Methods for Assessing Therapeutic Change in Psychological Test Protocols

  • Sidney J. Blatt
  • Richard Q. Ford
Part of the Applied Clinical Psychology book series (NSSB)


Coordinated with the preparation of the clinical case reports after the first 6 weeks of hospitalization and again much later in the treatment process (after at least 1 year of treatment), all patients were administered an extensive battery of diagnostic psychological tests, including the Rorschach, the Thematic Apperception Test (TAT), a Wechsler Intelligence Test, and, in some cases, the Human Figure Drawing (HFD) test. This testing was conducted by advanced, postdoctoral fellows in clinical psychology who were committed to diagnostic psychological testing and supervised by senior clinical psychologists. The test procedures were administered using a standard, well-specified format and a consistent theoretical orientation (Rapaport, Gill, & Schafer, 1945). The test protocols were all recorded verbatim and parallel the quality of the clinical records in detail and thoroughness. These psychological test protocols provide the data for independent evaluations of a number of important psychological dimensions. In addition to regular scoring procedures, newly developed conceptual schemes were used to score various aspects of these protocols.


Object Representation Defense Effectiveness Therapeutic Change Thought Disorder Experience Balance 
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  1. 1.
    As noted by Blatt, Tuber, and Auerbach (1990), there are substantial differences between this system for scoring thought disorder and the one proposed by Exner (1978; Exner, Weiner, & Schuyler, 1976; Weiner & Exner, 1978). In particular, the distinction between a fabulized combination-regular and a fabulized combination-serious, a thought disorder score not found in the Exner system, is an extension of Holt’s (1963) differentiation between (1) the combination of two independent and clearly separate objects in an incongruous relationship (e.g., a bear standing on a butterfly), and (2) a combination in which two parts are placed together in an incongruous relationship within a single object (e.g., a bear with a man’s head), such that each of the parts tends to lose its separate definition and integrity. The latter response, the fabulized combination-serious, is more akin to a contamination, in which the two objects or parts lose their separate identities and merge together to create an incongruous, illogical entity. In this sense, it indicates a more serious type of thought disorder than does the fabulized combination-regular, in which the separate definition and identity of the two objects or parts are maintained. Research (Blatt & Berman, 1984; Lerner, Sugarman, & Barbour, 1985; Wilson, 1982, 1985) supports the formulation that these two types of fabulized combinations indicate very different levels of pathological thinking. Exner (1978; Exner et al., 1976) scores the fabulized combination-serious response as an incongruous combination (INCOM). In contrast to Holt (1962) and Blatt & Berman (1984), Exner considered this type of response less disturbed than the fabulized combination-regular, primarily because he found that the incongruous combination score is more frequent in a normal sample than is the fabulized combination-regular (Exner’s FABCOM score). The relatively higher frequency of Exner’s incongruous combination response as compared to his FABCOM score is probably an artifact of Exner’s placing several different types of responses within the INCOM category. He included not only the fabulized combination-serious response, as defined by Holt (1963) and Blatt and Berman (1984), but also responses in which form and color are arbitrarily and unrealistically combined (e.g., pink bears). Exner’s inclusion of FCarb responses (Allison, Blatt, & Zimet, 1968; Rapaport, Gill, & Schafer, 1945), along with the fabulized combination-serious, in his incongruous combination category, may be the reason why he found that this category occurs with a greater frequency in normals than does the fabulized combinationregular. Exner provided no theoretical or empirical justification, however, for combining the fabulized combination-serious response and the arbitrary color response (FCarb) into a single scoring category, INCOM. The FCarb score reflects an individual’s difficulty integrating affective experiences with logical thought (cf. Rapaport et al., 1945), whereas the fabulized combination-serious score reflects difficulty maintaining a boundary between independent and separate ideas and concepts (Blatt & Wild, 1976). Thus, until there is more substantial theoretical rationale or empirical support for Exner’s decision to merge fabulized combination-serious and arbitrary color responses into the INCOM category, it seems judicious to maintain the distinction between the two very different types of thought disorder expressed in fabulized combination-serious and fabulized combination-regular responses. Empirical findings (Lerner et al., 1985; Wilson, 1982, 1985) suggest that it seems appropriate to view the fabulized combination-serious responses as a more severe form of pathological thought.Google Scholar
  2. 2.
    Material in this section is derived from an article (Robins, Blatt, & Ford, 1991) published in the Journal of Personality Assessment.Google Scholar
  3. 3.
    Material in this section is derived from an article (Cramer, Blatt, & Ford, 1988) published in the Journal of Personality Assessment.Google Scholar
  4. 4.
    We are indebted to Professors Robert Manuck and Donald M. Quinlan at Yale University and Professor Patrick Shrout at New York University for their consultation and advice on this matter.Google Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Sidney J. Blatt
    • 1
  • Richard Q. Ford
    • 2
  1. 1.Yale UniversityNew HavenUSA
  2. 2.Austen Riggs Center, Inc.StockbridgeUSA

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