Leonard Handler

Rorschach and MMPI-2 Indices of Early Psychotherapy Termination.

This study was an investigation of the differences between 97 patients who had prematurely terminated psychotherapy (M = 1 session) and 81 who had participated in individual psychotherapy for at least 6 months and 24 sessions (M = 18 months/72 sessions) on selected Minnesota Multiphasic Personality Inventory--2 (MMPI-2) and Rorschach variables. None of the between-group comparisons using the MMPI-2 proved to be significant. However, a multivariate analysis of variance of 9 Rorschach variables in 3 conceptual categories--(a) interpersonal relatedness, (b) psychological resources versus resource demand, and (c) level of psychopathology--proved to be significant at p = .008. The Rorschach scores from the interpersonal-relational category proved to be the most robust in differentiating the 2 groups. The theoretical implications of interpersonal variables are discussed in relation to the termination and continuation of patients in psychotherapy.

Psychological Assessment on Internship: A Survey of Training Directors and Their Expectations for Students

We used a survey of internship training directors to examine the nature of assessment use and assessment skills training at 382 internship settings in professional psychology across the United States and Canada. For the purposes of this study, we created a questionnaire that inquired about the types of assessment instruments used at each internship setting, the amount and type of training offered at internship sites, and the type of assessment experience desired of interns before beginning their rotations. The results revealed several differences across type of internship facility surveyed as well as several trends in the current use of assessment in applied settings. The findings further demonstrate the important role of projective assessment in the training of graduate students and lead to the conclusion that major discrepancies may exist between what is being taught in graduate school and what students are expected to know on entering their internship positions.

A replication of Rorschach and MMPI-2 convergent validity.

We replicated prior research on Rorschach and MMPI-2 convergent validity by testing 8 hypotheses in a new sample of patients. We also extended prior research by developing criteria to include more patients and by applying the same procedures to 2 self-report tests: the MMPI-2 and the MCMI-II. Results supported our hypotheses and paralleled the prior findings. Furthermore, 3 different tests for methodological artifacts could not account for the results. Thus, the convergence of Rorschach and MMPI-2 constructs seems to be partially a function of how patients interact with the tests. When patients approach each test with a similar style, conceptually aligned constructs tend to correlate. Although this result is less robust, when patients approach each test in an opposing manner, conceptually aligned constructs tend to be negatively correlated. When test interaction styles are ignored, MMPI-2 and Rorschach constructs tend to be uncorrelated, unless a sample just happens to possess a correlation between Rorschach and MMPI-2 stylistic variables. Remaining ambiguities and suggestions for further advances are discussed.

Therapeutic Assessment for Preadolescent Boys with Oppositional Defiant Disorder: A Replicated Single-Case Time-Series Design.

The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to track the process of change as it unfolds. All 3 families benefitted from participation in TA across multiple domains of functioning, but the way in which change unfolded was unique for each family. These findings are substantiated by the Behavior Assessment System for Children (Reynolds & Kamphaus, 2004). The TA model is shown to be an effective treatment for preadolescent boys with oppositional defiant disorder and their families. Further, the time-series design of this study illustrated how this empirically grounded case-based methodology reveals when and how change unfolds during treatment in a way that is usually not possible with other research designs.

Narcissism in the Rorschach Revisited: Some Reflections on Empirical Data.

This study investigates the extent to which the Rorschach was able to identify accurately pathological expressions of narcissism according to the methodological recommendations offered by T. Nezworski and J. Wood (1995). Ninety-one patients who were found to meet DSM-IV criteria for an Axis II disorder (Cluster A personality disorders = 10; antisocial = 20, borderline = 25, histrionic = 5, narcissistic [NPD] =15; Cluster C personality disorders = 16) and 50 nonclinical participants were compared on 5 Rorschach variables: reflection, pair, personalization, idealization, and the egocentricity index. The results of this study indicate that selected Rorschach variables can be used effectively to differentiate NPD patients from a nonclinical sample and from Cluster A, Cluster C, and other Cluster B personality disorders. Also, the reflection and idealization variables were found to be empirically related to DSM-IV diagnostic criteria for NPD and a self-report measure of NPD. Finally, these two variables could be used for classification purposes in ways that were clinically meaningful in the diagnosis of NPD. Narcissistic personality disorder (NPD) was included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) in large part because of widespread interest in the theoretical and clinical concept of narcissism by psychodynamic psychotherapists (Kernberg, 1970, 1975, 1984; Kohut, 1971, 1977; Pulver, 1970; Stolorow, 1975; Teicholz, 1978). However, the justification for regarding NPD as an independent diagnostic entity having distinguishable features from other personality disorders has been the matter of some controversy

Assessment of narcissistic personality disorder: A multi-method review

Abstract This review examines the available empirical data for the diagnosis of narcissistic personality disorder (NPD) for three methods of assessment: semi-structured interviews, self-report inventories, and projective techniques. Issues of reliability, validity, and clinical utility are examined for each instrument (or scale). An overview of the relative advantages, disadvantages, and empirical support for each method of assessment in the diagnosis of NPD is presented in a discussion after the review of the salient literature. In general, it was found that semi-structured interviews are a fairly reliable and valid method of diagnosis for Axis II disorders but, for the most part, these studies have used woefully small samples of NPDs. In general, self-report instruments were best at screening for the presence or absence of personality disorder, identifying members of personality disorder clusters, and identifying negative instances of specific personality disorders or clusters. Self-report inventories and the structured interviews are often in disagreement concerning presence of specific personality pathology. In general, previous studies have found the tendency for self-report measures to diagnose personality disorders at much higher frequencies than do clinicians. Moreover, self-report measures frequently attributed two or more personality disorders to a particular individual. Additionally, research with projective methods over the last decade has shown this mode of assessment to be useful in the differential diagnosis of NPD from both related and unrelated personality disorders. It seems prudent that the clinician and researcher alike should employ multiple methods of measurement and utilize information in a systematic and theoretical fashion when evaluating a patient for NPD diagnosis.

Testing the Effectiveness of Family Therapeutic Assessment: A Case Study Using a Time-Series Design

We describe a family Therapeutic Assessment (TA) case study employing 2 assessors, 2 assessment rooms, and a video link. In the study, we employed a daily measures time-series design with a pretreatment baseline and follow-up period to examine the family TA treatment model. In addition to being an illustrative addition to a number of clinical reports suggesting the efficacy of family TA, this study is the first to apply a case-based time-series design to test whether family TA leads to clinical improvement and also illustrates when that improvement occurs. Results support the trajectory of change proposed by Finn (2007), the TA models creator, who posits that benefits continue beyond the formal treatment itself.

FIGURE DRAWING ANXIETY INDEXES: A REVIEW OF THE LITERATURE.

Summary The authors reviewed 51 studies of human figure drawings with reference to 21 anxiety indexes. The research findings for each of 21 indexes with traditional clinical interpretation were categorized as: a) in agreement b) in disagreement: opposite direction, or, c) nonsignificant. The authors conclude that on the whole, research results seem to uphold the validity of a number of anxiety indexes. A total of 147 findings were found to be in agreement with traditional interpretation, while only 30 findings were significant in the opposite direction, and 78 findings were nonsignificant. Omission, distortion, detail loss, line pressure increase, heavy line, size increase and decrease, head simplification, and trunk simplification have consistently yielded significant results in the expected direction (increase indicates anxiety). Evidence was less consistent for reinforcement, line discontinuity, light line, vertical imbalance, delineation line absence, and transparency. Some studies found significantly...

Therapeutic assessment of families in healthcare settings: a case presentation of the model's application.

In this article, we present a case study of a Therapeutic Assessment (TA) with an 11-year-old boy who had two unexplained behavioral episodes suggesting neurological impairment, which led to two emergency department visits at a childrens hospital. TA is a semistructured approach that blends the extensive conceptualizing benefits of psychological assessment with the principles and techniques of evidence-based child and family interventions. We use this case to illustrate how TA is an adaptive and flexible approach to child-centered family assessment that can meet the goals of psychologists working in pediatric and general medical hospitals, primary care clinics, family medicine practices, and other health care settings. With the current case, the clinician was able to use the procedures of TA to clarify for the family their sons unexplained behaviors, while also providing them with a therapeutic experience. In addition to addressing the familys concerns, the clinician also addressed a number of specific questions provided by the referring neurologist that informed ongoing care of the child. This case illustrates the potential utility and effectiveness of the TA model with children and families referred to a typical psychology service in a health care setting. This case is one of the first applications of the TA model with this population and its success suggests further research in this area is warranted.

“Why Do I Get in Trouble So Much?”: A Family Therapeutic Assessment Case Study

Recent case studies have demonstrated the potential benefits of Finns Therapeutic Assessment (TA) model with families (e.g., Handler, 2007; Tharinger, Finn, Wilkinson, & Schaber, 2007). This case study of a 6-year-old girl and her family follows the Therapeutic Assessment (TA) model, focusing on the specified goals of each session and how those goals were accomplished. In this article, we illustrate the flexibility afforded by the TA model to tailor an appropriate intervention for a specific family and also show that extensive experience with the TA model is not necessary for this approach to yield clinically significant results.