Integration of Test Results with Clinical Observations A Diagnostic Case Study

In this study, we aimed to investigate the application of an externally rated measure of interpersonal representations (Social Cognition and Object Relations Scale [SCORS]; Westen, 1995) to dream narratives. A total of 80 student participants enrolled at a private university in the New York City metropolitan area completed a Dream Log and affect adjective checklist (Wellman, 2002) based on a recalled dream at both 1 month and 3 months following the September 11, 2001, terrorist attacks. Using the dreams provided in this study we examined the interrater reliability of SCORS ratings, the relationship of SCORS variables to an independently rated measure of dream distortion, and the relationship of SCORS variables to participants' own ratings of dream affect. Results indicated that dreams were reliably rated using the SCORS, 3 cognitive SCORS variables were significantly related to dream distortion, and affective SCORS variables were meaningfully related to participants' own ratings of affect in their dreams. Findings from this study provide support for the application of SCORS ratings to dream narratives. We discuss implications for further research and clinical application.     

Reliability and validity of the Social Cognition and Object Relations Scale (SCORS) in the assessment of dream narratives

In this study, we aimed to investigate the application of an externally rated measure of interpersonal representations (Social Cognition and Object Relations Scale [SCORS]; Westen, 1995) to dream narratives. A total of 80 student participants enrolled at a private university in the New York City metropolitan area completed a Dream Log and affect adjective checklist (Wellman, 2002) based on a recalled dream at both 1 month and 3 months following the September 11, 2001, terrorist attacks. Using the dreams provided in this study we examined the interrater reliability of SCORS ratings, the relationship of SCORS variables to an independently rated measure of dream distortion, and the relationship of SCORS variables to participants' own ratings of dream affect. Results indicated that dreams were reliably rated using the SCORS, 3 cognitive SCORS variables were significantly related to dream distortion, and affective SCORS variables were meaningfully related to participants' own ratings of affect in their dreams. Findings from this study provide support for the application of SCORS ratings to dream narratives. We discuss implications for further research and clinical application.     

Use of the TAT in the Assessment of DSM-IV Cluster B Personality Disorders

The Social Cognition and Object Relations Scale (SCORS), developed by Westen, Lohr, Silk, Kerber, and Goodrich (1985), is a diagnostic instrument used to assess an array of psychological functioning by using clinical narratives such as the Thematic Apperception Test (TAT; Murray, 1943) stories. This study investigated the utility of the SCORS to differentiate between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder (ANPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and Cluster C personality disorder (CPD). A sample of 58 patients was separated into four groups: ANPD (n = 9), BPD (n = 21; 18 with a primary BPD diagnosis and 3 with prominent borderline traits who met 4 of the 5 DSM-IV criteria necessary for a BPD diagnosis), NPD (n = 16; 8 with a primary NPD diagnosis and 8 with prominent narcissistic traits who met 4 of the 5 DSM-IV criteria necessary for a NPD diagnosis), and CPD (n = 12). These groups were then compared on the 8 SCORS variables by using 5 TAT cards (1, 2, 3BM, 4, and 13MF). Spearman-Brown correction for 2-way mixed effects model of reliability for the 8 SCORS variables ranged from .70 to .95. The results of categorical and dimensional analyses indicate that (a) the SCORS variables can be used to differentiate ANPD, BPD, and NPD; (b) the BPD group scored significantly lower (greater maladjustment) than did the CPD group on certain variables; (c) the BPD group scored significantly lower (greater maladjustment) than did the NPD group on all 8 SCORS variables; (d) the ANPD group scored significantly lower than did the NPD group on certain variables; (e) certain variables were found to be empirically related to the total number of DSM-IV ANPD, BPD, and NPD criteria; and (f) certain variables were found to be empirically related to Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) personality disorder scales. The results of this study are discussed in terms of clinical utility, conceptual, and theoretical implications.     

The Use of the Social Cognition and Object Relations Scale in a Primary Care Setting

Research has indicated that as many as 10% to 15% of primary care patients have symptoms that are not well explained medically. These patients could be labeled as “somatizers.” This study assessed the extent to which underlying psychological characteristics contribute to a person's level of somatization and service utilization. The Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, 1995) was used to rate early memory narratives of 100 patients in a suburban primary care setting. Using principal axis factoring, the SCORS–G was divided into 2 components and these components (cognitive and affective) were used in subsequent analyses. The affective component was significantly negatively correlated with 2 measures of somatization and positively related to physician ratings of global health. The affective component also showed a trend toward significance on overnight hospital stays and patient-rated health. The cognitive component showed a trend toward significance with both measures of somatization, but it was not correlated with other measures of health. This study demonstrates the value of assessing underlying processes (via SCORS–G ratings of early memory narratives) that contribute to increased rates of somatization and health care utilization. Clinical implications for the relationship between affect and physical health are explored.     

Object relations and real life relationships: A cross method assessment

This study examines the relationship between the psychoanalytic concept of object relations and real life behavior of being in an intimate relationship among heterosexual women. In a multi‐method approach we used two different measures; the self‐report Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, Billington & Becker, 1986 ) and the performance based Thematic Apperception Test (TAT) Social Cognition & Object Relations Scale‐ Global Rating Method SCORS‐G (Westen, 1995 ) to measure the object relations of 60 women. The Alienation subscale of the BORRTI and understanding of social causality subscale of the SCORS‐G explained 34.8% of variance of the intimate relationship variable. Thus, women involved in a romantic relationship reported lower rates of alienation on the BORRTI and produced TAT narratives that were more adaptive with regard to understanding of social causality as measured by the SCORS‐G than those not currently in a relationship. Results are discussed with reference to the relationship between object relations and real life measures of healthy individuals and in light of the need for a multi‐method approach of assessment.     

Object relations and interpersonal problems in sexually abused female patients: an empirical study with the SCORS and the IIP

In this study, we examined how retrospective reports of experiencing traumatic sexual abuse in childhood relates to both the development of self-representations and object representations and the occurrence of interpersonal problems. A total of 30 psychosomatic female patients who reported sexual abuse in childhood were compared with a corresponding number of eating-disordered patients and a nonclinical control group. The object relations technique (ORT; Phillipson, 1955), evaluated using the Social Cognition and Object Relations Scale (SCORS; Westen, 1985, 1991b), and the Inventory of Interpersonal Problems (Horowitz, Rosenberg, Baer, & Ureno, 1988) were used to measure the groups. The patients reporting sexual abuse achieved significantly lower scores in the cognitive scales of the SCORS; in the affective scales, they differed from the control group but not from the patients with an eating disorder. Concerning interpersonal problems, the patients reporting childhood sexual abuse reported interpersonal conflicts more frequently. The results of the study support the influence of traumatic sexual abuse on the formation of self-representations and object representations and on the occurrence of interpersonal conflicts.     

Use of the TAT in the assessment of DSM-IV cluster B personality disorders

The Social Cognition and Object Relations Scale (SCORS), developed by Western, Lohr, Silk, Kerber, and Goodrich (1985), is a diagnostic instrument used to assess an array of psychological functioning by using clinical narratives such as the Thematic Apperception Test (TAT; Murray, 1943) stories. This study investigated the utility of the SCORS to differentiate between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder (ANPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and Cluster C personality disorder (CPD). A sample of 58 patients was separated into four groups: ANPD (n = 9), BPD (n = 21; 18 with a primary BPD diagnosis and 3 with prominent borderline traits who met 4 of the 5 DSM-IV criteria necessary for a BPD diagnosis), NPD (n = 16; 8 with a primary NPD diagnosis and 8 with prominent narcissistic traits who met 4 of the 5 DSM-IV criteria necessary for a NPD diagnosis), and CPD (n = 12). These groups were then compared on the 8 SCORS variables by using 5 TAT cards (1, 2, 3BM, 4, and 13MF). Spearman-Brown correction for 2-way mixed effects model of reliability for the 8 SCORS variables ranged from .70 to .95. The results of categorical and dimensional analyses indicate that (a) SCORS variables can be used to differentiate ANPD, BPD, and NPD; (b) the BPD group scored significantly lower (greater maladjustment) than did the CPD group on certain variables; (c) the BPD group scored significantly lower (greater maladjustment) than did the NPD group on all 8 SCORS variables; (d) the ANPD group scored significantly lower than did the NPD group on certain variables; (e) certain variables were found to be empirically related to the total number of DSM-IV ANPD, BPD, and NPD criteria; and (f) certain variables were found to be empirically related to Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Personality disorder scales. The results of this study are discussed in terms of clinical utility, conceptual, and theoretical implications.     

Exploring the construct validity of the social cognition and object relations scale in a clinical sample

The Social Cognition and Object Relations Scale-Global rating method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, 1995) measures the quality of object relations in narrative material. This study employed a multimethod approach to explore the structure and construct validity of the SCORS-G. The Thematic Apperception Test (TAT; Murray, 1943) was administered to 59 patients referred for psychological assessment at a large Northeastern U.S. hospital. The resulting 301 TAT narratives were rated using the SCORS-G method. The 8 SCORS variables were found to have high interrater reliability and good internal consistency. Principal components analysis revealed a 3-component solution with components tapping emotions/affect regulation in relationships, self-image, and aspects of cognition. Next, the construct validity of the SCORS-G components was explored using measures of intellectual and executive functioning, psychopathology, and normal personality. The 3 SCORS-G components showed unique and theoretically meaningful relationships across these broad and diverse psychological measures. This study demonstrates the value of using a standardized scoring method, like the SCORS-G, to reveal the rich and complex nature of narrative material.     

Children's internal representations,empathy, and fantasy play: a validity study of the SCORS-Q

The authors investigated relationships among internal representations, empathy, and affective and cognitive processes in fantasy play to test the validity of the Social Cognition and Object Relations Scale Q-Sort (SCORS-Q; D. Westen, 1995) with children. Eighty-six 8-10-year-olds were administered 8 Thematic Apperception Test cards, a standardized play task, and a self-report empathy measure. Teachers rated children's empathy and helpfulness. As predicted, internal representations were related to empathy, helpfulness, and quality of fantasy play. Developmental differences on the SCORS-Q were consistent with object relations theory and with results from the original SCORS. The findings support the value of internal representations as a means of understanding children's interpersonal functioning and contribute to the validity of the SCORS-Q for use with children.     

Borderline pathology and the Personality Assessment Inventory (PAI): an evaluation of criterion and concurrent validity

In this study, we examined how patients diagnosed with borderline pathology (BP) would respond on the Personality Assessment Inventory (PAI; Morey, 1991) Borderline (BOR) scales in relation to patients without BP pathology. In addition, we examined whether the PAI BOR scales would be related to variables on the Social Cognition and Object Relations Scale (SCORS; Hilsenroth, Stein, & Pinsker, 2004; Westen, 1995) derived from early memory narratives. Results indicate that outpatients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnosis of BP scored significantly higher on the PAI BOR Total (BOR-Total) score, Identity Problems, and Self- Harm scales in comparison to a Non-BP clinical sample. The overall correct classification rate for the presence or absence of BP using the BOR Total scale (T >or= 70) was 73%. In addition, there were several significant relationships between dimensional PAI BOR scales and the presence versus absence of DSM-IV BP. Moreover, both the BOR-Total and Affect Instability scales were significantly related to the SCORS variable Complexity of Representations. We provide clinical examples to illustrate these research findings in an applied manner.     

Introduction to the Special Section on the Social Cognition and Object Relations Scale–Global Rating Method: From Research to Practice

There continues to be a need in the field of psychology for measures that quantify qualitative data in dynamically rich and clinically meaningful ways. The Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G; Westen, 1995) is a clinician-rated measure with a strong theoretical foundation that assesses sophisticated underlying constructs, specifically 8 dimensions of object relations (Stein &; Slavin-Mulford, 2018 Stein, M. B., &; Slavin-Mulford, J. (2018). The Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G): A comprehensive guide for clinicians and researchers. New York, NY: Routledge. [Google Scholar]). The SCORS–G has steadily increased in popularity and this special section of the Journal of Personality Assessment reflects this growing interest. In this introduction, we provide readers with a brief overview of the 5 articles in this special section and note ways in which they reflect and build on the existing SCORS–G empirical literature. Contextualizing these articles within the broader literature allows us to highlight how the measure is employed in clinical and research settings. Each of these 5 articles also highlights areas and opportunities for future research that would address gaps in the SCORS–G literature and strengthen the utility of the measure. We close by noting how each of studies can be seen as a model for future lines of research.     

Cognitive and Affective Representations of People and MCMI--II Personality Psychopathology

Hibbard, Hilsenroth, Hibbard, and Wash (1995) found that affective, but not cognitive, dimensions of object representations were related to the severity of psychopathology among outpatients. In this study, the Social Cognition and Object Relations Scale (Westen, Barends, Leigh, Mendel, & Silbert, 1990) developed for interview data (Relationship Episodes; Luborsky,l990) was used to assess the object representations of 33 men and 38 women entering psychotherapy. The Millon Clinical Multiaxial Inventory-II was used to assess the personality traits of the 71 participants. The results support earlier findings that only affective dimensions of object representations are related to outpatient personality pathology.     

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.     

Reliability and construct validity of the College Student Stress Scale

Reliability and construct validity of the 11-item College Student Stress Scale were investigated with exploratory (N = 273) and confirmatory factor analyses (N = 185) in undergraduate college students. Two factors were observed; however, reliability of the 3-item factor was too low and one item failed to load on either factor. A 7-item measure (Factor 1) had acceptable reliability (.81) and good convergence with the Perceived Stress Scale. This measure was significantly correlated with Neuroticism, Test Anxiety, and Self-efficacy for Learning, but not Social Desirability or age.     

A comparison of two multidimensional health locus of control instruments

This study examined the factor structure, internal consistency reliability, and construct validity of the multidimensional health locus of control (MHLC) instruments developed by K.A. Wallston, B.S. Wallston, and DeVellis (1978) and Lau (Lau, 1982; Lau & Ware, 1981). Both measures were administered to a sample of Veterans Administration (VA) medical outpatients (N = 181). Only minimal evidence of convergence was found between corresponding scales of the two MHLC instruments. Low convergent validity appears attributable to the poor internal consistency reliability of the Lau-Ware subscales. Moreover, results of factor analysis largely supported the a priori factor structure of the K.A. Wallston et al. (1978) MHLC instrument but failed to support the factor structure of the Lau-Ware instrument. Health locus of control (HLC) dimensions that emerged from simultaneous factor analysis of both instruments were most consistent with a three-dimensional typology (i.e., Personal Control, Professional Control, and Chance) rather than the four-dimensional typology proposed by Lau (Lau, 1982; Lau & Ware, 1981). Implications for HLC conceptualization and measurement are discussed.     

A Comparison of Two Multidimensional Health Locus of Control Instruments

This study examined the factor structure, internal consistency reliability and construct validity of the multidimensional health locus of control (MHLC) instruments developed by K. A. Wallston, B. S. Wallston, and DeVellis (1978) and Lau (Lau, 1982; Lau & Ware, 1981), Both measures were administered to a sample of Veterans Administration (VA) medical outpatients (N = 181). Only minimal evidence of convergence was found between corresponding scales of the two MHLC instruments. Low convergent validity appears attributable to the poor internal consistency reliability of the Lau-Ware subscales. Moreover, results of factor analysis largely supported the a priori factor structure of the K. A. Wallston et at. (1978) MHLC instrument but failed to support the factor structure of the Lau-Ware instrument, Health locus of control (HLC) dimensions that emerged from simultaneous factor analysis of both instruments were most consistent with a three-dimensional typology (i.e., Personal Control, Professional Control and Chance) rather than the four-dimensional typology proposed by Lau (Lau, 1982; Lau & Ware, 1981). Implications for HLC conceptualization and measurement are discussed.