Klinik ve adli bağlamda ruhsal travmanın değerlendirilmesinde Minnesota Çok Yönlü Kişilik Envanteri, Tematik Algı Testi ve Rorschach Mürekkep Lekeleri Testi’nin kullanımı

Yıl 2022, Cilt: 6 Sayı: 2, 232 - 248, 25.08.2022

Burcu Kahveci Öncü Bahar Baştuğ

https://doi.org/10.5455/kpd.26024438m000063

Öz

Travma sonrası stres bozukluğu (TSSB) genel olarak kişinin ölüm ya da ciddi yaralanma tehdidine maruz kalmasına bağlı olarak ortaya çıkabilen bir ruh sağlığı problemidir. Belirtileri açısından farklı tanılarla karıştırılma olasılığı yüksek olan TSSB’nin klinik açıdan değerlendirilmesinde psikolojik ölçme araçlarına sıklıkla başvurulmaktadır. Adli konularda ise özellikle tazminat talepleri sebebiyle yapılan başvurularda ruh sağlığı alanında çalışan kişiler sıklıkla TSSB’nin varlığını değerlendirmek durumunda kalmaktadır. Bu çalışmada klinik ve adli psikolojik değerlendirmede sık kullanılan Minnesota Çok Yönlü Kişilik Envanteri (MMPI), Tematik Algı Testi (TAT) ve Rorschach Mürekkep Lekeleri Testi ile travma mağduru kişilerin değerlendirildiği çalışmalarda ortaya çıkan profil özelliklerinin incelenmesi amaçlanmaktadır. Bunun yanında alanyazındaki bilgilerin derlenerek sunulması da amaçlar arasındadır. Yapılan çalışmalar MMPI, TAT ve Rorschach Mürekkep Lekeleri Testi’nin travmanın değerlendirilmesinde başarıyla kullanılabilen araçlar olduğunu göstermekte ancak tanısal ya da adli karar verirken tek başına testlerden elde edilen bilgilerin yanıltıcı sonuçlar doğurabileceği de sıklıkla vurgulanmaktadır. Bu tür durumlarda psikolojik değerlendirme araçlarının kullanımı özellikle önemli olup bu değerlendirmeleri yapan kişilerin de konuyla ilgili alanyazın bilgisine hâkim olması ve güncel çalışmaları takip etmesi yapılan değerlendirmelerin daha doğru şekilde ele alınmasını sağlayacaktır.

Anahtar Kelimeler

travma, psikolojik testler, adli değerlendirme, MMPI, TAT, Rorschach Mürekkep Lekeleri Testi

The use of Minnesota Multiphasic Personality Inventory (MMPI), Thematic Apperception Test (TAT) and Rorschach Inkblot Test in the evaluation of mental trauma in clinical and forensic context

Öz

Post-traumatic stress disorder (PTSD) is a mental health problem that can occur generally because of the threat of death or serious injury. Psychological assessment tools are often used in the clinical evaluation of PTSD, whose symptoms are likely to be confused with different diagnoses. In forensic areas, people working in the mental health field often have to evaluate the presence of PTSD, especially in applications with compensation claims. This study, it was aimed to examine the Minnesota Multiphasic Personality Inventory (MMPI), Thematic Apperception Test (TAT), and Rorschach Inkblot Test which are widely used in clinical and forensic psychological evaluation, and the profile characteristics that emerge in the studies where trauma victims are evaluated. Besides, the presentation of compiled information in the literature is also among the aims of this study. Studies showed that MMPI, TAT, and Rorschach Inkblot Test can be used successfully in the evaluation of trauma, but it is frequently emphasized that the information obtained from the tests alone can cause misleading results when deciding on diagnosis or forensic situations. In such cases, it is especially important to use psychological evaluation tools, and mental health professionals evaluating PTSD should have knowledge of the literature on this subject and follow current studies and so it could be ensured that the evaluations are handled more accurately.

Anahtar Kelimeler

trauma, psychological tests, forensic evaluation, MMPI, TAT, Rorschach Inkblot Test

Kaynakça

• American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Arbisi, P. A., Ben-Porath, Y. S., & McNulty, J. (2006). The ability of the MMPI-2 to detect feigned PTSD within the context of compensation seeking. Psychological Services, 3(4), 249-261.
• Archer, R.P., Buffington-Vollum, J.K., Stredny, R.V. ve Handel, R. W. (2006). A Survey of Psychological Test Use Patterns Among Forensic Psychologists. Journal of Personality Assessment, 87(1), 84-94.
• Areh, I. (2020). Forensic assessment may be based on common sense assumptions rather than science. International Journal of Law and Psychiatry, 71, 1-10.
• Armstrong, J.G. (2002). Deciphering the broken narrative of trauma: Signs of traumatic dissociation on the Rorschach. Rorschachiana, 25(1), 11–27.
• Armstrong, J.G. ve Loewenstein, R.J. (1990). Characteristics of patients with multiple personality and dissociative disorders on pychological testing. The Journal of Nervous and Mental Disease, 178 (7), 448-454.
• Armstrong, J.G. ve Kaser-Boyd, N. (2004). Projective assessment of psychological trauma. (M. Hilsenroth ve D. Segal (Ed.), Comprehensive handbook of psycholo gical assessment: Vol. 2. Personality assessment içinde (s. 500–512). NY: Wiley.
• Arnon, Z., Maoz, G., Gazit, T. ve Klein, E. (2011). Rorschach indicators of PTSD: A retrospective study. Rorschachiana, 32(1), 5–26.
• Asari, T., Konishi, S., Jimura, K., Chikazoe, J., Nakamura, N. ve Miyashita, Y. (2008). Right temporopolar activation associated with unique perception. NeuroImage, 41(1), 145-152.
• Asari, T., Konishi, S., Jimura, K., Chikazoe, J., Nakamura, N. ve Miyashita, Y. (2010a). Amygdalar modulation of frontotemporal connectivity during the inkblot test. Psychiatry Research, 182(2), 103–110.
• Asari, T., Konishi, S., Jimura, K., Chikazoe, J., Nakamura, N. ve Miyashita, Y. (2010b). Amygdalar enlargement associated with unique perception. Cortex, 46(1), 94–99.
• Baillés, E., Pintor, L., Fernandez-Egea, E., Torres, X., Matrai, S., De Pablo, J. ve Arroyo, S. (2004). Psychiatric disorders, trauma, and MMPI profile in a Spanish sample of nonepileptic seizure patients. General Hospital Psychiatry, 26, 310-315.
• Bedi, R., Muller, R.T. ve Thornback, K. (2013). Object relations and psychopathology among adult survivors of childhood abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), 233–240.
• Bornstein, R.F. (2002). A process dissociation approach to objective-projective test score interrelationships. Journal of Personality Assessment, 78(1), 47–68.
• Brand, B.L., Armstrong, J.G. ve Loewenstein, R.J. (2006). Psychological assessment of patients with dissociative ıdentity disorder. Psychiatric Clinics of North America, 29, 145-168.
• Brand, B.L., Armstrong, J.G., Loewenstein, R.J. ve McNary, S.W. (2009). Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients. Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), 188–205.
• Briere, J.N. ve Scott C. (2016). Travma terapisinin ilkeleri. (B.D. Genç, Çev.). İstanbul Bilgi Üniversitesi Yayınları (Orijinal çalışma basım tarihi 2014).
• Cannon, D.S., Bell, W.E., Andrews, R.H. ve Finkelstein, A.S. (1987). Correspondence between MMPI PTSD measures and clinical diagnosis. Journal Of Personality Assessment, 51(4), 517–521.
• Carlson, E. B. ve Dalenberg, C. J. (2000). A conceptual framework for the impact of traumatic experiences. Trauma, Violence, & Abuse, 1(1), 4–28.
• Carlson, E. B., Furby, L., Armstrong, J. ve Shlaes, J. (1997). A conceptual framework for the the long-term psychological effects of traumatic childhood abuse. Child Maltreatment, 2(3), 272–295.
• Cashel, M. L., Ovaert, L. ve Holliman, N. G. (2000). Evaluating PTSD in incarcerated male juveniles with the MMPI-A: An exploratory analysis. Journal of Clinical Psychology, 56(12), 1535–1549.
• Çolak, B., Kokurcan, A. ve Özsan, H.H. (2010). DSM’ler boyunca travma kavramının seyri. Kriz Dergisi, 18 (3), 19-25.
• Efendov, A.A., Sellbom, M. ve Bagby, R.M. (2008). The utility and comparative incremental validity of the MMPI-2 and Trauma symptom Inventory validity scales in the detection of feigned PTSD. Psychological Assessment, 20(4), 317–326.
• Elhai, J.D., Frueh, B.C., Gold, P.B., Hamner, M.B. ve Gold, S.N. (2003). posttraumatic stress, depression and dissociation as predictors of MMPI-2 scale 8 scores in combat veterans with PTSD, Journal of Trauma &Dissociation, 4(1), 51-64.
• El-Shenawy, O.E. (2017). Traditional psychological tests usage in forensic assessment. Journal of Forensic Legal Investigative Science, 3(1), 1-5.
• Engels, M.L., Moisan, D. ve Harris, D. (1994). MMPI indices of childhood trauma among 110 female outpatients. Journal of Personality Assesment, 63(1), 135-147.
• Ephraim, D. (2002). Rorschach trauma assessment of survivors of torture and state violence. Rorschachiana, 25(1), 58–76.
• Finn, S.E. (2012). Implications of recent research in neurobiology for psychological assessment. Journal of Personality Assessment, 94(5), 440-449.
• Forbes, D., Creamer, M. ve McHugh, T. (1999). MMPI-2 data for Australian Vietnam Veterans with combat-related PTSD. Journal of Traumatic Stress, 12(2), 371–378.
• Franklin, C.L., Repasky, S.A., Thompson, K.E., Shelton, S.A. ve Uddo, M. (2002). Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD. Journal of Personality Assessment, 79(2), 274–285.
• Freedenfeld, R.N., Ornduff, S. R. ve Kelsey, R.M. (1995). Object relations and physical abuse: A TAT analysis. Journal of Personality Assessment, 64(3), 552–568.
• Frueh, B. C., Leverett, J. P. ve Kinder, B. N. (1995). Interrelationship between MMPI-2 and Rorschach variables in a sample of Vietnam veterans with PTSD. Journal of Personality Assessment, 64(2), 312–318.
• Garb, H.N., Wood, J.M. ve Nezworski, M.T. (2000). Projective techniques and the detection of child sexual abuse. Child Maltreatment, 5(2), 161–168.
• Goldfinger, D.A., Amdur, R.L. ve Liberzon, I. (1998). Psychophysiologic responses to the Rorschach in PTSD patients, noncombat and combat controls. Depression and Anxiety, 8(3), 112–120.
• Greenblatt, R.L. ve Davis, W.E. (1999). Differential diagnosis of PTSD, schizophrenia, and depression with the MMPI-2. Journal of Clinical Psychology, 55(2), 217–223.
• Hall, R.C. ve Hall, R.C. (2006). Malingering of PTSD: forensic and diagnostic considerations, characteristics of malingerers and clinical presentations. General hospital Psychiatry, 28(6), 525–535.
• Holaday M. (2000). Rorschach protocols from children and adolescents diagnosed with posttraumatic stress disorder. Journal of Personality Assessment, 75(1), 143–157.
• Holaday, M., Armsworth, M.W., Swank, P.R. ve Vincent, K.R. (1992). Rorschach responding in traumatized children and adolescents. Journal of Traumatic Stress, 5(1), 119-129.
• Inoue, N. (2007). Trauma assessment of domestic violence victims: A multi-dimensional approach for the assessment of trauma impact using the TAT. Bulletin of Centre of Clinical Psychology and Counseling at Ochanomizu University, 9, 40–53.
• Inoue, N. (2009). Evaluation of an EMDR treatment outcome using the Rorschach, the TAT, and the IES-R: A case study of a human-caused trauma survivor. Rorschachiana, 30(2), 180–218.
• Kamphuis, J.H., Kugeares, S.L. ve Finn, S.E. (2000). Rorschach correlates of sexual abuse: trauma content and aggression indexes. Journal of Personality Assessment, 75(2), 212–224.
• Keane, T.M., Malloy, P. F. ve Fairbank, J.A. (1984). Empirical development of an MMPI subscale for the assessment of combat-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 52(5), 888–891.
• Kenderdine, S.K., Phillips, E.J. ve Scurfield, R.M. (1992). Comparison of the MMPI PTSD subscale with PTSD and substance abuse patient populations. Journal of Clinical Psychology, 48(1), 136-139.
• Kirz, J.L., Drescher, K.D., Klein, J.L., Gusman, F.D. ve Schwartz, M.F. (2001). MMPI-2 assessment of differential post-traumatic stress disorder patterns in combat veterans and sexual assault victims. Journal of Interpersonal Violence, 16(7), 619–639.
• Kleinman, S.B. ve Martell, D. (2015). Failings of trauma-specific and related psychological tests in detecting post-traumatic stress disorder in forensic settings. Journal of Forensic Sciences, 60(1), 76–83.
• Klopfer, B. ve Davidson, H.H. (1962). The rorschach technique: An introductory Manual. Hartcourt, Brace & World, Inc.
• Koch, W.J., O'Neill, M. ve Douglas, K.S. (2005). Empirical limits for the forensic assessment of PTSD litigants. Law and Human Behavior, 29(1), 121–149.
• Koretzky, M.B. ve Peck, A.H. (1990). Validation and cross-validation of the PTSD subscale of the MMPI with civilian trauma victims. Journal of Clinical Psychology, 46(3), 296-300.
• Lally, S.J. (2003). What tests are acceptable for use in forensic evaluations? A survey of experts. Professional Psychology: Research and Practice, 34(5), 491–498.
• Lange, R.T., Sullivan, K.A. ve Scott, C. (2010). Comparison of MMPI-2 and PAI validity indicators to detect feigned depression and PTSD symptom reporting. Psychiatry Research, 176(2-3), 229–235.
• Lees-Haley, P.R. (1992). Efficacy of MMPI-2 validity scales and MCMI-II modifier scales for detecting spurious PTSD claims: F, F-K, fake bad scale, ego strength, subtle-obvious subscales, DIS, and DEB. Journal of Clinical Psychology, 48(5), 681-689.
• Luxenberg, T. ve Levin, P. (2004). The role of the Rorschach in the assessment and treatment of trauma. (J.P. Wilson ve T.M. Keane (Ed.), Assessing psychological trauma and PTSD (2. baskı) içinde (s. 190–225). Guilford Press.
• Lyons, J.A., Gerardi, R.J., Wolfe, J. Ve Keane, T.M. (1988). Multidimensional assessment of combat-related PTSD: Phenomenological, psychometric and physiological considerations. Journal of Traumatic Stress, 3, 373-394.
• Lyons, J. A. ve Keane, T. M. (1992). Keane PTSD Scale: MMPI and MMPI-2 update. Journal of Traumatic Stress, 5(1), 111–117.
• Lyons, J. A. Ve Wheeler-Cox, T. (1999). MMPI, MMPI-2 and PTSD: overview of scores, scales, and profiles. Journal of Traumatic Stress, 12(1), 175–183.
• Martin, H. ve Frackowiak, M. (2017). The value of projective/performance-based techniques in therapeutic assessment. Journal of Projective Psychology & Mental Health, 24(2), 91–95.
• Mason, L.H., Shandera-Ochsner, A.L., Williamson, K. D., Harp, J.P., Edmundson, M., Berry, D.T. ve High Jr, W.M., (2013). Accuracy of MMPI-2-RF validity scales for identifying feigned PTSD symptoms, random responding, and genuine PTSD. Journal of Personality Assessment, 95(6), 585–593.
• McDevitt-Murphy, M. E., Weathers, F.W., Flood, A.M., Eakin, D.E. ve Benson, T. A. (2007). The utility of the PAI and the MMPI-2 for discriminating PTSD, depression, and social phobia in trauma-exposed college students. Assessment, 14(2), 181–195.
• Oğuztürk, Ö., Bayar Muluk, N., Oral, N., Yalçınkaya, F. ve Bülbül, S.F. (2008). Minnesota Multiphasic Personality Inventory of the workers exposed to blast trauma at bomb filling atelier of ammunition factory. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 10(1), 18-25.
• Opaas, M., Hartmann, E., Wentzel-Larsen, T. ve Varvin, S. (2016). Relationship of pretreatment rorschach factors to symptoms, quality of life, and real-life functioning in a 3-year follow-up of traumatized refugee patients. Journal of Personality Assessment, 98(3), 247–260.
• Ornduff, S.R. ve Kelsey, R.M. (1996). Object relations of sexually and physically abused female children: A TAT analysis, Journal of Personality Assessment, 66(1), 91-105.
• Özer, A. K. (1995). Rorschach: Bütünleyici" Exner" Sistemi. Boğaziçi Üniversitesi.
• Pica, M., Beere, D., Lovinger, S. ve Dush, D. (2001). The responses of dissociative patients on the Thematic Apperception Test. Journal of Clinical Psychology, 57(7), 847–864.
• Pistole, D.R. ve Ornduff, S.R. (1994). TAT assessment of sexually abused girls: an analysis of manifest content. Journal of Personality Assessment, 63(2), 211–222.
• Rademaker, A. R., Kleber, R. J., Meijer, M. E. ve Vermetten, E. (2009). Investigating the MMPI-2 trauma profile in treatment-seeking peacekeepers. Journal of Personality Assessment, 91(6), 593–600.
• Reinhard, M. J., Wolf, G. ve Cozolino, L. (2010). Using the MMPI to assess reported cognitive disturbances and somatization as a core feature of complex PTSD. Journal of Trauma & Dissociation, 11(1), 57–72.
• Scortegagna, S.A. ve Villemor-Amaral, A.E. (2013). Traumatic loss and helplessness: qualitative analysis of responses in the Rorschach. Psico-USF, 18(1), 1-12.
• Scotti, J. R., Sturges, L. V. ve Lyons, J. A. (1996). The Keane PTSD Scale extracted from the MMPI: sensitivity and specificity with Vietnam veterans. Journal of Traumatic Stress, 9(3), 643–650.
• Shercliffe, R. J. ve Colotla, V. (2009). MMPI-2 profiles in civilian PTSD: an examination of differential responses between victims of crime and industrial accidents. Journal of Interpersonal Violence, 24(2), 349–360.
• Smith, J.M., Gacono, C.B. ve Cunliffe, Ted, B. (2020). Using the Rorschach Trauma Content Index (TCI) with incarcerated women. SIS Journal of Projective Psychology & Mental Health, 27, 12-20.
• Tanis, T.C. (2018). What’s your story? Assessing childhood maltreatment using the Thematic Apperception Test in an adult inpatient population (Yayınlanmamış doktora tezi). City University of New York, New York.
• Tedeschi, F.K. ve Billick, S.B. (2017). Pediatric PTSD: Clinical, forensic, and diagnostic understanding. The journal of the American Academy of Psychiatry and the Law, 45(2), 161–169.
• Uluç, S. (2008). MMPI-2 Depresyon, kaygı ve öfke içerik ölçeklerinin ölçüt geçerliği açısından değerlendirilmesi. Türk Psikiyatri Dergisi, 19(1), 57-66.
• Van der Kolk, B.A. ve Ducey, C.P. (1989). The psychological processing of traumatic experience: Rorschach patterns in PTSD. Journal of Traumatic Stress, 2(3), 259–274.
• Vatan, S. ve Dağ, İ. (2009). Problem çözme, umutsuzluk, çaresizlik ve talihsizlik MMPI-2 ile ölçülen psikopatolojinin yordayıcıları olabilir mi? Anadolu Psikiyatri Dergisi 10, 187-197.
• Viglione, D. J., Towns, B. ve Lindshield, D. (2012). Understanding and using the Rorschach Inkblot Test to assess post-traumatic conditions. Psychological Injury and Law, 5(2), 135-144.
• Villemor-Amaral, A.E. ve Finn, S.E. (2020). The Rorschach as a window into past traumas during therapeutic assessment. Rorschachiana, 41(2), 93–106.
• West, M.M. (1998). Meta-analysis of studies assessing the efficacy of projective techniques in discriminating child sexual abuse. Child Abuse & Neglect, 22(11), 1151–1166.
• Wetzel, R.D., Murphy, G.E., Simons, A., Lustman, P., North, C. ve Yutzy, S. (2003). What does the Keane PTSD scale of the MMPI measure? Repeated measurements in a group of patients with major depression. Psychological Reports, 92, 781–786.
• Wilson, J.P. ve Walker, A.J. (1990). Toward an MMPI trauma profile. Journal of Traumatic Stress, 3(1), 151–168.
• Zukerman, G., Itzchak, E.B., Fostick, L. ve Armony-Sivan, R. (2017). Information rocessing of the Rorschach's Traumatic Content Index in trauma-exposed adults: An Event Related Potential (ERP) Study. Biological Psychology, 127, 108–122.