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May 1, 2013

Communication :: Assertive Training :: ASSESSMENT

What should be Ruled Out?
Assertiveness appears to be of differential utility in the context of domestic violence. Some research suggests that battered women are potentially at increased risk as a result of assertive behavior in the context of ongoing domestic violence (O’Leary, Curley, Rosenbaum & Clarke, 1985). On the other hand, assertiveness training has been found to contribute to a woman’s decision to leave a violent relationship (Meyers-Abell, & Jansen, 1980). Research addressing male batterers suggests that batterers have assertiveness deficits that may contribute to there use of aggression and violence to express their needs and manage the needs of their domestic partner (Maiuro, Cahn, & Vitiliano, 1986). In the context of female sexual victimization, assertiveness training appears to empower women and reduce their exposure to violence (Mac Greene & Navarro, 1998).

What is Involved in Effective Assessment?
Assessment of assertiveness skills and performance abilities should be broad enough to capture and distinguish among various explanations for performance failure. Traditionally, a hierarchical task analysis is used to determine the causal variable that accounts for the skill/performance deficit (Dow, 1994). Initially assertiveness skills are evaluated in a nonthreatening (or less threatening) environment. Given that the client demonstrates adequate assertiveness skill in the nonthreatening environment, assertiveness skills are evaluated in the context of more clinically relevant social situations. Given that skills are adequately performed in clinically relevant social situations, other contributions to response failure are evaluated including affective and cognitive variables that might mediate the skill–performance relation. 
Behavioral models of depression suggest that the pursuit of social interaction (and, thus, experience of reinforcement) may be limited by negative affective experiences that are present throughout the interaction (Lewinsohn, 1974). For example, anxiety that is experienced during an assertive interaction may be insufficient to impair performance but may be sufficient to render the interaction a punishing rather than reinforcing event. Assertive behaviors presuppose the existence of adequate social skills. An assertive communication is measured not only by the content of the verbalization but also by the accompanying nonverbal behaviors. Appropriate posture and eyecontact are essential in executing an appropriately assertive response. An appropriately assertive posture would convey relaxed but focused attention, this posture contrasted with an overly rigid posture that might convey either anxiety or obstinacy. 

Other important nonverbal behaviors include facial expression and body movements and gestures. Affective displays should be congruent with the content of the assertive communication, not suggesting anxiety, false gaiety, or anger. Body movements that indicate nervousness and uncertainty (e.g. hand-wringing) should be avoided. Movements that convey anger or dominance (e.g., invasion of the other’s personal space) should also be avoided. These nonverbal behaviors are included among behaviors identified by Dow (1985) as relevant to socially skilled behaving.

The content of the assertive communication is important in its clarity and form. The tone and fluidity of the request, command or refusal are also important. Generally, the assertive request is characterized by its reasonableness, its specificity regarding actions required to fulfill the request, and its inclusion of statements that convey the potential impact(s) of request fulfillment for both the individual making the request and the request recipient. The tone in which the request is delivered should convey the importance of the request; however, the tone should not imply some obligation on the part of the request recipient to comply with the request. The content and tone of assertive refusals share the quality of being evenhanded and unwavering.
Assessment of skill sets and performance competencies is necessary prior to skills training and throughout the skills acquisition/practice process. Skills for assertive behaving are evaluated through the use of self-report instruments as well as behavioral observation in contrived and natural settings.

Clinician-administered measures. Generally evaluations of assertive behavior involve observations of skill displays (e.g., communication, social interactions) in clinical, analogue, and natural settings, rather than using clinically administere measures of assertiveness. 

Observational ratings of skill assets, deficits, and mastery made by the treating clinician can be formalized by systematically targeting all nonverbal and verbal behaviors considered relevant to assertive behaving. There are structured clinical interviews that assess diagnostic features of anxiety, the reader is referred to the social anxiety disorder chapter in this text for that information.

Self-report measures. Assertiveness skill evaluation and training often occurs in the broader context of social skill and social competence. The self-report instruments that purport to measure assertiveness range from actual measures of assertive behaviors to instruments that assess related constructs such as social avoidance, self-esteem, and locus of control. The most commonly used measur of assertiveness skills is the Rathus Assertiveness Scale (Rathus, 1973). 

Self-monitoring of social behaviors performed in the client’s natural environment is essential to both assessment and treatment of potential skills and performance deficits. Monitoring instructions usually require that the client describe their social interactions with others along a number of dimensions. The client may be instructed to briefly describe interactions with males versus females, acquaintances versus intimate others, peers versus persons in authority, and in structured versus unstructured interactions.

Although real world evaluation of skills is preferable, the office is the most common arena for skills evaluation and practice. Therefore it is essential that the client provide detailed accounts of problem interactions and that the content and cues of the experimental arena be as consistent with that real world as possible.

Behavioral assessment. Behavioral observation is considered the preferred strategy for evaluating assertiveness skills and performance competencies. Usually observations/evaluations of assertive performances are made in clinical or research settings rather than real world settings. Clinic and laboratory settings provide contexts for informal observation (waiting room behaviors and behaviors engaged in by the client during the clinical interview) and formal observation (social interactiontasks and role-plays) of an individual’s behavior.
Clinical interview. In the clinical setting, the client’s waiting room behavior (i.e., his/her interactions with other persons in the waiting room and with clinic staff) is available for observation. Exchanges had during initial assessment sessions also serve as data to be used in establishing the presence or absence of verbal and nonverbal communication skills considered essential to assertive displays as well as contextual/situational/interpersonal factors that may influence the likelihood of assertive behaving and the mastery with which assertive behaviors are performed.
Social interaction tasks in analog settings. In evaluating a client’s social skill and comfort, the therapist may enlist confederates to engage the client in interactions that test the client’s ability to initiate and participate in casual exchanges. These tasks are considered low demand tasks. Usually, these tasks do not contain any of the elements of identified problematic interactions.
Social interaction tasks in real-world settings. Of course, the optimal arena for evaluating assertive behavior is the client’s natural environment. As often as possible, the real world context should be captured. 

For example, a male client reporting difficulty initiating social interactions with female peers might be observed in real world settings that are familiar to him and that present opportunities for contact with female peers (e.g., the college library, an undergraduate seminar, a scheduled, on-campus extracurricular event). Other local contact arenas are also acceptable for evaluation of skills including coffee houses, dance clubs, etc.

Role-plays. In the clinical context, a “true” observation of assertive behaviors is made through the use of role-playing. Based on the client’s report of difficult interpersonal interactions/exchanges, interaction opportunities that mimic these difficult interpersonal interactions (to a lesser or greater degree) are engineered and the client’s use of assertive behaviors observed. Typically, the therapist serves as the “relevant other” in such role play situations. Research participants or clients are asked to display their skills repertoire in the context of contrived interactions with the researcher/therapist or some confederate. 

In structuring the role play, the therapist aims to lessen the artificial quality of the role play and to strengthen the correlation/correspondence/reliability between the client’s performance in artificial and natural settings. This is best achieved through the use of dialogue and contextual cues that most closely approximate the naturally occurring problematic interactions. Role-play confederates and scenarios are often selected with relevant contextual factors in mind.

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