Effects of client personality on dominance and affiliation during early sessions of rational-emotive psychotherapy

This is a study of effects of client personality on interpersonal presentation during early Rational-Emotive therapy (RET). Independent variables were intake scores for clients from the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). Dependent variables, from audiotapes of sessions at the Institute for RET (IRET), were Revised Interpersonal Adjective Scale (IAS-R; Wiggins, Trapnell and Phillips, 1988) ratings of clients and therapists. Three commonly adaptive axis II traits (histrionic, narcissistic and antisocial) had significant positive effects on clients, increasing their apparent interpersonal dominance. Paranoid traits, which have previously shown either neutral or positive patterns, mirrored the adaptive patterns. Compulsive traits, which have also been helpful in other stressful situations, seemed maladaptive, however, here. Finally, six commonly maladaptive axis II traits (schizoid, avoidant, dependent, passive-aggressive, schizotypal and borderline) had weak, insignificant effects on clients. In general, these findings suggest that the IRET therapeutic setting may be a psychologically “safe” place for clients. Personality traits that are usually troublesome did not impair self presentation in early sessions of RET, and several usually positive traits appear helpful. The order of authorship was determined by mutual agreement, based on the number of hours each author committed to the project. Dempsey's thesis, based on his work, was submitted in partial fulfillment of the requirements for Henry Rutgers Scholars honors at Rutgers College. Lamon's thesis, based on his work, was submitted in partial fulfillment of the requirements for the Ph. D. at the University of Vermont.     

Stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administrations at intake into treatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

Stability of the Personality and Symptom Scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administration at intake into retreatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

The convergent and discriminant validity of the MCMI as a measure of the DSM-III personality disorders

The personality scales of the Millon Clinical Multiaxial Inventory (MCMI) were constructed and validated to measure the typology developed by Millon (1981). The ability of the MCMI to measure the DSM-III personality disorders has not yet been empirically evaluated. The current study found better convergent validity for the DSM-III personality disorders that are consistent with Millon's typology (i.e., the avoidant and the dependent) than for the disorders that are inconsistent (i.e., the antisocial and the passive-aggressive). However, the results may reflect some advantages Millon's typology might have over the DSM-III. The discriminant validity of all four scales was limited, due in part to the overlap among the MCMI scales and the DSM-III personality disorders. We discuss implications of the results for the revision of the MCMI and the DSM-III.     

An examination of the relationship between personality patterns and symptom/mood patterns

Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility; (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.     

The MCMI as a measure of DSM-III

The Millon Clinical Multiaxial Inventory (MCMI) has been interpreted as a measure of DSM-III disorders. However, the MCMI was constructed and validated primarily as a measure of Millon's (1969, 1981) taxonomy, not DSM-III. Comparison of the two taxonomies and examination of the MCMI's content validity for two of the MCMI scales indicate only a partial congruence between the Millon and DSM-III taxonomies. There has been no published empirical research concerning the relationship between the MCMI and DSM-III, and the derivation and cross-validation research for the MCMI scales employed Millon's taxonomy and not DSM-III. It is suggested that until such data have been presented one should be cautious in one's interpretation of the MCMI as a measure of DSM-III disorders.     

The stability of the Millon Clinical Multiaxial Inventory for psychiatric inpatients

This study investigated the stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of psychiatric inpatients. Patients were administered the MCMI shortly following admission and shortly preceding discharge. As would be expected theoretically, results indicated that stability estimates were greater for the basic personality scales than for the symptom scales. These results were also compared with results from a previous study investigating the stability of MCMI scales. Overall, stability coefficients for the inpatient sample were lower than those reported for other samples. Possible explanations for this and other findings are discussed.     

Factor Structure of the MCMI Basic Personality Scales and Common-Item Artifact

The eight basic personality scales of the Millon Clinical Multiaxial inventory (MCMI) were derived from Millon's theory of personality, but the adequacy of the MCMI for measuring Millon's personality constructs has never been assessed. One major problem with using factor analysis to illuminate the structure of the MCMI personality scales is that artifactual structure may result from item overlap among the scales. To analyze this, item-overlap coefficients were factored and compared to the factor structures of five subject samples. For the eight basic personality scales, three factors emerged for the overlap matrix and each of the five sample matrices: Aloof-Social, Aggressive-Submissive, and Lability-Restraint. It was concluded that these three factors are inconsistent with Millon's theory and that they will be found artifactually across a wide variety of populations due to overlapping items.     

The relationship between MCMI subtlety and severity

Wierzbicki (Wierzbicki & Daleiden, 1993; Wierzbicki & Howard, 1992) has suggested that the Subtle-Obvious distinction may be useful for detecting faking on the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). This study examined Schretlen's (1990) criticism that, on the MMPI, subtlety is confounded with severity. Nine clinical psychology graduate students rated MCMI items for severity. Severity was significantly correlated (r = -.48) with item subtlety. However, this association was lower than that reported by Schretlen on the MMPI.     

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In this study, we examined Millon Clinical Multiaxial Inventory–III (MCMI–III; Millon, 2009) characteristics in an Old Order Amish outpatient sample (n = 166), with a comparison group of Old Order Amish who were not receiving mental health treatment at the time of testing (n = 80). We also graphically compared the 2 Amish groups to a non-Amish psychiatric sample in the literature. Consistent with our hypotheses, the Old Order Amish outpatients scored significantly higher than the Old Order Amish comparison group on the majority of MCMI–III scales, with mostly medium effect sizes, suggesting that the MCMI–III is a useful personality instrument in discriminating between Old Order Amish clinical and nonclinical groups. In addition, the Amish outpatients scored similar to a non-Amish psychiatric sample in the literature on most personality scales. Future MCMI–III studies with the Amish are needed to replicate and generalize our findings.     

The Relationship Between MCMI Subtlety and Severity

Wierzbicki (Wierzbicki & Daleiden, 1993; Wierzbicki & Howard, 1992) has suggested that the Subtle-Obvious distinction may be useful for detecting faking on the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). This study examined Schretlen's (1990) criticism that, on the MMPI, subtlety is confounded with severity. Nine clinical psychology graduate students rated MCMI items for severity. Severity was significantly correlated (r = -.48) with item subtlety. However, this association was lower than that reported by Schretlen on the MMPI.     

Validity of the Superiority and Goal Instability Scales as Measures of Defects in the Self

A series of four canonical correlation analyses was conducted to compare the Superiority and Goal Instability scales both with personality pattern and clinical syndrome scales from the Millon Clinical Multiaxial Inventory (MCMI) and with therapist ratings of personality traits and symptom patterns using 91 clients from a cross-section of outpatient and inpatient mental health agencies. The Superiority scale was related to a pattern of social gregariousness, interpersonal exploitation, and impulsivity and Goal Instability was related to a pattern of social withdrawal, depression, and lack of ambitions and goals. These results clarify the meaning of the two self-scales as well as providing preliminary data on self-pathology and character types.     

Validity of the Superiority and Goal Instability scales as measures of defects in the self

A series of four canonical correlation analyses was conducted to compare the Superiority and Goal Instability scales both with personality pattern and clinical syndrome scales from the Millon Clinical Multiaxial Inventory (MCMI) and with therapist ratings of personality traits and symptom patterns using 91 clients from a cross-section of outpatient and inpatient mental health agencies. The Superiority scale was related to a pattern of social gregariousness, interpersonal exploitation, and impulsivity and Goal Instability was related to a pattern of social withdrawal, depression, and lack of ambitions and goals. These results clarify the meaning of the two self-scales as well as providing preliminary data on self-pathology and character types.     

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Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility: (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.     

Efficacy of the Millon Clinical Multiaxial Inventory–II in Discriminating Mental Health Patients With and Without Suicidal Ideation

A total of 42 mental health clinic patients with suicidal idweation and 89 patients without suicidal ideation were administered the Millon Clinical Multiaxial Inventory–II (MCMI–II; Millon, 1987 Millon, T. (1987). Millon Clinical Multiaxial Inventory (MCMI–II) manual. Minneapolis, MN: National Computer Systems. [Google Scholar]). All participants were active duty military personnel. A total of 15 MCMI–II scale elevations were significantly different between the 2 groups. A pair of discriminant analyses, the 1st utilizing all 25 MCMI–II scales, and the 2nd with only the 13 MCMI–II personality scales, produced correct classification rates of 80.92% and 75.57%, respectively. A total of 6 of 7 MCMI–II “suicide” items significantly differentiated suicidal ideation and nonsuicidal ideation groups. Results of this study offer initial support for the utility of the MCMI–II as a potential screening device for suicidal ideation.     

Factor structure of the MCMI basic personality scales and common-item artifact

The eight basic personality scales of the Millon Clinical Multiaxial Inventory (MCMI) were derived from Millon's theory of personality, but the adequacy of the MCMI for measuring Millon's personality constructs has never been assessed. One major problem with using factor analysis to illuminate the structure of the MCMI personality scales is that artifactual structure may result from item overlap among the scales. To analyze this, item-overlap coefficients were factored and compared to the factor structures of five subject samples. For the eight basic personality scales, three factors emerged for the overlap matrix and each of the five sample matrices: Aloof-Social, Aggressive-Submissive, and Lability-Restraint. It was concluded that these three factors are inconsistent with Millon's theory and that they will be found artifactually across a wide variety of populations due to overlapping items.     

A Multitrait-multimethod examination of Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI)

Recently, certain Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) scales have seen increasing usage for the measurement of DSM-III personality disorders. The current study sought to identify the convergent and discriminant validity of these two sets of scales for this purpose. In general, the results indicated significant convergence across the two instruments. However, better convergent validity was found for scales representing those DSM-III disorders which are most consistent with the typology upon which the MCMI was based. In particular, convergent and discriminant validity results were poorest for Compulsive, Antisocial, and Passive-Aggressive personality scales.     

The Relationship Between the MCMI Personality Scales and DSM-III,Axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.     

The relationship between the MCMI personality scales and DSM-III, axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.     

Millon Clinical Multiaxial Inventory (MCMI) scores with a collegiate sample: Long-term stability and self-other agreement

This study examined (a) the stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of university undergraduates and (b) the correspondence between MCMI scores from self-report versus scores obtained from knowledgeable others who responded by describing the subject rather than themselves. The MCMI was administered to subjects during their freshman year and then again during their senior year. As in clinical populations, stability estimates in this collegiate sample were greater for the basic personality scales than for the symptom scales. Comparison of the results with those from previous studies further showed that the stability coefficients for the collegiate sample were somewhat lower overall than those from treatment follow-up studies with clinical populations. The results also showed that reasonable agreement between self- and others' ratings was obtained on most MCMI scales. The greatest agreement was found for scales that reflect more observable behaviors and relate to an introversion-extroversion dimension, whereas the least agreement was found for scales related to a psychoticism dimension. Lower levels of agreement were also found for scales having a lower mean proportion of items endorsed.This study was sponsored in part by PHS Grant R01 MH31750-01-6, by PHS Grant 5R01 AA06754-01-03, and by funds from the University of Connecticut Research Foundation and Computer Center.