MMPI Expert Dave Nichols Reviews the MMPI-RF on Listserv

February 9th, 2010

Dave Nichols gave me permission to copy his recent post to a Rorschach Listserv. This is a great response, typical of Dave.

Dr. Edelson writes: “My first course of action in this situation would be to administer the MMPI-2 and/or MMPI-RF.”

Although Dr. Edelson may well not intend it so, her statement could be misleadingly read to indicate a rough equivalence between the MMPI-2 and the MMPI-2-RF. This would be unfortunate. The MMPI-2-RF is only tenuously related to the MMPI-2, amounting largely to the two tests sharing 338 items and the 1989 Restandardization norms. The use of the familiar MMPI acronym in the MMPI-2-RF, while understandable as a means of commercial promotion given the established reputation of the MMPI/MMPI-2, risks (or intends?) distraction from the differences between the two forms. These are substantial, including the elimination of the 10 standard Clinical Scales from the RF, and their substitution by the new Restructured Clinical (RC) scales.

A close examination of the literature of the MMPI-2-RF and the RC scales will reveal a level of arrogance and sloppiness in their construction that some may find disconcerting.

Arrogance: Rather than taking the necessary pains to fully describe the development of each of the 28 new scales (out of 50) in the MMPI-2-RF for the benefit of customers, users and, especially, researchers, the authors of the new form state: “In the following we do not report the particulars of scale derivation in the same detail as we have provided for the RC scales (noting, as we did in the case of the RC scales, that ultimately what is most important is the results, the content, structure, correlates, and functions of each new scale). Instead we offer a narrative summary.” (Tellegen & Ben-Porath, 2008, MMPI-2-RF Technical Manual, p. 18)

Possible translations: 1) Trust us. 2) None of your business.

Sloppiness: One possible reason for avoiding the detailed description of the development of these 28 new RF scales is the sloppiness that was evident in these authors’ previous description of the development of the RC scales. Examples:

1) Their failure to provide in the RC Monograph (2003) a complete scoring key for the preliminary Demoralization scale (Dem), the version of the scale used in their factor analyses of the original Clinical Scales in order to identify a core construct for each (Step 2).

2) Their failure to confirm the results of these analyses after having dropped 5 items from Dem and added 6 new items to create the revised and final version of the Demoralization scale (RCd).

3) The contamination that resulted from appending Dem to the items of Scales 2 and 7, respectively, in their Step 2, after having previously recruited the Dem items exclusively from these same two scales in Step 1, thereby essentially ruling out any items overlapping Dem and either of Scales 2 or 7 as candidates for the latter scales’ core constructs. Unlike the Step 2 procedures followed to determine the core constructs of Scales 1, 3, 4, 6, 8, & 9, applying the same procedure to Scales 2 & 7 would have the effect of extracting the very same factor these scales had earlier been recruited to enlist!

4) Their failure to factor the final RC scales in any of their developmental samples to confirm that the core construct for each scale as embodied in the seed scales selected from each parent Clinical Scale survived as the dominant factor in its RC counterpart, or at least to report such analyses.

More extensive critical analysis of the RC scales and, by extension, the MMPI-2-RF, may be found in: Nichols (2006). The trials of separating bath water from baby: A review and critique of the MMPI–2 Restructured Clinical scales. Journal of Personality Assessment, 87, 121-138; Rouse, Greene, Butcher, Nichols, & Williams (2008). What do the MMPI–2 Restructured Clinical scales reliably measure? Answers from multiple research settings. Journal of Personality Assessment, 90, 435-442; Greene, Rouse, Butcher, Nichols, & Williams (2009). The MMPI–2 Restructured Clinical (RC) scales and redundancy: Response to Tellegen, Ben-Porath, and Sellbom. Journal of Personality Assessment, 91, 222-226; and in Ranson, Nichols, Rouse, & Harrington (2009). Changing or replacing an established psychological assessment standard: Issues, goals, and problems with special reference to recent developments in the MMPI-2. In J. N. Butcher (Ed.), Oxford Handbook of Personality Assessment (pp. 112-139). New York: Oxford University Press.

Dave Nichols

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Are we getting crazier? What do the MMPI norms say about that?

January 30th, 2010

From: “Robert M. Gordon”
Date: January 13, 2010 9:30:02 PM EST
To: PPA@LISTS.APAPRACTICE.ORG
Subject: Re: [PPA] college students, the MMPI and pathology
Reply-To: “Robert M. Gordon”

Eric,
Thanks for this study comparing MMPI scores from students in 1938 and 2007. This is a good example of the problems of interpreting causative hypotheses form correlational data. Their assumption is that students are more mentally ill now.

I noticed the same differences in adults when the MMPI-2 first came out in 1989. But I looked at not just the scale differences but also what items within the scales were meaningfully different (I would not worry about “significant” differences in p values since the N is 77,576. They were right to speak in terms of %)

Of course I have a completely different take than these authors after my studying the subscales and actual item differences. I do not think that there were the “good old days” and that now students are more mentally ill.
When comparing the MMPI norms of 1938 to the MMPI-2 norms of the late 1980’s, the specific increased means in K, Hy, Pd, Pa, Ma and Mf in males, I believe, reflect not only the higher SES and education of the MMPI-2 sample over the original sample, but that overall, people today are more psychologically sophisticated than in 1938. The higher scores in Hy and Pa are due to the higher means in Hy2 Need for Affection and Pa3 Naivete, K, Hy2 and Pa3 measure confidence, trust and honesty in normals. The higher Pd is associated with admitting to common faults (being more honest), e.g. stealing something as a child, or being disappointed in love. The elevation in Ma is due mainly to Ma2 Psychomotor Acceleration. The pace of life is faster today than in 1938, and people today seek more stimulation. The higher Mf for men is associated with items that show that men are more sensitive today than in their grandfather’s time, e.g. men today are less likely to think that teasing animals is fun, or exploit friends, and more likely to admit to feelings and talk about them.

The MMPI-2 manual lists the percent of males and females answering “true” to each item. The biggest difference is that today 77% of females and 70% of males say that they are an important person. However, over forty years ago, only 9% of females and 17 percent of males said “true” to item 61. That item is on the Hypomania scale to assess egotism. It was a valid item then, but is it now, when 70-77% of the sample today say that they are an important person? Are people much more egotistical today, or are people interpreting the meaning of an “important person” differently? I think it is mainly the latter, though the issue is up for debate. In the past, individuals associated an important person with position and wealth. Today, with the popularization of psychology, people are told that they are intrinsically important regardless of position, wealth or other external factors.

The responses to the items indicate that people today are more psychologically minded, confident, open, trusting, thrill seeking and interested in looking attractive than two generations ago. There have been changes toward healthier sex role attitudes. Men are less likely to see friends in terms of how useful they are (item 254). This went from 50% “true” to 24% “true”. Men are less likely to say that it is better to keep their mouth shut when in trouble (item 26, from 68% to 47%). Men are also more likely to admit to being disappointed in love (item 219, 24% to 51%), to feel more intensely than most others (item 271, 23% to 39%) and are less likely to think that teasing animals is a lot of fun (item 68, 45% to 28%). Overall, men are more sensitive and open than in the past.

Women also are responding in a direction indicating a healthy change in sex role behavior. Women are more likely to say that they should have as much sexual freedom as men, than they did in the past (item 88, 52% to 83%). (Interestingly, it was women that were judgmental of women, men remained high in their beliefs that there should not be a double standard, 83% to 89%.) More women today believe it is ok to laugh at a dirty joke ( item 260, from, 78% to 90%), and more likely to talk up in a group of people (item 262, from 55% to 72%).

People are more open and honest about sex according to their responses. People in the MMPI-2 sample were more likely to say that they like to flirt, talk about sex, like sexual stories and jokes, and are less likely to believe that a large number of people are guilty of bad sexual conduct.

The differences also indicate that people are more psychologically minded today. For example, the item #13 on the MMPI-2 that one should try to understand what dreams mean and be guided by them is keyed “true” on scales 6, 7, and 8 (Paranoia, Psychasthenia and Schizophrenia). Once, this was a crazy thought. Not today, when dream research is often in the press stating that dreams can not only tell us about past traumas, but also tell us how we may react to certain situations. Fifteen percent of the females responded “true” in 1938, now females respond “true” 34% of the time. Males went from 13% to 27%. People are more likely to say that they do dream, and admit that they have dreams about sex. People are less likely to state that they wish that they were a child again, less likely to state that they cannot understand why they get angry, less likely to feel that they are misunderstood, or feel that stepping on the sidewalk cracks is something to be avoided. People in the MMPI-2 sample were more likely to state that the hardest battles are with themselves, and that they know who is responsible for their problems. All these changes indicate greater insight about dreams, feelings, ones own responsibility for personal problems and less superstition.

The MMPI-2 sample indicates that people today have a more benign attitude towards others. They are less likely to feel that: people exaggerate a lot to get sympathy, that it is safer to trust no one, that most people do not want to know the truth and that it is better to be on guard with people who seem friendlier than one would expect. People in the MMPI-2 sample are more likely to state that: they are important, would be a good leader, and if they had the chance, that they would be a benefit to the world.

Overall, I believe that the changes in the MMPI-2 sample’s responses to the items as compared to the original sample from 1938 indicates that people are more open with their emotions and feelings, have more confidence, have less rigid sex roles and are more psychologically minded than in the past.

Bob (the MMPI guy)

Study: More of today’s US youth have serious mental health issues than previous generations
By Martha Irvine

CHICAGO A new study has found that five times as many high school and college students in the U.S. are dealing with anxiety and other mental health issues than youth of the same age who were studied in the Great Depression era.

The findings, culled from responses to a popular psychological questionnaire used as far back as 1938, confirm what counsellors on campuses nationwide have long suspected as more students struggle with the stresses of school and life in general.

“It’s another piece of the puzzle – that yes, this does seem to be a problem, that there are more young people who report anxiety and depression,” says Jean Twenge, a San Diego State University psychology professor and the study’s lead author. “The next question is: what do we do about it?”

Though the study, released Monday, does not provide a definitive correlation, Twenge and mental health professionals speculate that a popular culture increasingly focused on the external – from wealth to looks and status – has contributed to the uptick in mental health issues.

Pulling together the data for the study was no small task. Led by Twenge, researchers at five universities analyzed the responses of 77,576 high school or college students who, from 1938 through 2007, took the Minnesota Multiphasic Personality Inventory, or MMPI. The results will be published in a future issue of the Clinical Psychology Review.

Overall, an average of five times as many students in 2007 surpassed thresholds in one or more mental health categories, compared with those who did so in 1938. A few individual categories increased at an even greater rate – with six times as many scoring high in two areas:

-”hypomania,” a measure of anxiety and unrealistic optimism (from 5 per cent of students in 1938 to 31 per cent in 2007)

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More on What is the Best Psychotherapy? The APA Press Release

January 28th, 2010

The Efficacy of Psychodynamic Psychotherapy

January 25, 2010

Psychodynamic Psychotherapy Brings Lasting Benefits through Self-Knowledge.

Patients Continue to Improve After Treatment Ends, New Study Finds—Psychodynamic psychotherapy is effective for a wide range of mental health symptoms, including depression, anxiety, panic and stress-related physical ailments, and the benefits of the therapy grow after treatment has ended, according to new research published by the American Psychological Association. Psychodynamic therapy focuses on the psychological roots of emotional suffering. Its hallmarks are self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient’s life. Its goal is not only to alleviate the most obvious symptoms but to help people lead healthier lives. “The American public has been told that only newer, symptom-focused treatments like cognitive behavior therapy or medication have scientific support,” said study author Jonathan Shedler, PhD, of the University of Colorado Denver School of Medicine. “The actual scientific evidence shows that psychodynamic therapy is highly effective. The benefits are at least as large as those of other psychotherapies, and they last.” To reach these conclusions, Shedler reviewed eight meta-analyses comprising 160 studies of psychodynamic therapy, plus nine meta-analyses of other psychological treatments and antidepressant medications. Shedler focused on effect size, which measures the amount of change produced by each treatment. An effect size of 0.80 is considered a large effect in psychological and medical research. One major meta-analysis of psychodynamic therapy included 1,431 patients with a range of mental health problems and found an effect size of 0.97 for overall symptom improvement (the therapy was typically once per week and lasted less than a year). The effect size increased by 50 percent, to 1.51, when patients were re-evaluated nine or more months after therapy ended. The effect size for the most widely used antidepressant medications is a more modest 0.31. The findings are published in the February issue of American Psychologist, the flagship journal of the American Psychological Association. The eight meta-analyses, representing the best available scientific evidence on psychodynamic therapy, all showed substantial treatment benefits, according to Shedler. Effect sizes were impressive even for personality disorders—deeply ingrained maladaptive traits that are notoriously difficult to treat, he said. “The consistent trend toward larger effect sizes at follow-up suggests that psychodynamic psychotherapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended,” Shedler said. “In contrast, the benefits of other ‘empirically supported’ therapies tend to diminish over time for the most common conditions, like depression and generalized anxiety.” “Pharmaceutical companies and health insurance companies have a financial incentive to promote the view that mental suffering can be reduced to lists of symptoms, and that treatment means managing those symptoms and little else. For some specific psychiatric conditions, this makes sense,” he added. “But more often, emotional suffering is woven into the fabric of the person’s life and rooted in relationship patterns, inner contradictions and emotional blind spots. This is what psychodynamic therapy is designed to address.” Shedler acknowledged that there are many more studies of other psychological treatments (other than psychodynamic), and that the developers of other therapies took the lead in recognizing the importance of rigorous scientific evaluation. “Accountability is crucial,” said Shedler. “But now that research is putting psychodynamic therapy to the test, we are not seeing evidence that the newer therapies are more effective.” Shedler also noted that existing research does not adequately capture the benefits that psychodynamic therapy aims to achieve. “It is easy to measure change in acute symptoms, harder to measure deeper personality changes. But it can be done.” The research also suggests that when other psychotherapies are effective, it may be because they include unacknowledged psychodynamic elements. “When you look past therapy ‘brand names’ and look at what the effective therapists are actually doing, it turns out they are doing what psychodynamic therapists have always done—facilitating self-exploration, examining emotional blind spots, understanding relationship patterns.” Four studies of therapy for depression used actual recordings of therapy sessions to study what therapists said and did that was effective or ineffective. The more the therapists acted like psychodynamic therapists, the better the outcome, Shedler said. “This was true regardless of the kind of therapy the therapists believed they were providing.” Article: “The Efficacy of Psychodynamic Psychotherapy,” Jonathan K. Shedler, PhD, University of Colorado Denver School of Medicine; American Psychologist, Vol. 65. No.2.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

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What is the best psychotherapy? What does the MMPI-2 say about it?

January 23rd, 2010

In Matt Jarvis’s text (2004) “Psychodynamic Psychology- Classical Theory & Contemporary Research” he refers to my 2001 study using the MMPI as a treatment outcome measure. CBT and other non-psychoanalytic treatments use outcome measures of just the surface symptoms. They do not use the MMPI, which measures the personality traits and syndromes underneath the psychological symptoms. The MMPI does not react to CBT and other shallow treatments. Psychoanalytic-psychodynamic treatments aim at the underlying personality traits and should show changes in the MMPI scores. Jarvis wrote:
“The most widely used measure of psychopathology, the Minnesota Multiphasic Personality Inventory (MMPI), generally reveals quite small changes in response to brief psychological therapies. Gordon (2001) set out to test whether long-term psychoanalytic psychotherapy would show greater change as assessed by the MMPI: 55 outpatients with multiple symptoms were tracked and retested on the MMPI. Personality change took an average of two years, but by the end of treatment all the patients had decreased significantly in psychopathology, entering the normal rage of MMPI scores. This is a highly significant finding as it suggests that there is something unique about the effects of long-term psychoanalytic psychotherapy above and beyond those of briefer psychological therapies.” (p.184)

In 2010, Jonathan Shedler had his article, “The Efficacy of Psychodynamic Psychotherapy”, published in psychology’s main journal, the American Psychologist. In his review of the best research available, psychodynamic therapy (PDT) (this includes all the psychoanalytic treatments) was found to be better than CBT and other non-psychoanalytic treatments for: depression, anxiety, panic, somatoform disorders, eating disorders, substance related disorders, and personality disorders. The effects did not decay over time as with the more surface treatments, and the patients continued to grow by using the insights they had learned in PDT (See my review 2010).

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Is the new MMPI-RF Really an MMPI? Is it better?

January 21st, 2010

Don’t use the MMPI-RF when an MMPI-2 is required. They are not the same test. In fact, the MMPI-RF has poor sensitivity to psychopathology and is a poor diagnostic instrument. When the MMPI-RC scales first came out, I was very critical of them. I had a hard time getting my paper published. I had to fight with Psych. Reports and I won. The editor agreed to publish it finally in 2006 over the reviewers unanimous criticism of it. Later Jim Butcher and Carolyn Williams wrote (2009) “Gordon (2006) indicated that the RC Scales are based on false assumptions about psychopathology (i.e. that consistent items are needed to assess all psychopathologies), pointing to complex diagnostic conditions like Hysteria, Post Traumatic Stress Disorder, and Borderline Personality Disorder that are better understood with a psychodynamic formulation recognizing internal conflicts and contradictions. He indicates that a simplistic behavioral approach with an insistence on more internally consistent and distinct scales does not produce more external validity or useful measures for many of the complex disorders found in clinical practice.”

The MMPI RC scales became the main clinical scales of  the MMPI-RF. Now most the leading MMPI experts agree that the MMPI-RF is a flawed test. So stick with the MMPI-2.

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Can someone take an MMPI-2 home?

January 20th, 2010

Gordon, R.M. (2010), Test at Home Not Unethical per se, The National Psychologist, January/February, p.24.

Dear Editor,

Often you can let patients that you trust and with strict instructions, take an MMPI-2 home to complete. It is not automatically unethical. We don’t want psychologists to think of ethics in such black and white terms (Gordon, 2006). Dr. Jeffery E. Barnett’s ethical reasoning in the Nov-Dec. 2009 issue of The National Psychologist misses the letter and intent of Standard 9.11 by stating that it “should never occur.” He responded with an unequivocal “unethical.” He referred to Standard 9.11 “Psychologists make reasonable efforts to maintain the integrity and security of test materials and other assessment techniques consistent with law and contractual obligation and in a manner that permits adherence to this Ethics Code.”

The intent of this standard is to remind us of our obligation to protect the validity of our testing instruments and try to get the most valid results from each situation as well as to honor legal, contractual and ethical standards. We do not want the test answers published on the Internet, and we do not want a particular testee to give us invalid results. The psychologist might not know who took the test and if the testee got help in answering the questions. Certainly, we should never let a forensic client or job applicant take a test home, but patients have very different motivations. Even so, it would be foolish to give an MMPI-2 to take home if the patient has a problem with responsibility or passive aggressiveness. These are serious concerns to be considered, but it is not inherently unethical.

Dr. Barnett is worried about distractions affecting the test scores at a patient’s home. If the MMPI-2 were so fragile, it would not be a reliable and valid instrument of personality traits.

However, within the office, testees can take pictures of the test questions with their smart phones and later post them on Internet. There are web sites to help people “pass” such tests as the MMPI-2, which is also available on smart phones. The intent of 9.11 is that we all try to address these concerns- regardless of venue. The greater good and least likely harm may at times be allowing a patient to take an MMPI-2 home. The testee may have a medical condition that makes it more humane to take it at home, or someone may wish for more privacy. Quite testing rooms may not be available. Also Dr. Barnett assumes that seeing the MMPI-2 items outside of the office will compromise the test validity. As I just stated, the items are already out there, but that does not help a person who wants to cheat the test. Self report personality tests such as the MMPI-2 are not based on ‘right’ answers such as an ability test. In fact there are several self report personality tests that can be taken over the Internet. True a testee can fake to look good or bad, but that will happen regardless of venue. There is also a difference between the test items versus the scoring keys. The later is not available on test booklets and therefore there is no issue about the loss of validity.

There are no contractual or legal issues to letting patients take a self report personality test at home. I have been doing this for over 35 years.

I am an ethics educator and an MMPI-2 expert. My effectiveness research on 55 patients in long-term psychotherapy would have been very hard to do if I did not allow my patients to take the MMPIs home (Gordon, 2001). I do agree that we need to understand the intent of ethical standards and then weight the pros and cons. The issue is one of concern and caution, but not a matter of simply being labeled “unethical.” The last thing we need is another reason for licensing boards to go after psychologists.

Gordon, R.M. (2001) MMPI/MMPI-2 Changes in Long-Term Psychoanalytic Psychotherapy, Issues in Psychoanalytic Psychology, 23, (1 and 2), 59-79.

Gordon, R.M. (2006) The APA Ethics Code as a Projective Test. Psychologist-Psychoanalyst, XXVI, 1, 67-68.

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