Practical Nine (Cultural Competence & MSE)

Question 1

3 factors cultural competence is founded on?

Answer 1

knowledge, skills and critical-self reflexivity

Question 2

Cultural Competence - Knowledge?

Answer 2

Understand the nature and significance of a person’s cultural background

Awareness of factors which might have a negative impact on therapy in the
cultural context

Knowing what differences there might be in communication styles

Are there perceptions that might influence the client-therapist relationship (e.g.
does the person have fears about psychologists given generational or individual
history?)

Question 3

Cultural Competence - Skills?

Answer 3

You need to develop generic skills to allow appropriate and respectful interactions

Being able to distinguish when culture might be influencing presentation or not
(psychosis versus trance)

Being able to select appropriate assessments if needed, and knowing their
limitations

You might need to consider using approaches that might fall outside of the typical
Western skillset (e.g. yarning)

Question 4

Cultural Competence - Critical Self-Reflexivity

Answer 4

What are your attitudes and beliefs about people from other cultures?

How might you appear to someone from another culture?

How have people from a given culture previously experienced psychology? (e.g.
testing, stolen generations)

And what can you do to reduce any tensions associated with these differences/beliefs?

Question 5

MSE?

Answer 5

A template that is routinely used in the collation and organization of clinical information
about a client’s presentation and functioning, based on observations of verbal and nonverbal behavior, emotional state and cognitive function.

Question 6

What does MSE do?

Answer 6

Helps clinicians to consistently note all elements of a client’s presentation, can
be used as the foundation for writing up a report.

Question 7

MSE appearance?

Answer 7

A concise summary of the client’s physical presentation is given – how are they
dressed, grooming, hygiene, as well as any relevant noteworthy aspects of
appearance

Question 8

MSE attitude?

Answer 8

Identifiers of the person’s attitude: may be open, friendly, cooperative, willing, and
responsive on the hand or closed, guarded, hostile, suspicious, passive on the other
Describe attentiveness, responses to questions, expression, posture, eye contact, etc

Question 9

MSE behaviour?

Answer 9

May make reference to:
• level of consciousness (is the person alert, drowsy, confused, restless, or disoriented)
• degree of arousal (e.g., hypervigilance)
• mannerisms (e.g., tics and compulsions).

Question 10

MSE speech?

Answer 10

Described in terms of:
• Rate (e.g., slow, rapid)
• Intonation (e.g., monotonous)
• Spontaneity
• Articulation
• Volume
• Quantity of information conveyed
• mutism (i.e., absence of speech)
• poverty of speech (i.e., reduced spontaneous speech)
• pressured speech (i.e., rapid speech that is hard to interrupt and understand)
• Disturbances such as aphasia

Question 11

MSE affect?

Answer 11

An external expression of an emotional state which can be observed by clinician. Things
to consider:
• Lability: when expression fluctuates swiftly
• Congruency/Appropriateness (expression incongruent with verbal descriptions and
behavior)
• Constricted/restricted (i.e., low intensity or range of emotional expression)
• blunted (i.e., severe declines in range and intensity of emotional range and
expression)
• flat (i.e., absence of emotional expression,)
• exaggerated (i.e., an overly strong emotional reaction)

Question 12

MSE mood?

Answer 12

(internal emotional experience) require clinician to depend on the client’s
introspections
• Descriptors: euthymic, irritable, elevated, anxious, depressed

Question 13

MSE thought processes?

Answer 13

• Does there appear to be logical and goal-directed thought? Or is the person
disorganized in their thinking?
• What is the quantity and speed of thought production?
• They may show a loosening of associations, where the logical connections between
thoughts are tenuous or bizarre.

Question 14

MSE thought content?

Answer 14

Is there evidence of:
• delusions
• phobias (excessive and irrational fears)
• obsessions (repetitive, and intrusive thoughts, images, or impulses)
• preoccupations (e.g., with illness or symptoms).
• Risk or harm to self or others? – if yes, how high risk?

Question 15

MSE perception?

Answer 15

• Any evidence of hallucinations or delusions?
• Other perceptual disturbances include:
• external world is unreal, different, or unfamiliar (derealization)
• self is different or unreal in that the individual may feel unreal, that the body is distorted or being
perceived from a distance (depersonalization)

Question 16

MSE orientation?

Answer 16

Is the person aware of time, place, and person/self?

Question 17

MSE memory and concentration?

Answer 17

Can use a test (eg digit span) to test short term memory, and test or recall for long
term
Is the person distracted/able to maintain normal attention levels?

Question 18

MSE insight?

Answer 18

Is a dimension that describes the extent to which clients are aware of the current
issues the person is experiencing, and their potential consequences
• A strong lack of insight can be an important indicator of unwillingness to accept
treatment

Question 19

MSE judgement?

Answer 19

The ability to make sound decisions can be compromised for a number of reasons
• ascertain if poor decisions are the result of problems in the cognitive processes
involved in the decision making process, motivational issues, or failures to
execute a planned course of action