MMPI and other Psychological Assessment / Evaluation

Psychological evaluations can be used for various clinical, occupational, and legal or forensic reasons. The MMPI (Minnesota Multiphasic Personality Inventory) is one of the most used and useful of these tools in my opinion. It can help clarify diagnostic questions, guide treatment recommendations, improve our understanding of our personality and symptoms, help us to understand vocational strengths and hurdles, is common or even ubiquitous as a fitness for duty determination for police and other similar professions, or provide implications for legal questions.

A clinical evaluation includes several things:

• Evaluation question: why is the evaluation being requested / completed?

  • What is the venue - legal, vocational, treatment or something else?

  • Who will have access to the results? If it is legal or vocational, the person being assessed is (or ought to be) agreeing to have the results released typically without reviewing them and regardless of the assessment outcomes. However, people can seek out their own evaluation.

  • Specific question: very specifically, what is the information you are hoping to get? What is the goal? What is the assessment question we seek to answer? This must be clear otherwise the psychologist providing the evaluation will have to at least re-write the report if not complete additional assessments and clinical interview, all of which will come with additional hourly costs (this is a rare occurrence).

• Parts of the evaluation:

  • Formal assessment tools such as the MMPI. There may be an hourly fee for proctoring or administering assessments while others can be self-reported on your own time. Likewise, some assessments require hand-scoring and interpretation while others are computer scored and interpreted or quick and straightforward enough that this would not result in increased assessment costs. Some assessments cost money to use or interpret (the MMPI ranges from $20-50 typically but can be self-administered so it doesn't always incur an hourly fee), and may be the client's financial responsibility (often included in the overall quote for the service).

  • Clinical interview: this involves discussing the results of any formal assessment tools that may have been used as well as getting information pertinent to the reason for the assessment, psychological history, etc. This not only provides tangible information to the psychologist, but experience with the individual for our objective clinical opinion beyond simply the content of the discussion.

  • Interpretation and report writing: Beyond interpreting individual assessments, if a battery of assessments is used (multiple assessments tools), an integrative interpretation and report writing process occurs. Insurance companies don't typically cover this cost, so it is either not reimbursed to the psychologist or is self-pay billed hourly.

• Costs: sometimes covered by insurance but frequently not at a reasonable reimbursement rate, so some or all parts are often self-pay or out-of-pocket.

  • Many psychologists' hourly rate begins around $150/hour, which is the current Medicare rate in Western PA (varies by region), considered to be a gold-standard benchmark. You can request a superbill, which is like an invoice or receipt, allowing you to request reimbursement from insurance or the psychologist may be willing to do so for you. Discuss this prior to the assessment. However, frequently some cost is due up front or before the report is written / released.

  • Most commonly, I quote 2-4 hours of billing depending on how many assessments are used and if they are self-report. If proctored (has to be observed by a professional) or administered by a psychologist, the time it takes for the assessment will be billed hourly. Typically 1-hour of clinical interview. Typically 1-hour of report writing unless there is a battery of assessments used requiring integrative interpretation and report writing.

  • If there are follow ups, this will typically incur additional fees, such as further communication with court or lawyer. If you are aware that this will be likely or required, it should be communicated prior to the assessment. Most important, if you want or expect that psychologist will be asked to testify, let them know ahead of time - some psychologist are versed in this while others prefer not to and may not be experienced in the court. Typically, testifying will result in fees for travel and court times - basically any amount of time.

  • Note for providers: I have a consent for assessment indicating this is not an ongoing therapy relationship, and our professional relationship is terminated at the closure of our assessment and report process. Likewise, any missed or late cancelled appointments, just like therapy, incur additional costs, or any additional services needed such as if the client adds to the assessment question, additional communication of report/interpretation results, or unexpected requests like court appearance. If the assessment is requested by an outside/third party agency, in addition to the baseline quotes, I include the same information, additional fees will be incurred, at the same hourly rate, for missed or late cancelled sessions, additional sessions if things are added to the assessment question, or if unexpected court appearances are necessary including travel expenses (hours and travel costs).

What does the MMPI tell me?

The MMPI tells us various things depending on the type of interpretative report we choose. The basic report is $20 while the full clinical interpretation is about $50 with the police and similar professions (firefighter) comparison group / fitness for duty interpretation being about $34.

The first section of the results are the validity scales, which tells us if we can rely on the rest of the results. If questions were not answered, answered randomly, if there was a bias towards true/yes false/no answers, if there was an unusually high or low occurrence of certain types of answers.

Higher-order (H-O) scales indicate if there is psychological dysfunction or concern in a broad domain, including emotional/internalizing, thought dysfunction or behavioral/externalizing.

The Restructured Clinical (RC) scales are a mid-level view: more specific than the higher-order scales but less specific than the specific problem scales. RC may help clarify interpretation, and functional and diagnostic questions. These were designed to disentangle potential confusion from inter-correlation between the other clinical scales.

And, not surprisingly, the specific problem scales give the most finite detail. They shouldn't be thought of as subscales, but as additional information that helps clarify interpretation in integration with the other scales. These fall into the categories:

• Somatic/Cognitive and Internalizing Scales

• Externalizing and Interpersonal Scales

• Personality and Psychopathology (Psy-5) Scales

The clinical interpretive report adds (again, surprise!) a clinical interpretation to the basic score report (there are also specific versions for certain utilizations and comparison groups, like police). The report includes the following sections:

• Synopsis

• Protocol validity (is the assessment valid enough to make sound interpretations, per the section above on the validity scales)

• Substantive scale interpretation: impressions based upon responses that result in high-scores on specific clinical scales.

• Diagnostic considerations

• Treatment Considerations

• Critical Responses should also be reviewed under the item-level information, a long with any other clinically indicated safety assessment, for indications about safety concerns.

Of note, this computer generated interpretation can be highly useful, but is not adequate or ethically appropriate for direct-patient access without interpretation by/from a competent care-provider such as a licensed psychologist. It is unethical to share this interpretation without doing so - consequently, any MMPI assessment should be coupled with an interpretative report generated by the LP (licensed psychologist) (or other "Level C" qualifications). To generate this report, it is almost certain to require a clinical interview and sometimes other assessments used in conjunction with the MMPI depending on the assessment question that person requesting the assessment set out to answer.

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Other types of assessment (but not limited to...)

Symptom severity checklists do not give us conclusive information about diagnosis, often also requiring information about how long the symptoms have occurred, for example, that are not typically collected in a symptom severity checklists. However, this can help in various ways: is the person experiencing currently distressing symptoms? Should we do further clinical interview or assessment based upon this information to clarify diagnostic considerations? How is this person progressing in treatment (therapy or medication)? Is there severe distress that might be cause for concern?

Safety assessments look at suicide risk and / or protective factors that might reduce suicide risk. We often look at vulnerability factors, triggers, symptoms and early warning signs, presence of and utilization of coping skills, history of suicidal ideation or attempts, history of close friends or relatives who have completed suicide, thoughts (ideation), plan (how the person might hurt or kill themselves), and intent (wish to hurt or kill self), as well as intensity of those feelings and intents. And protective factors like pets, family, meaning and joy, insight, and future plans (even planning on attending next therapy session or fear of hospitalization as it would impede in work or other life events), and coping skills including actions one would take if suicidality worsened (including calling care providers or going to psychiatric emergency department).

Diagnostic assessments such as the Structured Clinical Interview for the DSM help to give clear answers about likely diagnoses. Other assessments may be helpful or necessary for certain diagnoses particularly if the person seeking assessment needs access to resources or accomodations.

Intellectual assessment helps not only give information about aptitude and deficits, learning disabilities and possibly neurodevelopmental disorders, but may be necessary (and sometimes necessary during developmental years) to gain access to certain services, resources and accommodations.

Cognitive / Neurocognitive assessments are highly varied and often used in a battery (a group of assessments) to help disentangle complex diagnostic and functioning questions. However, there are also basic ones that give us a snapshot of cognitive/neurocognitive functioning that can be vital for protecting individuals who may have cognitive decline. Physicians often utilize cognitive assessments, such as the Montreal Cognitive Assessment (MoCA) to determine if there is a like Major Neurocognitive Disorder (dementia), and to initiate safety measures including but not limited to removing a drivers license, ensuring adequate support in the living situation or access to a nursing home with memory care.

Vocational assessment helps answer questions for our career or occupation. It can identify strengths and weaknesses, interests and aptitudes, and needs.

Personality assessment grossly falls into two categories ranging from looking at psychopathology and diagnostic implications to non-pathological implications about personality type and style. Also included in this category also includes projective assessments like the Rorschach and Thematic Apperception Test (TAT).

How do I use assessment?

In my practice, I do MMPI-3's via computer using Pearson's (the company that owns the assessment) Q-Global system that allows the person seeking assessment to complete the questionnaire and for me to generate a report. This could be for individuals with diagnostic complexity, custody or other court or forensic purposes (though I do not take cases that require court appearances), pre-surgical evaluation, or fitness for duty such as police officers.

I also do a lot of DBQ (Disability Benefits Questionnaire) assessments for veterans of war, which includes an array of psychological symptoms and often PTSD (Post-traumatic Stress Disorder) diagnostic criteria checklist.

While I do not consider myself a specialist in this domain, it is not uncommon for me to see adult clients who have concerns about ADHD or Level 1 Autism (formerly Asperger syndrome) and using an adult ADHD checklist or autism assessment can begin that conversation. Sometimes it provides adequate clarity for the client's needs. For example, an adult client with many years in therapy for anxiety and dysthymia switched from SSRI to Wellbutrin and saw remarkable improvements in functioning, mood and anxiety as well as no longer having sexual side effects of SSRI treatment. Another example, many adults with level 1 Autism find it very meaningful to get even basic clarification and validation of their experiences with social difficulties. Other times, I will refer out to a neurodevelopmental evaluation specialist especially if access to services is a current or likely future goal/need.

Some clients use symptom severity checklists. It is a "best practice" and increasingly common to use checklists like the PHQ-9, DASS-21, MDQ or others to track progress in therapy. My clients with Bipolar Disorder benefit significantly from regular assessment of mood symptoms to increase awareness of and insight into early signs of mood episodes in order to initiate lifestyle behavior change.