Bringing a psychoanalytic mindset to neuropsychological testing: From parameters and testing the limits to the “something more”.

Abstract

If one understands the projective hypothesis most simply as "the active structuring of the world according to inner requirements and outer demands" (Schafer, 1954, p. 37), then it is evident that a patient's response to an ostensibly neuropsychological measure can provide significant insights beyond the typical neurocognitive yield. Indeed, the more ambiguous the instructions or stimuli, the greater the potential for projective elements to be introduced. The Wisconsin Card Sorting Test offers such an opportunity, particularly in its more recent computerized version. In this paper, a clinical vignette illuminates how bringing a psychoanalytic mindset to the administration and interpretation of this widely used measure can enrich its diagnostic utility. A distinction is made between a parameter (as applied to psychological testing) and testing the limits, with appreciation for how both can lead to vivid clinical moments that inform diagnostic questions-a "something more." Such interventions maintain the essence of a standardized administration without allowing technical rigidity to obscure deeper contact with, and understanding of, the patient.