Thesis on "Personality Assessment Instruments"

Thesis 7 pages (2270 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Personality Assessment Instruments

Millon, Rorschach and other methods of evaluation

This paper will attempt to give an overview of two relatively common and recently derived questionnaire-type personality assessments used by mental health professionals, the MCMI-III (Millon Clinical Multiaxial Inventory) and the MACI (Millon ™ Adolescent Clinical Inventory). It will compare the Millon approach with more subjective assessment methods such as the Rorschach 'inkblot' test once commonly used in clinical practice. Such a comparison is useful given the striking difference between the objective and comprehensive Millon approach with the highly subjective and personalized Rorschach method of assessment. Then, it will conclude with a final assessment of other common and less scientific methods of personality screening and testing, such as Jungian methods of personality classification and self-directed online personality surveys.

Validity

The validity of personality assessment devices such as the MCMI-III (Millon Clinical Multiaxial Inventory) and its adolescent incarnation the MACI (Millon Adolescent Clinical Inventory) has been subject to increasing scrutiny over the years. Such tests have grown increasingly popular because of their relative ease of use in providing an assessment of an individual's state of mental health. In particular, Millon's emphasis on cohering with the criteria of different Axis I and Axis II definitions make it useful, as the findings correlate with the bureaucratic requirements of demonstrating mental health or lack thereof on insurance claims for patient treatment. The Millon approach is also helpful in screening a study pool of individuals for research studies. Overall, personality testing has become more common in psychotherapeutic practice, given the need for quick assessments for individuals with limited therapeutic sessions due to insurance company limitations on mental health treatment, as well as the pressures for a quick diagnosis in cost and time-strapped hospital environment. Psychological assessment through testing in general has become more widespread in nature and more accepted by the public and clinicians at large. It is now manifest in many workplace environments, in the employment and pre-employment screening process, in schools, even in online self-assessments. Many of these questionnaires resemble the Millon batteries in their short, multiple-choice and/or yes and no formats.

However, rather than merely test dishonesty or give a general picture of an individual's tendency to manifest introversion or extroversion, the MCMI-III takes upon itself a more serious and potentially overwhelming task. On the surface, it seems almost frighteningly simple -- it is a questionnaire, with multiple-choice answers that are then assessed by trained, clinical professionals. According to its authors, the test takes only twenty-five minutes to complete, and is explicitly designed to "obtain the maximum amount of information with a minimal amount of patient effort. As the need for efficient and accurate differential diagnosis of complex disorders grows, mental health professional have increasingly come to value the MCMI-III test's brevity" (Millon, Millon, Davis & Grossman, 2008). The authors of the test support the validity of their findings by noting that "the extensive normative sample for the MCMI-III test consists of 998 males and females with a wide variety of diagnoses. This group includes patients seen in independent practices, clinics, mental health centers, forensic settings, residential facilities and hospitals (Millon, Millon, Davis & Grossman, 2008).

In contrast, the Rorschach inkblots test arose organically from the clinical practice of the Swiss psychiatrist Hermann Rorschach who developed a set of inkblots to test subjects in his clinical practice of Gestalt, or holistic therapy. The inkblots themselves depict ambiguous forms, and are printed on 18X24 centimeter cards, in both black and white and color. "Their very ambiguity provokes free associations in the test subject. The diagnostician stimulates the formation of these flights of fantasy by asking questions such as 'What is this? What might this be?' S/he then proceeds to record, verbatim, the patient's responses as well as the inkblot's spatial position and orientation. An example of such record would read: 'Card V upside down, child sitting on a porch and crying, waiting for his mother to return'" (Vaknin 2008). In contrast to the multiple-choice format of the Millon tests, the Rorschach tests take a long time to administer, and must be done in a personalized setting. However, it should be noted that the inkblots are not selected at random, and the same inkblots are used for every individual. This allows the administrator to conduct a comparative sampling of results with previous test-takers and also with what the test designers consider normative responses in the ways that form and color are used, cognitively, by the test-taker.

In contrast, the questions in the MCMI-III are designed to reflect the diagnostic criteria of the DSM-IV of Axis I and Axis II disorders, that is, major mental disorders as well as personality disorders. However, critics contend that the results often assess the respondents in a very schematic fashion and thus question its validity in painting a true picture of the subject's mental health. For example, "the first criterion from the DSM-IV dependent personality disorder reads 'Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others,' and its parallel MCMI-III item reads 'People can easily change my ideas, even if I thought my mind was made up'" (Vaknin 2008). Words from the DSM-IV seem to be taken verbatim and put into questionnaire form, without questioning if 'dependant personality disorder' is a valid category.

The Rorschach inkblot test was designed to assess patient's reasoning style, and not specifically to assess the patient's pathology according to the DSM-IV criteria. Scoring the Rorschach test is done in what is often called a 'literary' style, with no uniform, automated scoring system. Instead, the scorer notes certain items for each card. The first is "location," or "which parts of the inkblot were singled out or emphasized in the subject's responses" -- i.e. If the whole blot was used or the 'white space' (Vaknin 2008).The second is the determinant, if the blot resembles what the patient saw in it, in terms of form, movement, color, texture, dimensionality, shading, or symmetrical pairing or if it corresponds more " to the subject's visual fantasy and narrative" form, movement, color, texture, dimensionality, shading, or symmetrical pairing (Vaknin 2008). The scorer thus must rate and assess what he or she sees as coherence with the reality of the form and the subject's impression of that form.

Content, the third area of assessment, is slightly less subjective on the Rorschach, and compared with twenty-seven predetermined content categories of other patients and evaluated in terms of frequency of seeing human figures, versus objects for example. The fourth screens the patient's responses as compared to the overall distribution of the answers of previous test-takers. The fifth category of assessment, determines how "coherent and organized is the patient's narrative and how well does s/he link the various images together" while the sixth category, that of form quality assesses how well does the patient's perception fit with the blot overall" (Vaknin 2008). The test, reflecting its Gestalt origins (although it has been modified and somewhat standardized since its 1921 origins) stresses the overall assessment of the patient's holistic comprehension and state of mental health, rather than screens for specific disorders like the Millon tests.

The structure of the Millon test is statistical and quantitative, as well as qualitative in its method of assessment. "The MCMI-III consists of twenty-four clinical scales and three modifier scales" (Vaknin 2008). To improve both the reliability and the validity, the modifier scales also attempt to identify the patient's level of disclosure, or the "tendency to hide a pathology or to exaggerate," to manifest "desirability," or "a bias towards socially desirable responses," and debasement, or the attempt to falsely seem mentally ill (Vaknin 2008). In contrast to the Rorschach test: "scoring is easy and runs from 0 to 115 per each scale, with 85 and above signifying pathology. The configuration of the results of all 24 scales provides serious and reliable insights into the tested subject (Millon, Millon, Davis & Grossman, 2008).

Critics of the MCMI-III have pointed "to its oversimplification of complex cognitive and emotional processes, its over-reliance on a model of human psychology and behavior that is far from proven and not in the mainstream (Millon's multiaxial model), and its susceptibility to bias in the interpretative phase" (Millon, Millon, Davis & Grossman, 2008). Multiaxial models include biological, psychological, and social factors in the diagnosis of a patient. This is one reason why Millon developed a specifically adolescent test battery to take into consideration adolescent's unique needs and the different biological requirements of adolescents. While responses are screened subjectively for age-appropriateness with the Rorschach test, Millon's adolescent exam is divided into two clearly different categories of assessment, that of an age 13-15-year-old-group, and 15 to 19 years. The test was normed on 1,017 adolescents from outpatient, inpatient and residential treatment programs (Millon, Millon, Davis & Grossman, 2008).

This use of multifaceted diagnosis can be seen as follows in an interpretation of the adolescent version of the test, a thirty-minute series of multiple choice questions: "In addition to the preceding considerations, the profile report… READ MORE

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