Transcript Title

Chapter 9: Clinical Assessment
Objective Personality Tests
Projective Personality Tests
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Defining Clinical Assessment
The process of assessing the client
through multiple methods, including:
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the clinical interview (see Chapter 12),
the administration of informal assessment
techniques (Chapter 10), and
the administration of objective and
projective tests (this chapter).
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Defining Clinical Assessment (Cont’d)
Clinical assessment can do the following:
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Helps client gain greater insight.
Aid in case conceptualization and diagnostic formulations.
Assist in the decision-making concerning psychotropic medications.
Assist in treatment planning.
Assist in court decisions (e.g., custody decisions; testing a
defendant in a child molestation case).
Assist in job placement decisions (e.g., high security jobs),
Aid in diagnostic decisions for health related problems (e.g.,
Alzheimer’s), and
Identify individuals at risk (e.g., to identify students at risk for
suicide or students with low self-esteem).
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Objective Personality Testing
Definition: A type of paper and pencil personality
assessment, often in multiple choice or true/false
formats, that assesses personality.
Often used to:
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increase client insight
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identify psychopathology
3.
assist in treatment planning
Each objective personality test measures different
aspects of personality based on the specific constructs
defined by the test developer.
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Common Objective Personality Tests
Many of the tests we will examine were
identified by Camara, Nathan and Puente
(2000) as one of the eleven most frequently
used tests (see Table 1, Intro to Section III,
p. 103).
For a list of the tests we will review, and
their general purpose, see Table 9.1, p. 170.
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Common Objective Personality Tests: Minnesota
Multiphasic Personality Inventory - 2
Most widely used personality test.
Developed in 1942, revised last in 1989.
90 minutes to take the 527 items.
To interpret requires grad level course in psychological
testing and a grad level course in psychopathology
Provides six validity scales, ten basic (clinical) scales,
and fifteen content scales.
Commonly used scales: three validity scales and ten
basic scales (see Figures 9.1 and Table 9.1, p. 171).
Adolescent version also exists: MMPI-A
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MMPI-2 (Cont’d)
It is important to understand the meaning of each scale.
A high L (Lie) means the client is having trouble admitting to his or
her faults– makes entire test results suspect.
The Basic Scales are useful in diagnosis and treatment planning
Look at patterns of responses.
“Clinical significance” is a T score of 65 or greater.
Content Scales, identify 15 specific traits such as anxiety, fears,
anger, cynicism, low self-esteem.
Reliability estimates on the different scales (.37 to .92)
Some high intercorrelations in scales, probably because scales
share some items.
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Common Objective Personality Tests: Millon
Clinical Multiaxial Inventory, 3rd Ed. (MCMI-III)
Second most used objective personality test.
Designed to assess DSM-IV-TR personality disorders
and clinical symptomatology.
Adolescent version also exists.
175 true/false items take 25 minutes.
Has six different major scales (Table 9.3, p. 174):
1. Clinical Personality Pattern Scales
2. Severe Personality Pathology Scales
3. Clinical Syndrome Scales
4. Severe Clinical Syndrome Scales
5. Modifying Indices
6. Validity Index
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MCMI-III (Cont’d)
Uses Base Rate (BR): Converts raw score to a more
meaningful standardized score
 Sets median for non-psychiatric individuals at 35,
and 60 for psychiatric population.
 A BR of 75 indicates that some of the features are
present while a BR of 85 indicates that the trait is
clearly present.
Reliability ranges from .67 to .90
Scales have been correlated with several other scales
such as the MMPI and the BDI.
Other studies demonstrated predictive validity for the
instrument with DSM-IV-TR diagnoses.
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Common Objective Personality Tests: The
Beck Depression Inventory—II (BDI-II)
BDI-II developed in 1996
21 questions on 0 to 3 scale to measure depressive
symptoms.
Takes 10 minutes to take.
Cut-off scores are given to measure depression (see
Table 9.4, p. 175).
Scores related to groups of depressed and nondepressed individuals.
High reliability estimates (in .90s).
Convergent validity with original BDI and discriminant
validity with other disorders.
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Common Objective Personality Tests:
The Myers-Briggs Type Indicator
Most widely used personality assessment for normal
functioning (for adolescent through adults).
Based on Jung’s work, following characteristics derived:
extroverted or introverted, sensing or intuiting, thinking
or feeling.
Myers and Briggs added judging or perceiving.
See Figures 9.2, p. 177 and 9.3, pp. 178-179.
Some have questioned the reliability of results
Most agree with results and they seem to correlate with
scores on other tests (e.g., CPI).
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Common Objective Personality Tests: The
California Personality Inventory (CPI)
Describe basic personality characteristics.
Used with normal clients; helpful to further client
insight.
Twenty folks scales, 3 vectors (see Table 9.5, p. 181)
13 “special scales” available with computer scoring,
usually used for career and business-related activities.
Uses T scores. Generally, the higher the better, but
some argue that low scores fit their personality better
(see Fig. 9.4, p. 182)
Reliability: .68 - .76.
Some scales correlate too highly with one another
(questionable factor purity).
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Common Objective Personality Tests: The
Coopersmith Self-Esteem Inventory
Measures self-esteem for children 8 – 15, in four areas:
1. general self (24 items),
2. self in relation to peers (8 items),
3. self in relation to parents (8 items), and
4. self in relation to school (8 items).
Total score: Multiply by two the total number of positive self-esteem
items chosen by the child.
Reliability ranges from .87 to .90, but information dates back to
early 1970s.
Validity studies are dated and some are questionable.
Authors gave the instrument to students in a number of different
settings, and thus have broad ethnic comparisons.
Generally, mean scores ranged from the mid-50s to the mid-70s,
and standard deviations were between 12 and 20.
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Common Objective Personality
Tests: Name Recognition
There are dozens of common objective personality tests.
Some others, include:
 16 PF: Measures 16 personality factors identified by
Raymond Cattell.
 Taylor-Johnson Temperament Analysis: Assesses
personality variables that effect social, family, marital,
work, and other environments.
 The Marital Satisfaction Inventory: Assesses the
severity and nature of conflict in a relationship.
 Miller Marriage Satisfaction Rating Scale: Reports how
a couples’ satisfaction compares to another couples’.
(On-line—lack of validity data).
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Projective Testing
Defined:
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Type of personality assessment where a client is
presented a stimuli and personality factors are
interpreted.
Often used to identify psychopathology and to
assist in treatment planning.
Much more difficult to measure validity when one
is dealing with abstract responses to vague
stimuli, such as those in projective tests.
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Common Projective Tests:
Thematic Apperception Test (TAT)
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Developed in 1938 Henry Murray
Series of 31 cards with vague pictures on them (see
Fig. 9.5, p. 185)
8 to 12 cards generally used during an assessment
Examiner asks the client to create and describe a
story that has a beginning, middle and end.
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.
No universally agreed upon scoring and
interpretation method.
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Common Projective Tests:
TAT (Cont’d)
Most clinicians use qualitative process of interpreting
responses.
Controversy over reliability and validity of instrument.
Controlled setting interscorer reliability: .82.
Due to age of cards and because figures are almost
exclusively white, many cards seem biased and dated.
To counter some of TAT problems: Southern Mississippi’s
TAT (SM-TAT), and Apperceptive Personality Test (APT).
Also, CAT (animals) and CAT-H (humans) developed for
children.
Many still use TAT– argue that cross-cultural issues not as
critical (you’ll project yourself onto whatever you see).
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Common Projective Tests:
Rorschach Inblot Test
Herman Rorschach developed inkblot test in 1921 by
splattering ink on paper and folding them in half (See
Fig. 9.6, p. 186).
Chose 10 final cards that have become the Rorschach
inkblot test still used today.
When giving the Rorschach, clinicians show clients
cards, one at a time, and ask them to tell them what
they see on the card.
Rorschach believed images on the inkblots allowed
one to express his or her unconscious.
Difficulty showing adequate validity.
Requires extensive training and practice to use.
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Common Projective Tests:
Rorschach (Cont’d)
Exner scoring system uses three components:
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Location: where on blot response occurred (e.g.,):
1. whole blot (w),
2. common details (D),
3. unusual details (Dd),
4. white space details (S)
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Determinants: how examinee understood what was seen:
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Content: 22 categories, e.g.,: whole human, human detail,
1. form (“that looks just like a bat”)
2. color (e.g., “it’s blood, because it’s red”)
3. shading (“it looks like smoke because it’s grayish-white”).
animal, art, blood, clouds, fire, household items, sex, etc.
Specific content can hold meaning.
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Common Projective Tests: The
Bender Visual-Motor Gestalt (2nd ed.)
Lauretta Bender originally published test in 1938.
Takes 5-10 minutes and measures developmental
level, psychological functioning, as well as neurological
deficits after a traumatic brain injury.
Children, 4 – 7 and individuals 8 – 85+ replicate the
original nine cards shown in Figure 9.7. p. 188.
In 2nd ed., children 4 –7 have four additional cards and
individuals 8 – 85+ have three additional cards.
5-point scoring system. 0 represents no resemblance
and 4 represents a nearly perfect drawing.
Reliability in .80s and .90s.
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Common Projective Tests: House-TreePerson and Other Drawing Tests
Drawing tests try to tap into unconscious. Focus
might vary depending on content of test.
Some popular ones:
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House-Tree-Person
Kinetic-House-Tree-Person (Table 9.8, p. 190)
Draw-A-Man
Draw-A-Woman
Kinetic Family Drawing: Draw a picture of your
family all doing something together.
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Common Projective Tests: Sentence
Completion Tests
A sentence stem is given to client for client to
respond to.
Gather important content information and possible
unconscious issues.
Some common tests:
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The Sentence Completion Series
EPS Sentence Completion Technique.
Questions about the validity and reliability of
sentence completion tests remain, but can be quick
and useful way of gathering info.
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Role of Helpers in Clinical Assessment
Helpers should conduct clinical assessment. E.g.:
 Elementary school counselor uses self-esteem
inventory when working with young children.
 High school counselor might use objective personality
measures to identify concerns and aid in treatment
planning.
 College counselors, agency clinicians, social workers,
and private practice professionals use clinical
assessment tools to help identify issues and devise
strategies for problem solving.
 All clinicians should consider clinical assessment tools
and whether they have the appropriate training to
administer and interpret instruments.
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Final Thoughts on Clinical Assessment
Clinical assessment results in making decisions
for clients that will critically affect their lives.
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.
Examiners must remember the impact that
their decisions will have on clients and monitor:
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the quality of the tests they use
their level of competence to administer tests,
their ability at making accurate interpretations of
client material.
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