What follows is a description of an advanced course in personality assessment much like the one taught by the first author (Handler). We will present this model to the reader for consideration because it is based on data culled from work on creative reasoning processes and is supported by research. In addition, we have added the use of integration approaches based on the use of metaphor, as well as an approach with which to facilitate empathic attunement with the patient. To this experiential approach we have also added an approach that asks the interpreter to imagine interacting with the person who produced the test results.
A second important reason we have used the following description as a suggested model is that the model can be used with any test battery the instructor wishes to teach, because the approach is not test specific. We suggest that the reader attempt to use this model in communicating integrative and contextual approaches to assessment teaching, modifying and tailoring the approach to fit individual needs and style.
Nevertheless, we recognize that this approach will not be suitable in its entirety for some clinicians who teach personality assessment. However, readers should nevertheless feel free to use any part or parts of this model that are consistent with their theoretical point of view and their preferred interpretive style. We believe the approach described here can be of use to those with an emphasis on intuition, as well as to those who prefer a more objective approach, because the heart of the approach to data integration is the use of convergent and divergent reasoning processes. This approach can be applicable to self-report data as well as to projective test data. Indeed, in the class described, the first author models the same approaches to the interpretation of the MMPI-2 and the Personality Assessment Inventory (PAI), for example, that we do to the Rorschach and the Thematic Apperception Test (TAT).
In this second course, students typically begin assessing patients. They must now focus on using their own judgment and intuitive skills to make interpretations and to integrate data. The task now, as we proceed, is the use of higher-level integrative approaches to create an accurate picture of the person they are assessing. The instructor should describe the changed focus and the difficult and complex problem of interpretation, along with the assurance that students will be able to master the process. Nevertheless, students are typically quite anxious, because interpretation places novel demands on them; for the first time they are being placed in a position of authority as experts and are being called upon to use themselves as an assessment tool. They have difficulty in the integration of experiential data and objective data, such as test scores and ratios. The complexity of the data is often overwhelming, and this pressure often leads students to search instead for cookbook answers.
With no attention to the interpretive process, students make low-level interpretations; they stay too close to the data, and therefore little meaningful integration is achieved. Hypotheses generated from this incomplete interpretive process are mere laundry lists of disconnected and often meaningless technical jargon. An approach is needed that systematically focuses on helping students develop meaningful interpretations and on the integration of these interpretations to produce a meaningful report (Handler, Fowler, & Hilsenroth, 1998).
Emphasis is now placed on the communication of the experiential and cognitive aspects involved in the process of interpretation. Students are told that the interpretive process is systematized at each step of their learning, that each step will be described in detail, and that the focus will be on the development of an experience-near picture of the person assessed. First they observe the instructor making interpretations from assessment data. In the next step the focus is on group interpretation, to be described subsequently. Next, the student does the interpretation and integration with the help of a supervisor and then writes a report free of technical jargon, responding to the referral questions. Reports are returned to the students with detailed comments about integration, style, accuracy, and about how well the referral questions were answered. The students rewrite or correct them and return them to the instructor for review.
The group interpretation focuses on protocols collected by students in their clinical setting. Only the student who did the assessment knows the referral issue, the history, and any other relevant information. The remainder of the class and the instructor are ignorant of all details. Only age and gender are supplied.
Tests typically included in many test batteries include the WAIS-III, the Symptom Checklist-90-Revised (SCL-90-R), the MMPI-2, the PAI, the Bender Gestalt, a sentence completion test, figure drawings, the Rorschach, the TAT, a variety of self-report depression and anxiety measures, and early memories. However, instructors might add or delete tests depending upon their interests and the students' interests. Although this is much more than a full battery, these tests are included to give students wide exposure to many instruments.
The instructor describes various systematic ways in which one can interpret and integrate the data. The first two methods are derived from research in creativity. The first, divergent thinking, is derived from measures of creativity that ask a person to come up with as many ways as he or she can in which a specific object, such as a piece of string, or a box can be used. Those who find many novel uses for the object are said to be creative (Torrance, 1966, 1974; Williams, 1980). Handler and Finley (1994) found that people who scored high on tests of divergent thinking were significantly better Draw-a-Person (DAP) interpreters than those who were low on divergent thinking. (Degree of accuracy in the interpretation of the DAP protocols was determined by first generating a list of questions about three drawings, each list generated from an interview with that person's therapist). The participants were asked to look at each drawing and to mark each specific statement as either true or false. This approach asks students to come up with more than one interpretation for each observation or group of observations of the data.
Rather than seeking only one isolated interpretation for a specific test response, students are able to see that several interpretations might fit the data, and that although one of these might be the best choice as a hypothesis, it is also possible that several interpretations can fit the data simultaneously. This approach is especially useful in preventing students from ignoring possible alternatives and in helping them avoid the problem of confirmatory bias: ignoring data that do not fit the hypothesis and selecting data that confirm the initial hypothesis. Gradually, the students interpret larger and larger pieces of data by searching for additional possibilities, because they understand that it is premature to focus on certainty.
The second interpretive method based on creativity research is called convergent thinking. It asks how different bits of information can be brought together so that they reflect something unique and quite different from any of the pieces but are related to those pieces. Convergent thinking has been measured by the Remote Associates Test (RAT; Mednick & Mednick, 1967), in which the respondent is asked to come up with a word that is related in some way to three other presented stimulus words. For example, for the following three words: "base," round," and "dance," the correct answer is "ball." The interpretive process concerns "seeing relationships among seemingly mutually remote ideas" (Mednick & Mednick, 1967, p. 4). This is essentially the same type of task that is required in effective assessment interpretation, in which diverse pieces of data are fitted together to create an interpretive hypothesis. Burley and Handler (1997) found that the RAT significantly differentiated good and poor DAP interpreters (determined as in the Handler & Finley study cited earlier) in groups of undergraduate students and in a group of graduate students in clinical psychology.
A helpful teaching heuristic in the interpretive process is the use of the metaphor (Hilsenroth, 1998), in which students are taught to offer an interpretive response as though it were an expression of the patient's experience. They are asked to summarize the essential needs, wishes, expectations, major beliefs, and unresolved issues of the patient through the use of a short declarative statement, typically beginning with "I wish," "I feel," "I think," "I want," or "I am." This "metaphor of the self" facilitates interpretation because it allows for a quick and easy way to frame the response to empathize vicariously with the patient. When this approach is combined with the cognitive approaches of divergent and convergent thinking, students generate meaningful hypotheses not only about self-experience, but also about how others might experience the patient in other settings. To facilitate this latter approach, students are asked how they would feel interacting with the patient who gave a certain response if they met the person at a party or in some other interpersonal setting (Potash, 1998).
At first students focus on individual findings, gradually branching out to include patterns of data from a series of responses, and finally integrating these interpretations across various tests. Initial attempts at interpretation are little more than observations, couched as interpretations, such as "This response is an F-"; "She drew her hands behind her back"; "He forgot to say how the person was feeling in this TAT story." The student is surprised when the instructor states that the interpretation was merely an observation. To discourage this descriptive approach the instructor typically asks the student to tell all the things that such an observation could mean, thereby encouraging divergent thinking.
At the next level, students typically begin to shift their interpretations to a somewhat less descriptive approach, but the interpretations are still test based, rather than being psychologically relevant. Examples of this type of interpretation are "She seems to be experiencing anxiety on this card" and "The patient seems to oscillate between being too abstract and too concrete on the WAIS-III." Again, the instructor asks the student to generate a psychologically relevant interpretation concerning the meaning of this observation in reference to the person's life issues, or in reference to the data we have already processed.
Efforts are made to sharpen and focus interpretations. Other students are asked to help by attempting to clarify and focus a student's overly general interpretation, and often a discussion ensues among several students to further define the original interpretation. The instructor focuses the questions to facilitate the process. The task here is to model the generation of detailed, specific hypotheses that can be validated once we have completed all the interpretation and integration of the data.
Whenever a segment of the data begins to build a picture of the person tested, students are asked to separately commit themselves to paper in class by writing a paragraph that summarizes and integrates the data available so far. The act of committing their interpretations to paper forces students to focus and to be responsible for what they write. They are impressed with each other's work and typically find that several people have focused on additional interpretations they had not noticed.
Anyone who uses this teaching format will inevitably encounter resistance from students who have been trained to stick closely to empirical findings. Sometimes a student will feel the class is engaging in reckless and irresponsible activities, and/or that they are saying negative and harmful things about people, without evidence. It is necessary to patiently but persistently work through these defensive barriers. It is also sometimes frightening for students to experience blatant pathology so closely that it becomes necessary to back away from interpretation and, perhaps, to condemn the entire process.
The instructor should be extremely supportive and facilita-tive, offering hints when a student feels stuck and a helpful direction when the student cannot proceed further. The entire class becomes a protective and encouraging environment, offering suggestions, ideas for rephrasing, and a great deal of praise for effort expended and for successful interpretations. It is also important to empower students, reassuring them that they are on the correct path and that even at this early stage they are doing especially creative work. Students are also introduced to relatively new material concerning the problem of test integration. The work of Beutler and Berren (1995), Ganellen (1996), Handleretal. (1998), Meyer(1997), andWeiner (1998) have focused on different aspects of this issue.
Once the entire record is processed and a list of specific hypotheses is recorded, the student who did the assessment tells the class about the patient, including history, presenting problem(s), pattern and style of interaction, and so forth. Each hypothesis generated is classified as "correct," "incorrect," or "cannot say," because of lack of information. Typically, correct responses range from 90 to 95%, with only one or two "incorrect" hypotheses and one or two "cannot say" responses.
In this advanced course students might complete three reports. They should continue to do additional supervised assessments in their program's training clinic and, later, in their clinical placements throughout the remainder of their university training.
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