THE CLINICIAN'S PERSONALITY AND HIS CASE REPORTS

105 Pages·4.364 MB·English

by  FILER, RICHARD NELSON

THE CLINICIAN'S PERSONALITY
AND
HIS CASE REPORTS
by
Richard Nelson Filer
A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy in the
University of Michigan
1951
Committee in charge:
Assistant Professor Daniel R. Miller, Chairman
Assistant Professor John W. Atkinson
Assistant Professor Gerald S. Blum
Lecturer Robert G. Gibby
Lecturer Dorothy P. Marquis
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ACKNO .VLEDGEM ENT 3
I am very indebted to Dr. Robert G. Gibby for hie facilita­
tion of the study at the Detroit Mental Hygiene Clinic, and to
Dr. Edward L« Walker for his valuable discussions of experimental
design.
I owe a deep debt of gratitude to my advisor, Dr. Daniel Miller,
for his constant encouragement during the planning and execution of
the study and for his many hours of very helpful criticism during the
writing of the final report. Many valuable suggestions were obtained
from other members of my doctoral committee: Dr. Dorothy P. Marquis,
Dr. John W. Atkinson, Dr. Gerald S. Blum and Dr. Robert G. Gibby.
This study would not have been possible without the many tedious
hours spent by Victor and Mildred Goertzel in tabulating references in
the reports. Finally,for her patience and warm encouragement, my deep­
est affections go to my wife Mabel, to whom this work is dedicated#
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TABLE OF CONTENTS
Page
LIST OF TABLES V
Chapter
I. THE PROBLEM AND ITS THEORETICAL BACKGROUND 1
Introduction 1
Theoretical Issues 2
Methodological Issues 5
Personality Dynamics and the Interpretive Process 8
The Role of the Clinician in the Interpretive
Process 15
II, METHODOLOGY: EXAMINER DIFFERENCES IN REPORT
WRITING 16
Sub j ec t s 16
Major Hypothesis 18
Differences Among Examiners 18
III. METHODOLOGY: DEVELOPMENT AND USE OF
CRITERION MEASURES 24
The Selection of Judges 24
The Criterion Measures 25
Derivation of Specific Hypotheses 50
Consensual Validation of Rationales 5^
Summary of Methodology 56
IV. ASCENDENT AND SUBMISSIVE EXAMINERS 59
V. DEPRESSION 44
VI. INTR0PUNITIVENES3, EXTRAP'JNITIVSNESS,
IKPUNITIVENEG3 49
VII. DISCUSSION OF RESULTS 55
Depression and Submission 55
Intropurxitiveneas and Depression 58
Extrapunitiveneas, Impunitiveness, and Ascendency 60
Contradictions between Predictions and Ratings 62
Summary 65
iii
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iv
Page
VIII. MECHANICS OF DEFENSE 64
Tabulations of Frequenoies of References to
Defenses 66
Methodological Procedures 69
Results 71
Other Mechanisms 72
IX. IMPLICATIONS FOR THE CLINICIAN AND FUTURE
RESEARCH 75
The Clinician
Projective Tests 77
Implications for Future Research 80
SUMMARY 85
APPENDIXES
A. List of Terms Defining Dimensions 86
B. Ascendency Scale 87
C. Depression Scale 89
D. Questionnaire for Submission Criteria 91
E. Questionnaire for Direction of Aggression
Criteria 92
F. Rating Scale for Direction of Aggression 95
Q. Word List for Counting Defense Mechanisms 94
H. Scale for Ranking Defense Mechanisms: Patients 95
I. Scale for Ranking Defense Mechanisms: Clinicians 96
BIBLIOGRAPHY 97
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LI3T OF TABLES
Number Page
1. Reliabilities of Tabulations from Reports 21
2. Adjusted Scores of Frequencies of References to
Dimensions 22
5» Mean Adjusted Frequency Scores for Upper and
Lower Groups , 25
4. Sample Responses to Ascendency Scale 27
5» Combination of Rankings for Predicting Direction of
Aggression 55
6. Judges' Agreements with Rationales 5^
7. Examiners in the Upper and Lower Groups on Four
Dimensions 57
8. Judges' Ratings and Predicted Classification on
Ascendency 40
9* Prediction of Ascendency 41
10. Judges' Ratings and Predicted Classification
on Ascendency 45
11. Prediction of Depression ^*7
12. Judges' Ratings and Predicted Classification on
Intropunitiveness, Extrapunitiveness and Impunitiveness 51
15* Prediction of Intropunitiveness 52
14. Prediction of Extrapunitiveness 52
15» Prediction of Impunitiveness 55
16. Comparison of Ascendency Scores with Sxtrapunitive
and Impunitive Ratings 61
17. Mentions of Defense Mechanisms in Reports 67
18. fcmphasia of Defense Mechanisms 70
v
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CHAPTER I
THE PROBLEM AND ITS THEORETICAL BACKGROUND
Introduction
Investigations of error variance in projective testing have
focused increasingly on the characteristics of the examiner. Among
the procedures which could vary as a function of the examiner are ad­
ministration, scoring, inquiry, testing the limits and interpretation.
The present study is concerned with the relationships between the ex­
aminer1 a personality and his interpretation of tests. Two major prob­
lems are explored; (1) whether different examiners emphasize different
personality dimensions in their case reports; and (2) if such differ­
ences exist, their relationships to the examiners' behavior.
In this chapter the theoretical and experimental backgrounds
of the problem are developed. A discussion of the issue of intuition
versus objectivity is followed by a survey of the literature on the
influence of personality variables on perception. The methodology
of the present study is presented in Chapters II and III. Chapters
IV, V and VI contain results of the investigation of hypotheses re­
lating the examiners' personality to their interpretations. Further
discussion of these results and their various interrelationships ap­
pear in Chapter VII. Chapter VIII describes an investigation of
1
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defense mechanians in report writing* Implications of the results
for the clinician, the use of projective tests and future research
are presented in Chapter IX*
Theoretical Issues
The constant efforts of psychologists to develop valid tests
of personality have traditionally been directed at developing and re­
fining particular testa. Whereas the interpretation of objective
personality tests depends to a great extent upon standard tables of
norms, the interpretation of projective tests is much less structured
The clinician is more oriented to the configuration of scores and at­
tempts to be more sensitive to nuances in the responses and the con­
notations of omissions* The relative lack of structure can be both
an asset and a liability* While it allows for pertinent, sensitive
observations that might be lost in objective testing, it also allows
an opportunity for the examiner to project his own needs* According
to Sullivan's (55) theory of interpersonal relations, all the exam­
iner' s needs, conscious and unconscious, become involved in his re­
lationships with the patient. From this premise, it seems probable
that the examiner's unconscious needs and sources of anxiety tend to
distort his perception of the patient's behavior*
A brief review of the methodological issues involved in the
utilization of projective techniques is presented in the remainder of
the chapter* The discussion attempts to review j the evidence that
suggested the present exploratory investigation*
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^
<m
Methodological Issues
The advent of psychological tests, specifically designated
as projective techniques, brought to the surface a basic methodolog­
ical conflict which probably had lain dormant in the young science of
psychology. These ingenious devices, based on the assumption that a
subject would project his "private world" (20) into responses to var­
ious unstructured materials, were viewed as yielding a protocol anal­
ogous to an X-ray negative. Examination of the record, it was claimed,
would reveal Information about the inner personality structure which
a subject could not or would not give in response to more direct prob­
ing. Some clinicians appeared to have remarkable success in predic­
ting behavior from protocols. However these same clinicians also had
failures or borderline results. Was this science or an art? Did it
require a talent that some clinicians possessed and some did not? The
nebulous, subjective approach inherent in these techniques seemed al­
most immediately to divide psychologists into two camps. Advocates
of projective testing had to chose a role somewhere between the crea­
tive artist painting personality portraits and the objective scien­
tist applying the rigorous principles of the scientific method. Many
still rely very heavily on their intuitive talents in utilizing these
techniques. However the literature of the past two decades furnishes
ample evidence that there is an ever-increasing group who require more
objectivity and standardization to counteract the limitations of a
purely intuitive approach. Two major remedial trends have occurred;
attempts at greater standardization, and the creation of new projec­
tive techniques.
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Efforts at Standardilation*
A recent evalution of research trends in the field of clin-
ical psychology by Schofield (50) shows that validity studies of the
older projective techniques rank third in order of frequency of re­
search studies reported in the past several years in the journals*
Psychologists thus seem to recognize the need for additional emphaeis
on standardization of older projective techniques on which there is a
large background of experience and understanding*
Since the Rorschach is probably the most widely known pro­
jective technique, it serves well to illustrate the problems inherent
in validation of a projective technique* At the opposite extreme to
the artistic approach are what Klopfer (55) calls the "orthodox exper­
imentalists* n They want a standardized test complete with accessory,
iron-clad tables and rigid mechanical interpretation* In this they
are following the model set by many paper and pencil tests* Hertz (27)
advocates a position between that of the experimentalist and intuitionr-
ist* The Rorschach technique is a total process within which some as­
pects are amenable to standardization* But as in the case of the
Stanford-Binet test, some variables cannot be completely objectified
without sacrificing some of the method’s valuable potential* An in­
dication of the voluminous literature on the standardization of the
Rorschach is the bibliography of Hertz's article, which contains Jk6
references and is far from complete*
Most of this research, however, has been on the standardiza­
tion of procedures involved in obtaining the protocol* Attention has
been directed to several points in this process where error variance
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might possibly enter. Schachtel (49) writes on the testae’s subjec­
tive definition of the situation. This definition determines in part
the subject's attitude toward the test, thus influencing the character­
istic mode of response. Schachtel thinks this subjective definition
must be understood by the examiner and taken into account in eval-
j
uating the protocol. Recent studies by Gibby (24), Milton (58), and
Pottharst (42) demonstrate the influence of various experimental sets
on different Rorschach determinants. Calden (9) and Cohen (15) admin­
istered group Rorschacha under different test instructions and levels
of ego involvement and found significant differences among many Ror­
schach determinants for the differently oriented groups. Administra­
tive and scoring methods have probably received the greatest emphasis.
Cleveland (12) and Sanders (47) single out the effect of the examiner's
personality on the subject's responses. They found that anxious or
hostile examiners obtained significantly different responses among
various determinants. In the areas of interpretation, Hertz comments
pessimistically that although researchers made great strides in stan­
dardizing administration and scoring, they have not made any progress
with interpretation. Efforts in this area have dealt mainly with est­
ablishing approaches to standard interpretation. Some suggest est­
imating the level of intelligence as the first step; Beck (2) and Pio-
trowski (49) emphasize the unusual patterns and immediately investi­
gate them. Klopfer (54) has outlined a rational system of beginning
with an examination of F material, then analyzing the relationship be­
tween the various factors of the graph which describes the *Person-
ality Gestalt." Then a blind diagnosis is made followed by comparison
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