Journeys Through the Valley of Death: Multimethod Psychological Assessment and Personality Transformation in Long-Term Psychotherapy

Abstract

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is based on the assumption that an in-depth understanding of clients’ underlying emotional, personality, and interpersonal patterns will facilitate their treatment. In this article I show how such an understanding can be achieved through multimethod psychological assessment, and how useful such information can be in long-term psychotherapy with high-achieving, successful clients who struggle with forming and maintaining intimate relationships. Such treatments are extremely difficult, because when these clients attach to their psychotherapists, many of them temporarily become more symptomatic. I illustrate these points with a detailed account of my long-term therapy with a resilient but highly traumatized young man. Repeated use of the Minnesota Multiphasic Personality Disorder–2 (MMPI–2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach with my client helped guide us in our work, and also helped create an important therapeutic “opening” into the underlying traumatic material. This and other experiences have convinced me that it is extremely useful for psychologists to have training in both assessment and psychotherapy.

Notes

My stance in long-term psychotherapy is based primarily on my training in humanistic, interpersonal, and intersubjective approaches.

The elevation on Scale 5 (69T) is not at all unusual for a gay man with interests in the arts (Martin & Finn, 2010).

To see these responses in the context of the entire Rorschach, see the Appendix.

I do not mean to imply that the fact that Thomas was given the Rorschach by his own therapist had no effect on his responses. In fact, I am sure many of his responses were unconscious communications to me of material he wanted to deal with in the therapy. However, I do believe that the scores on his Structural Summary cannot be explained by his taking the Rorschach with me rather than with an unknown assessor.

I am sure Thomas was referring to the “Valley of the Shadow of Death” from Psalm 23, which he knew well. I found his slight error significant and even more descriptive of the process we were undergoing than the original phrase.

I made the decision to include the added information only after careful deliberation and after consulting with numerous colleagues and several ethics experts. In the end, it was clear to me that Thomas's urge to tell his story “as it really was” reflected his having overcome great shame about the things revealed in this article and not some pathological form of exhibitionism. I also felt it would be hypocritical and antitherapeutic on my part to urge more secrecy than Thomas wanted. Thomas and I thoroughly discussed the possibility that a motivated person could determine his identity and thereby link him to the highly personal information revealed here. He did not dismiss this eventuality, but said it did not worry him and would not cause him harm if it happened. In a series of discussions, Thomas and I also talked about the relational and psychological meaning of my having chosen to write about him and our work. Once again, I was impressed by his openness, level-headedness, and psychological awareness. I became convinced that our work on this article had in fact reinforced some of the gains Thomas made in therapy. Finally, I acknowledge that it is not commonplace to ask a client to contribute a comment to a published case history, but such an action fits well into the humanistic and phenomenological model of collaborative/therapeutic assessment that I use in my work (Finn, 2007; Fischer, 1985/1994), and also is encouraged by this journal for cases submitted for publication (Meyer, Nichols, & Handler, 2005).