concept of observation in clinical psychology.




Clinical psychology is an exciting and growing field that encompasses both research and practice related to psychopathology and to mental and physical health. Understanding, treating and preventing mental health problems and their associate effect is the business of clinical psychology.

Clinical psychologists play a central role in the assessment, diagnosis, treatment and prevention of mental health problems.

Through the use of psychological tests, interviews, observations of behavior, various forms of psychological treatment (e.g. cognitive behavioral therapy, interpersonal psychotherapy, marital and family therapy) clinical psychologists are on the front line in the treatment of mental health problems.

They are increasingly involved in the treatment of behavioral and psychological factors that are related to physical diseases, including cancer, heart disease, diabetes, asthma and chronic pain etc. They are also involved in the delivery of programs to prevent mental health problems and to promote positive mental and physical health.

As a result, clinical psychologists engage in work in which the stakes are high and the opportunities are great to bring meaningful changes in the lives of others.

The word “Clinical”, derived from the Latin and Greek words for Bed, suggests the treatment of individuals who are ill. But clinical psychology has come to mean a broader area than just mental illness of individuals. Among the ultimate aims of clinical psychology are the psychological well-being and beneficial behavior of persons; therefore, it focuses on internal psychobiological conditions and on external social and physical environments within which individuals function.

Clinical psychology is the largest single speciality within psychology that deals with principles and skills applied outside the laboratory, it is by no means all of applied psychology, which includes industrial, educational, organizational, military and several other specialties.




·         Clinical Psychology is a branch of psychology devoted to the study, diagnosis, and treatment of people with mental illnesses and other psychological disorders.

·         Clinical psychology is the scientific study, diagnosis, and treatment of people who have psychological problems adjusting to themselves and the environment. Clinical psychologists deal with both normal and abnormal behaviors. They administer and interpret psychological tests, and assist in the diagnosis and treatment of mental disorders. They also study the structure and development of personality.

·         Clinical psychology is a broad field of practice and research within the discipline of psychology, which applies psychological principles to the assessment, prevention, amelioration, and rehabilitation of psychological distress, disability, dysfunctional behaviors, and health-risk behaviors, and to the enhancement of psychological and physical well-being.

·         Clinical psychology includes both scientific research, focusing on the search for general principles, and clinical service, focusing on the study and care of clients, and information gathered from each of these activities influences practice and research.

·         Clinical psychology is a broad approach to human problems (both individual and interpersonal) consisting of assessment,  diagnosis, consultation, treatment, program development, administration, and research with regard to numerous populations, including children, adolescents, adults, the elderly, families, groups, and disadvantaged persons.

·         Clinical psychology focuses on the assessment, treatment, and understanding of psychological and behavioral problems and disorders. In fact, clinical psychology focuses its efforts on the ways in which the human psyche interacts with physical, emotional, and social aspects of health and dysfunction.

·         According to the American Psychological Association, clinical psychology attempts to use the principles of psychology to better understand, predict, and alleviate "intellectual, emotional, psychological, and behavioral disability and discomfort" (American Psychological Association, 1981).

·         Clinical psychology is "the aspect of psychological science and practice concerned with the analysis, treatment, and prevention of human psychological disabilities and with the enhancing of personal adjustment and effectiveness" (Rodnick, 1985).


Thus, clinical psychology uses what is known about the principles of human behavior to help people with the numerous troubles and concerns they experience during the course of life in their relationships, emotions, and physical selves. For example, a clinical psychologist might evaluate a child using intellectual and educational tests to determine if the child has a learning disability or an attentional problem that might contribute to poor school performance. Another example includes a psychologist who treats an adult experiencing severe depression following a recent divorce. People experiencing alcohol addiction, hallucinations, compulsive eating, sexual dysfunctions, physical abuse, suicidal impulses, and head injuries are a few of the many problem areas that are of interest to clinical psychologists.

 Clinical Observation:

i)  To describe what the client talks and thinks about and how he/she acts.

ii) Clinicians use observation to assess a client's behavior and functioning, with particular attention to the symptoms associated with psychological disturbance.


Clinical psychologists are also trained to gather data by observing behavior.

Observation is a core skill of psychiatrists,nurses, and other qualified mental health providers. It is a systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders.

It is a structured way of observing and describing a patient's current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgement.


a) Appearance

Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient's gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or intoxication with alcohol.

b) Attitude, Manner and approach

Attitude, also known as rapport, refers to the patient's approach to the interview process and the interaction with the examiner. The patient's attitude may be described for example as cooperative, uncooperative, hostile, guarded, suspicious or regressed.

Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)

Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated)

Expressive Language (no problems expressing self, circumstantial and tangential responses, anomia, difficulties finding words, misuse of words in a low-vocabulary-skills way, misuse of words in a bizarre-thinking-processes way, echolalia, mumbling)

Receptive Language (normal, able to comprehend questions, difficulty understanding questions)

c) Behaviour

Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), posture (slouched, erect), work speed, any noteworthy mannerisms or gestures.

Eye Contact (makes, avoids, seems hesitant to make eye contact)

Abnormalities of behaviour, also called abnormalities of activity, include observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, and observations of the patient's eye contact and gait. Abnormal movements, for example choreiform or athetoid movements may indicate a neurological disorder. A tremor may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary movements or vocalizations) which may be a symptom of Tourette's syndrome. There are a range of abnormalities of movement which are typical of catatonia, such as echopraxia, catalepsy, waxy flexibility and paratonia. Stereotypies (repetitive purposeless movements such a rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia or autism. More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity) which might reflect mania or delirium. An inability to sit still might represent akathisia, a side effect of antipsychotic medication. Similarly a global decrease in arousal and movement (described as psychomotor retardation, akinesia or stupor) might indicate depression or a medical condition such as Parkinson's disease, dementia or delirium. The examiner would also comment on eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and the quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest autism.

d) Speech

Speech (normal rate and volume, pressured, slow, accent, loud, quiet, impoverished)

When observing the patient's spontaneous speech, the interviewer will note paralinguistic features such as the loudness, rhythm, intonation, pitch, articulation, quantity, rate, spontaneity and latency of speech.

Language assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism may have abnormalities in paralinguistic aspects of their speech. Echolalia (repetition of another person's words) and palilalia (repetition of the subject's own words) can be heard with patients with autism, schizophrenia or Alzheimer's disease. A person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them. Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.


e) Mood and Affect


Affect is the patient's immediate expression of emotion; mood refers to the more sustained emotional makeup of the patient's personality.

Affect or how they felt a given moment (comments can include range of emotions like broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation and facial expressions, pessimistic, optimistic) as well as inappropriate signs (began dancing in the office, verbally threatened examiner, cried while discussing recent happy event and unable to explain why).

Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset)

Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful when discussing such and such)

Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected)

Impulsivity (low medium, high, effected by substance use)

Patients display a range of affect that may be described as broad, restricted, labile, or flat. Affect is inappropriate when there is no consonance between what the patient is experiencing or describing and the emotion he is showing at the same time (e.g., laughing when relating the recent death of a loved one). Both affect and mood can be described as dysphoric (depression, anxiety, guilt), euthymic (normal), or euphoric (implying a pathologically elevated sense of well-being).

For example, someone who shows a bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder; heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorders.

Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia.

f) Thought processes

Thought Processes (could/could not recall the plot of a favorite movie or book logically, difficult to understand line of reasoning, showed loose associations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, delusions, reports of experiences of depersonalization, Hallucinations ( visual, olfactory and auditory).

Thought process refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Regarding the tempo of thought, some people may experience flight of ideas, when their thoughts are so rapid that their speech seems incoherent, although a careful observer can discern a chain of poetic associations in the patient's speech. Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought is a global reduction in the quantity of thought. A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and might be described more specifically as thought blocking, fusion, loosening of associations. 

Flight of ideas is typical of mania. Conversely, patients with depression may have retarded or inhibited thinking. Poverty of thought is one of the negative symptoms of schizophrenia, and might also be a feature of severe depression or dementia. Formal thought disorder is a common feature of schizophrenia. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders.

g) Cognition

Covers the patient's level of alertness, orientation, sensorium,attention, memory.

Orientation (person, place, time, presidents, your name)

Alertness (sleepy, alert, tired for working late, dull and uninterested, highly distractible)

Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)

Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible, but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication.

Body Language interpretation

What people say could often be very different from what they're thinking or feeling. It's very easy to say something untrue or insincere, so we can never rely on words alone.

Fortunately, there's a proven way to accurately decode people's thoughts, emotions or mood - and that's by reading their body language. People may lie, but their body silently and unconsciously speaks the truth.



a) Depressed people tend not to put as much effort into their appearance, body language and mannerisms, and their communication style tends to be negative.

b) Frustration body forms :

The following are some other body forms that indicate frustration:

c) Anxiety is one of the body's language that can not be identified by one gesture or the other; you have to combine more than one signal to know whether that person's anxious or not. The presence of three or more signs of the below shows that this person is anxious:

d)  Lie detection



2: Naturalistic Observation

 Naturalistic observation is a method of observation, commonly used by psychologists, behavioral scientists and social scientists, that involves observing subjects in their natural habitats. Objectively, studying events as they occur naturally, without intervention. It usually involves observing humans or animals as they go about their activities in real life settings. The psychologist looks for cause-and-effect relationships between events and for broad patterns of behaviour. 

Naturalistic observation is a technique used to collect behavioral data in real-life situations as opposed to laboratory or other controlled settings. This technique is most useful when little is known about the matter under consideration. Underlying the interpretation of data obtained through this procedure is the assumption that the investigator did not interfere with the natural order of the situation. This type of research is often utilized in situations where conducting lab research is unrealistic, cost prohibitive or would unduly affect the subject's behavior.

The researcher simply records what occurs and does not intervene in the situation. Psychologists use naturalistic observation to study the interactions between parents and children, doctors and patients, police and citizens, and managers and workers.

Naturalistic observation is also common among developmental psychologists who study social play, parent-child attachments, and other aspects of child development. These researchers observe children at home, in school, on the playground, and in other settings.


Usually involves careful observation of participants in their natural surroundings.

Observational methods involve an investigator viewing users as they work and taking notes on the activity which takes place. Observation may be either direct, where the investigator is actually present during the task, or indirect, where the task is viewed by some other means such as through use of a video camera.

For example, I might have an interest in the eating habits of humans. My school has a cafeteria, so I could just sit at a table, enjoy my lunch with a notebook, and make observations of the eating habits of my fellow students and teachers. You should pick a behaviour that you do not have a predetermined theory or even opinion about, though this is difficult to do.




1) As an example of naturalistic observation, the study of parent-child interaction may involve videotaping the parent and child in their home either as they go about their daily routine or as they perform an activity given to them by the researcher. These videotaped interactions can then be taken back to the laboratory and analyzed using a variety of techniques in order to extract the desired information from them. This particular research technique has the advantage of making it easier for research participants to be involved in the study.


2) Sex Differences in Children's Risk-Taking Behavior

Popular belief has it that males are bigger risk takers than females. Is this true?

Because of a lack of empirical evidence on this, Ginsburg and Miller (1982) set out to find out if young boys or girls are more willing to take risks. They chose the naturalistic observation method because they wanted to study this behavior in the real world rather than the laboratory.


The setting they chose was the San Antonio Zoo. They operationally defined risk-taking and measured it in four ways:


         riding an elephant

         petting a burro

         feeding animals

         climbing a steep wooden bridge.


The investigators recorded the number of boys and girls engaging in these "risky" behaviors. They found that boys engaged in risk-taking behaviors more frequently than girls.




A main strength of observational studies is that they get to see how participants actually behave rather than what they say they do. It allows researchers to observe behavior in the setting in which it normally occurs rather than the artificial and limited setting of the laboratory. It Enables the study of situations that cannot be artificially set up. Allows the observer to view what users actually do in context. Direct observation allows the investigator to focus attention on specific areas of interest. Indirect observation captures activity that would otherwise have gone unrecorded or unnoticed. More natural behaviour occurs if people are unaware of observation.

A further strength of observational studies is that they offer ways of studying behaviour when there are ethical problems with manipulating variables. For example there will be less ethical issues with carry out a naturalistic observation of school children compared to carrying out experiments on school children.

Observational studies are also useful as a starting point in research. For example the researchers may be investigating a new area of research in order to produce hypotheses for future investigations such as experiments.


Observations do not provide information about what participants are thinking or feeling.

Observing can be obtrusive and subjects may alter their behaviour due to the presence of an observer. Co operation of users is vital and so the interpersonal skills of the observer are important. Notes and video tape need to be analyzed by the note-taker which can be time consuming and prevents the task being split up for analysis by a number of people.

There is little or no control of extraneous variables in observational studies therefore we can not make cause and effect statements.

There is also the problem of observer bias with observational studies. This occurs if the observers ‘see’ what they expect to see.

A number of ethical issues can arise with observational studies including problems with a lack of informed consent and invasion of privacy.

Observations can also be very time consuming, one  may have to wait for some time to observe the behavior of interest. It requires careful preparation and possibly training for the observers.

Types of observations

Naturalistic observation, can be divided into two main sections, overt and covert(undisclosed observation).

Overt, when participant are aware they are being observed. And in covert or undisclosed observation the participants do not know they are being observed.

That advantages of using overt naturalistic observation is that you see your participants in their natural everyday environment, going about their daily lives as they would normally, however, this can cause demand characteristics in the participants as they may behave how they think the researcher wants them to.

The advantages of using Covert naturalistic observation is that your results will be extremely high in ecological validity, and there will be very few if none strange behaviours, however, covert observation of any kind can bring about numerous ethical issues.




These unconscious behavioral or psychological maneuvers enable the individual to minimize or avoid anxiety, affects or impulses arising out of conflict.


denial | distortion | projection


acting out | blocking | hypochondriasis | introjection | passive aggression | projection | regression | schizoid fantasy | somatization


controlling | displacement | dissociation | externalization | inhibition | intellectualization | isolation of affect | rationalization | reaction formation | repression | sexualization


altruism | anticipation | asceticism | humor | sublimation | suppression


affiliation | aim inhibition | autistic fantasy | avoidance | compartmentalization | compensation | conversion | counterphobia | deflection | devaluation | fixation | help-rejecting complaining | idealization | identification | identification with the aggressor | incorporation | instinctualization | introjective identification | moralization | omnipotence | projective identification | resistance | restitution | reversal | restitution | self-assertion | self-observation | splitting | substitution | symbolization | turning against the self | undoing | withdrawal

Also: avoidance mechanism, defence, escape mechanism, mechanism of defense


Defense Mechanisms

The use of defence mechanisms can indicate problem areas for a person as a defence mechanism gives some relief from anxiety producing thoughts and actions at the expense of distorting the real world. Defense mechanisms protect us from being consciously aware of a thought or feeling which we cannot tolerate. The defense only allows the unconscious thought or feeling to be expressed indirectly in a disguised form. Let's say you are angry with a professor because he is very critical of you. Here's how the various defenses might hide and/or transform that anger:

Denial: You completely reject the thought or feeling. "I'm not angry with him!"

Suppression: You are vaguely aware of the thought or feeling, but try to hide it. "I'm going to try to be nice to him."

Reaction Formation: You turn the feeling into its opposite. "I think he's really great!"

Projection: You think someone else has your thought or feeling. "That professor hates me."
Displacement: You redirect your feelings to another target."I hate that secretary."

Rationalization: You come up with various explanations to justify the situation (while denying your feelings). "He's so critical because he's trying to help us do our best."

Intellectualization: A type of rationalization, only more intellectualized. "This situation reminds me of how Nietzsche said that anger is ontological despair."

Undoing: You try to reverse or undo your feeling by DOING something that indicates the opposite feeling. It may be an "apology" for the feeling you find unacceptable within yourself. "I think I'll give that professor an apple."

Isolation of affect: You "think" the feeling but don't really feel it. "I guess I'm angry with him, sort of."

Regression: You revert to an old, usually immature behavior to ventilate your feeling or return to a less mature, anxiety reducing behaviour. "Let's shoot spitballs at people!"

Sublimation: You redirect the feeling into a socially productive activity. "I'm going to write a poem about anger.

Repression: the removal of threatening thoughts from awareness;

Displacement: substituting a less threatening object for impulses;