Chapter 9
Clinical Assessment:
Objective and
Projective Personality Tests
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Defining Clinical Assessment
The process of assessing the client through
multiple methods, including:
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the clinical interview (see Chapter 12)
the administration of informal assessment
techniques (Chapter 10), and
the administration of objective and projective tests
(this chapter)
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Defining Clinical Assessment (Cont’d)
Clinical assessment can do the following:
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Helps client gain greater insight
Aid in case conceptualization and diagnostic formulations
Assist in the decision-making concerning psychotropic
medications
Assist in treatment planning
Assist in court decisions (e.g., custody decisions; testing a
defendant in a child molestation case)
Assist in job placement decisions (e.g., high security jobs)
Aid in diagnostic decisions for health related problems (e.g.,
Alzheimer’s)
Identify individuals at risk (e.g., to identify students at risk for
suicide or students with low self-esteem)
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Objective Personality Testing
Definition: A type of personality assessment that uses
paper-and-pencil tests, often in multiple-choice or
true/false formats, to assess various aspects of
personality
Each objective personality test measures different
aspects of personality based on the specific constructs
defined by the test developer
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Common Objective Personality Tests
Many of the tests we will examine were identified as
one of the most frequently used tests (see Table 1,
p. 106, Intro to Section III).
For a list of the tests we will review, and their
general purpose see Table 9.1, p. 188
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(MMPI-2)
Minnesota Multiphasic Personality Inventory - 2
Most widely used personality test
Developed in 1942, revised in 1989
90 minutes to take the 567 items
Interpretation requires grad testing and
psychopathology courses
Provides six validity scales, ten basic (clinical) scales,
and fifteen content scales
Most commonly used scales: 3 validity scales and ten
basic scales (Figures 9.1 and Table 9.2, pp. 189-190)
Adolescent version also exists: MMPI-A
Important to understand the meaning of each scale
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MMPI-2 (Cont’d)
A high L (Lie) score: Not necessarily lying; means client has
trouble admitting faults--makes test suspect
Basic Scales useful in diagnosis and treatment planning
Patterns of responses, as opposed to specific scales, often
used in making decisions
“Clinical significance” is a T score of 65 or greater.
The Content Scales:
 15 specific traits such as anxiety, fears, anger, cynicism,
low self-esteem
 useful in creating more detailed perspective
Reliability estimates on different scales: .37 to .92
High intercorrelations among some scales (shared items?)
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(MCMI-III)
Millon Clinical Multiaxial Inventory (3rd ed.)
Second most used objective personality test
Designed to assess DSM-IV-TR personality disorders
and clinical symptomatology (axis II)
Adolescent version also exists
175 true/false items take 25 minutes
Has six different major scales (Table 9.3, p. 192)
 Clinical Personality Pattern Scales
 Severe Personality Pathology Scales
 Clinical Syndrome Scales
 Severe Clinical Syndrome Scales
 Modifying Indices
 Validity Index
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MCMI-III (Cont’d)
Uses Base Rate (BR): Converts raw score to a more
meaningful standardized score
 Sets median for non-psychiatric individuals at 35,
and 60 for psychiatric population.
 A BR of 75 indicates that some of the features are
present while a BR of 85 indicates that the trait is
clearly present
Reliability ranges from .67 to .90
Scales have been correlated with several other scales
such as the MMPI and the BDI
Other studies demonstrated predictive validity for the
instrument with DSM-IV-TR diagnoses
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PAI
Personality Assessment Inventory
Aids in making clinical diagnoses, screening for
psychopathology, and assist in treatment planning
18 and older
344 items; 50-60 minutes
4-point ordinal scale: false, slightly true, mainly true,
very true
Hand scored, computer scored, or sent in
4 validity scales, 11 clinical scales, 5 treatment sclaes,
2 interpersonal scales
T-scores (see Table 9.4, p. 194)
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PAI (Cont’d)
Reliability: Most scales show descent reliability
estimates
Exceptions to reliability: Inconsistency and Infrequency
scales—low
Numerous studies seem to show concurrent validity on
a number of the scales
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(BDI-II)
The Beck Depression Inventory - II
BDI-II developed in 1996
21 questions on 0 to 3 scale, 10 minutes
If 2 or 3 on items 2 (hopelessness) and 9 (suicidal
ideation)—red flag
Cut-off scores to measure depression (see Table 9.5,
p. 194)
Scores related to groups of depressed and nondepressed individuals
High reliability estimates (in .90s)
Convergent validity with original BDI and discriminant
validity with other disorders
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(MBTI)
Myers-Briggs Type Indicator
Most widely used personality assessment for normal
functioning (for adolescent through adults)
Based on Jung’s work, following characteristics were
derived: extroverted or introverted, sensing or intuiting,
thinking or feeling.
Myers and Briggs added judging or perceiving
See Figures 9.2 and 9.3 (pp. 196 and 197)
Evidence for validity of separate scales, but weaker for
synergistic combination of four scales
90% of people agree with the results
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(16PF)
16 Personality Factors Questionnaire
Based on Raymond Cattell’s 16 primary personality
components
Not pathology, describes human behavior
185 items, 45 minutes
16 Primary Factors on bipolar scale (see Table 9.6, p.
198)
 Uses sten scores (average: 4-7)
 1-3 left of bipolar scale, 8-10 right of bipolar scale
5 Global Factors are combinations of the primary
factors (see Table 9.7, p. 199)
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16PF (Cont’d)
3 Validity Scales
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Impression management: measures social desirability
and faking good (high score) or faking bad (low
score)
Infrequency scale: responding unusually (problems
with reading comprehension, random responding, or
making “right” impression
Acquiescence: random responding, misunderstanding
items, difficulty evaluating self
Reliability: ranges from .60s to mid .80s
Validity: Factor analysis confirms items
Validity: Convergent and other validity shown
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Big Five Personality Traits
and the NEO-PI-R & NEO-FFI
Research by Thurstone and many others suggest a fivefactor model of personality
 Openness, Conscientiousness, Extraversion,
Agreeableness, Neuroticism (see pp. 199-200)
NEO Personality Inventory measures these 5 factors
each of which has 6 facets (see Table 9.8, p. 201)
 240 items, 17 years and older
 5 point Likert-type scale: strongly disagree to
strongly agree
 Uses T-Scores
 Narrative describing personality style
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Big Five Personality Traits
and the NEO-PI-RI & NEO-FFI
NEO PI-R
 Reliability: high for five factors, .56-.90 for facets
 Much convergent, discriminant, and concurrent
validity over a number of different studies
NEO-FFI: Shortened version
 60 items
 15 minutes
 Test worthiness lowered due to the fact that it’s a
shorter version
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(SEI)
Coopersmith Self-Esteem Inventory
Measures self-esteem for children 8 – 15, in four areas:
1. general self (24 items)
2. self in relation to peers (8 items)
3. self in relation to parents (8 items)
4. self in relation to school (8 items)
Total score: Multiply by two the total number of positive selfesteem items chosen by the child.
Reliability: 87 to .90, but information dates back to early 1970s
Validity studies are dated and some are questionable
Given to students in many settings--broad ethnic comparisons
Generally, mean scores ranged from the mid-50s to the mid70s, and standard deviations were between 12 and 20
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(SASSI)
Substance Abuse Subtle Screening Inventory
Two versions: Adult & Adolescent (SASSI-3 & SASSI-A2)
Suggests substance dependency with 93+% accuracy
SASSI-3
 30 minutes to take, 5 to score
 1st section: 67 “subtle” T/F items
 2nd section: 26 “overt” alcohol and other drugs
related questions rated on 4-point scale
 Nine subscales: face valid alcohol, face valid other
drugs, symptoms, obvious attributes, subtle
attributes, defensiveness, supplemental addiction
scale, family vs. controls, and correctional
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SASSI (Cont’d)
SASSI-3
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Patterns of subscale responding helps in diagnosis,
treatment planning, and validity of responses
Reliability
 Particularly high for overall instrument (.93)
 Test-retest over two weeks ranges from .92-.100
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Validity: Criterion-related: Correlates with DSM-IV
diagnoses
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Other Common
Objective Personality Tests
There are dozens of common objective personality
tests. Naming just a couple more:
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Taylor-Johnson Temperament Analysis
 Assesses personality variables that effect
social, family, marital, work, and other
environments
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The Marital Satisfaction Inventory
 Assesses the severity and nature of conflict
in a relationship
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Projective Testing
Defined:
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Type of personality assessment where a client is
presented a stimuli and personality factors are
interpreted
Often used to identify psychopathology and to
assist in treatment planning
Much more difficult to measure validity when one
is dealing with abstract responses to vague
stimuli, such as those in projective tests
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(TAT)
Thematic Apperception Test
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Developed in 1938 Henry Murray
Series of 31 cards with vague pictures on them (see
Figure 9.4, p. 205)
8 to 12 cards generally used during an assessment
Ask client to create and describe story that has a
beginning, middle and end
Based on Murray's need-press theory: People driven by
internal desires, such as attitudes, values, goals, etc.
(needs), or external stimuli (press) from the
environment
No universally agreed upon scoring and interpretation
method
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TAT (Cont’d)
Most clinicians use qualitative process of interpretation
Controversy over reliability and validity of instrument
Controlled setting interscorer reliability .82
Due to age of cards, and because figures are almost
exclusively white, many cards seem biased and dated
To counter some of TAT problems
 Southern Mississippi’s TAT (SM-TAT)
 Apperceptive Personality Test (APT)
 For children: CAT (animals) and CAT-H (humans)
Many still use TAT. argue that cross-cultural issues not
as critical (you project yourself onto whatever you see)
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Rorschach Inkblot Test
Herman Rorschach developed inkblot test in 1921 by
splattering ink on paper and folding them in half (See
Fig. 9.5, p. 207)
He chose 10 final cards that have become the
Rorschach inkblot test still used today
When giving the Rorschach, clinicians show clients
cards, one at a time, and ask them to tell them what
they see on the card
Rorschach believed images on the inkblots allowed
one to express his or her unconscious
Difficulty showing adequate validity
Requires extensive training and practice to use
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Rorschach (Cont’d)
Exner scoring system uses three components:
 Location: where on blot response occurred (e.g.,):
1. whole blot (w),
3. unusual details (Dd),
2. common details (D),
4. white space details (S)
 Determinants: how examinee understood what’s seen:
1. form (“that looks just like a bat”)
2. color (e.g., “it’s blood, because it’s red”)
3. shading (“it looks like smoke because it’s grayishwhite”).
 Content: 22 categories: whole human, human detail,
animal, art, blood, clouds, fire, household items, sex,
etc. Specific content can hold meaning (See Box 9.1, p.
207)
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Bender Visual-Motor Gestalt
Lauretta Bender originally published test in 1938
Takes 5-10 minutes and measures developmental
level, psychological functioning, as well as neurological
deficits after a traumatic brain injury
Children, 4 – 7 and individuals 8 – 85+ replicate the
original nine cards shown in Figure 9.6, p. 209
In 2nd ed., children 4 –7 have four additional cards
and individuals 8 – 85+ have three additional cards
5-point scoring system. 0 represents no resemblance
and 4 represents a nearly perfect drawing
Reliability in .80s and .90s
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House-Tree-Person
and Other Drawing Tests
Drawing tests try to tap into unconscious.
Focus might vary depending on content of test.
Some popular ones:
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House-Tree-Person
Kinetic-House-Tree-Person (see Table 9.9. p. 210)
Draw-A-Man
Draw-A-Woman
Kinetic Family Drawing: Draw a picture of your
family all doing something together
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Sentence Completion Tests
A sentence stem is given to client for client to
respond to
Gather important content information and possible
unconscious issues
Some common tests:
 The Sentence Completion Series
 EPS Sentence Completion Technique.
Questions about the validity and reliability of
sentence completion tests remain, but can be quick
and useful way of gathering info
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Role of Helpers in Clinical Assessment
Helpers should conduct clinical assessment:
 Elementary school counselor uses self-esteem
inventory when working with young children
 High school counselor might use objective personality
measures to identify concerns and aid in treatment
planning
 College counselors, agency clinicians, social workers,
and private practice professionals use clinical
assessment tools to help identify issues and devise
strategies for problem solving
 All clinicians should consider clinical assessment tools
and whether they have the appropriate training to
administer and interpret instruments
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Final Thoughts On Clinical Assessment
Clinical assessment results in making decisions for
clients that will critically affect their lives
Such decisions can result in a person being labeled,
institutionalized, incarcerated, stigmatized, placed on
medication, lose or gain a job, have access to their
children, and more
Examiners must remember the impact that their
decisions will have on clients and monitor:
 the quality of the tests they use
 their level of competence to administer tests,
 their ability at making accurate interpretations of
client material.
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