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Psychological Testing

The Wechsler I.Q. series is the most prominent psychological I.Q. test used in the United States. There are other I.Q. tests but they donít have much of a market share compared to this. Intelligence is a difficult thing to define. If youíve got theorists on intelligence they would argue about a definition of it. Iím not all that interested in a definition of intelligence except for how it informs, how the test can be used. And Wechsler wrote back in the 40ís that, "Intelligence as a hypothetical construct is the aggregate or global capacity of an individual to act purposefully, to think rationally, and to deal effectively with the environment." That gives you a hint as to why we like to measure it. It has some relationship to adaptive function. So there are Wechsler I.Q. tests that cover the full range of humans, the full age range of humans from preschool up to age 89. All of

A couple of things to keep in mind, though, about I.Q. tests. The main thing to keep in mind is that I.Q. as we measure it and use it clinically is really not measuring something that is innate or genetically determined. By the time somebody comes into an inpatient unit or into your office and requires testing, enough things in their environment or enough events like head injuries or alcoholism or drug use or just other - prolonged depression - have intervened and have reduced or affected intellectual function. You are really not going to send an adult with a good life story to be tested and say, "Thereís your natural God-given I.Q." And even the score itself is just a statistical convention. One hundred, thereís nothing magical about 100. Thatís just the average score. So itís best to think of these scores as representing a patientís ordinal position. Their percentile ranking. In fact, when I teach my interns I teach them not to give so much the I.Q. score, 100, 105, 116, but the percentile ranking so you know where in the normative sample of about 1200 people this patientís score would fall. If it falls at the 75 percentile, thatís extremely high. If it falls at the 50 percentile, thatís right at average. If it falls down around the 25 or 40 percentile, thatís a little low. And if you think about it like that, you get away from the idea that this is something innate or God-given and it is a thing. Itís just the aggregate of performance on these 10 or 11 tests and itís related to the sample. So try to think about it in terms of its position as a percentile score and not as something that exists, that you can touch.

Next we are going to talk about two different types of psychological tests that measure psychopathology and personality. We are going to talk about objective tests and projective tests. The objective tests are the self-report test that are usually scored true/false. And weíll go over the MMPI, the MCMI and the PAI. Every test gets a nice set of initials. This is the Minnesota Multiphasic Personality Inventory. This is the Millon Clinical Multiaxial Inventory and this is the Personality Assessment Inventory. Inventory apparently is a big word in tests these days. And then the projected tests. This is going to be the Rorschach and the Thematic Apperception Test. What separates these out is that these are more

The first objective test that we are going to talk about, the Minnesota Multiphasic Personality Inventory, was developed in 1943 by Hathaway and McKinley, a duo. A duo, a psychologist and psychiatrist duo at the University of Minnesota Hospital and it has 567 questions. They are answered true/false. Takes a couple of hours to complete. It makes 10 original clinical scales, three validity scales and it has well over 500 now, experimental or new scales. Youíve got to wonder; a test that has more scales than items. Either itís an incredibly rich item pool or theyíve yet to find anything really useful from the test. So I am just still trying to figure that out. And Iím going to show you an MMPI profile in one second. All of these tests transform into a T-score. For the MMPI a T-score of equal to or greater than 65 indicates clinical pathology, and you read an MMPI interpretation based on either the highest or three point code. Letís see what this looks like. So this is the scale. This is the printout that the psychologist gets from the computer and sometimes it looks just about that clear. So here are the T-scores running across this side and this side. They bottom out at 30 and they top out at 110. This is 50, so this is average right here. This is the 65 line, so anything at or above that is of clinical importance, and these are the scales down here. So this dotted line here differentiates the validity scales, the lie scale, the infrequency scale, the 

The next test is the Millon Clinical Multiaxial Inventory 3. Now this is only 175 items. Again, itís true/false. It can be completed in an hour. This is an interesting test and one of the reasons I like it is if you subtract 365 from Ö or if you take 567 and subtract out Ö the amount of items here is about one-third of the items of the MMPI so itís much less daunting to patients who come into the hospital. You can often get them to fill it out. Itís a rationally constructed test. It tests Millonís theory of psychopathology and personality. It does something unique. It tries to accurately measure state and trait conditions at the same time. It has a number of internal corrections that try to control for either excess anxiety or depression 

The test that I use is the Personality Assessment Inventory. This is a 344 item test and it finally uses a modern response format of four choices. So this allows the computer to do the work. The other tests were developed to be hand-scored. This was developed to be computer-scored. You get four choices; false, slightly true, mainly true or very true. That allows the 344 items to work as if there are about 1200 items. You get much more variation here. It produces 22 non-overlapping scales; 4 clinical scales, 4 validity scales, 11 clinical scales, 5 treatment scales and two interpersonal scales. Now how the scales were designed as itís offered. Surveys were sent to practicing clinicians that said, "What would you want in a screening measure for new patients coming in? What would you want to know?" So for example, under these five treatment scales are a 

All of these tests have validity scales and those validity scales, like the lie scale, help us decide what the response set is of the patient, or if there is a response set. That tells us how they are approaching the test. Response sets can distort a patientís profile. The most common response sets are confused or random responding. The patient might be psychotic, they might not be able to read, they could be delirious, they could just not care. That happens a lot on my unit. Itís also over-reporting. Endorsing too many symptoms, trying to look bad. This is either the cry-for-help or malingering. Again, you donít know the motivation. You have to go back and ask the patient. And lastly, there is the under-reporting, or trying to look good. So you could have somebody in rounds say, "Iíd like to leave today" and the psychiatrist says, "Well, you have to take a psychological 

Objective tests in the DSM: let me just say, the test-makers print out these fancy computer reports and they give you suggested DSM diagnoses, Axis I and Axis II, at best they are informed suggestions. I hate to say most of them are just marketing gimmicks. Tests donít make diagnoses. Either licensed professionals make diagnoses, so donít trust it if it just gets printed out and says thatís what it is.

The Rorschach Ink Blot Test is just a fascinating psychological instrument. Introduced by Herman Rorschach in 1921 after years of working with his cards. The cards are a series of 10 plates. Three are black and white, 2 are red and white and 3 are pastels. The test is administered in two phases. The response phase, in which the subject reports what the ink blots might be, and the inquiry phase in which the subject reports where they saw the image and what made it look that way. So there are two parts to the Rorschach test. The verbal responses from both phases of the test are coded into Rorschach scoring language and thatís what you wind up with. You take these verbalizations and you produce a score from them. Thereís card 1, or a representation of card 1. Then, like I said, the objective tests ask you questions. "My friends are available if I need

This is the pastel. The pastels are supposed to stimulate pleasant or libidinal affect. This is the red, black and white. This is supposed to have some propensity to pull for aggression. This is card 3 in the TAT. So if you give a Rorschach you might also give a TAT, Thematic Apperception Test. Now this is one of the doom and gloom cards, appropriately described. This is the color. These are drawn ambiguously. We donít really know the sex, we donít really know whatís happened here and there seems to be something down here that, when you blow it up, looks clearly like a gun. But on the standard size card might just actually be a set of keys. So the question that you say to the patient is, "Tell me a story. I want you to look at this picture and make up a story around it and like all good stories it should have a beginning, a middle and an end, and tell me what the people

TAT scores: I gave him those cards, you know. He produced on card one - it was a theme of parents pressuring the little boy to play the violin. External pressure to achieve, passive resistance and a wish to be better understood. Card 3, that was the one of the woman huddled on the couch. Itís a tragedy. You know, death of a loved one or a personal failure. He kind of equated some meaningless little personal failure to the death of a loved one. So that kind of gives you a hint about how well he differentiates his own narcissistic injuries. Painful emotions are experienced in