Quantifying Complexity: Personality Assessment and Its Relationship with Psychoanalysis

Abstract

The fields of personality assessment and psychoanalysis have an entwined history and share much in common, notably an appreciation of the importance of understanding a person with complexity and depth, including the role of unconscious (or implicit) psychological processes. Personality assessment (or diagnostic psychological testing) offers a complement to psychoanalysis’ primarily idiographic approach by integrating it with a nomothetic one; that is, applying quantitative methods to determine in what ways and to what extent a person is similar or different relative to normative data. It is surprising, then, that contemporary psychoanalysts are largely unfamiliar with the field of personality assessment and seldom refer their patients for evaluation to assist with diagnostic formulation and treatment planning. In this article, we offer practicing analysts (1) a general description of the ways that testing can assist diagnostically, (2) an introduction to categories of psychological tests that sample functioning under varying conditions or from different vantage points, (3) a survey of assessment research that has provided empirical validation of key psychoanalytic concepts, (4) a window into the assessment process as it is applied clinically, and (5) cases to illustrate when and to what benefit analysts might consider referrals for testing. Examples include use of testing in instances when a new patient reports a history of repeated treatment failures; when patient and analyst are embroiled in a protracted impasse; and when a fine-tuned assessment of analyzability is warranted.

Notes

¹ Although some make a distinction between personality assessment and diagnostic psychological testing, we use these two terms, along with psychological testing or testing or assessment, interchangeably in this article. Similarly, we refer to the psychologist conducting testing or assessment as the examiner, diagnostician, or assessor.

² Although Schafer’s (2006) clinical and scholarly focus later shifted away from psychological testing toward broader theoretical and technical developments of psychoanalysis, he maintained a deep appreciation for the way in which his professional identity was shaped foundationally through his earlier diagnostic testing work under Rapaport’s tutelage.

³ The Rorschach can also make a contribution to when there are questions about complex differential diagnosis of DSM psychotic (Kleiger, 1999) or personality disorders (Huprich, 2006).

⁴ Note that, compared to self-report questionnaires, many structured interviews such as the SCID also enable the clinician to draw conclusions based on other data (e.g., appearance, nonverbal cues, interpersonal style). Thus, compared to questionnaires, structured interviews are somewhat less susceptible to defensive distortion and impression management.

⁵ Recently, the ROD has been incorporated into the Rorschach Performance Assessment System (Meyer et al., 2011) where it has been renamed Oral Dependent Language.

⁶ There are good reasons for the development of clinically pragmatic applications the IAT and/or for other performance-based measures of self-esteem. The self-esteem scale of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Stein et al., 2011) based on the TAT or other narrative data holds promise for this. Unfortunately, the Rorschach Egocentricity Index, which may have been useful for this purpose, has recently been determined to be of questionable validity (Mihura et al., 2013).

⁷ Space limitations preclude a comprehensive review.

⁸ Rigorous training for scoring such measures is typically provided within research laboratories for specific projects. Such training is usually not available to, or practical for, most clinical assessors. It would be unusual if even a highly experienced clinical diagnostician had formal training in more than one of these research measures.

⁹ Attachment theory overlaps with theories of object relations, though it diverges in important ways as well (see Fonagy, 2001). In the past two decades, attachment theory has been increasingly embraced by and stimulated creative research and clinical applications among analysts. Because of space limitations, we are unable to take up the measurement of attachment-related constructs. Suffice it to say that self-report (questionnaire and structured interview) and performance-based measures have been developed and studied extensively (see summaries by Fonagy, 2001; Stein et al., 1998; see also George and West, 2012).

¹⁰ This would require arrangements with a trained rater to score. There is presently a paucity of such raters available.

¹¹ Note that there are multiple versions of the DSQ with varying numbers of items.

¹² An abbreviated version of the Adult Attachment Interview (AAI) has been recently developed to promote greater efficiency in assessing RF (Falkenstrom et al., 2014).

¹³ Level of personality organization is represented by the P Axis in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006).

¹⁴ When the diagnostician does not have specialized expertise in these areas, he or she partners with a colleague who does.

Additional information

Notes on contributors

Anthony D. Bram

Anthony D. Bram, Ph.D., is in private practice and with the Cambridge Health Alliance/Harvard Medical School and Boston Psychoanalytic Society and Institute.

Jed Yalof

Jed Yalof, Psy.D., is affiliated with Immaculata University, Department of Graduate Psychology, Immaculata, Pennsylvania, and the Psychoanalytic Center of Philadelphia, as well as being in private practice.