Therapeutic Feedback with the MMPI-2

A Positive Psychology Approach

Richard W. Levak, Liza Siegel, David S. Nichols

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136811586
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychische Gesundheit in der Psychologie

Therapeutic Feedback with the MMPI-2 provides the clinician with empirically-based, practical information about how to convey the abundance of information in the MMPI-2 profile in a way that is collaborative, empathic, hopeful, and facilitates a therapeutic alliance. Readers will find this book to be as useful and applicable as the MMPI-2 itself, which is used in psychiatric hospitals; correctional settings; in evaluations for job selection, general medicine, forensic and child custody cases; and even in screenings for television, game, and reality shows. The authors expand upon this already robust test by demonstrating how therapeutic assessment and feedback can be improved upon by considering three contributions from positive psychology:

• that behavior can be viewed as potentially adaptive; traditional pathological and maladaptive behaviors can be reframed as understandable responses to stressors
• that therapeutic feedback is empathic, nonjudgmental, and mostly jargon free; humans respond to overwhelming stress in understandable ways that the therapist can give coherence and meaning to
• lastly, that therapeutic feedback stresses self-esteem and resilience building through self-awareness as a goal.

Discussion centers around ten scales and 27 common code types. Each section addresses the complaints, thoughts, emotions, traits and behaviors associated with the profile; therapists' notes; lifestyle and family background; modifying scales; therapy and therapeutic pitfalls; feedback statements; and treatment and self-help suggestions. The larger page size reflects the size of the MMPI-2 interpretive reports and makes it easy for clinicians to copy pages of the book to share with their clients. Therapeutic Feedback with the MMPI-2 is the most detailed volume available on MMPI-2 feedback and is a valuable addition to the bookshelf of any clinician who uses this test.

Chapter 1

Introduction

History of the MMPI/MMPI-2

The Minnesota Multiphasic Personality Inventory (MMPI) was developed as a diagnostic instrument in the 1940s during the Zeitgeist of “dustbowl empiricism.” The developers, Starke Hathaway and J. C. McKinley, were trained as scientists, bringing to psychology the objective eyes and methods of engineers (Lindzey, 1989). Hathaway was known to be a rigorous and meticulous researcher but also a man who was humane and empathic (“Starke R. Hathaway: Distinguished Contribution,” in the American Psychologist, January 1978), and the MMPI reflects his acute understanding of personality and psychopathology. The MMPI was a breakthrough in the field of empirical psychology (Greene, 2011), but the power of the instrument as a measure of the richness of personality was developed through the contribution of clinicians and researchers over the years.

In a 1956 American Psychologist article, Paul Meehl called for a good “cookbook” that would provide an actuarial description of the MMPI. Philip Marks and his colleagues responded (Butcher, 1969; Gilberstadt, 1970; Gilberstadt & Duker; 1965, Marks & Seeman, 1963; Marks, Seeman, & Haller, 1974) and empirically generated the personality and psychopathology descriptors for the individual scales and commonly occurring code types of the MMPI. After Marks and Seeman’s work was published, more than 10,000 books and articles followed (Butcher, 1987; Graham, 2006), adding an enormous amount of empirical and clinical data about the correlates of MMPI scale elevations for various populations.

Evolution of the MMPI/MMPI-2

Since its inception, the MMPI has evolved as researchers and clinicians have continued to adapt and refine the test (Butcher, 2000; Weed & Butcher, 1992). Although the instrument itself was highly respected and well validated, there was criticism that the original “normal” standardization sample was not representative of the U.S. socioeconomic and ethnic makeup in the last decades of the 20th century (Butcher & Pope, 1992; Dahlstrom, 1993; Pancoast & Archer, 1989).

The sampling problem, as well as issues of outdated and sexist language and a need for more relevant content scales (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; Duckworth, 1991), led to the revision of the MMPI and the 1989 release of the MMPI-2. The MMPI-2, currently the most researched and widely used personality test available (Ben-Porath & Archer, 2008; Butcher, 2006; Butcher & Rouse, 1996; Greene, 2011; Lubin, Larsen, Matarazzo, & Seever, 1985), left the MMPI scale and code type correlates essentially unchanged, maintaining consistency with the earlier work of Butcher, Marks, and his colleagues. The MMPI-2 is used in psychiatric hospitals, correctional settings, and private-practice for diagnosis and treatment planning and in evaluations for job selection, general medicine, forensic and child custody cases, surgery candidates, possible candidates for fertility treatments, and even screenings for television game and reality shows. The wide range of uses speaks to the robustness of a test that was originally developed over half a century ago.

Psychologists who use the instrument do so with the confidence of more than 50 years of research to support their decisions and recommendations (Graham, Ben-Porath, & McNulty, 1999). As of 2006, more than 2,800 journal articles had been written about the MMPI-2 (Graham, 2006) and its use in various settings and for a variety of purposes (Butcher, 2005; Butcher, Ones, & Cullen, 2006; Pope, Butcher, & Seelen, 2006), and each year numerous new articles about the MMPI-2 are published; a search of the American Psychological Association PsychNET database yields over 80 new MMPI-2 articles published in 2009 alone. Practitioners using the test over a clinical lifetime have also developed an internal database about the clinical meaning of various profiles and their relevance to psychotherapy.

The Restructured Clinical Scales (RC Scales: Tellegen, Ben-Porath, McNulty, Arbisi, Graham, & Kaemmer, 2003) are the most recent major addition to the MMPI-2. The RC Scales comprise eight independent “Restructured” clinical scales and one scale measuring Demoralization. They are described as restructured because they purport to measure the core component of each of the orginal clinical scales without the confounding effects of demoralization which the authors believe is associated with each clinical scale. Tellegen et al. suggest that the removal of demoralization from each of the clinical scales was necessary because its inclusion resulted in patterns of multiple elevations without clear profile definition (Ben-Porath & Tellegen, 2008). Tellegen et al. (2003) recommend that the RC Scales be used to aid in the interpretation of the clinical scales profile and that they not be combined with each other in RC code types.

The introduction of the RC scales has stimulated controversy in the MMPI-2 community. Interested readers should review a series of articles in a special issue of the Journal of Personality Assessment (October, 2006, Vol. 87) as well as articles by Greene, Rouse, Butcher, Nichols, and Williams (2009); Helmes (2008); Rouse, Greene, Butcher, Nichols, and Williams (2008); and Tellegen, Ben-Porath, and Sellbom (2009) for a sampling of the debates on this topic. Although we have not included feedback about the RC Scales in this book, we have included them as modifying scales where appropriate. The RC Scales now anchor an entirely new instrument called the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008). This new test includes the RC Scales and 41 other new or revised scales, but not the MMPI-2 clinical scales that are the focus of this book. The MMPI-2-RF consists of 338 items from the original MMPI-2 and takes less time to complete than the MMPI-2. MMPI-2-RF scores and scale information will not be included in this book, as it is a relatively new test.

Traditional Uses of the MMPI/MMPI-2

The MMPI/MMPI-2 evolved in part according to the medical model that views diagnosis of malfunction and disease as the first step in treatment (Barron, 1998). Its focus was pathology. Clinical psychology has historically assumed that human nature is largely motivated by aggressive, self-serving impulses, negative emotions, and unconscious self-defeating drives (Domino & Conway, 2001; Freud, 1930; James, 1902; Seligman, 2002). Assessment psychologists have traditionally focused on diagnosing pathology and suggesting treatment strategies (Tallent, 1992; Vaillant, 2000).

Although the MMPI-2 does contain some scales such as Ego Strength scale (Es), Dominance (Do), Responsibility (Re), Serenity subscale (S2), Contentment with Life subscale (S3), and Belief in Human Goodness subscale (S1), which measure positive attributes (Butcher & Han, 1995; Himelstein, 1964; Korman, 1960), most of the scales measure psychopathology, and most texts describe the meaning of scale elevations in negative terms. According to this negative traditional paradigm, defenses are labeled as “maladaptive,” “immature,” or “regressive,” and the role of treatment is to increase “adaptive” higher-order defenses.

The MMPI/MMPI-2 and Feedback

The MMPI/MMPI-2 was not developed with the goal of feedback in mind (Hathaway, 1939; Hathaway & McKinley, 1943). In fact, the test and the personality correlates were developed because of a firm belief in empiricism and the actuarial method in an era when clinicians’ judgment was highly suspect (Meehl, 1954/1996). Consequently, the concept of using feedback as a collaborative data-gathering and therapeutic tool was antithetical to the actuarial method. Although actuarial personality descriptors were an improvement from the vague, intuitively based methods practiced earlier, there were some costs and some early critics (Fischer, 1985/1994). Reports written about clients were, at times, so judgmental and potentially pejorative that they were often stamped, “Do not share with the client.” Psychologists trained in the 1980s will recall it was considered unethical to share records with clients because the content was so potentially distressing. Perhaps this was a manifestation of the Freudian belief that people with psychopathology resist interpretation of their symptoms and that the work of the therapist is to circumvent defenses (Eagle, 1999; Grossman, 1993). Traditional models of assessment assumed that clients’ resistance was inevitable (Engle & Arkowitz, 2006; Rosenthal, 1987) and therefore that the process of insight had to be circuitous to avoid it. Recent research, however, suggests that clients can be open to feedback, even concerning negative attributes, if it is presented in a balanced nonjudgmental way (El-Shaieb, 2005; Finn & Tonsager, 1992).

Over the past 15 years, psychology has undergone a shift, and recent laws associated with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the current American Psychological Association (APA) Ethical Principles of Psychologists (2002) stipulate that test results must, if requested, be shared with clients unless otherwise precluded (i.e., some organizational consulting, preemployment or security screenings, or forensic evaluations). These guidelines give consumers the right to their medical records and even, in some cases, the right to the actual test protocols unless a psychologist can show that harm would result from the disclosure. Accordingly, there is a need for assessment psychology to develop feedback language that is empirically based but is also comprehensible, useful, and not harmful to clients.

Although traditional assessment was hierarchical, authoritarian, and assumed the assessor had the answers and the assessed did not, some researchers in school and university settings attempted early on to describe positive adaptive correlates for some of the MMPI scales (Duckworth & Barley, 1988; Kunce & Anderson, 1976). There were also attempts to reformulate the clinical language of the MMPI into more user-friendly terms. The Therapist Guide to the MMPI and the MMPI-2 (Levak, Marks, & Nelson, 1990) was published within a year of the MMPI-2’s release so it was limited in its MMPI-2 descriptors. It provided an empirical–phenomenological framework for giving MMPI feedback to clients in nonjudgmental, jargon-free language. In this approach, the therapist is seen as a guide rather than an authority, and the process is collaborative instead of hierarchical. A summary of recent research (Poston & Hanson, 2010) has demonstrated that a collaborative assessment feedback approach can produce positive therapeutic effects even after one session.

Over the past 20 years, the number of people seeking some kind of counseling has grown exponentially (Cooper, 2001). Many clients do not suffer serious psychopathology but seek help with life transition, family, or marital issues. The language of psychopathology does not lend itself to creating a therapeutic alliance, whether clients are seriously disturbed or merely seeking help with a transitional issue. We believe the large increase in the profession of “coaching” (Williams & Davis, 2002), usually practiced by people with less formal clinical training but with a “nondiagnostic” mentality, is a manifestation of how much psychology has fallen behind in developing a positive, nonjudgmental paradigm to help people with reactive problems by providing personality feedback. MMPI-2 psychology needs user-friendly feedback language.

The Influence of Positive Psychology

In 1964 Martin Seligman and his colleagues were conducting tests of learning theory in the University of Pennsylvania psychology department where dogs in a shuttle box were repeatedly exposed to a mild inescapable electric shock (Seligman & Maier, 1967). Eventually, most dogs gave up the effort to escape, even when provided an easy opportunity to do so. The researchers explained that the dogs had “learned” to be helpless. The extrapolation was that both the helpless dog and the depressed person have learned that escape actions are useless (Seligman, Maier, & Geer, 1968). However, there were exceptions to the learned helplessness paradigm (Seligman & Weiss, 1980). About one in four dogs, even after they had been exposed to the “helpless situation,” did not develop learned helplessness. The same thing happened in human experiments when people were given insolvable tasks or inescapable noise; about one in four did not behave in a manner consistent with the learned helplessness paradigm.

Eventually, it became evident that the early theory of human nature and learned helplessness was only “half-baked” (Seligman, 1990, p. iii) and that some people manifest a buffering strength, a core resilience that inoculates them against depression and other symptoms of severe stress. Seligman theorized that people could also learn to be optimistic and went on to write several books on optimism (1990, 1993, 1996, 2002), thereby spawning a new field of interest: positive psychology.

In 1996, when he was elected president of the APA, Seligman (1990) made it his mission to encourage psychologists to study the positive as well as the negative aspects of human response to stress. Since then, positive psychology has evolved to encompass the study of positive emotions (joy, resilience, happiness), positive traits (strengths and virtues), and positive institutions (Foster & Lloyd, 2007; Fredrickson, 2001; Gable & Haidt, 2005; Seligman, 2002). It aims to complement the traditional focus on understanding, preventing, and curing negative psychological states by gaining a better understanding of human strengths (Aspinwall & Staudinger, 2003). Recent contributions from the field of positive psychology are shifting the paradigm away from pathology and mental illness to cultivating the qualities that benefit health, relationships, and careers (Seligman, 2002).

Treatment paradigms of positive psychology draw on research about how people exposed to severe risk factors maintain positive mental health and live a full life (Peterson & Park, 2003). By attempting to understand how some people survive and even thrive after being exposed to traumatic events, psychologists hope to shed light on learnable resilience skills and are now empirically testing the therapeutic applications of positive psychology (Linley & Joseph, 2004).

Many see the assessment of psychological health as a future trend in treatment paradigms (Borgen & Betz, 2008; Lopez & Snyder, 2003; Naglieri & Graham, 2003). Positive psychology is beginning to make an impact on the field of assessment in general (Jiang & Shen, 2007; Park & Peterson, 2007), but it has had a relatively small impact in the realm of traditional assessment tools like the MMPI-2. In Positive Psychological Assessment: A Handbook of Models and Measures, Lopez and Snyder call for the research and development of measures that will highlight human strengths and potentials. The authors also stress that it is important not to ignore human weakness but to bring balance into assessment by building and recognizing strengths.

History of Therapeutic Models of Assessment

Therapeutic models of assessment developed from disparate roots: some based in philosophy, some accidental, and some humanistic. Fischer’s collaborative model (Fischer, 1985/1994, 2000, 2006), was based on existential/phenomenological philosophy with an inherent respect for the individual. Craddick (1972, 1975) and Dana (1982, 1984) came from a humanistic multi-cultural perspective, recommending that clients be more involved in the assessment process through discussions with the testing psychologist about the purpose of their psychological assessment. Therapeutic assessment (Finn, 1996, 2007; Finn & Tonsanger, 1992; Newman & Greenway, 1997), developed when Finn became curious about the fact that some clients appeared to have life-changing experiences as a result of the psychological testing (Finn, 2007). Incorporating these traditions, Beutler & Groth-Marnet (2003) called for a more integrated approach to the reporting of assessment data, avoiding the use of jargon and the rote reporting of test scores. Though grounded in empiricism, all of these approaches aim to provide a more complete, existential, and therapeutically oriented assessment of the individual.

Therapeutic models of assessment can be viewed as consonant with the humanistic model (Poston & Hanson, 2010) that human nature is creative, active, and purposeful in shaping a response to the environment (Adler, 1964; Allport, 1950; Maslow, 1954/1987; May, 1965/1989; Rogers 1951; Vaillant, 1977). Carl Rogers’ (1961) interest in the intrinsic value of the therapeutic relationship encourages therapists to accept clients “unconditionally,” and viewed the therapeutic process as “client centered.”

Integrative assessment (Groth-Marnat, 2009), the individualized/collaborative approach (Fischer 2000, 2006; Purves, 2002), therapeutic assessment (Finn 1996, 2007; Finn and Tonsager, 1992) and the feedback approach developed by Levak and colleagues (1990) reflect roots in existential/phenomenological and humanistic perspectives. In all these approaches, the focus is client-rather than test-centered, with the aim of describing the unique individual tested, rather then the “typical individual” with “similar test scores” in the hope of providing a better focused, balanced, and therapeutically useful assessment.

One of the best-received contemporary assessment models has been well articulated by Stephen Finn, who outlined the concept of Therapeutic Assessment, after recognizing the profound psychological changes that clients undergo as a result of their more active participation in the psychological assessment proves. Finn and his colleagues view assessment as having a potentially therapeutic aspect, rather than being a sterile and unidirectional endeavor (Riddle, Byers, & Grimesey, 2002). The therapeutic/collaborative/integrative assessment models have become important new paradigms in the field of assessment psychology.

Basics of the Therapeutic Assessment

Although therapeutic assessment is a blanket term for humanistically based assessment methods in general, Finn and Tonsager (1997) developed a highly structured approach and distinguished their own brand of TA (Finn & Kamphuis, 2006). Their approach is based on the principle that clients become most engaged in taking the MMPI-2 when they fully understand how the informatio...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Foreword
• Acknowledgments
• 1. Introduction: History of the MMPI/MMPI-2
• 2. Steps of a Therapeutic Assessment and Feedback
• 3. Validity
• 4. Scale 1
• 5. Scale 2
• 6. Scale 3
• 7. Scale 4
• 8. Scale 5
• 9. Scale 6
• 10. Scale
• 11. Scale 8
• 12. Scale 9
• 13. Scale 0
• Bibliography
• Index