All scientifically based and validated psychodiagnostic tests are valuable tools, but-if taken individually-not sufficient to fully investigate personality.
Therefore, IRPSI advocates the importance of integrated multi-method assessment and conveys a way of working that considers the integration of different materials a strength of assessment.
The subject reacts to different test stimuli by activating different states of mind, which may be integrated with each other or dissociated, or integrated to different degrees: it is therefore necessary to propose different test conditions, different stimuli (images with different degrees of structuring, questionnaires, performance tests) and competing for the purpose of eliciting different behaviors in different contexts.
Therefore, we advocate a model of work, both clinical and forensic, that involves a wide range of rigorous and scientific testing tools, which complement each other through the different facets, and the various stimulations they propose to the person.
Our daily experience of working in public facilities and in private settings with clinical patients, adults and minors, and with forensic subjects, has taught us that, on the one hand, psychodiagnostic reagents do not give only the specific information pertinent to that type of proposed stimulus, and that, on the other hand, no test, no matter how extraordinarily rich and elaborate as the Rorschach Comprehensive System test is, for example, can be considered, by itself, exhaustive.
In fact, we know that careful and articulate use of broad cognitive tests such as the WAIS-IV will give much more information than just intellectual level, and that, on the other hand, the Rorschach Test or the MMPI-2 will give very detailed information that goes beyond personality structure; however, none of these, used individually, will be able to comprehensively provide data with the reliability required in the psychiatric-forensic field.
The integration of multiple tools allows for in-depth evaluation, highlighting possible forcing or simulations, and understanding particular transient states.
Qualitative-quantitative reading will make it possible to describe, for example using the WAIS-IV, a subject’s intellectual level and a very detailed, articulate and comprehensive overall profile of his or her cognitive skills.
However, these skills are realized in a manner that is not divorced from a particular personality structure, with a certain mode of adaptation and interpersonal relations, in a specific organization of thinking, with a certain capacity for adequacy to reality; on the other hand, information will be derived from personality tests that, in addition to personality structure, will also concern cognitive processes, their adequacy and richness of resources.
It could therefore be argued that since much of this information is relevant to the same areas, some of it might appear as mere repetition.
Instead, neither of these tests can replace the other.
Different tests are not redundant at all, but complementary, for several reasons.
– First of all, similar information on the same areas, but coming from different methodological and conceptual horizons, is nevertheless characterized and contextualized differently because of the different textual framework in which it is proposed and is specified and complemented by each other.
– Second, the more or less structured characteristics of the material of different tests stress a subject at different levels from each other.
– Third, having different instruments ‘resonate together’ brings out unexpected implicit factors and allows for new data with additional interpretive values, which have been studied by several authors (R.J Ganellen 1996, 2013, G. Meyer 2000, S. Finn 2007).
– Finally, in the possible discordances and dissonances, any resistance or forcing that, consciously or unconsciously, a subject may oppose to the request for a sincere expression of his or her spontaneous processes and results of self-observation emerge.
Different methodological and conceptual frameworks
Regarding a first aspect, related to the different contexts, we can consider an example in the intellectual level, which will be defined in numerical terms by the WAIS-IV and in structural terms by the Rorschach Comprehensive System test: in the WAIS-IV, composite scores highlight the subject’s actual performance in a wide range of different fields, articulated in defined scores and comparable with the average level of both the universality of subjects, peers in age and schooling, and again with that of the subject’s own performance. From these comparisons, a specific profile will emerge that characterizes the performance and cognitive skills of that specific subject, in the different areas, described by the different theories (CHC and its updates) and the way in which these skills translate into greater or lesser capacity for effective adaptation in the subject’s daily life.
An intellectual evaluation of the subject can also be derived from the Rorschach test, which, however, is neither quantified nor uniquely comparable, but is nevertheless sensitive to various aspects of how the subject applies his or her cognitive abilities to his or her experience of the world: to the greater or lesser accuracy of analytical and synthesis skills, to the attention devoted to the main and less obvious information in the stimulus-field, to the aptitude for establishing relationships or evaluating the data of experience in isolation. In addition, the Rorschach test provides useful indications for pointing out any deficit of an organic nature, or for hypothesizing inhibitions or deterioration of basic potential due to psychopathological causes of an emotional nature.
Different degree of structuring of reagents
To exemplify the second aspect, concerning the different degree of structuring of test reagents, recall these features:
the WAIS-IV consists of highly structured items, according to the question-and-answer formula; its execution also requires the performance of practical tasks according to certain instructions, and for its performance the subject is engaged in his or her own more structured and conscious psychic components, and predominantly at a more conscious and will-controlled level;
the Rorschach test, on the other hand, consists of a very loosely structured stimulus-material with particular color components and involves a much more emotionally intense stress, thus less conscious and less controllable by the will;
the MMPI-2 test is presented as a True-False questionnaire, with many similarities to those usually faced by a person in school and work life.
If all these involve the whole person, and address the ego as the mediator between the self and the world, the level reactive as well as the questionnaire privilege the more evolved, conscious and structured parts, while the Rorschach test brings out the less conscious ones, to be understood both in the psychodynamic meaning of the Unconscious with its deep and removed themes, and as spontaneous cognitive ways of approaching and analyzing experience and problem solving in the face of complexity: it is indeed useful to assess differences in the functioning of the subject, the further one moves away from the plane of awareness, predictability and conscious will.
Comparison of results between different psychodiagnostic reagents
To exemplify the third aspect, concerning the evaluation of differences in results between different tests, it is useful to exemplify it through a particular diagnostic hypothesis, such as depression. A mood disturbance on the Rorschach test will emerge through a defined constellation of a certain configuration and pairing of 14 different indices or ratios; they express a certain internal emotional state, derived from the way the field-stimulus is perceived and interpreted, orienting the subject’s approach to sensitivity to certain perceptual components, at the expense of others.
Of this information, it will be useful to assess the concordance with data from the MMPI-2 (or the MMPI-2-RF form)
At self-report, depressive state will instead result from the subject’s self-description of himself or herself, who observes and reports certain information about aspects of himself or herself that he or she grasps and wishes to communicate: the assessment is articulated from the interrelationships of numerous items, which are crossed and connected to form a variety of indices: for example, for the MMPI-2, the clinical scale (2) (D-Depression), the content scale DEP, Welsh’s A-index, and again, many other indices, critical items and subscales.
All of these indices are derived from the subject’s self-description, but in a mediated way, and are based only in part on the subject’s insight: therefore, it is possible to show, through specific indices and comparisons, how aware the subject is of his or her own deep emotions and how sparse he or she is in describing them.
For the fourth aspect, just the comparison and possible discordance between the different recti, when not otherwise explainable through clinical reasons, any attempts at forcing or falsification will emerge.
Similarly, the SCID-5-PD and the alternative version SCID-5-AMPD, for the diagnosis of personality disorders according to DSM-5, express the subject’s level of self-knowledge. They are largely based on self-description, so they have no internal criteria for reliability, but the data from them must be supplemented with those provided by clinical observation, history and other tests. In addition, because they are structured with open-ended questions, they allow the evaluation of response style and consistency.
Even from the WAIS-IV , seemingly so far removed from an assessment of emotional state, a specific emotional state will emerge through a characteristic quantitative profile, a mode of approach to testing marked by certain typical behavioral aspects, and often also by the emergence of peculiar verbalizations.
So that different tests illuminate and enrich each other, and the different procedure of constructing diagnostic hypotheses for each of them ensures the non-silateralism of the whole cognitive path.
However, it is not ruled out that the psychodiagnostic may resort to the use of other instruments, agreeing on their choice with the forensic psychiatrist or medico-legal examiner, when special technical-diagnostic needs for a specific case arise.
What is crucial, however, is that the psychodiagnostic has not only been professionally trained by attending theoretical training courses, but has acquired adequate clinical experience, which is possible only if he or she performs his or her work within clinical institutions, whether university or hospital, in which psychiatric diagnostic and treatment services (SPDC) exist.
In the absence of this component of professional training, a psychodiagnostic will be able to perform scholastically accurate psychodiagnostic examinations, perhaps useful in some contexts, but hardly adequate in the clinical setting and not at all in the Forensic Psychiatric setting, where clinical experience is necessary and irreplaceable and it is imperative to adhere to absolute methodological rigor.
Collaborative model of psychodiagnosis
The collaborative model of psychodiagnosis was born out of the insight into the radical intersubjectivity of human exchange and the criticisms advanced as early as the 1950s and 1960s by the humanistic and then psychodynamic and systemic movement of traditional psychometric-type psychodiagnosis because it was considered reductionist, dehumanizing and judgmental.
Beginning with the loosely structured and predominantly implicit collaborative psychodiagnosis of the early authors, particularly the brilliant ‘pioneer’ Constantine Fisher and Leonard Handler, Stephen Finn with his colleagues at the Center for Therapeutic Assessment in Austin, Texas, has since the 1980s developed an explicit and articulate procedure that he called Terapeutic Assessment® (2007) and that includes specific structured and codified steps that help the clinician apply this working model effectively according to a well-defined path. Next, the more flexible model of BETAssessment (Building Empathy Through Assessment), by R. Erard and Barton Evan (2017), was developed. Whether one adopts Finn’s highly structured model or retains a flexibility of general assessment procedures, there are two cornerstones of this conceptual framework: rigor in the administration and quotation of protocols, and emphasis on creating an empathetic and supportive relational context toward the patient/client.
The first goal of collaborative psychodiagnosis is for the subject, when he or she concludes the assessment process, to feel that he or she has had a new experience, in particular
- Of having experienced empathic containment
- of having obtained new information about himself that may change, at least in part, his way of considering himself,
- to have the opportunity to deal with many situations in his life differently than before,
- Of having created a mental space in which content and events are thinkable and sustainable
- of having acquired a kind gaze toward oneself, able to observe oneself in a nonjudgmental way, tolerant but also willing to change, overcoming both the feeling of shame and the ‘blind’ areas due to the rigidity of defense mechanisms.