Cornerstone Testing Services, Inc.
12345 Main Street
Richmond, VA
Phone: (888) 123-4567
PSYCHOLOGICAL EVALUATION
IDENTIFYING INFORMATION
Name:
Date of Birth:
Age:
Last Grade:
Referral Source:
Name of Examiners:
Dates of Evaluations:
Date of Report:
Assessment Techniques:
CT
November 1, 1985
23
16
Foreign Service Placement Services
Lee A. Underwood, Psy.D.,
Licensed Clinical Psychologist &
Christine E. Buckingham, LCPC
June 10, 2009
June 27, 2009
Psychosocial History
Brown &Unger Sentence Completion - Adult (SCT)
Minnesota Multiphasic Personality Inventory (MMPI-2)
Brief Symptom Inventory (BSI)
Beck Depression Inventory-Two (BDI-2)
Shipley Institute of Living Scale (IQ measure)
REASON FOR REFERRAL
Client self-referred to Cornerstone Testing Services for a psychological battery of tests to
assess his functioning using personality, cognitive (IQ), personality, emotional, projective
and behavioral assessments to make recommendations about his suitability for relocating
to Europe and living in a foreign culture.
AGREEMENT TO EVALUATION
The examiners met with the client at Cornerstone Testing Services, Inc. for this
evaluation. The examiners informed him that the purpose of the evaluation was to
conduct a psychological evaluation to respond to the referral question. Client was
informed that he would be asked to answer questions that were of a personal and
potentially embarrassing nature. The examiners explained the limits of confidentiality,
especially, that under law and professional ethics, the examiners were required report any
suspected or disclosed sexual abuse he may have experienced. Client stated that he did
not have any questions about the procedure or informed consent or limits to
confidentiality and verbally indicated that he understood the purpose of the evaluation,
the limits to confidentiality, and agreed to continue with the assessment.
©2010 Christine E. Buckingham. All rights reserved.
www.CEBuckingham.com
Peter Buckingham, II 2
PERTINENT PSYCHOSOCIAL INFORMATION
Client is a 23-year old, single Caucasian male. In anticipation of starting a teaching
position in France, since graduating from college in 2008 he has resided with his parents
in their home in the Virginia Beach area. He graduated from M College cum laude with a
degree in French and Communications. Following college, he traveled cross country for
six weeks with college friends. After returning home, he went to Colorado where he
earned a certificate to teach English as a second language. He has professional fluency in
French, reads and speaks Spanish and some Japanese, and is currently a studying Arabic.
He works as a customer service agent at a luxury business hotel in Virginia Beach that
has international staff and clientele.
Family History
Client is an only child. He grew up in the Virginia Beach area and has lived in the same
house his whole life. His parents worked at home and he doesn’t “remember a time when
they weren’t around.”
Academic/Professional
Client was homeschooled until the middle of sixth grade when he entered a private
Christian school. Client had some difficulty with testing though he did not have an
identified learning disorder. He graduated summa cum laude, with a 4.06 GPA, served as
class president during high school, and was elected to the National Honor Society. As a
student in high school and college, client was regularly recognized for his leadership
abilities. As a college freshman, he was elected to the Roundtable, an honorary service
fraternity, and was inducted into the Omicron Delta Kappa Society, an international
honor society.
While a junior in college, client attended the Institute in France for one semester, after
which he moved to Paris where he lived for 5 months, serving as an intern in the Public
Affairs office at the U. S. Embassy.
Substance Abuse/Mental Health/Legal
Client admits to drinking socially with friends perhaps once a week. He denied use or
abuse of any illegal substances. He denied a history of mental health or legal issues.
Family/Interpersonal Relationships/Financial Status
Client has a large, supportive extended family. Growing up, he had close relationships
with grandparents, aunts, uncles, and cousins. His nuclear and extended family are
nurturing and affirming and continue to be very supportive of him and his goals. His
family hosts the annual Christmas party, they gather as a family during the year for a
summer reunion, and they participate at major family events such as graduations. He has
had a close relationship with two of his cousins from the area, but now they rarely
connect outside of family events.
Peter Buckingham, II 3
Client has traveled extensively beginning with a mission trip to France the summer after
8th grade. He lived on his own in France for eight months in his junior year of college,
traveling widely alone or with friends during breaks. When traveling with friends both
home and abroad, client is usually the trip initiator, organizer, and planner, and others
defer to his abilities in this area. He values friendships and has close friends from high
school and college that he sees regularly. He is not currently dating anyone.
Client has no debt. He owns a car and has some savings to supplement his income while
he will be working in France. In addition to working full time, he works ten hours a week
with a private counseling practice as an intake counselor and as the newsletter editor
Hobbies and Interests
Client enjoys spending time with his friends and family. He is passionately interested in
travel and linguistics. He enjoys a wide range of music and literature. He enjoys the
family pets and is especially fond of his cat he has had since he was ten years old.
EVALUATION RESULTS
Projective
Brown & Unger Sentence Completion - Adult (SCT) is a projective test used to reveal
underlying psychological issues and symptoms of mental states. SCT’s can reveal
motivation, beliefs, attitudes and possible symptoms of psychopathology. Interpretation
relies heavily on the clinical judgment of the interviewer, thus SCT’s are most useful
when rounding out the clinical picture of the test taker. They do not have predictive
value, rather, only present behavior and personality.
Client’s responses indicate a strong positive future focus (“My life’s story…is just
beginning.”), with clear goals. He has warm relationship with his parents, with a
developmentally appropriate tension between being temporarily dependent (“I wish I
were less dependent on my parents”) and being, “happy that I am…going to France.” His
answers reveal an overarching theme of valuing relationships. He has a strong selfconcept (“My appearance… is well-refined”; “My personality… is very warm”), with “a
sense of humor and personality that others like.” He views himself as being authentic
with others, “happy”, able to manage stress. He has a sense of humor and is selfaccepting (“Physically…I’m a skinny white boy.”). He balances spending time with
friends and time alone. . He identifies himself as “able to work hard” but with a sense of
fun and a large capacity to enjoy life. The one statement he made that indicates anxiety
was that he “fears…my parents dying.”
Cognitive & Intelligence
The Shipley Institute of Living Scales is a brief measure of intelligence. The Shipley is a
widely used scale that highly correlates highly with the full scale IQ on the Wechsler
Adult Intelligence Scale (WAIS). The Shipley provides a screening of intellectual
functions and is used to guide treatment and consider cognitive strengths and limitations.
Client achieved an estimated Full Scale IQ score of 123 (Table D-1), placing him in the
Superior range of functioning. The Shipley routinely underestimates the IQ of individuals
Peter Buckingham, II 4
who score 120 and above which is in the superior-to-very-superior IQ range. There is no
clinically significant difference between client’s subscales making it likely that -- aside
from the likely under-representation of total IQ -- the test results are an adequate
representation of his cognitive abilities.
Estimated WAIS Full Scale IQ from Shipley Institute of Living Total Raw Score
Scale
IQ
Qualitative
Description
Estimated
Full Scale
(FSIQ)
123
Superior
Mental Status, Personality & Substance Abuse (MMPI-2, BPRS, BDI-2)
MENTAL STATUS EVALUATION
During the evaluation, client appeared appropriately dressed, well groomed, with
appropriate eye contact. His appearance matched his reported age. He was alert and
engaged during the interview. His speech was consistent and his interaction was friendly
and positive. His mood was appropriate. As he provided information, his thought process
was logical and goal-oriented. He was fully oriented to person, place, time, and situation.
There was no evidence of delusions, hallucinations, or signs of a formal thought disorder.
He denied any suicidal or homicidal thoughts.
Minnesota Multiphasic Personality Inventory Two (MMPI-2)
The Minnesota Multiphasic Personality Inventory-Two (MMPI-2) is one of the most
widely used objective clinical personality tests available and is valid and reliable across
many cultures and languages. Personality styles, clinical traits and psychological
symptoms are scored on ten basic scales. The test also has additional scales that provide
information about test taker faking, levels of anxiety, depression, and presence of
psychotic symptoms.
Client has a valid profile. His clinical profile includes a spike 9 (65) which is consistent
with persons who tend to be energetic, outgoing, and active. Many of these individuals
are perceived by others to be pleasant and efficient. This score is typical for college
students with high aspirations. A combination of high 9 and K indicates an organized,
managerial type with authority others will defer to, for example, as indicated by his
ability to organize travel for his friends. His spike on scale 5 (68) can be expected with
individuals with a broad education and cultural background and is reflected in a socially
perceptive and interpersonally sensitive individual. It is strongly corrected with education,
intelligence, and cultural breadth, which accurately describes the client’s personality and
background.
On the negative side, an elevated two-scale of the 5 and 9 scales can indicate the
evidence of emotional dependency, especially mother dependency. This and lack of
Peter Buckingham, II 5
assertiveness are the most likely problem areas for a 5/9 elevation. This resonates with
client’s self-asserted concern about dependence on parents (though he did not single out
mother). Client has stated that he intentionally works at taking more initiative
relationally and recognizes that he has grown more assertive.
Brief Psychiatric Inventory (BPRS)
The Brief Psychiatric Rating Scale was administered to identify possible symptoms of
psychiatric illness. Client’s profile is not of a nature or magnitude to be considered in the
clinical range. General symptomatic distress levels are extremely low suggesting
appropriate psychological integration and very little global psychological distress. There
are mild symptoms of anxiety as indicated by mildly elevated scores of somatic concern,
anxiety, and tension in client’s profile, yet nothing out of the ordinary. Client exhibits
some excitement when he talks about the pending career change and move to France. He
demonstrates some mild anxiety when he discusses the concerns he has about potential
financial constraints in France.
Beck Depression Inventory Two (BDI-2)
The Beck Depression Inventory Two (BDI-2) was administered to identify possible
symptoms of depression and agitation. Client’s score of 8 was within what is considered
the minimal range, suggesting a very low likelihood of either depression or agitation. He
denied feelings of sadness, guilt, self-dislike or criticism, or agitation. He denied the
presence of suicidal thoughts and wishes, or thoughts of worthlessness. Client’s levels of
pessimism, loss of pleasure, concentration, energy, irritability and tiredness are slightly
elevated which he attributed to working a variable shift at his full time job and having a
second job he works part time.
Diagnostic Impressions:
(DSM-IV-TR)
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:
V71.09 No diagnosis
V71.09 No diagnosis
None
None
GAF: 93
SUMMARY
Client self referred to Cornerstone Testing Services to uncover any impediments to his
planned relocation to Europe. The purpose of the evaluation was to assess his personality
and his cognitive, emotional, social, and behavioral functioning and if appropriate, to
provide recommendations.
Based on the results of this evaluation, the client’s psychological profile suggests he is
free of any significant areas of psychopathology.
Peter Buckingham, II 6
The client’s results indicate mild levels of anxiety. The client has a strong support system
and good network or friends. His anxiety seems to be generated primarily from the
impending changes of lifestyle, occupation, and location. The client seems to be
relatively free from stress and has good stress management skills
The client’s results indicate that he has good coping mechanisms and draws on family
and friends for support. He has a positive view of himself, others, and his future.
RECOMMENDATIONS
The results of this evaluation do not include any treatment indications. The examiners did
not find any reasons to contradict the client’s decision to relocate to France. Based on the
results of his tests and the interview, he appears to be well suited and well adapted to
living in a foreign culture.
Thank you for this referral. If you need additional information, please free to contact Dr.
Underwood at 757-630-4442.
______________________________
Christine E. Buckingham
Licensed Clinical Professional Counselor
NBCC Nationally Certified Counselor
_______________
Date
______________________________
Lee A. Underwood, Psy. D.
Licensed Clinical Psychologist
Certified Sex Offender Treatment Provider
_______________
Date