View Sample Report

Background observations  The original intent of the MMPI enterprise was to facilitate the treatment of disturbed and distressed individuals.  The more fully we understand the person in front of us, the more effectively and quickly we can intervene.  Historically the clinical use started, as best I can infer, in pursuit of the refinement of differential diagnosis.  The MMPI initially provided a quantification of particular elements of the person’s disorder, and the other inferences and predictions began to accumulate over time.  Short of mental health professionals, the MMPI was almost immediately adopted in VA settings after World Was II.  Psychotherapeutic help was crucial; at that time etiology was mostly loose speculation.
Early on, it became evident that there was a great amount of information that was being communicated by the code types above and beyond what was available in any way from the scales individually.  This prompted Hathaway to spend two years in a self-imposed isolation reading charts from which the MMPI results had been removed, and he dictated summaries of almost 1000 cases.  Thus, the clinician could look up the patient’s code in the Atlas and see what was going on with others who obtained similar profiles (Hathaway & Meehl, 1951).  Numerous other studies have expanded greatly on our body of code-specific information.  The works of Marks and Seeman, 1963, Gilberstadt and Duker, 1965, and the books on adolescents by Hathaway and Monachesi, 1961, and of Marks, Seeman, and Haller, 1974, particularly stand out in the elaboration of code type meanings.
The great glaring empty space in the accumulating editions of the DSM has been the persisting absence of any corresponding systematic array of etiologies.  The DSM diagnoses are symptom collections that often overlap, and although some categories are naturally well defined, many are seriously ambiguous as to any precise boundaries between them.  The categorical diagnosis model also creates what I believe are false and needless struggles over the normal versus diagnostically pathological boundary, which also carries over into the arbitrary “within normal limits” MMPI-2 cutoff.  This leads many to a needless rejection of much valuable information; see the discussion of the “normal range” problem in the Counseling and Coaching section of this website.
Thirty years ago, in exploring what makes the scales and code types hold together, I began considering the hypothesis that there may be a central dimension of fear for each of the eight clinical scales (as former seminar students can attest to my mounting preoccupation).  Moving from the eight spectra of fear (Caldwell, 2001) to the far greater etiologic specificity of the code types, as of this writing my postulated system has evolved into a set of 23 code type etiologies.  This is still very much a “work in progress” with much to be added and refined.  I think that the foundation of a comprehensive array of testable and disprovable etiologies would be the final and finest culmination of Hathaway’s gift to us. 

Sample case  As a sample for psychotherapeutic utilization we chose a 48/84 coded profile, Early sexual abuse and the poisoning of trust.  For years I said, “This MMPI code has no diagnosis that matches it, not depression, not personality disorder, and not schizophrenia even if it has a bit of each.”  Then the DSM III came out with Borderline Personality Disorder which is a good codetype fit, although the conspicuously loose DSM boundary problem has led to a notably overinclusive use of the term (sometimes I think it mainly means, “I don’t like this person).  The striking historical issue with this codetype, time and again, has been a history of relatively early sexual abuse.  The question arises, what is the connection between the often deep and pervasive distrust and the prevalence of sexual abuse?  When I finally focused on that, the answer seemed to jump out at me: what is the relationship to the perpetrator?  So often it is a highly trusted family member or other esteemed adult whom the child feels helpless or too frightened to oppose.  The great intensity of the abuse experience thus implants the violation of trust at a deep level.  The new Adaptation and Attachment supplement to the narrative report then explores this abuse-trust conjunction in considerable detail.  This is longer than most of these supplements; there seemed more that needed to be said compared to most of the code types. 
Clients with 48/84/248 codes (the meaningful core of the Borderline Personality Disorder category) can be difficult challenges for the professional not to be judgmental.  The self-empathy of the 48 is about as poor as their empathy for others, so they often give the professional little help in gaining empathy for them.  Given the pervasiveness of distrust, I think they have somehow experienced empathy (in almost any direction) as a dangerous vulnerability.  This is an MMPI-2 pattern where guidance to etiology can be especially helpful, which is why we chose it as a sample profile for psychotherapy utilization – or, as I would prefer, the facilitation of adaptation.

View the report: 48/84 Female, Early sexual abuse and the poisoning of trust (pdf format)

References

Caldwell, A. B. (2001). What do the MMPI scales fundamentally measure? Some hypotheses.
Journal of Personality Assessment, 76, 1-17.

Gilberstadt, H., & Duker, J. (1965). A handbook for clinical and actuarial MMPI interpretation.
Philadelphia: Saunders.

Hathaway, S. R., & Meehl, P. E. (1951). An atlas for the clinical use of the MMPI. Minneapolis:
University of Minnesota Press.

Marks, P. A., & Seeman, W. (1963). The actuarial description of abnormal personality.
Baltimore: Williams & Wilkins.

Marks, P. A., Seeman, W., & Haller, D. L. (1974). The actuarial use of the MMPI with adolescents and adults. Baltimore: Williams & Wilkins.