Integrating Different Kinds of Data with the MMPI-2 An Advanced Workshop Robert M. Gordon, Ph.D.

1. Integrating Different Kinds of Data with the MMPI-2An Advanced WorkshopRobert M. Gordon, Ph.D.  The real story about different types of personality scales Learn how to increase predictive validity by combining the MMP-2 with additional sources of data

2. What are the assumptions of self-report personality testing? We construct items and scales that are assumed to correspond to actual subjective experiences and behaviors (content and construct validity) People are honest and insightful in responding The items must be internally consistent The main domains of psychopathology are all tapped (personality structures, temperaments, capacities and symptoms) The tests make predictions (predictive validity)

3. Self-Report Personality Tests 1. Easy to administer, score and interpret 2. Are all easy to fake to look good or bad 3. About 15-30% of testees can fake without detection 4. More self-reports only add to the problem 5. The self report must be compared to history and current observations.

4. Types of Validity to Consider Content Validity refers to how well the item content of the scale represents all facets of a given concept. Construct Validity refers to whether a scale correlates with a theorized psychological construct. Validity Generalization, External Validity, Ecological Validity, Criterion validity, and Predictive Validity all deal with how well the test scores relate to the real world.

5. Should Scales Be Internally Consistent? You can�t add apples and oranges, right? We all the sum of our parts, right? But these are behavioral assumptions.

6. Psychoanalytic assumptions allow for internal scale inconsistencies. Behavioral assumptions demand internally consistent scales. Psychoanalytic assumptions allow for internal scale inconsistencies. Behavioral assumptions demand internally consistent scales.

7. Most of psychological and neuroscience research disproves the behavioral assumption that the mind is a blank slate written on by the environment and the sum of its parts.

8. Our brains guided us for millions of years without consciousness or rationality. Our brains have primitive parts and rational parts that are often in conflict, most of it is unconscious.

9. A self report developed from people with complex psychopathology will reflect the conflicts and contradictions of that psychopathology. The MMPI is the only multi-trait test of various psychopathologies developed on actual criterion groups. Most other self reports were developed by the author�s theory, factor analysis, or rationally deciding on item content. For example the Hypochondriasis scale was developed from the responses of a known group of patients with hypochondria; the Depression scale was developed from the responses of patients with major depression; the Hysteria scale was developed from the responses of patients with conversion hysteria, and so on.

10. Morey, L., & Hopwood, C., (2008) Objective Personality Evaluation (Chap. 18, 455) in Handbook of Clinical Psychology (eds Michel Hersen and Alan Gross, Wiley.

11. Psychodynamic Complexity and the MMPI-2 Both the MMPI clinical scales and Psychodynamic theory reflect a psychopathology that is complex and contradictory unlike behavioral assumptions of personality as the whole as the sum of the parts. Example: Freud (1893) observed in hysteria, psychological trauma often led to repression, pseudo-neurological symptoms, avoidance of insight, conflicts over sexuality and aggression, seductiveness and poor judgment.

12. The MMPIand the Case of Hysteria Dahlstrom, Welsh, and Dahlstrom (1972) said of the items in the Hysteria scale, �Many of seem mutually contradictory.� The Hysteria scale has such seemingly unrelated issues such as: somatic complaints, naivet�, denial of aggressive motives, unhappy home life and sexual conflicts. (Gordon, R.M. (2006c) False Assumptions About Psychopathology, Hysteria and the MMPI-2 Restructured Clinical Scales. Psychological Reports, 98, 870-872.) See full article at http://www.mmpi-info.com/mmpivita.htmlSee full article at http://www.mmpi-info.com/mmpivita.html

13. More concerns with sexual conflicts six to twelve months into psychoanalysis with analysands diagnosed with hysteria vs. obsessional patients  Rosemary Cogan and John H. Porcerelli, presented at the American Psychoanalytic Assoc. New York, 1.19.07Used the SWAP-200 on 6 men and 6 women in psychoanalysis Rosemary Cogan and John H. Porcerelli, presented at the American Psychoanalytic Assoc. New York, 1.19.07 Used the SWAP-200 on 6 men and 6 women in psychoanalysis Rosemary Cogan and John H. Porcerelli, presented at the American Psychoanalytic Assoc. New York, 1.19.07 Used the SWAP-200 on 6 men and 6 women in psychoanalysis

14. Restructured Clinical (RC) Scales What happens when you make scales distinct and internally consistent (Where did Hysteria go?) RCd dem Demoralization RC1 som Somatic Complaints RC2 lpe Low Positive Emotions RC3 cyn Cynicism RC4 asb Antisocial Behavior RC6 per Ideas of Persecution RC7 dne Dysfunctional Negative Emotions RC8 abx Aberrant Experiences RC9 hpm Hypomanic Activation

15. False Assumptions about Psychopathology �Gordon (2006) indicated that the RC Scales are based on false assumptions about psychopathology (i.e. that consistent items are needed to assess all psychopathologies), pointing to complex diagnostic conditions like Hysteria, Post Traumatic Stress Disorder, and Borderline Personality Disorder that are better understood with a psychodynamic formulation recognizing internal conflicts and contradictions. He indicates that a simplistic behavioral approach with an insistence on more internally consistent and distinct scales does not produce more external validity or useful measures for many of the complex disorders found in clinical practice." (Butcher and Williams, 2009, p.13) Butcher, J.N. and Williams, C.L. (2009), Personality Assessment with the MMPI-2:Historical Roots, International Adaptations, and Current Challenges, Applied Psychology: Health And Well-Being, 1 (1), 105�135. Gordon, R.M. (2006) False Assumptions about Psychopathology, Hysteria and the MMPI-2 Restructured Clinical Scales. Psychological Reports, 98, 870-872.

16. MMPI-2 Depression Subtle- Aggression Guilt Many subtle items involve the denial of symptoms. �At times I feel like smashing things. False.� This is a subtle item in the Depression Scale. In the context of a person who is clinically depressed, it assesses the denial of aggressive motives. Psychoanalytic theory states that depression can be due to loss or the turning of the aggression inwards. A person may have guilt over aggressive feelings and turn aggression towards the self. Depression-Subtle items correlate negatively to Wiggins Manifest Hostility scale (-.62), and positively with Lie (.50) and K (.48).

17. Paranoia Subtle- Splitting and Projection An obvious item from the Paranoia Scale is: �I believe I am being plotted against. True� (persecutory ideation). A subtle item from the Paranoia Scale is: �I think most people would lie to get ahead. False.� (naively trusting). People with paranoia project the split within their own personalities on to others. The damaged self is projected onto a devalued group, and the grandiose self is projected on to an idealized group.

19. Test set and a testing state of mindTest set and a testing state of mind

20. Now it is measuring a normal person�s test set (state) to look good and at the same time personality trait of high stress toleranceNow it is measuring a normal person�s test set (state) to look good and at the same time personality trait of high stress tolerance

21. Psychopathic defendant charged with child neglect Similar L F K configuration of a psychopath in jail lying about the fact that she let her skunk eat the arm of a baby in her day care center. (borderline level psychopath)Similar L F K configuration of a psychopath in jail lying about the fact that she let her skunk eat the arm of a baby in her day care center. (borderline level psychopath)

22. Mother alleging child sex abuse of father on infant daughter who is not lying but is delusional Borderline level hysteric with a delusional disorder, sure that her infant daughter was sexually abused based on rashes. Later accused me of verbally abusing her (dismissed by board upon reviewing my records)Borderline level hysteric with a delusional disorder, sure that her infant daughter was sexually abused based on rashes. Later accused me of verbally abusing her (dismissed by board upon reviewing my records)

23. Gordon, R. M., Stoffey, R., & Bottinelli, J. (2008). MMPI-2 findings of primitive defenses in alienating parents. American Journal of Family Therapy, 36: 211-228.Parents who alienate their children from the other parent have elevated self-favorable scales. This measures the primitive defense of splitting (self as �good� other as �bad�). L F K used to measure primitive defenses in alienating parents who are at the borderline level of functioning (2007 submitted for publication)L F K used to measure primitive defenses in alienating parents who are at the borderline level of functioning (2007 submitted for publication)

24. Not invalid. History of psychiatric hospitalizations. Borderline level with psychotic episodes. Not invalid. History of psychiatric hospitalizations. Borderline level with psychotic episodes.

25. Neurotic level faking for the moneyNeurotic level faking for the money

26. How Do We Use Different Kinds of Scales?

27. Main Clinical Scales 1 Hs - Hypochondriasis? 2 D - Depression? 3 Hy - Hysteria? 4 Pd - Psychopathic Deviate? 5 Mf - Masculinity-Femininity? 6 Pa - Paranoia? 7 Pt - Psychasthenia? 8 Sc - Schizophrenia? 9 Ma - Hypomania? 0 Si - Social Introversion

28. How to Use The Sub-Scales:Depression

29. Hysteria

30. Psychopathic Deviate

31. M-F

32. Paranoia

33. Schizophrenia

34. Hypomania

35. Introversion

36. Rationally Derived Content Scales (symptoms) ANX - Anxiety? FRS - Fears? OBS - Obsessiveness? DEP - Depression? HEA - Health Concerns? BIZ - Bizarre Mentation? ANG - Anger? CYN - Cynicism? ASP - Antisocial Practices? TPA - Type A? LSE - Low Self-Esteem? SOD - Social Discomfort? FAM - Family Problems? WRK - Work Interference? TRT - Negative Treatment Indicators

37. MMPI-2 Psychopathology Five Scales (PSY-5)?Factor Analysis of Traits AGGR - Aggressiveness? PSYC - Psychoticism? DISC - Disconstraint? NEGE - Negative Emotionality/Neuroticism? INTR - Introversion/Low Positive Emotionality

38. Order of interpreting scales Did the person meaningfully respond (items left blank, inconsistent responding, etc.)? Did the person respond with a self-favorable bias (Lie, K, S), a self-unfavorable bias (F, Fp) or without bias? If there is a self-favorable bias, is it due to the context or enduring defenses? If there is a self-unfavorable bias, is it due to symptom amplification or acute psychopathology? How did it distort the clinical scales? Look at the main clinical scales. Look at its subscales to help understand the main clinical scales. Look at cluster of scales on a single issue (ex. all the scales of aggression). Look at all the elevated scales and interpolate what they all indicate.

42. Using the MMPI-2 with Other Stuff for Better Predictive Validity

43. Meehl, P. E. (1956). Wanted--a good cook-book. American Psychologist, 11(6), 263-272. The "rule-of-thumb method" for generating personality descriptions from tests involves the clinician's personal experience, skill, and creative artistry; the "cookbook method" refers to "the transition from psychometric pattern to personality description is an automatic, mechanical, 'clerical' kind of task, proceeding by the use of explicit rules set forth in the cookbook." Data are cited indicating the superiority of the "cookbook method."

44. Meehl�s 1956 Article DominatedDiagnostic Assumptions for Decades But was he right? His results were poorly supported by other research Almost all the research indicates that structured interviewing by a trained expert is far superior to self reports

45. Graham, J. R., Ben-Porath,Y.S., and McNutly,J.L. (1999). MMPI-2 Correlates for Outpatient Community Mental Health Settings: University of Minnesota Press.Graham, J. R., Ben-Porath,Y.S., and McNutly,J.L. (1999). MMPI-2 Correlates for Outpatient Community Mental Health Settings: University of Minnesota Press.

46. Hunsley, J. & Mash, E. (Eds), (2008) A Guide to Assessments that Work, Oxford University Press, 2008 p.416

47. Know both the DSM and PDM Psychodiagnostic Systems The best self report accounts for about 10% of the variance of personality. Structured interviewing does better. Both combined does best. That means you need to know the DSM and PDM to interview. The DSM clearly defines Axis I symptoms. The DSM is good for clearly defined research variables. The DSM is good for assessing psychotropic medication needs. The PDM clarifies personality organization, traits, mental capacities and then symptoms. It better classifies the complexity of personality. The PDM is better for understanding psychotherapy patients.

48. The Psychodiagnostic Battery In addition to a multi-trait personality self-report (ex. MMPI-2), use different methodologies Document review and prior test results, Structured psychodiagnostic interview, Evaluator generated objective test (ex. the Shedler-Westen Assessment Procedure-200) (Shedler, & Westen, 1998), A quantative or qualitative projective assessment (ex. Rorschach, or the patient�s distortions of the evaluator), A brief neuropsychological screening, a memory and/or intelligence test Collateral interviews with family, professionals, etc. If you are unable to give a full battery, then use the most relevant test or tests along with the structured interview. Gordon, R.M. (2009). The Psychodiagnostic Report for Treatment Recommendations. The Pennsylvania Psychologist Quarterly, 69, 3, 17-18.

49. Summary Scales based on actual cases (MMPI) are the best for assessing complex psychopathology Use Multi-trait tests Use the bias scales to understand test set and defenses Use different methodologies Know both the DSM and PDM Use a structured interview History and observation and more powerful than test data.

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