Psychological Counselling

The ten Swiss ink - blots that constitute the Rorschach were first unveiled to the professional world in Hermann Rorschach's classic monograph, Psychodiagnostik, published in 1921.

Administration and Scoring:

The test usually takes 45 to 55 minutes ,unless the client is unusually verbose or extremely resistive. Each of the ten cards is presented to the client twice ; first during a "Free Association Period" in which the therapist simply hands each card to the client , one at a time, and the client reports what the blot , parts of it, look like; and second during " Inquiry" in which the therapist through nondirective questioning, determines what part of the blot has been used for each response. The therapist recalls verbatim the verbalizations of the client both during free association and inquiry. After the administration of the test is completed , the responses are scored or coded. The scoring procedure consists of translating Rorschach words into Rorschach symbols.

Advantages :

Rorschach is considered by many practicing psychologist as an X - ray, a pneumoencephalogram and a case history rolled into one. It is difficult and almost impossible for a common man to see how it reveals a part of personality that defies other methods. One cannot fake one's responses if one doesn't know what is expected before realising anything, one reveals one`s true self on it. It also provides a good example of a culture fair test as there is no culture bias in the construction of the ink- blots. It has been found the different Psychiatric groups behave differently on this test.

Limitations:

Psychologist who believes in objective questionnaires have either left or considerably reduced the use of Rorschach test in clinical settings. They doubt the objectivity (in terms of the meaning of the stimulus provided), reliability (in terms of consistency in scoring) and validity (in terms of use liability) of the Rorschach test. They feel that Rorschach being the subjective test cannot reveal personality. Most of the times however the above criticism is offered by those who have not undergone adequate supervised training required for Rorschach administration, scoring and interpretation.

Reliability:

The nature of Rorschach score presents many difficulties. Amongst the type of reliability that is alternate form, split - half and test - retest; none of these are satisfactory. For split - half reliability the test is to be splitted into two equal halves but the task of categorizing them into two equal halves becomes difficult. Also there are difficulties in preparing exactly an equivalent form of the Rorschach test. If the test is readministered with a shorter gap memory factors play a role in test - retest reliability.

Validity:

For any test to be valid there must be a sound theoretical background and this test doesn't have any theoretical framework. Its diagnostic and screening value is also badly criticized and the contents of the test do not appear to measure various aspects of personality.

THEMATIC APPERCEPTION TEST:

The Thematic Apperception Test familiarly known as the TAT was originally described by Morgan and Murray in 1925. It is a method of revealing some of the dominant drives, emotions, sentiments, complexes and conflicts of personality.

Administration and Interpretation:

The TAT cards comprise of 30 pictures, most of which show people in implied action and are divided so that the therapist can create specific groupings for male and female clients and for children, adolescents and adults. The client is told that he will be shown a series of cards and, that the test is one of imagination. His task then is to create a story about the picture which includes what is happening at the movement, what has led to this event, what the characters are feeling or thinking, and what the outcome will be.

Morgan and Murray offered the first scoring system which comprised of weights for each of a series of possible needs and presses apparent in a story. A need is defined as a force emanating from the hero of the story and a press is defined as a force or forces emanating from the environment. A common practice is to use a comprehensive list of 28 needs according to the direction or immediate personal goal of the activity. The needs would include needs for abasement, achievement, aggression, dominance, succorance etc.

Advantages:

TAT is found useful in any comprehensive study of personality and in the interpretation of behavior disorders, psychosomatic illnesses, neuroses and psychoses. It is a technique for investigation of the dynamics of personality as it manifests itself in interpersonal relations. This technique is especially recommended as a preface to a series of psychotherapeutic interviews or to a short psychoanalysis. The pictures have been found to be effective in stirring a person's imagination and they serve to force the client to deal in his own way with certain classical human situations.

Limitations:

One of the major limitations of TAT is that it has been trait specific and consequently of minimal use to the practitioner in the clinical settings. TAT has also not demonstrated much utility with respect to specific issues of Psychiatric diagnosis. Also this need - press interpretation scheme by Murray takes 4 to 5 hours to interpret 20 stories with this system.

ROSENZWEIG - PICTURE - FRUSTRATION TEST (R - P -F):

The R-P-F test is designed to assess patterns of reaction to typical stress situations where the client is assumed to express something of his own personality and pattern of reaction by the manner in which he interprets and deals with ambiguous stimulus material. The characters in the pictures are shown without any facial expressions or posture that would suggest particular responses and it is therefore assumed that the client in his response identifies with the frustrated character , for whom he speaks and into whom he projects his own typical pattern of reaction.

Administration and scoring :

The procedure of administering the R-P-F test is relatively simple and is carried through with as much precision as possible. The client is given the test booklet and the therapist reads over the instructions with him. The booklet is then opened, the first situation read and explained, and the client is asked to tell the first thing he thinks of that the frustrated person might say. When he has answered, he is told to write his reply in the balloon over the frustrated characters head and then to proceed in a similar way and the client is discouraged from making any changes in his responses once he ahs written them.

In scoring given response , it is necessary to decide whether aggression is expressed towards the environment ( Extra punitive ), is turned inward against the self ( Intropunitive ) or is suppressed and glossed over ( Impunitive ).One also has to consider whether the response represents blocking at the point of the frustration itself ( Obstacle - Dominance ), defenses against the ego - threatening qualities of the situation , usually in the form of assignment of blame ( ego - defense ), or drive towards solution of the problem (need - persistence ).

Reliability And Validity:

Little is known about the reliability and validity of this test apart from what may be inferred from actual clinical experience with the instrument. Because of the difficulty of establishing a consistent and objective scoring system, the first work of this sort was done to determine the reliability of scoring, using a comparison of independent judgments of experienced scorers. After final revision of the scoring samples had been made, it was found that such scorers agreed in 85 % of their judgments. The test- retest reliability coefficients was .60 to .80 on the adult form and preliminary results with the children's form seem to be at about the same level. In the absence of definite data, it appears that the validity of this instrument must be thought of in terms of its usefulness in clinical practice, and must be measured by the extent to which it serves to corroborate and amplify the findings of other clinical tools. One major problem in establishing the validity has been the difficulty in finding a criterion against which to measure it.

DRAW - A - PERSON - TEST (D - A- P):

The first formal development of a projective drawing technique was Goodenough's (1926) draw - a - man -test. She used it solely to estimate the child's cognitive abilities as reflected in the quality of the drawing. Machover's (1949) draw - a- person (DAP) expanded projective drawings beyond the area of cognitive assessment and into the interpretation of personality.

Administration and Interpretation:

Clients are given a sheet of blank paper, 8 � into 11" and a medium soft pencil .They are simply told to draw a picture of a person and when they have completed the first drawing, they are given a sheet of new paper and requested to draw a person of the opposite sex. All preliminary questions asked by the client are answered with a non - committal "just as you please". A note is made regarding which figure was drawn first.

Interpretation varies on a continuum ranging from objective scoring to an intuitive, impressionistic analysis. Objectivity is based primarily on specific details that occur in the drawings and this might include scoring for such factors as cognitive maturity, impulsiveness, neurological deficit or overall level of adjustment. An impressionistic approach night begin with considering the overall feel of the drawing , proceeding to standard interpretations of specific signs, and integrating the hypothesis derived from these steps within the context of information obtained from other sources.

Advantages:

Proponents stress that the drawings are simple , can be administered quickly require few materials and provide a large amount of information relating to a persons self concept , ego ideal , perceptions of the persons of the opposite sex , level of adjustment , impulsiveness, anxiety and conflict areas. Since drawings are nonverbal, they can be used with client's who have poor verbal skills or those who are withdrawn, evasive or defensive. It can be administered individually or in groups and can be used to indicate change as a result of psychotherapy.

Limitations:

Empirically oriented reviewers have criticized projective drawings because the interpretation is very subjective. Subjectivity is doubled in that not only does the client subjectively project portions of him or herself into the drawings, but the interpreter might project him or herself into his or her interpretation. Norms are either non existent or where norms have been provided they are typically poorly developed. Also the assumption that the test is relatively culture free has been challenged.

Reliability and Validity:

Test -Retest reliability based on quantitative scoring using the Harris (1963) DAP guidelines have found moderate reliabilities of contents (Mdn r = .74), whereas test - retest reliability of contents have been low. Inter- rater reliability has been much better with a median of .90 for the drawing of a man and .94 for the woman. Reliability of adult DAP's have likewise been respectable. Attempts to demonstrate adequate validity has been more problematic.

PERSONALITY INVENTORIES:

Personality develops in an interpersonal context. Objective personality measuring devices are commonly designed so that the client must answer "true" or "false". The concepts of another's personality are primarily determined by the social stimulus value of others - what impact they have, and how they affect people who come in contact with them.

THE MINNESOTA MULTIOPHASIC PERSONALITY INVENTORY (MMPI):

Since its development by Hathaway and McKinley in 1940, the MMPI has become the most widely used clinical personality inventory. The MMPI is a standardized questionnaire that elicits a wide range of self-descriptions scored to give a quantitative measurement of an individual's level of emotional adjustment and attitudes towards test taking. Presently the two versions MMPI -1 and MMPI - 2 are known both by their scale numbers and by scale abbreviations.

Administration:

The MMPI - 1 / MMPI -2 can be administered to persons who are 16 years of age or older with an 8th grade reading level. Both forms of an MMPI have 566 items that requires special scoring. The booklet form request client's to mark their answers on both sides of the answer sheet.

Advantages:

A significant asset is the MMPI's immense popularity and familiarity within the field. It has been translated into many languages and is available in numerous countries. MMPI has stimulated a vast amount of literature and has frequently been used as a measurement devised in research in research studies. Majority of MMPI questions deal with psychiatric, Neurological, psychological and physical symptoms. This inventory despite its well known faults continues to dominate the field of objective assessment of personality and psychopathology.

Limitations:

Criticisms of MMPI have primarily centered on its growing obsolescence, difficulty with the original scale construction, inadequacy of its standardization sample and difficulties with many of the items. Problems with the items include possible racial bias, archaic phrases and objectionable content. The MMPI has never lacked for critics, but nonetheless rolls merrily along, piling up new records for clinical usage and research activity with each passing year.

Reliability:

Reliability studies on the MMPI indicate that it has moderate levels of temporal stability and internal consistency. Hunsley, Hanson and Parker (1988) concluded that all MMPI scales are quite reliable, with values that range from a low of .71 to a high of .84.

THE SIXTEEN PERSONALITY FACTOR'S QUESTIONNAIRE (16 PF):

Raymond b Cattell devised the 16 PF and he describes it as not a questionnaire composed of arbitrary scales, but one, which consists of scales carefully, oriented and groomed to basic concepts in human personality structure research. There are five form of 16 PF: Forms A and B for newspaper literate adults consisting of 187 items each: Forms C and D with a somewhat less demanding vocabulary and consisting of 105 items each and Form E which has 128 items with a very simple vocabulary for the educationally disadvantaged.

It measures 16 human personality factors, which are designated by a letter, and these include dominance, shyness, anxiety, suspiciousness, venturesomeness, independence etc.

PERSONALITY DISORDER EXAMINATION (PDE):

The PDE is arranged in a format that attempts to provide the optimal balance between a spontaneous, natural clinical interview and the requirements of standardization and objectivity. The questions flow in a natural sequence that is congenial to the clinician and are arranged under 6 headings: Work, Self, Interpersonal Relationships, Affects, Reality testing and Impulse control. The headings are not only convenient labels but they play an organizational or thematic role.

Administration and Scoring:

In order to maintain the interest of both the client and the therapist, it is recommended that the entire PDE should not be given in one session. Once an interview goes beyond an hour there is danger that the examiners will not pursue responses with the same alertness and the client's responses will be briefer. The sections are usually introduced by open - ended inquiries that offer the client an opportunity to discuss the topic as much as he chooses.

Much of the behavior described in the criteria exists on a continuum with normality. The PDE scoring is based on the convention that a behavior or trait maybe absent or normal (0), exaggerated or accentuated ( 1 ) , and criterion level or pathological (2 ). The item is scored NA (Not Applicable) if the client never assumes those roles. The Scoring category is reserved for occasions when the client refuses to answer questions.

Advantages:

Its purpose is to identify those traits and behaviors that are relevant to an assessment of the criteria for personality disorders in the Diagnostic and Statistical Manual. PDE examines every client for the presence or absence of all the DSM Axis - 2criteria.

Limitations:

The PDE is essentially a self report instrument and assumes that a person is capable of providing a valid description of disturbances in his personality. An individual may be unaware of some of his traits and may also be resistant to acknowledging behavior if it is socially undesirable or its disclosure is likely to adversely effect what he believes to be his best interest. This is especially likely to occur in client's who wish to terminate treatment prematurely or in those about to be discharged from a mental health facility. Others may exaggerate disturbances in their behavior and this is sometimes observed in those who are frantically seeking help or who are dissatisfied with their treatment the amount of attention they are receiving.

Reliability:

There are some methodological obstacles to trying to measure the reliability of the interview process itself. Once the client has been given the PDE, he is no longer in virginal state Vis - a - Vis subsequent interviews, whether conducted by the same or different interviewer. The client may construe the repetition as an indication of dissatisfaction with his previous responses, or as an attempt to check them.

Validity:

The problems associated with establishing the validity of a semi-structured interview are formidable. It would be meaningless to validate the PDE against the diagnosis of clinicians without first having established their reliability if not their validity. The common practice of invoking construct validity is by demonstrating that an interview has some degree of correlation with other interviews or an inventory purporting to measure the same phenomena is a dubious one, since the various instruments usually sample identical content and often employ similar methods.

NEUROPSYCHOLOGICAL TEST BATTERY:

The Neuropsychological Test Battery helps in the assessment of the psychological- behavioral effects of real or suspected brain lesions and the diagnosis of organic brain conditions. It is necessary to be acutely aware of the many complex patterns that various neurological disorders may produce on a battery of neuropsychological tests and a proper diagnosis requires knowledge of neuropath logical processes, an awareness of their possible courses and an understanding of secondary problems that may arise.

LURIA NEBRASKA NEUROPSYCHOLOGICAL TEST BATTERY (LNNB)

The work of the Russian neuropsychologist Alexander Romanovich Luria (1902 - 1977) is highly respected by academic neuropsychologists and neurologists. There are 2 forms of the LNNB, which are as follows:

Form - 1 which was introduced in 1980 comprises of 269 items and is hand or computer scored.

Form - -2 which was introduced in 1984, comprises of 279 items and is only computer scored.

These two forms are not independent of one another. Off the 279 items of Form- 2, 84 (approximately 30%) are identical to items of Form - 1.

Administration and Scoring:

During administration, the examiner circles each item score in the administration and scoring booklet. The items are scored on the basis of the criteria listed for each items and the scores are as follows:

0 - indicates normal performance.

1- indicates weak evidence of brain disorder.

2- indicates strong evidence of brain disorder.

The most general scoring dimension used on the battery is the total number of errors within an item or sub- item. Thus higher raw score indicates poorer response, in turn indicating poor response. The LNNB yields both quantitative and qualitative scores.

Advantages:

The test identifies brain damage in individuals who have symptoms of uncertain etiology and helps in assessing the extent of and nature of deficits in clients. It also helps in evaluating the effects of specific interventions or rehabilitation strategies on neuro - psychological functioning.

Limitations:

The test is not suitable to evaluate aphasics since complex verbal instructions are used and language skills are frequently employed to assess non language functions such as naming an object placed in ones hand. Many of the stimulus items are repeatedly used across subtests and the test is frequently boring for the patients who are not that severely impaired and for the administrators.

HALSTEAD REITAN NEUROPSYCHOLOGICAL TEST BATTERY:

This test battery is the most frequently used in clinical neuropsychological today. A variety of independent tests make up this battery and most of them were developed in Halstead's laboratory at the university of Chicago and the others were added by Reitan (e.g. - Trails A and B) and also deleted tests that were theoretically interesting but failed to statistically discriminate between brain damaged and normal subjects.

Advantages:

It offers an excellent survey of cognitive, sensory-perceptual, motor functions that well serves the purpose of differential diagnosis and decision-making in neuropsychological. Its use is supported by a wealth of research data, and, many clinicians have learned to interpret the subtle nuances that can be so important in the inferential process.

Limitations:

The necessary equipment is expensive and the battery itself is time consuming and tiring for the patients. It cannot be easily transported and it is difficult to test patients at bedside and the interpretation of test results requires considerable experience and expertise.

Reliability and Validity:

The reliability of this test has not been investigated as thoroughly as has its validity. Once a test is learned, retesting on that test would result in a spuriously high score. Parallel forms of the Halstead -Reitan battery do not exist at present. Inspite of these difficulties studies of the reliability of this battery have demonstrated sufficient psychometric reliability to make the test clinically useful. Validity of this test has simply compared the performance of brain- damaged patients on the battery with the performance of psychiatric controls patients on each individual test of the battery as well as on overall impairment index. A few studies have compared organic dysfunctional patient's performances on this battery with neurological findings from brain scans, EEG's and angiographies.