Computers in Human Behavior, Vol. 6, pp. 207-210, 1990 074%5632/90 $3.00 + .00 Printed in the U.S.A. All rights reserved. Copyright © 1990 Pergamon Press pie

The MMPI Assistant: A Microcomputer Program to Assist in Teaching

Interpretation of the MMPI

Barry A. Tanner

Detroit Receiving Hospital and University Health Center and Wayne State University

Abstract - - The design and distribution of the MMPI Assistant is believed to partially answer several criticisms of commercially available profile interpretation programs. The Assistant is intended for research and training in the interpretation of psychiatric patient profiles only, and output from it is never to appear in a patient's chart. The program encourages the inclusion of additional information by writing to a disk file suitable for editing with a word processor, rather than directly to the printer. The rules used for each interpretive hypothesis precede that hypothesis, first on the screen and then in the output file. Certain blatant attempts to misuse the program result in termination of the program. The program is available only upon completion of a statement agreeing to abide by the author's rules for its use (professional licensure, specific training, target population). Finally, research is encouraged by making the program available to qualified persons at no charge.

While there are numerous commercially available programs for interpreting the MMPI, the Assistant differs from many of these in who it is to be used by, how it may be obtained, how it is to be used, and in the information provided about how it works. Each of these points will be covered below, as the program itself is described.

TARGET AUDIENCE

Although the intended user is not always clearly identified, many commercial pro- grams appear to target service providers. Matarazzo (1985, 1986) has expressed

Requests for reprints should be addressed to Barry A. Tanner, PhD, Psychology 9B, Detroit Receiving Hospital and University Health Center, 4201 St. Antoine, Detroit, M148201.

207

208 Tanner

concern that scoring services and microcomputer programs are likely to be used by professionals with insufficient training in testing to appreciate the limitations of current computer generated interpretations. Fowler (1985) points out that there are no clear standards regarding who is qualified to use psychological tests, and that publishers have traditionally not limited their sale to psychologists, let alone to psychologists qualified in their use. The Assistant is intended to be used primarily as a training tool for future clinical psychologists, and is to be used under the supervision of psychologists already competent with the test. As a result, it is avail- able only to doctoral level clinical psychologists licensed at the independent prac- tice level, who report prior training in and competence with the MMPI. They may then use the Assistant as part of their training programs. The expectation is that graduate students and practicing psychologists will be aware of the limitations of any computer generated interpretation, thereby reducing the likelihood of uncritical acceptance of program output (Honaker, Hector, & Harrell, 1986).

USE OF THE PROGRAM

The Assistant is to be used only for identified psychiatric patients. This is stated on screen as the program runs, and again in the output file. The user is queried regarding the subject of the evaluation, and if the subject is identified as other than a patient, the program aborts.

In order to minimize the likelihood of the program's output being used in isolation, encouragement to use professional judgement appears on screen. The output file contains further statements regarding the need to include information specific to the setting in which it is being used, as well as information about the particular subject of the evaluation. In fact, the very production of an ASCII output file is intended to facilitate loading it into a word processor, where other test and interview data can be added, while the output from the Assistant is modified through professional judgement. Experience with my own students indicates that this approach is feasible.

After passing the admittedly simple tests for use of the program, the user is asked for minimal information about the subject. Raw scores on F and K, as well as T-scores on the basic scores are then entered manually. The Assistant is written in Turbo Basic, requires an IBM PC with at least 90k of available memory, and DOS 2.x or above. Either an MDA or a graphics adaptor and monitor may be used.

INFORMATION PROVIDED

Moreland (1985) has suggested that identifying the studies which are the basis of the interpretive statements contained in computer generated reports, would allow potential users to make better informed decisions about using these reports. Statements in the Assistant were influenced by four actuarial studies (Boerger, Graham, & Lilly, 1974; Gynther, Altman, & Sletten, 1973; Lachar, 1968; Lewandowski & Graham, 1972), four more impressionistic studies (Carson, 1969; Gilberstadt & Duker, 1965; Graham, 1987; Tanner, in press a; Tanner, in press b, by the scholarly work of Dahlstrom, Welsh, & Dahlstrom (1972), and by my own

MMPI interpretation training program 209

experience with the MMPI. An earlier version of the Assistant was demonstrated at a national meeting, where it was subject to peer review (Tanner, 1989).

The American Psychological Association's guidelines for developers of interpretive programs states that adequate information about the system should be made available to allow peer review (APA, 1986). This information should include how test scores are transformed into interpretive statements. The Assistant includes statements for 23 validity configurations, 44 two-point clinical codes (all except the 3-0/0-3 code type), 10 high scoring single-point clinical scales, and 10 low scoring clinical scales. The cutting points for each interpretive statement used for any given profile are provided on screen as the program runs, and precede each interpretive statement in the output file produced by the program. Furthermore, the cutting points are immediately followed in the output file by the subject's scores on the relevant scales, to facilitate the user judging the applicability to a given subject.

One or more validity profile rules are triggered by the subject's scores. The program continues to the clinical scales even if the validity configuration questions the accuracy of self-reporting, in order that the psychologist might determine the applicability of the paragraphs generated. The subject is assigned a two-point code corresponding to the two highest clinical scales, regardless of their absolute elevation, and the associated paragraphs are then printed. Interpretive hypotheses are provided for up to two high scoring scales (T > 64) not part of the two-point code, and up to two low scoring scales (T < 46). Experience with an earlier version of the program, which printed statements for larger numbers of high and low scoring scales, revealed that the likelihood of contradictory statements increased substantially with interpretation of more than two scales. Prognostic and diagnostic hypotheses are then provided, based upon the two-point code. The psychologist is then given the option of including a graphic representation of the profile in the output file, and of running the Assistant again.

AVAILABILITY

The Assistant is available at no charge to qualified psychologists who agree to abide by the author's conditions for its use. Potential users must state in writing that they hold a doctorate in clinical or professional psychology from a regionally accredited university or school of professional psychology, that they are licensed at the independent practice level in state X, that they have been trained in the administration and interpretation of the MMPI, and are competent in the use of the MMPI. Furthermore, they must state that they will use the Assistant only for noncommercial, training and research, and that all output from the program will be rewritten under their supervision, in order to include additional information about subjects. Although they may copy the program for such use under their personal supervision, they may not distribute it to other persons, may not modify the program, and may not include any or all of it in any other programs. Finally, they should send a disk formatted for their system, with a self-addressed, stamped disk mailer.

Admittedly, the attempts described above to decrease the potential for abuse of reports generated by one particular program are limited. A more stringent safeguard against misuse, for example, would be for the program to erase itself rather than simply abort, when the user indicates that the subject of the test is not a psychiatric patient. However, such a response strikes me as extreme, given the

21o Tanner

possibili ty o f a typing error in responding to the program. My bel ief is that the most effect ive and yet reasonable safeguards will be in the form of the way in which the user interacts with the program, requiring increasing sophistication to obtain useful results. Perhaps the next generation of software will include such safeguards.

REFERENCES

American Psychological Association (1986). Guidelines for computer-based tests and interpretations. Washington, DC: American Psychological Association.

Boerger, A.R., Graham, J.R., & Lilly, R.S. (1974). Behavioral correlates of single-scale MMPI code types. Journal of Consulting and Clinical Psychology, 42, 398-402.

Carson, R. C. (1969). Interpretive manual to the MMPI. In J. N. Butcher (Ed.), MMPI: Research developments and clinical applications. New York: McGraw-Hill.

Dahlstrom, W. G., Welsh, G. S., & Dahlstrom, U E. (1972). An MMPI handbook. Volume 1: Clinical interpretation (Revised edition). Minneapolis, MN: University of Minnesota Press.

Fowler, R.D. (1985). Landmarks in computer-assisted psychological assessment. Journal of Consulting and Clinical Psychology, 53, 748-759.

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

Graham, J R. (1987). The MMPI: A practical guide (Second edition). New York: Oxford University Press.

Gynther, M. D., Altman, H., & Sletten, I. W. (1973). Replicated correlates of MMPI two-point code types: The Missouri actuarial system. Journal of Clinical Psychology (supplement), 29, 263-289.

Honaker, L.M., Hector, V.S., & Harrell, T.H. (1986). Perceived validity of computer- versus clinician- generated MMPI reports. Computers in Human Behavior, 2, 77-83.

Lachar, D. (1968). MMPI two-point code-type correlates in a state hospital population. Journal of Clinical Psychology, 24,424-427.

Lewandowski, D., & Graham, J.R. (1972). Empirical correlates of frequently occurring two-point MMPI code types: A replicated study. Journal of Consulting and Clinical Psychology, 39,467-472.

Matarazzo, J.D. (1985). Clinical psychological test interpretations by computer:. Hardware outpaces software. Computers in Human Behavior, 1,235-253.

Matarazzo, J.D. (1986). Computerized clinical psychological test interpretaitons. American Psychologist, 41, 14-24.

Moreland, K.L. (1985). Computer-assisted psychological assessment in 1986: A practical guide. Computers in Human Behavior, 22, 1-233.

Tanner, B.A. (1989). The MMPI Assistant: A microcomputer based expert system to assist in interpreting MMPI profiles. In L. C. K ingsland, HI (Ed.), Proceedings of the Thirteenth Annual Symposium on Computer Applications in Medical Care (p. 956). Washington, DC: IEEE Press.

Tanner, B. A. (in press-a). Composite descriptions associated with rare MMPI two-point code types in an adult urban psychiatric setting: Codes involving scale 0. Journal of Clinical Psychology.

Tanner, B. A. (in press-b). Composite descriptions associated with rare MMPI two-point code types: Codes involving scale 5. Journal of Clinical Psychology.