Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psy- chometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instru- ments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summa- rize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psycholo- gists regarding projective techniques.

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The Scientific Status of Projective Techniques

Assessment of Personality and Psychopathology: Psychodiagnosis Case Formulation Behavioural Predication Treatment Planning Neuropsychological Assessment Methods and Recommendations for Making Judgements Clinical Judgement Computers and Judgement Improving Psychological Assessment.

Studying the Clinician: Judgment Research and Psychological Assessment

Fundamental Statistics in Psychology and Education

specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). Conclusions:Toourknowledge,thesefindingsareconsistent with and extend the findings of previous reports by providing the first available information on the associationbetweenphysician-diagnosedasthmaandDSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthmaandarangeofmentaldisorders.Longitudinalstudies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms. Arch Gen Psychiatry. 2003;60:1125-1130

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/208036/YOA30024.pdf

Mental disorders and asthma in the community.

Research assessing consumer satisfaction with mental health treatment: A review of findings

In a prior study,1 development of a 15-item Minnesota Multiphasic Personality Inventory (MMPI) Panic-Fear scale was described which relates to the reported frequency of Panic-Fear symptoms (e.g., feeling scared, panicky, worried, and frightened) on the Asthma Symptom Checklist (ASC). High MMPI Panic-Fear scale scores describe fearful, highly emotional individuals who profess to have their feelings hurt more easily than others, to feel helpless and to give up easily in the face of difficulty. High-scoring asthmatic patients were found to have been prescribed more intensive oral corticosteroid regimens at the time of discharge from a residential treatment facility months after testing. This relationship was not attributable to differences in pulmonary function.In the present study, the results of the earlier research were expanded in several ways. First, the MMPI Panic-Fear scale was found to be related to an aspect of medical intractability, i.e., length of hospitalization, in two chronic respiratory illne...

Panic-fear: a personality dimension related to length of hospitalization in respiratory illness.

Psychomaintenance refers to the psychologic and behavioral perpetuation and exacerbation of physical illness (Dirks, 1978; Jones, Kinsman, Dirks, & Dahlem, 1979). In this regard, it should be noted that psychomaintenance does not address the etiology of illness as an area of interest but instead focuses on how psychologic and behavioral factors maintain and increase both perceived severity and medical intractability of the illness once it has already developed. How is it that the patient continues to be functionally incapacitated by illness, despite medical treatment that is effective in most other cases? How is it that the patient appears to require a disproportionately intense medication regimen? How is it that the patient continues to be hospitalized longer and more frequently than would be indicated by the objective medical parameters of the illness? What is the patient doing to contribute adversely to his or her medical response? What is the patient not doing in relation to the illness, and what negative effects does that have on medical management and treatment? These are questions whereby the specific mechanisms of psychomaintenance can be isolated. The mechanisms of psychomaintenance appear to be general across illness types and often so commonplace as to be overlooked.

Psychomaintenance of Chronic Physical Illness

The present study explores the complex interplay of objective indices of illness-severity and personal characteristics of patients and physicians as they influence judged illness-severity and medical decisions concerning length of hospitalization and intensity of prescribed oral corticosteroids in a chronic asthmatic population. The results indicate that, depending on the physician's personal characteristics, he may: a) confuse his patient's psychological physical distress, resulting in medical judgment and decisions being influenced by patient personality; b) accurately distinguish between psychological physical distress but treat a psychological problem as though it were a medical problem; c) judge and treat the patient's illness objectively, regardless of the patient's personality. These findings stress the importance of expanding the present biomedical model of medicine to include a better appreciation of how social, psychological, and behavioral factors influence the medical decisions about treatment and the resulting outcome.

Patient and physician characteristics influencing medical decisions in asthma.

One hundred and fifty-five hospitalized asthma patients were administered the Minnesota Multiphasic Personality Inventory (MMPI) in order to evaluate the existence of common personality characteristics. When the full sample was divided into subgroups according to age, sex, and duration of the illness, it was found that patterns emerged that appeared largely explicable by these variables rather than the asthma per se. The single most frequent pattern observed across these subgroups was a V-shaped configuration of a "neurotic triad" (scales 1, 2, and 3). This pattern is not unique to asthma, but is also characteristic of other chronic illness populations and seems to represent a defensive stance in coping with the problems of chronic illness. The findings speak against any stereotypic asthmatic personality. It appears more profitable to investigate individual personality patterns associated with coping styles and their relationship to the illness via behaviors that either maintain or delimit the effects of chronic asthma.

Personality profiles in asthma

Coping styles in asthma indexed by a Panic-Fear personality measure are known to influence physicians' medical decisions and long-term treatment outcome. Unusually High or Low Panic-Fear personality styles are maladaptive, the former characterized by anxious, helpless dependency and the latter by an extreme counterphobic independence. In this study (N = 90), the psychological experiences among Panic-Fear personality groups (Low, Moderate, and High) of asthma patients are described at three levels of assessment: (1) general personality characteristics; (2) attitudes toward asthma and its treatment; and (3) the subjective symptoms reported during breathing difficulties. Comparisons among the groups delineated the linkages between Panic-Fear personality and more illness-specific attitudes, symptoms, and experiences in asthma. Discussion centered upon how general personality and illness-specific characteristics associated with extreme High and Low Panic-Fear personality may contribute to the psychomaintenance of asthma.

Nelson F. Jones

Papers

Panic-fear: a personality dimension related to length of hospitalization in respiratory illness.

Psychomaintenance of Chronic Physical Illness

Patient and physician characteristics influencing medical decisions in asthma.

Personality profiles in asthma

Levels of psychological experience in asthma: general and illness-specific concomitants of panic-fear personality.