Announcements

1. Personality Assessment IPSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.October 10, 2013

2. Announcements • Exam #2 is this Thursday, October 17th • Next response paper due October 24th • Next 2 response paper articles and questions are posted on course website

3. In the News (Sort of) • My first blog: http://www.madinamerica.com/2013/09/united-states-biomedical-model-five-anecdotes/

4. From Last Class • Projective tests (Rorschach, TAT, drawings) • Illusory correlation • Misuse of personality tests in forensic settings • Intelligence: Nature, tests, scoring, predictors, stereotype threat

5. Exam Review • Chapter 5: Issues in Assessment • Issues in prediction (e.g., factors that affect predictive accuracy) • Clinical judgment, experience, and the illusion of learning

6. Exam Review • Chapter 6: Clinical Interviewing • Types of interviews (e.g., intake, mental status exam) • Verbal communication strategies • Nonverbal communication strategies • Listening skills • Structured and unstructured diagnostic interviews

7. Exam Review • Hunsley, Lee, & Wood (2003) article • When is a test a test? • Standardization, reliability, validity, & norms • Evaluation of specific tests

8. Exam Review • Chapter 7: Cognitive Assessment • What is intelligence? • Theories of intelligence • Wechsler intelligence tests • Controversies in intellectual assessment

9. Exam Review • Chapter 8: Personality Assessment • Projective vs. objective assessment • Projective tests (primarily Rorschach Inkblot Test, also TAT and drawings) • MMPI-2

10. Ethics and Projective Tests • “Now that I am no longer a member of the American Psychological Association Ethics Committee, I can express my personal opinion that the use of Rorschach interpretations in establishing an individual's legal status and child custody is the single most unethical practice of my colleagues.  It is done, widely.  Losing legal rights as a result of responding to what is presented as a "test of imagination," often in the context of "helping" violates what I believe to be a basic ethical principle in this society — that people are judged on the basis of what they do, not on the basis of what they feel, think, or might have a propensity to do.  And being judged on an invalid assessment of such thoughts, feelings, and propensities amounts to losing one's civil rights on an essentially random basis.” -Psychologist Robin Dawes

11. Minnesota Multiphasic Personality Inventory (MMPI) • One of the most widely used and studied psychological tests • Original version published in 1943 • Developed to diagnose psychiatric patients • Normative sample: Psychiatric patients and “normals” in Minnesota in 1930s

12. Development of the MMPI • Uses empirical keying approach to item selection (not rationally-derived approach) • Test items are chosen based on their ability to discriminate one group of people from another • Atheoretical nature • What’s important is how a person answers a question, not whether the answer is true

13. Development of the Original MMPI • Eight psychiatric patient groups formed for test development (about 50 in each group): • Hypochondriasis • Depression • Hysteria • Psychopathic Deviate • Paranoia • Psychasthenia • Schizophrenia • Hypomania

14. Development of the Original MMPI • Items were selected for a scale if the psychiatric group scored higher than normals • Example: “Much of the time my head seems to hurt all over” • Endorsed by 4% of normals • Endorsed by 12% of Hypochondriasis group • Difference was statistically significant

15. Development of the Original MMPI • To make final cut, items had to discriminate between a psychiatric patient group and a second group of “normals” (cross-validation) • 550 items in total, 10 clinical scales Hypochondriasis Depression Hysteria Psychopathic Deviate Paranoia Psychasthenia Schizophrenia Hypomania Masculinity-Femininity Social Introversion

16. Development of the Original MMPI • Concern about effects of test-taking attitude • What kinds of test-taking attitudes might a client have?

17. Test-Taking Attitude: An Example “Although Mr. X admitted to having experienced a variety of significant mental health problems in the past during the interview, he tended to become visibly dysphoric and irritable when discussing these problems. After voicing concerns about the meaningfulness of the assessment during the first session, he agreed to proceed based on the understanding that it would inform his psychiatric care in the ADS. In between our first and second session, Mr. X met with his ADS psychiatrist and discontinued his medication, effectively terminating the perceived relevance of the assessment for him. Approximately 30 minutes into the second assessment session he stated that he did not see the point of continuing and asked to use the restroom, at which point he discontinued the session without informing the interviewer, figuratively “pissing on” the process as he made egress.”

18. Development of the Original MMPI • Created four validity scales • Cannot Say (?) • Lie (L) • Correction (K) • Infrequency (F)

19. Development of the MMPI-2 • MMPI-2 published in 1989 • Re-normed on more representative sample • 2600 people from across the country representative of 1980 U.S. census data • Rewrote awkward or offensive items, some new items added, some old items removed • Tension between revision and tradition • MMPI-A published in 1992 for adolescents

20. Development of the MMPI-2 • New scales on the MMPI-2 • Validity Scales • True response inconsistency scale (TRIN) • Variable response inconsistency scale (VRIN) • Content Scales • 15 rationally-derived scales using existing items (Anxiety, Anger, Type A, Family Problems, Low Self-Esteem, Cynicism)

21. Sample MMPI-2 Profile

22. Interpreting the MMPI scales: Examples • 1. Test-tasking attitude “The patient’s MMPI-2 profile is valid. Mr. Smith approached the MMPI-2 in an honest and open manner, willing to admit his faults without being overly self-critical. His responses suggest a severe degree of psychiatric symptomatology and general distress.” “Mr. Smith produced a valid but somewhat exaggerated MMPI-2 profile. He approached the test in a self-critical manner characterized by magnification of his negative characteristics. Similar individuals may be trying to impress upon their caregivers that they are in serious need of assistance. Overall, Mr. Smith’s profile suggests the presence of numerous deviant behaviors and personality traits that are causing him intense emotional distress.”

23. Interpreting the MMPI scales • 2. General level of adjustment • 3. Characteristic behaviors, attitudes, defenses, etc. • 4. Psychological factors that contribute to #3 • 5. Diagnostic considerations • 6. Treatment implications

24. Example MMPI-2 Interpretation The patient’s MMPI-2 profile is valid. Mr. Anderson approached the MMPI-2 in an honest and open manner, willing to admit his faults without being overly self-critical. His responses suggest a severe degree of psychiatric symptomatology and general distress. Mr. Anderson’s profile suggests that he experiences severe anxiety and emotional distress. Individuals with similar profiles feel chronically anxious, tense, and agitated. They tend to be shy and do not interact well socially. They may have unwanted and disturbing thoughts and often fear loss of emotional and cognitive control. Similar individuals feel overwhelmed by the responsibilities of daily life and may become confused, disorganized, and maladaptive under stress. Mr. Anderson’s profile indicates that he experiences chronic feelings of depression. He tends to feel unhappy, helpless, and pessimistic about the future. Individuals with similar profiles get little enjoyment out of life and lack energy for coping with the problems of their everyday lives. They tend to have poor self-esteem and feelings of self-depreciation and guilt, which may contribute to thoughts of suicide. Similar individuals are likely to be given anxiety and depressive disorder diagnoses.

25. Example MMPI-2 Interpretation Mr. Anderson’s MMPI-2 profile suggests that he experiences a variety of psychotic symptoms. He is likely to have difficulty separating reality from fantasy. He appears to experience unusual perceptual experiences, including auditory hallucinations. The patient may feel that others are trying to harm him, leading him to adopt a withdrawn, schizoid lifestyle. His thinking is likely to be disturbed, reflecting delusions of persecution and/or ideas of reference. Individuals with similar profiles often feel isolated, alienated, and misunderstood. They may show extremely poor judgment, and typically respond to stress by withdrawing into daydreams and fantasies. They may also experience sexual preoccupation. Similar individuals are likely to be given psychotic disorder diagnoses. Mr. Anderson’s profile suggests that he tends to harbor hostility toward his family for what he perceives as a lack of love, understanding, and support. As a result of his pervasive mistrust he tends to feel alienated, isolated, and estranged from the world. He also appears to experience a variety of other problems, including chronic somatic complaints, antisocial behavior, and substance abuse. Individuals with similar profiles tend to have a poor prognosis for psychotherapy because of the long-standing nature of their problems and their reluctance to relate in a meaningful way to the therapist. They may feel that no one can understand them and feel unable to make significant changes in their lives.

26. Evaluation of the MMPI scales • Positive attributes: • Easy to administer and score • Interpretation is largely objective • Validity scales help interpretation • Most well-validated test of psychopathology and personality

27. Evaluation of the MMPI scales • Negative attributes: • Outdated and misleading labels for clinical scales; don’t map onto current DSM diagnoses very well • Demographic differences in scale scores (education, ethnicity, age) • Not an efficient method of diagnosis

28. General Assessment Questions • An unstructured clinical interview is conducted with nearly every client • Why bother to conduct additional psychological testing? • When is it a good use of your and the client’s time to use: • Semi-structured Intellectual testing (SCID)? • Projective personality testing (Rorschach)? • Objective personality testing (MMPI)?

29. General Assessment Questions • In what contexts are psychological tests used in the UW Psychology Clinic? • Semi-structured Intellectual testing (SCID)? • Projective personality testing (Rorschach)? • Objective personality testing (MMPI)?