Applications In Personality Testing

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CHAPTER 8 Origins of Personality Testing

TOPIC 8A Theories of Personality and Projective Techniques

8.1 Personality: An Overview (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec1#ch08lev1sec1)

8.2 Psychoanalytic Theories of Personality (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec2#ch08lev1sec2)

8.3 Type Theories of Personality (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec3#ch08lev1sec3)

8.4 Phenomenological Theories of Personality (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec4#ch08lev1sec4)

8.5 Behavioral and Social Learning Theories (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec5#ch08lev1sec5)

8.6 Trait Conceptions of Personality (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec6#ch08lev1sec6)

8.7 The Projective Hypothesis (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec7#ch08lev1sec7)

8.8 Association Techniques (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec8#ch08lev1sec8)

8.9 Completion Techniques (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec9#ch08lev1sec9)

8.10 Construction Techniques (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec10#ch08lev1sec10)

8.11 Expression Techniques (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec11#ch08lev1sec11)

Case Exhibit 8.1 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec11#ch08box1a) Projective Tests as Ancillary to the Interview

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In psychological testing a fundamental distinction often is drawn between ability tests and personality tests. Defined in the broadest sense, ability tests include a plethora of instruments for measuring intelligence, achievement, and aptitude. In the preceding seven chapters we have explored the nature, construction, application, reliability, and validity of ability tests. In the next two chapters we shift the emphasis to personality tests and related matters. Personality tests seek to measure one or more of the following: personality traits, dynamic motivation, symptoms of distress, personal strengths, and attitudinal characteristics. Measures of spirituality, creativity, and emotional intelligence also fall within this realm.

Theories of personality provide an underpinning for the multiplicity of instruments available in the field. For this reason, we begin this chapter with a survey of prominent personality theories. The many ways in which theorists conceptualize personality clearly have impacted the design of personality tests and assessments. This is especially evident with projective techniques such as the Rorschach inkblot method, which emanated from psychoanalytic conceptions of personality. Thus, in Topic 8A (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08#ch08box1) , Theories of Personality and Projective Techniques, in addition to the survey of personality theories, we have included an introduction to several instruments based on the turn-of-the-twentieth-century psychoanalytic hypothesis where responses to ambiguous stimuli reveal the innermost, unconscious mental processes of the examinee. The coverage of personality assessment continues in Topic 8B (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec11#ch08box2) , Self-Report and Behavioral Assessment of Psychopathology, which includes a review of structured tests and procedures, including self-report inventories and behavioral assessment approaches. These time-honored topics of Chapter 8 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08#ch08) — theories of personality, projective techniques, and structured personality tests—are followed by the relatively new focus of Chapter 9 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch09#ch09) —the assessment of normality and human strengths.

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8.1 PERSONALITY: AN OVERVIEW Although personality is difficult to define, we can distinguish two fundamental features of this vague construct. First, each person is consistent to some extent; we have coherent traits and action patterns that arise repeatedly. Second, each person is distinctive to some extent; behavioral differences exist between individuals. Consider the reactions of three graduate students when their midterm examinations were handed back. Although all three students received nearly identical grades (solid B’s), personal reactions were quite diverse. The first student walked off sullenly and was later overheard to say that a complaint to the departmental administrator was in order. The second student was pleased, stating out loud that a B was, after all, a respectable grade. The third student was disappointed but stoical. He blamed himself for not studying harder.

How are we to understand the different reactions of these three persons, each of whom was responding to an identical stimulus? Psychologists and laypersons alike invoke the concept of personality (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss239) to make sense out of the behavior and expressed feelings of others. The notion of personality is used to explain behavioral differences between persons (for example, why one complains and another is stoical) and to understand the behavioral consistency within each individual (for example, why the complaining student noted previously was generally sour and dissatisfied).

Why people differ is just one of many key issues in the study of personality. Mayer (2007–8 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1070) ) provides a thoughtful discussion of the big questions in personality psychology, which he defines as “those questions that are simple, important, and central to many people’s lives.” He identifies 20 big questions, only a few of which can be addressed through testing and assessment. These questions involve existential matters such as the purpose of life, the nature of personhood, and the difficulties encountered in seeking self- knowledge. His captivating article is a reminder that some vital issues can be approached through the empiricism of psychological research and testing, whereas other crucial matters remain elusive and are amenable mainly to philosophical and phenomenological inquiry.

In addition to understanding personality, psychologists also seek to measure it. Literally hundreds of personality tests are available for this purpose; we will review historically prominent instruments and also discuss some promising new approaches. However, in order that the reader can better comprehend the diversity of instruments and approaches, we begin with a more fundamental question: How is personality best conceptualized? As the reader will discover, in order to measure personality we must first envision what it is we seek to measure. The reader will better appreciate the multiplicity of tests and procedures if we also briefly describe the personality theories that comprise the underpinnings for these instruments.

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8.2 PSYCHOANALYTIC THEORIES OF PERSONALITY Psychoanalysis was the original creation of Sigmund Freud (1856–1939). While it is true that many others have revised and adapted his theories, the changes have been slight in comparison to the substantial foundations that can be traced to this singular genius of the Victorian and early-twentieth-century era. Freud was enormously prolific in his writing and theorizing. We restrict our discussion to just those aspects of psychoanalysis that have influenced psychological testing. In particular, the Rorschach, the Thematic Apperception Test, and most of the projective techniques critiqued in the next topic dictate a psychoanalytic framework for interpretation. Readers who wish a more thorough review of Freud’s contributions can start with the New Introductory Lectures on Psychoanalysis (Freud, 1933 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib543) ). Reviews and interpretations of Freud’s theories can be found in Stafford-Clark (1971 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1544) ) and Fisher and Greenberg (1984 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib506) ).

Origins of Psychoanalytic Theory Freud began his professional career as a neurologist but was soon specializing in the treatment of hysteria, an emotional disorder characterized by histrionic behavior and physical symptoms of psychic origin such as paralysis, blindness, and loss of sensation. With his colleague Joseph Breuer, Freud postulated that the root cause of hysteria was buried memories of traumatic experiences such as childhood sexual molestation. If these memories could be brought forth under hypnosis, a release of emotion called abreaction would take place and the hysterical symptoms would disappear, at least briefly (Studies on Hysteria, Breuer & Freud, 1893–1895 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib217) ).

From these early studies Freud developed a general theory of psychological functioning with the concept of the unconscious as its foundation. He believed that the unconscious was the reservoir of instinctual drives and a storehouse of thoughts and wishes that would be unacceptable to our conscious self. Thus, Freud argued that our most significant personal motivations are largely beyond conscious awareness. The concept of the unconscious was discussed in elaborate detail in his first book (The Interpretation of Dreams, Freud, 1900 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib541) ). Freud believed that dreams portray our unconscious motives in a disguised form. Even a seemingly innocuous dream might actually have a hidden sexual or aggressive meaning, if it is interpreted correctly.

Freud’s concept of the unconscious penetrated the very underpinnings of psychological testing early in the twentieth century. An entire family of projective techniques emerged, including ink-blot tests, word association approaches, sentence completion techniques, and storytelling (apperception) techniques (Frank, 1939 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib529) , 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib530) ). Each of these methods was predicated on the assumption that unconscious motives could be divined from an examinee’s responses to ambiguous and unstructured stimuli. In fact, Rorschach (1921 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1404) ) likened his inkblot test to an X ray of the unconscious mind. Although he patently overstated the power of projective techniques, it is evident from Rorschach’s view that the psychoanalytic conception of the unconscious had a strong influence on testing practices.

The Structure of the Mind

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Freud divided the mind into three structures: the id, the ego, and the superego. The id is the obscure and inaccessible part of our personality that Freud likened to “a chaos, a cauldron of seething excitement.” Because the id (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss149) is entirely unconscious, we must infer its characteristics indirectly by analyzing dreams and symptoms such as anxiety. From such an analysis, Freud concluded that the id is the seat of all instinctual needs such as for food, water, sexual gratification, and avoidance of pain. The id has only one purpose, to obtain immediate satisfaction for these needs in accordance with the pleasure principle. The pleasure principle is the impulsion toward immediate satisfaction without regard for values, good or evil, or morality. The id is also incapable of logic and possesses no concept of time. The chaotic mental processes of the id are, therefore, unaltered by the passage of time, and impressions that have been pushed down into the id “are virtually immortal and are preserved for whole decades as though they had only recently occurred” (Freud, 1933 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib543) ).

If our personality consisted only of an id striving to gratify its instincts without regard for reality, we would soon be annihilated by outside forces. Fortunately, soon after birth, part of the id develops into the ego (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss99) or conscious self. The purpose of the ego is to mediate between the id and reality. The ego is part of the id and servant to it, but the ego “interpolates between desire and action the procrastinating factor of thought” (Freud, 1933 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib543) ). Thus, the ego is largely conscious and obeys the reality principle; it seeks realistic and safe ways of discharging the instinctual tensions that are constantly pushing forth from the id.

The ego must also contend with the superego (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss319) , the ethical component of personality that starts to emerge in the first five years of life. The superego is roughly synonymous with conscience and comprises the societal standards of right and wrong that are conveyed to us by our parents. The superego is partly conscious, but a large part of it is unconscious, that is, we are not always aware of its existence or operation. The function of the superego is to restrict the attempts of the id and ego to obtain gratification. Its main weapon is guilt, which it uses to punish the wrongdoings of the ego and id. Thus, it is not enough for the ego to find a safe and realistic way for the gratification of id strivings. The ego must also choose a morally acceptable outlet, or it will suffer punishment from its overseer, the superego. This explains why we may feel guilty for immoral behavior such as theft even when getting caught is impossible. Another part of the superego is the ego ideal, which consists of our aims and aspirations. The ego measures itself against the ego ideal and strives to fulfill its demands for perfection. If the ego falls too far short of meeting the standards of the ego ideal, a feeling of guilt may result. We commonly interpret this feeling as a sense of inferiority (Freud, 1933 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib543) ).

The Role of Defense Mechanisms The ego certainly has a difficult task, acting as mediator and servant to three tyrants: id, superego, and external reality. It may seem to the reader that the task would be essentially impossible and that the individual would, therefore, be in a constant state of anxiety. Fortunately, the ego has a set of tools at its disposal to help carry out its work, namely, mental strategies collectively labeled defense mechanisms (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss90) .

Defense mechanisms come in many varieties, but they all share three characteristics in common. First, their exclusive purpose is to help the ego reduce anxiety created by the conflicting demands of id, superego, and external reality. In fact, Freud felt that anxiety was a signal telling the ego to invoke one or more defense mechanisms in its own behalf. Defense mechanisms and anxiety are, therefore,

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complementary concepts in psychoanalytic theory, one existing as a counterforce to the other. The second common feature of defense mechanisms is that they operate unconsciously. Thus, even though defense mechanisms are controlled by the ego, we are not aware of their operation. The third characteristic of defense mechanisms is that they distort inner or outer reality. This property is what makes them capable of reducing anxiety. By allowing the ego to view a challenge from the id, superego, or external reality in a less-threatening manner, defense mechanisms help the ego avoid crippling levels of anxiety. Of course, because they distort reality, the rigid, excessive application of defense mechanisms may create more problems than it solves.

Assessment of Defense Mechanisms and Ego Functions Although Freud introduced the concept of defense mechanisms, it was left to his followers to elucidate these unconscious mental strategies in more detail (Paulhus, Fridhandler, & Hayes, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1273) ). Vaillant (1971 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1681) ) developed a hierarchy of ego defense mechanisms based on the assumption that some mechanisms are healthier or more adaptive than others. He suggested four broad types, listed here in ascending level of maturity: psychotic, immature, neurotic, mature. Each type includes specific defense mechanisms such as denial, projection, repression, and altruism, described below. Perry and Henry (2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) ) proposed a similar hierarchy of adaptation in defense mechanisms. They also developed a sophisticated rating scale, which, as we will see, is of value in clinical practice. A hierarchy of types of defense mechanisms (least mature to most mature) is provided in Table 8.1 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec2#ch08tab1) .

Psychotic defense mechanisms are the least healthy because they distort reality to an extreme degree. One example includes gross denial of external reality such as the refusal to acknowledge the death of a loved one. Another example is delusional projection, which consists of frank delusions about external reality, usually of a persecutory nature. The second grouping, Acting Out, comprises several forms of maladaptive action such as passive-aggressive behavior (e.g., intentional lateness to aggravate a partner), impulsive behavior designed to reduce tension, and complaining while simultaneously rejecting help.

Borderline defense mechanisms include patterns of behavior often found in persons with a diagnosis of Borderline Personality Disorder (American Psychiatric Association, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib33) ). The specific mechanisms include splitting, in which the images of others (or self) alternate rapidly from all good to all bad, and projective identification which is the projection of an unwanted, unrecognized trait (like anger) onto others. Neurotic defense mechanisms, the fourth group, are found to some degree in most persons and include repression (inexplicable memory lapses or failure to acknowledge information, such as “forgetting” a dental appointment) and displacement, which comprises the transfer of feelings from the real object onto someone or something else, such as kicking the dog when angry with the boss.

TABLE 8.1 A Hierarchy of Types of Defense Mechanisms (Least Mature to Most Mature)

Type Description and Examples

Psychotic Gross denial of external reality such as frank delusions; includes denial and distortion

Acting Out Maladaptive behaviors such as impulsive actions; includes passive-aggressiveness

Borderline Splitting the image of others into good and bad; includes splitting and schizoid fantasy

Neurotic Mechanisms that involve minor reality distortion; includes repression and displacement

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Type Description and Examples

Obsessive Somewhat adaptive mechanisms; includes isolation of affect and intellectualization

Mature Mature forms of defense with minor reality distortion; includes humor and sublimation

Source: Based on Perry and Henry (2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) ) and Vaillant (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1682) ).

Obsessive defense mechanisms also are very common and consist of mental patterns like isolation of affect or intellectualization. Isolation of affect involves the superficial acknowledgement of a feeling in the absence of a full emotional experience. In intellectualization, threatening matters are acknowledged but explored in bland terms that are relatively devoid of feelings. For example, Vaillant (1971 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1681) ) describes a physician whose mother had died recently of cancer. The doctor talked at length about the medical characteristics of her illness, thereby easing his sense of loss.

Mature defense mechanisms appear to the beholder as convenient virtues. An example is certain forms of humor that do not distort reality but that can ease the burden of matters “too terrible to be borne” (Vaillant, 1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1682) ). Specific kinds of mature mechanisms include:

Altruism: Vicarious but constructive and gratifying service to others. Humor: Playful acknowledgment of ideas and feelings without discomfort and without unpleasant effects on others; does not include sarcasm. Suppression: Conscious or semiconscious decision to postpone paying attention to a conscious conflict or impulse. Anticipation: Realistic anticipation of or planning for future inner discomfort; for example, realistic anticipation of surgery or separation. Sublimation: Indirect expression of instinctual wishes without adverse consequences or loss of pleasure; for example, channeling aggression into sports.

An example of humor as a mature defense mechanism would be former president Ronald Reagan’s quip to doctors in 1981 as he entered surgery for a bullet wound from his attempted assassination. He is reported to have said, “I hope you’re all Republicans.”

Perry and colleagues developed the Defense Mechanism Rating Scales (DMRS) as a basis for assessing the level, type, and severity of defense mechanisms encountered in psychotherapy patients (Perry, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1282) ; Perry & Harris, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) ). The DMRS was devised for rating the presence of 30 discrete defense mechanisms (e.g., acting out, splitting, denial, projection, repression, intellectualization, altruism, etc.) in a 50-minute dynamically oriented interview. In the original scale, a 3-point qualitative rating of absent, probably present, or definitely present was obtained for each defense mechanism identified in a review of a videotaped session.

Subsequently, the test developers adopted a simple quantitative scoring approach in which defense mechanisms were isolated and identified in short, meaningful segments of the taped interview. They found that a typical therapy session includes anywhere from 15 to 75 illustrations of the various defense mechanisms. Based on prior research, each defense mechanism receives a score from 1 (highly immature and maladaptive) to 7 (highly mature and adaptive). Although the scale offers a number of scoring options, the most useful score is the Overall Defensive Functioning (ODF) score, which is the simple

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average of the ratings of the observed defense mechanisms. The theoretical range of scores is 1.0 to 7.0, although scores of 3.0 and below are rare. Scores below 5.0 indicate significant personality disorder or severe depression. Scores of 6.0 and higher indicate normal or healthy functioning. Interrater reliabilities from six studies were mostly in the mid- to high-.80s for the ODF scores. The stability coefficient for a small sample of patients over a one-month interval was a respectable .75 (Perry & Harris, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) ).

The ODF scores tend to improve over the course of dynamically oriented therapy, which supports the validity of the construct being measured, maturity of defense mechanisms. In four studies involving one- month to one-year follow-up with small samples, the within-group effect sizes for gains in ODF scores ranged from .02 to 1.05, with most in the range of .41 to .82 (Perry Harris, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) , Table 9.5 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch09lev1sec6#ch09tab5) ). Effect sizes of this magnitude are considered moderate to large, that is, meaningful gains are being accomplished, as registered by the increased maturity of the defense mechanisms emerging in the therapy sessions. The authors observe:

Defenses can be viewed as both process phenomena (psychological mechanisms in action) and as a measure of adaptive outcome, when aggregated across sessions and time. This gives the study of defenses great potential clinical relevance. To develop and test predictive hypotheses about treatment will make the study of defense very relevant to daily clinical work, and both scientifically promising and exciting (Perry & Harris, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1283) , p. 190).

The meaningful assessment of defense mechanisms largely has eluded clinical researchers, but instruments like the DMRS show promise of making key elements of psychoanalytic theory accessible to empirical validation (Perry, Beck, Constantinides, & Foley, 2009 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1284) ). However, this approach does have two drawbacks: The practitioner needs specialized training to identify defense mechanisms, and the process of collecting relevant information from patients is very time-consuming.

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8.3 TYPE THEORIES OF PERSONALITY The earliest personality theories attempted to sort individuals into discrete categories or types. For example, the Greek physician Hippocrates (ca. 460–377 B.C.) proposed a humoral theory with four personality types (sanguine, choleric, melancholic, and phlegmatic) that was too simplistic to be useful. In the 1940s, Sheldon and Stevens (1942 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1489) ) proposed a type theory based on the relationship between body build and temperament. Their approach stimulated a flurry of research and then faded into obscurity. Nonetheless, typological theories have continued to capture intermittent interest among personality researchers. We will illustrate type theories by reviewing contemporary research on coronary-prone personality types.

Type A Coronary-Prone Behavior Pattern Friedman and Rosenman (1974) investigated the psychological variables that put individuals at higher risk of coronary heart disease. They were the first to identify a Type A coronary-prone behavior pattern (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss338) , which they described as “an action–emotion complex that can be observed in any person who is aggressively involved in a chronic, incessant struggle to achieve more and more in less and less time, and if required to do so, against the opposing efforts of other things or persons” (Friedman & Rosenman, 1974). At the opposite extreme is the Type B behavior pattern, characterized by an easygoing, non-competitive, relaxed lifestyle. Of course, people vary along a continuum from “pure” Type A to “pure” Type B.

Friedman and Ulmer (1984) have provided a detailed description of the full-fledged Type A behavior pattern, and it is not an appealing picture. These individuals display a deep insecurity, regardless of their achievements. They desire to dominate others, and typically are indifferent to the feelings of competitors. They exhibit a free-floating hostility, and easily find things that irritate them. They also suffer from a sense of urgency about getting things done. Type A persons often engage in multitasking, such as reviewing correspondence while making a phone call. Almost beyond belief, one patient confessed to using two electric shavers, one for each hand (Friedman & Ulmer, 1984).

In other studies, researchers have found only a weak relationship—or no relationship at all—between Type A behavior and CHD (e.g., Eaker & Castelli, 1988; Smedslund & Rundmo, 1999). In the most comprehensive review of its kind, Myrtek (2007 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1199) ) conducted a meta-analysis of 25 prospective studies of Type A behavior and CHD and concluded flatly that “Type A behavior is not an independent risk factor for CHD.” Effect sizes in this review were not just small, they were effectively zero, on the order of .003. It did not matter whether structured interviews or questionnaires were used to assess Type A behavior. Myrtek (2007 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1199) ) also warns that the existence of the concept itself can be dangerous because it provides patients an “external causal attribution” and relieves them of the responsibility for behavior change. The Type A concept also gives false benefit to physicians when they work with CHD patients who lack the usual risk factors (smoking, poor diet, lack of exercise). Blaming Type A behavior is easier than admitting that the causes of CHD sometimes are unknown.

Other researchers have found that CHD is linked not so much with the full-blown Type A behavior pattern as with specific components such as being anger-prone (Dembroski, MacDougall, Williams, & Haney, 1985) or possessing time urgency (Wright, 1988). Wielgosz and Nolan (2000) identified hostility,

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cynicism, and suppression of anger, as well as stress, depression, and social isolation as significant risk factors in Type A behavior. Certainly there continues to be a need to sort out the specific risk factors in this area of investigation. What we do know with certainty is that the simple equation of Type A behavior causes CHD no longer is convincing.

Type A behavior can be diagnosed from a short interview consisting of questions about habits of working, talking, eating, reading, and thinking (Friedman, 1996). The more flagrant cases of Type A behavior can also be detected by paper-and-pencil tests (Jackson & Gray, 1987). However, the questionnaire approach is limited because it cannot reveal the facial, vocal, and psychomotor indices of hostility and time urgency that are usually evident in interview (Friedman & Ulmer, 1984).

Early studies indicated that persons who exhibited the Type A behavior pattern were at greatly increased risk of coronary disease and heart attack. In one 9-year study of more than 3,000 healthy men, persons with the Type A behavior pattern were 2½times more likely to suffer heart attacks than those with Type B behavior pattern (Friedman & Ulmer, 1984). In fact, not one of the “pure” Type B’s—the extremely relaxed, easygoing, and noncompetitive members of the study—had suffered a heart attack. In the famous Framingham longitudinal study, Type A men ages 55 to 64 were about twice as likely at 10-year follow-up to develop coronary heart disease as Type B men (Haynes, Feinleib, & Eaker, 1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib724) ). In this study, the link between Type A behavior and coronary heart disease (CHD) was especially strong for white-collar workers.

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8.4 PHENOMENOLOGICAL THEORIES OF PERSONALITY Phenomenological theories of personality emphasize the importance of immediate, personal, subjective experience as a determinant of behavior. Some of the theoretical positions subsumed under this title have been given other labels also, such as humanistic theories, existential theories, construct theories, self- theories, and fulfillment theories (Maddi, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1030) ). Nonetheless, these approaches share a common focus on the person’s subjective experience, personal world view, and self-concept as the major wellsprings of behavior.

Origins of the Phenomenological Approach The orientation briefly reviewed in this section has numerous sources that reach back to turn-of-the- twentieth-century European philosophy and literature. Nonetheless, two persons, one a philosopher and the other a writer, stand out as seminal contributors to the modern phenomenological viewpoint. The German philosopher Edmund Husserl (1859–1938) invented a complex philosophy of phenomenology that was concerned with the description of pure mental phenomena. Husserl’s approach was heavily introspective and nearly inscrutable. More approachable was the Danish writer Søren Kierkegaard (1813– 1855), well known for his contributions to existentialism. Existentialism is the literary and philosophical movement concerned with the meaning of life and an individual’s freedom to choose personal goals. The phenomenology of Husserl and the existentialism of Kierkegaard influenced dozens of prominent philosophers and psychologists. Vestiges of these early viewpoints are evident in virtually every contemporary phenomenological personality theory (Maddi, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1030) ).

Carl Rogers, Self-Theory, and the Q-Technique The most influential phenomenological theorist was Carl Rogers (1902–1987). His contributions to personality theory, known as self-theory, are extensive and generally well appreciated by students of psychology (Rogers, 1951 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1383) , 1961 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1384) , 1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1385) ). But it is also true, albeit little recognized, that Rogers helped shape a small part of psychological testing by popularizing the Q-technique.

The Q-technique (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss262) is a procedure for studying changes in the self-concept, a key element in Rogers’s self-theory. The technique was developed by Stephenson (1953 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1554) ) but a series of studies by Rogers and his colleagues served to popularize this measurement approach (Rogers & Dymond, 1954 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1386) ). Also known as a Q-sort, the Q-technique is a generalized procedure that is especially useful for studying

changes in self-concept.1 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec4#ch08fn01) The Q-sort consists of a large number of cards, each containing a printed statement such as the following:

I am poised I put on a false front I make strong demands on myself

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I am a submissive person I am likeable

The examinee is asked to sort a hundred or so statements into nine piles, putting a prescribed number of cards into each, thus forcing a near-normal distribution. The instructions specify that the examinee put the cards most descriptive of him or her at one end, those least descriptive at the opposite end, and those about which he or she is indifferent or undecided around the middle of the distribution. The required distribution might look like this:

Least Like Me Most Like Me

Pile No. 1 2   3   4   5   6   7 8 9

No. of cards 1 4 11 21 26 21 11 4 1

The nature of the items is determined by the needs of the researcher or practitioner. Rogers used a set of items devised by Butler and Haigh (Rogers & Dymond, 1954 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1386) , chap. 4) to tap the self-concept. These statements were taken at random from available therapeutic protocols; their Q-sort items represented actual client statements, reworded for clarity. But a special virtue of the Q-technique is that other researchers or practitioners are free to craft their own items. For example, Marks and Seeman (1963 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1043) ) used a psychodynamic perspective in devising items for the therapist description of patient groups. Examples of their items include the following:

Utilizes acting out as a defense mechanism Tends to be flippant in both word and gesture Genotype has paranoid features Appears to be poised, self-assured, socially at ease Exhibits depression (manifest sad mood)

Scoring a Q-sort is usually a matter of comparing or correlating the distribution of items against an established norm. For example, well-adjusted persons might be asked to sort the items so as to derive an average pile placement number (ranging from 1 to 9) for each item. An individual examinee would be considered more- or less-adjusted according to the resemblance between his or her sortings and the average sorting for adjusted persons. We will refer the reader to Block (1961 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib164) , 2008 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib165) ) for details.

Another way to use the Q-sort is to compare an examinee’s self-sort with his or her ideal sort. Rogers used the discrepancy between these two sortings as an index of adjustment. His subjects were required to sort the items twice, according to the following instructions:

Self-sort. Sort these cards to describe yourself as you see yourself today, from those that are least like you to those that are most like you. Ideal sort. Now sort these cards to describe your ideal person—the person you would most like within yourself to be (Rogers & Dymond, 1954 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1386) ).

Using the item pile numbers, Rogers then correlated the two sorts for each subject separately. Consider what these data mean: If the self-sort and the ideal sort are highly similar, the correlation of Q-sort data

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will approach 1.0; if the two sorts are opposite one another, the correlation will approach −1.0. Of course, most sorts will be somewhere in between but typically on the positive side. Butler and Haigh found that psychotherapy clients increased their congruence between self and ideal (Rogers & Dymond, 1954 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1386) , chap. 4). Even so, adjusted control subjects possessed a greater congruence.

1The Q-technique has additional applications as well. Marks and Seeman (1963 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1043) ) employed Q-sorts by therapists to describe patients with specific MMPI profiles. Bem and Funder (1978 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib131) ) recommend a Q-sort to derive a profile of characteristics associated with successful performance of a specific task. Persons whose self- descriptions match the derived profile can be predicted to succeed at the selected task.

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8.5 BEHAVIORAL AND SOCIAL LEARNING THEORIES Behavioral and social learning theories have their origins in laboratory studies on operant learning and classical conditioning. A fundamental assumption of all behavioral theorists is that many of the behaviors that make up personality are learned. To understand personality, then, we must know about the learning history of the individual. Behavioral theorists also believe that the environment is of supreme importance in shaping and maintaining behavior. Behavioral inquiry, therefore, seeks to identify the specific components of the current environment that are controlling a person’s behavior. The behavioral approach to personality has produced a variety of direct assessment methods, which we discuss in the next chapter.

Behavioral theorists disagree mainly on the role that cognitions play in determining behavior. Cognitions are inferred mental processes such as problem solving, judging, or reasoning. Radical behaviorists believe that resorting to mentalistic explanations of any kind is futile: “When what a person does is attributed to what is going on inside him, investigation is brought to an end” (Skinner, 1974 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1506) ). By contrast, social learning theorists make cautious reference to cognitions in explaining what it is, specifically, that a person learns. A social learning theorist might argue that we learn expectations or rules about the environment, not just stimulus and response connections.

Modern social learning theory can be viewed as a cognitive variant of the strict behaviorism that was dominant in U.S. psychology early in the twentieth century. Social learning theorists accept the Skinnerian premise that external reinforcement is an important determinant of behavior. But they also maintain that cognitions have a critical influence on our actions as well. For example, Rotter (1972 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1410) ) has popularized the view that our expectations about future outcomes are the primary determinants of behavior. The probability that a person will behave self-assertively, for example, depends on his or her expectations about the likely results of self-assertiveness. If the expected outcome is valued by the person, the behavior is more likely. Of course, expectations are a function of the person’s history of reinforcement, so Rotter’s social learning perspective is similar to the behavioral viewpoint. But the implication of social learning theory is that behavior is the result of a belief, in particular, a belief that the behavior will result in a desired outcome. Thus, cognitions are assumed to affect actions.

Based on his social learning views, Rotter (1966 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1409) ) developed the Internal-External (I-E) Scale, an interesting measure of internal versus external locus of control. The construct of locus of control (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss190) refers to the perceptions that individuals have about the source of things that happen to them. In particular, the I-E Scale seeks to assess the examinee’s generalized expectancies for internal versus external control of reinforcement. The purpose of the I-E Scale is to determine the extent to which the examinee believes that reinforcement is contingent upon his or her behavior (internal locus of control) as opposed to the outside world (external locus of control). The instrument is a forced-choice self-report inventory. For each item, the examinee chooses the single statement (from a pair) with which he or she more strongly concurs. Items resemble the following:

In general, most people get the respect they deserve. OR In reality, a person’s worth often passes unrecognized.

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For the preceding item, the first alternative indicates an internal locus of control, whereas the second alternative signifies an external locus of control. The balance of internal to external responses determines the overall score on the scale. The I-E Scale is a reliable and valid instrument that has stimulated a huge body of research on the nature and meaning of locus of control and related variables. Research indicates that locus of control has a strong relationship to occupational success, physical health, academic achievement, and numerous other variables. As the reader might suspect, an internal locus of control generally predicts a more positive outcome than an external locus of control. The interested reader can consult Lefcourt (1991) for further details.

Important contributions to social learning theory have also been made by Albert Bandura. In his early studies, Bandura examined the role of observational learning and vicarious reinforcement in the development of behavior (Bandura, 1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib82) , 1971 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib83) ; Bandura & Walters, 1963 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib88) ). More recently, he has proposed that perceived self-efficacy is a central mechanism in human action (Bandura, 1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib85) ; Bandura, Taylor, Ewart, Miller, & DeBusk, 1985). Self-efficacy (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss288) is a personal judgment of “how well one can execute courses of action required to deal with prospective situations” (Bandura, 1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib85) ). The concept of self-efficacy is useful in explaining why correct knowledge does not necessarily predict efficient action. For example, two boys may be equally convinced that a garden snake in the bathtub presents no hazard, but one will pick it up while the other runs out the door. These differences in behavior illustrate the role of self-referential thought as a mediator between knowledge and action. The boy who ran out the door did not believe he could deal with the situation effectively. He had little perceived self- efficacy for snake handling. Bandura would argue that the primary determinant of the boy’s behavior is a self-judgment about personal capabilities. Cognitions are, therefore, assumed to be a major determinant of behavior.

Bandura (1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib86) , 2006 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib87) ) has developed an appealing approach to the assessment of self-efficacy expectations outlined below. But he warns against the idea that there can be one all-purpose measure of perceived self-efficacy:

One cannot be all things, which would require mastery of every realm of human life. People differ in the areas in which they cultivate their efficacy and in the levels to which they develop it even within their given pursuits. For example, a business executive may have a high sense of organizational efficacy but low parenting efficacy. Thus, the efficacy belief system is not a global trait but a differentiated set of self-beliefs linked to distinct realms of functioning (Bandura, 2006 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib87) , p. 307).

As a consequence, scales of self-efficacy need to be adapted to the particular domain of functioning of interest to the practitioner or researcher.

Fortunately, Bandura (2006 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib87) ) has outlined a strategy for developing self-efficacy scales. The starting point is a simple rating format, which resembles the following hypothetical example of a scale that school administrators might use with teachers to gauge classroom self-efficacy:

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Classroom Questionnaire: We are interested in the areas of challenge that teachers face in the classroom. Your answers will not be disclosed to others. Please rate your degree of confidence for doing the things below using this scale:

0 10 20 30 40 50 60 70 80 90 100

Can’t Do

Mildly Uncertain

Moderately Certain

Completely Certain Confidence: (0 to 100)

Maintain control of the classroom when lecturing _____

Keep students on track during hard assignments _____

Deal with individuals who keep talking out of turn _____

Teach students who don’t want to be in class _____

Teach students who have no parental support _____

Motivate students who resist doing homework _____

Keep the brightest students interested in class _____

This is a only a preliminary and generic example. A complete scale would be longer and would undergo a few iterative cycles of revision before final draft. In a recent and helpful chapter, Bandura (2006 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib87) ) also gives advice on how to construct the best self-efficacy scales, starting with issues of content validity, response bias, item analysis, and ending with strategies for validation of scales. Yet, regardless of their psychometric excellence, self-efficacy scales need to be practical. They should be judged by the extent to which, ultimately, they enable people to fulfill desired personal and social transformations (Bandura, 2006 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib87) ).

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8.6 TRAIT CONCEPTIONS OF PERSONALITY A trait (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss334) is any “relatively enduring way in which one individual differs from another” (Guilford, 1959 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib665) ). Psychologists developed the concept of trait from the ways people describe other people in everyday life. As language evolved, people found words to portray the consistencies and differences they encountered in their daily interactions with others. Thus, when we say one person is sociable and another is shy we are using trait names to describe consistencies within individuals and also differences between them (Goldberg, 1981a (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib604) ; Fiske, 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib507) ).

Trait conceptions of personality have been enormously popular throughout the history of psychological testing, so the coverage here is necessarily selective. We will review two prominent and influential positions from the dozens of trait theories that have been proposed. These approaches differ primarily in terms of whether traits are split off into finely discriminable variants or grouped together into a small number of broad dimensions:

Cattell’s factor-analytic viewpoint identifies 16 to 20 bipolar trait dimensions. Eysenck’s trait-dimensional approach coalesces dozens of traits into two overriding dimensions. Goldberg and others have sought a modern synthesis of all trait approaches by proposing a five- factor model of personality.

For readers who desire a more detailed discussion of this topic, Pervin (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1285) ) and Wiggins (1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1756) ) provide an excellent review of trait approaches to personality theory.

Cattell’s Factor-Analytic Trait Theory Cattell (1950 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib283) , 1973 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib286) ) refined existing methods of factor analysis to help reveal the basic traits of personality. He referred to the more obvious aspects of personality as surface traits (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss320) . These would typically emerge in the first stages of factor analysis when individual test items were correlated with each other. For example, true–false items such as “I enjoy a good prize fight,” “Getting stuck behind a slow driver really bothers me,” and “It’s important to let people know who is in charge” might be answered similarly by subjects, revealing a surface trait of aggressiveness.

But surface traits themselves tended to come in clusters, as revealed by Cattell’s more sophisticated application of factor analysis. For Cattell, this was evidence of the existence of source traits (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss297) , the stable and constant sources of behavior. Source traits are, therefore, less visible than surface traits but are more important in accounting for behavior.

Cattell (1950 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib283) ) was unrivaled in his use of factor analysis to discover how traits were organized and how they were related to each other. One approach was to have persons rate others they knew well by checking various adjectives

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such as aggressive, thoughtful, and dominating from a list of 171 choices. When the results from 208 subjects were subsequently factor analyzed, about 20 underlying personality factors or traits were tentatively identified. Another approach was to have thousands of persons answer questions about themselves and then factor-analyze their responses. Sixteen of the original 20 personality traits were independently confirmed by this second approach (Cattell, 1973 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib286) ). These 16 source traits have been incorporated into the Sixteen Personality Factor Questionnaire (16PF), a trait-based paper-and-pencil test of personality that is discussed in the next chapter.

The Five-Factor Model of Personality The five-factor model of personality has its origins in a review chapter by Goldberg (1981b (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib605) ). In his analysis of factor-analytic trait research, Goldberg identified several consistencies, which he referred to as the “Big Five” dimensions. Although researchers have used slightly different terms for these factors, the most common labels are

Neuroticism Extraversion Openness to Experience Agreeableness Conscientiousness

Rearranging the factors yields a simple acronym: OCEAN. The five-factor model is rapidly becoming theconsensus model of personality. Support for the five-factor approach comes from several sources, including factor analysis of trait terms in language and the analysis of personality from an evolutionary perspective. We discuss these perspectives in the following.

The use of trait terms in the analysis of personality is based upon the fundamental lexical hypothesis (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss131) . The essential point of this hypothesis is that trait terms have survived in language because they convey important information about our dealings with others:

The variety of individual differences is nearly boundless, yet most of these differences are insignificant in people’s daily interactions with others and have remained largely unnoticed. Sir Francis Galton may have been among the first scientists to recognize explicitly the fundamental lexical hypothesis—namely that the most important individual differences in human transactions will come to be encoded as single terms in some or all of the world’s languages. (Goldberg, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib606) )

When trait terms in English are distilled down to a reasonably distinct and nonoverlapping set of adjectives, a few hundred characteristics typically emerge (Allport, 1937 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib19) ). For decades, researchers have been asking individuals to rate themselves or others on these or similar traits. When these ratings are subjected to factor analysis, the “Big Five” dimensions previously listed usually appear in one guise or another. In sum, a mounting body of research indicates that the five-factor model captures a valid and useful representation of the structure of human traits.

The five-factor approach also possesses evolutionary plausibility. Specifically, the five factors of personality previously listed capture individual differences that relate to such basic evolutionary functions as survival and reproductive success (Buss, 1997

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib236) ; Pervin, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1285) ). Goldberg (1981b (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib605) ) has theorized that people implicitly ask the following questions in their interactions with others:

Is X active and dominant or passive and submissive? (Can I bully X or will X try to bully me?) Is X agreeable (warm and pleasant) or disagreeable (cold and distant)? Can I count on X? (Is X responsible and conscientious or undependable and negligent?) Is X crazy (unpredictable) or sane (stable)? Is X smart or dumb? (How easy will it be for me to teach X?)

Directly or indirectly, each of these evaluations has a bearing on survival and reproductive success. For example, point 3 (conscientiousness) involves a trait that might ensure group survival in a hostile world. A person low on this trait (undependable) would be a poor choice for guarding the food supply. The ability to discern conscientiousness in others therefore has adaptive value. Not surprisingly, the five points previously listed correspond to the five-factor personality model.

The five-factor model of personality has inspired several personality scales and other systems for assessment (deRaad & Perugini, 2002). For example, Costa and McCrae have developed two personality tests based on the five-factor model (Costa, 1991 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib355) ; McCrae & Costa, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1085) ). The Revised NEO Personality Inventory (NEO-PI-R) contains 240 items rated on a five-point scale. In addition to the five major domains of personality, the inventory measures six specific traits (called facets) within each domain. A shortened 60-item version known as the NEO Five-Factor Inventory (NEO-FFI) also is available. Trull, Widiger, Useda, and others (1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1669) ) have published a semistructured interview for the assessment of the five-factor model of personality. These tests are discussed in the next chapter.

Comment on the Trait Concept All trait approaches to personality share certain problems in common. First, there is disagreement whether traits cause behavior or merely describe behavior (Fiske, 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib507) ). It can be persuasively argued that invoking traits as causes is an empty form of circular reasoning. For example, a person with extremely high standards might be said to possess the trait of perfectionism. But when asked to explain what is meant by perfectionism, we invariably end up referring to a pattern of extremely high standards. Thus, when we assert that someone is perfectionistic, are we really doing anything more than providing a short-hand description of their past behavior? Miller (1991 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1151) ) has voiced this criticism of the five-factor approach, noting that the model merely describes psychopathology but does not explain it.

A second problem with traits is their apparently low predictive validity. Mischel (1968 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1164) ) is credited with the first effective disparagement of the trait concept in his influential book Personality and Assessment. He stated that “while trait theory predicts behavioral consistency, it is behavior inconsistency that is typically observed” (Mischel, 1968 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1164) ). In a wide-ranging

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review of existing research, Mischel noted that trait scales produced validity coefficients with an upper limit of r = .30. He coined the term personality coefficient (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss240) to describe these low correlations. Undoubtedly significant for large samples of subjects, correlations of r = .30 are of minimal value in the prediction of individual behavior.

Trait researchers responded to Mischel’s attack by refining and limiting the trait concept. Researchers sought to identify subgroups of persons whose behavior could be accurately predicted on the basis of trait scores and also attempted to distinguish the kinds of situations in which behavior is largely determined by traits (e.g., Mischel, Shoda, & Mendoza-Denton, 2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1165) ; Wasylkiw & Fekken, 2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1718) ). These efforts met with modest success, raising the validity of some trait questionnaires—in some contexts with some persons—substantially beyond the ominous r = .30 barrier posited by Mischel (1968 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1164) ). But gone forever are the days of simplistic, generalized assertions such as “trait X predicts behavior Y.”

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8.7 THE PROJECTIVE HYPOTHESIS Frank (1939 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib529) , 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib530) ) introduced the term projective method to describe a category of tests for studying personality with unstructured stimuli. In a projective test (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss255) the examinee encounters vague, ambiguous stimuli and responds with his or her own constructions. Disciples of projective testing are heavily vested in psychoanalytic theory and its postulation of unconscious aspects of personality. These examiners believe that unstructured, vague, ambiguous stimuli provide the ideal circumstance for revelations about inner aspects of personality. The central assumption of projective testing is that responses to the test represent projections from the innermost unconscious mental processes of the examinee. We introduce this topic with some preliminary concepts and distinctions relevant to projective testing.

The assumption that personal interpretations of ambiguous stimuli must necessarily reflect the unconscious needs, motives, and conflicts of the examinee is known as the projective hypothesis (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss254) . Frank (1939 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib529) ) is generally credited with popularizing the projective hypothesis:

When we scrutinize the actual procedures that may be called projective methods we find a wide variety of techniques and materials being employed for the same general purpose, to obtain from the subject, “what he cannot or will not say,” frequently because he does not know himself and is not aware what he is revealing about himself through his projections.

The challenge of projective testing is to decipher underlying personality processes (needs, motives, and conflicts) based on the individualized, unique, subjective responses of each examinee. In the sections that follow we will examine how well projective tests have met this portentous assignment.

A Classification of Projective Techniques Lindzey (1959 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib995) ) has offered a classification of projective techniques that we will follow here. Based on the response required, he divided projectives into five categories:

Association to inkblots or words Construction of stories or sequences Completions of sentences or stories Arrangement/selection of pictures or verbal choices Expression with drawings or play

Association techniques include the widely used Rorschach inkblot test and its psychometrically superior cousin the Holtzman Inkblot Technique, as well as word association tests. Construction techniques include the Thematic Apperception Test and the many variations upon this early instrument. Completion techniques consist mainly of sentence completion tests, discussed later. Arrangement/selection procedures such as the Szondi test (discussed in the first chapter) are currently seldom used. Finally, expression techniques such as the Draw-A-Person or House-Tree-Person test are very popular among clinicians in spite of dubious validity data.

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We will review prominent techniques within each category except the antiquated arrangement/selection approaches, which are almost never used. However, the literature on major projective techniques is simply overwhelming, running to perhaps tens of thousands of articles on the Rorschach alone. We can suggest major trends in the research, but the reader will need to consult other sources for comprehensive reviews.

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8.8 ASSOCIATION TECHNIQUES

The Rorschach The Rorschach consists of 10 inkblots devised by Herman Rorschach (1884–1922) in the early 1900s. He formed the inkblots by dribbling ink on a sheet of paper and folding the paper in half, producing relatively symmetrical bilateral designs. Five of the inkblots are black or shades of gray, while five contain color; each is displayed on a white background. An inkblot of the type employed by Rorschach is shown in Figure 8.1 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec8#ch08fig1) . The Rorschach is suited to persons age 5 and up but is most commonly used with adults.

FIGURE 8.1 An Inkblot Similar to Those Found on the Rorschach

Regrettably, Rorschach died before he could complete his scoring methods, so the systematization of Rorschach scoring was left to his followers. Five American psychologists produced overlapping but independent approaches to the test—Samuel Beck, Marguerite Hertz, Bruno Klopfer, Zygmunt Piotrowski, and David Rapaport (Erdberg, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib463) ). Predictably, the nuances of scoring varied from one scoring method to another. Beginning in the 1990s, John Exner and his colleagues began to codify and synthesize the scoring approaches into a single method known as the Rorschach Comprehensive System (Exner, 1991 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib468) , 1993

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib469) ; Exner & Weiner, 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib471) ). The Comprehensive System (CS) supplanted all previous methods and became the preferred scoring system because it was more clearly grounded in empirical research. Even so, reservations about the Rorschach in general and the CS in particular persisted in the trade (Lilienfield, Wood, & Garb, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib990) , 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib991) ).

Beginning in about 2010, a new system for administration, scoring, and interpretation of the Rorschach emerged as the clear choice for practitioners. The Rorschach Performance Assessment System (R-PAS) represents an extension and improvement of the CS (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1140) ). Erard (2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib462) ) provides a succinct summary of its appeal:

Despite its recent formal introduction to the professional assessment community, R-PAS takes advantage of decades of research in peer reviewed publications (including the insights of Rorschach critics) and builds on established validity and general acceptance for most of its procedures and features (p. 122).

In using the R-PAS, the examiner first establishes rapport and then sits to the side of the client or patient to minimize body language communication. For each card, the examiner asks the respondent to look at the stimulus and to answer “What might this be?” Before the test, the examiner asks for “two, maybe three responses” per card. During the test, if only one reply is given, the examiner prompts for additional response(s), and pulls the card after four responses are provided. This is called response optimization, which elicits a typical range of 18 to 28 responses. This technique greatly reduces short and long records (protocols with upwards of 100 responses have been encountered), which affords a better fit with norms. The R-PAS incorporates several laudable improvements (www.r-pas.org (http://www.r-pas.org) ):

Evidence-based selection of scoring variables Detailed guidelines for test administration Methods to optimize the number of responses Guidelines for clarifying coding uncertainties Normative reference values for international samples Form quality tables for accuracy and conventionality Inexpensive scoring with a web-based program Easy-to-read graphs with standard scores Translations into several languages

Once the test is administered and the responses recorded, scoring begins. This is an intricate process that requires significant training. We can only refer to highlights here. Responses are scored for a number of variables such as location, content, form quality, thought processes, and determinants. Determinants are different aspects of the blot such as color, shading, and form, which appear to have influenced examinee responses (Table 8.2 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec8#ch08tab2) ).

Interrater reliability of R-PAS scores is excellent. Using a diverse sample of 50 Rorschach records randomly selected from ongoing research, the median intraclass correlation coefficient (an index of agreement between raters) for 60 variables was .92 (Viglione, Blume-Marcovici, Miller, Giromini, & Meyer, 2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1699) ).

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Another useful feature of this new approach to Rorschach scoring is the availability of an international reference sample for standardization of scoring variables. This sample of 1,396 protocols was obtained from 15 nations, including Australia, Brazil, Japan, Israel, and Spain—just to give a sense of the global distribution.

The validity of the Rorschach as scored with the R-PAS (or any other scoring system) is difficult to summarize in any simple manner. Individual studies indicate good validity for some purposes, but limited validity for other applications. For example, with the R-PAS, Complexity scores were correlated with functional capacity (r = .30) and social skills capacity (r = .34) in a sample of 72 middle-aged and older outpatients with schizophrenia (Moore, Viglione, Rosenfarb, Patterson, & Mausbach, 2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1171) ). Psychological complexity, as measured by the Complexity score, assesses the mental effort, intricacy, and integration evident in responses, with higher scores indicating better coping skills. Thus, it makes theoretical and empirical sense that psychological complexity would show positive correlations with functional and social capacities. These results support the validity of this Rorschach variable.

Once the entire protocol has been coded, the examiner computes a number of summary scores that form the primary basis for hypothesizing about the personality of the examinee. For example, the F+ percent is the proportion of the total responses that uses pure form as a determinant. A voluminous literature exists on the meaning of this index, but it seems safe to hypothesize that when the F+ percentage falls below 70 percent, the examiner should consider the possibility of severe psychopathology, brain impairment, or intellectual deficit in the examinee (Exner, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib469) ). The F+ percent is also considered to be an index of ego strength, with higher scores indicating a greater capacity to deal effectively with stress. Meyer and Eblin (2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1138) ) discuss R-PAS variables and composites.

TABLE 8.2 Summary of Major Rorschach Scoring criteria

Location: Where on the blot was the percept located?

W Whole Entire inkblot used

D Common detail Well-defined part used

Dd Unusual detail Unusual part used

White Space: Was white space used in the response?

SR Space reversal White space as the figure

SI Space integration White space integrated in percept

Content: What is seen, and is it synthesized or vague?

H Human Percept of a whole human form

Hd Human detail Human form incomplete in any way

Ex Explosion An actual explosion

Sy Synthesis Objects are meaningfully related

Vg Vagueness Objects in the percept are vague

2 Pair Two identical, mirror-image percepts

Form Quality: How well does the percept fit the blot?

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o Ordinary Obvious and easily seen

u Unusual Unusual but still a good fit

− Minus Distorted and unrealistic percept

P Popular Designated high frequency percept

Determinants: What feature of the blot determined the response?

M Movement Movement seen or implied in percept

C Color Color helped determine the response

F Form Form a major determinant of percept

T Texture Shading involved in the response

Thought Processes: Are there issues with thought processes or themes?

DV1 Deviant Verbalization-1 Odd or unusual verbalization

DV2 Deviant Verbalization-2 Clearly bizarre verbalization

MOR Morbid Response has a clearly dysphoric tone

Note: This list is incomplete and illustrative only. The full scoring system is complex and allows for blends. For example, the determinant FC means that both form and color were used to determine the percept, but form was more important than color.

Source: Based on Exner (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib469) ) and Meyer et al. (2011 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1140) ).

Frank (1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib528) ) has emphasized that formal scoring of the Rorschach is insufficient for some purposes such as the diagnosis of schizophrenia. He stresses that an analysis of the patient’s thinking for the presence of highly personal, illogical, and bizarre associations to the blots is essential for psychodiagnosis. In his approach, the Rorschach is really an adjunct to the interview, and not a test per se.

Bornstein and Masling (2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib184) ) have reminded us that neither the CS nor the R-PAS should be confused with being “the Rorschach.” After all, there are many other helpful and validated approaches to scoring the test. Their book, Scoring the Rorschach: Seven Validated Systems (2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib184) ), is a wonderful compendium of alternative scoring systems that can be used to answer specialized assessment questions. A case in point is the Rorschach Prognostic Rating Scale (RPRS; Handler & Clemence, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib691) ), a promising and validated system for predicting who will be successful in psychotherapy and who will not. Scoring the RPRS is complex and consists of assigning or subtracting points for various categories of clearly defined responses. For example, a positive score is given if a response depicts a human as dancing, running, talking, or pointing, whereas a score of zero is coded if humans are seen as sleeping, lying down, sitting, or balancing. The meaningful use of color in the response also contributes to a positive score, whereas using color to depict explosions or diseases results in points being subtracted. Several categories are scored, yielding a total score that ranges from −12 to +17. The following interpretations are then assigned to different ranges of the RPRS score:

17 to 13:

The person is almost able to help himself. A very promising case that just needs a little help.

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12 to 7:

Not quite so capable as the previous case to work out his problems himself but with some help is likely to do pretty well.

6 to 2:

Better than 50–50 chance; any treatment will be of some help.

1 to −2:

50–50 chance.

−3 to −6:

A difficult case that may be helped somewhat but is generally a poor treatment prospect.

−7 to −12:

A hopeless case. (Handler & Clemence, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib691)

, p. 54)

Meyer and Handler (1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1137) ) used meta- analysis to synthesize the results of 18 validity studies of the RPRS, comprising a total sample of 752 participants. Their results translated to a 78 percent success rate in psychotherapy for clients with high scores on the RPRS, but only a 22 percent success rate for clients with low scores on the scale. The RPRS is a promising scale that should receive wider use in clinical practice.

Another useful scoring system for the Rorschach is the Thought Disorder Index (TDI), which assesses formal thought disorder (Holtzman, Levy, & Johnston, 2005). Thought disorder exists on a continuum from mild slippage to bizarre disorganization and is especially characteristic of patients with schizophrenia. Thus, the assessment of thought disorder is pivotal in the diagnosis and treatment of individuals with schizophrenia or other serious mental illness.

The following examples of thought disorder are from Holzman et al. (2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib781) ). Mild examples would include clients with peculiar language that employs stilted, inappropriate, or odd expressions. For example, in responding to the Rorschach, a patient with mild thought disorder might use expressions such as “He’s organizing in his organs” or “There’s a segregation between mouth and nose” or “Red is trouble, and Africa being red symbolizes that maybe the origin of man was in Africa and that’s why it looks red.” As thought disorder becomes more prominent, Rorschach responses reveal increasingly queer and confused qualities. The patient might describe portions of the blot as being “A foxed comic dog” or “The adhesive adjunctive extensions” or “These are the posterior pronunciations.” Extreme examples of thought disorder show an incoherent quality such as “Blood, and break their neck, you know, reject” or the invention of words, for example, “The property is more closely centulated to the trailroads.”

The TDI is calculated by scoring each response for the severity level of thought disorder from none to extreme, with possible scores of 0, .25, .50, .75, and 1.0. Then the average score is computed across all responses. This number is multiplied by 100 to yield the final score on a range from 0 to 100. Thus, an overall score of 0 would mean that not one response revealed any thought disorder, whereas a score of 100 would signify that, without exception, every response was highly bizarre and disorganized.

The reliability of the TDI is reasonably good, with split-half correlations around .80 and interrater reliability coefficients of .90 and higher. Validity has been supported from a number of directions, such as huge improvements in scores when patients with schizophrenia are tested before and after comprehensive interventions including drug therapies (Holtzman et al., 2005). Mastering the TDI scoring

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criteria is far easier than learning the Comprehensive System. Insofar as the TDI provides valuable information about the extent of thought disorder—one of the foremost reasons that practitioners use the Rorschach—we can expect to see increased reliance on this approach to test scoring.

Space does not permit us to summarize validated scoring systems. These scales are derived largely from psychoanalytic theory and include an index of object relations, a measure of oral dependency, barrier and penetration indices based on body image, a measure of primary process thinking, and a scale that assesses primitive psychological defenses (Bornstein & Masling, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib184) ).

Comment on the Rorschach The Rorschach has provoked more controversy in the field of assessment than any other personality test or instrument. Opinions tend to be polarized, and both proponents and detractors cite studies and analyses to support their case. For example, critics of the test refer to a fascinating study by Albert, Fox, and Kahn (1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib16) ) on the susceptibility of the Rorschach to faking. We remind the reader that literally thousands of Rorschach research studies have been published. In fact, a search of PsychINFO using the key title word Rorschach yielded 5,324 articles dating back to 1925 (the test was published in 1921). The majority of these studies are positive in tone. But the skeptical results reported by Albert, Fox, and Kahn (1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib16) ) are not isolated. They submitted the Rorschach protocols of 24 persons to a panel of experts, asking for psychiatric diagnoses of each examinee. The 24 Rorschach protocols consisted of results from four groups of six persons each:

Mental hospital patients with a diagnosis of paranoid schizophrenia Uninformed fakers given instructions to fake the responses of a paranoid schizophrenic Informed fakers who listened to a detailed audiotape about paranoid schizophrenia Normal controls who took the test under standard instructions

The uninformed fakers, informed fakers, and normal controls were students who had passed an MMPI screening and were judged reasonably normal during interview. Each protocol was rated by six to nine judges, all fellows of the Society for Personality Assessment. The judges were told to provide a psychiatric diagnosis as well as other information not reported here. The judges were not informed as to the purpose of the study but were told to assess whether any profiles appeared to be malingered.

The informed fakers must have done an excellent job, for they were more likely to be diagnosed psychotic than the real patients themselves (72 percent versus 48 percent, respectively). The uninformed fakers were fairly convincing, too, with a 46 percent rate of diagnosed psychosis. The normal controls were diagnosed as psychotic 24 percent of the time. Granted that the diagnostic challenge in this study was immense, it is still disturbing to find that the expert judges rated 24 percent of the normal protocols as psychotic, while correctly identifying psychosis in only 48 percent of the actual psychotic protocols. A more recent study by Netter and Viglione (1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1228) ) also concluded that the Rorschach was susceptible to the faking of psychosis.

In general, critics portray the test as possessing low reliability and a general lack of predictive validity (Carlson, Kula, & St. Laurent, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib270) ; Wood, Nezworski, & Stejskal, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1784) ;

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Lilienfeld, Wood, & Garb, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib990) ). In their meta- analytic review, Garb, Florio, and Grove (1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib562) ) concluded that the Rorschach explained a dismal 8 to 13 percent of the variance in client characteristics, as compared to the MMPI, which explained 23 to 30 percent of the variance.

Supporters of the test cite improvements in scoring offered by the R-PAS approach and are more optimistic in their outlook (Meyer & Eblin, 2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1138) ). A recent study by McGrath, Pogge, Stokes, and others (2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1094) ) found that the Rorschach could be scored with respectable reliability, even in the less controlled conditions typical of real-world testing. This was an important finding because virtually all prior studies of reliability have been conducted in research settings. In response to the ongoing controversy, the prestigious Society for Personality Assessment requisitioned external reviews by an independent panel of “blue ribbon” experts, who concluded that the Rorschach possesses reliability and validity similar to other accepted tests like the MMPI-2. The trustees of the society assert that the continued use of the Rorschach, therefore, is appropriate and justified (Board of Trustees for the Society for Personality Assessment, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib171) ).

The controversy over the Rorschach probably will subside for awhile, but it is not likely to disappear entirely. Even if the test continues to prevail because of studies supporting the reliability of scoring and the validity of inferences, there are other concerns seldom mentioned by skeptics. One liability is that learning the scoring system is an arduous and time consuming task that requires dozens of hours of practice and years of supervised experience. Some doctoral programs offer an entire course (or two) on the Rorschach, and this is just the beginning of the training needed. A second problem is that administering and scoring the Rorschach requires a few hours of professional time from a licensed psychologist. This time is a precious and expensive commodity. Someone has to pay for it. These practical issues are daunting. In regard to learning the test in the first place, and devoting the time to administer and score it in the second place, many clinical training directors and practitioners (and not a few insurance companies) are asking “Is it worth it?”

FIGURE 8.2 Example of a Short Sentence Completion Test

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8.9 COMPLETION TECHNIQUES

Sentence Completion Tests In a sentence completion test, the respondent is presented with a series of stems consisting of the first few words of a sentence, and the task is to provide an ending. As with any projective technique, the examiner assumes that the completed sentences reflect the underlying motivations, attitudes, conflicts, and fears of the respondent. Usually, sentence completion tests can be interpreted in two different ways: subjective- intuitive analysis of the underlying motivations projected in the subject’s responses, or objective analysis by means of scores assigned to each completed sentence.

An example of a sentence completion test is shown in Figure 8.2 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec8#ch08fig2) . This test is quite similar to existing instruments in that the stems are very short and restricted to a small number of basic themes. The reader will notice that three topics reoccur in this short test (the respondent’s self-concept, mother, and father). In this manner the examinee has multiple opportunities to reveal underlying motivations about each topic. Of course, most sentence completion tests are much longer—anywhere from 40 to 100 stems—and contain more themes—anywhere from 4 to 15 topics.

Dozens of sentence completion tests have been developed; most are unpublished and unstandardized instruments produced to meet a specific clinical need. Some representative sentence completion tests in current use are outlined in Table 8.3 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec9#ch08tab3) . Of these instruments, Loevinger’s Washington University Sentence Completion Test is the most sophisticated and theory-bound (e.g., Weiss, Zilberg, & Genevro, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1746) ). However, the Rotter Incomplete Sentences Blank has the strongest empirical underpinnings and is the most widely used in clinical settings. We examine this instrument in more detail.

TABLE 8.3 Brief Outline of Representative Sentence Completion Tests

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Sentence Completion Series Psychological Assessment Resources

The SCS consists of 50 sentence stems designed to aid the clinician in identifying underlying concerns and specific areas of client distress. A unique feature of this instrument is the publication of eight different forms, parallel in content, which allow for repeated testing.

Forer Structured Sentence Completion Test Western Psychological Services

This instrument is available in separate forms for men, women, adolescent boys, and adolescent girls. Each form contains 100 sentence stems designed to cover attitude–value systems, evasiveness, and defense mechanisms.

Geriatric Sentence Completion Form Psychological Assessment Resources

The GSCF is a 30-item form specifically developed for use with older adult clients. The GSCF elicits personal responses to four content domains: physical, psychological, social, and temporal orientation. The test manual includes a number of clinical case illustrations.

Washington University Sentence Completion Test, Privately published by Loevinger

The WUSC uses separate forms for men, women, and younger male and female subjects. This test is highly theory-bound; responses are classified according to seven stages of ego development: presocial and symbiotic, impulsive, self-protective, conformist, conscientious, autonomous, integrated.

Rotter Incomplete Sentences Blank The Rotter Incomplete Sentences Blank (RISB) consists of three similar forms—high school, college, and adult—each containing 40 sentence stems written mostly in the first person (Rotter & Rafferty, 1950 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1411) ; Rotter, Lah, & Rafferty, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1412) ). Although the test can be subjectively interpreted in the usual manner through qualitative analysis of needs projected in the subject’s responses, it is the objective and quantitative scoring of the RISB that has drawn the most attention.

In the objective scoring system each completed sentence receives an adjustment score from 0 (good adjustment) to 6 (very poor adjustment). These scores are based initially on the categorizing of each response as follows:

Omission—no response or response too short to be meaningful Conflict response—indicative of hostility or unhappiness Positive response—indicative of positive or hopeful attitude Neutral response—declarative statement with neither positive nor negative affect

Examples of the last three categories include:

I hate . . . the entire world. (conflict response) The best . . . is yet to come. (positive response) Most girls . . . are women. (neutral response)

Conflict responses are scored 4, 5, or 6, from lowest to highest degree of the conflict expressed. Positive responses are scored 2, 1, or 0, from least to most positive response. Neutral responses and omissions receive no score. The manual gives examples of each scoring category. The overall adjustment score is obtained by adding the weighted ratings in the conflict and positive categories. The adjustment score can vary from 0 to 240, with higher scores indicating greater maladjustment.

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The reliability of the adjustment score is exceptionally good, even when derived by assistants with minimal psychological expertise. Typically, interscorer reliabilities are in the .90s and split-half coefficients are in the .80s (Rotter et al., 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1412) ; Rotter, Rafferty, & Schachtitz, 1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1413) ). The validity of this index has been investigated in numerous studies using the RISB as a screening device with a “maladjustment” cutoff score. For example, a cutoff score of 135 has been found to correctly screen delinquent youths 60 percent of the time while identifying nondelinquent youths correctly 73 percent of the time (Fuller, Parmelee, & Carroll, 1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib552) ). The same cutoff identifies heavy drug users 80 to 100 percent of the time (Gardner, 1967 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib568) ). These and similar findings support the construct validity of the adjustment index but also indicate that classification rates are much lower than needed for individual decision making or effective screening. It also appears that the norms for the adjustment index are outdated. Lah and Rotter (1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib945) ) found that student scores differ significantly from those obtained in the original study by Rotter and Rafferty (1950 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1411) ). Lah (1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib944) ) and Rotter et al. (1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1412) ) provide new normative, scoring, and validity data for the RISB.

As discussed by P. Goldberg (1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib603) ), the simplicity of the single adjustment score is both the test’s strength and weakness. True, the test provides a quick and efficient method for obtaining an overall index of how respondents are functioning on a day-to-day basis. However, a single score cannot possibly capture any nuances of personality functioning. In addition, the RISB is subject to the same types of bias as other self-report measures, namely, the information will reflect mainly what the respondent wants the examiner to know.

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8.10 CONSTRUCTION TECHNIQUES

The Thematic Apperception Test (TAT) The TAT consists of 30 pictures that portray a variety of subject matters and themes in black-and-white drawings and photographs; one card is blank. Most of the cards depict one or more persons engaged in ambiguous activities. Some cards are used for adult males (M), adult females (F), boys (B), or girls (G), or some combination (e.g., BM). As a consequence, exactly 20 cards are appropriate for every examinee.

A picture similar to those on the TAT is shown in Figure 8.3 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec10#ch08fig3) . In administering the TAT, the examiner requests the examinee to make up a dramatic story for each picture, telling what led up to the current scene, what is happening at the moment, how the characters are thinking and feeling, and what the outcome will be. The examiner writes down the story verbatim for later scoring and analysis.

FIGURE 8.3 A Picture Similar to Those on the Thematic Apperception Test

The TAT was developed by Henry Murray and his colleagues at the Harvard Psychological Clinic (Morgan & Murray, 1935 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1175) ; Murray, 1938 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1193) ). The test was originally designed to assess constructs such as needs and press, elements central to Murray’s personality theory. According to Murray, needs organize perception, thought, and action and energize behavior in the direction of their satisfaction. Examples of needs include the needs for achievement, affiliation, and dominance. In contrast, press refers to the power of environmental events to influence a person. Alpha press is objective or “real” external forces, whereas beta press concerns the subjective or perceived components of external forces. Murray (1938 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1193) , 1943

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1194) ) developed an elaborate TAT scoring system for measuring 36 different needs and various aspects of press, as revealed by the examinee’s stories.

Almost as soon as Murray released the TAT, other clinicians began to develop alternative scoring systems (e.g.,Dana, 1959 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib387) ; Tomkins, 1947 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1655) ). Literature on the administration, scoring, and interpretation of the TAT burgeoned extensively, as documented by reviews (Aiken, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib13) , chap. 12; Groth- Marnat, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib657) ; Weiner & Kuehnle, 1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1742) ). By the 1950s, there was no single preferred mode of administration, no single preferred system of scoring, and no single preferred method of interpretation, a predicament that still endures today. Clinicians even vary the wording of the instructions and commonly select an individualized subset of TAT cards for each client. Indeed, the absence of standardized procedures is such that we should rightly regard the TAT as a method, not a test.

It is worth mentioning that Murray’s instructions included a statement that the TAT was “a test of imagination, one form of intelligence” and further stipulated:

I am going to show you some pictures, one at a time; and your task will be to make up as dramatic a story as you can for each. Tell what has led up to the event shown in the picture, describe what is happening at the moment, what the characters are feeling and thinking; and then give the outcome. Speak your thoughts as they come to your mind. Do you understand? Since you have fifty minutes for ten pictures, you can devote about five minutes to each story. Here is the first picture. (Murray, 1943 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1194) )

Currently, clinicians downplay the emphasis on imagination and intelligence when giving instructions. Surely, this omission must influence the quality of the stories produced.

Even though more than a dozen scoring systems have been proposed, interpretation of the TAT is usually based on a clinical-qualitative analysis of the story productions. A central consideration harks back to Murray’s “hero” assumption. According to this viewpoint, the hero is the protagonist of the examinee’s story. It is assumed that the examinee clearly identifies with this character and projects his or her own needs, strivings, and feelings onto the hero. Conversely, thoughts, feelings, or actions avoided by the hero may represent areas of conflict for the examinee. A specific example will help clarify these points. Consider

the response to Card 3BM given by a depressed examinee2

(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec10#ch08fn02) :

Looks like . . . I can’t tell if it’s a girl or boy. Could be either. I guess it doesn’t matter. This person just had a hard physical workout. I guess it’s a her. She’s just tired. No trauma happened or anything. She was sitting around a table with friends and she got real tired. She’s not in a health danger or anything. These are her keys. Her friends drag her back to her room and put her to bed. She’s O.K. the next day. No trauma. She’s tired physically, not mentally. (Ryan, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1422) )

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What stands out in this response is the repetitive denial of danger or trauma. But later in the testing, the denial of trauma is no longer maintained. Read how the examinee responded to the blank card, relating a story of a young man, traumatized at school, who takes his car down to the river:

He sees the bridge, he’s really down. He remembers that he’s heard stories about people jumping off and killing themselves. He could never understand why they did that. Now he understands, he jumps and dies . . . he should have waited ’cause things always get better sometime. But he didn’t wait, he died. (Ryan, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1422) )

Most clinicians would conclude that the examinee who produced these stories had been traumatized and was defending against self-destructive impulses. Correspondingly, the clinician would be well advised to explore these issues in psychotherapy.

The psychometric adequacy of the TAT is difficult to evaluate because of the abundance of scoring and interpretation methods. Clinicians defend the test on an anecdotal basis, pointing out remarkable and confirmatory findings such as illustrated here. However, data-minded researchers are more cautious. One problem is that formally scored TAT protocols possess very low test–retest reliability, with a reported median value of r = .28 (Winter & Stewart, 1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1770) ). Furthermore, an astonishing 97 percent of test users employ subjective and “personalized” procedures for interpreting the TAT; that is, only a tiny fraction of clinical practitioners rely on a standardized scoring system (Lilienfeld, Wood, & Garb, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib991) ). This is troubling because a consistent theme in research on projective testing is that intuitive interpretations are likely to overdiagnose psychological disturbance.

In addition to clinical applications, the TAT has received considerable use for research purposes. For example, Turk, Brown, Symington, and Paul (2010 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1671) ) examined the content of TAT stories from 22 persons with agenesis of the corpus callosum (ACC), a congenital brain disorder in which the pathways connecting the two cerebral hemispheres are partially or completely absent. They used the linguistic inquiry software of James Pennebaker (Tauszcik & Pennebaker, 2010 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1615) ) to count words in psychologically meaningful categories. Compared to age- and IQ-matched controls, the ACC individuals used fewer words pertaining to emotionality, cognitive processes, and social processes, indicating that they experienced greater difficulty imagining and inferring the mental and emotional states of others. In this research application, the TAT proved helpful for enhancing our understanding of the unique qualities of persons with ACC.

The Picture Projective Test The Picture Projective Test (PPT) is an attempt to construct a general-purpose instrument with improved psychometric qualities (Ritzler, Sharkey, & Chudy, 1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1371) ; Sharkey & Ritzler, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1485) ). The developers of the PPT note that the majority of the TAT pictures exert a strong negative stimulus “pull” on storytelling. The TAT cards are cast in dark, shaded tones and most scenes portray persons in low-key or gloomy situations. It is not surprising, then, that projective responses to the TAT are strongly

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channeled toward negative, melancholic stories (Goldfried & Zax, 1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib610) ).

In contrast, the PPT uses a set of pictures taken from the Family of Man photo essay published by the Museum of Modern Art (1955 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1195) ). The following criteria were used in selecting 30 pictures:

The pictures had to show promise of eliciting meaningful projective material. Most but not all of the pictures had to include more than one human character. About half of the pictures had to depict humans showing positive affective expression (e.g., smiling, embracing, dancing). About half of the pictures had to depict humans in active poses, not simply standing, sitting, or lying down.

In an initial pilot study, the authors compared TAT and PPT story productions of eight undergraduates on several variables such as length of stories, emotional tone, and activity level (Ritzler, Sharkey, & Chudy, 1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1371) ). Compared to the TAT productions, the PPT stories were of comparable length but were much more positive in thematic content and emotional tone. The PPT stories were also much more active, meaning that the central character had an active, self-determined effect on the situation in the story. Furthermore, the PPT stories placed greater emphasis on interpersonal rather than intrapersonal themes. In other words, the PPT stories placed more emphasis on “healthy,” adaptive aspects of personality adjustment than did the TAT productions.

The PPT developers also compared their instrument against the TAT in a diagnostic validity study (Sharkey & Ritzler, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1485) ). PPT and TAT story productions of 50 subjects were compared: normals, nonhospitalized depressives, hospitalized depressives, hospitalized psychotics with good premorbid histories, and hospitalized psychotics with poor premorbid histories (10 subjects in each group). Although the TAT and PPT were essentially equal in their capacity to discriminate normal from depressed subjects, the PPT was superior in differentiating psychotics from normals and depressives. On the PPT, depressives told stories with gloomier emotional tone and psychotics made more perceptual distortions, and thematic/interpretive deviations. The PPT appears to be a very promising instrument, although it is obvious that further research is needed on its psychometric qualities. One noteworthy feature is that anyone can purchase the PPT stimuli at their local bookstore. The requisite materials are found in the Family of Man photo collection (Museum of Modern Art, 1955 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1195) ).

Children’s Apperception Test Designed as a direct extension of the TAT, the Children’s Apperception Test (CAT) consists of 10 pictures and is suitable for children 3 to 10 years of age. The preferred version for younger children (CAT-A) depicts animals in unmistakably human social settings (Bellak & Bellak, 1991 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib128) ). The test developers used animal drawings on the assumption that young children would identify better with animals than humans. A human figure version (CAT-H) is available for older children (Bellak & Bellak, 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib129) ). No formal scoring system exists for the CAT and no statistical information is provided on reliability or validity. Instead, the examiner prepares a diagnosis or personality description based on a synthesis of 10 variables

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recorded for each story: (1) main theme; (2) main hero; (3) main needs and drives of hero; (4) conception of environment (or world); (5) perception of parental, contemporary, and junior figures; (6) conflicts; (7) anxieties; (8) defenses; (9) adequacy of superego; (10) integration of ego (including originality of story and nature of outcome) (Bellak, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib127) ). The lack of attention to psychometric issues of scoring, reliability, and validity of the CAT is troublesome to most testing specialists.

TABLE 8.4 Thematic Apperception Tests for Specific Populations

Family Apperception Test

For children ages 6 and older, the Family Apperception Test consists of 21 cards depicting a family in various situations. For example, one card shows a family sitting around a table with parents talking while the children eat. As with the TAT, the examinee is asked to describe what led up to the scene, what is happening now, what will happen next, and what the main characters are feeling. The test is based on family systems theory. The manual provides a scoring guide for categories such as limit-setting, conflict resolution, boundaries, quality of relationships, and emotional tone (Sotile, Julian, Henry, & Sotile, 1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1524) ).

Blacky Pictures

For children ages 5 and older, the Blacky Pictures test was also based on the premise that children identify more readily with animals than humans. The 11 cartoon stimuli depict the adventures of the dog Blacky and his family (Mama, Papa, and sibling Tippy). In addition to requesting a story for each card, the examiner also presents multiple-choice questions based on stages of psychosexual development derived from psychoanalytic theory (Blum, 1950 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib166) ). Although the test was originally developed with adults, children enjoy taking the Blacky and are quite responsive to the pictures. Problems with this test include the absence of norms, especially for children, and poor stability of scores (LaVoie, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib958) ).

Michigan Picture Test-Revised

For older children ages 8 to 14 years, the MPT-R consists of 15 pictures and a blank card. Responses are scored for Tension Index (e.g., portrayal of personal adequacy), Direction of Force (whether the central figure acts or is acted upon), and Verb Tense (e.g., past, present, future). These three scores can be combined to yield a Maladjustment Index. Reliability and norms are adequate, although evidence of validity is unsatisfactory. A major problem with this test is that the cards portray interpersonal relationships so vividly that little is left to the child’s imagination (Aiken, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib13) ).

Senior Apperception Test (SAT)

Although the 16 situations depicted on the SAT cards include some positive circumstances, the majority of pictures were designed to reflect themes of helplessness, abandonment, disability, family problems, loneliness, dependence, and low self-esteem (Bellak, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib127) ). Critics complain that the SAT stereotypes the elderly and therefore discourages active responding (Schaie, 1978 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1450) ).

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Other Variations on the TAT The TAT has inspired a number of similar tests designed for children and older adults (Table 8.4 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec10#ch08tab4) ). In addition, modifications and variations of the TAT have been developed for ethnic, racial, and linguistic minorities. One of the first was the Thompson TAT (T-TAT) in which 21 of the original TAT pictures were redrawn with African American figures (Thompson, 1949 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1634) ). This TAT modification incorporated certain unintended changes—for example, in facial expressions and the situations portrayed. As a result, the T-TAT should be considered a new test and not just a TAT translation suited to African American individuals (Aiken, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib13) ).

Another specialized TAT-like test is the TEMAS, which consists of 23 colorful drawings that depict Hispanic persons interacting in contemporary, inner-city settings (Aiken, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib13) ; Constantino, Malgady, & Rogler, 1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib346) ). TEMAS is Spanish for themes and an acronym for “tell me a story.” The thematic content of TEMAS stories is scored for 18 cognitive functions, 9 personality (ego) functions, and 7 affective functions. The test can also be scored for various objective indices such as reaction time, fluency, unanswered inquiries, and stimulus transformations (e.g., a letter is transformed into a bomb). Hispanic children respond well to the TEMAS, even though they may be inarticulate in response to traditional projective tests.

The inconsistent reliability of the TEMAS is a source of concern, because reliability constrains validity. The manual reports that Cronbach’s alpha for the 34 scoring functions ranged from .31 to .98 with half below .70. Test–retest reliabilities were even lower; the highest correlation was r = .53 and for 26 of the 34 functions the correlations were near zero! In spite of the questionable reliability of the instrument, several studies provide support for its concurrent and predictive validity. For example, in a clinical sample of 210 Puerto Rican children, TEMAS scale scores predicted independent criteria of ego development, trait anxiety, and adaptive behavior reasonably well, with correlations ranging from .27 to .51 (Malgady, Constantino, & Rogler, 1984 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1035) ). A steady stream of research has continued to bolster the utility of this instrument, as surveyed by Constantino & Malgady (1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib344) ). Flanagan and di Guiseppe (1999 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib510) ) provide a critical review of the TEMAS; Constantino and Malgady (2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib345) ) describe recent developments with the test.

2Card 3BM depicts one person—arguably male or female—kneeling or slumped over on a couch with head bowed on one arm. In the corner is a vaguely drawn object interpreted by some examinees to be a handgun or other weapon.

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8.11 EXPRESSION TECHNIQUES

The Draw-A-Person Test As the reader will recall from an earlier chapter, Goodenough (1926 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib616) ) used the Draw-A- Man task as a basis for estimating intelligence. Subsequently, psychodynamically minded psychologists adapted the procedure to the projective assessment of personality. Karen Machover (1949 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1025) , 1951 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1026) ) was the pioneer in this new field. Her procedure became known as the Draw-A-Person Test (DAP). Her test enjoyed early popularity and is still widely used as a clinical assessment tool. Watkins, Campbell, Nieberding, and Hallmark (1995 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1719) ) report that projective drawings such as the DAP rank eighth in popularity among clinicians in the United States.

The DAP is administered by presenting the examinee with a blank sheet of paper and a pencil with eraser, then asking the examinee to “draw a person.” When the drawing is completed the examinee usually is directed to draw another person of the sex opposite that of the first figure. Finally, the examinee is asked to “make up a story about this person as if he [or she] were a character in a novel or a play” (Machover, 1949 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1025) ).

Interpretation of the DAP proceeds in an entirely clinical-intuitive manner, guided by a number of tentative psychodynamically based hypotheses (Machover, 1949 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1025) , 1951 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1026) ). For example, Machover maintained that examinees were likely to project acceptable impulses onto the same-sex figure and unacceptable impulses onto the opposite-sex figure. She also believed that the relative sizes of the male and female figures revealed clues about the sexual identification of the examinee. For example, drawing a man with large eyes and lashes was thought to indicate a homosexually inclined male.

These interpretive premises are colorful, interesting, and plausible. However, they are based entirely on psychodynamic theory and anecdotal observations. Machover made little effort to validate the interpretations. The empirical support for her hypotheses is somewhere between meager and nonexistent (Swensen, 1968). In favor of the DAP, the overall quality of drawings does weakly predict psychological adjustment (Lewinsohn, 1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib974) ; Yama, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1794) ). However, judged by contemporary standards of evidence, the sweeping and cavalier assessments of personality so often derived from the DAP are embarrassing. Some reviewers have concluded that the DAP is an unworthy test that should no longer be used (Gresham, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib653) ; Motta, Little, & Tobin, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1183) ).

Rather than using the DAP to infer nuances of personality, a more appropriate application of this test is in the screening of children suspected of behavior disorder and emotional disturbance. For this purpose, Naglieri, McNeish, and Bardos (1991 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1213) ) developed the Draw A Person: Screening Procedure for Emotional Disturbance (DAP:SPED). In one study, diagnostic

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accuracy of problem children was significantly improved by application of the DAP:SPED scoring approach (Naglieri & Pfeiffer, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1206) ).

The House-Tree-Person Test (H-T-P) The H-T-P is a projective test that uses freehand drawings of a house, tree, and person (Buck, 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib229) , 1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) ). The examinee is given almost complete freedom in sketching the three objects; separate pencil and crayon drawings are requested. Although the examiner can improvise an H-T-P Test with mere blank pieces of paper, Buck (1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) ) recommends the use of a four-page drawing form with identification information on the first page. Pages two, three, and four are titled House, Tree, and Person. Two drawing forms are needed for each examinee, one for pencil drawings and the other for crayon drawings. Buck (1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) ) also provides a separate four-page form for a postdrawing interrogation phase, which consists of 60 questions designed to elicit the examinee’s opinions about elements of the drawings. Many practitioners feel the postdrawing interrogation phase is not worth the extended effort. Also, the value of separate crayon drawings is questioned (Killian, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib888) ).

The House-Tree-Person Test has much the same familial lineage as the Draw-A-Person Test. Like the DAP Test, the H-T-P Test was originally conceived as a measure of intelligence, complete with a quantitative scoring system to appraise an approximate level of ability (Buck, 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib229) ). However, clinicians soon abandoned the use of the H-T-P as a measure of intelligence, and it is now used almost exclusively as a projective measure of personality.

Although we will not delve into any details here, the interpretation of the H-T-P rests on three general assumptions: the House drawing mirrors the examinee’s home life and intrafamilial relationships; the Tree drawing reflects the manner in which the examinee experiences the environment; and the Person drawing echoes the examinee’s interpersonal relationships. Buck (1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) ) provides numerous interpretive hypotheses for both quantitative and qualitative aspects of the three drawings.

The H-T-P is an alluring test that has fascinated clinicians for more than 40 years. Unfortunately, Buck (1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib229) , 1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) ) has never provided any evidence to support the reliability or validity of this instrument. Indeed, he is perhaps his own worst critic. At one point in his test manual, he even asserts that validational research is not possible with the H- T-P (Buck, 1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib230) , p. 164).

In general, attempts to validate the H-T-P as a personality measure have failed miserably (for reviews see Krugman, 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib921) ; Killian, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib888) ). Thoughtful reviewers have repeatedly recommended the abandonment of the H-T-P and similar figure- drawing approaches to personality assessment. The popularity of the H-T-P has dropped off in recent

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years. A search of PsychINFO revealed only nine articles on the test since 2000, including four dissertations.

Many clinicians do not use projective methods as tests at all but as auxiliary approaches to the clinical interview. These practitioners use projective techniques as clinical tools to derive tentative hypotheses about the examinee. Most of these hypotheses will turn out to be false when examined more closely. However, the few that are confirmed may have important implications for the clinical management of the examinee. Furthermore, we suspect that these fruitful hypotheses might not emerge—or might emerge more slowly—if the practitioner relied entirely on the interview or used only formal tests with established reliability and validity (Case Exhibit 8.1 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec11#ch08box1a) ). However, this assertion is difficult to test empirically.

CASE EXHIBIT 8.1

Projective Tests as Ancillary to the Interview

A specific example may help to clarify the role of projective techniques as ancillary to the clinical interview. During the Vietnam War, a Veteran’s Administration psychologist tested a young soldier who had accidentally shot himself in the leg with a 45-caliber pistol while practicing quick draw in the jungle. Surgeons found it necessary to amputate the soldier’s leg from the knee down. He was quite depressed, and everyone assumed that he suffered from grief and guilt over his great personal tragedy. He was virtually mute and nearly untestable. However, he was persuaded to complete a series of figure drawings. In one drawing he depicted himself as a helicopter gunner, spraying bullets indiscriminantly into the jungle below. When questioned about this drawing, he became quite animated and confessed that he relished combat. Guided by the possible implications of the morbid drawing, the psychologist sought to learn more about the veteran’s attitudes toward combat. In the course of several interviews, the veteran revealed that he particularly enjoyed firing on moving objects—animals, soldiers, civilians—it made no difference to him. Gradually, it became clear that the young veteran was an incipient war criminal who was depressed because his injury would prevent him from returning to the front lines. Needless to say, this information had quite an impact on the tenor of the psychological report.

TOPIC 8B Self-Report and Behavioral Assessment of Psychopathology

8.12 Theory-Guided Inventories (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec12#ch08lev1sec12)

8.13 Factor-Analytically Derived Inventories (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec13#ch08lev1sec13)

8.14 Criterion-Keyed Inventories (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08lev1sec14)

8.15 Behavioral Assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec15#ch08lev1sec15)

8.16 Behavior Therapy and Behavioral Assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec16#ch08lev1sec16)

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8.17 Structured Interview Schedules (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec17#ch08lev1sec17)

8.18 Assessment by Systematic Direct Observation (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec18#ch08lev1sec18)

8.19 Analogue Behavioral Assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec19#ch08lev1sec19)

8.20 Ecological Momentary Assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec20#ch08lev1sec20)

Although there are many methods for the assessment of personality and related qualities, broadly speaking two approaches have dominated the field: unstructured and structured. Unstructured methods such as the Rorschach, TAT, and sentence completion blanks permit broad latitude in the responses of the examinee. These approaches dominated personality testing in the early twentieth century but then slowly faded in standing. In contrast, structured approaches such as self-report inventories and behavior rating scales gained prominence in the mid-twentieth century and have continued to expand in popularity to the present time. Whereas only a handful of unstructured techniques has ever risen to distinction, the number of structured instruments for assessment has grown almost exponentially.

In the previous topic we introduced the reader to the many varieties of unstructured tests such as inkblots, stimulus cards, and sentence completion blanks. These methods are resplendent in the richness of the hypotheses they yield; however, projective techniques largely lack the approval of psychometrically oriented clinicians. In this topic, we focus on the more structured, objective methods for personality assessment favored by measurement-minded psychologists. We review a wide variety of true–false, rating scale, and forced-choice instruments for assessing personality and other qualities.

This review takes in a variety of personality tests, including the Minnesota Multiphasic Personality Inventory-2, arguably the most famous personality test ever published. We also examine contemporary approaches that rely upon structured interview, behavioral observation, and ratings.

The self-report approaches to testing discussed in the following sections are steeped in the details of psychometric methodology. These tests feature prominent references to reliability indices, criterion keying, factor analysis, construct validation, and other forms of technical craftsmanship. For this reason, the approaches discussed here often are considered objective—as contrasted with projective. However, whether they are objective in any meaningful sense is really an empirical question that must be answered on the basis of research. Perhaps it is more accurate to call these methods structured. They are structured in the sense that highly specific rules are followed in the administration, scoring, interpretation, and narrative reporting of results. In fact, some of the approaches are so completely structured that an examinee can answer questions presented on a computer screen and observe a computer-generated

narrative report spewed forth from the printer, literally seconds later.3

(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec11#ch08fn03)

We begin our discussion of structured assessment by reviewing several prominent personality tests. Contemporary psychometricians have relied mainly upon three tactics for personality test development: theory-bounded approaches, factor-analytic approaches, and criterion-key methods. We will organize the

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discussion of personality inventories around these three categories. Of course, the boundaries are somewhat artificial and many test developers use a combination of methods.

3Computerized narrative reports may not be altogether a positive development. We discuss the benefits and pitfalls of computer-generated reports in the next chapter.

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8.12 THEORY-GUIDED INVENTORIES The construction of several self-report inventories was guided closely by formal or informal theories of personality. In these cases, the test developer designed the instrument around a preexisting theory. Theory-guided inventories stand in contrast to factor-analytic approaches that often produce a retrospective theory based upon initial test findings. Theory-guided inventories also differ from the stark atheoretical empiricism found in criterion-key instruments such as the MMPI and MMPI-2. An example of a theory-guided inventory is the Personality Research Form (PRF), based on Murray’s (1938 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1193) ) need-press theory of personality. Some theory-guided inventories such as the State-Trait Anxiety Inventory (STAI) attempt to measure very specific components of personality. We review these tests in more detail in the following.

Personality Research Form The Personality Research Form (Jackson, 1999) is a true–false inventory based loosely on Murray’s (1938 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1193) ) theory of manifest needs. The reader will recall from an earlier discussion that Murray posited 15 needs and developed a projective test, the Thematic Apperception Test, to tap those needs. Based on factor-analytic approaches, Jackson expanded the number of needs and produced several forms for assessment. The forms differ in the number of scales and number of items per scale. In addition to parallel short tests (forms A and B), the Personality Research Form (PRF) also exists as parallel long forms (forms AA and BB). These forms, used primarily with college students, consist of 440 true–false items. The long forms yield 20 personality-scale scores and two validity scores, Infrequency and Desirability (Table 8.5 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec12#ch08tab5) ). The most popular version of the PRF is form E, which consists of all 22 scales in a modified 352-item test.

In constructing the PRF form E, Jackson first formulated rigorous and theoretically based definitions of the traits to be measured, following Murray’s (1938 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1193) ) system for personality description. Next, for each scale over 100 items were written to tape the traits underlying the hypothesized needs. After editorial review, these items were administered to large samples of college students. Item selection was based on simplicity of wording, high biserial correlations with total scale scores, low correlations with other scales (maximizing scale independence), and low correlations with the Desirability scale (minimizing social desirability bias). Convergent and discriminant validity was considered throughout. For the original long forms AA and BB, 20 items were selected for each scale, resulting in 20 × 22 or 440 items. For the PRF form E, about four items were dropped from each scale, yielding a 352-item test.

Unlike many other personality inventories, the PRF scales have no item overlap. As a result, the scales are unusually independent, with most intercorrelation coefficients in the vicinity of ±.30 (Gynther & Gynther, 1976 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib677) ). Furthermore, the rigorous scale construction procedures employed by Jackson (1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib816) ) yielded scales with good internal consistency, with a median coefficient alpha of .70. Test–retest reliabilities are exceptionally strong, ranging from .80 to .96 for a two-week interval, with a median of .91 (Jackson, 1999). Norms are based on thousands of college students from North America, and also include subgroup norms for psychiatric inpatients and criminal offenders. A desirable feature of the PRF is its readability: The test

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requires only a fifth- or sixth-grade reading level (Reddon & Jackson, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1341) ).

The validity of the PRF rests upon a substantial body of research over many decades. A lengthy bibliography citing more than 300 articles about the test can be found at www.sigmaassessmentsystems.com (http://www.sigmaassessmentsystems.com) . For example, correlations between self and roommate ratings on the PRF constructs are reported to range from .27 to .74, with a median of .53.

The construct validity of the PRF rests especially upon confirmatory factor analyses corroborating the grouping of the items into 20 scales (Jackson, 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib816) , 1984b (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib818) ). In addition, research indicates positive correlations with comparable scales on other inventories (Mungas, Trontel, & Weingardner, 1981). For example, Edwards and Abbott (1973) found exceptionally strong and confirmatory correlations between similar scales on the PRF and the Edwards Personality Inventory (EPI; Edwards, 1967). The EPI is a respected but little-used test consisting of 1,200(!) true–false questions.

TABLE 8.5 Personality Research Form Scales

Scale Interpretation of High Score

Abasement Self-effacing, humble, blame-accepting

Achievement Goal striving, competitive

Affiliation Friendly, accepting, sociable

Aggression Argues, combative, easily annoyed

Autonomy Independent, avoids restrictions

Change Avoids routine, seeks change

Cognitive Structure Prefers certainty, dislikes ambiguity

Defendence On guard, takes offense easily

Dominance Influential, enjoys leading

Endurance Persevering, hard-working

Exhibition Dramatic, enjoys attention

Harm Avoidance Avoids risk and excitement

Impulsivity Impulsive, speaks freely

Nurturance Caring, sympathetic, comforting

Order Organized, dislikes confusion

Play Playful, light-hearted, enjoys jokes

Sentience Notices, remembers sensations

Social Recognition Concern for reputation and approval

Succorance Insecure, seeks reassurance

Understanding Values logical thought

Desirability Validity Scale: favorable presentation

Infrequency Validity Scale: infrequent responses

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Source: Based on Personality Research Form Scales and Descriptions from Jackson, D. N. (1989). Personality research form manual (3rd ed.). Port Huron, MI: Sigma Assessment Systems, Inc., Research Psychologists Press division. (800) 265- 1285.

Some of the confirmatory correlations between PRF and EPI scales for 218 male and female college students are reported as follows:

Achievement (PRF) × Is a Hard Worker (EPI). 74

Change (PRF) × Likes a Set Routine (EPI) −.54

Nurturance (PRF) × Helps Others (EPI) .64

Succorance (PRF) × Dependent (EPI) .73

Because these instruments were developed independently according to different test construction philosophies, the findings bolster the validity of both tests. Several recent empirical comparisons also support the validity and utility of the PRF. For example, Goffin, Rothstein, and Johnston (2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib602) ) proved that the PRF outperformed the more widely used Sixteen Personality Factor Questionnaire (16PF, discussed later in this section) in predicting the job performance of 487 candidates for managerial positions. Vernon (2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1695) ) also reports favorably on the validity of the PRF in his review of recent studies.

State-Trait Anxiety Inventory The State-Trait Anxiety Inventory (STAI) is a popular self-report measure of anxiety, used in research and clinical settings (Spielberger, 1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1533) , 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1534) ). The current version is called Form Y, a minor revision of the original Form X (Spielberger, Gorsuch, & Lushene, 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1537) ). A similar scale for children also is available (Spielberger, 1973 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1532) ). The test has been translated into more than 40 languages. We limit our discussion here to the adult version.

The purpose of the STAI is to differentiate between the temporary condition of state anxiety and the more long-standing quality of trait anxiety. State anxiety (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss313) is defined as a “transitory emotional state or condition characterized by subjective feelings of tension and apprehension, and by activation of the autonomic nervous system.” Trait anxiety (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss335) refers to “relatively stable individual differences in anxiety proneness” (Gaudry, Vagg, & Spielberger, 1975 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib571) , p. 331).

The state scale (A-State scale) consists of 20 items that evaluate how the respondent feels “right now, at this moment.” Items are similar to I feel at peace and I am distressed. Responses are on a 4-point scale (Not At All, Somewhat, Moderately So, and Very Much So). The trait scale (A-Trait scale) consists of 20 items that assess how the respondent feels “generally.” Items are similar to I am a stable person and I lack confidence. Reponses are on a 4-point scale (Almost Never, Sometimes, Often, and Almost Always). Of course, scoring is reversed for positively stated items. The range of scores for each scale is 20 to 80, with higher scores indicating greater anxiety. Extensive normative data are available, stratified by age and subdivided by setting (employed adults, college students, high school students, military recruits). The

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STAI has received extensive service in research, and also is used in health-related clinical applications such as gauging anxiety in pregnant women (Gunning, Denison, Stockley, and others, 2010 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib673) ), monitoring improvement in psychotherapy patients (Vautier & Pohl, 2009 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1692) ), and detecting mental disorder in elderly patients (Kvaal, Ulstein, Nordhus, & Engedal, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib934) ).

State anxiety fluctuates in response to environmental circumstances and may change even from hour to hour. Therefore, we can expect that test–retest reliability will be lower for state anxiety than for trait anxiety. This is precisely what researchers find, with short-range reliability in the .40s and .50s for the A- State scale and in the high .80s for the A-Trait scale (Rule & Traver, 1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1417) ; Spielberger et al., 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1537) ). Internal consistency of the scale is excellent, with Cronbach’s alpha of .86 for the total score in a sample of medical patients (Quek, Low, Razack, Loh, & Chua, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1329) ). Individual alpha values for A-State and A-Trait are robust as well, with results of .95 and .93, respectively, in a sample of 567 patients treated at an anxiety disorders clinic (Grös, Antony, Simms, & McCabe, 2007 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib655) ).

The validity of the STAI is well established from dozens of studies demonstrating content validity, convergent/discriminant validity, and construct validity (Spielberger, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1534) ). In a factor- analytic study of scores for 205 patients with panic disorder, Oei, Evans, and Crook (1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1248) ) found that a two- factor oblique solution was the best fit, accounting for 41 percent of the variance. Notably, 18 of the A- State items revealed salient loadings on factor 1 (state anxiety) and all 20 of the A-Trait items showed prominent loadings on factor 2 (trait anxiety). In sum, the STAI is a brief, reliable, and valid measure of state and trait anxiety. The measure is a mainstay for clinicians and researchers.

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8.13 FACTOR-ANALYTICALLY DERIVED INVENTORIES

Eysenck Personality Questionnaire The Eysenck Personality Questionnaire (EPQ) was designed to measure the major dimensions of normal and abnormal personality (Eysenck & Eysenck, 1975 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib477) ). Based on a lifelong program of factor-analytic questionnaire research and laboratory experiments on learning and conditioning, Eysenck isolated three major dimensions of personality: Psychoticism (P), Extraversion (E), and Neuroticism (N). The EPQ consists of scales to measure these dimensions and also incorporates a Lie (L) scale to assess the validity of an examinee’s responses. The EPQ contains 90 statements answered “yes” or “no” and is designed for persons aged 16 and older. A Junior EPQ containing 81 statements is suitable for children ages 7 to 15.

Items on the P scale resemble the following:

Do you often break the rules? (T) Would you worry if you were in debt? (F) Do you take risks just for fun? (T)

High scores on the P scale indicate aggressive and hostile traits, impulsivity, a preference for liking odd or unusual things, and empathy defects. Antisocial and schizoid patients often obtain high scores on this dimension. In contrast, low scores on P foretell more desirable characteristics such as empathy and interpersonal sensitivity. Items on the E scale resemble the following:

Do you like to meet new people? (T) Are you quiet when with others? (F) Do you like lots of excitement? (T)

High scores on the E scale indicate a loud, gregarious, outgoing, fun-loving person. Low scores on the E scale indicate introverted traits such as a preference for solitude and quiet activities. Items on the N scale resemble the following:

Are you a moody person? (T) Do you feel that life is dull? (T) Are your feelings easily hurt? (T)

The N scale reflects a dimension of emotionality that ranges from nervous, maladjusted, and overemotional (high scores) to stable and confident (low scores).

The reliability of the EPQ is excellent. For example, the one-month test–retest correlations were .78 (P), .89 (E), .86 (N), and .84 (L). Internal consistencies were in the .70s for P and the .80s for the other three scales. The construct validity of the EPQ is also well established through dozens of studies using behavioral, emotional, learning, attentional, and therapeutic criteria (reviewed in Eysenck & Eysenck, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib478) ). Friedman (1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib546) ) provides a short but thorough introduction to other sources on the EPQ.

A major focus of research with the EPQ has been on the empirical correlates of extraversion (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss109) and its polar

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opposite, introversion (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss167) . Eysenck and Eysenck (1975 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib477) ) describe the typical extravert as follows:

The typical extravert is sociable, likes parties, has many friends, needs to have people to talk to, and does not like reading or studying by himself. He craves excitement, takes chances, often sticks his neck out, acts on the spur of the moment, and is generally an impulsive individual.

They describe the typical introvert as follows:

The typical introvert is a quiet, retiring sort of person, introspective, fond of books rather than people; he is reserved and distant except to intimate friends. He tends to plan ahead, “looks before he leaps,” and mistrusts the impulse of the moment.

Eysenck and his followers have linked a number of perceptual and physiological factors to the extraversion/introversion dimension. Because of space limitations, we can only list representative findings here:

Introverts are more vigilant in watchkeeping. Introverts do better at signal-detection tasks. Introverts are less tolerant of pain but more tolerant of sensory deprivation. Extraverts are more easily conditioned to stimuli associated with sexual arousal. Extraverts have a greater need for external stimulation.

Aiken (1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib13) ) summarizes additional research on the real-world correlates of the EPQ extraversion/introversion dimension.

In general, the technical characteristics of the EPQ are very strong, certainly stronger than found in most self-report inventories. The practical utility of the instrument is supported by voluminous research literature. Nonetheless, the EPQ has never caught on among American psychologists, who seem enamored of multiphasic instruments that produce 10, 20, or 30 scores, not a simple trio of basic dimensions.

Comrey Personality Scales For practitioners who desire a short self-report inventory suitable for college students and other adults, the Comrey Personality Scales (Comrey, 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib330) , 1980 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib332) , 2008 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib333) ) would be a good choice. As a protégé of Guilford, Comrey pursued a factor-analytic strategy in developing his 180-item test. Comrey relied exclusively upon college students in the development and standardization of his test, so the CPS is well suited to assessment of personality in this subpopulation.

A special virtue of the CPS is its brevity. Consisting of 180 statements, the test is only one-third as long as competing instruments such as the MMPI-2. The eight CPS personality scales consist of 20 items each, divided equally between positively and negatively worded statements. Another 20 items are devoted to a validity check and the assessment of social desirability response bias.

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The following description of CPS scales is based upon Merenda (1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1132) ) and Comrey (1995 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib329) , 2008 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib333) ):

(V) Validity Check. A score of 8 is the expected raw score. Any score on the V scale that gives a T- score equivalent below 70 is still within the normal range, however. Higher scores are suggestive of an invalid record. (R) Response Bias. High scores indicate a tendency to answer questions in a socially desirable way, making the respondent look like a “nice” person. (T) Trust versus Defensiveness. High scores indicate a belief in the basic honesty, trustworthiness, and good intentions of other people. (O) Orderliness versus Lack of Compulsion. High scores are characteristic of careful, meticulous, orderly, and highly organized individuals. (C) Social Conformity versus Rebelliousness. Individuals with high scores accept society as it is, resent nonconformity in others, seek the approval of society, and respect the law. (A) Activity versus Lack of Energy. High-scoring individuals have a great deal of energy and endurance, work hard, and strive to excel. (S) Emotional Stability versus Neuroticism. High-scoring persons are free from depression, optimistic, relaxed, stable in mood, and confident. (E) Extraversion versus Introversion. High-scoring individuals meet people easily, seek new friends, feel comfortable with strangers, and do not suffer from stage fright. (M) Mental Toughness versus Sensitivity. High-scoring individuals tend to be rather tough-minded people who are not bothered by blood, crawling creatures, vulgarity, and who do not cry easily or show much interest in love stories. (P) Empathy versus Egocentrism. High-scoring individuals describe themselves as helpful, generous, sympathetic people who are interested in devoting their lives to the service of others.

Reflecting its careful factor-analytic derivation, the CPS scales possess exceptional internal consistencies, which range from .91 to .96. These findings indicate that the CPS is most likely a reliable test, but traditional test–retest data are scant. Cross-cultural studies with the CPS are highly supportive of its validity. Brief and Comrey (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib218) ) report that the eight-factor solution to CPS item responses is found in factor analyses with Russian, U.S., Brazilian, Israeli, Italian, and New Zealand samples. Other validational studies with the CPS are not straightforward in their interpretation. On the one hand, the correlations between CPS scale scores and personality-relevant biographical data are very small (Comrey & Backer, 1970 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib330) ; Comrey & Schiebel, 1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib335) ). On the other hand, extreme scores on the CPS scales are strongly associated with psychological disturbance (Comrey & Schiebel, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib336) ). This is particularly true for low scores on Trust versus Defensiveness, Activity versus Lack of Energy, Emotional Stability versus Neuroticism, Extraversion versus Introversion, and high scores on Orderliness versus Lack of Compulsion. Shen and Comrey (1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1490) ) describe the utility of the CPS with medical students, showing that the test is a reasonable predictor of clinical performance and personal suitability. In general, reviewers conclude that the CPS is a promising test that needs updated standardization and additional documentation on its technical qualities. Comrey (1995

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib329) ) summarizes validity studies of his test.

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8.14 CRITERION-KEYED INVENTORIES The final self-report inventories that we will review embody a criterion-keyed test development strategy. In a criterion-keyed approach, test items are assigned to a particular scale if, and only if, they discriminate between a well-defined criterion group and a relevant control group. For example, in devising a self-report scale for depression, items endorsed by depressed persons significantly more (or less) frequently than by normal controls would be assigned to the depression scale, keyed in the appropriate direction. A similar approach might be used to develop scales for other constructs of interest to clinicians such as schizophrenia, anxiety reaction, and the like. Notice that the test developer does not consult any theory of schizophrenia, depression, or anxiety reaction to determine which items belong on the respective scales.

The essence of the criterion-keyed procedure is, so to speak, to let the items fall where they may.4

(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08fn04)

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) First published in 1943, the MMPI was a 566-item true–false personality inventory designed originally as an aid in psychiatric diagnosis (Hathaway & McKinley, 1940 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib715) , 1943 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib717) ; McKinley & Hathaway, 1940 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1105) , 1944 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1106) ; McKinley, Hathaway, & Meehl, 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1107) ). The test authors followed a strict empirical keying approach in the construction of the MMPI scales. The clinical scales were developed by contrasting item responses of carefully defined psychiatric patient groups (average N of about 50) with item responses of 724 control subjects. The result was a remarkable test useful both in psychiatric assessment and the description of normal personality. Within a few years, the MMPI became the most widely used personality test in the United States.

At first the MMPI aged gracefully; what appeared to be minor flaws were tolerated by practitioners. But as the MMPI reached middle age, the need for rejuvenation became increasingly obvious. The most serious problem was the original control group, which consisted primarily of relatives and visitors of medical patients at the University of Minnesota Hospital. The narrow choice of control subjects, tested mainly in the 1930s, proved to be a persistent source of criticism for the MMPI. All of the control subjects were white, and most were young (average age about 35), married, and from a small town or rural area. This was a sample of convenience that was significantly unrepresentative of the population at large.

The item content of the MMPI also raised concerns (Graham, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib639) ). Several items used archaic and obsolete terminology, referring to “drop the handkerchief” (a parlor game from the 1930s), sleeping powders (sleeping pills), and streetcars (electric-powered buses). Other items used sexist language. Examinees found some items objectionable, especially those dealing with Christian religious beliefs. These items were the source of occasional lawsuits alleging invasion of privacy. Finally, a few items dealing with bowel functions and sexual behavior were just downright offensive.

From the standpoint of measurement, a more serious problem with item content was that of omission. The MMPI item pool was not broad enough to assess many important characteristics, including suicidal tendencies, drug abuse, and treatment-related behaviors. An additional motive for MMPI revision was to extend the range of item coverage.

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The MMPI-2 was released in 1989 after nearly a decade of revision and restandardization. The new, improved MMPI-2 incorporates a contemporary normative sample of 2,600 individuals who are loosely representative of the general population on major demographic variables (geographic location, race, age, occupational level, and income). Although higher educational levels are overrepresented, the MMPI-2 normative sample is still a vast improvement over the MMPI normative sample. The item pool has been significantly improved by revision of obsolete items, deletion of offensive items, and addition of new items to extend content coverage.

The MMPI-2 is a significant improvement upon the MMPI, but maintains substantial continuity with its esteemed predecessor. The test developers retained the same titles and measurement objectives for the traditional validity and clinical scales. The restandardization provides a better calibration for scale elevations, a much-needed improvement (Tellegen & Ben-Porath, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1623) ). Although dozens of items were rewritten, most of these revisions are cosmetic and do not affect the psychometric characteristics of the test (Ben-Porath & Butcher, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib137) ). In fact, when large samples of subjects complete the MMPI and the MMPI-2, scores on the individual validity and clinical scales typically correlate near .99.

The MMPI-2 consists of 567 items carefully designed to assess a wide range of concerns. The examinee is asked to mark “true” or “false” for each statement as it applies to himself or herself. Most of the items are self-referential. The items encompass a wide variety of mainly pathological themes (Dahlstrom, Welsh, & Dahlstrom, 1972; Graham, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib639) ).

The MMPI requires a sixth-grade reading level and is completed by most persons in 1 to 1½ hours.

The original MMPI scales were developed by contrasting item responses of carefully defined psychiatric patient groups (average N of about 50) with item responses of about 700 controls. The psychiatric patient groups included the following diagnostic categories: hypochondriasis, depression, hysteria, psychopathy,

male homosexuality, paranoia, psychasthenia,5

(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08fn05) schizophrenia, and the early phase of mania (hypomania). In addition, samples of socially introverted and socially extraverted college students were used to construct a scale for social introversion. The MMPI-2 retains the basic clinical scales with only minor item deletions and revisions. Ben-Porath and Butcher (1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib137) ) investigated the characteristics of the rewritten items on the MMPI-2 and discovered that they are psychometrically equivalent to the original items.

The MMPI-2 can be scored for four validity scales, 10 standard clinical scales, and dozens of supplementary scales. In practice, clinicians place the greatest emphasis upon the validity and standard clinical scales. The supplementary scales are just that—supplementary. They provide information helpful in fine-tuning the interpretation of the traditional validity and clinical scales. MMPI-2 scale raw scores are converted to T scores, with a mean of 50 and a standard deviation of 10. Scores that exceed T of 65 merit special consideration. These elevated scores are statistically uncommon in the general population and may signify the presence of psychiatric symptomatology. We will concentrate upon the traditional scales here, beginning with a review of the four validity scales, known as Cannot Say (or ?), L, F, and K.

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The Cannot Say score is simply the total number of items omitted or double-marked in completion of the answer sheet. The instructions for the test encourage examinees to mark all items, but omissions or double-marked items will occur. However, this is rare—the modal number of items omitted is zero (Tamkin & Scherer, 1957 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1609) ). Omission of up to 10 items appears to have little effect on the overall test results—one of the benefits of having a huge pool of statements in the MMPI-2. A very high score on this scale may indicate a reading problem, opposition to authority, defensiveness, or indecisiveness caused by depression.

The L Scale is composed of 15 items all scored in the false direction. By answering “false” to L Scale items, the examinee asserts that he or she possesses a degree of personal virtue that is rarely observed in our culture (e.g., never gets angry, likes everyone, never lies, reads every newspaper editorial, and would rather lose than win). The L Scale was designed to identify a general, deliberate, evasive test-taking attitude. A high score on the L Scale indicates that the examinee is not only defensive, but naively so. Persons with any degree of psychological sophistication can adopt a defensive test-taking attitude and still score in the normal range on the L Scale.

The F Scale consists of 60 items answered by normal subjects in the scored direction no more than 10 percent of the time. These items reflect a broad spectrum of serious maladjustment, including peculiar thoughts, apathy, and social alienation. Even though F Scale items seem to indicate psychiatric pathology, they are seldom endorsed by patients. Fewer than 50 percent of these items appear on the clinical scales. Many persons with significant psychiatric disturbance do produce elevated scores in the range of T =70 or 80 on the F Scale. On the other hand, exceptionally high scores suggest additional hypotheses: insufficient reading ability, random or uncooperative responding, a motivated attempt to “fake bad” on the test, or an exaggerated “cry for help” in a distressed client.

The K Scale was designed to help detect a subtle form of defensiveness. The 30-item scale is composed, in part, of 22 items that differentiated normal profiles produced by defensive hospitalized psychiatric patients from those produced by normal controls. Additionally, eight items that improved discrimination of depressive and schizophrenic symptoms were added (McKinley, Hathaway & Meehl, 1948 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1107) ). An elevated score on the K Scale may indicate a defensive test-taking attitude. Normal range elevations on the K Scale suggest good ego strength—the presence of useful psychological defenses that allow the person to function well in spite of internal conflict.

The combined use of F and K may be useful in the detection of MMPI-2 profiles that have been faked or malingered. In one study, 81 percent of fake-good profiles were identified by a simple decision rule (using raw scores) of F−K < −12, whereas 87 percent of fake-bad profiles were identified by a simple decision rule (using raw scores) of F–K > 7 (Bagby, Rogers, Buis, & Kalemba, 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib75) ).

Several clinical scales are “K-corrected” to improve their discriminatory power. The rationale for this practice is that elevations on K betoken an artificial reduction of scores on these clinical scales. Portions of the raw score on K are thus added to these clinical scale scores prior to computation of the T scores. The K-corrected scales, discussed later, include Hypochondriasis, Psychopathic Deviate, Psychasthenia, Schizophrenia, and Hypomania. Whether K correction actually improves the MMPI-2 is debatable, but the test publishers continued the tradition from the MMPI for the sake of continuity. Separate norms for non- K-corrected scale score transformations are also available.

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In addition to the validity scales, the MMPI-2 is always scored for 10 clinical scales. With the exception of Social Introversion, these clinical scales were constructed in the usual criterion-keyed manner by contrasting responses of clinical subjects and normal controls. As noted previously, Social Introversion was developed by contrasting the responses of college students high and low in social introversion. The 10 clinical scales and common interpretations of elevated scores are outlined in Table 8.6 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08tab6) .

Dozens of supplementary scales can also be scored on the MMPI-2. Some of the supplementary scales are based upon rational identification of symptom clusters and subsequent scale purification by empirical means. Fifteen useful MMPI-2 Content Scales were developed in this manner (Butcher, Graham, Williams, & Ben-Porath, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib247) ). Many of the supplementary scales were developed by independent investigators; these scales vary widely in quality. In practice, only about 30 of the additional scales are routinely scored. Examples of the supplementary scales include Anxiety, Repression, Ego Strength, and the MacAndrew Alcoholism Scale-Revised. Anxiety (A) and Repression (R) are the first two major factors that always emerge from factor analysis of MMPI-2 responses. An interesting supplementary scale is Barron’s (1953 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib99) ) Ego Strength (Es) Scale, which purports to predict positive response to psychotherapy. However, not all studies confirm this use of the scale (Graham, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib638) ). The MacAndrew Alcoholism Scale-Revised (MAC-R; MacAndrew, 1965 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1024) ) is a useful index of alcohol or other substance abuse. The MAC-R is not only useful in assessment of alcoholism but is also helpful in the identification of heavy drinkers and drug-dependent individuals (Wolf, Schubert, Patterson, Grande, & Pendleton, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1777) ). We cannot possibly review all the useful supplementary scales here. The interested reader should consult Butcher and Williams (1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib244) ) and Graham (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib639) ).

TABLE 8.6 The 10 Clinical Scales from the Minnesota Multiphasic Personality Inventory-2

Scale No. and Abbreviation Scale Name

K Correction Typical Interpretation of Elevation

1  Hs Hypochondriasis .5K Excessive physical preoccupation

2  D  Depression   Sad feelings, hopelessness

3  Hy Hysteria   Immaturity, use of repression, denial

4  Pd Psychopathic deviate

.4K Authority conflict, impulsivity

5  Mf Masculinity- femininity

  Masculine interests [women], feminine interests [men]

6  Pa Paranoia   Suspiciousness, hostility

7  Pt Psychasthenia 1K Anxiety and obsessive thinking

8  Sc Schizophrenia 1K Alienation, unusual thought processes

9  Ma Hypomania .2K High energy, possible agitation

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Scale No. and Abbreviation Scale Name

K Correction Typical Interpretation of Elevation

0  Si Social introversion   Shyness and introversion

MMPI-2 Interpretation The interpretation of an MMPI-2 profile can proceed along two different paths: scale by scale or configural. In the simplest possible approach, scale by scale, the examiner determines the validity of the test, as discussed previously, by inspecting the four validity scales. If the test appears reasonably valid by these criteria, the examiner consults a relevant resource book and proceeds scale by scale to produce a series of hypotheses. For example, Lachar (1974 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib939) ) has distilled the meaning of various elevations on the Pa or Paranoia scale as follows:

T = 27–44 examinee may be stubborn, touchy, or difficult T = 45–59 no undue sensitivity and adequate regard for others T = 60–69 increasing probability of rigidity and oversensitivity T = 70–79 rigid, touchy, projects blame and hostility T = 79–100 frankly delusional paranoid features may be present

The configural approach to MMPI-2 interpretation is somewhat more complicated and consists of classifying the profile as belonging to one or another loosely defined code type that has been studied extensively. Code types are usually defined by a combination of elevation (two or more clinical scales elevated beyond a certain criterion) and definition (two or more clinical scales clearly standing out from the others). For example, in its full-blown manifestation, the 4–9 code type can be defined by a valid profile in which scale 4 (Psychopathic Deviate) and scale 9 (Hypomania) are the high-point elevations, both exceed T of 65 (elevation), and both exceed the next highest clinical scale by at least 5 T-score points (definition). Here is how Graham (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib639) ) describes persons who fit this code type:

The most salient characteristics of 49/94 individuals is a marked disregard for social standards and values. They frequently get in trouble with the authorities because of antisocial behavior. They have a poorly developed conscience, easy morals, and fluctuating ethical values. Alcoholism, fighting, marital problems, sexual acting out, and a wide array of delinquent acts are among the difficulties in which they may be involved. This is a common code type among persons who abuse alcohol and other substances.

The most likely diagnosis for such individuals is antisocial personality disorder.

We should mention briefly that several computerized interpretation systems are available for the MMPI and the MMPI-2 (Fowler, 1985 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib526) ; Butcher, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib242) ). The Minnesota Report™ (Butcher, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib239) ) is the best. This system generates a very cautious and methodical 16-page report that includes discussion of profile validity, symptomatic patterns, interpersonal relations, diagnostic considerations, and treatment considerations. The Minnesota Report™ also provides a variety of figures and tables to illustrate test results.

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The adequacy of computerized MMPI-2 narrative reports is generally good, but the reader should realize that computer programs are written by fallible human beings. There is a danger that computer-generated test reports will be erroneous. Furthermore, some less-reputable interpretive systems can be purchased on microcomputer diskette for a few hundred dollars. This increases the risk that computer-based test interpretations will be misused by unqualified persons. We discuss the pitfalls of computerized test interpretation in the final chapter of the book.

Technical Properties of the MMPI-2 From the standpoint of traditional psychometric criteria, the MMPI-2 presents a mixed picture. Reliability data are generally positive, with median internal consistency coefficients (alpha) typically in the .70s and .80s, but as low as the .30s for some scales in some samples. One-week test–retest coefficients range from the high .50s to the low .90s, with a median in the .80s (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib246) ). These are good figures considering that some attributes—such as those measured by the Depression scale —change so quickly that the test–retest methodology is of questionable suitability.

A shortcoming of the MMPI-2 is that inter-correlations among the clinical scales are extremely high. For example, in the case of scales 7 and 8, the Psychasthenia and Schizophrenia scales, the correlation is commonly in the .70s. In part, this reflects the item overlap between MMPI scales—scales 7 and 8 share 17 items in common. But it is also true that the criterion-keyed approach is not well suited to the development of independent measures. A high inter-correlation of basic scales is one price to be paid for using this test development strategy.

The validity of the MMPI-2 is difficult to summarize, owing to the sheer volume of research on this instrument and its predecessor, the MMPI. As of 1975, over 6,000 studies employing the MMPI had been completed (Dahlstrom, Welsh, & Dahlstrom, 1975 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib385) ). Of course, thousands of additional studies have been published since then. Graham (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib639) ) provides a brief but excellent review of validity studies on the MMPI/MMPI-2. He notes that the average validity coefficient for MMPI studies conducted between 1970 and 1981 was a healthy .46. He also points out the confirming pattern of extratest correlates in dozens of studies of identified patient groups. Research also indicates that the MMPI-2 is highly comparable to the MMPI, for which a substantial body of validity data has been compiled (Hargrave, Hiatt, Ogard, & Karr, 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib704) ). Finally, bias studies comparing MMPI-2 results for Caucasian and African American clients indicate that slight racial differences do exist in average profiles. However, these differences validly reflect emotional functioning; that is, the MMPI-2 is not racially biased (McNulty, Graham, Ben-Porath, & Stein, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1110) ). The MMPI-2 likely will maintain its status as the premiere instrument for assessment of psychopathology in adulthood for many years to come.

In 2008, a new version of the MMPI-2 with reduced length and restructured scales was released (Ben- Porath & Tellegen, 2008 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib138) ; Tellegen & Ben- Porath, 2008 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1624) ). Because it embodies a restructured format (RF), the recent entry is called the MMPI-2-RF. This innovative test comprises 338 items carefully selected from the original 567 items of the MMPI-2, using modern psychometric methods for scale construction. Certainly the reduced length is a potential advantage.

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Patients often tire when completing the MMPI-2, and some find the experience tedious and onerous. Even so, the MMPI-2-RF constitutes a dramatic departure from the parent instrument and is therefore really a new test (Butcher, 2011 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib241) ). The utility of the MMPI-2-RF will rest upon accumulated research in the coming years.

TABLE 8.7 Scales of the Millon Clinical Multiaxial Inventory-III

Clinical Personality Patterns Clinical Syndromes

1 Schizoid A Anxiety

2A Avoidant H Somatoform

2B Depressive N Bipolar: Manic

3 Dependent D Dysthymia

4 Histrionic B Alcohol Dependence

5 Narcissistic R Post-Traumatic Stress Disorder

6A Antisocial    

6B Aggressive (Sadistic) Severe Syndromes

7 Compulsive SS Thought Disorder

8A Passive-Aggressive (Negativistic) CC Major Depression

8B Self-Defeating PP Delusional Disorder

Severe Personality Pathology Validity (Modifying) Indices

S Schizotypal X Disclosure

C Borderline Y Desirability

P Paranoid Z Debasement

Millon Clinical Multiaxial Inventory-III (MCMI-III) The MCMI-III is a personality inventory designed for the same purposes as the MMPI-2, namely, to provide useful information for psychiatric diagnosis (Millon, 1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1155) , 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1157) , 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1158) ). The MCMI-III has two advantages over the MMPI-2. First, it is much shorter (175 true–false items) and, therefore, more palatable to clinical referrals; second, it is planned and organized to identify clinical patterns in a manner that is compatible with the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association.

The MCMI-III is a highly theory-driven test, incorporating Millon’s elaborate theoretical formulations on the nature of psychopathology and personality disorder (Millon, 1969 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1153) , 1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1154) , 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1156) ; Millon & Davis, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1159) ). The test includes 27 scales, listed in Table 8.7 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08tab7) . The first 11 scales measure personality styles or traits such as narcissism and antisocial tendencies; the next three

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assess more severe personality pathology (schizotypal, borderline, and paranoid disorders); the following seven scales assess clinical syndromes such as anxiety and depression; the next three scales assess severe clinical syndromes such as thought disorder; the last three scales are validity (response style) indices. Scores on these scales (Disclosure, Desirability, and Debasement) are used to adjust the other scale scores upward or downward, based on defensiveness or exaggeration of symptoms, respectively.

Scale development for the MCMI-III and its precursors was careful and methodical. We can only portray the broad outline here, in which 3,500 initial items were culled to 175 statements in three stages of test development: a theoretical-substantive stage (theory-guided item writing), an internal-structural stage (item-scale correlations), and an external-criterion stage (contrast of diagnostic groups with the reference group). A special feature of the last stage was Millon’s use of general psychiatric patients instead of normal controls as the reference group. The purpose of this strategy was to enhance the capacity of MCMI scales to differentiate specific diagnostic groups from one another. Unfortunately, one side effect of this particular criterion-keyed approach was a rather substantial degree of item overlap for the clinical scales. Millon planned for and expected the item overlap but probably did not anticipate that some pairs of scales on the MCMI would share the majority of their items in common. Some of this overlap was eliminated with the further refinement of the test for the second and third editions. The revised instrument also incorporates an item-weighting procedure. In this approach, individual questions are weighted 2 or 1 to reflect their importance in discriminating the prototype for each scale. The item-weighting approach has been criticized as unnecessary and unwieldy (Streiner, Goldberg, & Miller, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1588) ).

The normative sample for the MCMI-III consisted of about a thousand men and women patients from across the United States. This is an unusual and controversial approach to the collection of a normative sample. More typically, population-proportionate sampling of reasonably normal individuals is used. Millon offers the arguable justification that a patient sample is adequate for the normative sample because the base rates (in the general population) for specific personality and clinical disorders were consulted to calibrate the cutting points on the individual scales (Millon & Davis, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1159) ). But this approach is complex, experimental, and difficult to understand. The reliability of the individual scales is good: Internal consistency coefficients average .82 to .90, and test–retest coefficients for one week range from .81 to .87. Support for the validity of the MCMI-III is mixed (Haladyna, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib684) ; Piersma & Boes, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1299) ). Craig (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib366) ) has assembled a series of articles that are largely supportive of the MCMI. Jankowski (2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib825) ) provides a beginner’s guide to the test.

Personality Inventory for Children-2 (PIC-2) The PIC-2 (Lachar & Gruber, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib942) ) is a substantial revision of the PIC-R, a popular instrument that dates back to the late 1950s (Wirt & Broen, 1958 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1771) ; Wirt, Lachar, Klinedinst, & Seat, 1984 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1772) ). The current version, suitable for children 5 through 19 years of age, consists of 275 true–false statements that are completed by a parent or parental surrogate. The PIC-2 is one corner of a triad of instruments developed by David Lachar and colleagues to provide a comprehensive, multiview perspective on children’s

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emotional and behavioral adjustment in the home, school, and community. The complementary instruments are the Personality Inventory for Youth (PIY), which is filled out by the child, and the Student Behavior Survey (SBS), which is filled out by the teacher. We discuss only the PIC-2 here. Items on the PIC- 2 resemble the following:

My child finds it difficult to fall asleep. My child is a finicky eater. My child has threatened to kill himself (herself). Sometimes my child swears at other adults. Our marriage has been full of turmoil.

The instrument also provides a shorter 96-item version known as the Behavioral Summary, suitable for screening and research purposes.

The test developers of the PIC-2 followed a complex multistage methodology to assign individual items to scales and subscales. The goal was to minimize content overlap between scales and subscales by examining preliminary item × subscale correlations and then retaining only those items for each specific subscale that showed high correlations. As a consequence of this test development strategy, each subscale possesses homogeneous content and the individual statements correlate substantially with one another. The resulting instrument consists of three response validity scales (Inconsistency, Dissimulation, Defensiveness) and nine adjustment scales. Each of the adjustment scales includes two or three subscales (Table 8.8 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec14#ch08tab8) ).

Scale raw scores are converted to T scores with a mean of 50 and standard deviation of 10. Higher T scores indicated increased probability of psychopathology or deficit. Norms for children ages 5 through 19 years of age are based on a nationally representative sample of 2,306 parents of boys and girls in kindergarten through 12th grade.

With the possible exception of the three validity scales (Inconsistency, Dissimulation, and Defensiveness), the PIC-2 scale and subscale names are self-explanatory. The validity scales are (1) Inconsistency, which includes 35 similar pairs of items to determine consistency of responding; (2) Dissimulation, a 35-item scale designed to identify deliberate exaggeration (fake bad) about symptoms or random responding; and (3) Defensiveness, a 24-item scale consisting of improbable virtues (e.g., “my child never has any problems”) and therefore an index of naive defensiveness.

The reliability of PIC-2 scales and subscales is good, with test–retest values in the range of .82 to .92 and internal consistency coefficients in the range of .81 to .92. The test manual (Lachar & Gruber, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib942) ) summarizes a huge body of criterion-related validity studies such as correlations with independent ratings from clinicians. These correlations are very strong for similar behavioral dimensions (and weak for dissimilar behavioral dimensions), thus supporting the validity of individual scales and sub-scales. In like manner, PIC-2 subscale scores show theory-consistent relationships with the DSM-IV diagnostic categories of clinic- referred children. For example, 63 children independently diagnosed with Oppositional Defiant Disorder showed highly elevated scores (average T scores of 75 to 80) on the following PIC-2 subscales: Disruptive Behavior, Fearlessness, Dyscontrol, and Noncompliance. This is a perfect match to the major clinical features of this DSM-IV diagnostic category. Overall, the test developers have cited an impressive body of research that supports the reliability and validity of their instrument. Although independent studies of this test are yet to be published, it seems clear that the PIC-2 will earn wide usage in the behavioral and emotional assessment of school-aged children.

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TABLE 8.8 Adjustment Scales and Subscales of the Personality Inventory for Children-2

Adjustment Scales Subscales

Cognitive Impairment Inadequate Abilities

Poor Achievement

Developmental Delay

Impulsivity and Distractibility Disruptive Behavior Fearlessness

Delinquency Antisocial Behavior

Dyscontrol

Noncompliance

Family Dysfunction Conflict among Members

Parent Maladjustment

Reality Distortion Developmental Deviation

Hallucinations and Delusions

Somatic Concern Psychosomatic Preoccupation

Muscular Tension and Anxiety

Psychological Discomfort Fear and Worry

Depression

Sleep Disturbance/Death Preoccupation

Social Withdrawal Social Introversion

Isolation

Social Skills Deficits Limited Peer Status

Conflict with Peers

4We are glossing over certain complexities here. Some items reflecting general psychopathology might discriminate all the contrast groups from the control group. The test developer might discard these in favor of items that are differentially discriminating for just one contrast group but not the others.

5This outdated diagnostic term is quite similar to what would now be labeled obsessive-compulsive disorder.

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8.15 BEHAVIORAL ASSESSMENT Behavioral assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss29) concentrates on behavior itself rather than on underlying traits, hypothetical causes, or presumed dimensions of personality. The many methods of behavioral assessment offer a practical alternative to projective tests, self-report inventories, and other unwieldy techniques aimed at global personality assessment.

Typically, behavioral assessment is designed to meet the needs of therapists and their clients in a quick and uncomplicated manner. But behavioral assessment differs from traditional assessment in more than its simplicity. The basic assumptions, practical aspects, and essential goals of behavioral and traditional approaches are as different as night and day. Traditional assessment strategies tend to be complex, indirect, psychodynamic, and often extraneous to treatment. In contrast, behavioral assessment strategies tend to be simple, direct, behavior-analytic, and continuous with treatment.

Behavior therapists use a wide range of modalities to evaluate their clients, patients, and subjects. The methods of behavioral assessment include, but are not limited to, behavioral observations, self-reports, parent ratings, staff ratings, sibling ratings, judges’ ratings, teacher ratings, therapist ratings, nurses’ ratings, physiological assessment, biochemical assessment, biological assessment, structured interviews, semistructured interviews, and analogue tests. In their Dictionary of Behavioral Assessment Techniques, Hersen and Bellack (1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib739) ) list 286 behavioral tests used in widely diverse problems and disorders in children, adolescents, adults, and the geriatric population. Dozens more are referenced in a more recent compendium (Hersen & Bellack, 1998). So that the reader can appreciate the diversity of techniques available, we provide a sampling of these tests in Table 8.9 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec15#ch08tab9) .

In recent years, a new form of behavioral assessment known as ecological momentary assessment has become increasingly popular. In ecological momentary assessment, the client carries a wireless handheld device similar to a personal digital assistant and responds in real time to preplanned inquiries from the researcher. This approach is designed to circumvent a number of limitations of traditional self-report techniques. We discuss ecological momentary assessment in more detail at the end of this chapter.

TABLE 8.9 A Sampling of Behavioral Assessment Tests and Techniques

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Abnormal Involuntary Movement Scale

Alcohol Dependence Scale

Assertiveness Self-Statement Test

Automatic Thoughts Scale

Behavioral Assessment of Satiety

Behavioral Pain Scale

Blood Alcohol Level

Body Sensation Questionnaire

Compulsive Activity Checklist

Conversational Skills Rating Scale

Current Dieting Questionnaire

Dementia Behavioral Assessment Test

Drinking Context Scale

Gifted Behaviors Rating Scale

Goal Attainment Scaling

Health Risk Attitude Scale

Irrational Beliefs Inventory

McGill Pain Questionnaire

Physical Activity and TV Viewing

Physical Fighting—Youth Risk Survey

Pittsburgh Insomnia Rating Scale

Prosocial Behaviors of Children

Rape Trauma Symptom Rating Scale

Scale for the Assessment and Rating of Ataxia

Scale of Sexual Experience

Six Minute Walk Test

Sleep Assessment Scale

Victimization in Dating Relationships

Behavioral assessment is often—but not always—an integral part of behavior therapy (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss28) designed to change the duration, frequency, or intensity of a well-defined target behavior. For example, one therapy goal for a shy college student might be that she initiate a minimum of five conversations lasting two minutes or more each day. The therapist might recommend that she approach this goal incrementally, beginning with a few brief social exchanges before proceeding to lengthier conversations with strangers. In this example,

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behavioral assessment might take the form of self-monitoring in which the student uses a wristwatch for timing and a diary for keeping track of conversations.

As noted, behavioral assessment often exists in service of behavior therapy. In many cases, the nature of behavioral assessment is dictated by the procedures and goals of behavior therapy. For this reason, the reader will better appreciate behavioral assessment tools if we interweave this topic with a discussion of behavior therapy methods.

Behavior therapy, also called behavior modification, is the application of the methods and findings of experimental psychology to the modification of maladaptive behavior (Plaud & Eifert, 1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1309) ). The roots of behavior therapy can be traced to Skinner’s (1953 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1505) ) seminal book, Science and Human Behavior, which detailed the application of operant conditioning to the problems of human behavior. Skinner shunned any reference to private, nonobservable events such as thoughts or feelings; he emphasized the importance of identifying observable behaviors and methodically altering the environmental consequences of those behaviors.

Research by Wolpe (1958 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1780) ) on the systematic behavioral treatment of phobias also was influential in founding the methods of behavior therapy. Wolpe’s clinical procedures were derived from his laboratory work on the conditioning and counter-conditioning of fear in cats. Like Skinner, Wolpe deemphasized the significance of thoughts and beliefs. He viewed fear as a learned phenomenon that could be unlearned by following a strict protocol of graduated exposure to the feared object or situation.

After Skinner, Bandura (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib84) ), Mahoney and Arnkoff (1978 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1031) ), and Meichenbaum (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1120) ) reintroduced cognitive factors into the ever-changing behavioral framework. For example, Bandura (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib84) ) demonstrated that persons are perfectly capable of cognitively based learning. In particular, he showed that individuals can learn from mere observation of the response contingencies experienced by models. Since this learning occurs in the absence of personal consequences, it must be cognitively mediated. As a consequence of this paradigm shift, practically all modern-day behavior therapists concern themselves—at least to some extent—with the thoughts and beliefs of their clients. This new emphasis is reflected in a family of very popular treatment procedures known collectively as cognitive behavior therapy (Hofmann & Reinecke, 2010 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib754) ).

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8.16 BEHAVIOR THERAPY AND BEHAVIORAL ASSESSMENT At present, the specific techniques of behavior therapy can be classified into four overlapping categories (Johnston, 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib844) ): exposure-based methods, cognitive behavior therapies, self-control procedures, and social skills training. Behavioral assessment is used in all of these approaches, as reviewed in the following sections. However, there are relatively few behaviorally based tools for the evaluation of social skills, so this category is not discussed. Readers who desire limited coverage of instruments for the behavioral evaluation of social skills training (including assertiveness) should consult Meier and Hope (1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1122) ).

Exposure-Based Methods Exposure-based methods of behavioral therapy are well suited to the treatment of phobias, which include intense and unreasonable fears (e.g., of spiders, blood, public speaking). One approach to phobic avoidance is systematic exposure of the client to the feared situation or object. Wolpe (1973 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1781) ) favored gradual exposure with minimal anxiety in a procedure known as systematic desensitization. In this therapeutic approach, the client first learns total relaxation and then proceeds from imagined exposure to actual or in vivo exposure to the feared stimulus. Another exposure-based method is flooding or implosion in which the client is immediately and totally immersed in the anxiety-inducing situation.

The therapist needs some type of behavioral assessment to gauge the continuing progress of a client undergoing an exposure-based treatment for a phobia. In the simplest possible assessment approach, known as a behavioral avoidance test (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss30) (BAT), the therapist measures how long the client can tolerate the anxiety-inducing stimulus. Here is one classic example of a standardized BAT used to evaluate patients with agoraphobia, a disabling fear of open spaces often accompanied by panic attacks:

The standardized Behavioral Avoidance Test (BAT) was conducted a week after intake. All anxiolytics, antidepressants, or other psycho-tropic medication had been taken away at least 4 days before the test. The test was administered by the first author, who was blind to the patients’ diagnoses [and] not involved in the treatment. The patients were asked to walk alone as far as they could from the hospital along a mildly trafficated road that was 2 km long. The route was divided into eight intervals of equal length, and the patients rated their anxiety level on a 0–10 scale at the end of each interval. Uncompleted intervals were given a score of 10. An avoidance-anxiety score was computed by summing the anxiety scores for all intervals. (Hoffart, Friis, Strand, & Olsen, 1994 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib752) )

The researchers discovered that the avoidance-anxiety score from the BAT technique was strongly related to self-reports of catastrophic thoughts (e.g., choking to death, having a heart attack, acting foolish, becoming helpless). This finding illustrates that behavioral assessment approaches often encompass a cognitive component as well. Notice, too, the direct relationship between the goal of therapy and the behavioral avoidance test. In agoraphobia, the primary treatment goal is to reduce patients’ anxiety about walking alone in open spaces—which is exactly what the BAT measures.

The BAT approach is predicated on the reasonable assumption that the client’s fear is the main determinant of behavior in the testing situation. Unfortunately, demand characteristics for desirable

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behavior may exert a strong influence on the client’s behavior. The client’s tolerance of the anxiety- inducing stimulus will bear some relationship to experienced fear but also has much to do with the situational context of assessment (McGlynn & Rose, 1998 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1092) ). The results of BAT assessments may not generalize, and the therapist must be wary of foreclosing treatment too soon.

A fear survey schedule (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss118) is another type of behavioral assessment useful in the identification and quantification of fears. Fear survey schedules are face valid devices that require respondents to indicate the presence and intensity of their fears in relation to various stimuli, typically on a 5- or 7-point Likert scale. Dozens of these instruments have been published, including versions by Wolpe (1973 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1781) ), Ollendick (1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1253) ), and Cautela (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib287) ). Tasto, Hickson, and Rubin (1971 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1613) ) used factor analysis to develop a 40-item survey that yields a profile of fear scores in five categories. A generic fear survey schedule is shown in Table 8.10 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec16#ch08tab10) . Fear survey schedules are often used in research projects to screen large samples of persons in search of subjects who share a common fear. Another use of these schedules is to monitor changes in fears, including those that have been targeted for clinical intervention.

Klieger and Franklin (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib898) ) have raised a number of cautions about the use of fear survey schedules in clinical research. These authors note that reliability data for fear surveys are almost nonexistent. A more serious problem has to do with the validity of these instruments. Using the Wolpe and Lang (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1782) ) Fear Survey Schedule-III (FSS-III), a highly respected and widely used schedule, Klieger and Franklin (1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib898) ) found no relationship between reported fears on the FSS-III and BAT measures of the same fears. For example, subjects who reported a high fear of blood on the FSS-III were just as likely to approach a bloody white towel and touch it as were subjects who reported no fear of blood. Similar results were found for subjects who feared snakes, spiders, and fire. The researchers concluded that the FSS-III and similar instruments are a poor choice for identifying experimental groups and a poor basis for measuring the outcome of therapeutic interventions. The essential downfall seems to be that fear survey schedules possess such “obvious” validity that few researchers have bothered to evaluate the traditional psychometric characteristics of reliability and validity. Fear survey schedules should be used with caution.

Cognitive Behavior Therapies The one factor common to all cognitive behavior therapies is an emphasis on changing the belief structure of the client. The three best-known variants of cognitive behavior therapy (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss53) are Ellis’s (1962 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib455) ) rational emotive therapy (RET), Meichenbaum’s (1977 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1120) ) self-instructional training, and Beck’s (1976

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib114) ) cognitive therapy. Ellis postulates that most disturbed behavior is caused by irrational beliefs, such as the widespread belief that one must have the love and approval of all significant persons at all times. Ellis attempts to alter such core irrational beliefs, primarily by logical argument and forceful exhortation. Meichenbaum’s self- instructional technique consists of teaching the client to use coping self-statements to combat stressful situations. For example, a college student suffering from intense test-taking anxiety might be taught to use the following self-talk during examinations: “You have a strategy this time. . . . Take a deep breath and relax. . . . Just answer one question at a time. . . .” Beck’s cognitive therapy concentrates mainly on the role of cognitive distortions in the maintenance of depression and other emotional disturbances. Beck (1983 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib115) ) regards depression as primarily a cognitive disorder characterized by the negative cognitive triad: a pessimistic view of the world, a pessimistic self-concept, and a pessimistic view of the future. In therapy, he uses a gentle form of cognitive restructuring to help the client perceive his or her problems in alternative, solvable terms.

TABLE 8.10 Example of a Fear Survey Schedule

Cognitive behavior therapists need not use formal assessment tools in their clinical practice. Typically, these therapists monitor the belief structure of their clients on an informal session-to-session basis. Irrational and distorted thoughts are challenged as they arise during therapy. In the end, the client’s self- report of improvement may constitute the main index of therapeutic success. Nonetheless, several straightforward measures of cognitive distortion are available. We have outlined a few prominent instruments in Table 8.11 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec16#ch08tab11) . These instruments are mainly research questionnaires suitable to the testing of group differences, but not sufficiently validated for individual assessment. Clark (1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib308) ) faults the developers of cognitive distortion questionnaires for premature release of their instruments. In particular, he notes the absence of research on the concurrent and discriminant validity of most self-statement measures. Another problem is that existing questionnaires were designed to validate constructs in research and consequently do not work well in clinical practice.

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TABLE 8.11 Questionnaire Measures of Cognitive Distortion

Anxious Self-Statements Questionnaire (ASSQ) (Kendall & Hollon, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib876) )

Examinee rates how often specific anxious thoughts occurred over the last week. Items are of the form: I can’t stand it anymore. What’s going to happen to me now? I’m not going to make it.

A psychometrically sound instrument, the ASSQ can be used to assess changes in the frequency of anxious self-talk.

Automatic Thoughts Questionnaire (ATQ) (Hollon & Kendall, 1980; Kazdin, 1990 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib872) )

The ATQ is a frequency measure of depression-related cognitions that assesses personal maladjustment, negative self-concept and expectations, low self-esteem, and giving up/helplessness. The 30-item ATQ correlates very well with the MMPI Depression scale and the Beck Depression Inventory (Ross, Gottfredson, Christensen, & Weaver, 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1406) ).

Cognitive Errors Questionnaire (CEQ) (Lefebvre, 1981 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib964) )

The CEQ assesses the degree of maladaptive thinking in general situations and also situations related to chronic low back pain. Discrete vignettes concerning chronic back pain and general scenes are each followed by an illogical dysphoric cognition. The respodent indicates on a 5-point scale how similar the cognition is to the thought he or she would have in the same situation. For example: “You just finished spending three hours cleaning the basement. Your spouse, however, doesn’t say anything about it. You think to yourself, ‘S(he) must think I did a poor job.’” Smith, Follick, Ahern, and Adams (1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1514) ) found that overgeneralization was the specific CEQ cognitive error most consistently correlated with chronic low back pain disability.

Attribution Styles Questionnaire (ASQ) (Seligman, Abramson, Semmel, & Von Baeyer, 1979 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1482) )

The ASQ measures three attributional dimensions relevant to Seligman’s learned helplessness model of depression: internal-external, stable-unstable, and global-specific. Depressed persons attribute bad outcomes to internal, stable, and global causes; they attribute good outcomes to external, unstable causes. The questionnaire consists of 12 hypothetical situations, 6 describing good outcomes, 6 describing bad outcomes (e.g., “You have been looking for a job unsuccessfully for some time”). The respondents rate each vignette on a 7-point scale for degree of internality, stability, and globality.

Hopelessness Scale (HS) (Beck, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib116) ; Dyce, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib445) )

A 20-item true/false scale, the HS is designed to quantify hopelessness, one component of the negative cognitive triad found in depressed persons. (The triad consists of negative views of self, world, and

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future.) The scale is sensitive to changes in the patient’s state of depression. In a validational study, Beck, Riskind, Brown, and Steer (1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib119) ) found that HS scores had a negligible relationship to anxiety or general psychopathology when the influence of coexisting depression was partialed out. Thus, the HS appears to measure a specific attribute of depression rather than general psychopathology.

An exceptional and well-validated measure not listed in Table 8.11 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec16#ch08tab11) is the Beck Depression Inventory (BDI). The BDI is a short, simple, self-report questionnaire that focuses, in part, on the cognitive distortions that underlie depression (Beck & Steer, 1987 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib116) ; Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib120) ). One reason for its popularity is that most patients can complete the 21 items on the BDI in 10 minutes or less. The test has been widely used: More than 1,900 articles using the BDI have been published (Conoley, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib342) ). A second edition of the inventory was released in 1996 (Beck, Steer, & Brown, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib118) ). On the BDI-II, several items were revised so as to bring the inventory into closer conformity with prevailing diagnostic criteria for depression. The 21 items are of the following form:

Check the statement from this group that you feel is most true about you:

0  I am upbeat about the future. 1  I feel slightly discouraged about the future. 2  I feel the future has little to offer for me. 3  I feel that the future is utterly hopeless.

Thirteen items cover cognitive and affective components of depression such as pessimism, guilt, crying, indecision, and self-accusations; eight items assess somatic and performance variables such as sleep problems, body image, work difficulties, and loss of interest in sex. The examinee receives a score of 0 to 3 for each item; the total raw score is the sum of the endorsements for the 21 items; the highest possible score is 63.

In a meta-analysis of BDI research studies, the internal consistency of the scale (coefficient alpha) ranged from .73 to .95, with a mean of .86 in nine psychiatric populations (Beck, Steer, & Garbin, 1988 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib119) ). The BDI-II possesses excellent internal consistency with a coefficient alpha of .92 (Beck, Steer, & Brown, 1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib118) ). Test–retest reliability of the BDI is modest, with a range of .60 to .83 in nonpsychiatric samples and .48 to .86 in psychiatric samples. However, the test–retest methodology is not well suited to phenomena such as depression that are naturally unstable. Subjective depression fluctuates dramatically from week to week, day to day, even hour to hour. A lackluster value for test–retest reliability might signify valid change in the construct being measured rather than unwanted measurement error.

A variety of normative results are available, with BDI data for samples of patients with major depression, dysthymia, alcoholism, heroin addiction, and mixed problems. The manual also provides guidelines for degree of depression based upon BDI score (0 to 9, normal; 10 to 19, mild to moderate; 20 to 29, moderate to severe; 30 and above, extremely severe). These ratings are based upon clinical evaluations of patients.

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The BDI has been extensively validated against other measures of depression and independent criteria of depression. For example, correlations with clinical ratings and scales of depression such as from the MMPI are typically in the range of .60 to .76 (Conoley, 1992 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib342) ). Sex differences are minimal, although there may be slight differences in the expression of depression between men and women (Steer, Beck, & Brown, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1548) ). Large college student samples of Whites (N = 838) and Blacks (N = 139), the BDI-II was found to be free of racial bias (Sashidharan, Pawlow, & Pettibone, 2012 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1436) ). Yet, in a comparison of 218 older patients (M = 69.4 years of age) versus 613 younger patients (M = 37.9 years of age), Kim, Pilkonis, Frank, Thase, and Reynolds (2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib891) ) found strong evidence of differential item functioning. Specifically, older patients tended to report fewer cognitive symptoms, especially for low to average levels of depression, and tended to report more somatic symptoms, especially for high levels of depression. The authors propose revised cut-off scores for the various levels of depression (mild, moderate, and severe) in older patients.

The BDI-II is particularly useful in primary care medical settings, where the presence of significant depression can be overlooked. Many patients are not aware of their illness, and some physicians may not be trained to examine for it. In a sample of 340 medical outpatients, Arnau, Meagher, Norris, and Bramson (2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib61) ) found that 23 percent of the group scored in the range indicative of mild, moderate, or severe depression on the test. The instrument proved helpful in identifying patients with depression who might otherwise be overlooked. Overall, the BDI-II was 92 percent accurate in identifying patients meeting the formal criteria for Major Depressive Disorder.

The only shortcoming of the BDI-II is its transparency. Patients who wish to hide their despair or exaggerate their depression can do so easily. However, for patients who are motivated to accurately report their cognitive and emotional status, the BDI-II ranks among the best instruments for indexing the presence and degree of depression. Some clinicians ask patients to complete the BDI-II after each therapy session; they use the BDI much as a physician might use a thermometer.

Self-Monitoring Procedures A common misconception about behavior therapy is that it consists of authoritarian therapists applying powerful rewards and punishments to passive clients. Although this stereotypical model may be true for some impaired clients with limited behavioral repertoires, for the most part behavior therapy consists of humane practitioners teaching their clients methods of self-control. An emphasis upon self-monitoring is fundamental to all forms of behavior therapy. In self-monitoring (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss289) , the client chooses the goals and actively participates in supervising, charting, and recording progress toward the end point(s) of therapy. According to this model, the therapist is relegated to the status of expert consultant.

Self-monitoring procedures are especially useful in the treatment of depression, a prevalent behavior disorder consisting of sad mood, low activity level, feelings of worthlessness, concentration problems, and physical symptoms (sleep loss, appetite disturbance, reduced interest in sex). Several self-monitoring programs for depression have been reported (Lewinsohn & Talkington, 1979 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib976) ; Rehm, Kornblith, O’Hara, & others, 1981

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(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1345) ). In order to illustrate the self-monitoring approach to the control of depression, we will summarize one small corner of the program advocated by Lewinsohn and his colleagues (Lewinsohn, Munoz, Youngren, & Zeiss, 1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib975) ).

Lewinsohn observed that depression goes hand in hand with a marked reduction in the experiencing of pleasant events. Depressed persons retreat from engaging in pleasant activities; the behavioral withdrawal only contributes further to their depression, inciting a continuous downward spiral. Fortunately, it is possible to replace the downward spiral with an upward one. To help reverse the downward spiral of depression, Lewinsohn and his colleagues devised the Pleasant Events Schedule (PES; MacPhillamy & Lewinsohn, 1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1029) ). The purpose of the PES is twofold. First, in the baseline assessment phase, the PES is used to self-monitor the frequency (F) and pleasantness (P) of 320 largely ordinary, everyday events. Examples of the kinds of events listed on the PES include the following:

reading magazines going for a walk being with pets playing a musical instrument making food for charity listening to the radio reading poetry attending a church service watching a sports event playing catch with a friend working on my job

The frequency and pleasantness of these everyday events are both rated 0 to 2.6

(http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec16#ch08fn06) The mean rate of pleasant activities is then calculated from the sum of the F × P scores; that is, mean rate = F × P/320. Normative findings for mean F, mean P, and mean F × P are reported in Lewinsohn, Munoz, Youngren, and Zeiss (1986 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib975) ) and serve as a basis for treatment planning. Participants in the Lewinsohn program also monitor their daily mood on a simple 1 (worst) to 9 (best) basis.

The second use of the PES is to self-monitor therapeutic progress. Based on the initial PES results, clients identify 100 or so potentially pleasant events and strive to increase the frequency of these events, monitoring daily mood along the way. Clients who increase the frequency of pleasant events generally show an improvement in mood and other depressive symptoms.

The PES is a highly useful tool for clinicians who wish to implement a self-monitoring approach to the assessment and treatment of depression. MacPhillamy and Lewinsohn (1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1029) ) report favorably on the technical qualities of the PES and discuss a variety of rational, factorial, and empirical subscales, which we cannot review here. The instrument has fair to good test–retest reliability (one-month correlations in the range of .69 to .86), excellent concurrent validity with trained observers, and promising construct validity. In general, the subscales behave as one would predict on the basis of the constructs

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they purport to measure—we refer the reader to MacPhillamy and Lewinsohn (1982 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1029) ) for details.

6The Frequency Scale is calibrated as follows: 0—This has not happened in the past 30 days.

1—This has happened a few times (1 to 6 times) in the past 30 days. 2—This has happened often (7 times or more) in the past 30 days.

The Pleasantness Scale is calibrated as follows: 0—This was not pleasant.

1—This was somewhat pleasant. 2—This was very pleasant.

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8.17 STRUCTURED INTERVIEW SCHEDULES An important responsibility for many mental health practitioners is to determine a proper psychiatric diagnosis for their patients, within prevailing guidelines. Almost without exception, practitioners utilize the Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition (DSM-IV; APA, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib33) ). The latest version includes a “Text Revision” and for this reason is known technically as DSM-IV-TR. Here we use the less cumbersome acronym DSM-IV. DSM-V is scheduled for release in 2013.

Five axes are included in the DSM-IV classification. Axis I concerns clinical disorders such as Alcohol Use Disorder, Panic Disorder, Major Depressive Disorder, or Schizophrenia. Axis II pertains to personality disorders such as Borderline Personality Disorder, Avoidant Personality Disorder, or Dependent Personality Disorder. Axis III is employed to identify general medical conditions (e.g., hypothyroidism, heart disease) that may bear upon psychological adjustment. Axis IV is for reporting psychosocial and environmental problems (e.g., loss of friends, unemployment, litigation, no health insurance) that may impact personal functioning. Axis V consists of an anchored rating scale, the Global Assessment of Function (GAF) Scale, used to assign a summary score of functioning from 1 (e.g., immobilized, suicidal) to 100 (e.g., thriving, sought out). Of course, intermediate scores are available and clearly operationalized. For example, a GAF score of 70 indicates some mild symptoms but generally good psychological functioning.

Diagnosis is construed by some people as a form of pointless, overconfident, pigeonholing. In truth, it serves a number of indispensable functions. As outlined by Andreasen and Black (1995 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib52) ), these key purposes include:

Reducing the complexity of clinical phenomena Facilitating communication between clinicians Predicting the outcome of the disorder Deciding on an appropriate treatment Assisting in the search for etiology Determining the prevalence of diseases worldwide Making decisions about insurance coverage

Yet, for all of its advantages, there are also problems with DSM-IV. One problem is the sheer amount of time it can take to determine a multiaxial diagnosis. A second and related difficulty is that, although the DSM-IV textbook describes the diagnostic categories and alternatives with great precision, it does not specify a coherent method for arriving at the diagnosis. A third problem flows from the previous two, namely, psychiatric diagnosis is mixed in its reliability (Andreasen & Black, 1995 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib52) ). Interrater agreement for some diagnoses is very high (e.g., Alcohol Use Disorder) but for other diagnoses it is only moderate to low (e.g., Borderline Personality Disorder).

Several interview schedules have been developed to reduce the time needed for diagnosis and also to improve the reliability of the enterprise by standardizing the procedures. Broadly speaking, these instruments are of two types: semistructured approaches that allow for some clinician leeway in follow- up questioning, and structured approaches that mandate a completely scripted approach. Here we will describe two prominent schedules to illustrate this important form of psychological assessment.

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The Schedule for Affective Disorders and Schizophrenia (SADS; Spitzer & Endicott, 1978 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1538) ) is a highly respected diagnostic interview for evaluating Axis I mood and psychotic disorders. The SADS is a semistructured inquiry that includes standard questions asked of all patients and optional probes used to clarify patient responses (Rogers, Jackson, & Cashel, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1395) ). Additional unstructured questions can be asked to augment the optional probes. Part I of the SADS methodically examines Axis I symptoms for the current episode, including the worst period and the current week, whereas Part II provides a survey of past episodes. Through a progression of questions and criteria, the interviewer solicits sufficient information to assess the severity of disturbance and also to elucidate the diagnosis. For example, one item on the SADS addresses prominent signs of depression: pessimism and hopelessness. A standard inquiry for this item might be: “Have you felt discouraged?” An affirmative answer would trigger optional probes such as “How do you see things working out?”

Rogers (2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1390) ) has reviewed the voluminous research on reliability and validity of the SADS and offers an encouraging endorsement of the instrument. For example, the consensus from over 21 studies is that the interrater reliability for specific diagnoses is typically strong, with median kappa coefficients of greater than .85. Kappa (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss179) is the index of interrater agreement, corrected for chance (Cohen, 1960 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib316) ). Validity for the SADS also is robust with moderate predictive validity (e.g., results moderately predict the course and outcome of mood disorders) and strong concurrent validity (e.g., results correlate with other similar schedules). A child’s version of the schedule, known as the “kiddie” SADS or K-SADS, also is available (Ambrosini, 2000 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib27) ).

Finally, we would be remiss not to mention a family of instruments known as SCID, the Structured Clinical Interview for DSM-IV (First & Gibbon, 2004 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib504) ). SCID comes in numerous editions and variations, including SCID-I for Axis I diagnoses, SCID-II for Axis II diagnoses, SCID-P for determining the differential diagnosis of psychotic symptoms, and SCID-NP for nonpatient settings in which a current psychiatric disorder is unlikely. All of the forms follow the same format in which the interviewer reads the SCID questions to the client in sequence, the objective being to elicit sufficient information to determine whether individual DSM-IV criteria are met. The interviewer has the leeway to ask for specific examples of affirmative answers. Thus, SCID is a semistructured interview. A logical flow sheet is followed to determine the appropriate diagnosis. The SCID reveals generally good interrater agreement for DSM-IV diagnosis, but this is variable from one diagnosis to the other. In Table 8.12 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec17#ch08tab12) , we have summarized the average kappas from multiple studies of SCID reliability. Kappa values above .70 are considered good agreement, values from .50 to .69 are deemed fair, and values below .50 indicate poor agreement.

TABLE 8.12 Average SCID Interrater Agreement for Psychiatric Diagnosis

Axis I Diagnoses Weighted Kappa

Major Depressive Disorder 79

Dysthymic Disorder 63

Bipolar Disorder 77

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Schizophrenia 80

Alcohol Dependence/Abuse 90

Other Substance Dependence/Abuse 86

Panic Disorder 75

Social Phobia 63

Obsessive Compulsive Disorder 53

Generalized Anxiety Disorder 66

Post-Traumatic Stress Disorder 89

Somatoform Disorder 41

Eating Disorder 71

Axis II Personality Disorders  

Avoidant 64

Dependent 66

Obsessive Compulsive 56

Passive-Aggressive 67

Self-Defeating 62

Depressive 65

Paranoid 68

Schizotypal 70

Schizoid 76

Histrionic 64

Narcissistic 74

Borderline 62

Antisocial 72

Note: Decimals omitted.

Source: Average results for multiple studies reported on the SCID website (www.scid4.org (http://www.scid4.org) ).

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8.18 ASSESSMENT BY SYSTEMATIC DIRECT OBSERVATION Although not a prominent approach with adults, systematic and direct observation is widely used in the evaluation of children, especially by psychologists who work in school systems. In fact, Wilson and Reschly (1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1764) ) determined that systematic observation is the single most commonly used assessment method among school-based practitioners, who reported an average of more than 15 student behavioral observations per month.

It is essential to distinguish systematic, direct observation from more casual approaches such as naturalistic observation. Anyone can engage in the informal and anecdotal methods that characterize naturalistic observation—and most people do so every day. These methods typically culminate in formless conclusions such as “Johnny seems to be out of his seat a lot during the school day.” In contrast, systematic and direct observation is highly structured and set apart by five characteristics (Hintze, Volpe, & Shapiro, 2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib749) ; Salvia & Ysseldyke, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1432) ):

1. The goal of observation is to measure specific behaviors. 2. The target behaviors have been operationally defined beforehand. 3. Observations are conducted under objective, standardized procedures. 4. The times and places for observation are carefully specified. 5. Scoring is standardized and does not vary from one observer to another.

This form of assessment is appealing because of its direct link to intervention. In fact, it is common to employ observational assessment before, during, and after an intervention to determine the impact on the individual student.

Commonly, systematic and direct observation is executed by means of an objective, structured coding system. Many different styles of coding systems have been proposed; we have space here only to illustrate a few popular methods. Sattler (2002) provides an extensive review, devoting two chapters to this topic. One straightforward approach is simple frequency counting of target behaviors. Typically, the target behaviors are undesirable behaviors such as a student leaving his or her seat, calling out, or being off task. Of course, the characteristics of these behaviors would be carefully specified in advance. Then an observer sits off to the side and unobtrusively records the frequency of each behavior within discrete time periods. The purpose of this kind of assessment is to objectify the extent of troublesome actions. This information serves as a baseline for later comparison to determine the effectiveness of any interventions. See Figure 8.4 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec18#ch08fig4) for an example. In this hypothetical example, it is evident that the student “Sammy” is more out of control in the afternoon than the morning, which may be valuable information when it comes to remediation planning.

Another approach to systematic, direct observation is to record the duration of target behaviors. Typically, target behaviors are undesirable actions such as temper tantrums, social isolation, or aggressive outbursts, but the focus of assessment also may include desirable behaviors such as staying on task during a designated reading period or vigilantly working on a homework assignment (Hintze, Volpe, & Shapiro, 2002 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib749) ). For some behaviors, duration may be more important than frequency. Consider out-of-seat behavior as an example. A third grader who is out of his seat in a morning for six brief episodes of a few seconds each is far, far less problematic—both to self and others—than a student who leaves his seat once for 10 minutes. See Figure 8.5 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch08lev1sec18#ch08fig5) for an

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example of a duration recording sheet. In this hypothetical example, it is evident that “Susan” exhibits a high level of undesirable behavior. The goal of intervention might be to reduce both the frequency and the average duration of her tantrum behaviors.

FIGURE 8.4 Example of a Frequency Recording Sheet

In addition to the individualized forms of direct observation that we have illustrated here, dozens of published forms also are available (e.g., Sattler, 2002, Chapters 4 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch04#ch04) and 5 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/ch05#ch05) ). For these instruments, the categories of observation and the operational definitions are prespecified, which saves time for the practitioner. For example, Shapiro (1996 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1484) ) has issued the Behavior Observation of Students in Schools (BOSS), a straightforward form that consists of six categories of classroom behavior—five designed for students and one for the teacher. The BOSS classifies behaviors as active engagement, passive engagement, off-task motor, off-task verbal, and off-task passive. Of course, these categories are thoroughly defined in operational terms. Direct instruction by the teacher also is recorded. The BOSS is rated in 15-second intervals for a 15-minute interval. The instrument also allows for the collection of behavioral norms for classmates to determine normative patterns in each category.

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FIGURE 8.5 Example of a Duration Recording Sheet

Although direct observations offer the utmost simplicity in format, it is important to recognize a number of threats to reliability and validity for this genre of assessment (Baer, Harrison, Fradenburg, Petersen, & Milla, 2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib74) ). Sattler (2002) has catalogued the sources of unreliability, which include personal qualities of the observer, poor design of instruments, and problems in obtaining a representative sample of behavior. For example, observer drift (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss226) occurs when an observer becomes fatigued and less vigilant over time, thus failing to notice target behaviors when they occur. Expectations also can influence ratings such as when the observer has been told that a child is aggressive—and then records questionably aggressive acts as aggressive. The primary antidote to observer inaccuracy is careful training and cross-checking of one observer against another to demonstrate a high level of interrater agreement. With regard to poor design of instruments, the most common error is coding complexity (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss51) , in which there are too many categories or ill-defined categories. Attention to design of rating scales and pretesting of instruments will avert this problem. Problems also can arise in the suitable sampling of behavior. For example, if a child’s attentional difficulties mainly arise in the afternoon, clearly it is pointless to collect data only in the morning. Ratings should be collected throughout the day or, if this is not possible, during the most salient time periods.

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8.19 ANALOGUE BEHAVIORAL ASSESSMENT The methods of analogue behavioral assessment are closely related to the methods of systematic, direct observation. The main difference has to do with the settings in which the observations occur. In systematic, direct observation, the assessment of clients takes place in a natural setting such as a classroom. In analogue behavioral assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss12) , clients are observed in a contrived but plausible setting and also are instructed to engage in relevant tasks designed to elicit behaviors of interest (Haynes, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib725) ). The goal is to create a state of affairs analogous to pivotal situations in real life—hence, the use of the word analogue in describing this form of observational assessment.

Perhaps some examples will help clarify the nature and scope of this approach. One application of analogue behavioral assessment is the evaluation of children referred for assessment of behavior or school problems (Mori & Armendariz, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1177) ). A specialist who works with these children could dedicate a separate room in his or her clinic to analogue behavioral assessment. The room might resemble a small classroom, complete with blackboard, a few student desks, and bookcases. The referred child would be given a realistic homework assignment and told to work on it for 30 minutes while waiting for the interview. The psychologist then observes through a one-way window and records relevant behaviors using a suitable rating scale.

Analogue behavioral assessment also can be used to evaluate parent–child interactions. For example, in evaluating a 3-year-old referred for behavior problems, the clinician might place the parent and child in a room full of toys with instructions to play for 10 minutes. The psychologist then instructs the parent to tell the child, “Okay, it’s time to go. You have to pick up the toys just like you do at home.” The clinician observes through a one-way window and codes both the parental management style and the nature and degree of child compliance.

In like manner, analogue behavioral assessment has been used in the assessment of adult couples, including husbands and wives seeking marital therapy (Heyman, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib741) ). In a standard paradigm, the clinician asks the couple to discuss two conflict areas for 5 to 7 minutes each. The clinician sits to the side observing the interactions and recording communication patterns with a standard form such as the Rapid Couples Interaction Scoring System (RCISS; Krokoff, Gottman, & Hass, 1989 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib920) ). The RCISS consists of 22 codes that address speaker and listener behaviors, both verbal and nonverbal, in such categories as criticism, disagreement, compromise, positive solution, questioning, humor, and smiling. Instruments of this genre typically do not reveal strong interrater agreement for specific constructs (e.g., put-downs), but the more inclusive constructs such as positive affect versus negative affect fare better and provide information that is helpful in characterizing communication patterns (Heyman, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib741) ). There are little or no data on the test–retest reliability of the RCISS or similar instruments, and some researchers advise caution in their use. For example, King (2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib892) ) faults the RCISS because it does not deal adequately with issues of subtext or “reading between the lines” in couples’ communication.

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8.20 ECOLOGICAL MOMENTARY ASSESSMENT Recent advances in wireless connectivity have spawned an entirely new approach to assessment known as ecological momentary assessment (EMA). Ecological momentary assessment (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm01#bm01gloss98) is defined as the “real-time measurement of patient experience in the real world, at the point of experience” (Shiffman, Hufford, & Paty, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1492) ). Consider the research problem of determining whether a new drug treatment is effective in ameliorating the severe pain of migraine headaches. Whereas previous research methods relied upon retrospective questionnaire reports of patients receiving a new drug treatment, an EMA approach instead would consist of patients reporting their instantaneous experiences on a handheld device, with responses immediately transmitted (via the same wireless technology used by cell phones) to a central computer for ultimate analysis with sophisticated software. For example, the handheld device might “beep” to signal that the patient should immediately respond (on a touch-sensitive screen) to a series of rating scales for pain, mood, fatigue, and other relevant dimensions. The entire self-rating procedure might take less than a minute. The ratings would be requested several times a day on a randomized schedule.

Because EMA responses of clients are immediate and based on a schedule determined by the researcher, several biases of human recall are avoided. For example, consider the biasing effects of saliency, in which emotionally charged events dominate recall. For instance, a very brief episode of severe migraine pain may be recalled as lasting much longer than the actual experience because of the emotional valence of the incident. Whereas a retrospective questionnaire report of this pain would be affected by the salience of the event, an EMA analysis, with periodic real-time sampling of the actual pain experiences, would provide a more accurate portrayal of the episode. Recency is another recall bias that is circumvented by EMA. The recency bias refers to the fact that people are more likely to recall recent events than remote events. Potentially, this could lead to underestimation of the therapeutic effects of a drug if retrospective recall coincided with the onset of symptoms. In contrast, with an EMA analysis, client reporting consists of periodic and instantaneous time samples; the results are relatively unaffected by the recency bias.

In general, EMA provides a more accurate and reliable approach to the assessment of patient experience than traditional approaches such as retrospective questionnaires. One advantage is that compliance cannot be faked (as when patients fill out a week’s worth of daily questionnaires minutes before handing them in to the researcher). In fact, because EMA approaches are highly user-friendly, researchers report an astonishing overall compliance of 93 to 99 percent averaged across many studies (Shiffman et al., 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1492) ). EMA has been used in research into treatments for acute pain, alcoholism, arthritis, asthma, depression, eating disorders, headaches, hypertension, gastrointestinal disorders, schizophrenia, smoking, and urinary incontinence (Shiffman & Hufford, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1492) ; Shiffman, Hufford, Hickcox, and others, 1997 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1494) ; Smyth, Wonderlich, Crosby, and others, 2001 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1515) ). As EMA technology becomes streamlined and more affordable, we can expect this new technique to become commonplace in psychological outcome studies with clients.

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In addition to practical applications in health care research, the EMA methodology also can be used to test psychological theories, as illustrated by a recent study of emotions. Tong, Bishop, Enkelmann, and others (2005 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1656) ) enlisted the cooperation of 118 police officers in Singapore to wear an ambulatory blood pressure monitor during their work day. This device also beeped at random about every 30 minutes, a signal that the officer should fill out a simple 12-item questionnaire in a palmtop as soon as possible. The items, rated on 5-point scales, included topics such as:

How pleasant is this event? To what extent are you getting what you expected? How much personal effort is needed to deal with it? How much control do you have over the event?

With practice, it would take less than a minute to fill out a questionnaire of this nature. Of course, the added advantage of the EMA approach is that data are collected in naturalistic settings in real time, and, therefore, not prone to biases in recall.

In some cases, EMA provides for insights that would be difficult to achieve with any other research methodology. Consider the common belief that binge eating is maintained because it reduces negative affect, which is known as the affect regulation model (Polivy & Herman, 1993 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib1310) ). Put simply, this is the view that people binge on food because they feel bad, and bingeing helps them feel better, at least in the short run. Because retrospective reports are notoriously untrustworthy, researchers prefer more immediate access to personal experiences in real time. Fortunately, when EMA is used with large samples of binge eaters, it is inevitable that some of the randomly requested mood reports will occur just before and just after episodes of binge eating. In a meta-analysis of 36 EMA studies including 968 participants, Haedt-Matt and Keel (2011 (http://content.thuzelearning.com/books/Gregory.8055.17.1/sections/bm02#bm02bib682) ) found that negative affect increased prior to episodes of binge eating. But they also discovered that negative affect continues to increase afterward, which fails to support a key prediction of the affect regulation model.