MACI™ Narrative
Report Example
Learning to interpret a multiaxial instrument at the item, scale, and profile configuration levels is a time consuming task. From a purely practical standpoint, automated interpretive reports provide a significant saving of professional time and effort. However, automatic reports have their own intrinsic limitations. MACI™ reports are normed on patients who were in the early phases of assessment or psychotherapy because of emotional discomforts or social difficulties. Respondents who do not fit this normative population or who have inappropriately taken the MACI™ for nonclinical purposes may have distorted reports. To optimize clinical utility, the report highlights pathological characteristics and dynamics rather than strengths and positive attributes. This focus should be kept in mind by the referring clinician reading the report.
Based on theoretical inferences and probabilistic data from actuarial research, the MACI™ report cannot be judged definitive. It must be viewed as only one facet of a comprehensive psychological assessment, and should be evaluated in conjunction with additional clinical data (for example, current life circumstances, observed behavior, biographic history, interview responses, and information from other tests). To avoid its miscontrual or misuse, the report should be evaluated by mental health clinicians trained in recognizing the strengths and limitations of psychological test data. Given its limited data base and pathologic focus, the report should not be shown to patients or their relatives.
MACI™ Clinical Interpretive Reportt Theodore Millon, PhD
ID Number 11111111 Male Age 16 2/21/97
Copyright © 1993 DICANDRIEN, INC. All
rights reserved. "Millon Adolescent Clinical
Inventory" and "MACII" are trademarks of DICANDRIEN, INC.
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| MACI Clinical Interpretive
Report The MACI report narratives have been normed on adolescent patients
seen in professional treatment settings for either genuine emotional discomforts or social
difficulties and are applicable primarily during the early phases of assessment or
psychotherapy. Distortions such as exaggerated severity may occur among respondents who
have inappropriately taken the MACI for essentially educational or self-exploratory
purposes; in a school counseling setting, the MAPI guidance report is likely to be more
relevant and provide a more suitable picture of the psychological and vocational traits of
this teenager. Inferential and probabilistic, this report must be viewed as only one
aspect of a thorough diagnostic study. Moreover, these inferences should be reevaluated
periodically in light of the pattern of attitude change and emotional growth that typifies
the adolescent period. For these reasons, it should not be shown to patients or their
relatives. In addition to the preceding considerations, the interpretive narrative should be evaluated in light of the following demographic and situational factors. This 16-year-old male is not currently attending school. In the demographic portion of the test, he identifies "drugs/alcohol" and "lonely/depressed" as the problems that are troubling him the most. It is not unusual for this adolescent to exaggerate symptoms and to complain and indulge in self-pity. On the other hand, his response style may convey feelings of extreme vulnerability, associated with a current episode of acute turmoil. Similarly, it may signify an anxious plea for help owing to an inability to cope with stress. Whatever the impetus for the response style, his scale scores, particularly those on the clinical indices, may be somewhat exaggerated, and the interpretations should be read with this consideration in mind. Thoughttul professional judgment in identifying the grounds for these tendencies is warranted. The BR scores reported for this adolescent have been modified to
account for the high raw X (Disclosure) scale score, which reflects high self-revealing
inclinations, the dejection shown by the elevation on Scale FF (Depressive Affect), and
the self-deprecating response tendencies shown by the extreme elevation of Scale Z
(Debasement) over Scale Y (Desirability). This section of the interpretive report pertains to those relatively enduring and pervasive characterological traits that underlie the personal and interpersonal difficulties of this adolescent Rather than focus on specific complaints and problem areas, to be discussed in later paragraphs, this section concentrates on the more habitual, maladaptive methods of relating, behaving, thinking, and feeling. Although Scale 9 (Borderline Tendency) is not as elevated as some of the Personality Patterns scales, it is still elevated enough to indicate a moderate level of pathology in the overall personality structure of this adolescent. He probably has a checkered history of disappointments in his personal and family relationships. Deficits in his scholastic attainments and peer relationships may be notable, as well as a tendency to precipitate self-defeating vicious circles. Earlier aspirations may have met with fiustrating setbacks, and efforts to achieve a comfortable niche in life appear to have failed. |
MACI Clinical Interpretive
Report Although he is usually able to flinction on a satisfactory day-to-day basis, he may experience periods of marked emotional, cognitive, or behavioral dystunctions. There is an affective and interpersonal instability in this adolescent that may be traced in great measure to his defective psychic structures and to his failure to develop internal cohesion and hierarchic priorities. Both a source and a consequence of this lack of inner harmony is his uncertain sense of self, the confusion he experiences as a result of an immature, nebulous, or wavering sense of identity. Hence, the deeper structural undergirding for intrapsychic regulation and interpersonal processing provides an inadequate scaffolding for both psychic continuity and self-integration. Segmented and fragmented, subjected to the flux of his own contradictory attitudes and enigmatic actions, his very sense of being remains precarious, his erratic and conflicting inclinations continue as both cause and effect, generating new experiences that feed back and reinforce an already diminished sense of wholeness. The MACI profile of this adolescent is characterized by an anxious dependency, a persistent seeking of reassurance from others, and the expectation that he will lose the support of those who have provided it in the past. Significant relationships in his life have become increasingly insecure and unreliable. As a consequence, he has become erratic and moody and now experiences prolonged periods of futility and dejection that may be interspersed with obstructive behavior, irritability, and angry outbursts. Primarily dejected and anxious, he is at other times sullen, unpredictable, and irritable. He will typically vacillate between being downcast and pessimistic and then passively aggressive and withdrawn. Complicating his family relationships are his frequent complaints of being treated unfairly, a pattern of behavior that keeps peers and family members on edge, not knowing if he will react in an agreeable or a sulky manner. Mthough he attempts at times to be obliging, he has learned to expect disappointment and often provokes it by testing the behavior of others and by questioning the sincerity of their concern for him. These erratic and testing behaviors have exasperated and alienated those upon whom he leans, and, as a consequence, he has begun to give up hope that he will ever regain their support. Guilt and self-condemnation may be employed to undo his negativistic and moody behavior, but this he feels is futileas well. This adolescent has a sense of helplessness about his future. He recognizes that others have begun to grow weary of his unpredictable and oppositional behavior. Increasingly, he has begun to question who he is and what will become of him. To add to his contusion, he is unable to stop alternating between voicing self-deprecation and remorse, being petulant and bitter, and withdrawing into a shell of protective indifference. His struggle is the typical one of adolescents, that between dependent acquiescence to others and a desire to assert autonomy and independence. Unfortunately, in his case, this struggle is especially troublesome. His inability to regulate his emotional controls and his feeling of being misunderstood by others only produce further moodiness and negativism that add to his persistent tension and periodic dysphoria. Instability and ambivalence in this adolescent's life have resulted in fluctuating attitudes, erratic or uncontrolled emotions, and a general capriciousness and undependability. He is impulsive, unpredictable, and often explosive, and it is difficult for others to be comfortable in his presence. Both relatives and acquaintances feel "on edge," waiting for this adolescent to display a sullen and hurt look or become obstinate and nasty. In being unpredictably contrary, manipulative, and volatile, he often elicits rejection rather than the support he seeks. |
MACI Clinical Interpretive
Report Angered by the failure of others to be nurturant, he employs moods
and threats as vehicles to "get back," to "teach them a lesson." By
exaggerating his plight and by moping about, he avoids responsibilities and places added
burdens on others, causing his family not only to care for him, but to suffer and feel
guilt while doing so. In the same way, cold and stubborn silence may function as an
instrument of punitive blackmail, a way of threatening others with further trouble in the
offing. Fasily nettled and offended by trifles, he is readily provoked into being sullen
and contrary. He is impatient and irritable unless things go his way. The scales in this section pertain to the personal perceptions of this adolescent concerning several issues of psychological development, actualization, and concern. Because experiences at this age are notably subjective, it is important to record how this teenager sees events and reports feelings, not just how others may objectively report them to be. For comparative purposes, his attitudes regarding a wide range of personal, social, and familial matters are contrasted with those expressed by a broad cross section of teenagers of the same sex and age with psychological problems. Feeling confused and uncertain regarding his life direction, this young man demonstrates a problem frequently seen in troubled adolescents. He feels that others have a surer sense than he of their identity and goals. Moreover, he appears to be upset by his incapacity to achieve greater clarity in this regard. In addition, this problem may be exhibited in withdrawal behavior or in a difflise unruliness and resentment of others. A central difficulty for this adolescent is his pervasive sense of dissatisfaction with himself. Finding himself of low worth, he steadfastly maintains the belief that others feel similarly in regard to him. This inability to accept himself, and his unwillingness to believe that others think differently of him, will no doubt complicate efforts at therapeutic intervention. Complicating any other difficulties, this young man describes serious problems in his family - tension and a lack of support are typical. Depending on the personality style noted elsewhere in this report, these difficulties may reflect either severe parental rejection or, conversely, a sharp break on the part of this adolescent as he asserts independence from traditional societal values. This young man recalls having been victimized by adults through much of his childhood. Remembering incidents in which they abused him, he now feels a degree of anger and confusion regarding these events. |
MACI Clinical Interpretive
Report CLINICAL SYNDROMES The features and dynamics of the following distinctive clinical syndromes are worthy of description and analysis. They may arise in response to external precipitants, but are likely to reflect and accentuate enduring and pervasive aspects of this young man's basic personality makeup. Pervasive feelings of inadequacy, worthlessness, and guilt appear to have taken the form of suicidal ideation in the clinical picture of this socially awkward and introverted adolescent. Timid, shy, and apprehensive, he is especially sensitive to public humiliation and rejection. Worthy of note has been his tolerance of daily unhappiness and emptiness. However, his former willingness to accept feelings of worthlessness and guilt has now taken the turn of self-destructive thoughts. Plagued with self-doubts and thoughts of death, he may be notably saddened by the view that he is both socially unattractive and physically inferior. Fearful of expressing his discontent to others who might further reject or humiliate him, he deals with his frustration by turning it inward, becoming intropunitively depressed and suicidal. Evidence indicates that recurrent periods of alcoholism or drug use
are a major problem for this troubled adolescent. Anxious, lonely, and socially
apprehensive, he finds intoxication to be a useful lubricant that reduces tensions, stirs
fantasies of enhanced esteem, and permits the quick dissolution of psychic pain. By
disconnecting his preoccupation over social rejection and isolation, these substances
serve to undo his sense of alienation, to bolster his diminished self-confidence, and to
provide a respite from the omnipresent anguish and frustration that characterize much of
his life. The client answered the following statements in the direction noted
in parentheses. These items suggest specific problem areas that the clinician may wish to
investigate. Dangerous Ideation |
MACI Clinical Interpretive
Report Emotional Isolation Anorexic Tendency Bulimic Tendency Drug-Abuse Inclination Alcohol-Abuse Inclination Childhood Abuse DIAGNOSTIC HYPOTHESES Although the diagnostic criteria used in the MACI differ somewhat from those in the DSM-III-R and DSM-IV, there are sufficient parallels to recommend consideration of the following assignments. More definitive judgments should draw upon biographical, observational, and interview data in addition to self-report inventories such as the MACI. |
MACI Clinical Interpretive
Report Axis H: Personality Disorders, Traits, and Features Although traits and features of personality disorders are often observable in adolescents, the data from the MACI should not be used to assign diagnostic labels without additional clinical inforniation. Even when assigned, diagnostic labels tend to be less stable for adolescents than for adults. The traits listed below are suggested by the MACI results and may be important adjuncts to the diagnostic process. Negativistic and Depressive Personality Traits with Self-Defeating and Avoidant Features Note: The preceding traits and features may be made more severe by
the presence of Borderline Axis I: Clinical Syndromes The following list contains suggested clinical syndromes and other conditions relating to the DSM-III-R DSM-IV that may be a focus of clinical attention. Note that DSM-IV codes are in brackets pending final modifications by the APA Task Force on DSM-IV. 305.90 Psychoactive Substance Abuse [305.90 Other (or Unknown) Substance Abuse] 300.4 Dysthymia, early onset V61 .20 Parent-Child Problem V61 .20 Parent-Child Problem PROGNOSTIC AND THERAPEUTIC IMPLICATIONS It would be advisable to attend to and ameliorate this adolescent's current borderline tendencies, depression, and suicidal preoccupations by the rapid implementation of supportive psychotherapeutic measures or targeted psychopharniacologic medications. The possibility of an acute alcohol- or drug-abuse problem should be carefully considered for this teenager. If verified, appropriate behavioral management or group therapeutic programs should be implemented. Once this adolescent has been adequately stabilized, attention may be directed toward the more fundamental goals suggested in the following paragraphs. |
MACI Clinical Interpretive
Report Because of the intense conflict between this adolescent's desire for reassurance and nurturance and his fear of trusting an unknown person, he may have difficulty sustaining a therapeutic relationship. If he agrees to treatment, he is likely to employ frequent maneuvers to test the sincerity and motives of the therapist. To reduce the stressors of his home life, working with family members may be necessary, and if they are not optimally motivated, treatment may become complicated. Because of the preceding reasons, treatment may be terminated long before substantial improvement has occurred. The possibility of this teenager's withdrawal from treatment also stems from his unwillingness to face the humiliation of confronting recent memories and feelings. He may be unwilling to reexperience the false hopes and disappointments usually awakened by psychological therapy. Protectively, he may refuse to wait for others to be rejecting. Instead, he may pull back when things are going well, thereby cutting off experiences that might have proved gratifying had they been completed. Moreover, his anticipation of setback prompts him into a self-fulfilling prophecy. By his own hand, he defeats chances to experience events that could promote change and growth. It is this pattern that a cognitive behavioral approach may successfully interrupt. Adolescents like this one frequently decompensate into anxiety and depressive disorders. The therapist must anticipate suicidal attempts because this adolescent may act impulsively when he feels guilty, needs attention, or seeks a dramatic form of retribution. A major goal of therapy should be to guide him into recognizing the sources and character of his ambivalence and to reinforce a more consistent approach to life. Because he may enter treatment in an agitated state, his anxieties and guilt should be calmed early in treatment. Specific techniques may be helpful during therapy. First, environmental pressures that aggravate this teen's anxieties and dejection should be removed. Supportive therapy may be employed in relieving his anxieties, as may pharmacological agents. If depressive features predominate, antidepressant drugs should be prescribed. Formal behavior modification methods may be explored to achieve consistency in this adolescent's social relationships, especially in the family setting. More directive cognitive techniques may be used to confront him with the obstructive and self-defeating character of his beliefs and assumptions. Such approaches must be handled cautiously, however, lest he become unduly guilt-ridden, depressed, and suicidal. The greatest benefit derived through these approaches is to stabilize him, to help him put reins on his vacillations of mood and behavior. The therapist should not set goals too high or press changes too
quickly because this adolescent cannot tolerate demands or expectations well. Initial
efforts should seek to build his trust, direct his attention to his positive traits, and
enhance his confidence and self-esteem. End of Report |
