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Dr. Bob is Robert Hsiung, MD,
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Posted by Camille Dumont on March 5, 2004, at 20:45:59
I was wondering if anybody has ever had a psychological evaluation usting projectives tests before?
The psychiatrist recommended them but if I want them done without waiting 6 months ... I have to go private and most likely it will not be paid by the insurance ... so I'd have to dish out like 500$. I mean the cash is not a problem but I still would like to have your opinion on their usefullness ... or at least if they're worth the expense.
Oh ya ... a lil idea of what it consists of would also be appreciated :)
Thanks
Posted by Apperceptor on March 5, 2004, at 21:30:36
In reply to Projective tests ... are they worth it?, posted by Camille Dumont on March 5, 2004, at 20:45:59
Camille-
Projective tests have been called the most controversial issue in modern clinical psychology. The "hard science" research on them has been largely disappointing, but clinical experience often views them as an irreplaceable tool for really getting at the heart of the matter.
I currently give projective tests for my clinical training, and I absolutely love them. If you get them done, please try for a doctorally trained clinical psychologist who is reputable in personality assessment. You can contact the Society of Personality Assessment for referrals...website, I believe, is www.personality.org. These tests require a very high degree of clinical acumen to have any meaning, and in the wrong hands they can be dangerous.
To get your money's worth, it is essential that you be completely honest. There are heavy restrictions on the use of PTs, so you probably needn't worry that your results will return to haunt you.
The most common PT is the Rorschach Comprehensive System ("Exner System"). This uses the famous inkblots. You will be asked what you see, and later how you saw it. 10 cards, about 20-40 minutes. Nightmare to score :-).
Other common tests:
Thematic Apperception Test - 10-20 cards with pictures. You tell a "dramatic" story about what is going on. Takes 1 hour.
Sentence Completion - Literally fill in the blank. "I like......." etc.
Draw a Person / House-Tree-Person - you draw these things and they are interpreted. I am very leery of these, but I defer to the psychodiagnosticians with vastly more experience.
Childhood Hand that Disturbs - you draw a childhood picture, a hand, and a "hand that disturbs," meaning the most horrifying/disgusting hand you can imagine. Suprisingly useful, big in France & Italy.
Tautophone - VERY rare but some use it. You listen to a barely perceptible "conversation" and say what you think you heard being discussed. Questionable.
There are over 400 projectives, so if you are going to take one not here and want me to find you a description, let me know. You have a right to be informed about any and all tests you take, as well as how they will be used. Please exercise that right.
My best-
Posted by Apperceptor on March 5, 2004, at 21:35:23
In reply to Re: Projective tests ... are they worth it?, posted by Apperceptor on March 5, 2004, at 21:30:36
Should probably also mention the idea behind projectives - the original thought is that they are a way of getting at your unconsious, which bypasses your conscious thought and "projects" its traits onto ambiguous test stimuli (hence "projective"). Many still believe this, but some think they are more of a "what is your thinking style" approach. Either way, they are very valuable, in my opinion.
Posted by Elle2021 on March 5, 2004, at 22:41:22
In reply to Projective tests ... are they worth it?, posted by Camille Dumont on March 5, 2004, at 20:45:59
One of my psychology professors seems to view them with skepticism. I think they are only partially helpful. A major problem with them is that there are so many different ways to interpret what is there. One book I read seemed to think that they are more helpful when used in combination with open ended clinical interviews.
Elle
Posted by Elle2021 on March 5, 2004, at 22:45:05
In reply to Re: Projective tests ... are they worth it?, posted by Apperceptor on March 5, 2004, at 21:30:36
> Tautophone - VERY rare but some use it. You listen to a barely perceptible "conversation" and say what you think you heard being discussed. Questionable.
That sounds fascinating. Can you tell me more about that one?
Elle
Posted by Dinah on March 5, 2004, at 23:40:03
In reply to Re: Projective tests ... are they worth it? » Camille Dumont, posted by Elle2021 on March 5, 2004, at 22:41:22
My personal experience was that my Rorschach results matched rather suspiciously close to what I believe she had already concluded from the interview. :) I also looked up that test afterwards, and so was able to understand what one piece of data she based one remark in her report on. Which was fortunate, since I think it might have upset me if I hadn't understood *why* she had come to that conclusion.
But I loved my MMPI. I'm a 2-7-8, and it fits me perfectly. I suppose it didn't tell me anything I didn't already know about myself, but it was still interesting that a check the box 600 someodd multiple choice test could get me so well. Better than the psychologist with her interview, Rorschach, and Briggs Myers did. But then she was an awfully cheerful psychologist and did an awfully cheerful report. :P When my therapist asked if I had reviewed what I sent him, and I remarked on the cheerfulness, he responded that she had told him she liked to write the client's report as positively as possible. I'd love to see his version.
So the short answer to all that was, mine were only $200 and probably worth it. I don't think it would have been at $500, but that's just me.
Posted by Dinah on March 5, 2004, at 23:56:57
In reply to Re: Projective tests ... are they worth it? » Elle2021, posted by Dinah on March 5, 2004, at 23:40:03
Posted by Apperceptor on March 6, 2004, at 3:08:04
In reply to Re: Projective tests ... are they worth it? » Apperceptor, posted by Elle2021 on March 5, 2004, at 22:45:05
Hi Elle-
It's exceedingly archaic, as it did not seem to prove of much use. I've never used it with a client, and have only seen it demonstrated "in person" once. The idea for the Tautophone, ironically, came from BF Skinner (!?).
It is basically a record player-type thing that plays conversations between 2 people. They sound like you are listening to them from the next room...*almost* understandable, but not quite. The psychologist asks you to repeat what you think the people were saying.
The best way to describe it, I think, is as an audio-Rorschach. Soundblots, if you will :-).
I will let you know if I find out more!
Posted by Elle2021 on March 6, 2004, at 3:23:19
In reply to Re: Projective tests ... are they worth it? » Elle2021, posted by Apperceptor on March 6, 2004, at 3:08:04
Hi,
Thanks for responding. That just seems like it would be the best test. Seems like it would get at the core issue of what is going on with a client. I think one would be prone to "hear" about the situation that they are having the most problems with. I wish it was more widely used. I did the house, tree, person test once. It was fairly accurate...more accurate then I would have liked!
Elle
Posted by Camille Dumont on March 6, 2004, at 17:17:14
In reply to Re: Projective tests ... are they worth it? » Apperceptor, posted by Elle2021 on March 6, 2004, at 3:23:19
Thanks for your answers and opinions ... Dinah the price difference might be because its C$ and not US$.
It would be a different pdoc from my own ... so hopefully preconcived opinions wouldn't be that much a part of it.
I'm an awfully curious person so in the end I think I'll go ahead with it ... be it just for the fun of it ;P
Posted by gardenergirl on March 6, 2004, at 23:11:01
In reply to Re: Projective tests ... are they worth it?, posted by Camille Dumont on March 6, 2004, at 17:17:14
There is some very good information here, I hope it helped you to make your decision. Elle, I believe, posted something about using projectives in conjunction with a clinical interview. My own preference is to use an interview, a projective, and an objective (like MMPI or MCMI). I think the more data you get from different types of sources, the more likely you are to get a true picture. People can sometimes respond differently to different types of tests, i.e. really guarded on one and really open on the other. This can give you useful information besides the test results themsevles, sometimes.
I hope you find your experience useful!
gg
Posted by gardenergirl on March 6, 2004, at 23:14:17
In reply to Re: Projective tests ... are they worth it?, posted by Apperceptor on March 5, 2004, at 21:30:36
>> The most common PT is the Rorschach Comprehensive System ("Exner System"). This uses the famous inkblots. You will be asked what you see, and later how you saw it. 10 cards, about 20-40 minutes. Nightmare to score :-).
Amen to the scoring part. We had one class just on Exner's Comprehensive System. Now that was a fun semester! :P
>
> Draw a Person / House-Tree-Person - you draw these things and they are interpreted. I am very leery of these, but I defer to the psychodiagnosticians with vastly more experience.I'm not overly nuts about these, either.
>You seem to have quite a bit of knowlege of these. Is this personal interest or a specialty of your program? Also, which would you recommend for use with older adults?
Thanks,
gg
Posted by Apperceptor on March 6, 2004, at 23:48:38
In reply to Re: Projective tests ... are they worth it? » Apperceptor, posted by gardenergirl on March 6, 2004, at 23:14:17
Hi gg-
First off, I certainly second the motion that ideally, projective tests should be part of a clinical interview, rather than being used alone, and I would also include an objective (and ideally an intellectual test as well). I think a very good strategy for the majority of clients is to use the WISC/WAIS (or possibly WASI), Rorschach, and MMPI or CPI.
We did the semester of Exner too....by the end, I found myself thinking "FABCOM" while talking to people. :-)
Personality testing is both a personal interest of mine, and fortunately, an unofficial specialty of our program. We have what I consider to be excellent opportunities in practica to gain experience with it.
I'm afraid I'm not too sure what I would do different for an elderly client. I'd be inclined, depending on the person, to include Bender-Gestalt if there seems to be an organic concern in addition to emotional problems. I think the Rorschach should still hold up regardless of age. I would also be inclined to try the Thematic Apperception Test if time weren't an issue and I were concerned about psychopathology relating to loneliness or interpersonal loss.
The Childhood Hand that Disturbs, while supposedly for all ages, does not strike me as suitable in the least for elderly clients.
Because it's so simple, short, and relatively harmless, I'd throw in Sentence Completion just in case it provided anything useful.
Hope this helps...let me know if you'd like to chat more, I love this stuff :-).
Posted by gardenergirl on March 7, 2004, at 0:11:57
In reply to Re: Projective tests ... are they worth it? » gardenergirl, posted by Apperceptor on March 6, 2004, at 23:48:38
>
> We did the semester of Exner too....by the end, I found myself thinking "FABCOM" while talking to people. :-)ROFL!!!
>About gero, you make some good suggestions. The only opportunity I had to do a Rorschach with one of my older clients was not good. She was so guarded she obviously was censoring, as much came out in the inquiry that I'm sure she censored in the beginning. Also, she really didn't understand the inquiry phase. Only marginally valid. And this was my CCE case. Oh well. I had lots more to go on.
There is a Senior Apperception Test (just remembered it from Gero Assessment.) It seems to be much less ambiguous than the TAT, though. Quite obvious what it is pulling for. I think I would be more inclined to stick with the TAT.
Thanks!
gg
Posted by Apperceptor on March 7, 2004, at 2:03:58
In reply to Re: Projective tests ... are they worth it?, posted by gardenergirl on March 7, 2004, at 0:11:57
Good call, I completely forgot the Senior AT. I've absolutely no experience with that so I'm going to take your word for it.
I like the TAT a lot, except I'm sometimes a little concerned because the people are all european and from the 1930's. I also wish there would be apperceptive tests that work with LGBT clients, as that is a "special population" I work with. There have been attempts to update ATs, but so far the TAT is the only one that seems to have real staying power.
What you mentioned about your client holding back answers...I can't help but wonder if that would be, unfortunately, a generalized problem with projective tests for elderly clients, who may be much more suspicious of psychologists and psychiatrists due to the "therapy is only for psychos" attitude of the mid 1900's. Let me know more about your experiences as you get them, I'm curious!
Posted by Camille Dumont on March 7, 2004, at 12:00:39
In reply to Re: Projective tests ... are they worth it? » gardenergirl, posted by Apperceptor on March 6, 2004, at 23:48:38
Ya, the psychiatrist has suggested it as part of her ongoing diagnosis. She's seen me twice at the request of my regular doc. I think its supposed to be part of her investigating the potential cause of the visual pseudo-hallucinations I see.
I also have all the psychiatric evaluations sent to my psychologist so she can also have an easyer time helping me.
Posted by gardenergirl on March 7, 2004, at 13:04:42
In reply to Re: Projective tests ... are they worth it?, posted by Camille Dumont on March 7, 2004, at 12:00:39
Nice to hear that your T and your pdoc are collaborating. Just curious? Have you had a neuro exam? (perhaps I missed this in a previous post?)
gg
Posted by Apperceptor on March 7, 2004, at 14:26:52
In reply to Re: Projective tests ... are they worth it? » Camille Dumont, posted by gardenergirl on March 7, 2004, at 13:04:42
Camille,
I must admit that my "knee-jerk" reaction when I read your most recent post was the same as GardnerGirl...if you haven't looked into it, a neuropsychological evaluation could be profoundly valuable. I would hate to see some aspect of your difficulty be overlooked, or have you labeled with a false and very misleading diagnosis.
If you need help finding a neuropsychologist, let me know. Of course, talk to your doctor about this first...I've quite a few years before I should be doling out these suggestions :-)
Posted by Camille Dumont on March 7, 2004, at 15:15:46
In reply to Re: Projective tests ... are they worth it?(CD/gg), posted by Apperceptor on March 7, 2004, at 14:26:52
Well, I've had a ct-scan done ... all normal ... also an ophtalmological exam ... all normal as well.
Psychiatrist is not sure wether its more "psychological ... i.e. my thought scheme", "endocrinal" as I've had to take growth hormone to make up for what my hypophise (sorry don't know the english name for it)was not producing or some sort of epilepsy because when I took Zyprexa I was having one petit mal seizures after the other.
I haven't seen her report but the mentionned sending me to a neurologist or an endocrinologist and doing an EEG ... yippee ... with the average waiting delays in Canada I should be done in a couple of years :P
About the possiblity of misdiagnosis with the projective tests ... its a big reason why I'm looking into having it done in the private sector rather than the psych hospital. When I went there last time after a suicide attempt they sent me home with no meds, no refferal, nothing safe a silly "adaptation trouble ... to be reevaluated" diagnosis ... telling me to go to the ER if I ever felt like killing myself again ... yippee.
It was also there that the silly doctor told me "you know its not NORMAL to have ideas like that" ... when I mentionned suicidal ideation ... well DUH! Lets say he didn't make that great of a first impression on me.
The psychiatrist I see now (private practice but covered) was suggested by my psychologist and she's so much more humane and actually takes time to talk to you. It takes about a month to get an appointment but its worth it. Last time I went to see her, I saw her for 1.25h .... and my first evaluation was 2h. So I figure if she reffers me to another psychologist for the projective tests (saying she doesn't have the right experience to do those herself) he must be competent and I'm reassured she's at least professional and not too cash motivated.
Posted by Dinah on March 7, 2004, at 15:49:02
In reply to Re: Projective tests ... are they worth it?, posted by Camille Dumont on March 6, 2004, at 17:17:14
I'm not sorry I did it either. It was fun. I think I would have liked it better if the psychologist hadn't annoyed me so much with her chipper outlook.
I've told this story before and people might be sick of hearing it. But the psychologist had refused to show me the actual scores from my MMPI. When pressed, all she would give was the 2-7-8 elevations. She said she wasn't allowed under her professional guidelines to show me the scores. Now I happened to know (because as soon as I had finished the test, I looked up everything I could about it), that that wasn't true. There was even at least one book devoted to how best to share the results with the client. I don't like being lied to.
So I went to the university library and using several different texts managed to reconstruct the test on a lotus schedule, complete with scoring protocol, and gave it to myself. Then I could not only what my scores were, but why certain scales were elevated. And I did tons of research into what it meant.
I went back to clarify a couple of points with her, and brought my lotus schedule. She looked absolutely alarmed, poor thing. But when I showed my therapist he laughed. Because it was so much like something I would do. He just worried about the time I wasted on it. :) But I don't think it was a waste of time. I think it said more about my personality than the testing did. lol.
So, curious? I definitely understand curious. :D
Posted by Camille Dumont on March 7, 2004, at 18:23:51
In reply to Re: Projective tests ... are they worth it? » Camille Dumont, posted by Dinah on March 7, 2004, at 15:49:02
Thats silly .. not wanting to show you your results. From what my psychologist says, the only reason that she can withold test / evaluation results is if they could "hurt" you or put you in danger.
But some practicians seem way too paranoid about showing files ... At my GP's place, they refused to show me my psychiatric evaluation ... but I asked my psychologist and she said ok, made me sign a paper and handed me a copy. Frankly there was nothing scary in there ... I had to look up a few things like the different axis and such though
I agree with you, its always good to know more about yourself. I guess with people who have paranoid delusions, seeing a psych eval might be risky but for things like depression, how can it hurt?
Posted by Apperceptor on March 7, 2004, at 18:38:14
In reply to Re: Projective tests ... are they worth it?, posted by Camille Dumont on March 7, 2004, at 18:23:51
Camille's psychologist is absolutely correct, and as a rule I also share my findings with the client (or, right now, the client's parent(s)) unless I seriously think it would hinder therapy or cause harm. Even in this case, however, you can "push" the issue...if you want to see your results, you can ask for a second opinion, of sorts. I guess my only caveat to that is that if your psychologist is normally someone you respect, and he or she says it would be unwise, I would be inclined to think they have good reason to say this....but "No i won't show you they're mine" is not good reason. You still deserve a reasoned explanation
Also, Dinah, if you'd like to compare your personal research findings to those of the psychologist, you have the right to request access to your records as long as they remain on file (generally 5-7 years in the US, but sometimes longer. I think it's about the same for Canada. UK NHS I'm not sure). With the new HIPPA laws, your access is even less restricted. You may have to have a licensed psychologist present while you review the record, but in my opinion that's not a bad idea...I'd liken it to a hematologist's presence when you see your blood test results.
One note on the MMPI, in particular...while I think the test is very (sometimes eerily) valid, it's language and phrasing of results could be considered somewhat antiquated (read: psychaesthenia = anxiety). This could be a reason for this particular test why results aren't just given with no questions, but you do seem a very well informed consumer (! good job!!). Also with the MMPI, do keep in mind that the L and...I think it's K...scales can be an interprative issue. Since you clearly did your homework (and you don't seem like you're motivated to fake anything), I'm not concerned in your case, but it could be an issue for some. My MMPI-A, which I took at the age of 13, was invalid due to the L scale :-).
I love hearing about people who take such initiative with their testing as both of you have, Dinah and Camille.
This is all very interesting to me, because I have a story that I'm hoping to look back on and laugh about in a few months. My (now ex?) boyfriend stated 45 minutes ago that we are "over." Do you want to know why? Because I irresponsibly gave him the Rorschach, and he didn't like the results. So look here...living, current proof that you've got to be careful with these!!!!
Posted by Dinah on March 7, 2004, at 20:14:40
In reply to Re: Projective tests ... are they worth it? (Dinah, posted by Apperceptor on March 7, 2004, at 18:38:14
Ouch. I'm sorry. Hopefully that will blow over. :( Especially if you show him *why* you got the results you did.
I don't do anything in half measures. I did my scores with and without K correction, which resulted in low 70's in 2,7,8, and 0. So it did agree with the psychologist's results, which gave me some assurance I had done it right. I also did the Harris-Lingoes Subscales and a few of the supplementary scales. I might have made a few errors though because my Ego Strength raw score was too low to have a T corrected score, and that seems impossible. My therapist always said I had poor ego strength, but too poor to be scored? Well!
I was looking over it just now, and I think I might go back and do the F subscales. My F score was a bit higher than I'd like and it would be interesting to find out why.
I just find the whole thing fascinating, and I'm sort of glad the bubbly psychologist refused to show me the results. I'd have missed out on learning something really interesting.
Posted by Dinah on March 7, 2004, at 20:15:17
In reply to Re: Projective tests ... are they worth it? (Dinah, posted by Apperceptor on March 7, 2004, at 18:38:14
Posted by Apperceptor on March 7, 2004, at 21:24:03
In reply to Re: Projective tests ... are they worth it? (Dinah, posted by Dinah on March 7, 2004, at 20:14:40
Dinah,
You certainly have found something interesting, and I definitely think you've gotten a MUCH richer experience than you would have had you taken the results at face value.
I must confess something...I've not yet had formal clinical training in objective personality testing (like MMPI), so much of what you said, KUDOS TO YOU!!! :-D, is over my head right now! I admire your knowledge! I would feel comfortable discussing most projective tests, but I can't comment on your MMPI because I simply don't know as much as you do. Get back to me in 4 months!
Keep up the studying, you're great!!! :-)
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