Clinical Psych Exam #2

What Defines Psychopathology:

* Psychologists use the Diagnostic and Statistical Manual of Mental Disorders DSM to make diagnoses

* DSM-5-TR defines psychopathology as the significant disturbance in “cognition, emotional regulation or behavior” that indicates a “dysfunction in mental functioning” 

“Usually associated with/ a significant distress or disabilities” in work, relationships or other areas of functioning.

* There’s a DSM task force that creates the diagnostic categories of the DSM

* They follow a medical code of psychotherapy

* The task force has historically (especially in the DSM I to DSM III) has been fairly homogenous group

* Remember, the first DSM was published in 1952

* Recent efforts to include more diversity 

Why is the Definition Important?

* How does the task force define each disorder…

Impacts research, Impacts clinicians (in terms of diagnosis and conceptualization), Impacts clients,  Lastly, could b a positive or negative impact

Earlier DSM Editions (I and II)

DSM I (1952) and DSM (II) (1968)

* Very similar in content 

* Only 3 broad categories of disorders: Psychoses (today’s Schizophrenia), Neuroses (today’s major depression, bipolar and anxiety disorders), Character Disorders (would contain today’s personality disorders) 

_____in orientation —> based on Freud's ideas of psychopathology. Didn’t provide diagnostic criteria, only vague paragraph long descriptions of the disorder.

DSM…More Recent Editions:

* DSM III (1980) was very different from the DSM I and DSM II:

Relied on empirical data to determine which disorders include and how to define them.

Specific Diagnostic criteria used to define disorder 

_______

DSM III was much longer and more extensive than the previous versions

* There were 265 new disorders included!

* DSM III introduced the multi axial assessment system (dropped in the DSM-5)

1. Axis I: episodic disorders 

2. Axis II: long lasting disorders

3. Axis III: general medical conditions

4. Axis IV: Psychosocial and environmental problems

5. Axis V: Global Assessment of Functioning (GAF) Scale

* 100 point continuum describing client's verbal level of functioning 

* DSM-IV new text revision; DSM-IV-TR was published in 2000)

DSM-5 and DSM-5-TR:

DSM-5 was published in 2013 was the first substantial revision in 20 years 

* Initially formed a task force…hundreds of exporters came to make revisions from dozens of countries.

Work Groups: composed of experts, each or group focused on a particular area of mental disorders (Eating disorders)

* Considered proposals for revision including ideas for adding, eliminating, combining, splitting, or ravishing definitions of disorders 

* Scientific Review Committee…involved experts separate from the work group. Field trials.

Changes DSM-5 Didn’t Make:

Initially considered emphasizing the biological roots of mental disorders. Ex: gene analyses, blood tests, etc.

A Dimensional approach was considered for some disorders but was ultimately rejected. Ex: personality disorders 

* many additional disorders were considered for inclusion, but ended up in the proposal criteria sets/conditions for further study section.

Ex:internet gaming disorder and other behavioral addictions, Nonsucidial self-injury disorder.

New Features in DSM-5:

* It’s DSM-5 not DSM-V!!

* Elimination of multiracial assessment system 

* Disorders that are thought to be more short-term are no longer listed on separate axis than those that are thought to be to persist long-term

* Elimination of Axis V(Global Assessment of Functioning)    

New Disorders in DSM-5:

Premenstrual dysphoric disorder (PMDD)…basically a severe version of premenstrual syndrome (PMS)

Criticisms of Utilizing  Diagnoses:

* The use of diagnostic labeling implies understanding of the problem 

* label may assist with communication, impacts insurance

* Lack of reliability of diagnosis historically: poor agreement between clinicians about whether or not an individual meets criteria for a specific disorder 

Associated Stigma: Individual w/ certain disorders may be discriminated against in jobs, housing, social relationships, etc.

Current approach is categorical… an individual “has” or “does not have” a given disorder. There are certain disorders that seem to be categorical 

Alternative Approach:_____ the issue isn't the presence or absence of symptoms, but where does and individual’s symptoms fall along the continuum 

Assessment:

* Assessment Techniques should have: Validity, Reliability, Utility

Assessments involve giving clients feedback after their testing 

Clinical psychologists most frequently rely on the clinical interview 

Case History: 

* Detailed description of the client’s background

* Often provides info necessary to make a diagnosis or determine necessity of treatment  

Info received from client includes:

1. Birth and Development: complications during pregnancy, normative development milestones

2. Family Origin: who was the client raised by; is the client still in contact; relationship with parents & siblings; family history of mental health 

3. Educational History: what is the client’s highest level of educational history; learning disorders, special education services; significant behavioral problems (suspensions, expulsions)

4. Employment History: what types of jobs have they had and for how long?

5. Recreation/Leisure: hobbies, interest 

6. Sexual History: sexual functions, relationships

7. Relationship History: when client began dating; significant romantic relationships 

8. Alcohol and Drugs: pattern of use substances. Any legal employment, or social problems due to use?

9. Physical Health: significant medical history, like injuries, chronic illnesses, allergies.

10. Other considerations: make observations about the client’s speech pattern, thought processes, ability to regulate their emotions, etc. Gathering collateral info can be important…when working with a child at more than just the parent questions. Inquire their teachers, the child, etc

The Interviewer:

* General skills and interviewer should have: quieting yourself, being self-aware, ability to develop a positive working relationship 

* Specific Behaviors: eye contact (communicates that you're listening) but this may depend on the lines and whether or not they’re comfortable with eye contact because of their culture or any other factor.

Follow the client’s lead.

* Take into consideration: body language, vocal qualities, verbal tracking 

* Repeat key words and phrases that clients use and weaving the in to your own speech and questions

Referring to the clients by their proper name     

Components of the Interview:

Rapport: plosive, comfortable relationship between interviewer and client: Typically lead to client disclosing more info

* Remember that the first interaction with the client can be a little intimidating

Technique: what the interviewer does w/ clients—questions, responses and other specific actions

Directive: questions targeted toward specific info

Non-directive: allows the client to guide the course of the interview   

Both have advantages and disadvantages…

New Disordered In DSM-5:

* Premenstrual dysphoric disorder (PMDD): Essentially a severe version of premenstrual syndrome (PMS)

* Symptoms include: affective lability, irritability or anger, depressed mood, anxiety/tension, and other typical symptoms of depression (ex: difficulty concentrating, hypersomnia or insomnia

* Disruptive mood dysregulation disorder (DMDD): essentially frequent temper tantrums in children 6-18 years old     

* At least 3 tantrums per week over a year long period.

* Tantrums are clearly below expected level of maturity  

Binge Eating Disorder (BED): person overindulges in food but doesn't engage in compensatory behavior (excessive working gout)

* Binges must take place at least once per week for three months 

 - Other symptoms include…lack off control over the eating, rapid eating pms eating until overly full, eating alone to avoid embarrassment and feelings of guilt or depression afterward 

Hoarding Disorder: person has continued difficulty disregarding possessions no matter how objectively worthless they are

* They live in a congested cluttered house

* Causes social, safety, and work impairment  

Major Revisions Made to the DSM-5:

Here’s the highlights of some of the DSM-5 revisions…

Bereavement Exclusion: was dropped for major depressive episode 

* Ensures that people in mourning who are suffering from depression will be reorganized, diagnosed, and receive prompt treatment.

* Diagnosis of Autism disorder and Asperger’s disorder were combined into a single diagnosis: autism spectrum disorder

* Represent various point on the same spectrum of impairment: mild, moderate, severe

* The separate DSM-IV diagnoses of substance abuse and substance dependence were combined into substance use disorder.

* B4, tolerance and withdrawal linked solely w/ dependence but research has demonstrated that it's not true.

* mental retardation was renamed intellectual disability 

* In the DSM-5-TR, it was again renamed to Intellectual Developmental Disorder

* OCD was removed from the Anxiety disorders category and placed in its own new category (along w/ later diagnoses)

Mood disorders were split into 2 separate categories: Depressive Disorders and Bipolar and Related Disorders.  

DSM-5-TR:

Diagnostic and Statistical Manual of Mental Disorder, 5th Edition, Text Revisions (DSM-5-TR) was released in March 2022

* Important changes… Prologned Grieft Disorer was added as a diagnosis, Suicidal Behavior and Non suicidal Self-Injury were added to proposed criteria sets/conditions for further study section 

* Diagnostic over expansion…concern that diagnosis is a difficult or non favorable life experience and label them as mental illnesses.

Transparency of Revisions process: one critic argued that the DSM-5 authors were vague and selective Baity what they shared and too many decisions were made behind closed doors.

 Membership of the Work Groups: those invited process were predominantly researchers; concerns about clinical utility

Price: DSM-IV sold for $65 in 1994; DSM-5 had a list price of $199 (hardback) when it was released.

General Criticisms of DSM:

* Controversial Cutoffs: Seemingly arbitrary requirement of certain never of symptoms/certain time prod.

Ex: why are the indium of 5 symptoms for MDD? Why 2 weeks?

* Cultural Issues: original creators of the DSM were not diverse (primarily white men) Much of the research is lacking cultural diversity.

* Potential Gender Bias: some disorders are diagnosed more frequently in men some are  diagnosed more in women…

Are some disorders biased toward pathologizing one gender more than the other?

* Non-empirical Influences: at times politics and public opinion may have an impact on the DSM

EX: changing the status of homosexuality…an official disorder in DSM-I and DSM-II, but absent from the manual since a revision of DSM-III.

Technique:

* Ask open and closed ended questions…has a large impact on the info a client provides.

* Open ended questions allow for individualized and spontaneous response from clients

EX: “What has your experience of depression been like?”

* be consistent with a non direct interview style 

* Closed-ended questions allow for less elaboration and self-expressiveness by the client, but yield precise answers.

Ex: “have you been hospitalized for depression in the past?” This is more directive interview style 

* Common mistake when asking questions to gather info

*  both asking and answering a question

Clarification: making sure you have an accurate understanding of the client’s comments; Also communicates that the interviewer actively listening

Confrontation: used when an interviewer notices discrepancies or inconsistencies in a client’s comments

Paraphrasing: used to assure clients that they are being heard. Not to clarify or resolve contradictions. Repeating what they said back to them 

* A rephrasing of the content of the client’s message 

Reflection of feeling: echoes the clients emotions…intended to make the client feel that their emotions are being recognized.

* Often includes the interviewer making an inference 

Summarizing: typically involves trying together various topics that may have been discussed and indemnifying themselves that have recurred 

Pragmatics of the Interview:

Note taking: different job settings might have different expectations 

Ex: some require concurrent documentation 

* It’s always a good idea to explain to the client why you're taking notes 

Audio and Video Recording: require written permission from client. This could potentially risk rapport or openness.

The interview Room: clients tend to Peter comfortable, neat rooms

EX: w/ soft lighting, comfortable furniture, art on the wall 

Clinical psychologists typically steer clear of overtly personal items. Ex: family photos

Types of Interviews:

Intake interviews: essentially determines whether to “nosiest” the client. Whether the client needs treatment and what type.

Diagnostic Interviews: the purpose is to diagnose the client

* The professional should be able to diagnose the client w/ a DSM diagnosis

Different types of Diagnostic Interviews: 

* Structures Interview: predetermined, planned sequence of questions that an interviewer asks a client 

* Unstructured Interview: no predetermined or planned questions. Interviewers instead improvise based on what they believe is relevant during the interview. 

Diagnostic Interviews: 

Structured Interviewers: proved a diagnosis based explicitly on DSM criteria

* Tend to be more reliable 

* Format is typically more rigid, can hinder rapport 

* Don’t typically allow for inquiries such as relationship issues, personal history, etc 

* Tend to be fairly lengthy   

Structured Clinical Interview for DSM Disorders (SCID) 

* Modular: clinicians can choose only these modules that are relevant to a particular case

Many clinicians have blended structured and unstructured interviews and utilize semi structured interviews

Mental Status Exam:

Mostly in medical settings, assesses how the client is functioning at the time of the evaluation.

Areas typically assessed in Mental Status Exam (MSE)

* General Appearance Behavior: gait, posture, dress, personal hygiene, level of activity 

* Speech a Thought: is the client’s speech coherent? Is the client's speech pressured (ex: does it seem that the client is having a difficult time speaking fast enough to express his/her thoughts?) 

* Evidence of delusional thinking?  

Consciousness : is the client alert or attentive?

Perception: Evidence of hallucinations?

Memory: Are they having trouble remembering things, big or small?

Crisis Interview:

* This interview is designed to assess a problem demanding urgent attention (most clients considereing suicide or harming others) a provide immediate intervention.

Must quickly establish rapport, express empathy for crises.

When assessing suicidality, must take into account 5 specific issues:

1. How depressed is the client? 

2. Does the client have suicidal thoughts?

3. Dos the client have a suicide plan?

4. How much self. Control does the client currently appear to have?

5.  Does the client have definite suicidal intentions?

Intellectual and Educational Assessment:

Intelligence Tests: measure a client's intellectual abilities

Achievement Tests: Measure what a client has accomplished w/ those intellectual  tests

Defining Intelligence:

Theories of Intelligence: Early 1900’s —Charles Spearman (intelligence is a singular characteristics)

Intelligence is represented by…general global, overall intellectual ability.

Found a strong correlation between a wide range of abilities: abstract reasoning, comprehension,  problem solving.

* Impacts things like visual-motor coordination, motor speed and attention.

Theories of Intelligence:

Louis Thurstone: Opponent  of Spearman…believed that intelligence is vast and shouldn’t be one single ability

Used multiple factor analysis to determine what underlies intellectual ability

* Found several independent factors: Verbal comprehension, numerical ability, spatial reasoning and memory.

Hierarchical Model of Intelligence: Specific abilities (“s”) exist and are important, but they are all at least somewhat related to one another to a global, overall intelligence. 

Spear and and Thurstone compromised by settling on this model 

Measurement:

* Most intelligence tests produce a single overall score

* Also produce a number of other scores representing more specific abilities

* Commonly used intelligence tests that we will discuss: Wechsler Intelligence Tests, Stanford-Binet  Intelligence Scales (5th Edition), Intelligence tests have a wide range of clinical applications

Wechsler Intelligence Tests:

* Most common measure of intelligence

* 3 seperate Wechsler intelligence tests for different developmental periods

* Wechsler Adult Intelligence Scale (4th Edition: WAIS-IV) from ages 16-90

* Wechsler Intelligence Scale for Children (5th Edition: WISC-V) from ages 6-16

Wechsler Preschool and Primary Scale of Intelligence (4th Edition: WPPSI-IV) From ages 2 and 6 months - 7 and 3 months

* The tests will have a single full scale intelligence score; it reflects a global level of intelligence. (similar to “g”) 4 index scores.

Specific subset scores

* Index scores and subset scores are reflective of more specific areas of ability 

* Tests are administered one-on-one and face-to-face.

* Each subtlest is brief (last 2-10 mins) and consists of items that increase in difficulty as the subtext progresses 

Each Wechsler has a small # of unique sub tests, but most sub tests appear in all 3.

Wechsler Subset:

Vocabulary: orally explain the meaning of a word 

Similarities: orally explain how 2 things or concepts are alike

Info: orally answer questions on specific items of general knowledge 

Comprehension: orally answer questions about general social principles and social situations    

Block Design: recreate a pattern or design with the colored blocks 

Picture Completion: vi pic of a simple object or scene and identify the important part that is missing

Matrix reasoning: View an incomplete matrix and select the missing portion from the multiple choices provided.

Coding: sing pencils and paper, repeatedly copy implement shapes/symbols in appropriate spaces according to a key provided 

Symbol Speech: scan a group of visual shapes/symbols to determine if target shapes/symbols appear in a group

* Subsets to assess attention, concentration, mental control:

Digital Span: Individual is given a string of numbers (7-8-3) and must repeat them back 

Letter-Number Sequencing: the examiner presents a combination of letters and numbers ex: 9-L-2-A. The person must repeat first the numbers in order from smallest to largest followed by letters in alphabetical order 

Wechsler Intelligencr Scales: Four Index Scores

Verbal Comprehension Index: A measure of verbal concept formation and verbal reasoning

Perceptual Reasoning Index: A measure of fluid reasoning, spatial processing and visual-motor integration 

Working Memory Index: A measure of the capacity to store, transform, and recall incoming information and data in short-term memory 

Processing Speed Index: A measure of of the ability to process simple or rote information rapidly and accurately 

Wechsler Intelligence Scale:

Collecting Normative Data…each set includes data of 2,000 people 

* Sample closely matches recent US census data in terms of gender, age, race/ethnicity and geographic region.

* Full-scale and index scores are “IQ” scores —they reflect an intelligence “quotient”

* Mean of IQ is 100 + standard deviation is 15

* The quotient reflects your intelligence which is than compared to the person’s age 

* Strong psychometric properties: Strong reliability and validity

Stanford Binet Intelligence Scales (5th Edition):

* Similar to the Wechsler tests

* Also administered face to face and one on one.

Employs a hierarchical model of intelligence

Yields a singular measure of full scale IQ, 5 factor cores, and specific sub tests

* Feature the same mean (100) and stand deviation (15) 

* Similarity strong reliability and validity data 

Differences…Covers the entire lifespan (ages 2-85) in one test

* The normative sample matches recent US census data, but also includes normative data from individual w/ more specific disorders for comparison.

* Each subtest has a greater # of very easy and very difficult items 

* adaptive 

Tests Achievement:

Intelligence tests are based on cognitive capacity V.S. achievement tests focuses on what the person has accomplished 

*  Particularly focuses on areas like reading, spelling, writing and math

* There’s several different types of achievement tests

* Some are subject specific 

-Wechsler Individual Achievement Test—3rd Edition (WIAT-III)

* Focuses on ages 4-50

* Administered face to face and one on one.

-Measures reading, math, written language and oral language

WIAT-III:

* Oral Language Composite (derived from 2 subsets): listening Comprehension, Oral expression 

* Reading Composite: word reading, pseudo word decoding: using skills to sound out nonsense words, such as “”plore” and “tharch” (fake words)

* Math Composite: Numerical Operations, Math Problem Solving 

* Written Language opposite: spelling, sentence composition, essay composition 

* Has standard scores on the same scale as most intelligence tests 

* Mean of 100, SD of 15

Standardized on about 3,000 spells who were chosen to match recent US census data.

* Many people were also administered the Wechsler intelligence scales 

* Overall strong reliability and validity data 

Neuropsychological Testing:

* Purpose: measure cognitive function o impairment of the brain 

* Can be used to:

1. make a prognosis for improvement

2. Plan rehab

3.Determine eligibility for accommodations at school or work

4. Established baseline neuropsychological abilities 

Some neuropsychological testing is really lengthy comprehensive batteries, others are much briefer dan typically used to screen impairment 

Full Length Neuropsychological Batteries:

* Halstead-Retina Neuropsychological Battery (HRB): Battery of 8 standardized neuropsychological tests; Suitable for 15 years of age and above; Primary purpose is to identify people w/ brain damage.

Ex Tests:  Trail Making Tests; Resembles dot-to-dot puzzles; Finger tapping (finger oscillation) Test; Estimates motor speed

The publisher compares the clients test scores to published norms, overall assesses the performance, and determines strengths and weaknesses.

Strengths of HRB: Empirical research suggests that the HRB and its tests are reliable and valid. Comprehensive.

weaknesses of HRB: Length, inflexibility (as a fixed battery), Limited overlap w/ real-life day-today tasks

Brief Neuropsychological Measures:

Bender Gestalt Test (currently available as the Bender Visual—Motor Gestalt Second Edition)

* Most commonly use in neuropsychological screen 

Straightforward copying for task

Client is given a pencil, paper, 9 simple geometric designs and asked to copy each design as accurately as possible.

Very Brief: takes about 6 mins to administers 

* Appropriate of clients abo 3 years of age 

* Typically included as a quick  “check’ for neuropsychological problems.

Poor performances is indicated by a variety of of errors 

Ex: figures that collide with/ each other on the page  

    MMPI: 

* Most popular and psychometric ally sound personality assessments.

* Initially 550 self descriptive sentences; true or false ; pencil and paper

Ex of the Questions: “I feel like I am low on energy much of the time” “I often find myself in conflicts w/ people in authority”

Development of the MMPI:

* Published in 1943 by Starke Hathaway and J.C. McKinley 

* Emphasis on construction on the empirical measure    

* Used empirical criterion keying to construct the test: this method involves identifying distinct groups of people asking them all to respond to the same test items. Comparing responses  between groups 

* Must distinguish between the groups on an empirical basis not theoretical

Ex: “I have visions of things that aren’t real that other people can’t see”

* Evaluated people with mental health disorders and a group of people who didn’t

* Began w/ 1,000 items retained 550 items after empirical criterion keying to construct

* As a result they came up with 10 clinical scales; the same 10 Clinical Scales in the MMPI-2 and MMPI-3

Object Methods:

* Characteristics of a objective personality assessment: Unambiguous tests items; Offers clients a limited range of responses; Objectively scored  

* In contact the projective methods are typically less structured (ambitious and open-ended) & involve a greater degree of judgment in scoring and interpretation.

* Projective Assessment = Performance-BAsed personality Traits   (Terms are interchangeable)

MMPI Validity Scales:

* Testing clinet’s test taking attitudes

* Self-report measures like… “fake bad” = exaggerating answers OR “fake good” = not being true to your symptoms  OR “random answering” = answering anything 

Validity Scale:

* Provides info about how the client approached the test and allows psychologists to determine if a test is valid

Validity Scales Examples: 

* L = Lying: suggesting “fake good”

* K = Defensiveness: suggesting “faking good”

* F = Infrequency: suggesting “faking bad”  

MMPI-2 and MMPI-A:

* MMPI-1 was published in 1989

 It addressed several weaknesses  of the original MMPI:

 - Normative data matched current census data; Some tests were removed or revised that had outdated or awkward wording.

MMPI-A: Adolescent Inventory

* Focused on ages 14 - 18; published in 1992; Similar in administration, scoring and interpretation to MMPI-2

MMPI-2-RF & MMPI-3

* MMPI-2 was reconstructed and turned into the MMPI-2-RF that was released in 2008.

* Shorter than the MMPI-2

* Contains only 338 of the (over 550) MMPI-2 items.

* Reconstructed Clinical Scales 

 - Removal of overlapping terms in between scales and there were separate scales created

* Close to 10 Clinical sales of earlier versions

*Took out the masculinity-Femininity Scale and Social Introversion Scale 

Addition of the PSY-5 Scales—correspond to personality disorders. MMPI-3 recently released (2020). There’s 335-item self-report measures     

Use and Criticisms of MMPI:

* Currently this can make diagnosis, and exploring treatment options 

* However, this shouldn’t be the only resource that you use in order to diagnose someone. You need multi-method assessment: like textbook diagnosis, interviews, etc

* Used in many specialty areas: Forensic, personnel testing

Criticisms: too long and time-consuming; requires reading ability and prolonged attention; does it focus on forms of psychopathology or personality??  

Millon Clinical Multi-axial Inventory-IV:

* Similar to MMPI but stronger emphasis on personality disorders

* Separate clinical scales  for each of the current DSM personality disorders Ex: Borderline Personality Disorder

* First created in 1977 by Theodore Millon the current version (MCMI-IV) that was published in 2015

* 195 t or f items 

* Includes “modifier indices” (similar to MMPI validity scales)

* Best use: identifying personality disorders

Projective Methods:

Alison known as the Performance-BAsed Personality Tests

-Based on the assumptions that people will “project” their personalities if presented w/ unsructure, ambiguous, stimuli and an unrestricted opportunity to respond any way that you’d like  

* Strongly based in psychodynamic model

* Trying to avoid clients not being truthful int Shri responses 

Ex: “tell me what you see”

* Some procedures are usually disguised to some degree  

Major Criticism: 

* Lack of objectivity when scoring and interpreting 

Proponents say: 

* people are less likely to fake their responses. 

* Only way to gather info about unconscious desires and motivations.

* Again, projective assessments are strongly based on the psychodynamic model   

Rorschach Inkblot Method:

* Hermann Rorschach: created the inkblot test in 1921

* 1on inkblots

Administration occurs in 2 phases:

* Response or Free Association Phase

* Inquiry Phase 

Not published w/o a scoring method: Rorschach died about a year after publishing his measure   

* John Exner combined aspects of scoring systems to create the Comprehension System

* Included normative data that is lacking in the Rorschach method.

* Includes normative data from thousands of children and adults 

* When determining your clients score keep in mind…

Locartion: are they looking at the entire inkblot or just a small detail

Determinants; Form Quality, Popular responses (nuanced repose from the client), Content (were they common themes they saw in each inkblot. Ex: food, violence, etc.

The way the client makes sense of the inkblot is typically a parallel of how they view the world 

Thematic Apperception Test (TAT):

* Involves presenting the client w/ a series of cards, w/ each being ambiguous pic.

* TAT cards feature interpersonal scenes 

* Client must create a story to go along with/ scene

-Includes 31 cards, but typically not all are used

* Often analyzed w/o formal scoring 

* TAT interpretation is often more of an art than a science.   

Sentence Completion Test:

* Ambiguous stimuli are the beginnings of sentences 

* The client's personality is revealed by the endings they add to the sentences .

Rotter Incomplete Sentence Blank (RISB): tests are most widely known and only used.

Ex: “I enjoy______.”  “It makes me furious_______.”  

* Not used regularly in clinical psychologists