THE USE OF THE MMPI-2 AND THE RORSCHACH IN THE CHILD CUSTODY CONTEXT
How Can the MMPI-2
Help Child Custody Examiners?
Alex B. Caldwell, Jr.
SUMMARY. The paper explores what hypotheses we can infer from the MMPI-2 regarding parenting behaviors and what are the significant limitations on our inferences. The first half looks at the MMPI-2 from a child custody view: is there a foundation from which the test can generate expectations regarding five basic issues, i.e., the quality of attachment and bonding, potential for antisocial behavior, temper control, alienation of affection, and chemical abuse and dependence. The second half looks at custody from an MMPI-2 point of view: what is the range of possible variables that will generate useful hypotheses regarding parent-child interactions and family systems? The effects of the circumstances of litigation on score elevations are considered, including recommended limits as to how much elevation can be dismissed as only contextual. âOccasion validityâ (are these scores trustworthy) is distinguished from âAttribute validityâ (what do the scores tell us). The clinical application of an objective interpretation system is discussed, including the courtroom credibility of explicit convergent validity.
[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <httÂp:/Â/wwÂw.HÂawoÂrthÂPreÂss.Âcom> © 2005 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. MMPI, child custody
There have been many responses to the basic question of whether the MMPI-2 can help or not in child custody evaluations. Some clinicians have asserted flatly that it should not be used. They argue that the test was developed on severe psychiatric patients and not on custody clients, so it is simply inappropriate. Others have emphasized that there is no established body of parent-child MMPI or MMPI-2 research to cite in support of a custodial opinion or recommendations. In contrast to these arguments is the near universal use of the test in custody examinations, estimated to be around 90% by Ackerman and Ackerman (1997) in both their data and those of Keilin and Bloom (1986). This use does not prove validity, of course, but it suggests a widespread belief that it can potentially be of help.
This paper was written to elaborate and extend an approach to the MMPI-2 that I believe many clinicians have been following, at least in general concepts. The common goal is to generate as many workable hypotheses and as much useful information from the test scores and profile patterns as is reasonably possible. In pursuit of this, I will discuss a variety of parenting-relevant variables that I believe can be estimated, with satisfactory accuracy, using available scores from the MMPI-2. I will start by looking at the MMPI-2 from the custody perspective, i.e., can the test generate practical hypotheses in examining the so-called Big Five: attachment, antisocial behavior, temper control, alienation, and chemical abuse and dependence. This will be followed by an analysis of custody from an MMPI-2 perspective, what are the range and variety of topics about which the MMPI-2 can help focus our examinations. These are the component parts of the custody report I have developed: a discussion of several parental role-modeling variables, and then by other variables that I believe to be potentially informative regarding significant aspects of parenting behaviors and family systems. I will discuss the issue of situational pressures and temporal fluctuations in the context of adversarial custody disputes later, as the influence functions across the variables. Lastly, I will discuss normative and validity questions regarding the interpretive custody report I have developed.
FROM THE CUSTODY-PARENTING PERSPECTIVE:
CAN THE MMPI-2 SPEAK TO THE MAJOR ISSUES?
Attachment/Bonding
A basic judgment in a child custody examination is of the depth and dependability of the parent-child bonding, the attachment from which the love flows, the solid anchor of caring, and the development of the child's own eventual capacity to bond to others as an adult. All of the recurrently listed descriptors of people with primary elevations on scale 4-Pd (the multifaceted and complex behavioral shifts in the direction of asocial and amoral psychopathy) relate to problems of impaired bonding: egocentric, impulsive, demanding, manipulative, callous, uses others as objects, financial irresponsibility, etc. (e.g., see Gilberstadt & Duker, 1965, pp. 57â60). If one posits (1) a genetic vulnerability, (2) unwantedness in infancy, childhood, and possibly in utero, and (3) chronic and intense strife in the childhood home as all contributing substantially to elevations on scale 4-Pd, then one understandably has a quite broad construct (Caldwell, 2001a). Its expressions are very diverse, from persistently problematic relationships to failures of conscience to the callous side of criminal activity. I consider it to be a single, broad construct with expressions that range from highly subtle and disguised to flagrantly evident. For further comments, seeCaldwell (2001a).
The behavioral continuum identified by the Pd scale can be defined in part by the characteristics of those with extreme elevations. Keeping in mind that the population and its contextual demands are radically different, Megargee and Bohn (1979) provide descriptions of mostly two- and three-scale code types on federal prisoners, and this was updated for the MMPI-2 by Megargee, Carbonell, Bohn, and Sliger in 2001. Of their 10 male types (nine of which replicated among female inmates in 2001), their âDeltaâ group was defined by a singular, high spike on scale 4-Pd. This group produced a sharp picture of the extreme of this scale. Among numerous related qualities, these subjects came from the most unfavorable childhood backgrounds the authors had encountered among their prisoner types with the highest or second highest scores on lifelong attributes of âFamily incohesiveness,â âParent-child tension,â and âSocial deviance of the siblingsâ and almost no socializing or nurturing parental or family influences (pp. 253â254). In prison they bonded to no one, they were assaultive when thwarted (although not actively seeking out violence), and they left prison notably unchanged. Their central 4-Pd core is a lifelong inability to bond. Note that the heritability factor for 4-Pd in the Minnesota twin data (DiLalla, Carey, Gottesman, & Bouchard, 1996) was just over 60%, which is directly consistent with the markedly impaired bonding throughout their families.
It should be emphasized that depth of attachment problems come in all degrees; in the normal range it may be no more than an unsatisfying adjustment in a particular area of the person's life, e.g., a bit too much focus on the person's self-interests and ambitions to the disregard or subtle occasions of indifference to or emotional neglect of children and spouses, an occasional coldness in personal or work relationships, or just instances of more than expected egocentrism and of taking advantage of others. Low scorers have been described as having notably stable long-term attachments and as sexually unassertive (Meehl, 1951). Drake and Oetting (1959) observed low scores on scale 4-Pd to be âindicative of conformity with the mores of the social groupâ (p. 22). Thus, impairments of bonding and attachment are well assessed by scale 4-Pd across a wide range of levels.
For interpretive purposes, it should be considered that the 4-Pd scale is strongly affected by the revised norms for the MMPI-2. That is, the same raw score (and no items were deleted from 4-Pd in the revision process) yields a T-score eight to ten points lower throughout the range from the mid-T-40s to the T-70s for women and up to T-90 for men, and the differences are only slightly smaller above those ranges. The typical nine-point downward shift throughout this working range, consistently more than any other scale in this range, often leads to a substantial underestimation of the importance of a 4-Pd score both absolutely and via displacement to a lower rank in the code. In hindsight there appears to have been an overrepresentation of 4-Pd in the volunteer sample (Caldwell, 1997b), so in comparison to them everyone looks less disposed to 4-Pd behaviors.
It is difficult to ascertain how much of a custody litigant's 4-Pd score reflects state versus trait characteristics. Obviously, custody litigants are in the very midst of the severing of a life-central attachment, and a sizable proportion of them are having it severed against their wishes. Further, they are also confronted with the potential forced disruption of much of their parent-child attachments. From a more trait, or chronic, perspective, a custody litigant whose attachments are to whatever degree unstable or shallow is not going to volunteer that that is the case, very possibly trying hard to impress the examiner with the opposite. The estimation of this issue is then from other sources and primarily historical data unless there are obvious lapses of âbeing there for a childâ in the person's narration (which can go surprisingly easily unnoticed by the self-justified narrator) or be otherwise evident in the parent-child interaction. Thus, it is difficult to know from the MMPI-2 scores alone what a prominent 4-Pd elevation-mildly to moderately elevated-most meaningfully reflects: chronic attachment problems, primarily the acute state of currently conflict-reduced attachments to the spouse and children, rage at the other spouse's attachment-destroying actions and litigation, or new attachment fears that the litigant is facing as a possible outcome of the legal process. In any case, an elevated scale 4-Pd generates a variety of hypotheses with regard to attachment that are critical to examine further.
Potential for Antisocial Behavior
Otto, Buffington, and Edens (2003) stressed that one of the most consistent findings regarding child development has been that parents who show antisocial behaviors tend to have children who show a variety of significant adjustment problems. These typically are externalizing actions such as aggression and delinquency. They cited that, âwhen predicting antisocial behavior at age 32, Farrington (2000) reported that having a criminally-convicted parent when the individual was between ages eight and ten was the single strongest predictor among a host of risk factors (odd ratio = 3.7)â (p. 31). Otto also stressed that the effects of antisocial parental behaviors are apt to reach well into the adulthood of their children.
The aggression, irresponsibility, deceitfulness, general non-conformity, impulsivity, and lack of remorse that define Antisocial Personality Disorder (DSM-IV; American Psychiatric Association, 1994) are also the prototypic descriptors for profiles that code as â4-8-9â (the three highest scales in any order; the tendency is still there although the picture is more mixed if these three scales are first, second, and fourth or first, third, and fourth). These three scales were also the three specific âactivatorsâ of juvenile delinquency in the extensive longitudinal studies of Hathaway and Monachesi (1963).
Again defining the extreme, Megargee et al.'s (2001) âFoxtrotâ code type, with an elevated 9-4-8 mean code, identifies prison predators who need to be segregated because of their exploitative and abusive danger to other inmates. Interpretively, the Pd adds the callousness, the Ma adds the pressured impulsivity and drives the aggression, and the Sc turns it all mean or even sadistic (e.g., Megargee's Foxtrot data and the cases coded 489-in any order and especially if coded 4896-in the Atlas [Hathaway & Meehl, 1951]); at the extreme it can involve the pleasure of being in control of the cruelty rather than the helpless victim one was as a child). In contrast, at mild elevations (e.g., around T-60 on the MMPI-2) one sees people who manage adequately but at the expense of less than optimal long-term gratification in one or more areas of their lives. There may be some emotional exploitation or subtle intimidation of those around them, occasional deceits and manipulations, a heightened degree of sexual aggressiveness, and fewer self-restraints than others would wish.
Bosquet and Egeland (2000) studied parenting behaviors of a sample of women in a low-income housing project (92% unmarried) according to their scores on the Antisocial Practices (ASP) content scale of the MMPI-2. When their children were 13 and 24 months old, the mothers with elevations on ASP at T-70 or higher (45 of 141, 32% of their subjects) were observed to be significantly less understanding and more hostile and harsh in their parenting styles than mothers in their two other groups from the same setting. They demonstrated higher levels of insensitive and angry parenting behavior during stressful laboratory tasks, were more physically and antisocially coercive, and demonstrated more physically abusive behaviors in both home and laboratory settings.
Unfortunately this data is of almost no direct applicability to custody litigation in that these women were typically of less than high school education, and they were very open and candid with elevated scores on scale F and low scores on scales L and especially K (directly opposite to the great majority of litigating parents). For example, custody litigants taking the MMPI-2 do not say true (the scored response) to ASP items such as that they would sneak into a movie theater without paying if they could get away with it, that nearly anyone would lie to keep out of trouble, or that they have hoped that criminals would get away with it if they are really clever. Of 554 unselected female child custody litigants (the group is described in the âAs compared to what norms?â section below), 79% scored below T-50 on ASP, 95% below T-60, and 99% below T-70; only five individuals of the 554 exceeded T-70. Even slightly fewer of a sample of 550 male litigants...