Contemporary Rorschach Interpretation

By J. Reid Meloy; Marvin W. Acklin et al. | Go to book overview

21
Personality Factors in Chronic
Fatigue Syndrome: Psychological
Assessment

Robert Lovitt
Cynthia A. Claassen
The University of Texas Southwestern Medical Center

Psychodiagnostic evaluation and consultation is a prized and important skill for psychologists practicing in medical-surgical settings ( Lovitt 1984, 1987; Lovitt & Weiner, 1980). Cases in which patients do not respond to traditional medical therapies or in which symptomatic complaints exceed what can be inferred from medical-psychiatric evaluation are perplexing to medical personnel and expensive and frustrating for patients. The ability of psychologists to provide diagnostic and treatment recommendations in such cases has been well described in the Minnesota Multiphasic Personality Inventory (MMPI) literature ( Graham, 1993). In its original conception, MMPI ( Hathaway & McKinley, 1940) scales were constructed to identify patients who developed physical symptoms in response to psychic stressors ( Dahlstrom & Welsh, 1960). Rorschach work with medical patients has been less thoroughly documented, and interest in hysterical and psychophysiological processes had a more indirect and limited impact on this test's construction. Therefore, the Rorschach has had a more limited role in the assessment of somaticizing conditions than it has had with other psychiatric groups. In addition, there are limited empirical data and few helpful models are available to the practicing clinician ( Lovitt 1987).

The biopsychosocial model ( Engel, 1980) provides the most comprehensive understanding of patients' illness behavior. The model asserts that a patient's behavioral response to disease is determined by an interaction of biological (e.g., a virus, specific organ system being affected), psychological (e.g., level of ego organization, personality style), and social-environmental factors (e.g., family support). The interaction between these factors transforms biological pathology into a highly subjective psychological experience resulting in a unique pattern of illness behavior. Illness behavior differs from cellular and

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