Class 5 Flashcards
Things to learn in the assessment interview
Presenting problem
Questions to be answered
History
Observation
Collateral sources of information
What are you looking for when administering a testing battery
Looking for patterns of scores that inform answers
Considering the patterns of elevation and low scores within the test
Comparing multiple tests to discern bigger patterns
Integrating history, collateral information, interactions
Personality Assessment battery
Self-report (MMPI, PAI, NEO)
Performance-based test (Rorschach, Wartegg Drawing Completion, Adult Attachment Projective, Thurston Cradock Test of Shame)
Early Memories
Other measures to explore/confirm
Cognitive Codes capture what
“Designed to capture disruptive or illogical thought processes that are indicative of a thought disturbance”
Two types of cognitive codes
Language and reasoning based (Oddities in describing or justifying a response):
- DV1, DV2
- DR1, DR2
- PEC
Perceptually-based (Oddities in combining visual images and response features):
- INC1, INC2
- FAB1, FAB2
- CON
Levels in Cognitive codes
Levels 1 and 2
1 = mild to modest cognitive slippage or deviation; Benign, often playful, parenthetical, or misinformed
2 = moderate to severe/bizarre cognitive slippage or deviation (stands out because manifestly inappropriate or bizarre)
> the two levels reflect the varying degree of bizarreness in the response (extent to which reality is disregarded)
DV
Deviant Verbalization
Mistaken or inappropriate word or phrase
DV1: verbalization is relatively clear and not bizarre (e.g he is all clowned up)
DV2: incomprehensible or very difficult to understand word misuse that interferes with communication. (e.g. “the outside lookers, the onlookers of the outside”)
If in doubt, go with Level 1 (Level 2 should be obvious)
What if a client corrects a DV
If recognized and taken back, lessen the severity appropriately.
If immediately recognized and corrected, don’t score a DV
May change a DV2 to a DV1
(E.G., Deer with antenna’s—no antlers > don not code DV1 or INCOM1)
How do you consider age and education with DVs
Do not consider age, education, etc. (these are considered in norms and interpretation)
Trivial redundancies (eg. Two twins) –> is that a DV
Trivial redundancies that are nearly conventional do NOT get a DV1
E.g., two twins, big giant, little tiny
Other exceptions for DVs
Colloquial suffixes like “ish” or “y” NOT DV1 (E.g., ”greenish” “lemony”)
Colloquial comical terms Not DV1 (E.g., “fancy-shamancy” “blew the bejeus out of it”)
DV and Bilingual
switching languages in itself is not reason to code DV
Obviously, DVs related to bilingualism should not be interpreted as related to thought disorder
DR
Deviant Response
Loose associations, task distortions, rambling circumstantial responses that drift off task.
Illogical or irrelevant replies to the question: What might this be?”
Don’t over code for benign or humorous asides, or understandable but unusual wording
DR1 (It could be oysters, but I guess they are out of season)
DR2 (It’s a little baby coming out of a mother, but she didn’t really have a little baby even though she is a mother)
DR and if the client beleives the response is real
Excessive emotional reaction as if the response is real or poses a threat
Whether Level 1 or 2 depends on the extent to which the client believes the response is real.
“A dark monster about to attack me”
“Oh my! This is a bug of some kind with blood. How did that happen? I don’t like the red though. It looks like blood”
“That’s the bf flying that I saw before (DR2–losing the “as if” and treating a response as if it is real)
When to not code DR
NO DR FOR
A. Brief asides (I must be hungry)
B. Brief parenthetical, humorous, flippant, self-descriptive, or insecure comments (you might think this is stupid)
C. Simple descriptions of personal attitudes or preferences
….BUT only if the client returns to the task
DR Threshold for Circumstantial Response
Two step Guideline
- At least 2 statements/ideas offered
- Second statement not closely related to the response or the Rorschach task
(AND no communication problem or problem solving failures that lead to a DR coding for other reasons)
PEC
Peculiar Logic
Peculiar, strained, confused, or overly concrete reasoning.
Two elements:
1. must be used to justify or to elaborate a response
- must be offered spontaneously (cannot be prompted by examiner clarification)
INCLUDES:
- Odd or confused reasoning (ex. its coming apart at the seam because its schizophrenic)
- Illogically restrictive or certitude (imperative) (ex. its on top so it must be a crown)
Is “witch because its black” a PEC
Witch because it is black–no PEC
Must be a witch because it is black (imperative)–is PEC
Overcoding of PEC
Assessors tend to over-code PEC to include all the imperatives (“has to be” “must be” even “because” responses) as PEC.
BUT there has to be an illogical or non-sensical component as well.
INC
Incongruous Combinations
Merging blot details into an implausible single object
e. g. woman with the head of a chicken
NOT scored if object is in a cartoon, or a fictional creature (like a minotaur)
An INC is a general bending or breaking of reality in a precept. So a red bear gets an INC, as does anthropomorphized animals, like a bear talking (because bears don’t talk).
INC1: A horse with wings; red bears; a cat’s face, it is smiling; a spider with a lot of antlers sticking out; a dive-bombing butterfly; a dancing bear
INC2: a frog with four testicles; a woman with the head of a chicken; a person with two heads; a dog laughing out loud; a guy with two heads for feet; a winged penis
No INC: A bear dancing in a circus; a person without a head; a bird without a beak
A person with a penis and breasts. This person could get themselves pregnant.
vs
A person with a penis and breasts, a hermaphrodite
INC?
A person with a penis and breasts. This person could get themselves pregnant.
- INC1
A person with a penis and breasts, a hermaphrodite
- No INC
If both FAB and INC?
Score FAB (higher weighted)
FAB
Fabulized combinations
Implausible or impossible relationship between 2 separate objects
Interaction not characteristic of species
- FAB1: two ants dancing together
Would also be INC1 but score the higher weighted FAB
Implausible transparencies is level 2
- FAB2: a man in a chair you can see his heart pumping
Do you score an unexplained relationship as FAB?
Don’t code an unexplained relationship, just illogical ones
INC vs FAB
INC and FAB are scored independently
BUT only one is scored if they both come from the same implausible element, in which case, use the code for the highest weight in the WSumCog.
E.G., 2 praying mantises playing cards. There are the cards and their hands.
FAB1
CON
Contamination
One part of the blot is seen as 2 objects in an impossible way.
Like a photographic double exposure, or requires a visual condensation.
e. g. a bug ox, a butterflower, blood and an island so a bloody island; a fire mountain
Can you score other unusual verbalization scores (DV, DR, INC, FAB, PEC) when CON is scored?
Don’t code other unusual verbalization scores (DV, DR, INC, FAB, PEC) when CON is scored
Multiple Cognitive Codes
Assign only one code of any type for any single verbalization (assign the code with the greatest weight) (e.g., bears clapping their hands (INC1) and playing patty cake (FAB1) = code FAB1)
Can code multiple cognitive codes for a response, but only one in each category (e.g., if qualify for a DV1 for one part of the response and DV2 for another part, assign the DV2)
If you code a Contamination (CON), do not code any of the other cognitive codes.
Are transparencies at CON?
Can be transparencies BUT still must have a visual condensation
> using a single blot area for both internal and external features
e. g. a spleenskin–using the same area as the external skin and the spleen
