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Journal of Personality Assessment Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjpa20
Recommendations for the Clinical Use of the Apperceptive Personality Test David E. Silber , Stephen A. Karp & Robert W. Holmstrom Published online: 22 Jun 2011.
To cite this article: David E. Silber , Stephen A. Karp & Robert W. Holmstrom (1990) Recommendations for the Clinical Use of the Apperceptive Personality Test, Journal of Personality Assessment, 55:3-4, 790-799, DOI: 10.1080/00223891.1990.9674113 To link to this article: http://dx.doi.org/10.1080/00223891.1990.9674113
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF PERSONALTY ASSESSMENT, 1990, 55(3&4), 790-799 Copyright GJ 1990, Lawrence Erlbaum Associates, Inc.
Recommendations for the Clinical Use of the Apperceptive Personality Test David E. Silber, Stephen A. Karp, and Robert W. Holmstrom Downloaded by [University of Sussex Library] at 02:32 02 February 2015
The George Washington University
The Apperceptive Personality Test (APT) is a new technique that combines the traditional story-telling method with a questionnaire about the characters in the story, to be filled out by the person being tested. The resulting information is tabulated, and a variety of scores are generated which yield information about the person's personality. The identified clinical signposts indicated by such scores are summarized in this article, along with two illustrative protocol fragments showing how the usual interpretive method is supplemented by the information from the questionnaire.
The Apperceptive Personality Test (APT) has recently been published as a multi-use personality assessment device (Karp, Holmstrom, Silber, & Condrell, 1989). Its reliability and validity have been established using samples that varied by age (Karp, Hall, Holmstrom, Silber, & Reiss, 1989), race, ethnicity (Karp, Holmstrom, Silber, & Reiss, 1989), gender (Silber, Wells, Holmstrom, & Karp, 1989), and psychiatric status (Karp, Brooks, Silber, Holmstrom, & Rosenauer, 1989). However, except for one report o n its clinical use (Silber, Karp, & Holmstrom, 1988), little is available t o the potential user aside from very basic material in the Manual (Karp, Holmstrom, & Silber, 1989). This article adds suggestions and recommendations gleaned from 5 years of continual clinical use of the APT in personality evaluation. For those not familiar with the APT, it combines a traditional apperceptive technique (telling stories about pictures) with a client-rated questionnaire concerning the character in the stories. The ratings are made by the person being tested, so that scoring decisions are objective and highly reliable; the results are computer scored, and a variety of indices are printed. There are eight plates, each depicting people with ambiguous expressions susceptible t o different interpretations, and most of the ~ l a t e s(six) depict two persons. Figure 1 shows Card 6 from APT and the portion of the questionnaire that asks for personality ratings of the characters. For a full description of the test, see Holmstrom, Silber,
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CLWICAL USE OF TKE APT
V E R Y
Smart 1 Mean 1 Capable 1 Caring 1 Dishonest 1 Aleader 1 Happy 1 Trustworthy1 Successful 1
F A I R L Y 2
2 2 2 2 2 2 2 2
A
M I D D L E
B I T
3
A B I T
F A I R L Y
V E R Y
5 6 7 6 7 K i 3 5 6 7 3 5 6 7 3 5 6 7 3 5 6 7 3 4 5 6 7 S 3 4 5 6 7 3 4 5 6 7
3
4
4
5 4 4 4 4
791
Stupid d Inept Indifferent Honest Afollower a d Untrustworthy Unsuccessful n
FIGURE 1 APT Card 6 and the ratings from the questionnaire. Reproduced with permission of International Diagnostic Systems, Inc.
and Karp (1990). The kPT is suitable for a variety of uses, including traditional, projective-based clinical interpretations of personality, enhanced by the presence of the information on the questionnaire. Although over 400 scores are generated by the scoring program (Karp, 1989), research and clinical interpretation has focused on 22 primary variables.
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GENERAL CONSIDERATIONS As with any clinical evaluation, the behavior of the client and the information gathered during the interview and from other tests is always integrated with interpretation of the APT. The APT user has three major sources of data: the behavior of the client during the testing and evaluation session, the stories generated by the plates, and the client's ratings of the characters in their stories. Research has suggested that the APT stories are longer-and hopefully richerwhen the test is given toward the end of the evaluation. In interpreting the meaning of the stories and the ratings, it has been found that often the stories to the APT are germane both to the person's total life situation and to specific concerns of the moment. Of the eight plates in the series, the last plate (Card 8, which shows a young person sitting on a park bench) tends to elicit the most autobiographical and easily recognized self-referant themes; these stories tend to reflect central concerns, issues, or conflicts in the client's life. Similarly, the questionnaire ratings to the first card (typically identified as a mother and daughter inside their own home) tend to be most helpful as indicators of the person's relations with significant others. The plates tend to evoke more emotional demand as the series continues, so that any observable increase in blandness or distance may suggest the person's reactivity to affective-evoking situations. Clinical interpretation should take into account that certain themes occur quite commonly in response to the APT plates. The common APT themes are listed in the Manual (Karp, Holmstrom, & Silber, 1989, p. 14); of the common themes, three are given frequently enough to be considered as "populars": Card 1 (an adult female in the foreground, a young girl in the background) elicits stories about a worried mother and a concerned daughter. Card 3 (an older man and a younger man on a couch) elicits themes of a father or father-figure giving advice to a son or someone in a similar situation, who is not happy about being there or getting the advice or both. Card 7 (two young-appearing males sitting down, close to each other) elicits themes of friends discussing their hopes and experiences, such as going to college or dating a particular girl. These cards were drawn to suggest several possible story lines. Card 1 can result in stories about an uruly daughter, about a worried mother, or a family problem. Card 3 may suggest a therapist-client relationship, a family discussion, or teacher-student conference. Card 7 could be interpreted as two friends discussing something or a pair of lovers (the figures are placed very close to each other). Stories that depart markedly from the popular themes are much more
CLINICAL USE OF THE APT
7%
likely to represent important interpersonal concerns of the client than those that do not.
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SPECIFIC CLINICAL SIGNPOSTS I . Attention/concentration. The indices helpful in highlighting problems in attention to the task are: (a) if two or more stories that neglect important picture elements (e.g., not mentioning the supine figure on Card 4 or the child-like figure on Card I), (b) if two or more stories in which the relationship of the figures to each other as given in the questionnaire does not match the relationship given in the story, (c) if very low character distinction scores would signal disinterest in the task, and (d) if all numbers are the same for a character on their ratings for two or more characters. 2. Cognitive deterioration. Three indices of serious cognitive deterioration are: (a) stories that are unrelated to the general visual stimuli of the plates, (b) an unusually high number of extreme negative ratings of characters on the rating scales, and (c) five or more stories in which the relationship of the figures on the questionnaire does not match those in the story. 3. Ego boundaries (self-other distinctions). Deteriorated ego boundaries are apparent when there is loss of emotional distance from the material, as signalled by lavish use of adjectives on three or more stories, ~ersonalizedstatements woven into two or more stories, or personal comments about the characters and their actions. In addition, very high character distinction scores might signal pathological processes. 4. Defensiveness. Defensiveness may be signalled in various ways on the APT: (a) short, unelaborated stories that are descriptive are associated with guardetdness; (b) stories that reflect the most obvious interpretation (populars) may indicate general guardedness as a style or to the evaluation (e.g., as a reuslt of suspiciousness); (c) defensiveness as a style may be reflected in a high percentage of extreme positive ratings or extremely positive outcomes-or both-on the questionnaire; (d) giving a story with two or more themes, without being able to pick one to focus on may be related to defensiveness; and (e) reference to guardedness on the part of the characters in more than one story is an indication of defensiveness. 5. Reality orientation. Problems in relating to reality may be signalled by: (a) stories that are disorganized; (b) stories that deviate from the picture stimuli lm unreasonable ways; (c)acceptance of the situation as real; (d)two or more stories that are peculiar, bizarre, or with peculiarities in the answers to the questionnaire; and (e) having a very high total extreme outcome score or total extreme rating score. 6. Paranoid thinking. Paranoid suspiciousness in the absence of guardedness on the part of the person is manifested as suspicion in stories-except Number 7 (two males sitting close together)-and in low ratings for trustworthy. Paranoid
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suspiciousness with guardedness (e.g., fear of disclosure to others) is associated with extremely low hostility scores and excessively high percentages of positive ratings, plus two or more blanks in response to the question, "who is the hero(ine) of the story?" 7. Emotional intensity. Emotional intensity in a person is signalled by the tone in the stories and types of feelings given on the questionnaire. The hostility scores separate the degree of angry feelings from angry actions, whereas the strong feelings indicate the intensity of emotions in general. More than 75% strong feelings may be associated wth depression or mania, whereas less than 50% strong feelings may signal an apathetic, schizoid orientation. 8. Intellect. Intellectual abilities-though not necessarily functioning useful intellect-are related to: (a) richness of vocabulary, (b) story length, (c) creativity of story themes, (d) coherence of story line, and (f) the ability to fulfill the tasks with a minimum of explanation or guidance. Research in progress suggests that Wechsler Adult Intelligence Scale-Revised Vocabulary scores do not correlate with any questionnaire indices. 9. Impulsiveness. Faulty impulse control relates to the degree to which hostile actions (HA) T-scores are higher than hostile feelings (HF) T-scores. Extremely high percentage of strong feelings may signal reduced impulse control as well. 10. Pessimistic outlook. Negative story outcomes, low averages on attitude towards others (an average of five of the rating scales), plus low story outcome ratings are combined in the outlook index and reflect a pessimistic view of others and the world. 11. Leadership potential. Leadership potential in males is associated with high scores on the questionnaire for initiating actions, leadership ratings, and successful ratings. 12. Anxiety. No single sign or index is currently identified as suggesting clinically relevant anxiety. Patterns of very low scores on average outcome (and, for females, attitudes towards others) and high scores for HA and character distinction (and, for males, on negative extreme outcomes) have been found to be associated with Minnesota Multiphasic Personality Inventory measures of anxiety. Table 1 summarizes these clinical signs, including percentages and T-scores where appropriate.
ILLUSTRATIVE PROTOCOLS The clinical user of the APT will use general signposts and a story-by-story approach to enhance conclusions. What follows is a fragment from an APT protocol (stories and questionnaire results) and interpretive comments, which is followed by a full APT protocol and commentary. The first APT fragment was obtained from a 40-year-old male. There were clear behavioral indications of an Axis I1 paranoid personalty disorder: He was
TABLE 1 Summary of Clinical Signposts From the APT Characteristic
Indications
Attention/concentration
Neglect important visual elements? Card & questionnaire relations match? Same number for all rating scales for 2 or more characters? Character distinction score T < 407 Stories unrelated to stimuli? 17% or more extreme negative ratings? Low emotional distance? Personal statements? Character distinction T > 601 Personal comments in stories? Short stories? Unelaborated stories? 40% or more extreme positive ratings? 36% or more extreme positive outcomes? 5 or more "popular" themes? Guarded characters in the stories? Guarded stories to the cards? Two or more themes to the same card? Less than 65% initiates feelings? Disorganized stories? Acceptance of stories as real? Stories deviate unreasonably from cards? 2 or more peculiar, bizzare stories? Peculiar, bizarre questionnaire ratings? Total extreme outcome above T = 601 Totae Extreme ratings above T = 60? Suspicion on stories? Ratings for trustworthiness below 4.50? Hostile actions less than 15%? Hostlle feelings less than lo%? 2 or more hero/ine answers left blank? Story tone Intense on three or more? Strong feelings > 75% or < 50%? Hostile feelings greater than 30%? Rich vocabulary in stories & interview? Creative stories? Long, coherant stories? Fulfill tasks with minimum of guidance? Impulsive score noted on questionnaire? Strong feelings more than 75%? 10% or more extreme negative outcomes? Attitude towards others T < 40%? Average happy-sad ratings less than 3.5?
Cognitive deterioration
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Ego boundaries
Defensiveness
Realitv orientation
Paranoid thinking
Emotional intensity
Intellect
Impulsiveness Pessimistic outlook
Yes?
-
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SILBER, KARP, HOLMSTROM TABLE 1(Continued)
Leadership (males only)
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Anxiety
Initiates actions T > 65%? Leadership ratings T > 60% Pattern of low average outcome scores (T < 40) and high hostile actions (T > 60) and high Character distinction (T > 60) and (males) high Negative extreme outcomes (> 15%) and (females) low attitudes towards others (T < 40)?
suspicious, constantly in trouble with his superiors because of his prickly insistence on adhering strictly to the regulations, unwillingness to compromise, and fearfulness of conspiracies. He continually received complaints by customers about his rude and brusque attitude. Three APT stories and questionnaire ratings follow.
APT Protocol: Mr. V Guarded, 40-Year-Old Male Card 2. (Puts his case in his lap.) A female, possibly in her early 20s, average clothes, possibly living at home. Possibly a mirror or glass sliding door in the background. She could be watching TV, come home from work, or from school or college. She just sat down, is being reflective . . . sitting down, before dinner time. That's all I can say . . this is like a Rorschach . . . I'm uncomfortable with this task.
.
Questionnaire. All ratings are middle ones, and the outcome is rated neutral. Card 3. It looks like two Caucasian males sitting on a sofa. The older one has a relationship with the younger. The younger one is frowning a bit; the leg is in an uncomfortable position. The older one, the adult, is explaining something. The problem is more personal than anything. The outcome, I don't know. These look like pictures of people with problems. Questionnaire. The figures are father and son; father is concerned about the son, and the son is worried; father teaches, and the son is taught by the father. The father is rated positively except for a middle rating on happiness, although the son is rated less positively: very sad, fairly unsuccessful, and a bit of a follower. Card 7. Two collegiate males, sitting on a blanket somewhere, just talking.
I don't see a conflict in this. Background looks like trees, not a beach. They haven't been hiking far, because they're not wearing hiking shoes. Maybe it's some wooded area not far from a park. Definitely wearing sneakers, not hiking shoes.
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Questionnaire. They are friends, each liked by the other, who rake no action toward each other. The outcome is neutral, and the ratings to be neutral -plus identical for both of them.
Comment. The three stories indicate his persistent discomfort with interpersonal situations, especially those that suggest problems; his avoidance of anything that would reveal his inner feelings; and his characteristic defensiveness. He uses intellectualization and distancing (concentrating on relatively unimportant details). When the stimuli are potentially quite evocative-as in Card 7- he became less organized; the issue (hiking or not) has no connection with the picture at all. He is somewhat aware of his tendencies, but cannot or will not change his style. Although underlying insecurity and concerns about interpersonal contact contribute to his behavior, the APT stories are consistent with the behavior pattern and the resulting Axis I1 diagnosis. The second protocol involved a person suspected on having an alcolhol abuse problem. He had been in two alcohol-related auto accidents (2 years apart), had been arrested following an alcohol induced brawl, and had unalergone an inpatient alcohol rehabilitation program 6 months prior to the evaduation. He was referred because, since the program, his employer was concerned about his likelihood of secretly abusing alcohol. He denied alcohol use as well as any particular problems. He was very concerned about keeping his job, and cooperated well.
APT Protocol: Mr. E Proof Card 1. Mother is sitting at a table, possibly worried about something, some type of ~roblem,possibly mad at the little girl. And the little girl is standing behind her, asking for her forgiveness, asking her not to worry (outcome?)Mother turns around, hugs the child, and says, "everything wiIl be OK."
.
Card 2. The lady just came home, and is sitting on the bed . . medicines on the table. Contemplating whether she's gonna' take it. (Outcome?)She just lays down and takes a nap. She could be contemplating suicide, but . . . she'll take a nap and sleep. Card 3. It looks like a father, sitting down, talking to his son, giving him some advice. And he seems to be thinking it over. (Advice?)How to pay his bills or whatever. Better manage his finances. Card 4. It looks like a lady, standing at a window looking at a man laying on a stretcher, who just had injuries. Hoping he'll be OK. She's holding her hand. He could have done something to her also, the way she's holding it.
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Card 5. It looks like a mother talking to her son. Maybe just coming out of the shower. (Saying?)Maybe he got home late, and she's questioning him why he got home late. If it's late. The picture doesn't define if it's late or not. He might be off to school, and she got up to see him off. Card 6. It looks like a guy getting ready to kiss a girl. Maybe he's gonna give her a kiss before he leaves . . . he's going out.
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Card 7. It looks like two guys sitting in the woods talking. One is daydreaming or deep in thought about something. Or maybe he's being given some advice and is thinking about the advice he's being given. Card 8. This looks like a little girl, sitting on a park bench, thinking. Maybe worried about something. A worried expression on her face . . . how to deal with it. And, she. . . may go to someone she can talk to about it. (Outcome?)She gets good advice, and (lost name) gives her a variety of things to do, and she chooses to do the right thing. Questionnaire. Of the general indications summarized in Table 1, all were average except three: He manifested some reduced impulse control, some defensiveness, and a very low pattern of anxiety. He rated his characters as happier than usual (T = 63, roughly the 90th percentile). His pattern of questionnaire answers showed some similarity to that of inpatient depressive patients, but not to inpatient alcoholic patients.
Comment. The stories that pictured single figures (Cards 2 and 8) were reflective of uncertainty and some depression. The remainder suggest a person who is fairly passive, concerned about his behavior, and expecting others to guide him. The three noteworthy clinical signs might be expected of a person at risk for alcohol abuse, even though the overall pattern did not show similarity to that of inpatient alcoholic patients; it appears he is at some risk for returning to alcohol abuse, but not currently abusing the drug. He appears to be experiencing some doubt with regard to the near future. He appears receptive to external help, and in fact appears, from the stories, to be contemplating whether to seek help. A postevaluation interview with Mr. Proof confirmed that he was occasionally drinking and that he did not feel he should be blamed for his difficulty, because he did not know when he was hired that his drinking was evidence "of a disease." He was receptive to counseling and agreed to both individual therapy and attendance at Alcoholics Anonymous. SUMMARY The APT is a helpful addition for clinical use and provides the psychodiagnostician with an easily scored, reliable, and fairly robust method of
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personality evaluation, By combining the traditional advantages of older apperceptive methods with objectively scored information, it widens the clinical possibilities for a variety of evaluation tasks.
ACKNOWLEDGMENT
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An earlier version of this article was presented at the Society for Personality Assessment Annual Meeting in San Diego, March 22-24, 1990.
REFERENCES Holmstrom, R. W., Silber, D. E., & Karp, S. A. (1990). Development of the Apperceptive Personality Test. Joumal of Personality Assessment, 54, 252-264. Karp, S. A. (1989). Scoring Program, APT. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Brooks, R., Silber, D. E., Holmstrom, R. W., & Rosenauer, A. (1989, April). Comparison of psychotics, alcoholics and normals on the Apperceptive Personality Test (APT). Paper presented at the Mid-Winter Meeting of the Society for Personality Assessment, New York. Karp, S. A., Hall, R., Holmstrom, R. W., Silber, D. E., & Reiss, M. (1989). Effects of age upon Apperceptive Personality Test Performance. IDS Monograph Series, 1(Whole No. 2). Karp, S. A., Holmstron, R. W., & Silber, D. E. (1989). Manual: Apperceptive Pe~sonalityTest. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Holmstrom, R. W., Silber, D. E., & Condrell, C. (1989). Apperceptive Personality Test. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Holmstrom, R. W., Silber, D. E., & Reiss, S. (1989). Effects of race, ethnicity, and private college status upon Apperceptive Personality Test Performance. IDS Monograph Series, I(Whole No. 1). Silber, D. E., Karp, S. A., & Holmstrom, R. W. (1988, March). The clinical we of the Appercepiioe Personality Test (APT).Paper presented at the Mid-Winter Meeting of the Society for Personality Assessment, New Orleans. Silber, D. E., Wells, M., Holmstrom, R. W., & Karp, S. A. (1989, April). Validity of the Apperceptive Personality Test (APT): Comparisons with the Edwards Personal Preference Schedule. Paper presenited at the Mid-Winter Meeting of the Society for Personality Assessment, New York.
David E. Silber Department of Psychology George Washington University Washington, DC 20052 Received February 26, 1990
Journal of Personality Assessment Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjpa20
Recommendations for the Clinical Use of the Apperceptive Personality Test David E. Silber , Stephen A. Karp & Robert W. Holmstrom Published online: 22 Jun 2011.
To cite this article: David E. Silber , Stephen A. Karp & Robert W. Holmstrom (1990) Recommendations for the Clinical Use of the Apperceptive Personality Test, Journal of Personality Assessment, 55:3-4, 790-799, DOI: 10.1080/00223891.1990.9674113 To link to this article: http://dx.doi.org/10.1080/00223891.1990.9674113
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF PERSONALTY ASSESSMENT, 1990, 55(3&4), 790-799 Copyright GJ 1990, Lawrence Erlbaum Associates, Inc.
Recommendations for the Clinical Use of the Apperceptive Personality Test David E. Silber, Stephen A. Karp, and Robert W. Holmstrom Downloaded by [University of Sussex Library] at 02:32 02 February 2015
The George Washington University
The Apperceptive Personality Test (APT) is a new technique that combines the traditional story-telling method with a questionnaire about the characters in the story, to be filled out by the person being tested. The resulting information is tabulated, and a variety of scores are generated which yield information about the person's personality. The identified clinical signposts indicated by such scores are summarized in this article, along with two illustrative protocol fragments showing how the usual interpretive method is supplemented by the information from the questionnaire.
The Apperceptive Personality Test (APT) has recently been published as a multi-use personality assessment device (Karp, Holmstrom, Silber, & Condrell, 1989). Its reliability and validity have been established using samples that varied by age (Karp, Hall, Holmstrom, Silber, & Reiss, 1989), race, ethnicity (Karp, Holmstrom, Silber, & Reiss, 1989), gender (Silber, Wells, Holmstrom, & Karp, 1989), and psychiatric status (Karp, Brooks, Silber, Holmstrom, & Rosenauer, 1989). However, except for one report o n its clinical use (Silber, Karp, & Holmstrom, 1988), little is available t o the potential user aside from very basic material in the Manual (Karp, Holmstrom, & Silber, 1989). This article adds suggestions and recommendations gleaned from 5 years of continual clinical use of the APT in personality evaluation. For those not familiar with the APT, it combines a traditional apperceptive technique (telling stories about pictures) with a client-rated questionnaire concerning the character in the stories. The ratings are made by the person being tested, so that scoring decisions are objective and highly reliable; the results are computer scored, and a variety of indices are printed. There are eight plates, each depicting people with ambiguous expressions susceptible t o different interpretations, and most of the ~ l a t e s(six) depict two persons. Figure 1 shows Card 6 from APT and the portion of the questionnaire that asks for personality ratings of the characters. For a full description of the test, see Holmstrom, Silber,
Downloaded by [University of Sussex Library] at 02:32 02 February 2015
CLWICAL USE OF TKE APT
V E R Y
Smart 1 Mean 1 Capable 1 Caring 1 Dishonest 1 Aleader 1 Happy 1 Trustworthy1 Successful 1
F A I R L Y 2
2 2 2 2 2 2 2 2
A
M I D D L E
B I T
3
A B I T
F A I R L Y
V E R Y
5 6 7 6 7 K i 3 5 6 7 3 5 6 7 3 5 6 7 3 5 6 7 3 4 5 6 7 S 3 4 5 6 7 3 4 5 6 7
3
4
4
5 4 4 4 4
791
Stupid d Inept Indifferent Honest Afollower a d Untrustworthy Unsuccessful n
FIGURE 1 APT Card 6 and the ratings from the questionnaire. Reproduced with permission of International Diagnostic Systems, Inc.
and Karp (1990). The kPT is suitable for a variety of uses, including traditional, projective-based clinical interpretations of personality, enhanced by the presence of the information on the questionnaire. Although over 400 scores are generated by the scoring program (Karp, 1989), research and clinical interpretation has focused on 22 primary variables.
792
SILBER, KARF, HOLMSTROM
Downloaded by [University of Sussex Library] at 02:32 02 February 2015
GENERAL CONSIDERATIONS As with any clinical evaluation, the behavior of the client and the information gathered during the interview and from other tests is always integrated with interpretation of the APT. The APT user has three major sources of data: the behavior of the client during the testing and evaluation session, the stories generated by the plates, and the client's ratings of the characters in their stories. Research has suggested that the APT stories are longer-and hopefully richerwhen the test is given toward the end of the evaluation. In interpreting the meaning of the stories and the ratings, it has been found that often the stories to the APT are germane both to the person's total life situation and to specific concerns of the moment. Of the eight plates in the series, the last plate (Card 8, which shows a young person sitting on a park bench) tends to elicit the most autobiographical and easily recognized self-referant themes; these stories tend to reflect central concerns, issues, or conflicts in the client's life. Similarly, the questionnaire ratings to the first card (typically identified as a mother and daughter inside their own home) tend to be most helpful as indicators of the person's relations with significant others. The plates tend to evoke more emotional demand as the series continues, so that any observable increase in blandness or distance may suggest the person's reactivity to affective-evoking situations. Clinical interpretation should take into account that certain themes occur quite commonly in response to the APT plates. The common APT themes are listed in the Manual (Karp, Holmstrom, & Silber, 1989, p. 14); of the common themes, three are given frequently enough to be considered as "populars": Card 1 (an adult female in the foreground, a young girl in the background) elicits stories about a worried mother and a concerned daughter. Card 3 (an older man and a younger man on a couch) elicits themes of a father or father-figure giving advice to a son or someone in a similar situation, who is not happy about being there or getting the advice or both. Card 7 (two young-appearing males sitting down, close to each other) elicits themes of friends discussing their hopes and experiences, such as going to college or dating a particular girl. These cards were drawn to suggest several possible story lines. Card 1 can result in stories about an uruly daughter, about a worried mother, or a family problem. Card 3 may suggest a therapist-client relationship, a family discussion, or teacher-student conference. Card 7 could be interpreted as two friends discussing something or a pair of lovers (the figures are placed very close to each other). Stories that depart markedly from the popular themes are much more
CLINICAL USE OF THE APT
7%
likely to represent important interpersonal concerns of the client than those that do not.
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SPECIFIC CLINICAL SIGNPOSTS I . Attention/concentration. The indices helpful in highlighting problems in attention to the task are: (a) if two or more stories that neglect important picture elements (e.g., not mentioning the supine figure on Card 4 or the child-like figure on Card I), (b) if two or more stories in which the relationship of the figures to each other as given in the questionnaire does not match the relationship given in the story, (c) if very low character distinction scores would signal disinterest in the task, and (d) if all numbers are the same for a character on their ratings for two or more characters. 2. Cognitive deterioration. Three indices of serious cognitive deterioration are: (a) stories that are unrelated to the general visual stimuli of the plates, (b) an unusually high number of extreme negative ratings of characters on the rating scales, and (c) five or more stories in which the relationship of the figures on the questionnaire does not match those in the story. 3. Ego boundaries (self-other distinctions). Deteriorated ego boundaries are apparent when there is loss of emotional distance from the material, as signalled by lavish use of adjectives on three or more stories, ~ersonalizedstatements woven into two or more stories, or personal comments about the characters and their actions. In addition, very high character distinction scores might signal pathological processes. 4. Defensiveness. Defensiveness may be signalled in various ways on the APT: (a) short, unelaborated stories that are descriptive are associated with guardetdness; (b) stories that reflect the most obvious interpretation (populars) may indicate general guardedness as a style or to the evaluation (e.g., as a reuslt of suspiciousness); (c) defensiveness as a style may be reflected in a high percentage of extreme positive ratings or extremely positive outcomes-or both-on the questionnaire; (d) giving a story with two or more themes, without being able to pick one to focus on may be related to defensiveness; and (e) reference to guardedness on the part of the characters in more than one story is an indication of defensiveness. 5. Reality orientation. Problems in relating to reality may be signalled by: (a) stories that are disorganized; (b) stories that deviate from the picture stimuli lm unreasonable ways; (c)acceptance of the situation as real; (d)two or more stories that are peculiar, bizarre, or with peculiarities in the answers to the questionnaire; and (e) having a very high total extreme outcome score or total extreme rating score. 6. Paranoid thinking. Paranoid suspiciousness in the absence of guardedness on the part of the person is manifested as suspicion in stories-except Number 7 (two males sitting close together)-and in low ratings for trustworthy. Paranoid
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suspiciousness with guardedness (e.g., fear of disclosure to others) is associated with extremely low hostility scores and excessively high percentages of positive ratings, plus two or more blanks in response to the question, "who is the hero(ine) of the story?" 7. Emotional intensity. Emotional intensity in a person is signalled by the tone in the stories and types of feelings given on the questionnaire. The hostility scores separate the degree of angry feelings from angry actions, whereas the strong feelings indicate the intensity of emotions in general. More than 75% strong feelings may be associated wth depression or mania, whereas less than 50% strong feelings may signal an apathetic, schizoid orientation. 8. Intellect. Intellectual abilities-though not necessarily functioning useful intellect-are related to: (a) richness of vocabulary, (b) story length, (c) creativity of story themes, (d) coherence of story line, and (f) the ability to fulfill the tasks with a minimum of explanation or guidance. Research in progress suggests that Wechsler Adult Intelligence Scale-Revised Vocabulary scores do not correlate with any questionnaire indices. 9. Impulsiveness. Faulty impulse control relates to the degree to which hostile actions (HA) T-scores are higher than hostile feelings (HF) T-scores. Extremely high percentage of strong feelings may signal reduced impulse control as well. 10. Pessimistic outlook. Negative story outcomes, low averages on attitude towards others (an average of five of the rating scales), plus low story outcome ratings are combined in the outlook index and reflect a pessimistic view of others and the world. 11. Leadership potential. Leadership potential in males is associated with high scores on the questionnaire for initiating actions, leadership ratings, and successful ratings. 12. Anxiety. No single sign or index is currently identified as suggesting clinically relevant anxiety. Patterns of very low scores on average outcome (and, for females, attitudes towards others) and high scores for HA and character distinction (and, for males, on negative extreme outcomes) have been found to be associated with Minnesota Multiphasic Personality Inventory measures of anxiety. Table 1 summarizes these clinical signs, including percentages and T-scores where appropriate.
ILLUSTRATIVE PROTOCOLS The clinical user of the APT will use general signposts and a story-by-story approach to enhance conclusions. What follows is a fragment from an APT protocol (stories and questionnaire results) and interpretive comments, which is followed by a full APT protocol and commentary. The first APT fragment was obtained from a 40-year-old male. There were clear behavioral indications of an Axis I1 paranoid personalty disorder: He was
TABLE 1 Summary of Clinical Signposts From the APT Characteristic
Indications
Attention/concentration
Neglect important visual elements? Card & questionnaire relations match? Same number for all rating scales for 2 or more characters? Character distinction score T < 407 Stories unrelated to stimuli? 17% or more extreme negative ratings? Low emotional distance? Personal statements? Character distinction T > 601 Personal comments in stories? Short stories? Unelaborated stories? 40% or more extreme positive ratings? 36% or more extreme positive outcomes? 5 or more "popular" themes? Guarded characters in the stories? Guarded stories to the cards? Two or more themes to the same card? Less than 65% initiates feelings? Disorganized stories? Acceptance of stories as real? Stories deviate unreasonably from cards? 2 or more peculiar, bizzare stories? Peculiar, bizarre questionnaire ratings? Total extreme outcome above T = 601 Totae Extreme ratings above T = 60? Suspicion on stories? Ratings for trustworthiness below 4.50? Hostile actions less than 15%? Hostlle feelings less than lo%? 2 or more hero/ine answers left blank? Story tone Intense on three or more? Strong feelings > 75% or < 50%? Hostile feelings greater than 30%? Rich vocabulary in stories & interview? Creative stories? Long, coherant stories? Fulfill tasks with minimum of guidance? Impulsive score noted on questionnaire? Strong feelings more than 75%? 10% or more extreme negative outcomes? Attitude towards others T < 40%? Average happy-sad ratings less than 3.5?
Cognitive deterioration
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Ego boundaries
Defensiveness
Realitv orientation
Paranoid thinking
Emotional intensity
Intellect
Impulsiveness Pessimistic outlook
Yes?
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Leadership (males only)
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Anxiety
Initiates actions T > 65%? Leadership ratings T > 60% Pattern of low average outcome scores (T < 40) and high hostile actions (T > 60) and high Character distinction (T > 60) and (males) high Negative extreme outcomes (> 15%) and (females) low attitudes towards others (T < 40)?
suspicious, constantly in trouble with his superiors because of his prickly insistence on adhering strictly to the regulations, unwillingness to compromise, and fearfulness of conspiracies. He continually received complaints by customers about his rude and brusque attitude. Three APT stories and questionnaire ratings follow.
APT Protocol: Mr. V Guarded, 40-Year-Old Male Card 2. (Puts his case in his lap.) A female, possibly in her early 20s, average clothes, possibly living at home. Possibly a mirror or glass sliding door in the background. She could be watching TV, come home from work, or from school or college. She just sat down, is being reflective . . . sitting down, before dinner time. That's all I can say . . this is like a Rorschach . . . I'm uncomfortable with this task.
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Questionnaire. All ratings are middle ones, and the outcome is rated neutral. Card 3. It looks like two Caucasian males sitting on a sofa. The older one has a relationship with the younger. The younger one is frowning a bit; the leg is in an uncomfortable position. The older one, the adult, is explaining something. The problem is more personal than anything. The outcome, I don't know. These look like pictures of people with problems. Questionnaire. The figures are father and son; father is concerned about the son, and the son is worried; father teaches, and the son is taught by the father. The father is rated positively except for a middle rating on happiness, although the son is rated less positively: very sad, fairly unsuccessful, and a bit of a follower. Card 7. Two collegiate males, sitting on a blanket somewhere, just talking.
I don't see a conflict in this. Background looks like trees, not a beach. They haven't been hiking far, because they're not wearing hiking shoes. Maybe it's some wooded area not far from a park. Definitely wearing sneakers, not hiking shoes.
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Questionnaire. They are friends, each liked by the other, who rake no action toward each other. The outcome is neutral, and the ratings to be neutral -plus identical for both of them.
Comment. The three stories indicate his persistent discomfort with interpersonal situations, especially those that suggest problems; his avoidance of anything that would reveal his inner feelings; and his characteristic defensiveness. He uses intellectualization and distancing (concentrating on relatively unimportant details). When the stimuli are potentially quite evocative-as in Card 7- he became less organized; the issue (hiking or not) has no connection with the picture at all. He is somewhat aware of his tendencies, but cannot or will not change his style. Although underlying insecurity and concerns about interpersonal contact contribute to his behavior, the APT stories are consistent with the behavior pattern and the resulting Axis I1 diagnosis. The second protocol involved a person suspected on having an alcolhol abuse problem. He had been in two alcohol-related auto accidents (2 years apart), had been arrested following an alcohol induced brawl, and had unalergone an inpatient alcohol rehabilitation program 6 months prior to the evaduation. He was referred because, since the program, his employer was concerned about his likelihood of secretly abusing alcohol. He denied alcohol use as well as any particular problems. He was very concerned about keeping his job, and cooperated well.
APT Protocol: Mr. E Proof Card 1. Mother is sitting at a table, possibly worried about something, some type of ~roblem,possibly mad at the little girl. And the little girl is standing behind her, asking for her forgiveness, asking her not to worry (outcome?)Mother turns around, hugs the child, and says, "everything wiIl be OK."
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Card 2. The lady just came home, and is sitting on the bed . . medicines on the table. Contemplating whether she's gonna' take it. (Outcome?)She just lays down and takes a nap. She could be contemplating suicide, but . . . she'll take a nap and sleep. Card 3. It looks like a father, sitting down, talking to his son, giving him some advice. And he seems to be thinking it over. (Advice?)How to pay his bills or whatever. Better manage his finances. Card 4. It looks like a lady, standing at a window looking at a man laying on a stretcher, who just had injuries. Hoping he'll be OK. She's holding her hand. He could have done something to her also, the way she's holding it.
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Card 5. It looks like a mother talking to her son. Maybe just coming out of the shower. (Saying?)Maybe he got home late, and she's questioning him why he got home late. If it's late. The picture doesn't define if it's late or not. He might be off to school, and she got up to see him off. Card 6. It looks like a guy getting ready to kiss a girl. Maybe he's gonna give her a kiss before he leaves . . . he's going out.
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Card 7. It looks like two guys sitting in the woods talking. One is daydreaming or deep in thought about something. Or maybe he's being given some advice and is thinking about the advice he's being given. Card 8. This looks like a little girl, sitting on a park bench, thinking. Maybe worried about something. A worried expression on her face . . . how to deal with it. And, she. . . may go to someone she can talk to about it. (Outcome?)She gets good advice, and (lost name) gives her a variety of things to do, and she chooses to do the right thing. Questionnaire. Of the general indications summarized in Table 1, all were average except three: He manifested some reduced impulse control, some defensiveness, and a very low pattern of anxiety. He rated his characters as happier than usual (T = 63, roughly the 90th percentile). His pattern of questionnaire answers showed some similarity to that of inpatient depressive patients, but not to inpatient alcoholic patients.
Comment. The stories that pictured single figures (Cards 2 and 8) were reflective of uncertainty and some depression. The remainder suggest a person who is fairly passive, concerned about his behavior, and expecting others to guide him. The three noteworthy clinical signs might be expected of a person at risk for alcohol abuse, even though the overall pattern did not show similarity to that of inpatient alcoholic patients; it appears he is at some risk for returning to alcohol abuse, but not currently abusing the drug. He appears to be experiencing some doubt with regard to the near future. He appears receptive to external help, and in fact appears, from the stories, to be contemplating whether to seek help. A postevaluation interview with Mr. Proof confirmed that he was occasionally drinking and that he did not feel he should be blamed for his difficulty, because he did not know when he was hired that his drinking was evidence "of a disease." He was receptive to counseling and agreed to both individual therapy and attendance at Alcoholics Anonymous. SUMMARY The APT is a helpful addition for clinical use and provides the psychodiagnostician with an easily scored, reliable, and fairly robust method of
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personality evaluation, By combining the traditional advantages of older apperceptive methods with objectively scored information, it widens the clinical possibilities for a variety of evaluation tasks.
ACKNOWLEDGMENT
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An earlier version of this article was presented at the Society for Personality Assessment Annual Meeting in San Diego, March 22-24, 1990.
REFERENCES Holmstrom, R. W., Silber, D. E., & Karp, S. A. (1990). Development of the Apperceptive Personality Test. Joumal of Personality Assessment, 54, 252-264. Karp, S. A. (1989). Scoring Program, APT. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Brooks, R., Silber, D. E., Holmstrom, R. W., & Rosenauer, A. (1989, April). Comparison of psychotics, alcoholics and normals on the Apperceptive Personality Test (APT). Paper presented at the Mid-Winter Meeting of the Society for Personality Assessment, New York. Karp, S. A., Hall, R., Holmstrom, R. W., Silber, D. E., & Reiss, M. (1989). Effects of age upon Apperceptive Personality Test Performance. IDS Monograph Series, 1(Whole No. 2). Karp, S. A., Holmstron, R. W., & Silber, D. E. (1989). Manual: Apperceptive Pe~sonalityTest. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Holmstrom, R. W., Silber, D. E., & Condrell, C. (1989). Apperceptive Personality Test. Orland Park, IL: International Diagnostic Systems. Karp, S. A., Holmstrom, R. W., Silber, D. E., & Reiss, S. (1989). Effects of race, ethnicity, and private college status upon Apperceptive Personality Test Performance. IDS Monograph Series, I(Whole No. 1). Silber, D. E., Karp, S. A., & Holmstrom, R. W. (1988, March). The clinical we of the Appercepiioe Personality Test (APT).Paper presented at the Mid-Winter Meeting of the Society for Personality Assessment, New Orleans. Silber, D. E., Wells, M., Holmstrom, R. W., & Karp, S. A. (1989, April). Validity of the Apperceptive Personality Test (APT): Comparisons with the Edwards Personal Preference Schedule. Paper presenited at the Mid-Winter Meeting of the Society for Personality Assessment, New York.
David E. Silber Department of Psychology George Washington University Washington, DC 20052 Received February 26, 1990
