Chapter Eight

CHAPTER 8:
Integrating MMPI-2 Inferences into an Interpretive Report


This chapter considers an approach to organizing MMPI-2-based inferences into an integrated interpretation.


A Strategy for Integrating MMPI-2 Information

- A purposeful strategy for organizing psychological test information is to consider the referral question.
- It is also desirable to pose a series of questions or issues that can be addressed regardless of the reason for referral. The following interpretation questions and treatment plan questions can help:

Questions for MMPI-2 Interpretations:
Are there any extratest factors that can possibly influence the MMPI-2 results?
What are the individual’s attitudes towards the test?
What are the individual’s reported symptoms and behaviours? Is the client experiencing any acute mood states?
Is the individual experiencing problems in self-control? If so, how might they be manifested?
Are there any trait-based hypotheses about the individual’s personality characteristics?
Does the individual show a potential for developing a problem with alcohol or other drugs? Has he or she acknowledged excessive alcohol or drug use?
What are the individual’s interpersonal relationships like? Is he or she able to deal effectively with others?
How frequent or rare is this pattern?
How stable is the individual’s profile likely to be over time?
How severely disturbed is the individual compared to others?
What are the diagnostic considerations in the case?

MMPI-2 Treatment Planning Questions:
Is the individual in need of psychological treatment at this time?
How aware is the individual of his or her problems?
How credible is the individual’s self-report?
Is the individual willing to disclose personal information to the therapist?
How motivated is the individual for treatment?
Is the individual capable of gaining insight into his or her problems?
Is he or she amenable to treatment? Is the individual willing to change his or her behaviour?
Are the specific treatment needs suggested by the MMPI-2?
Are there any strengths or assets that can be built on in treatment?
Are there negative personality features that could interfere with the treatment relationship?
1. Extratest Information
- Basic demographic and setting characteristics are important considerations because they set the stage for test interpretation by providing clear expectations by which to judge the clients MMPI-2.

Setting
- You should be aware of the factors that may influence a client’s responses and you should either alleviate their influence or compensate for them in your interpretation (ex. personnel screening, custody battles, court referrals). Clients may be exaggerating their symptoms or they may be defensive.
- Validity scales are especially useful in these situations. Be aware of the typical base-rate validity pattern for a particular setting.

Gender
- Gender influences responses to personality inventory items.- Use the appropriate norms!
- Content scale TPA is a better scale (and construct) for men than for women.Age
- People below the age of 18 respond to the items differently than adults.- Individuals younger than 18 should be tested with the MMPI-A- Some older individuals respond differently to MMPI items than do younger adults, but there are no different norms for them.Social Class- Social class factors, except in the case of very low socio-economic level on two of the standard scales, have not proven to be of much importance n interpreting MMPI profiles.- The new MMPI-2 norms are based on a more representative sample of middle- and high-SES subjects. Interpretive adjustments do not appear to be needed for MMPI-2 profiles from most socio-economic strata. However, the K and Mf scores from very low SES individuals, who often have a lower education level, should be interpreted with care.Education- For most people the new norms can be applied without adjustment.- For individuals with very low education (6th through 11th grades) some adjustment might be needed because the new MMPI-2 norms contain somewhat fewer subjects with this education level.- Caution should be taken in interpreting the K and Mf scales.- Reading comprehension becomes an issue.- The examiner should make sure that the clients F and VRIN scores are within the interpretable range (below a T of 90 for F and 80 for VRIN).Ethnic and Cultural Factors- The first MMPI was criticized for not having many minorities in the normative sample.- The MMPI-2 norms apply equally well regardless of the ethnic group background and no special interpretation considerations needs to be made with regards to race.- The MMPI-2 and MMPI-A have been widely translated and adapted for international use.- The test can assess abnormal behaviour in other countries and has a high degree of accuracy across cultures.2. Response Attitudes- The MMPI-2 and MMPI-A validity scale patterns provide important clues to the subject’s cooperativeness, ability to understand the items, literacy level, and willingness to follow instructions.
- The Cannot Say score: indicates whether the individual has answered all or most of the items.
- TRIN and VRIN: Provide information about response inconsistency.- F scale: indicates whether the individual is responding in a frank and open manner or is exaggerating symptoms to convince the examiner that he or she is more disturbed than is actually the case.L and K scales: indicate whether the individual is willing to admit relevant problems. Scores below 65 show a non-defensive symptom pattern.3. Assessing Symptoms and Behaviours- Evaluation of a client’s personality and behavioural problems should proceed from appraising the most significantly elevated scale scores or profile configurations. In profile interpretation, we must first decide which of the prototype (scale or code-type) MMPI-2 descriptors to use as the empirical structure of the report, that is, which scale or code-type correlates would most likely apply to a particular case.- Usually, you would take the highest clinical profile point, two-point pair, or three- or four-point code type as your prototype.- When several scales are elevated above 65, it may be more difficult to determine the code type to use. In such cases, it is best to use the prototype that includes the greatest number of scales in the profile code. - Once you have determined the most suitable profile prototype to follow and have chosen the correlates to serve as the empirical outline of your report, you can search for other scales elevations (e.g., the Harris-Lingoes subscales or the supplementary scales) for additional hypotheses about the individual’s problems and behaviour.- Usually you look for T scores higher than 65, but scores in the 60-65 range can also be useful in understanding the client’s behaviour.- Internal inconsistencies (e.g. elevation on both the D and Ma scales) are not necessarily bad. They can offer useful information in understanding the client. The Harris-Lingoes subscales should be consulted to understand the discrepancy.
- The presence of several scale elevations or profile relationships should alert the interpreter to the possibility that the individual is experiencing acute mood states.

Anxiety: Pt 65-79; Pt greater than Sc (Moderate)
Pt 80-89; Pt greater than Sc (Marked)
Pt 90+; Pt greater than Sc (Severe)

Depressive State: D 65-79; Ma Less than 40 (Moderate)
D 80-89; Ma Less than 40 (Marked)
D 90+; Ma Less than 40 (Severe)

Manic State: Ma greater than 80; Ma highest score; D less than 55

Psychosis: Sc greater than 80; Sc the highest score; Sc greater than Pt by 10 points

Suspicion-mistrust: Pa greater than 70; Pa the highest score

Acting out: Pd greater than 65 or Ma greater than 70 and Si lower than 40 or ANG greater than 65

Confused, disoriented: F greater than 80
Sc greater than 80 or
Pt greater than 80 or
Mean profile Elevation greater than 70

Crisis states: Koss-Butcher and Lachner-Wrobel critical items serve as clues to significant problems

4. Assessing Self-Control or Acting Out

Inhibition (constriction): Indicated by scores greater than 65 on the Si scale

Overcontrol (repression): Suggested by scores greater than 65 on the Hy scale

Acting out (impulsivity): Suggested by scores greater than 65 on the Pd and Ma scales or low Si scores (below 40)

Anger (loss of control): Suggested by scores greater than 65 on the ANG or Ho scale

5. Generating Trait-Based Hypotheses

Impulsivity: Indicated by Pd greater than 65 or Ma greater than 70 with Si below 40

Introversion: Si greater than 65

Obsessiveness: Pt greater than 65; Pt highest point in profile; OBS greater than 65

Dominance: Do greater than 65

Cynicism: CYN greater than 65

6. Problems with Alcohol or Other Drugs

- The APD and MAC-R scales have been developed to assess alcohol and drug problem potential.- The AAS scale addresses the individual’s willingness to acknowledge problems with alcohol or drug use- The MMPI-2 scale patterns most commonly associated with disorders of substance use or abuse are as follows:High elevation (T > 65) on PdHigh elevation (T > 65) on D and PdHigh elevation (T > 65) on D, Pd, and PtModerate to High elevations (T > 60) on MAC-R, APS, or AAS7. Assessing Quality of Interpersonal Relations

- The Si scale addresses social introversion and social maladjustment. The Si scale provides a reliable evaluation of the individual’s basic sociability and comfort in social situations.- Si subscales allow the interpreter to determine the relative contribution of the subscale components (shyness, avoidance, or self-alienation) to the individual’s self-reported interpersonal attitudes.8. Base-Rate Information- Base rate refers to the relative frequency of a particular problem in a given population.- Frequency information can be obtained from several published sources in addition to The Minnesota Report.9. Stability of the Profile- The Si scale measures personality characteristics that are unlikely to change over time.- D and Pt are likely to reflect a situational problem that could alter with change in circumstances.- The more defined a profile is, the more stable it will be. A well-defined profile is one where the two highest scales are 10 T-score points above the next scale in the code. Profiles with 5-9 T-score gap between them and the next highest scale or code type, also tend to be stable.
10. Severity of Disorder- An evaluation of the individual’s standard and content scale profiles and performance on the supplementary scales provides some general guidelines to how severely disturbed the individual is.- T scores of 60 would be viewed as well adjusted- 80+ T scores suggest severe psychological maladjustment11. Diagnostic Considerations- Although the MMPI was originally constructed with the idea that clinical scale elevation would correspond to diagnostic groups, clinical diagnosis has not been the primary focus in using the instrument. - It is used mostly for descriptive diagnosis- In descriptive diagnosis of clients with the MMPI-2, several sources of information are used: - Standard scale elevation - Slope of profile - Code-type information - Content scale scores

Treatment Considerations

- Response attitudes provide clues about the individual’s willingness to share personal information, awareness of problems, and ability to understand his or her problems.- The clinical scales provide clues about the extent of problems and motivation for treatment.- The content scales provide information about the nature of the individual’s problems, attitudes, self-views, or behaviours that might interfere with treatment progress.***There is an example in the book (p.200) that walks you through answering the treatment questions mentioned at the beginning of this summary. Might be worth reading, might not.