94 CHAPTER 3
complex functions. In the Bender Visual-Motor Gestalt Test, patients are shown a
series of drawings that range from simple to complex and are asked to reproduce
them. This test assesses the integration of visual and motor functioning, which
involves many distinct parts of the brain. The test may be used to help diagnose var-
ious problems, including learning disorders and memory problems (Brannigan &
Decker, 2006).
There are also sets of neuropsychological tests, such as the Luria-Nebraska
Neuropsychological Battery (Golden, Hammeke, & Purisch, 1980), which consists
of 14 tests that measure different abilities, or the Halstead-Reitan Neuropsychologi-
cal Battery (Reitan & Davison, 1974), which consists of 10 tests that measure dif-
ferent abilities. When specifi c neuropsychological tests suggest possible brain areas
that may be affected, the status of those areas can be verifi ed by neuroimaging.
A neuropsychologist may administer a whole battery of tests or only specifi c tests,
depending on the reason for the assessment and what information is already known
about the patient’s brain damage and ability to function.Assessing Psychological Factors
If Rose Mary and Rex Walls had been willing to see a mental health clinician, how
would the clinician have gone about assessing psychological factors relating to their
unusual behavior and beliefs? What would such an assessment entail? During an
assessment, clinicians and researchers often seek to identify the ways in which psy-
chological functioning is disordered and the ways in which it is not. For instance,
a clinical assessment would shed light on the extent to which Rex Walls’s problems
were primarily a result of his drinking or arose from underlying impairments that
may have been masked by his pronounced drinking. According to Jeannette’s memoir,
during the two stretches when Rex was sober, his functioning signifi cantly improved.
Certain areas of psychological functioning—mental processes and mental con-
tents, affect, and behavior—are often directly related to DSM-IV-TR criteria for
specifi c disorders. Further, these areas are frequently the most relevant for determin-
ing a person’s current and future ability to function in daily activities.
Mental health researchers and clinicians employ a variety of assessment tech-
niques and tools to ascertain psychological functioning, including interviews and
tests of cognitive and personality functioning. Which tools and techniques are used
depends on the purpose of the assessment. In the case of Rex and Rose Mary Walls,
the purpose of the assessment could be to determine whether either one or both
of them: (1) was so impaired that he or she posed a potential imminent danger to
self or others, and thus might best be admitted to a psychiatric unit of a hospital
to be observed around the clock; (2) was impaired enough to qualify for disability
payments; (3) had a psychological disorder, and if so, what specifi c disorder it was
and what type of treatment might be appropriate. If an assessment had been made
while Rex and Rose Mary’s children were still living with them, it could have helped
the clinician determine whether either or both parents were competent to be respon-
sible for their underage children.Clinical Interview
An important tool used to assess psychological functioning is the clinical interview,
a meeting between clinician and patient during which the clinician asks questions
related to the patient’s symptoms and functioning. A clinical interview provides two
types of information: the content of the answers to the interview questions, and the
manner in which the person answered them (Westen & Weinberger, 2004). Ques-
tions may focus on symptoms, general functioning, degree and type of impairment,
and the patient’s relevant history.
In an unstructured interview, the clinician asks whatever questions he or she
deems appropriate, depending on the patient’s responses. In contrast, in a struc-
tured interview, the clinician uses a fi xed set of questions to guide the interview.
The advantage of an unstructured interview is that it allows the clinician to pursueClinical interview
A meeting between clinician and patient
during which the clinician asks questions
related to the patient’s symptoms and
functioning.