Formulation
A thorough ecologically grounded assessment provides a diagnostic formulation which describes the strengths/assets and problems/dysfunctions in all three spheres ( P, E, and PXE).
By way of example, consider the following ecologically grounded assessment of Clement, a client who presented for treatment at a clinic for indigent and homeless individuals in a large Midwestern city. To illustrate ecological assessment, findings from evaluation of the person, his ecological niche, and his pattern of interactions within that environment will be presented.
Personal characteristics. Clement is a 48 year old, African American man. He appeared malnourished and disheveled. He carried several duffle bags which he guarded closely but was friendly and cooperative during the intake interview. His spoke uneducated English, but was a fluid conversationalist. His mood was cheerful, and his affect was stable and congruent, however he complained of periodic bouts of depression accompanied by suicidal ideation. His thought process was organized and he denied perceptual abnormalities. His thought content was unremarkable: he denied any current suicide ideation or violence ideation and there was no evidence of delusions, obsessions, or over-valued ideas. He was attentive, oriented, with intact short- and long-term memory. His intelligence was estimated to be in the borderline range of intelligence but, despite limited formal education (10th grade), he appeared to be attentive to current events and exhibited knowledge of modern technology. He evidenced good insight stating that his reason for presenting for treatment was that he got sad and depressed whenever he spent time thinking about what his life “had added up to.” A physical examination revealed he has asthma, for which he has been recommended inhalant medication and diabetes but is not insulin dependent.
Environmental characteristics. Clement currently lives in a publicly supported shelter for homeless men, a place where safety and security is minimally provided by a skeleton crew of para-professional staff. Many have complained that “it isn't very safe to get friendly with anyone down here—they take your stuff or try to get you using drugs.” Clement's parents are deceased, his sister “married money” and lives in Argentina and his brother died during combat in Iraq . He has been estranged from his wife since she left town with another man eleven years ago. He is not able to afford the recommended inhalant medication for his respiratory problems; and because of the quality of food served at soup kitchens, he is unable to maintain the diet recommended for his diabetic condition. He left school in 10th grade to help earn a living for his mother and sister when his father was disabled in an automobile accident. Duped by an older acquaintance, he took part in a scheme to make money with forged lottery tickets which resulted in a felony conviction. Since then, because of a city-wide policy regarding homeless individuals, he has had several run-ins with the police for vagrancy. When the allergen count is low, he works as a package handler in a local warehouse; otherwise, as a licensed street vendor, he sells a local street newspaper.
Pattern of interaction with the environment. Clement generally keeps to himself. At the shelter, he minds his own business. He cooperates with the shelter staff, follows the rules, and stays out of trouble as best he can. He said, “when folks get in my face, I just leave it alone.” However, he sells his papers “up the hill” on the outskirts of a city college. He said, “Folks treat you better up there. I listen to the television news and try to remember it. The students will talk to you if you now something about what's going on.” Clement uses the resources he has at hand. About his difficulty reading; he said, “I can't read very well, but I try to know what's in the papers I'm selling. Sometimes I get the shelter boss to read some of it to me.” Despite the differences between himself and his customers, he has developed a style that fits in: “As long as I stay where I am supposed to and act friendly, the kids up there treat me good and they pay me for the papers. Sometimes they bring me a sandwich back from their lunch.” About his bouts of depression, Clement said: “Most of the time, I'm OK. I know I haven't got much chance for a job. I got no education. I got a felony. I can't do warehouse work a lot of days because of the bad air. But I got a place to sleep and I don't go too hungry. And I got those kids to talk to when I sell papers. But sometimes I get down, thinking about how if I had some education and if I hadn't done that felony, I could have got me a job up the hill and had nicer folks to talk to more of the time. Then it gets bad inside me. Then I don't want to be here anymore.”
Who is Clement? To know Clement we must certainly know about his inner world, the strengths and deficits of his intrapsychic makeup. But to truly know Clement, we must also know about the ecological niche in which he lives and the interactions he has with his environment that form the basis for his sense of interpersonal effectiveness or interpersonal ineffectiveness. Ecologically grounded assessment addresses all three: the person, the environment, and the pattern of interactions that describe the unfolding of his life.
References
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Reproduced with permission of the Ohio Association for Mental Health Counselors (2005)
