A beginner's guide to the mcmi iii

“Clinical Formulation” Section Of Final Project

General Guidelines for Administering 3

and Scoring

T o provide meaningful data for both clinical and research uses, the MCMI-III must be properly administered and correctly scored. Test scores must accurately reflect the indi- vidual’s true condition. Although the MCMI-III is a psycho- metrically sound and clinically useful instrument, improper administration and scoring can undermine its effectiveness. A prime responsibility of the MCMI-III examiner is to ensure that the standardized instructions and procedures are always followed carefully when administering the MCMI-III, as well as any other instrument. According to Principle 8 in Casebook on Ethical Principles of Psychologists:

In the development, publication, and utilization of psychological assessment techniques, psychologists make every effort to promote the welfare and best interests of the client. They guard against misuse of assessment results. They respect the client’s right to know the results, the interpretations made, and the basis for their conclusions and recommendations. Psychologists make every effort to maintain the security of tests and other assessment techniques within limits of legal mandates. They strive to ensure the appropriate use of assessment techniques by others. (American Psychological Association, 1987, p. 109)

41http://dx.doi.org/10.1037/10446-003 A Beginner's Guide to the MCMI-III, by D. Jankowski Copyright © 2002 American Psychological Association. All rights reserved.

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42 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

Guidelines for Administration

An entire chapter can be devoted to a discussion of the proper proce- dural steps for test administration in general. However, such a review is beyond the scope of our presentation. In this section we will limit our focus to the general guidelines and procedural information for administering the MCMI-III. Before administering the MCMI-III, then, it is important for the beginning student to become acquainted with the various MCMI-III formats (available in English and Spanish), to include audiocassette recordings. If administered properly, all formats will yield comparable results. Let us begin with an overview of the general administration guidelines.

PROVIDE CLEAR AND STANDARDIZED INSTRUCTIONS

The test directions are clearly printed on the second page of the MCMI-III hand-scoring test booklet published by National Computer Systems (NCS). Remember that standardization implies uniform proce- dures. Sufficient time should be taken at the onset to present clear and standardized instructions to the examinee. It is my customary practice to ask the examinee to read the instructions privately before beginning the test, and, after addressing any questions, follow with a review of the printed procedures.

Self-report inventory. As with other objective personality instru- ments, the MCMI-III functions as a “self-report” inventory and should never be construed as a self-administered inventory. A trained clinical professional should be available to the examinee before, during, and after the administration to respond to any concerns. However, the test items should be answered with no coaching assistance from the examiner. Although the examinee is encouraged to complete all items, undecided items by the exam- inee should be marked in the false direction rather than omitted. In addition, because it is a self-report inventory, the true results of the MCMI-III are contingent on the examinee’s ability to re- spond to its items. In that light, the examiner should ensure that the examinee’s condition (e.g., sedated or intoxicated) is not a cause for a distorted protocol. Administration location. The inventory should be administered in a well-lighted, quiet environment, one that is free from distrac-

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Guidelines for Administering and Scoring 43

tions. The optimal location is a quiet office removed from the activity of a busy workplace, where the examinee can be as com- fortable and relaxed as possible. The logistics of the location should be identified beforehand to avoid unnecessary stressors for both the examiner and examinee at the time of testing. Examinee characteristics. The MCMI-III has been designed for use by adults who have at least an eighth-grade reading level. Ensure that the examinee is capable of adequately reading the questions before the actual test administration. If reading prob- lems are suspected and determined to be limited, an audiocassette recording can be administered in place of the written format. This format can also be used for visually impaired individuals. Equipment. Instruct the examinee to use a number 2 black lead pencil for marking the answer form, and provide the examinee a hard surface on which to take the test, particularly when the MCMI-III is scored by computer. If a hard surface desk is not available, provide the examinee with a hard-covered textbook to place beneath the answer sheet. Demographic data. Before starting the test, ensure that gender and all necessary requested demographic information are accu- rately entered by the examinee on the answer sheet. If gender information is not specified, the instrument cannot be scored. The examiner may assist the examinee in completing the required data. To protect confidentiality, identification numbers are used in place of names on the computer-scored forms. Review of data information. As a general practice, it is best to review the information in the presence of the examinee immedi- ately following the completion of the instrument. A thorough review of the answer sheet is necessary at this time not only to check for required data information but also to scan for excessive item omissions and random responding (e.g., all true/all false). If errors or excessive omissions (12 or more) are found, the mate- rials should be returned to the examinee to allow for corrections. At this time, the examiner can also address other concerns that the examinee may have about the instrument, as well as in gen- eral terms describe the process that will follow. Administration time. Most people take about a half an hour to complete the instrument. Be flexible, however, and allow the examinee to work at a comfortable pace. The examinee’s test- taking responses, as well as administrative time required, will vary according to the individual’s state. Response times of anxious or impulsive clients may differ appreciably from depressed clients or those with limited intelligence.

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44 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

TAKING AND SCORING THE TEST

As previously mentioned, the MCMI-III is available in several formats. Examinees can complete the inventory by using paper and pencil or computer. With the advances in computerization today, more mental health facilities are equipped with computerized testing equipment. In this case individuals directly enter their responses into the computer, with scores and reports automatically generated. If the MCMI-III is administered by computer, care should be taken to ensure that the examinee is comfortable with the automated testing process. A basic familiarity with computer use is recommended when this procedure is used.

If, however, conventional test-taking (paper and pencil) is pre- ferred, examinees can mark their responses on an answer sheet. These answer sheets can then be scanned through optical mark reading or key-entered into the computer for processing. Mail-in processing is also available with the purchase of prepaid answer sheets.

The speed and accuracy of computer-assisted administration, scor- ing, and report preparation make it more practical and efficient than processing by hand. There are several MCMI-III processing options available from NCS to include telescoring, mail-in scoring, and individ- ual software. All testing formats are published and distributed exclu- sively by NCS.

HAND-SCORING PROCEDURE

Hand-scoring the MCMI-III can be complex and tedious. Diligence should be used to avoid unnecessary transformation, recording, and calculation errors. The hand-scoring materials provided by NCS must be used when hand-scoring the MCMI-III. The following materials are required for hand-scoring the MCMI-III and are included in the hand- scoring starter kits:

Answer sheet Hand-Scoring User’s Guide Answer keys Hand-scoring worksheet Profile form MCMI-III Manual, Second Edition, 1997, NCS

The MCMI-III hand-scoring worksheet (Exhibit 3-1) is functionally designed to assist the clinician in scoring the results. The examiner’s

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Guidelines for Administering and Scoring 45

review of the completed answer sheet should be thorough, rechecking all necessary information. The first-time user should become familiar with the systematic layout of the hand-scoring worksheet.

When hand-scoring is used, the examiner should exercise diligence to ensure against scoring errors. Hand-scoring can be a complex proce- dure. The more common errors the scorer can make include

Use of incorrect templates Use of incorrect BR scores when adjusting scores Use of incorrect transformation tables Miscalculation

Although computerized administration and scoring are available, it is suggested that a first-time user hand-score at least one protocol, not only to gain familiarity with the instrument but also to understand the logical process involved in the scoring system. The first-time user is provided the following general scoring guidelines. Note that these guidelines are general in nature and not a substitute for the complete scoring procedures that are published and distributed by NCS.

INITIAL VALIDITY CHECK

The examiner should be aware that excessive omissions and double- marked responses (12 or more) will invalidate the instrument. Note, also, the responses to the three validity items: 65, 110, and 157. If no more than one response is marked true and no excessive number of omissions/double-marked items or random responding is detected, the profile can be scored.

If scored by optical scanning, thoroughly check the answer sheet to determine that it is acceptable for optical scanning (e.g., no markings outside the response circles, no perforations). After vis- ual review, the answer sheet is ready to be mailed to NCS for scoring and interpretation. If scored by hand, the MCMI-III hand-scoring worksheet is func- tionally designed to assist the examiner in providing an accurate record. The scorer is instructed to follow the hand-scoring work- sheet’s layout and directions exactly throughout the course of hand-scoring.

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46 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

E X H I B I T 3 - 1

MCMI-III Hand-Scoring Worksheet

Source: MCMI-III Hand-Scoring Worksheet by T. Millon, 1990, Minneapolis, MN: National Computer Systems. Copyright 1990, 1994 Dicandrian, Inc. Reprinted with permission.

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Guidelines for Administering and Scoring 47

MCMI–III Hand-Scoring Worksheet V Validity

Disclosure 1–8B

Adjustment

Disclosure S–PP

Adjustment

A/D 2B, 8B, C

Adjustment

A/D 2A, S

Adjustment

SS Impatient

Adjustment

CC Impatient

Adjustment

PP Impatient

Adjustment

Denial/ Complaint

Adjustment

Adjusted BRs

BR From Table

Raw Score

Adjusted BRs

Adjusted BRs

Adjusted BRs

Adjusted BR

Adjusted BR

Adjusted BR

Adjusted BRs

Final BR Score

ADJUSTMENT VALUES

MODIFYING

INDICES

X Disclosure

Y Desirability

Z Debasement

CLINICAL

PERSONALITY PATTERNS Adjusted

BRs BR From Table

Raw Score

Adjusted BRs

Adjusted BRs

Adjusted BRs

Adjusted BR

Adjusted BR

Adjusted BR

Adjusted BRs

Final BR Score

1 Schizoid

2A Avoidant

2B Depressive

3 Dependent

4 Histrionic

5 Narcissistic

6A Antisocial

6B Sadistic (Aggressive)

7 Compulsive

8A Negativistic (Passive-Aggressive)

8B Masochistic (Self-Defeating)

Adjusted BRs

BR From Table

Raw Score

Adjusted BRs

Adjusted BRs

Adjusted BRs

Adjusted BR

Adjusted BR

Adjusted BR

Adjusted BRs

Final BR Score

SEVERE PERSONALITY PATHOLOGY

S Schizotypal

C Borderline

P Paranoid

CLINICAL SYNDROMES

Adjusted BRs

BR From Table

Raw Score

Adjusted BRs

Adjusted BRs

Adjusted BRs

Adjusted BR

Adjusted BR

Adjusted BR

Adjusted BRs

Final BR Score

A Anxiety

H Somatoform

N Bipolar: Manic

D Dysthymia

B Alcohol Dependence

T Drug Dependence

R Post-Traumatic Stress Disorder

Adjusted BRs

BR From Table

Raw Score

Adjusted BRs

Adjusted BRs

Adjusted BRs

Adjusted BR

Adjusted BR

Adjusted BR

Adjusted BRs

Final BR Score

SEVERE CLINICAL PATHOLOGY

SS Thought Disorder

CC Major Depression

PP Delusional Disorder

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48 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

Determining Raw Scores

Arrange the answer keys in the same order as the scales appear on the worksheet, ensuring that the correct template is used for each of the 26 scales. Note that there is no template for Scale X or for the Validity index (Scale V). Score the darkened circles of each scale, paying atten- tion to the weighted values of each item. All items on Scale Y and Scale Z only receive a weighting of 1, and the rest of the scales (except Scale X) have weightings of 1 and 2. The obtained raw scores with the exception of Scale X are entered and then transformed into base- rate scores.

Scale X Validity Determination

The composite raw score of the 11 Clinical Personality Patterns (Scales 1 through 8B) determines the Disclosure index (Scale X) value. Note that the raw score of Scale 5 is multiplied by .6667. (Scale 5 is weighted by two thirds because of its length.) Profile validity requires the range of Scale X to fall between raw score 34 and raw score 178 inclusive. If raw score Scale X is less than 34 or greater than 178, the profile is invalid and scoring should be discontinued. Note: If the composite raw score of Scales 1 to 8B is not a whole number, rounding the number is necessary. If the decimal number is greater than or equal to 5, round the number up. If the decimal number is less than 5, round the number down.

Base-Rate Transformation Score

Base-rate transformation for Scale X is provided in a separate table. Note that it is the only transformation table that is applicable to both genders. See MCMI-III Manual, Second Edition (1997, appendix C-3), For all other scales—1 through PP and Scales Y and Z—use base-rate

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Guidelines for Administering and Scoring 49

transformation tables (appendices C-1 and C-2). Be sure to use the correct male/female base-rate transformation tables.

Also, when entering successive base-rate scores on the MCMI-III hand-scoring worksheet, make sure entries are made in proper col- umns. Cumulative totals are used as each additional adjustment is made.

Base-Rate Adjustments

Millon addressed the effects of response bias, as well as the client’s representative state of emotional distress, by developing base-rate ad- justments. Four adjustments are used if corrections are necessary. The disclosure adjustment, derived from the obtained raw score of Scale X, is applied to Scales 1 through PP to counter problematic response styles. The anxiety/depression adjustment is applied to Scales 2A, 2B, 8B, S, and C to balance the effects of distortion experienced in acute emotional states. The inpatient adjustment is applied to the severe clinical syn- drome scales (SS, CC, and PP) to offset the denial of symptom severity in recently hospitalized patients. The denial/complaint adjustment is applied to Scales 4, 5, or 7 to compensate for psychological defensive- ness. These adjustments are fully discussed in appendix D of the MCMI-III Manual, Second Edition (1997). Let us briefly examine them.

DISCLOSURE ADJUSTMENT

Problematic responding occurs if Scale X raw score is less than 61 (underreporting) or greater than 123 (overreporting), and adjustment is necessary. Disclosure adjustments (20 to –20) to the scales are made in base-rate values. Locate the correct adjustments, then add/subtract the disclosure adjustment value to/from Scales 1 through PP if an adjustment is required. Note: Use Table 1, “Disclosure Adjustment Val- ues” (MCMI-III Manual, Second Edition, 1997, NCS, appendix D, p. 178).

ANXIETY–DEPRESSION (A/D) ADJUSTMENT

The anxiety–depression adjustment is determined by the examinee’s base-rate scores on Scale A (Anxiety) and Scale D (Dysthymia) and corrects for acute emotional states. The scales (2A, 2B, 8B, S, and C) most often affected by psychic turmoil are clearly identified on the hand-scoring worksheet. If BR scores for Scale A and/or Scale D are BR 75 or above, Scales 2A, 2B, 8B, S, and C are adjusted (decreased).

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50 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

The degree of the A/D adjustment is contingent on the setting (non– inpatient or inpatient), as well as the duration of the client’s Axis I status. Note: Use Tables 2, 3, and 4, “A/D Adjustment Values” (see MCMI-III Manual, Second Edition, NCS, appendix D, pp. 177–180).

INPATIENT (AXIS I DURATION) ADJUSTMENT

The inpatient/Axis I duration adjustment is designed to offset the ten- dency of recently hospitalized patients to underrate the level of their emotional condition. This correction factor, if applicable, will increase (2 to 10 BR) an examinee’s base-rate scores on the Severe Clinical Syndromes scale (SS, CC, PP). Inpatient Axis I duration status and setting determine the adjustment to be applied. If an examinee is not an inpatient or if the examinee is an inpatient whose Axis I presenting problem is present for longer than four weeks, no adjustment is neces- sary. Note: Use Table 5, “Inpatient/Axis I Duration Status” (see MCMI-III Manual, Second Edition, 1997, NCS, appendix D, pp. 179–180).

DENIAL/COMPLAINT ADJUSTMENT

The denial/complaint adjustment compensates for psychological defen- siveness among examinees whose highest scale obtained on the Clinical Personality Patterns (Scales 1–8B) is Histrionic (Scale 4), Narcissistic (Scale 5), or Compulsive (Scale 7). If one of these three scales (4, 5, or 7) is the highest elevation obtained among the 11 Personality Pat- terns scales, 8 BR points are added to only that scale. Note: Use “Denial/ Complaint Adjustment” (see MCMI-III Manual, Second Edition, 1997, NCS, appendix D, p. 180).

Final BR Score

The final BR scores are the scores that determine scale interpretation. After all necessary adjustments are made, the final base-rate scores must fall between BR 0 and BR 115. Any adjusted scores less than BR 0 should be changed to BR 0; any scores greater than BR 115 should be changed to BR 115. If the final BR scores for each of the Clinical Personality Patterns (Scales 1–8B) are all less than BR 60, the result is a flat profile, and it is thus uninterpretable. That is to say, if no elevations on Scales 1 through 8B are above 59, no clear personality pattern emerges, and no subsequent interpretation should be made. Before

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Guidelines for Administering and Scoring 51

interpretation, the final base-rate scores are transferred to the corres- ponding scales on the profile form.

Profiling

A profile is a chart that graphically depicts the configuration of the base-rate scores obtained by the examinee. Profiling is a simple process that merely requires the plotting of each scale’s base-rate score by marking an “X” in the appropriate score location on the hand-scoring profile form. Profiling provides a useful visual representation of the configural relationship among the scale scores. (See Exhibit 3-2.)

Coding

Relevant information for interpreting the MCMI-III protocols is con- figural in nature. It is, therefore, helpful to index the scale elevations in relation to each other. The process of coding facilitates this procedure by recording the most essential information about a profile in concise form. The rules for coding are found on pages 114 and 115 in the MCMI-III Manual, Second Edition (1997). The 24 clinical scales of the MCMI-III are divided into four distinct sections and coded as distinct segments. The first two sections comprise the personality code; the second two sections comprise the syndrome code. Note that the 24 clinical scales are automatically coded on computer-scored profiles.

In Summary

In this chapter, general guidelines were included for administering and scoring the MCMI-III. Although hand-scoring is tedious, it is important for the individual who is learning the instrument to have a basic under- standing of the process. Once familiarization with the instrument is acquired, computerized scoring will likely become the preferred choice for scoring the MCMI-III. In addition to accurately scoring the instru- ment, computer-processed protocols also include a comprehensive re- port of the results, though a final caveat is in order: Learn well the basic

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52 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

E X H I B I T 3 - 2

MCMI-III Hand-Scoring Profile

Source: MCMI-III Hand-Scoring Profile by T. Millon, 1990, Minneapolis, MN: National Computer Systems. Copy- right 1990, 1994 Dicandrian, Inc. Reprinted with permission.

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Guidelines for Administering and Scoring 53

techniques of interpretation, so that a fuller and richer understanding of the computerized results can be gained. We now turn to the key area of scale interpretation.

Test Yourself Exercises 3 Fill in the Blanks.

1. Clients being administered the MCMI-III should have at least a(n) grade reading level.

2. If the Validity index score totals 2 or 3, the protocol is , and the clinician should scoring.

3. Items on Scales Y and Z have weighting values of . 4. The scale is the total of the summed raw scores of the 11 Clinical

Personality Patterns scales. 5. There is no MCMI-III scoring template for Scale . 6. The A/D adjustment is applied to the following scales:

a. b. c. d. e.

7. If no A/D adjustment is necessary, a value of is entered in the A/D adjustment box.

8. Scales that make up the denial/complaint adjustment are Scale , Scale , and Scale .

9. If all of the final BR scores for Scales 1 through 8B are less than BR 60, the result is a profile.

10. is the process of plotting each scale’s BR score.

Quick Quiz

Mark True or False. 1. A prime responsibility of the examiner is to ensure that the standardized

instructions and procedures are followed carefully when administering the MCMI-III.

2. The MCMI-III test instructions are clearly printed on the third page of the MCMI-III hand-scoring test booklet.

3. Virtually anyone who is familiar with the MCMI-III can administer the instrument.

4. Most people complete the MCMI-III administration in about 11⁄2 hours. 5. Among the more common errors made when hand-scoring the MCMI-III is

using the incorrect gender tables when transforming scores.

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54 B E G I N N E R ’ S G U I D E T O T H E M C M I - I I I

6. The process of coding records the most essential information about a profile in concise form.

7. The denial/compliant adjustment compensates for psychological defen- siveness.

8. The value of Scale X is derived from the composite raw score of Scales 1 through P.

9. The inpatient adjustment is designed to balance the tendency of recently hospitalized examinees’ denial of their emotional states.

10. If scores for Scales A and D are both less than BR 75, no A/D adjustment is necessary.

BR Exercise

Transform the following raw scores into final base-rate scores. (Client is an outpatient female. Validity index = 0). (1) Calculate Scale X raw score and convert raw scores to BR scores. (2) Code the profile.

Transform the following raw scores into final base-rate scores. (Client is an outpatient female. Validity index = 0.) 1. Calculate Scale X raw score and convert raw scores to BR scores. 2. Code the profile.

Scale Y 18 Scale S 4 Scale Z 8 Scale C 8 Scale 1 10 Scale P 12 Scale 2A 13 Scale A 6 Scale 2B 9 Scale H 10 Scale 3 9 Scale N 9 Scale 4 9 Scale D 12 Scale 5 1 Scale B 11 Scale 6A 4 Scale T 9 Scale 6B 10 Scale R 8 Scale 7 23 Scale SS 7 Scale 8A 15 Scale CC 7 Scale 8B 5 Scale PP 4Co

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