The Assessment of Personality

Assessment should serve as a guide to therapy. Without it, therapy cannot proceed with a logical foundation. The goal of assessment is essentially the goal of science, but applied to the whole person rather than a field of study. The clinician should gain a scientific understanding of the interaction of the patient's current symptoms, personality traits, and psychosocial factors. The components of the DSM multiaxial model should be separately assessed and then integrated into a single composite: the case conceptualization.

Relationship between Pure and Applied Science

Probably the best way to understand the process of assessment and therapy is by contrasting the pure and applied sciences. Where do they come from? In chemistry and physics, the two go hand in hand, so that pure science discoveries eventually trickle down to create new technologies and new instruments. The human genome project, for example, promises to revolutionize medicine. In the social sciences, however, the pure and applied branches of science have often developed independently. We continue to use instruments constructed decades ago, and the number of psychotherapies continues to increase without end.

The Nomothetic Approach

As many have argued, there are really two sciences of psychology. One, the nomothetic approach, is focused on hypothetical constructs and the theoretical propositions that relate different constructs to each other, called the nomological network. Research questions such as, "What is the relationship of locus of control to depression?" and "How does the continuum of self-schema complexity relate to stress vulnerability?" focus purely on psychological constructs. Individuality, the focus of clinical work, is actively excluded by gathering large samples of subjects. The particular characteristics of any one person must not contaminate the results. Two narcissists with unhappy marriages could be a coincidence; 200 constitute a finding.

The nomothetic approach serves the needs of science, which thrives on universal relationships. As a science, personality cannot afford to discover laws of behavior specific to one person; the fact that you cannot wake up without your morning coffee is not pub-lishable. Instead, the purpose of science is to develop theories applicable to realms of manifest phenomena not heretofore seen or understood. No one has ever seen, smelled, or touched a black hole, but the Theory of Relativity allows us to predict what would happen if you fell into one. In the same way, personality psychologists strive to identify universal propositions about behavior that can be demonstrated again and again over repeated experiments. Allport (1937, p. 4) compared the nomothetic approach to "finding a single thread running from individual nature to individual nature, visible only through the magical spectacles of a special, theoretic attitude."

The Idiographic Approach

The idiographic approach emphasizes the complexity of individuality. Each person is the unique product of a history of transactions between biological and environmental factors that has never existed before and will never exist again. Here, so-called universal laws and classification systems are of highly limited value. Instead, understanding individuals requires a knowledge of the particulars of their existence: where they were born, how they were influenced by their first-grade teacher, why they chose psychology over hamster farming as a career, and how their father's death in that awful storm in the spring of their fifth-grade year shattered their faith. According to Henry Murray (1938, p. 604), "The history of personality is the personality."

At its most extreme, the idiographic approach holds that there is something ineffable about individuality, that its complexity cannot be wholly contained within any single classification system. As such, taxonomies are only provisional explanatory systems to be modified as needed when additional evidence becomes available. Theoretical systems are only a point of departure, to be used as a self-conscious contrivance that facilitates understanding, not as an end point. Cross-sectional descriptions, such as diagnoses and personality profiles, are only the beginning. Because the most important goal is creating a rich description of each person, any concept from any theory or classification system is acceptable if it helps capture and communicate the uniqueness of the individual. Here, the eclecticism of multiple theories is not frowned on, but instead seen as offering fertile soil from which truly illuminating portrayals of individuality can be achieved.

Diagnosis versus Assessment

If the phenomena of psychology were as sharply boundaried as those of chemistry and physics, every person would be diagnosed into one and only one category, which would completely exhaust all his or her particular nature. Everything that you are about as a person would be telescoped into a single label, and by knowing this label, the kinds of problems to which you are vulnerable would automatically be known as well, as would the most effective therapies to treat them. In fact, everything would be predictable in advance. Sound measurement techniques would allow clinicians to isolate exactly what makes you tick, and the application of psychological laws would allow the small behaviors, feelings, and attitudes to be modified. Every fact of your being would be accountable within the context of this deterministic science. From this perspective, individuality is the enemy, a nuisance that obscures detection of the underlying pattern. By knowing a person's diagnostic label, you would know the person. If the person deviates in some way from diagnosis, this is noise, unessential information that can be discarded. Obviously, matters are not this simple; nevertheless, the search for such an idealized classification system continues.

The DSM personality disorders attempt to retain the best of a construct-centered approach, while allowing a measure of individuality. First, the DSM allows multiple personality disorder diagnoses to be assigned. Combinations of two, three, or even four personality disorders are not uncommon. Second, each personality disorder is opera-tionalized as a prototype that consists of many characteristics, its diagnostic criteria, as noted in Chapter 1. Because only a subset of the total number of criteria is needed to achieve a diagnosis, there are literally scores of ways of being a histrionic personality, a schizoid personality, a masochistic personality, and so on. There are probably hundreds of ways of satisfying the diagnostic criteria for any two personality disorders. Such vast possibilities are intended to accommodate individuality within the diagnostic system, whereas the shorthand of diagnostic labels nevertheless recognizes that all subjects who receive the same diagnosis bear a "family resemblance." All histrionics resemble one another, though some are more needy and demonstrative and others are more seductive, for example.

Falsification of the Classification System

In any categorical classification system, the question is which labels the subject will receive. The idiographic perspective, however, reminds us that taxonomies take us only so far, that diagnostic constructs are only reference points that facilitate understanding, against which the individual should be compared and contrasted. If the individual is characterized as narcissistic, the next question is: "How is the person different from the pure narcissistic personality?" Asking such a question redirects attention away from simple diagnostic labels and toward an understanding of the individual. Because the goal is an idiographic understanding of the person, assessment is really an endeavor to show the limitations of the diagnostic system with respect to the person at hand. A variety of self-report and projective instruments are available to help this process along. The study of personality thus begins as a science, but ends as an art.

Once the subject has been conceptualized in terms of personality prototypes of the classification system, biographical information can be added to answer the questions, "How did these personality characteristics develop?" and "Where did they come from?" Some answers come easily. For example, subjects might report, "My father was always stubborn, and I'm the same way," or "My mother was sick all the time when I was little, so I grew up to be independent." Such responses automatically lead

Getting to Know Anxiety

Getting to Know Anxiety

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