Forms of the MMPI-2 and MMPI-2-RF
The most commonly used version of the MMPI-2 is the printed booklet form, which appears in either softcover or hardcover form, and which contains 567 items. Both are reusable and are commonly used for individual or group administrations. The hardcover booklet is more commonly used for laptop administration when hard surfaces such as a desk are unavailable. Whereas the softcover booklet requires a separate answer sheet, the hardcover booklet uses one that is inserted over two pegs at the back, and follows a step-down format whereby each consecutive page reveals a new column of answer spaces matched to the booklet page of corresponding items. The columns use alternating shades of a light blue and non-shaded blue to assist the reader in matching the answer sheet to the appropriate page in the booklet. Because the step-down format reveals only one column of items and answer spaces at a time, the likelihood of misplacing responses to items is reduced. This is especially useful when testing confused patients or individuals unaccustomed to taking tests. The order of the items is the same in both the softcover and hardcover booklets. Separate sets of templates are needed for hand scoring these two forms of the MMPI-2. Therefore, the answer sheets for the soft- and hardcover forms are not interchangeable. Scoring the test is described in more detail later in this chapter.
The usual administration time for the MMPI-2 booklet is between 90 and 120 minutes, although limited reading ability or non-cooperativeness may extend test-taking time.
The CD version of the MMPI-2 is for individuals with visual impairments, reading difficulties, and physical handicaps (a proctor can record the responses, if necessary).
The MMPI-2 audio CD administration time is two hours and 15 minutes, with each item presented twice. In group administration, headphones and separate CD machines are recommended to prevent noise distraction and to allow an individual to replay unanswered items at a later time. It is also important to ensure that the participant is taught how to operate the CD player in order to pause it, for whatever reason, or to return to a previous item. Careful proctoring should be conducted in situations in which individuals are listening to the MMPI-2 CD with headphones. In one instance, a Social Security disability applicant being administered the MMPI-2 in this way replaced the MMPI-2 CD with a music CD, which the applicant found much more entertaining!
The MMPI-2-RF (described in detail in Chapter 11) has 229 fewer items than the MMPI-2, for a total of 338 items. This form is available in a softcover, or durable spiral-bound booklet, but not a hardcover step-down booklet as is available for the MMPI-2.
However, a “Lap Administrator Binder” is available that provides a hard surface when a table or desk is unavailable. The MMPI-2-RF is available only in English. Test completion
time of the RF for individuals with normal-range cognitive functioning and reading abilities using a booklet and answer sheet is typically 35–50 minutes, and about 25–35 minutes for a computerized administration (Ben-Porath & Tellegen, 2008, 2011). The English MMPI-2-RFaudio CD has an approximate administration time of 80 minutes, with each item presented twice. Given the shortened length of the test, there is no abbreviated version for the MMPI-2-RF as there is for the MMPI-2.
Computer-based administrations are common today, and administration time varies between one to one and a half hours for the MMPI-2. One major advantage to the computer-administered MMPI-2/MMPI-2-RF is efficiency and ease of scoring, although not all participants are comfortable with this type of administration. Spinhoven, Labbe, and Rombouts (1993) reported that although most patients feel favorable about using a computer in a clinical setting, little research has been conducted to assess patient characteristics that could pose potential difficulties in computerized assessments. They suggested conducting an assessment interview to learn how a participant feels about interacting with a computer, as this may have particular importance, for example, in a case of a psychotic patient with delusions/ideas of influence.
In general, clinicians’ attitudes toward computer-based testing are positive (Spielberger
& Piotrowski, 1990), although questions about the comparability between computer and booklet administrations have been raised. The evidence, however, is skewed toward showing few significant differences between computer and booklet administrations (Butcher, 2009).
More recently, there has been interest in computerized adaptive testing (CAT), which involves the application of the countdown method to reduce the number of items administered in order to reduce administration time. This technique involves the presentation of scale items until the participant endorses a predetermined number that indicates that he or she has either elevated or not elevated a particular scale. Although preliminary in nature, whereas several studies have suggested that adaptive testing may have promise in the future (e.g. Ben-Porath, Slutske, & Butcher, 1989; Butcher, Keller,
& Bacon, 1985; Clavelle & Butcher, 1977; Forbey & Porath, 2007; Forbey, Ben-Porath, & Gartland, 2009; Roper, Ben-Ben-Porath, & Butcher, 1991), more recent reviews have shown that this promise remains unfulfilled (Butcher, Perry, & Dean, 2009). An alternative to the countdown method for adaptive testing uses Item Response Theory (IRT). As Forbey, Ben-Porath, and Gartland (2009) point out: the IRT model does not seem to work well for the MMPI-2, most likely due to the multidimensional nature of the MMPI-2 clinical scales. It remains to be seen if IRT will be more efficacious with the more homogeneous scales on the MMPI-2-RF. See Chapter 12 for a fuller discussion of this topic.
Abbreviated and Short Forms
Because the full-length MMPI-2 can require one to one and a half hours or longer to complete, some test users have considered the length of the test prohibitive for practical application, especially with physically disabled or easily fatigued participants. The term abbreviated form refers to administering the first 370 items of the MMPI-2 in order to score all of the standard validity and clinical scales. The 370-item abbreviated MMPI-2 can reduce test-taking time, on average, from 20 to 40 minutes. Abbreviating
26 Administration, Scoring, and Codetyping
the test administration in this fashion may be indicated when an elderly or enfeebled participant is physically unable to tolerate a longer sitting, or becomes less cooperative over the course of testing. Likewise, a poor reader may struggle for an excessive length of time over the test booklet before completing all of the items. A major disadvantage in eliminating the remaining items, however, is that many of the items scored on the content, Personality Psychopathology Five (PSY–5), supplemental, restructured clinical, and the newer validity scales are found later in the test booklet. It is recommended that whenever possible, the individual complete the entire inventory, even if this requires multiple sittings, unless obvious reasons contraindicate such an effort.
Short forms of the test refer to reduced sets of items on different scales that are thought to be a valid substitute for their corresponding full scales. Most short forms were developed for the original MMPI rather than MMPI-2. However, no effort was made by the MMPI re-standardization committee (Butcher et al., 1989) to preserve any of the MMPI short forms for the MMPI-2.Butcher and Hostetler (1990) concluded that short forms for the MMPI-2 were inadequate measures of the constructs assessed by the full scales. In our opinion, too many factors mitigate against the use of any of the short forms to justify their routine clinical or research use. For example, the codetype correspondence to the full-length MMPI-2 is generally poor, and in shortening the test, many items are eliminated that are needed for scoring the content and supplementary scales, the Harris-Lingoes subscales, and various other special scales.
Investigations of short forms continue to support Alker’s (1978) statement that
“virtually no convincing evidence is available that the short forms make contributions to clinical decision-making in a fashion that compares favorably on statistical criteria with the full MMPI” (p. 934), and that no one version is clearly superior to any other.
Dahlstrom and Archer (2000) developed a 180-item short form based on the MMPI-2 re-standardization sample and psychiatric patients. They reported the high-point agreement between the MMPI-2 and their short form to be only 50 percent, whereas 2-point codes were congruent in only about one third of the cases. Subsequent to the development of the Dahlstrom and Archer (2000) short form, McGrath, Terranova, Pogge, and Kravic (2003) examined short forms of the MMPI-2 with 216 and 297 items derived from psychiatric inpatients. They concluded that the 216-item short form was not acceptable for either identifying the single most elevated clinical scale in the complete MMPI-2 or in predicting high-point codes. However, their longer 297-item version appears to have advantages over the Dahlstrom and Archer (2000) 180 short form in terms of code pattern congruence with the MMPI-2; but, as compared to administering their first 180 items in Dahlstrom and Archer’s (2000) short form, there is more scoring complexity involved in using the MMPI-297. As Cox, Weed, and Butcher (2009) note:
The MMPI-297 produces T-scores that are substantially different from those derived for the complete MMPI-2 and it also demonstrates weaker convergent validity across a number of domains. Additionally, it does not produce estimates of important scales such as F(p), a validity scale, or the restructured scales.
It is readily apparent that one problem common to all the short forms, whether for the original MMPI or the MMPI-2, is the failure to recapture the profile obtained from the full-length test (McLaughlin, Helmes, & Howe, 1983). Whenever a test is shortened,
the issue of the effect on its reliability is raised. Streiner and Miller (1986) concluded that no shortened scale will ever favorably compare to the full-length test, and Greene (1982) suggested that we treat shortened MMPI versions as new tests that must be validated individually.
While the above described concerns regarding poor correspondence between full-scale score profiles and estimated profiles appear substantial, there still may be value in using the shortened MMPI-2 180-item form (Dahlstrom & Archer, 2000) for screening psychopathology rather than completely identifying it. Future research will determine the utility of this form, particularly for use with special populations (Friedman et al., 2001; Gass & Gonzalez, 2003).
Foreign Translations
The original MMPI was used in over 65 countries and had more than 115 translations (Butcher & Graham, 1989). The first of these were produced in Italy and Japan in 1948.
Since the MMPI was re-standardized in 1989, numerous translation projects have been completed. Numerous translations for the MMPI-2 currently exist in Bulgarian, Chinese, Croatian, Czech, Danish, Dutch/Fleming, French, French-Canadian, German, Greek, Hebrew, Hmong, Hungarian, Italian, Korean, Norwegian, Polish, Swedish, and in Spanish for Spain, Mexico, South and Central America, and the U.S. The MMPI-2 is available in Spanish only in the softcover form. MMPI-2-RF translations are available in Italian, Korean, and in Spanish for Spain, South and Central America. Information about obtaining these translated versions of the test can be found at the University of Minnesota Press website, www.upress.umn.edu/tests/.
Lucio and Reyes-Lagunes (1994) developed normative data on a Mexican transliterated version of the MMPI-2 (see also Whitworth & McBlaine, 1993). Transliteration techniques follow the view that the psychological meaning of the item is more important than its literal equivalent. (For a comprehensive guide and description of general strategies for developing foreign translations of the test, see Butcher & Pancheri, 1976.) Butcher (1996) edited the comprehensive International Adaptations of the MMPI-2, which addresses important methodological issues in translating and adapting the MMPI-2 in foreign countries as well as presenting the results of several translation projects.
One MMPI-2 translation of potential practical importance is that for American Sign Language (ASL) for hearing-impaired persons with concurrent difficulty in reading.
Brauer (1992) stated that “this language of the deaf is spatial and motile, characteristics that do not lend the language to expression in written form; therefore, an ASL translation must be captured on videotape or film” (p. 381). Results from investigations into the effectiveness of this ASL version of the MMPI-2 hold promise for its future use with deaf individuals in the U.S. (Brauer, 1988, 1992, 1993). Cross (1945) developed a Braille version of the MMPI for administration to the blind, but the publisher of the MMPI-2 does not provide versions of either the Braille or American Sign Language formats. The MMPI-2 Manual (Butcher et al., 2001, p. 10) does, however, address individuals with visual limitations:
For individuals with limited vision, special provision must be made to facilitate their recording of responses and ensure adequate privacy. The use of a Braille
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typewriter or a computer can be helpful in such circumstances. If this equipment is not available, it may be necessary to have visually impaired test-takers dictate their responses to a clerk or ward aide.
User Qualifications and Test Instructions
Because administering the MMPI-2/MMPI-2-RF is a relatively straightforward task, clinicians may overlook important factors that can influence participants’ test-taking attitude and hence contribute to invalid results. Clinicians are urged to familiarize themselves with the MMPI-2/MMPI-2-RF test Manuals before administering, scoring, and interpreting the tests, as required by the Standards for Educational and Psychological Testing (American Educational Research Association et al., 1999). Additionally, it is recommended that there be an understanding of the relevant studies reported in the professional literature. The MMPI-2 and MMPI-2-RF Manuals (Ben-Porath & Tellegen, 2008, 2011; Butcher et al., 2001) specify the needed qualifications for competent test use.
Among these—in addition to training, supervision, and experience in the administration, scoring, and interpretation of the MMPI tests—is graduate training in personality, psychopathology and psychological assessment, familiarity with concepts of reliability and validity (and of measurement and classification error), and the establishment of norms and their conversion to standard scores.
MMPI tests are often administered by a trained clerk, secretary, or technician.
“Individuals entrusted with the responsibility of routine administration of the test must be carefully trained and well informed about the steps needed to obtain a valid and useful test protocol” (MMPI-2 Manual, Butcher et al., 2001, p. 8). This is quite important, particularly when the individual administering and/or scoring the test lacks a relevant professional degree or background in psychometrics. Pearson Assessments, the distributor of the tests, requires a level “C” qualification in order to purchase MMPI materials. Level “C” indicates that the purchaser must have licensure or certification to practice in their state or possess a doctorate degree in psychology, education, or closely related field with formal training in the ethical administration, scoring, and interpretation of standardized assessment tools and psychometrics.
The test should be presented to the test taker in a serious manner; too often clinicians minimize the importance of the test in an attempt to alleviate any performance anxiety.
As a result, participants often believe the test is not important and, thereby, compromise their cooperation by reading the items too quickly, carelessly, skipping some, and generally lessening their investment in the task. A clear explanation of how the results will be used can help increase cooperation as well as fulfill the ethical responsibilities of the psychologist to inform consumers about the nature and purpose of an evaluation.
Obtaining informed consent tells the test taker of the advantages and disadvantages of cooperating with the assessment, including how the information will be shared and used to influence decisions in treatment or a specific disposition (Nichols, 2011). It is critical to be clear about the psychologist’s relationship to the test taker so there is no confusion about for whom the former is acting as an agent. Psychologists should be explicit in explaining their role in the assessment process.
Levak, Siegel, Nichols, and Stolberg (2011) and Finn (1996) present models for involving the client in the assessment task and suggest ways to increase the client’s
cooperation, including encouragement of questions for the examiner to jointly formulate areas of interest that the test results might address. As Levak et al. (2011) note, the latest set of ethical principles of psychologists (America Psychological Association, 2002) now specifies that all clients be given feedback about test results in a way that facilitates their comprehension. If clients are treated as collaborators in the assessment process, they are more likely to give accurate and useful information when completing the test.
Psychologists unfamiliar with professional assessment guidelines may consult the following resources: “Ethical Principles of Psychologists and Code of Conduct”
(American Psychological Association, 2002); “Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations” (American Psychological Association, 1993); “Guidelines for Child Custody Evaluations in Divorce Proceedings” (American Psychological Association, 1994); Standards for Providers of Psychological Services (American Psychological Association, 1977); Standards for Educational and Psychological Testing (American Educational Research Association, 1999); and Guidelines for Users of Computer-Based Tests and Interpretations (American Psychological Association, 1986).
Instructions for completing the MMPI-2/MMPI-2-RF tests are printed on the softcover and hardcover booklet forms, and the audio instructions are presented at the beginning of the CD format. These instructions direct the test taker to decide whether an item is mostly True or mostly False as it applies to him- or herself, and encourage the test taker to try to respond to every statement. A question that commonly arises is, “Do I answer as I am currently feeling?” Most examiners encourage participants to answer as they feel at the present time, but sometimes, under special circumstances, an examiner may want to learn how participants wish to perceive themselves when they feel better, or are leaving the hospital or concluding psychotherapy. The examiner then may ask the participant to fill out the test looking ahead toward the completion of a therapy or hospital program, and answer the items in the way that he or she would expect to feel at that time. In some situations, the participant who is able to produce a less disturbed profile under such looking-ahead instructions (projected discharge profile), as compared with his or her admission or initial profile taken under the usual instructions, is considered to have a better prognosis (Marks et al., 1974).
In addition to the standardized instructions printed on the MMPI-2 forms, some test users and researchers use supplemental instructions and information to help answer commonly asked questions, to alleviate test anxiety, and to reduce the proportion of invalid profiles due to the over- or under-reporting of psychological strengths or problems, respectively. For example, Butcher, Morfitt, Rouse, and Holden (1997) found that a group of male job applicants for pilot positions who produced defensive MMPI-2 profiles were able, upon re-administration, to produce valid profiles after being given new test instructions.
These instructions were designed to inform them that defensiveness can invalidate the test.
These participants produced higher content scale scores without producing higher clinical scale scores. This study demonstrates that specialized instructions in pre-employment settings can reduce the number of profiles that may be judged invalid on the basis of defensiveness/under-reporting. Additional research is needed with other populations with high base rates for dissimulation. Examples include forensic settings, where pleas of insanity or diminished capacity are seen, or in disability and insurance compensation proceedings where claims of injury or disability are alleged.
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The following example of supplemental instructions for taking the MMPI-2 is adapted from the Caldwell Report (Caldwell, 1977):
1 Answer every question as truthfully you can; that’s very important for accuracy and
1 Answer every question as truthfully you can; that’s very important for accuracy and