A Beginner's Guide to the MMPI-2
James N. Butcher's newest book is a long overdue innovation. This is because the Minnesota Multiphasic Personality Inventory (MMPI-2) is extensively used, directly and indirectly, by a remarkably large number of people—psychiatrists, nonpsychiatric physicians, lawyers, corporate personnel, etc. —who have never received any formal exposure to this immensely influential measure. These consumers can now, with the aid of this work, better understand the computer-generated reports provided by the test distribution firm NCS and others, as well as the necessary analysis of the reports done by experienced MMPI users. Thus the title of this book might also have been The MMPI-2 for Non-Psychologists. Fortunately for these people, the book is very clearly written, and by the man most qualified to do so.
Dr. Butcher, who is Professor of Psychology at the University of Minnesota, has been an active researcher and clinical user of the MMPI for decades. He chaired the massive effort to revise and restandardize a much-loved instrument, which was showing its age after 50 years of use. It is a tribute to him and the group he chaired that the MMPI-2, released in 1989, has won wide acceptance for its continuity with past research and clinical use, as well as its capacity to extend that tradition with a more secure set of norms. Here he has skillfully shown the many older and newer scales that form the basic material for the interpretations generated by the clinician and the computer scoring system.
Chapter 1 concisely introduces the reasons for the development of the MMPI and the assumptions that guided early scale construction. (References to prior terms or historical trends that are no longer relevant do not clutter the chapters.) There is an important section on the philosophy of “empirical” scales. This method of scale construction, retaining the items that actually work best in diagnosis regardless of their content, was regarded as the best available at the time. It is important to understand this method because of its contrast with the theory of “content” scales, which has been the basis for much of recent MMPI scale development.
Chapter 2 deals extensively with a subject of prime concern to all: how do we form an opinion as to whether the subject has answered honestly or has tried to give a false impression? The MMPI is widely regarded as one of the best tools for assessment of malingering. In this chapter the common varieties of invalid response strategies are explained, with examples.
Chapter 3 presents the basic clinical scales, as currently understood, with case examples of “spike” profiles (single elevation above 65, the critical level). Similarly, Chapter 4 describes what is far more common, “complex” code types. Clinical populations, in my experience, produce profiles with multiple elevations of scales. There are only a few examples of these in the chapter. Fortunately there is an appendix, which gives the interpretations of 21 two-point code pairs.
Chapter 5 introduces methods of extending one's understanding beyond the basic profile. Dr. Butcher describes the new group of content scales developed for the MMPI-2. A previous group of content scales, introduced by Wiggins, is less useful in the modern revision because many of the items it used were dropped in the revision. As Dr. Butcher notes, these scales are most useful when the client is cooperative with the testing process. It is assumed that the test-taker wants to be understood and conveys information accurately and openly. Also described here is the use of Critical Items, the statements that have been empirically selected as good starting points for follow-up in the clinical interview. In a similar vein, Chapter 6 describes the use of scales to cover selected concerns, such as those directed to substance abuse and risk, marital distress, posttraumatic stress disorder, and hostility.
Chapter 7, which emphasizes the way all the information is assembled to produce a comprehensive impression, can actually serve as a review of the previous chapters. Readers will then be prepared for what may be the most impressive demonstration of the MMPI-2, in Chapter 8. Cases are presented showing the illustrated scale profiles, as well as the computer-generated Minnesota Reports prepared by NCS, the Minnesota-based company that distributes the MMPI-2. The Minnesota Reports are based on algorithms prepared by Dr. Butcher. One of these cases, of interest to readers of this journal, concerns a forensic evaluation of a patient complaining of symptoms resulting from brain injury. The report included evaluation of evidence for conscious distortion of responses. The extensive glossary in Appendix B can be helpful when reading these reports or those prepared by psychological testers.
Chapter 9, which describes the preparation of written results and their communication to the referral source or the client, may be less useful to the reader. Most of the people who will be preparing written reports will be psychologists, who will probably rely on more advanced texts on the MMPI. Attention should be paid, however, to the section on how to share information with the client.
The best endorsement I can give this book is that as a devoted user of this instrument for more than 25 years, I learned some new things from it. This was not surprising to me; the MMPI tradition is still vigorously active after 60 years. This book will help you appreciate just how much research strength there is to draw upon when applying the MMPI-2.
Dr. Stein is Chief Psychologist at Lenox Hill Hospital and Clinical Assistant Professor of Psychiatry at New York University Medical School, New York, NY.
