Psychological testing that matters: Creating a road map for effective treatment.

Abstract

Clinically, we observe that patients whose self-esteem is especially brittle require certain considerations in formulating a treatment plan (e.g., Gold & Stricker, 2011). We refer to such patients as narcissistically vulnerable, but we are not using the term narcissistic pejoratively or as an equivalent to the Diagnostic and Statistical Manual of Mental Disorders (DSM) category of Narcissistic Personality Disorder. In contemporary psychoanalysis, as informed by self psychology (Kohut, 1977, 1984) and relational theory (e.g., Mitchell, 1986), narcissism is appreciated as a normal part of being human, and healthy self-love has its own developmental course intertwined with that of developing love for others. Regulating self-love and self-worth-that is, self-esteem-through life's inevitable failures, successes, losses, accomplishments, disapproval, and praise is a universal challenge requiring multiple adjustments, calibrations, and stabilizations daily. Some people, however, because of developmental setbacks and insufficiencies, struggle significantly with restoring a realistic, positive, and integrated sense of themselves through the upturns and downturns of fortune and misfortune. 7 EXPERIENCE OF SELF AND OTHER: NARCISSISTIC VULNERABILITIES

To Resume a Stalled Psychotherapy? Psychological Testing to Understand an Impasse and Reevaluate Treatment Options

“…This patient-examiner evidence of such profound, poignant insecurity converged with her MMPI-2 profile, especially her elevation on scale 7 (Graham, 2006). Various hypothesis-testing interventions (see Bram & Peebles, 2014) on my part-for example, reassuring her that she was doing fine, praising her effort, in some cases telling her that she was correct, empathizing with her feelings about being evaluated-did not attenuate or shift her need and pressure for assurance. In efforts to collaborate with her to reflect on her Rorschach responses, she was able to tell me explicitly how terrified she is of being judged and then treated like there is something wrong with her.…”

“…Minisequence-configurational analysis of the Rorschach (Bram & Peebles, 2014;Weiner, 1998) was useful in learning about what strengths and coping or defensive strategies we might draw up to help her recover from moments or episodes of emotional destabilization. For example, consider the minisequence following her Card IX forest fire response.…”

“…Was there a way I could have done so 2 Space limitations and my aim to model a referral question-focused approach to test interpretation preclude a more comprehensive review of the data and their synthesis. 3 The Rorschach was administered and scored according to the CS (Exner 2003), although a testing-the-limits "second inquiry" was applied selectively following the standardized administration (described in chapter 3 of Bram & Peebles, 2014). Additionally, the sequence of scores presented in Appendix B includes some notations outside of the CS (e.g., Aggressive Content [AgC]; Meloy & Gacono, 1992).…”

“…The interpretative process also took into account Exner, Armbruster, and Mittman's (1978) empirical research regarding ways that therapists-as-testers impact Rorschach protocols (i.e., more total responses, blends, color and movement determinants, and sexual content; fewer popular responses and poorer form quality overall). As always, the data analyzed included formal scores, thematic content, patient-examiner relationship, and configuration and sequence analysis (see Bram & Peebles, 2014).…”

“…Typically, the testing diagnostician is an outside consultant to the therapist and patient (and often family as well) who are struggling and confused amidst an impasse (e.g., see Allen, 1981;Bram & Peebles, 2014;Cohen, 1980;Finn, 2007a). This a role with which I am familiar.…”