of 65, and 7.7% produce well-defined Pd peak scores in that range.

As the highest peak score in the profile, this spike on Pd is found in 15.1% of the women in a Veterans Administration inpatient sample (Arbisi & Ben-Porath, 1997). The highpoint Pd score was the second highest in frequency among the clinical scale high points. It was found to be well defined and elevated at or above a T of 65 in 11.6% of the cases.

The frequency of Pd spike scores on MMPI-2 was also high for women in the general psychiatric inpatient study conducted by Arbisi, Ben-Porath, Marshall, Boyd, and Strauman (1997). They found that this high-point score occurred in 23.1% of the high-point codes (the second most frequent peak score for women) and that 12.8% of high-point Pd scores were well-defined high-point profiles.

This elevated MMPI-2 two-point profile configuration (4-6/6-4) is found in 6.9% of the females in the Graham and

Butcher (1988) sample and in 4.6% of the females in the NCS inpatient sample. A similar frequency (4.7%) was obtained in the sample of female veterans in the VA hospital inpatient sample (Arbisi & Ben-Porath, 1997). Only 1.2% of these profiles were well defined at or above a T score of 65. Interestingly, this code type was found to be one of the most common profile configurations in the sample studied by Arbisi, Ben-Porath, Marshall, Boyd, and Strauman (1997). They reported that this high-point configuration occurred with 11.1% frequency (the second highest code type), with 4.4% having well-defined code types.

Ben-Porath and Stafford (1997) reported high-point and code type frequencies for men and women undergoing competency assessments. The high-point MMPI-2 score on Pd that the client received occurred with very high frequency (25.4%) in that sample. Additionally, this high point occurred with high frequency (14.1%) in terms of well-defined profiles at or above a T score of 65. The Pd spike was the most frequent clinical scale elevation for women undergoing competency evaluations. This MMPI-2 high-point code (4-6/6-4) can best be understood in the context of cases reported by Ben-Porath and Stafford (1997) in their study of individuals undergoing competency evaluations. This profile configuration (the most frequent two-point code) occurred with high frequency (12.7%) and with 3.5% frequency as a well-defined score at or above a T of 65.

Profile Stability

The relative elevation of the highest scales in her clinical profile shows very high profile definition. Her peak scores are likely to be very prominent in her profile pattern if she is retested at a later date. Her high-point score on Pd is likely to remain stable over time. Short-term test-retest studies have shown a correlation of 0.79 for this high-point score.

Interpersonal Relations

She has a great deal of difficulty in her social relationships. She feels that others do not understand her and do not give her enough sympathy. She is somewhat aloof, cold, non-giving, and uncompromising, attempting to advance herself at the expense of others. She may have a tendency to be verbally abusive toward her husband when she feels frustrated.

The content of this client's MMPI-2 responses suggests the following additional information concerning her interpersonal relationships. She feels intensely angry, hostile, and resentful toward others, and she would like to get back at them. She is competitive and uncooperative and tends to be very critical of others.

Mental Health Considerations

An individual with this profile is usually viewed as having a severe personality disorder, such as an antisocial or paranoid personality. The possibility of a paranoid disorder should also be considered. Her self-reported tendency toward experiencing depressed mood should be taken into consideration in any diagnostic formulation.

Individuals with this profile tend not to seek psychological treatment on their own and are usually not good candidates for psychotherapy. They resist psychological interpretation, argue, and tend to rationalize and blame others for their problems. They also tend to leave therapy prematurely and blame the therapist for their own failings.

If psychological treatment is being considered, it may be profitable for the therapist to explore the client's treatment motivation early in therapy. The item content she endorsed includes some feelings and attitudes that could be unproductive in psychological treatment and in implementing change.

Pre-Trial Criminal Considerations

Her approach to the test was open and cooperative and should provide valuable information for the case disposition. She endorsed some psychological symptoms without a great deal of exaggeration.

Some distinctive problems are evident in her MMPI-2 profile. She presented some clear personality problems that are probably relevant to an assessment of her day-to-day functioning. Her high elevations on the Pd and Pa scales may reflect a tendency to engage in angry, irresponsible, immature, and possibly antisocial behavior. In pre-trial situations, individuals with this personality pattern are usually suspicious of others and resentful of demands made on them. They may make excessive and unrealistic demands on others. They tend not to accept responsibility for their own behavior and are unrealistic and grandiose in their self-appraisal.

Individuals with this pattern are usually mistrustful of the people close to them and tend to have trouble with emotional involvement. Their irritable, sullen, argumentative, and generally obnoxious behavior can strain relationships. The extent to which this individual's behavior has caused her current problem situation should be further evaluated. Her tendency to resent and disregard authority might make her vulnerable to encountering problems with the law or with supervisors in the work place.

In addition to the problems indicated by the MMPI-2 clinical scales, she endorsed some items on the Content Scales that could reflect difficulties for her. Her proneness to experience depression might make it difficult for her to think clearly or function effectively. Her anger-control problems are likely to interfere with her functioning in relationships. The sources of her anger problems should be identified, and effective strategies for helping her gain better control over her aggressiveness should be implemented.

NOTE: This MMPI-2 interpretation can serve as a useful source of hypotheses about clients. This report is based on objectively derived scale indices and scale interpretations that have been developed with diverse groups of people. The personality descriptions, inferences, and recommendations contained herein should be verified by other sources of clinical information because individual clients may not fully match the prototype. The information in this report should be considered confidential and should be used by a trained, qualified test interpreter.

Appendix 159

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