Chapter 9


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Chapter 9

  1. 1. Chapter 9 Clinical Assessment: Objective and Projective Personality Tests
  2. 2. Defining Clinical Assessment <ul><li>T he process of assessing the client through multiple methods, including: </li></ul><ul><ul><li>the clinical interview (see Chapter 12) </li></ul></ul><ul><ul><li>the administration of informal assessment techniques (Chapter 10), and </li></ul></ul><ul><ul><li>the administration of objective and projective tests (this chapter) </li></ul></ul>
  3. 3. Defining Clinical Assessment (Cont’d) <ul><li>Clinical assessment can do the following: </li></ul><ul><ul><li>Helps client gain greater insight </li></ul></ul><ul><ul><li>Aid in case conceptualization and diagnostic formulations </li></ul></ul><ul><ul><li>Assist in the decision-making concerning psychotropic medications </li></ul></ul><ul><ul><li>Assist in treatment planning </li></ul></ul><ul><ul><li>Assist in court decisions (e.g., custody decisions; testing a defendant in a child molestation case) </li></ul></ul><ul><ul><li>Assist in job placement decisions (e.g., high security jobs) </li></ul></ul><ul><ul><li>Aid in diagnostic decisions for health related problems (e.g., Alzheimer’s) </li></ul></ul><ul><ul><li>Identify individuals at risk (e.g., to identify students at risk for suicide or students with low self-esteem) </li></ul></ul>
  4. 4. Objective Personality Testing <ul><li>Definition: A type of personality assessment that uses paper-and-pencil tests, often in multiple-choice or true/false formats, to assess various aspects of personality </li></ul><ul><li>Each objective personality test measures different aspects of personality based on the specific constructs defined by the test developer </li></ul>
  5. 5. Common Objective Personality Tests <ul><li>Many of the tests we will examine were identified as one of the most frequently used tests (see Table 1, p. 106, Intro to Section III). </li></ul><ul><li>For a list of the tests we will review, and their general purpose see Table 9.1, p. 188 </li></ul>
  6. 6. (MMPI-2) Minnesota Multiphasic Personality Inventory - 2 <ul><li>Most widely used personality test </li></ul><ul><li>Developed in 1942, revised in 1989 </li></ul><ul><li>90 minutes to take the 567 items </li></ul><ul><li>Interpretation requires grad testing and psychopathology courses </li></ul><ul><li>Provides six validity scales, ten basic (clinical) scales, and fifteen content scales </li></ul><ul><li>Most commonly used scales: 3 validity scales and ten basic scales (Figures 9.1 and Table 9.2, pp. 189-190) </li></ul><ul><li>Adolescent version also exists: MMPI-A </li></ul><ul><li>Important to understand the meaning of each scale </li></ul>
  7. 7. MMPI-2 (Cont’d) <ul><li>A high L (Lie) score: Not necessarily lying; means client has trouble admitting faults--makes test suspect </li></ul><ul><li>Basic Scales useful in diagnosis and treatment planning </li></ul><ul><li>Patterns of responses, as opposed to specific scales, often used in making decisions </li></ul><ul><li>“ Clinical significance” is a T score of 65 or greater. </li></ul><ul><li>The Content Scales: </li></ul><ul><ul><li>15 specific traits such as anxiety, fears, anger, cynicism, low self-esteem </li></ul></ul><ul><ul><li>useful in creating more detailed perspective </li></ul></ul><ul><li>Reliability estimates on different scales: .37 to .92 </li></ul><ul><li>High intercorrelations among some scales (shared items?) </li></ul>
  8. 8. (MCMI-III) Millon Clinical Multiaxial Inventory (3 rd ed.) <ul><li>Second most used objective personality test </li></ul><ul><li>Designed to assess DSM-IV-TR personality disorders and clinical symptomatology (axis II) </li></ul><ul><li>Adolescent version also exists </li></ul><ul><li>175 true/false items take 25 minutes </li></ul><ul><li>Has six different major scales (Table 9.3, p. 192) </li></ul><ul><ul><li>Clinical Personality Pattern Scales </li></ul></ul><ul><ul><li>Severe Personality Pathology Scales </li></ul></ul><ul><ul><li>Clinical Syndrome Scales </li></ul></ul><ul><ul><li>Severe Clinical Syndrome Scales </li></ul></ul><ul><ul><li>Modifying Indices </li></ul></ul><ul><ul><li>Validity Index </li></ul></ul>
  9. 9. MCMI-III (Cont’d) <ul><li>Uses Base Rate (BR): Converts raw score to a more meaningful standardized score </li></ul><ul><ul><li>Sets median for non-psychiatric individuals at 35, and 60 for psychiatric population. </li></ul></ul><ul><ul><li>A BR of 75 indicates that some of the features are present while a BR of 85 indicates that the trait is clearly present </li></ul></ul><ul><li>Reliability ranges from .67 to .90 </li></ul><ul><li>Scales have been correlated with several other scales such as the MMPI and the BDI </li></ul><ul><li>Other studies demonstrated predictive validity for the instrument with DSM-IV-TR diagnoses </li></ul>
  10. 10. PAI Personality Assessment Inventory <ul><li>Aids in making clinical diagnoses, screening for psychopathology, and assist in treatment planning </li></ul><ul><li>18 and older </li></ul><ul><li>344 items; 50-60 minutes </li></ul><ul><li>4-point ordinal scale: false, slightly true, mainly true, very true </li></ul><ul><li>Hand scored, computer scored, or sent in </li></ul><ul><li>4 validity scales, 11 clinical scales, 5 treatment sclaes, 2 interpersonal scales </li></ul><ul><li>T-scores (see Table 9.4, p. 194) </li></ul>
  11. 11. PAI (Cont’d) <ul><li>Reliability: Most scales show descent reliability estimates </li></ul><ul><li>Exceptions to reliability: Inconsistency and Infrequency scales—low </li></ul><ul><li>Numerous studies seem to show concurrent validity on a number of the scales </li></ul>
  12. 12. (BDI-II) The Beck Depression Inventory - II <ul><li>BDI-II developed in 1996 </li></ul><ul><li>21 questions on 0 to 3 scale, 10 minutes </li></ul><ul><li>If 2 or 3 on items 2 (hopelessness) and 9 (suicidal ideation)—red flag </li></ul><ul><li>Cut-off scores to measure depression (see Table 9.5, p. 194) </li></ul><ul><li>Scores related to groups of depressed and non-depressed individuals </li></ul><ul><li>High reliability estimates (in .90s) </li></ul><ul><li>Convergent validity with original BDI and discriminant validity with other disorders </li></ul>
  13. 13. (MBTI) Myers-Briggs Type Indicator <ul><li>Most widely used personality assessment for normal functioning (for adolescent through adults) </li></ul><ul><li>Based on Jung’s work, following characteristics were derived: extroverted or introverted, sensing or intuiting, thinking or feeling. </li></ul><ul><li>Myers and Briggs added judging or perceiving </li></ul><ul><li>See Figures 9.2 and 9.3 (pp. 196 and 197) </li></ul><ul><li>Evidence for validity of separate scales, but weaker for synergistic combination of four scales </li></ul><ul><li>90% of people agree with the results </li></ul>
  14. 14. (16PF) 16 Personality Factors Questionnaire <ul><li>Based on Raymond Cattell’s 16 primary personality components </li></ul><ul><li>Not pathology, describes human behavior </li></ul><ul><li>185 items, 45 minutes </li></ul><ul><li>16 Primary Factors on bipolar scale (see Table 9.6, p. 198) </li></ul><ul><ul><li>Uses sten scores (average: 4-7) </li></ul></ul><ul><ul><li>1-3 left of bipolar scale, 8-10 right of bipolar scale </li></ul></ul><ul><li>5 Global Factors are combinations of the primary factors (see Table 9.7, p. 199) </li></ul>
  15. 15. 16PF (Cont’d) <ul><li>3 Validity Scales </li></ul><ul><ul><li>Impression management: measures social desirability and faking good (high score) or faking bad (low score) </li></ul></ul><ul><ul><li>Infrequency scale: responding unusually (problems with reading comprehension, random responding, or making “right” impression </li></ul></ul><ul><ul><li>Acquiescence: random responding, misunderstanding items, difficulty evaluating self </li></ul></ul><ul><ul><li>Reliability: ranges from .60s to mid .80s </li></ul></ul><ul><ul><li>Validity: Factor analysis confirms items </li></ul></ul><ul><ul><li>Validity: Convergent and other validity shown </li></ul></ul>
  16. 16. Big Five Personality Traits and the NEO-PI-R & NEO-FFI <ul><li>Research by Thurstone and many others suggest a five-factor model of personality </li></ul><ul><ul><li>Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism (see pp. 199-200) </li></ul></ul><ul><li>NEO Personality Inventory measures these 5 factors each of which has 6 facets (see Table 9.8, p. 201) </li></ul><ul><ul><li>240 items, 17 years and older </li></ul></ul><ul><ul><li>5 point Likert-type scale: strongly disagree to strongly agree </li></ul></ul><ul><ul><li>Uses T-Scores </li></ul></ul><ul><ul><li>Narrative describing personality style </li></ul></ul>
  17. 17. Big Five Personality Traits and the NEO-PI-RI & NEO-FFI <ul><li>NEO PI-R </li></ul><ul><ul><li>Reliability: high for five factors, .56-.90 for facets </li></ul></ul><ul><ul><li>Much convergent, discriminant, and concurrent validity over a number of different studies </li></ul></ul><ul><li>NEO-FFI: Shortened version </li></ul><ul><ul><li>60 items </li></ul></ul><ul><ul><li>15 minutes </li></ul></ul><ul><ul><li>Test worthiness lowered due to the fact that it’s a shorter version </li></ul></ul>
  18. 18. ( SEI) Coopersmith Self-Esteem Inventory <ul><li>Measures self-esteem for children 8 – 15, in four areas: </li></ul><ul><ul><li>general self (24 items) </li></ul></ul><ul><ul><li>self in relation to peers (8 items) </li></ul></ul><ul><ul><li>self in relation to parents (8 items) </li></ul></ul><ul><ul><li>self in relation to school (8 items) </li></ul></ul><ul><li>Total score: Multiply by two the total number of positive self-esteem items chosen by the child. </li></ul><ul><li>Reliability: 87 to .90, but information dates back to early 1970s </li></ul><ul><li>Validity studies are dated and some are questionable </li></ul><ul><li>Given to students in many settings--broad ethnic comparisons </li></ul><ul><li>Generally, mean scores ranged from the mid-50s to the mid-70s, and standard deviations were between 12 and 20 </li></ul>
  19. 19. (SASSI) Substance Abuse Subtle Screening Inventory <ul><li>Two versions: Adult & Adolescent (SASSI-3 & SASSI-A2) </li></ul><ul><li>Suggests substance dependency with 93+% accuracy </li></ul><ul><li>SASSI-3 </li></ul><ul><ul><li>30 minutes to take, 5 to score </li></ul></ul><ul><ul><li>1 st section: 67 “subtle” T/F items </li></ul></ul><ul><ul><li>2 nd section: 26 “overt” alcohol and other drugs related questions rated on 4-point scale </li></ul></ul><ul><ul><li>Nine subscales: face valid alcohol, face valid other drugs, symptoms, obvious attributes, subtle attributes, defensiveness, supplemental addiction scale, family vs. controls, and correctional </li></ul></ul>
  20. 20. SASSI (Cont’d) <ul><li>SASSI-3 </li></ul><ul><ul><li>Patterns of subscale responding helps in diagnosis, treatment planning, and validity of responses </li></ul></ul><ul><ul><li>Reliability </li></ul></ul><ul><ul><ul><li>Particularly high for overall instrument (.93) </li></ul></ul></ul><ul><ul><ul><li>Test-retest over two weeks ranges from .92-.100 </li></ul></ul></ul><ul><ul><li>Validity: Criterion-related: Correlates with DSM-IV diagnoses </li></ul></ul>
  21. 21. Other Common Objective Personality Tests <ul><li>There are dozens of common objective personality tests. Naming just a couple more: </li></ul><ul><ul><li>Taylor-Johnson Temperament Analysis </li></ul></ul><ul><ul><ul><li>Assesses personality variables that effect social, family, marital, work, and other environments </li></ul></ul></ul><ul><ul><li>The Marital Satisfaction Inventory </li></ul></ul><ul><ul><ul><li>Assesses the severity and nature of conflict in a relationship </li></ul></ul></ul>
  22. 22. Projective Testing <ul><li>Defined: </li></ul><ul><ul><li>Type of personality assessment where a client is presented a stimuli and personality factors are interpreted </li></ul></ul><ul><ul><li>Often used to identify psychopathology and to assist in treatment planning </li></ul></ul><ul><ul><li>Much more difficult to measure validity when one is dealing with abstract responses to vague stimuli, such as those in projective tests </li></ul></ul>
  23. 23. (TAT) Thematic Apperception Test <ul><ul><li>Developed in 1938 Henry Murray </li></ul></ul><ul><ul><li>Series of 31 cards with vague pictures on them (see Figure 9.4, p. 205) </li></ul></ul><ul><ul><li>8 to 12 cards generally used during an assessment </li></ul></ul><ul><ul><li>Ask client to create and describe story that has a beginning, middle and end </li></ul></ul><ul><ul><li>Based on Murray's need-press theory: People driven by internal desires, such as attitudes, values, goals, etc. (needs), or external stimuli (press) from the environment </li></ul></ul><ul><ul><li>No universally agreed upon scoring and interpretation method </li></ul></ul>
  24. 24. TAT (Cont’d) <ul><li>Most clinicians use qualitative process of interpretation </li></ul><ul><li>Controversy over reliability and validity of instrument </li></ul><ul><li>Controlled setting interscorer reliability .82 </li></ul><ul><li>Due to age of cards, and because figures are almost exclusively white, many cards seem biased and dated </li></ul><ul><li>To counter some of TAT problems </li></ul><ul><ul><li>Southern Mississippi’s TAT (SM-TAT) </li></ul></ul><ul><ul><li>Apperceptive Personality Test (APT) </li></ul></ul><ul><ul><li>For children: CAT (animals) and CAT-H (humans) </li></ul></ul><ul><li>Many still use TAT. argue that cross-cultural issues not as critical (you project yourself onto whatever you see) </li></ul>
  25. 25. Rorschach Inkblot Test <ul><li>Herman Rorschach developed inkblot test in 1921 by splattering ink on paper and folding them in half (See Fig. 9.5, p. 207) </li></ul><ul><li>He chose 10 final cards that have become the Rorschach inkblot test still used today </li></ul><ul><li>When giving the Rorschach, clinicians show clients cards, one at a time, and ask them to tell them what they see on the card </li></ul><ul><li>Rorschach believed images on the inkblots allowed one to express his or her unconscious </li></ul><ul><li>Difficulty showing adequate validity </li></ul><ul><li>Requires extensive training and practice to use </li></ul>
  26. 26. Rorschach (Cont’d) <ul><li>Exner scoring system uses three components: </li></ul><ul><ul><li>Location: where on blot response occurred (e.g.,): </li></ul></ul><ul><ul><ul><li>whole blot (w), 3. unusual details (Dd), </li></ul></ul></ul><ul><ul><ul><li>common details (D), 4. white space details (S) </li></ul></ul></ul><ul><ul><li>Determinants: how examinee understood what’s seen: </li></ul></ul><ul><ul><ul><ul><li>form (“that looks just like a bat”) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>color (e.g., “it’s blood, because it’s red”) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>shading (“it looks like smoke because it’s grayish-white”). </li></ul></ul></ul></ul><ul><ul><li>Content: 22 categories: whole human, human detail, animal, art, blood, clouds, fire, household items, sex, etc. Specific content can hold meaning (See Box 9.1, p. 207) </li></ul></ul>
  27. 27. Bender Visual-Motor Gestalt <ul><li>Lauretta Bender originally published test in 1938 </li></ul><ul><li>Takes 5-10 minutes and measures developmental level, psychological functioning, as well as neurological deficits after a traumatic brain injury </li></ul><ul><li>Children, 4 – 7 and individuals 8 – 85+ replicate the original nine cards shown in Figure 9.6, p. 209 </li></ul><ul><li>In 2 nd ed., children 4 –7 have four additional cards and individuals 8 – 85+ have three additional cards </li></ul><ul><li>5-point scoring system. 0 represents no resemblance and 4 represents a nearly perfect drawing </li></ul><ul><li>Reliability in .80s and .90s </li></ul>
  28. 28. House-Tree-Person and Other Drawing Tests <ul><li>Drawing tests try to tap into unconscious. </li></ul><ul><li>Focus might vary depending on content of test. </li></ul><ul><li>Some popular ones: </li></ul><ul><ul><li>House-Tree-Person </li></ul></ul><ul><ul><li>Kinetic-House-Tree-Person (see Table 9.9. p. 210) </li></ul></ul><ul><ul><li>Draw-A-Man </li></ul></ul><ul><ul><li>Draw-A-Woman </li></ul></ul><ul><ul><li>Kinetic Family Drawing : Draw a picture of your family all doing something together </li></ul></ul>
  29. 29. Sentence Completion Tests <ul><li>A sentence stem is given to client for client to respond to </li></ul><ul><li>Gather important content information and possible unconscious issues </li></ul><ul><li>Some common tests: </li></ul><ul><ul><li>The Sentence Completion Series </li></ul></ul><ul><ul><li>EPS Sentence Completion Technique. </li></ul></ul><ul><li>Questions about the validity and reliability of sentence completion tests remain, but can be quick and useful way of gathering info </li></ul>
  30. 30. Role of Helpers in Clinical Assessment <ul><li>Helpers should conduct clinical assessment: </li></ul><ul><ul><li>Elementary school counselor uses self-esteem inventory when working with young children </li></ul></ul><ul><ul><li>High school counselor might use objective personality measures to identify concerns and aid in treatment planning </li></ul></ul><ul><ul><li>College counselors, agency clinicians, social workers, and private practice professionals use clinical assessment tools to help identify issues and devise strategies for problem solving </li></ul></ul><ul><ul><li>All clinicians should consider clinical assessment tools and whether they have the appropriate training to administer and interpret instruments </li></ul></ul>
  31. 31. Final Thoughts On Clinical Assessment <ul><li>Clinical assessment results in making decisions for clients that will critically affect their lives </li></ul><ul><li>Such decisions can result in a person being labeled, institutionalized, incarcerated, stigmatized, placed on medication, lose or gain a job, have access to their children, and more </li></ul><ul><li>Examiners must remember the impact that their decisions will have on clients and monitor: </li></ul><ul><ul><li>the quality of the tests they use </li></ul></ul><ul><ul><li>their level of competence to administer tests, </li></ul></ul><ul><ul><li>their ability at making accurate interpretations of client material. </li></ul></ul>