Chapter Five

CHAPTER 5

INTERPRETING MMPI-2 PROFILE TYPES (CODE TYPES)

Profile or code types are MMPI-2 clinical scale summary indexes that include the most prominent scale elevations in a configuration of the standard MMPI-2 scales.
Code-type interpretation was developed as recognition that in many cases, more than one standard scale was usually elevated. They are based on the analysis of scale patterns.
A code type is defined by the highest elevated scale or scales in the standard profile and their rank order in terms of elevation.
Scales most included in the research on code types: Hs, D, Hy, Pd, Pa, Pt, Sc, Ma.
For research on special populations include other scales, such as Mf and Si.
Single profile (profile spike): one single standard scale if elevated in the critical range.
Two point profile (more frequently researched): 2 clinical scales are elevated in the critical range (T≥65). The code defining such an occurrence would be something like 2-7/7-2.
Three-point code (frequent in different areas of research) occurs when 3 clinical scales are elevated in the profile (ex. 2-4-7, found in alcohol- and drug-treatment programs).
Four-point code is relatively rare. 1-2-3-4 can be found in medical settings.

How to use the code types

RULES
the profile should be clearly defined) i.e. 2 or more scales reach interpretative significance using the definitions discussed in the following). The more well-defined the code types is the better there is a match with the correlate literature.
there must be sufficient research on behavioural descriptions for the code. If a code type is an infrequent one, the scale-by-scale interpretation strategy should be used.
Rather than statistical analyses which have limited application and do not provide a more accurate classification, code types are practical, easy to apply and summarize better the most important elements of a given profile.

Code-type definitions and stability

Typically, a large number of cases is required to obtain a sufficient number of subjects with a particular code. Researchers grouped similar type codes, to obtain a higher number sample (ex. 2-7 and 7-2), ignoring the score level and the rank order of the elevated scales. HOWEVER, both these features do have their own importance in differentiating characteristics.
The order of the scales within the code type might make an important difference regarding the relative importance of empirical descriptors, therefore it’s best to emphasize the correlates of the higher elevated scale of the code type.
Same with the difference in elevations of the code types, because the s elevation describes the likelihood that the empirical correlates apply to the case (the higher the elevation, the more confident we can be that the person indeed is exhibiting said behaviours)
MMPI has good test-retest reliability, ranging from medium to high.
The stability of the codes depends on how well the code is defined and there are reports of low congruence on retest. On the other hand, codes with more extreme scores (that is those that were well-defined by a substantial point separation between the scale scores in the code type and those not included in the code) tended to be similar at rests.
The greatest code-type agreement at rests was obtained for profiles with a 10-point T-score spread between the code type and the rest of the profile code.
Rules of thumb for assessing the stability of a profile code:
Profile code types that are 10 points or more above the next highest score are very likely to be found at retest.
Profile code types that are 5-9 points above the next score are likely to remain constant on retest.
Profile code types that are 4 or fewer points above the next score may shift on later retest but future profiles will probably maintain some elements and correlates of the initial code types.

Similarity of the traditional MMPI and MMPI-2 code types

· Types are quite consistent between the two types
· The need to make T scores fall at equivalent percentile values has affected some codes, especially the ones with less of a clear definition
· 90% of the profiles with a 5-point profile code definition have the same codes on both interviews.
· Limitations to using the MMPI-2 codes:
i. There may be some slight shifting of scales within the profile code between the two forms because of the difference in standardization samples and T-score transformation procedures. It is said that discrepancies are minor, but keep them in mind.
ii. There are code types which have scarce empirical descriptors. It is a good idea in this case to interpret not only based on the code-types but also based on the individual profiles and content scales. See chapter 8 on how to do that.

Research on MMPI/MMPI-2 code types

Meehl showed that using actuarial tables to interpret the profiles is a better strategy than clinical interpretation. Subsequent research supported his findings.

Two-point code-type descriptors

Correlates were obtained by collecting groups of patients who had similar code types and studying their behavioural characteristics by use of Q-sort ratings, history or other assessment methods.

1-2/2-1 Code type

Symptoms and behaviours
- Extreme somatic problems or chronic pain.
- Complain though there might be no physical basis for their illness.
- Overly concerned with health and bodily functions
- Overreact to minor physical dysfunctions.
- Common somatic symptoms: weakness, fatigue, dizziness.
- They appear tense, anxious, restless, irritable, dysphoric, brooding and unhappy. Hypersensitive.
- Loss of initiative
- Report depressed mood, withdrawal and reclusiveness.
- Very self-conscious in talking to others.
- They doubt their own abilities.
- Vacillate even in minor matters.
Personality characteristics
- Self-conscious, introverted and shy in social situations.
- Passive dependent and harboring hostility towards those perceived as not offering enough attention and emotional support.
Predictions
- Excessive alcohol or prescription drug use as a tension reduction mechanism.
- Diagnosed as neurotic (Hypochondriacal, anxious or depressive).
- Poor prognosis for traditional psychotherapy because they can tolerate high levels of discomfort before becoming motivated to change. Also, they resist psychological interpretation of symptoms.
- Tend to use repression and somatization.
- Lack of insight and self-understanding therefore they resist accepting responsibility for own behaviour.
- Any treatment gains are short lived.

1-3/3-1 code type

Symptoms and behaviours
- Report vague physical complaints that might increase under stress and disappear when stress subsides.
- No severe anxiety or depression
- Can function at reduced level of efficiency.
- Preference for medical explanations of symptoms and resistance to psychological interpretations.
- Tendency to deny and rationalize, seeming uninsightful.
- They view themselves as normal, responsible and without fault, with no appropriate concern for their own symptoms and problems.
- Overly optimistic and Pollyannaish.
Personality characteristics
- Seen as immature, egocentric and selfish.
- Viewed as passive, dependent and insecure when their strong needs for attention, affection and sympathy are not met.
- Viewed as outgoing and socially extroverted, but with superficial relationships.
- Self-preoccupied and lacking genuine involvement with ppl.
- Manipulative in social relations, lacking skills in dealing with the opposite gender and low in heterosexual drive.
- Resentment and hostility toward those who seem to not offer enough attention.
- Are seen as overcontrolled and passive-aggressive in relationships.
- Occasional anger outbursts.
- Usually conforming and conventional in attitudes and beliefs.
Predictors
- Diagnosed with psychophysiologic disorder and anxiety disorder, such as conversion or psychogenic pain disorders.
- Not likely to be motivated for psychotherapy.
- Expect definite answers and simple solutions to their problems.
- Will terminate therapy prematurely when the therapist fails to respond to their demands.

1-4/4-1 Code type

Symptoms and behaviours
- Severe hypochondriacal symptoms, especially nonspecific headaches and stomach distress.
- Indecisive and anxious
- Socially extroverted but lacking skills with the opposite gender
- Rebellious toward home and parents but do not express these feelings openly.
- Likely to be dissatisfied, pessimistic, demanding and grouchy.
- Acting out behaviours leading up to their somatic complaints.
Personality characteristics
- Personality problems are central.
- Maladjustment probably cause by acting-out behaviours and poor judgement
Predictors
- Excessive use of alcohol
- Lack of drive. Problems sustaining work or productive activity.
- Poorly defined goals and motivation.
- Usually resistant to traditional psychotherapy.

1-8/8-1

Symptoms and behaviours
- Long-term psychological problems.
- Feelings of hostility and aggression which cannot be expressed in a modulated, adaptive manner.
- Either inhibited and “bottled up” or overly belligerent and abrasive.
- Feel unhappy, depressed, confused and distractible.
- Flat affect
- Feel socially inadequate and have difficulties relating to the opposite gender.
Personality characteristics
- Long-term personality issues.
- Feel socially inadequate and lack trust in ppl.
- Isolated and alienated
- Report having a nomadic lifestyle.
Predictions
- Schizophrenia diagnosis. Bizarre somatic complaints that will make Tx difficult
- If not schizophrenic, they might still exhibit severe, chronic, unusual, intractable symptoms.

1-9/9-1

Symptoms and behaviours
- Extreme distress.
- Anxious, tense, restless with somatic complaints.
- Aggressive and belligerent if their somatic complaints are minimized.
- May be ambitious and have high drive level, but they tend to lack clear goals, becoming frustrated by an inability to achieve a high level.
Personality characteristics
- Passive-dependent personality style
- They try to deny personality problems.
Predictors
- Reluctant to accept psychological explanations for their medical problems
- Code found in brain-damaged persons who have difficulty coping with organic deficits.

2-3/3-2

Symptoms and behaviours
- No anxiety, but report feeling nervous, tense, worried, sad and depressed.
- Somatic complaints: fatigue, exhaustion, physical weakness, gastrointestinal complaints.
- Lack of interest and involvement in life.
- Report unable to get started.
- Decreased physical activity and lethargy.
Personality characteristics
- Passive, docile, dependent.
- History of self-doubt, inadequacy, insecurity, helplessness.
- Engage in behaviours that elicit nurturance from others but do not obtain what they consider adequate recognition for their symptoms.
- Hurt by minor criticism
- Overcontrolled and unable to express feelings
- They deny unacceptable impulses, avoid social involvement and feel especially uncomfortable around the opposite gender.
- Sexual maladjustment, impotence and frigidity.
Predictors
- Diagnosed with depressive disorder
- Not very responsive to psychotherapy
- Lack introspective ability.
- Able to function at a low level of efficiency for long periods.
- Able to tolerate a high level of unhappiness without seeking behaviour change.
- Seem driven to succeed but are afraid to place themselves in directly competitive situations.
- Feel a need to increase their responsibility in life, but dread the pressure associated with this.

2-4/4-2

Symptoms
- History of legal problems and impulsive behaviour.
- Unable to delay gratification of impulses
- Get into trouble with others.
- Little respect for social standards and values.
- Tendency to act out…excessive drinking.
- Appear to be frustrated by their lack of accomplishments.
- Resentful of demands placed by others
- After acting out, they express guilt and remorse, lacking sincerity about changing.
Personality characteristics
- Appear sociable and outgoing, making a favourable first impression
- Manipulate others, showing maladaptive personality traits
- Cause resentment in long-term relationships
- Façade of competence and self-assurance.
- In reality, they are overly self-conscious and dissatisfied with themselves.
- Passive-dependent.
Predictors
- Suicidal ideation and attempts (ESPECIALLY IF BOTH SCALES ARE VERY ELEVATED)
- Express need for help and desire to change, but have poor prognosis for psychotherapy success.
- Likely to terminate therapy prematurely when the outside stress subsides.

2-7/7-2

Symptoms and behaviours
- Appear anxious, tense, nervous and depressed.
- Report feeling unhappy, sad and tend to worry excessively.
- Feel vulnerable to real and imagined threats.
- Typically anticipate problems before they occur and overreact to minor stress as if it is a major catastrophe.
- Somatic complaints, fatigue, exhaustion, tiredness, weight loss, slow personal tempo, slowed speech and retarded thought process.
- Brood and ruminate.
- Strong need for achievement and recognition, with high expectations for themselves and others.
- May feel guilty when goals are not met.
- Perfectionistic attitudes and a history of being conscientious.
- May be excessively religious and extremely moralistic.
Personality characteristics
- Appear docile and passive-dependent in relationships
- Report problems in being assertive
- Show capacity for forming deep emotional ties
- Tend to lean on ppl to an excessive degree.
- Solicit nurturance from others.
- Long term issues with feelings of inadequacy, insecurity and inferiority.
- Intropunitive in dealing with feelings of aggression.
Predictors
- Diagnosed with MDD, OCD or anxiety disorders.
- Usually motivated for psychotherapy.
- Remain in therapy longer than other patients.
- Pessimistic about overcoming problems
- Indecisive and rigid in thinking.
- These traits tend to interfere with their problem-solving ability, but they DO improve with treatment (THANK GOD!!! I was starting to wonder why we even bother with psychotherapy and not just prescribe drugs)

2-8/8-2

Symptoms and behaviours
- Anxious, agitated, tense and jumpy
- Report sleep disturbance and inability to concentrate
- Disturbed affect and somatic symptoms
- Clinically depressed.
- Soft slowed speech and thought.
- In interviews, they appear emotional and tearful. Otherwise seen as apathetic and indifferent.
- Anger and problems with interpersonal relations
- Report forgetfulness, confusion and inefficiency in carrying out responsibilities.
- Viewed as unoriginal and stereotyped in problem solving and thinking.
- Underestimate the seriousness of problems and engage in unrealistic self-appraisal,
- Overly sensitive to the reactions of others
- Suspicious of others’ motivations
- History of being emotionally hurt. They fear getting hurt more so they avoid close relationships.
- Feelings of despair and worthlessness.
Personality characteristics
- Dependent, unassertive, irritable and resentful.
- Fear losing control over own emotions.
- Deny impulses but experience dissociative periods.
- Chronic, incapacitating symptoms
- Guilt ridden and self-punitive.
Predictors
- Serious maladjustment
- Underevaluate problems
- Most common diagnoses: MDP, schizophrenia, schizoaffective type, severe personality disorder.
- Suicidal thoughts. Create specific plans for it.

2-9/9-2

Symptoms and behaviours
- Self-centered and narcissistic
- Ruminate a great deal about self-worth.
- Express concern about achieving a high level but then set themselves up for failure.
- Identity crisis (for younger persons)
- Anxious, tense, somatic complains (gastrointestinal tract)
- History (if not current) of depression.
Personality characteristics
- Denial that hides feelings of inadequacy and worthlessness.
- Diagnosis: Bipolar disorder.
- Profile seen sometimes among persons with brain-damage who have lost control or are trying to cope with deficits through excessive activity.
- Use of alcohol as an escape from stress and pressure.

3-4/4-3

Symptoms and behaviours
- Chronic and intense anger
- Harboring hostile and aggressive impulses but cannot express them appropriately.
- Problems of self-control
- Although usually overcontrolled, they experience occasional brief episodes of assaultative, violent acting-out.
- Lack insight into the origins and consequences of their aggressiveness
- Extrapunitive.
- Do not see their behaviour as problematic.
- No anxiety or depression, but somatic complaints are present.
- Upset not related to external stress.
- Sexual maladjustment and promiscuity.
Personality characteristics
- Long-term ingrained feelings of hostility toward family members.
- Demand attention and approval from others
- Overly sensitive to rejection. Hostile when criticized
- Outwardly conforming, but inwardly rebellious.
Predictors
- Suicidal thoughts and attempts following acting-out episodes
- Diagnoses: passive-aggressive personality disorder, emotionally unstable personality.

3-6/6-3

Symptoms and behaviours
- Symptoms not incapacitating
- Moderate tension, anxiety, physical complaints
- May not recognize hostile feelings
- Appear defiant, uncooperative and hard to get along with.
- Appear suspicious and resentful.
- Self-centered and narcissistic.
- Tend to deny psychological problems.
Personality characteristics
- Chronic and deep feelings of hostility towards family members and ppl close to them.
- Not likely to express negative feelings directly
Predictions
- Naïve attitudes toward others
- Gullible at times

3-8/8-3

Symptoms and behaviours
- Psychological turmoil: anxiousness, tension, nervousness and fearfulness.
- Disturbed thinking, including somatic delusions.
- Might display phobias
- Symptomatic depression and feelings of hopelessness behind a smiling façade.
- Indecisiveness even for minor matters.
- Physical complaints.
- Vague and evasive when talking about complaints and difficulties.
- Disturbed thinking, concentration problems, lapses of memory, unusual ideas, loose ideational associations, obsessive ruminations, delusions, hallucinations, irrelevand and incoherent speech.
Personality characteristics
- Immature and dependent.
- Strong need for attentions and affection.
- Intropunitive interpersonal behaviour.
Predictions
- Apathetic, pessimistic and not actively involved or interested in life activities.
- Limited rehab efforts.
- Insight-oriented therapy might not be very effective.
- Seem unoriginal and stereotyped in problem solving.
- Diagnosis: schizophrenia.
- Responsive to supportive therapy.

4-6/6-4

Symptoms and behaviours
- narcissistic, immature, self-indulgent.
- Excessive and unrealistic demands on relationships.
- Attention and sympathy seekers.
- Suspicious of others and resentful of the demands made on them.
- Relationship problems, especially with the opposite gender.
- Mistrustful of the motives of others.
- Avoid deep emotional involvement.
- Seen as irritable, sullen, generally obnoxious, resentful of authority.
- In a study of imprisoned Palestinian and Israeli terrorists, it was found that the overall mean profile of the participants was 4-6/6-4. In addition, religious fundamentalists scored high on 8 in addition to 4 and 6.
Personality characteristics
- Personality adjustment problems
- Passive-dependent
- Hostility and anger
Predictions
- Denial of any serious psych problems through rationalization and transfer of blame onto others.
- Cannot accept responsibility for their own behaviours. Unrealistic and grandiose in self-appraisals.
- Unreceptive to psychotherapy
- Diagnosis: passive-aggressive personality disorder and paranoid personality disorder, or paranoid schizophrenia.

4-7/7-4

Symptoms and behaviours
- Alternate periods of gross insensitivity to the consequences of their actions and excessive concern about the effects of their behaviour.
- Episodes of acting out followed by temporary guilt and self-condemnation.
- Vague somatic complaints
- Tension, fatigue, exhaustion.
- Report inability to face pressing environmental problems.
Personality characteristics
- feelings of dependency and personal insecurity
Predictors
- Therapy: they respond to support and reassurance.
- Hard to make personality changes that remain permanent
- Too insecure so they require constant reassurance of self-worth (basically, get ready, he’ll need a cookie-reward even for breathing, which we all know even algae do at some level…sorry…becoming mean here)

4-8/8-4

Symptoms and behaviours
- Serious psychological problems
- Lack of fit in society. Act out in asocial ways.
- Viewed as odd, nonconforming, resentful of authority.
- Likely to exhibit unusual religious or political views.
- Likely to behave in erratic ways.
- Withdrawal into fantasy or might strike out in anger as defense to being hurt.
- Impulse control issues.
- Viewed as angry, irritable and resentful (charming bunch, eh? Kinda inviting the hurt, me thinks).
- Delinquency, criminal acts or sexual deviation. Excessive drug/alcohol abuse.
- May be afraid of inability to perform sexually. May indulge in antisocial sexual acts to demonstrate sexual adequacy. VERY FREQUENT PROFILE FOR RAPISTS.
- Withdrawn and isolated socially.
- Periods of suicidal ideation.
- Distrustful of others. Avoid close relationships.
- Seen as impaired in empathic ability and lacking basic social skills.
Personality characteristics
- Poor self concept is central
- Set up for rejection and failure which fuels their feelings of insecurity
- Exaggerated needs for attention and affection
Predictors
- History of underachievement and marginal maladjustment
- Diagnoses: severe personality disorders (antisocial, paranoid, schizoid) and schizophrenia.
- Accept little responsibility for their behaviours.
- Not good outcome to therapy.
- Rationalize and blame others for own difficulties.
- World is seen as threatening and rejecting therefore they might have difficulties establishing a therapeutic relationship.

4-9/9-4

Symptoms and behaviours
- Marked disregard for social standards and values.
- Antisocial behaviour with poorly developed conscience, loose morals and fluctuating ethical values (there’s Machiavelli for you)
- Antisocial acts abound (alcoholism, fighting, sexual acting out)
- Seen as selfish, self-indulgent and impulsive.
- Cannot delay gratification of impulses
- Poor judgment, acting with no thought of consequences.
- Fail to learn from punishing experiences (no don’t spank…it’ll only hurt your hand)
- Low frustration tolerance, moodiness, irritability, caustic manner.
- Feelings of anger and hostility expressed in negative emotional outbursts.
- Viewed as energetic, restless, overactive and needing to seek out emotional stimulation and excitement.
- Seem uninhibited, extroverted and talkative, creating a good first impression.
- Relationships are superficial and wear out in time.
Behaviour characteristics
- Narcissistic and incapable of deep emotional ties.
- Keep others at distance emotionally
- Social façade successful, hiding the lack of self-confidence and of security.
- Might present features of immature, insecure and dependent personality.
Predictors
- Do not accept responsibility for actions.
- Will not seek Tx unless urged so by others.
- Rationalize their own shortcomings and failures
- Place blame on others
- Legal, work or personal problems are time persistent.

6-8/8-6

Symptoms and behaviours
- Inferiority, insecurity, low self-confidence and poor self-esteem.
- May feel guilty about perceived failures.
- Withdrawal from activities and emotional apathy.
- Not involved with other ppl.
- Seen as suspicious, and distrustful of others, avoiding deep emotional ties and seeming deficient in social skills.
- More comfy when alone.
- Resent demands placed on them.
- Moody, irritable, unfriendly and negativistic.
- Psychotic behaviour may be present.
- Thinking: autistic, fragmented, tangential and circumstantial.
- Bizarre thought content, difficulties in concentrating, attention deficit, memory issues.
- Poor judgment.
- May exhibit severe confusion, delusions of persecution/grandeur, feelings of unreality and preoccupation with obscure or abstract matters.
- Blunted affect.
- Rapid and incoherent speech, withdrawal into fantasy and daydreaming. Might have difficulty differentiating reality from fantasy.
- Seem to lack effective defenses.
- Regress under stress and pressure.
Personality characteristics
- Severe long-term psychological problems.
- Schizoid lifestyle.
Predictors
- Diagnosis: schizophrenia. This profile is confirmed in other countries also.
- Tx: psychotropic medication, placement into a supportive, structured environment if they are viewed as a danger to themselves.

6-9/9-6

Symptoms and behaviours
- Overly sensitive and mistrustful
- Feel vulnerable to real or imagined threat.
- Might feel anxious much of the time and may be fearful and trembling.
- Overreact to minor stress.
- Respond to severe setbacks by withdrawing into fantasy.
- Signs of thought disorder, complain of difficulties in thinking and concentration problems.
- Delusions, hallucinations, irrelevant and incoherent speech, appear disoriented and perplexed.
Personality characteristics
- Strong need for affection
- Passive-dependent in relationships
Predictors
- may be diagnosed as schizophrenic (paranoid type) or mood disorder.
- Difficult to implement psychological Tx because person is disorganized, unproductive, ruminating. Also overideational and obsessional.
- Problems expressing emotions in adaptive, modulated ways.
- Alternate between overcontrol and uncontrolled emotional outbursts.

7-8/8-7

Symptoms and behaviours
- Great turmoil
- Not hesitant in admitting that they have psychological problems (Wow!!! I’m flabbergasted)
- Lack defenses to keep themselves comfortable and anxiety free.
- Report feeling depressed, worried, tense and nervous.
- Confused and in a state of panic, showing indecisiveness and poor judgment.
- Do not profit from experience.
- Overly introspective, ruminative and ideational.
Behavioural characteristics
- Chronic feelings of insecurity, inadequacy and indecisiveness.
- Not socially poised or confident. Withdrawn from social interactions.
- Passive-dependent. Cannot take dominant role in relationships.
- Troubles with mature heterosexual relationships, inadequate in traditional gender roles.
- Extreme or unusual sexual practices
Predictors
- Anxiety disorder
- Increased SC scale is associated with likelihood of psychotic and personality disorder.
- Might not show blatant psychotic symptoms.
- Good to think about medications to control the intense anxiety and thinking problems.

8-9/9-8

Symptoms and behaviours
- Social withdrawal and isolation.
- Uncomfortable in heterosexual relationships. Poor sexual adjustment.
- Seen as hyperactive, emotionally labile, agitated and excited.
- Loud and excessively talkative.
- Unrealistic in appraising themselves, grandiose, boastful and fickle.
- Denial of problems.
- Vague and circumstantial.
- Feelings of inferiority and inadequacy. Low self esteem and limited involvement in competitive situations.
Personality behaviours
- Self-centered, infantile in expectations of others
- Demand too much attention, becoming resentful and hostile when demands are not met.
- Resist and ear close emotional involvement (then how the heck can anyone love them and give them attention?!!!)
- Unable to focus on issues.
- Viewed as odd, unusual, autistic.
- Circumstantial thinking, bizarre speech, delusions and hallucinations sometimes.
Predictors
- Diagnosis: schizophrenia, or severe personality disorder.
- Severe thought disturbance can occur: confused, perplexed, disoriented, difficulty thinking and concentrating.
- May state no need for help, might not enter willingly therapy.
- Thought they feel a need to achieve, their actual performance tends to be mediocre.

Three-point code-type descriptors

1-2-3

Symptoms and behaviours
- psychological distress and difficulty adjusting psychologically.
- Lack stamina.
- Feel weak, fatigued, tense and nervous much of the time.
- Physical symptoms as a reaction to stress. Most reported: abdominal pain, headaches.
- Overreact to minor or normal physical changes with extreme concern.
- Dysphoria. Worry.
Personality characteristics
- Passive in relationships.
- If interacting, they simply complain and whine.
- Dependent, to be taken care of.
- Hostile and irritable if needs not met.
Predictors
- Low sex drive, problems in heterosexual adjustment.
- Diagnosis: somatoform disorder in a passive-aggressive or dependent personality.
- Do not recognize the psychological component in their problems.
- Uninsightful, feeling no control over their symptoms.
- Poor candidates for insight-oriented psychotherapy.
- Stress-management: develop problem-solving skills to cope with the stress.
- Clinical individuals have a hostile interaction style, carried over into therapy.
- Not receptive to suggestions from others.

2-4-7/2-7-4

Symptoms and behaviours
- Alcohol/drug abuse.
- Alternate b/w periods of gross insensivity to the consequences of own actions and excessive concern about the effects of behaviours.
- Episodes of acting out then temporary guilt and self-condemnation.
- Vague somatic complaints, tension, fatigue, feeling exhausted ad unable to face environments pressure.
- Marital/work problems
Personality characteristics
- Dependency and personal insecurity.
- Severe personality problems.
- Self-oriented and hedonistic behaviour.
Predictors
- Permanent personality changes are difficult to make.
- Act out instead of dealing with conflict.

2-7-8

Symptoms and behaviours
- Chronic psychological maladjustment.
- Overwhelmed by anxiety, tension and depression.
- Feel helpless, alone inadequate and insecure.
- Attempt to control worries through intellectualization and unproductive self-analysis.
- Difficulty concentrating and making decisions.
- Functioning at very low levels of efficiency.
- Overreaction to minor stress, with rapid behavioural deterioration.
- Blame others for their problems.
- Chaotic lifestyle. Poor work history.
- Preoccupied with obscure religious ideas.
Personality characteristics
- Lack basic social skills.
- Behaviourally withdrawn.
- Relate to others ambivalently, never fully trusting or loving.
- Might never establish lasting, intimate relationships.
- The relations they do have are unrewarding, impoverished by feelings of insecurity and inadequacy.
Predictors
- Chronic behavioural pattern.
- Disorganized and unhappy existence.
- Episodes of intense and disturbed behaviour because of elevated stress level.
- Severe psychological disorder.
- Diagnosis: severe neurotic with anxiety disorder or dysthymic disorder in a schizoid personality.
- Seek and require professional help.
- Intensive therapy required due to chronicity.
- So many psychological concerns that it’s difficult to focus in therapy. Need a lot of emotional support.
- Low self-esteem. Feelings of inadequacy.
- Difficult for them to get energized towards the therapeutic action.
- Low expectation for positive therapy change therefore therapist must provide a positive, optimistic attitude.
- Overideational, unproductive rumination.
- Not good with unstructured, insight-oriented therapy. Might deteriorate if asked to do introspection.
- Might respond to supportive treatment and goal-oriented therapy.
- CLEAR SUICIDAL RISK.