amfbar odinan yukiko
Orestes Hardy
The Rotter Incomplete Sentences Blank is an attempt to standardize the sentence completion method for the use at college level. Forty stems are completed by the subject. These completions are then scored by comparing them against typical items in empirically derived scoring manuals for men and women and by assigning to each response a scale value from 0 to 6. The total score is an index of maladjustment
The sentence completion method of studying personality is a semi structured projective technique in which the subject is asked to finish a sentence for which the first word or words are supplied. As in other projective devices, it is assumed that the subject reflects his own wishes, desires, fears and attitudes in the sentences he makes. Historically, the incomplete sentence method is related most closely to the word association test. In some test incomplete sentences tests only a single word or brief response is called for; the major differences appears to be in the length of the stimulus. In the sentence completion tests, tendencies to block and to twist the meaning of the stimulus words appear and the responses may be categorized in a somewhat similar fashion to the word association method.
The Incomplete Sentences Blank consists of forty items revised from a form used by Rotter and Willermann (11) in the army. This form was, in turn, a revision of blanks used by Shor (15), Hutt (5), and Holzberg (4) at the Mason General Hospital. In the development of the ISB, two objectives were kept in mind. One aim was to provide a technique which could be used objectively for screening and experimental purposes. It was felt that this technique should have at least some of the advantages of projective methods, and also be economical from the point of view of administration and scoring. A second goal was to obtain information of rather specific diagnostic value for treatment purposes.
The Incomplete Sentences Blank can be used, of course, for general interpretation with a variety of subjects in much the same manner that a clinician trained in dynamic psychology uses any projective material. However, a feature of ISB is that one can derive a single over-all adjustment score. This over-all adjustment score is of particular value for screening purposes with college students and in experimental studies. The ISB has also been used in a vocational guidance center to select students requiring broader counseling than was usually given, in experimental studies of the effect of psychotherapy and in investigations of the relationship of adjustment to a variety of variables.
A psychologic test is a set of stimuli administered to an individual or a group under standard conditions to obtain a sample of behavior for assessment. There are basically two kinds of tests, objective and projective. The objective test requires the respondent to make a particular response to a structured set of instructions (e.g., true/false, yes/no, or the correct answer). The projective test is given in an ambiguous context in order to afford the respondent an opportunity to impose his or her own interpretation in answering.
Psychologic tests are rarely given in isolation but as a part of a battery. This is because any one test cannot sufficiently answer the complex questions usually asked in the clinical situation. Most diagnostic questions require the assessment of personality, intelligence, and perhaps even the presence of organic involvement. A typical battery of tests includes projective tests to assess personality such as the Rorschach and the Thematic Apperception Test (TAT), an objective personality test such as the Minnesota Multiphasic Personality Inventory (MMPI), a semistructured test like the Rotter Incomplete Sentence Test, and an intelligence test, usually the Wechsler Adult Intelligence Scale Revised (WAIS-R).
The most important consideration for the physician is when to ask for psychologic assessment. As with medical diagnostic procedures, we are interested in finding answers to diagnostic questions that cannot be obtained through direct observation or interview. In our clinical experience, there are a myriad of circumstances requiring psychologic consultation either to assist in or rule out medical intervention. Some of the more typical situations include compliance, behavioral management, affirmation of clinical findings, the use of supportive drug therapies, and continuity of care issues.
Mr. S. was a 35-year-old single salesman hospitalized for gastrointestinal problems associated with a previous operation. He had a history of noncompliance with both drugs and nutrition regimens. Severe debilitation would ensue following outpatient treatments, after which he would be hospitalized. This pattern repeated itself several times. Psychologic assessment data were consistent with a pattern of addictive behavior and poor coping mechanisms under stressful conditions. Recommendations included a drug rehabilitation program and stress management techniques.
Dr. L., a 68-year-old retired dentist, had severe behavioral management problems with the nursing staff. He was verbally punitive and intrusive of other patients" privacy. Psychologic assessment revealed an organic brain syndrome indicating greater individual care and a lower expectation of his performance.
A 21-year-old single male, Mr. N., was admitted for hospitalization complaining of severe stomach pains and rectal bleeding. Psychologic testing was administered because the internist could find no evidence of physical pathology. Test battery results described a young man under an inordinate amount of stress due to a huge difference between his intellectual capabilities and the demands of his work place. The recommendation was to find other employment and to work with a counselor to develop more realistic vocational goals.
Ms. C. was a middle-aged housewife complaining of panic attacks of unknown origin. She also said that she was in severe depression because of the death of her daughter 2 years previously. The clinical question was whether she should be given antidepressants or antianxiety agents as an adjunct to psychotherapeutic intervention. Test results were consistent with a state of anxiety as opposed to an affective disorder.
Ms. B. was a 23-year-old single female who was hospitalized following a drug overdose from a suicide attempt. Information was needed to determine how dangerous she was to herself, how restrictive an environment she needed for treatment, and what type of therapy was appropriate. Test results confirmed a compulsive personality with a dramatic flair. Ms. B. needed extensive individual psychotherapy but did not require lengthy hospitalization. Nevertheless, it was essential to link her with outpatient care while she was still motivated to receive care.
Although the above examples are by no means exhaustive, they do point out the variety of commonly occurring circumstances in which psychologic assessment may be useful. It is important when ordering testing to formulate the diagnostic question in as specific a manner as possible. Such requests as "describe personality dynamics" or "rule out psychologic disturbance" are too general to answer in an effective and efficient manner. Do not hesitate to ask exactly what you want to know. The psychologist will inform you if he or she is unable to answer. Use the examples described above to formulate your question: Is this patient depressed? Is this patient psychotic? Why is this patient not conforming to the treatment regimen?
When presenting a patient to a psychologist for evaluation, it is helpful to have demographic data and a detailed history of the client. Also, the description presented of the problems should be in behavioral terms. Saying that a patient appears to be depressed is not as helpful as describing him or her as having a loss of appetite, early morning rising, or slowness of speech. If the patient is a management problem, give a concrete description of what this entails: won"t go to rehabilitation therapy, won"t let a technician draw blood.
Finally, the referring physician may request either a specific test or an abbreviated battery. While some psychologists will go along with this practice, we do not encourage it. Psychologic tests, particularly personality ones, are only as good as the skills of the individual who administers and interprets them. The psychologist must feel confident and competent in the battery that he or she administers. Therefore, the number and choice of tests should be those of the psychologist, just as the medical procedures chosen for a patient are the responsibility of the physician in charge.
The most commonly used personality tests are the Rorschach, TAT, and MMPI. The assumptions underlying projective tests such as the Rorschach and TAT are that the standard set of stimuli are used as a screen to project material that cannot be obtained through a more structured approach. Ambiguous inkblots or pictures reinforce the use of individual expression and reduce resistance. A frequent criticism is the assumption that the individual simply responds to ambiguity with trivia or with what was most recently experienced, such as last night's television fare. The response to this criticism is the notion of psychic determinism. Behavior is a function of choice, not chance. Thus, how a person responds is a reflection of personal motives, fantasies, and needs.
The best-known psychologic assessment tool is the Rorschach, the "inkblot test." It was first published by Hermann Rorschach in 1921 and was introduced to the United States in 1930 by Samuel Beck. The test consists of 10 symmetrical inkblots, half of which are acromatic. It is administered by giving the respondent one card at a time and asking him or her to describe what is seen. The respondent is told that he or she can see one or more things and that there are no right or wrong answers. The tester records the responses verbatim. There is then a second phase of testing called the inquiry. The respondent is again presented with each of the ten cards and asked to note the location of the response and what determines his or her answers.
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