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Chapter 9

Clinical Assessment: Objective and

Projective Personality Tests

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Defining Clinical Assessment

The process of assessing the client through multiple methods, including:

the clinical interview (see Chapter 12)

the administration of informal assessment techniques (Chapter 10), and

the administration of objective and projective tests (this chapter)

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Defining Clinical Assessment (Cont’d)

Clinical assessment can do the following: Helps client gain greater insight Aid in case conceptualization and diagnostic formulations Assist in the decision-making concerning psychotropic

medications Assist in treatment planning Assist in court decisions (e.g., custody decisions; testing a

defendant in a child molestation case) Assist in job placement decisions (e.g., high security jobs) Aid in diagnostic decisions for health related problems

(e.g., Alzheimer’s) Identify individuals at risk (e.g., to identify students at

risk for suicide or students with low self-esteem)

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Objective Personality Testing

Definition: A type of personality assessment that uses paper-and-pencil tests, often in multiple-choice or true/false formats, to assess various aspects of personality

Each objective personality test measures different aspects of personality based on the specific constructs defined by the test developer

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Common Objective Personality Tests

Many of the tests we will examine were identified as one of the most frequently used tests (see Table 1, p. 106, Intro to Section III).

For a list of the tests we will review, and their general purpose see Table 9.1, p. 188

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(MMPI-2) Minnesota Multiphasic Personality Inventory -

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Most widely used personality testDeveloped in 1942, revised in 198990 minutes to take the 567 itemsInterpretation requires grad testing and psychopathology coursesProvides six validity scales, ten basic (clinical) scales, and fifteen content scalesMost commonly used scales: 3 validity scales and ten basic scales (Figures 9.1 and Table 9.2, pp. 189-190) Adolescent version also exists: MMPI-AImportant to understand the meaning of each scale

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MMPI-2 (Cont’d)

A high L (Lie) score: Not necessarily lying; means client has trouble admitting faults--makes test suspect

Basic Scales useful in diagnosis and treatment planning

Patterns of responses, as opposed to specific scales, often used in making decisions

“Clinical significance” is a T score of 65 or greater.

The Content Scales: 15 specific traits such as anxiety, fears, anger,

cynicism, low self-esteem useful in creating more detailed perspective

Reliability estimates on different scales: .37 to .92

High intercorrelations among some scales (shared items?)

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(MCMI-III) Millon Clinical Multiaxial Inventory (3rd ed.)

Second most used objective personality testDesigned to assess DSM-IV-TR personality disorders and clinical symptomatology (axis II)Adolescent version also exists175 true/false items take 25 minutesHas six different major scales (Table 9.3, p. 192) Clinical Personality Pattern Scales Severe Personality Pathology Scales Clinical Syndrome Scales Severe Clinical Syndrome Scales Modifying Indices Validity Index

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MCMI-III (Cont’d)

Uses Base Rate (BR): Converts raw score to a more meaningful standardized score Sets median for non-psychiatric individuals at 35,

and 60 for psychiatric population. A BR of 75 indicates that some of the features

are present while a BR of 85 indicates that the trait is clearly present

Reliability ranges from .67 to .90Scales have been correlated with several other scales such as the MMPI and the BDIOther studies demonstrated predictive validity for the instrument with DSM-IV-TR diagnoses

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PAIPersonality Assessment Inventory

Aids in making clinical diagnoses, screening for psychopathology, and assist in treatment planning

18 and older

344 items; 50-60 minutes

4-point ordinal scale: false, slightly true, mainly true, very true

Hand scored, computer scored, or sent in

4 validity scales, 11 clinical scales, 5 treatment sclaes, 2 interpersonal scales

T-scores (see Table 9.4, p. 194)

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PAI (Cont’d)

Reliability: Most scales show descent reliability estimatesExceptions to reliability: Inconsistency and Infrequency scales—lowNumerous studies seem to show concurrent validity on a number of the scales

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(BDI-II) The Beck Depression Inventory -

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BDI-II developed in 199621 questions on 0 to 3 scale, 10 minutesIf 2 or 3 on items 2 (hopelessness) and 9 (suicidal ideation)—red flagCut-off scores to measure depression (see Table 9.5, p. 194)Scores related to groups of depressed and non-depressed individualsHigh reliability estimates (in .90s)Convergent validity with original BDI and discriminant validity with other disorders

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(MBTI) Myers-Briggs Type Indicator

Most widely used personality assessment for normal functioning (for adolescent through adults)Based on Jung’s work, following characteristics were derived: extroverted or introverted, sensing or intuiting, thinking or feeling.Myers and Briggs added judging or perceivingSee Figures 9.2 and 9.3 (pp. 196 and 197)Evidence for validity of separate scales, but weaker for synergistic combination of four scales90% of people agree with the results

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(16PF) 16 Personality Factors

Questionnaire

Based on Raymond Cattell’s 16 primary personality componentsNot pathology, describes human behavior185 items, 45 minutes16 Primary Factors on bipolar scale (see Table 9.6, p. 198) Uses sten scores (average: 4-7) 1-3 left of bipolar scale, 8-10 right of bipolar

scale5 Global Factors are combinations of the primary factors (see Table 9.7, p. 199)

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16PF (Cont’d)

3 Validity Scales Impression management: measures social

desirability and faking good (high score) or faking bad (low score)

Infrequency scale: responding unusually (problems with reading comprehension, random responding, or making “right” impression

Acquiescence: random responding, misunderstanding items, difficulty evaluating self

Reliability: ranges from .60s to mid .80s Validity: Factor analysis confirms items Validity: Convergent and other validity shown

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Big Five Personality Traits and the NEO-PI-R & NEO-FFI

Research by Thurstone and many others suggest a five-factor model of personality Openness, Conscientiousness, Extraversion,

Agreeableness, Neuroticism (see pp. 199-200)

NEO Personality Inventory measures these 5 factors each of which has 6 facets (see Table 9.8, p. 201) 240 items, 17 years and older 5 point Likert-type scale: strongly disagree to

strongly agree Uses T-Scores Narrative describing personality style

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Big Five Personality Traits and the NEO-PI-RI & NEO-FFI

NEO PI-R Reliability: high for five factors, .56-.90 for facets Much convergent, discriminant, and concurrent

validity over a number of different studies

NEO-FFI: Shortened version 60 items 15 minutes Test worthiness lowered due to the fact that it’s

a shorter version

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(SEI) Coopersmith Self-Esteem

InventoryMeasures self-esteem for children 8 – 15, in four areas:

1. general self (24 items)

2. self in relation to peers (8 items)

3. self in relation to parents (8 items)

4. self in relation to school (8 items)

Total score: Multiply by two the total number of positive self-esteem items chosen by the child.

Reliability: 87 to .90, but information dates back to early 1970s

Validity studies are dated and some are questionable

Given to students in many settings--broad ethnic comparisons

Generally, mean scores ranged from the mid-50s to the mid-70s, and standard deviations were between 12 and 20

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(SASSI)Substance Abuse Subtle Screening

Inventory

Two versions: Adult & Adolescent (SASSI-3 & SASSI-A2)Suggests substance dependency with 93+% accuracySASSI-3 30 minutes to take, 5 to score 1st section: 67 “subtle” T/F items 2nd section: 26 “overt” alcohol and other drugs

related questions rated on 4-point scale Nine subscales: face valid alcohol, face valid other

drugs, symptoms, obvious attributes, subtle attributes, defensiveness, supplemental addiction scale, family vs. controls, and correctional

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SASSI (Cont’d)

SASSI-3

Patterns of subscale responding helps in diagnosis, treatment planning, and validity of responses

Reliability

Particularly high for overall instrument (.93)

Test-retest over two weeks ranges from .92-.100

Validity: Criterion-related: Correlates with DSM-IV diagnoses

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Other Common Objective Personality Tests

There are dozens of common objective personality tests. Naming just a couple more: Taylor-Johnson Temperament Analysis

Assesses personality variables that effect social, family, marital, work, and other environments

The Marital Satisfaction Inventory

Assesses the severity and nature of conflict in a relationship

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Projective Testing

Defined:

Type of personality assessment where a client is presented a stimuli and personality factors are interpreted

Often used to identify psychopathology and to assist in treatment planning

Much more difficult to measure validity when one is dealing with abstract responses to vague stimuli, such as those in projective tests

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(TAT) Thematic Apperception Test

Developed in 1938 Henry Murray Series of 31 cards with vague pictures on them (see

Figure 9.4, p. 205) 8 to 12 cards generally used during an assessment Ask client to create and describe story that has a

beginning, middle and end Based on Murray's need-press theory: People driven

by internal desires, such as attitudes, values, goals, etc. (needs), or external stimuli (press) from the environment

No universally agreed upon scoring and interpretation method

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TAT (Cont’d)Most clinicians use qualitative process of interpretationControversy over reliability and validity of instrumentControlled setting interscorer reliability .82Due to age of cards, and because figures are almost exclusively white, many cards seem biased and datedTo counter some of TAT problems Southern Mississippi’s TAT (SM-TAT) Apperceptive Personality Test (APT) For children: CAT (animals) and CAT-H (humans)

Many still use TAT. argue that cross-cultural issues not as critical (you project yourself onto whatever you see)

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Rorschach Inkblot TestHerman Rorschach developed inkblot test in 1921 by splattering ink on paper and folding them in half (See Fig. 9.5, p. 207)He chose 10 final cards that have become the Rorschach inkblot test still used todayWhen giving the Rorschach, clinicians show clients cards, one at a time, and ask them to tell them what they see on the cardRorschach believed images on the inkblots allowed one to express his or her unconsciousDifficulty showing adequate validityRequires extensive training and practice to use

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Rorschach (Cont’d)

Exner scoring system uses three components: Location: where on blot response occurred (e.g.,):

1. whole blot (w), 3. unusual details (Dd), 2. common details (D), 4. white space details (S)

Determinants: how examinee understood what’s seen:1. form (“that looks just like a bat”)2. color (e.g., “it’s blood, because it’s red”)3. shading (“it looks like smoke because it’s

grayish-white”). Content: 22 categories: whole human, human detail,

animal, art, blood, clouds, fire, household items, sex, etc. Specific content can hold meaning (See Box 9.1, p. 207)

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Bender Visual-Motor Gestalt

Lauretta Bender originally published test in 1938Takes 5-10 minutes and measures developmental level, psychological functioning, as well as neurological deficits after a traumatic brain injuryChildren, 4 – 7 and individuals 8 – 85+ replicate the original nine cards shown in Figure 9.6, p. 209In 2nd ed., children 4 –7 have four additional cards and individuals 8 – 85+ have three additional cards5-point scoring system. 0 represents no resemblance and 4 represents a nearly perfect drawingReliability in .80s and .90s

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House-Tree-Person and Other Drawing Tests

Drawing tests try to tap into unconscious. Focus might vary depending on content of test. Some popular ones: House-Tree-Person Kinetic-House-Tree-Person (see Table 9.9. p.

210) Draw-A-Man Draw-A-Woman Kinetic Family Drawing: Draw a picture of your

family all doing something together

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Sentence Completion Tests

A sentence stem is given to client for client to respond toGather important content information and possible unconscious issuesSome common tests: The Sentence Completion Series EPS Sentence Completion Technique.

Questions about the validity and reliability of sentence completion tests remain, but can be quick and useful way of gathering info

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Role of Helpers in Clinical Assessment

Helpers should conduct clinical assessment: Elementary school counselor uses self-esteem

inventory when working with young children High school counselor might use objective

personality measures to identify concerns and aid in treatment planning

College counselors, agency clinicians, social workers, and private practice professionals use clinical assessment tools to help identify issues and devise strategies for problem solving

All clinicians should consider clinical assessment tools and whether they have the appropriate training to administer and interpret instruments

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Final Thoughts On Clinical Assessment

Clinical assessment results in making decisions for clients that will critically affect their livesSuch decisions can result in a person being labeled, institutionalized, incarcerated, stigmatized, placed on medication, lose or gain a job, have access to their children, and moreExaminers must remember the impact that their decisions will have on clients and monitor: the quality of the tests they use their level of competence to administer tests, their ability at making accurate interpretations of

client material.