Lecture on the MCMI-IV

and good afternoon or good morning to who all or whatever time zone you might be in at this time very pleased this afternoon my time to be going over the relatively new instrument the MCM I for the most recent iteration of the MCM I this is published in November of 2015 and we have been enjoying a fairly good launch of the instrument and very happy to be just introducing that to some perhaps reinforcing some of the major Milan ideas to others and very hopefully getting people's appetite sweat for really understanding understanding the theory that works behind the instrument because I think this is what really makes the MCM I for as well as all of the ultimate law inventories that are sort of unique in a field of instruments that are primarily empirically derived and then empirically supported our instruments the thought behind them the one the thing that makes them different is that they're both empirically supported but also theoretically derive so that there's more of a backbone to be able to understand a deeper richer context for the work that you do so without further ado I want to look at a little bit of what we're going to be doing today as I've alluded to already we're going to be describing updates that constituted the MCM I for the MCM i3 which is probably something that many of you are still using at this point and certainly still legitimate to use I was originally published in the early 1990s I believe it was 1994 and it went through a couple of updates and some additions made to it as well as a major renormalized of that was late 80s early 90s and for however long that an instrument such as this remains really richly relevant the decision was made then to move forward with a newer version of the instrument that really captured a greater level of detail and breadth and I'll describe much of that I'll be going through most of the major scales of the MMC Y for spending a little bit more time on some than on others particularly those that have been reformulated in some way and if those that are new to this instrument in general and I'm hoping to spend a good amount of time today on the evolutionary theory itself and not so much as an intellectual exercise as much as it is the direct relevance of the theory to how it is that we really conceptualize persons and how it is that we can develop a greater empathic response and a much better therapeutic alliance utilizing elements of the theory that you can discern from the use of the test itself so to begin with I want to ask people to respond to a very simple question and that is have you used the MCM ein if you look at the answers that we have available to you you can say that you've used the four at this point that you've had some experience of the new instrument that you have our experience with the MCM i3 and I would say select that if you really haven't had much exposure to the MCM i-4 at all or if you're brand new to this and you really don't have experience with either of them choose I have not used either and I'm going to be looking through just a little bit here and give you a little bit of an idea the results as we go along don't be shy there's not a whole lot that have shown up just yet I think we're having some technical difficulties with with this poll sherry if you could jump on for just a moment and see if there's a difficulty with this and what we might be able to do with it we can bypass this certainly I am getting some responses but I want to see if there's anything to clarify that there is something wrong with the poll and people are submitting in the chat box okay we bypass this and then look at that what they're saying in the chat box okay I mean I can see a little bit about the poll and I'm seeing a general trend that most people who have been able to get through have responded with I've used the MCM i3 which is more or less what we'd expect a few or less fuel less than that have used the four on a few less than that have not used either so we have people who are relatively familiar with at least the evolutionary theory and the use of the MCM I three that's been out for a very long time and generally speaking I think that's kind of holding true to this trend right now so I would say that majority of folks that are joining us today are at least MCM I three users a fair number have some experience with the MCM I four and I'm glad that you're joining us today because we're going to go to a little more detail and a smaller number are not familiar with either instrument so what I like to do with this is I try to kind of tailor my remarks to emphasize one versus the other sort of perspective but I'm going to try to cover all the points for all three of the potential responses okay thank you all for responding we do have an idea now of of where we're at here and I will proceed accordingly okay to kind of flavor this part of this presentation was something that I want to share with you today is this quote from dr. Malan but he spoke while the emcee mi4 was in its earlier phases of development at this point the instrument was fairly well designed and at that point we were working on empirically validated it and that quote is as follows the emcee mi4 was specifically designed as are all of the Millan inventories to facilitate the therapeutic plans of the clinician now there's a few things about this quote one of them is that he's mentioning all of the Milan inventories and this has really been part of the focus really part of the overall design of all of the instruments dating back to the original MCM I now that does run counter to some degree to the reputation of the MCM I where I think a lot of clinicians have the notion correct in part but for the most part somewhat misguided that you need to have a personality disorder in order to get any kind of fruitful information from the instrument that really is not so and one of the big questions that we all asked ourselves as we were beginning to develop pmc mi4 was how do we address that issue what is it that this instrument is really after and looking at it from a couple of different angles there were some thoughts about expanding the range even further than what the final test was or really getting much more clinically specific but really what we wanted to try to do is to focus on the question of what's a clinical population because that's always been the focus of the clinically oriented Malad instruments which are most of them the mips and to some degree the mb md being the exceptions to that but what we really wanted to do was to say who is it that this instrument is really for and how can we best capture what the instrument is really after which really is personality attributes personality attributes in terms of what causes difficulty for this person the MC mi is still not a personality test for normal personality it's really not designed for that range it is still a clinical instrument but we want to be able to look at the wider range of personality functioning and I'll be saying quite a bit about that as we go along and because of that that also works towards saying what does it do in terms of an intervention we can specify quite a bit in terms of assessing a person but of what real clinical utility is that this is where a fuller understanding of both the empirical and the theoretical components of the instrument really help you in terms of where do you go from here and how do you get as close to the person's experience as possible so that's a major focus of a new instrument and of course the major focus of where we're going today so let's talk a little bit now about what's changed what's new in this instrument what were our overall thoughts some of which I've alluded to already well go into a little bit more detailed and how does that compare with where we've been in the past with the MC mi 3 as well as some of the other some of the legacy MC mi instruments as well as the others so in terms of what we were trying to do we were trying to stay with the same general intended clinical population that we have had and has been the focus of all the MC mi instruments an early pilot study however we really wanted to try to see would it be possible to combine the best of both worlds to be able to expand the range of the MC mi to include possibly some non clinical groups people that were not necessarily presenting for clinical counseling or psychological psychiatric difficulties and the results of that really showed that it wasn't as possible it intended to disc to discolor sort of the the focus that we were after to try to get that much of a range however we did include some of that data from the early pilot group in order to be able to help broaden the to the point where we can say that there's a range that we can look at that is generally speaking a fairly adaptive population but these people do show some personality attributes that can tend to become problematic when they're psychologically distressed so we were able to do that and broaden that range and include that as well in terms of the general overall normative population which we collected from the fall of 2014 to early 2015 and these were at many different sites that were clinical in their orientation as the instrument has been in the past it's an adult instrumental that's designed for ages 18 to 65 and above there's a fairly robust representation for those above that but we generally describe the instrument as a general range of adults leading up to approximately retirement age there are five validity indices I'll go into a bit of detail on that most people are familiar with at least the three disclosure desirability in the basement as well as one which is the invalidity index that has been with the instrument for multiple iterations and not as many are as familiar with the inconsistency scale which was first introduced in the MCM i3 in the late 2000s there are now 15 personality scales this is up from 14 from the MCM i3 there is a new one that I'll go into some detail about called the turbulent personality and there are 10 clinical syndrome scales that roughly equate with the same syndrome scales from the MCM i3 some with a little bit different formulation at this point these are as always scales that are designed to assess the syndrome but also to look at those clinical features primarily in context with the person who is this person and how does that affect what their symptom ology is how is an anxiety experience differently when you have a mix of perhaps avoidant and melancholic characteristics versus say schizoid and anti-social characteristics you're going to see a very different kind of anxiety or depression or somatoform difficulty and so on as always we've retained the base rates base rate system that we have used rather than T scores throughout the life of most of the melanda inventories this is a system that is anchored to the prevalence data for a particular disorder that is that each disorder really falls on its own sort of normative distribution rather than just assuming a regular normal distribution as you might in the overall population there's no assumption here of a normal curve there are the ketosis for example of obscured soit personality is very different from the normal curve so we find that this is a better reflection we have started to include however $10 which we thought to be important information to be able to give to the clinician to describe in general how many people in the population fall below this particular mark so we'll talk a little bit about that today as well again as always the scales have been designed to close the coordinate to DSM constructs and finally one of the features one of the things that we always want to try to do with them a lot of instruments is to try to keep the overall length of the instrument relatively reasonable and it continues to be one of the shorter instruments of its kind throughout the entire field coming in at 195 items which is up just a bit from the 175 from the MCM i3 so there are definitely numerous enhancements to the MCM i-4 which will go into some detail about and one of the things that we always want to clarify and continue to encourage people to really understand as best as they possibly can again for its clinical utility is the anchoring that the MCM I and all the Milan inventories have to dr. Milan's personality theory that's based an evolutionary sort of a framework so to look over this just in general we have updated norms on the MCM I four as well as new test items I'm trying to recall exactly what the number was in terms of new items that we have put in I believe it's in the 80s and I don't recall the exact number offhand but I believe it's about 87 new items combined with other items that have been in the MCM i3 and all of which really trying to update and really get to the point where we're speaking the same language of the 2010 2020 s and possibly into 2030 of the language that's popular that language - that is a good vernacular for the widest range of people in any given population whether that's the United States or some of the other some of the other language norms that we have it's all as always aligned with the DSM the currently dsm-5 criteria as well as the icd-10 criteria there are some changes to some of the scales so some of you who are familiar with a few of the nomenclatures from the MCM I 3 you'll see a couple of differences here at times that also represents a bit of a reformulation but will point out what's new what's not new as we go along as related to we have the turbulent scale that is a new personality scale and it's based in kind of an older idea the idea earlier on before we had bipolar disorder even before we really describe manic depressive disorder as a psychiatric disturbance we had sort of this hypomanic personality that's in the old psychoanalytic literature that's been updated along with notions that have come out of some of the popular writings most notably Kay Jameson's work who has written quite a bit about the idea of exuberance with in life and that extends from relatively well-functioning individuals all the way through to people who really have significant difficulties with that a major upgrade that we wanted to try to put into the MCM I for is really trying to get it as close to therapeutic practice as we possibly could really emphasizing this this has always been a part of the understanding of the MCM eyes as they've gone through the different iterations but we really wanted to put this really up front that what we're trying to do is to give clinical information that's going to help the therapeutic enterprise and the final point that we put into the new instrument one I'm not sure people are as familiar with us they might be but if you're like me and you've had some experience with using the MCM eye profile page with a client and you see all these psychiatric diagnostic labels they can be pretty intimidating they can also possibly lead to false positives so there's now an option on the MCM eye for to utilize abbreviated scale names that are derived from dr. Milan's latest iteration of the theory which is the 2011 book Disorders a personality third edition that really introduced the idea of the spectrum he utilized an abbreviation system that I'll introduce you to that you can now print out so that you can more freely utilize this profile page to be able to show the client the relationship between the different scales without there being as much emphasis on a particular label and I think that's really an important clinical utility item we'll talk again a little bit more about that as we get closer as I show you this abbreviated scale name system so overall we also wanted to look at what's been happening in our field what sorts of changes have come about since the early 1990s and as we all know that's quite a bit some there's been some major paradigm changes in terms of our understanding of different populations in terms of our sensitivity to certain kinds of issues and in terms of how it is that that the APA and other leading forces within our field have encouraged us to speak with clients for example an APA MCM I has always been tied to the DSM diagnosis and has always been historically kind of a notion that we don't discuss exact results and we kind of refrain away from utilizing this language whereas APA really wants us to be more transparent at this point to be able to say here are the results this is what these results mean and let's be a lot more forthcoming in terms of that so the APA standards have shifted the idea of a clinical population I think was a more constricted idea one time and at one time and we've also wondered what does that mean what is a clinical population when people think of the MCM is I think there's a tendency for a lot of people to say well that's the really highly dysfunctional sort of clinical population the ones with severe personality disorders whereas really what we're talking about is a mid-range to a higher range and the range does extend to that higher range of difficulties that people experience and if you were to ask yourself really in terms of the clinical population that you may work with let's say it's people in independent practice we're coming because they've got relational difficulties or they have what you think of as perhaps simple psychiatric symptoms that you're working with or an adjustment disorder how does who they are affect that we want to capture more that so that we wanted to capture a broader range of personality difficulties which if you really think about there's very few people in the world that don't have any and I think that's actually kind of a misnomer in a lot of ways so we really wanted to be able to say this should be applicable to people who are experiencing these difficulties that may extend into the clinical range and then finally one of the big field trends that we were looking at and has really become more of a standard now are gender differences and we've really come a very long way in terms of understanding gender is a much more fluid kind of construct and how most of us have thought about it in the past likewise across the field and in many if not most of the psychological instruments that have been updated in the last several years inclusive of the MMPI to RF and the end to a RF we have really begun as a field to try to put the norms together rather than having separate male and female gender norms which helps in terms of making gender not a specific entity in terms of what it is we're measuring and that has a lot of implications one of which obviously is that we're not going to see any difference in scales because a person is male or female or not suspended the other is that we rice elating that as a different part of our overall enterprise and the MCM I for as well as what's being worked on now that Maki - are really trying to address that much more clearly as well so overall we wanted to really kind of bring the MCM i-4 up to current standards some constructs have been redefined particularly along the lines of how diagnostic changes have occurred for DSM and we also wanted to address something that I think had been a bit of a shadow over some of the earlier Malad instruments in terms of some of the questions about empirical robustness there's always been a challenge in using a base rate system as well as a challenge and leading off with a theoretical kind of a construct that people have questioned you know there are some of the scales from the earlier instruments where we don't see as robust of an empirical backbone and we've really wanted to address that to a much greater degree and the instrument has gone through more steps in terms of really being able to back itself statistically using some of the newer statistical measures to really figure out all these constructs really what we're saying that they are and are they robust out of giving us the right kind of information all of this has gone into the overall understanding and the overall design of the new instrument this point I think is really one of the most important enhancements that we have here in terms of the MCM I wear as the MCM i3 and all the legacy MCM eyes have really tried to illuminate more of a dimensional capacity where it's fallen short in the past is that there was sort of a cutoff point where we set up until this point we're talking about adaptive personalities and at this point it's maladaptive that's kind of an arbitrary point in a lot of ways and what we found him and how dr. Millan has described it in the latest version of the theory and what we wanted to put into the instrument was really about trying to get a full picture of who the person is secondly what syndromes what complaints was a person experiencing and combine those aspects with level of personality functioning or non functioning and using much more of the continuum and breaking it down into different levels of functioning that I'll describe in just a moment all trying to get at this larger bandwidth than what has been reputation which is a much more compromised personality dysfunction so in doing so dr. Mullen now describes theory in terms of different levels of functioning so as you might know from the connection from the theory to the test the each one of the scales really represents a prototype or a textbook model in a lot of ways in terms of what's described for this particular personality prototype which most of them have a fairly clear connection to DSM criteria we've broken it down a little bit further now so for each one of these prototypes we now have three different levels rather than just functional or non-functional we broaden the range and these are tied to specific base rate scores on the instrument normal style which is generally adaptive any patterns this is what we're measuring when we see someone coming in between the base rate of 60 and 74 there's then in that normal trade or type where we start to see moderately maladaptive attributes that is that this person evidences personality difficulties more readily not really at the point of a disorder at this point but with some predictability we can say that these personality attributes are more directly connected to the level of distress that might be going on for them or perhaps for somebody within their social circle and then finally and that's that's the range of 75 to 84 and then at a range of 85 and above we have the clinical disorder range that is a greater likelihood of personality dysfunction it would probably in and of itself be something that is distress oriented either to that person individually or it's more along the lines of ego-syntonic but difficult for the people around them creating more of a social familial difficulty to describe these three different levels dr. Millan put out three different descriptors for each in most cases the the final one being the clinical terminology that we're used to there's now for example and this is the abbreviation system that I was talking about a C a narc spectrum the C would stand for confident efore egotistical and an for narcissistic can be abbreviated to cen as well but often times utilizing the extra letters gives you some more ian tation - - which prototype we're really talking about and again this major goal was to more adequately capture this broader range this is more for your reference than anything else so hopefully you have downloaded the this live material that was provided in the email and we'll go into a lot of detail about this this is the overall okay of all the different 15 personality spectra as well as their descriptions across those three different levels of functioning I do want to draw your attention though however to the last three these are as has been typically has been used in the nomenclature and in theory as three of the 15 that are considered to be more structurally compromised those are schizotypal borderline and paranoid where if you look at the theory what we're really talking about here are more dysfunctional variants of the other 12 personality functions so what we have there is the idea that there really isn't a more adaptive variant of these three in that normal style range you would see nomenclature that's more representative the abnormal type eccentric unstable and mistrustful the middle range really being what we're familiar with in terms of the functioning level of these particular three and dr. Millan has reintroduced some of the older terminology to describe the clinical disorder range meaning at a much higher level of dysfunction schizophrenic personality ciclo frantic personality and paraphernalia t meaning that the entire range in these three tends to shift to some degree now if you take one of the other webinars that we offer actually two of them will go into more detail about that is the therapeutic applications webinar as well as the case study webinar I go into a bit more detail in terms of the overall system for integrating any kind of a and elevation on these three scales in terms of how it is that you read those together with other elevations from the other 12 that is they colorize the other 12 it's a level of personality functioning so you can get an idea whether a person's overall personality compromise may have for example with this gets a tipple range more of a wavering orientation within the evolutionary polarities with a borderline more conflicts and with a paranoid more of a lockdown more of a constricted nasaw will hit that a little bit in the later part of today but just to give you that idea those three are a little bit different we have a couple of scale level changes we have that new personality scale talked about the turbulent again coming out of the idea of the hypomanic personality and being the first if you're familiar with the theory I'll just describe it briefly here but I'll go into more detail later the first of all the personality prototypes we're a major motivational orientation is towards seeking pleasure or seeking life enhancement possibly to a degree that really is is a much more dysfunctional at the higher range a couple new distinctions on scale names depressive because we've expanded some of the nomenclature we've wanted to now have the scale to be represented by a more unique and not as confused with other measures on this instrument new term actually an older term now called the melancholic personality and in the syndrome all scales what was called the thought disorder scale on the MCM I three we've now made the schizophrenic spectrum in this way what we've tried to do I think the old scale had some elements of soft neurological difficulties such as memory lapses and such as attentional problems that did not create quite as clear of a picture and it wasn't adequately capturing those areas which are really outside of the purview of the MCM I if you're thinking about really what you're trying to measure so this is more of a distilled specific schizophrenic spectrum kind of a scale at this point it's only moderately really recalibrated but in its clearer picture on one and the bottom grouping here are seven of the new noteworthy response categories they are added to the existing six that have always been part of the instrument that are moderately changed in some cases in terms of the terminology but we wanted to capture a number of other areas that are somewhat related these are not these kind of fall into two informal groups the ones of one such as an adult ADHD in autism spectrum as well as prescription drug abuse these are roughly speaking kind of differentials that is that they share some attributes with some of the more robust measures of the MCM I but they're not areas that the MCM is known for has ever really been a robust measure it's never really been the intentive for example to try to do any kind of a full assessment of autism spectrum it's outside the range of what we're trying to do but there are certain characteristics particularly in the schizoid personality as it's a tipple personality and a couple of the other other measures having to do with some soft signs where you say if there's enough of these you might want to do more of a differential others are more like the classic use of the noteworthy responses and that is they're not scale measures but there's their alerts to the clinician that you may need to do more of a tertiary intervention for perhaps vengefully prone which can be related to some people really trying to trying to act out on others maybe an individual basis more made or perhaps maybe on mass and some of these also are kind of a combined grouping of both of those particular areas and to kind of wrap up this section right now we have the interpretive reports and some improvements that have been made to these as most tests do is they go into new versions they really try to update the language because as a society we tend to change our language to some degree so we really try to clarify an update and bring that language up to up to sort of modern-day vernacular in terms of the overall usage of language within our interpretive material that is inclusive of clinical information as well as language that's used for descriptors that might be used in terms of feedback the main change that we've made here is that we've really tried to really try to improve the therapeutic guide so the same descriptions that are there that are really dr. Milan's language from his early conceptions on through his later thoughts about how do you describe different kind of personality attributes and add mixtures that's all there the therapeutic guide has always been something of a case conceptualization sort of a framework and one of my major difficulties with that was that it wasn't really including much in terms of the therapeutic directive leading up to the MC mi4 and it was really kind of my charge to really try to take that language and add something to it and that and the results of that are expanding on the process orientation really trying to get to the idea of not only here's the conceptualization but here's what you might be expecting and this might be some possible in road to be able to relate to the person on a deeper level I've also tried to integrate that with much of the theory using some of the theoretical language and translating that to the language that a client might understand so that if you have somebody who really was very active in their orientation who was always trying to keep their guard up and always trying to make themselves protected that translates to an active pain orientation in the theory and what I really try to do is introduce language that was related to the clients experience and put that into the therapeutic guide it still involves the personality domains all of the different areas of the theory that it always has but I've reordered it to a good degree to try to follow the treatment process a little bit more chronologically so we can understand a little bit more about how it is that a person might initially react to some of the information that yet and what some of the early defenses might be in terms of addressing the difficulties that they bring to the table and then as best as possible because everybody is going to have something of a different treatment trajectory to some degree see how those might loosen up at times what you might be able to do if you're seeing certain kinds of a fallback of different kinds of resistances that show up later on and try to match that as best as possible to the experience of therapy that we might be able to project moving forward okay we're going to switch gears a little bit and I want to speak more specifically in the time that we have left to the theory and how that relates into the instrument itself so a little bit about where the theory is placed here what most people think of as the reasons for why somebody is walking in the door syndrome all kinds of complaints anywhere from an adjustment disorder to a major depressive disorder or those kinds of psychiatric complaints that are not directly derived from the theory themselves they are they are introduced in the MC mi4 they are measured in in good detail there but there's a refinement that takes place with that level of information that is really and goes in terms of what the theory is after and that is who is this person and how does that affect how they experience a depression or an anxiety and how does anxiety or depression affect them as a human being that component of it is the major emphasis of the MCM I and all the Millan inventories that is that these are enduring personality characteristics so that's really upfront and each one of the scales in that section of the test is directly derived from the theory it is an operational measure of a personality prototype that is within the theory there's something that's called a dependent personality for example that dependent personality has a theoretical structure and that theoretical structure is really a textbook example of what would be with this particular constellation when you get to each one of the scales then you look between the different scales and say how does one affect the other and I like to use the example of a color wheel let's say somebody is highly elevated on a dependent scale and also on the avoidance scale that person that would not necessarily be described as a dependent personality or avoidant personality in the same way that orange is not a primary color that's the admixture of red and yellow and there are really separate entities and what we're trying to do is get as close to the person as possible and there's a method for doing that and there is a basic motivational pattern that's part of the overall Milan theory that develops each one of these individual scales and then gives you a framework to be able to combine things and this is probably the most important component of the theory in general you can do a lot more reading on this is a lot more information available but really what everything boils down to is a comparison with the rest of the living world around us and what we as human beings in terms of our personality and I would really call this more motivation than anything else and these are in fact called motivating aims how those motivations are similar to motivations that are out in the natural world every entity every living organism first at the top of this page has to exist very simple sort of a orientation that is a person exists or doesn't exist an entity an organism exists or doesn't exist they live or they die and at this very basic motivational level what we have are two different orientations simpler organisms may fall directly at one point or another the more complex the organism the more we get into mammals and up through human being the more that this is more of a dynamic entity and that is that we have our preferences for but a range of behaviors for either trying to enhance our lives that is trying to get as much out of life as possible not with a direct concern for or making sure that we are existing versus pain or really pain avoidance that is avoiding those things that might be harmful to us more of a life sustaining sort of a strategy a more adaptive functional human being will probably have a favored place along this line but we'll show a range of possible motivations based on what's out there in the world one of the demands a less functional person or less functional personality will probably show some kind of unique characteristic along here whether that means that they are much more adhered to one side versus the other or whether it is that they feel some conflict between these two the more disorder the more difficult that may be and that's the case for all of them moving forward on at the second level once we exist we some have to interact with our environment as do all organisms and generally speaking we have either a passive or accommodating kind of an motivation which is finding the environment that works well enough for the individual and if anything changing the individual to fit the environment versus the other side and that is modifying that is making sure that the environment really fits the needs of the individual in changing or acting on modifying the environment to fit the needs of the individual same admonition applies here better flexibility is generally going to be better at adaptivity as long as it's fairly well defined in some ways and then finally the idea that we are not organisms that are going to live forever we need to continue to propagate who it is that we are we have the self for more independently oriented person versus the other or dependent orient person how it is that we nurture our offspring based on evolutionary biology sorts of characteristics such as our strategy versus case strategy translated to personality really comes to something that's relatively self-explanatory do we try to get the most for ourselves to be nurtured self or do we put most of our emphasis on other people letting other people define us or working for others or working for something that is out there in the environment and this basic strategy really shows how it's possible to combine different elements to be able to show how it is that a particular scale is developed so then those polarities combine to then become the personality disorder scales many of which corresponds to the DSM and again for your reference I won't go into detail on the interest of time on this but this is the overall schematic of the evolutionary model and where each of the different personalities or personality disorders you see in the lower part of this figure where it is that they tend to go up to coalesce what different elements go into each and I'll give you a couple examples of these as we go along so now we're going to go through the scales of the instrument and tying in the theory as we go along to kind of give you the idea of all what's here those of you who are familiar with with the legacy instruments you know the disclosure desirability and distended basement structured in different ways whether that be a combination of scores that going to disclosure scale to show how much information a person may be giving us on a test desirability debasement somewhat self-explanatory using items from the overall Haddon pool to evidence how it is that a person may paint themselves or portray themselves positively or negatively we then have scale V which has always been a part of the CMI which are three very unlikely items if one of them is just as endorsed then we want to look at the the overall protocol is potentially invalid but not necessarily invalidating it two or more we would consider it to be invalid and of more recent iterations borrowing from techniques from other instruments is the inconsistency scale which was introduced towards the latter part of the MCM I threes run which is really about looking statistically and semantically at combinations of items that really should be endorsed in some form of a consistent manner but which there's a fairly conservative kind of a approach in terms of how many of those would constitute a problematic response I don't have the exact figures here but I believe it's up to six is not a problem six to believe nineteen is where we want to say questionable validity and then if they endorse more than that we would say that the overall response is invalid I've alluded to before we have the schizotypal borderline and paranoid scales which are the severe personality pathology where the overall structure of the person of the personality is really something that's at question at that point so with these they may be the primary diagnostic skills that they're among the highest or they may be something that informs you in terms of the overall structural integrity of the personality such that for example borderline which in the overall evolutionary structure shows a conflict between all of those different motivating aims if you see that as something that's elevated but perhaps not the most elevated you would want to say that perhaps this person has extra onic and perhaps negativistic sorts of characteristics and those are the the highest elevations you also want to consider that they're experiencing more conflict than they would otherwise that is more conflict within the overall sense of self but it still may be primarily more of a histrionic and negativistic presentation we then go into the main clinical personality patterns and as we talked about before the melancholic scale has a new name it was formerly depressive scale in the MCM i3 and we have the new scale the turbulent the others should be familiar to you from BMC mi3 they're largely unchanged although they've been reformulated to some degree to have some new items that are shared among all different new items that have come on to this test we then move on to the clinical syndromes we have the three severe clinical syndromes drawing attention to as I spoke to about before the schizophrenic spectrum which was thought disorder at MCM I three somewhat reformulated as long as well as the other two that had been there from earlier iterations and then the grouping of clinical syndromes some changes here because of the nomenclature change persistent depression replaces dysthymic disorder is that's the new term from the DSM and I also like to point out and I got this question actually yesterday from a customer about the bipolar spectrum it was really called bipolar the bipolar scale before and the decision was made to really broaden the spectrum there as well mainly because the MCM i3 and earlier versions really focused on symptom ology that was higher up in terms of the overall bipolar spectrum more towards manic symptoms II more towards bipolar one and a person would have to have good insight into their diagnosis already to be able to discern that if they match that what we found more useful and we found clinicians would find more useful is if we have some mood dysregulation from cyclothymic disorder through two different bipolar disorders at the higher level that we might be able to capture more that here in this scale the others again are updated but largely unchanged we also have a representation and this might be something that you've used in the MC mi3 that is the basis for the formulation of the facet scales and that is eight domains file under each one of the prototypes in terms of the theory the three most salient are identified through facet skills which I'll get to in a moment but I want to introduce you to functional and structural domains that make up each one of the overall prototypes functional being those that you can find that you can measure that you can observe to some degree in structural being those that you might need to infer to a greater degree they also tend to cover the different schools of thought from psychotherapy some of these are very behavioral some more cognitive some more psychodynamic others being more of a biophysical kind of a kind of an entity when you have a system such as this what you can do then is utilize a chart that organizes them across each of the spectra which you see on the left hand side going down in the column as well as across the rows which describe each one of the functional domains so that if you have add mixtures on this instrument you might be able to look at this and better discern from the facet skills as well where it is that a person may show more the emotional expression of one of their elevations but perhaps a cognitive style of another and be able to get to put together more of a molecular structure overall to how it is that you are assessing this person we have gone a little bit long-winded in terms of our timing so I'm going to be rather selective in this next section that I want to get to a couple questions as time permits so we're going to skip ahead a bit what I'm going to do is move ahead just a little bit to the new scale so that I can demonstrate for you not only this new scale but also how it is that a particular prototype may play out what we see here is sort of a graphic of those motivating aims from the evolutionary polarities and where it is that the different emphases are placed in general we have on the turbulent scale scale for B which is the newest scale we have as I inferred earlier very high sort of an emphasis on the enhancement or pleasure oriented end inspector and very active in orientation so when you combine these two and you're looking at that is the primary way of defining a turbulent prototype we have a person who is very strongly oriented towards getting as much out of life as possible without much concern for what the cost might be so there's very little emphasis in pain without much ability to kind of have the shutoff valve and not very passive but always looking for opportunities when you break that down to the dimensions the larger the dimension the more it tends to be kind of central to the construct with the three that are in shades the ones that were most evident in the MCM I themselves so if you look across these you have different kind of characteristics for the different domains we have there so we have material mood a scattered cognitive style and then some of the others that are important here are an exalted self-image feeling like there's nothing a person can't do high spirited interpersonal conduct meaning lots of energy in terms of how they socialize and impetuous 'no sin terms of their overall behavior with the others creating more of the overall structure and filling in some of the details of that particular personality we're going to have to skip this component right now in terms of interpretation but be happy to answer questions as they may come in if we don't get to them today we will make every effort to try to answer questions that come up in terms of scoring and interpretation but I am going to move forward through these and move on to one of the resources that I want to point out that's now available that has been published recently and that is the essentials of MCM I for assessment where we really go into much more detail the rings of myself and colleague of mine dr. Mendel ace where you might be able to get much more information on how it is that you transform this information from theory into therapeutic utility and what we really want to emphasize again is that more so than just trying to be diagnostically specific we want to be as person specific as possible and this was the major emphasis in terms of putting this book together as a rapid reference for the MCM I in general also want to mention briefly that the MCM I for is but one of a family of different instruments that utilize the same kind of methodology and much of what you understand from the MCM I can be applied to the various other instruments that are aimed at different populations as you see here and with very little time left I want to see if we can get to a question or two I'm going to turn it over to Vendetta and thank you very much for your time Ennis thank you dr. Grossman for the Dory helpful presentation we had a couple of questions come in can you talk a little bit more about the applications of DMC mi4 and forensic evaluation please for forensic evaluations there's kind of two questions that come up one is the most recent most robust kind of information that we can use that's mostly relevant and that is and the other being the relevance of a normative group itself there has not yet been a specific study that looks at different areas of forensic populations we're hoping to do that for Corrections the MCM I three still has the corrections report which is specific to that population for other areas and I'm thinking particularly those where you want to make sure that you're using the appropriate instrument I'm thinking particularly like an example of family law an issue that pops up there quite a bit is we have to make an assumption of some sort but a person is appropriate for use and an assessment with VMC mi4 we want to know independently that there is a clinical question involved not necessarily personality disorder but I would want to be able to defend the notion that you know based on the evaluation the safari you believe that there's a clinical question to be differentiated here and I think that's one of the things that in general would be sort of a precaution to begin use of the MCM i foremost forensic settings thank you everybody for joining we don't have big run out of time we don't have time for other questions we will respond to any unanswered questions via email with the next couple of days we also have a useful information about the MCM I for mentioned on the Pearson wonderful Chrome web page and we also have a free trial that they're offering writing up at the MCM I for if you haven't used it before so thank you again dr. Rosen for the really helpful presentation and thank you everybody for attending this webinar we hope to see you again one of our future webinars thank you

and good afternoon or good morning to who all or whatever time zone you might be in at this time very pleased this afternoon my time to be going over the relatively new instrument the MCM I for the most recent iteration of the MCM I this is published in November of 2015 and we have been enjoying a fairly good launch of the instrument and very happy to be just introducing that to some perhaps reinforcing some of the major Milan ideas to others and very hopefully getting people&#39;s appetite sweat for really understanding understanding the theory that works behind the instrument because I think this is what really makes the MCM I for as well as all of the ultimate law inventories that are sort of unique in a field of instruments that are primarily empirically derived and then empirically supported our instruments the thought behind them the one the thing that makes them different is that they&#39;re both empirically supported but also theoretically derive so that there&#39;s more of a backbone to be able to understand a deeper richer context for the work that you do so without further ado I want to look at a little bit of what we&#39;re going to be doing today as I&#39;ve alluded to already we&#39;re going to be describing updates that constituted the MCM I for the MCM i3 which is probably something that many of you are still using at this point and certainly still legitimate to use I was originally published in the early 1990s I believe it was 1994 and it went through a couple of updates and some additions made to it as well as a major renormalized of that was late 80s early 90s and for however long that an instrument such as this remains really richly relevant the decision was made then to move forward with a newer version of the instrument that really captured a greater level of detail and breadth and I&#39;ll describe much of that I&#39;ll be going through most of the major scales of the MMC Y for spending a little bit more time on some than on others particularly those that have been reformulated in some way and if those that are new to this instrument in general and I&#39;m hoping to spend a good amount of time today on the evolutionary theory itself and not so much as an intellectual exercise as much as it is the direct relevance of the theory to how it is that we really conceptualize persons and how it is that we can develop a greater empathic response and a much better therapeutic alliance utilizing elements of the theory that you can discern from the use of the test itself so to begin with I want to ask people to respond to a very simple question and that is have you used the MCM ein if you look at the answers that we have available to you you can say that you&#39;ve used the four at this point that you&#39;ve had some experience of the new instrument that you have our experience with the MCM i3 and I would say select that if you really haven&#39;t had much exposure to the MCM i-4 at all or if you&#39;re brand new to this and you really don&#39;t have experience with either of them choose I have not used either and I&#39;m going to be looking through just a little bit here and give you a little bit of an idea the results as we go along don&#39;t be shy there&#39;s not a whole lot that have shown up just yet I think we&#39;re having some technical difficulties with with this poll sherry if you could jump on for just a moment and see if there&#39;s a difficulty with this and what we might be able to do with it we can bypass this certainly I am getting some responses but I want to see if there&#39;s anything to clarify that there is something wrong with the poll and people are submitting in the chat box okay we bypass this and then look at that what they&#39;re saying in the chat box okay I mean I can see a little bit about the poll and I&#39;m seeing a general trend that most people who have been able to get through have responded with I&#39;ve used the MCM i3 which is more or less what we&#39;d expect a few or less fuel less than that have used the four on a few less than that have not used either so we have people who are relatively familiar with at least the evolutionary theory and the use of the MCM I three that&#39;s been out for a very long time and generally speaking I think that&#39;s kind of holding true to this trend right now so I would say that majority of folks that are joining us today are at least MCM I three users a fair number have some experience with the MCM I four and I&#39;m glad that you&#39;re joining us today because we&#39;re going to go to a little more detail and a smaller number are not familiar with either instrument so what I like to do with this is I try to kind of tailor my remarks to emphasize one versus the other sort of perspective but I&#39;m going to try to cover all the points for all three of the potential responses okay thank you all for responding we do have an idea now of of where we&#39;re at here and I will proceed accordingly okay to kind of flavor this part of this presentation was something that I want to share with you today is this quote from dr. Malan but he spoke while the emcee mi4 was in its earlier phases of development at this point the instrument was fairly well designed and at that point we were working on empirically validated it and that quote is as follows the emcee mi4 was specifically designed as are all of the Millan inventories to facilitate the therapeutic plans of the clinician now there&#39;s a few things about this quote one of them is that he&#39;s mentioning all of the Milan inventories and this has really been part of the focus really part of the overall design of all of the instruments dating back to the original MCM I now that does run counter to some degree to the reputation of the MCM I where I think a lot of clinicians have the notion correct in part but for the most part somewhat misguided that you need to have a personality disorder in order to get any kind of fruitful information from the instrument that really is not so and one of the big questions that we all asked ourselves as we were beginning to develop pmc mi4 was how do we address that issue what is it that this instrument is really after and looking at it from a couple of different angles there were some thoughts about expanding the range even further than what the final test was or really getting much more clinically specific but really what we wanted to try to do is to focus on the question of what&#39;s a clinical population because that&#39;s always been the focus of the clinically oriented Malad instruments which are most of them the mips and to some degree the mb md being the exceptions to that but what we really wanted to do was to say who is it that this instrument is really for and how can we best capture what the instrument is really after which really is personality attributes personality attributes in terms of what causes difficulty for this person the MC mi is still not a personality test for normal personality it&#39;s really not designed for that range it is still a clinical instrument but we want to be able to look at the wider range of personality functioning and I&#39;ll be saying quite a bit about that as we go along and because of that that also works towards saying what does it do in terms of an intervention we can specify quite a bit in terms of assessing a person but of what real clinical utility is that this is where a fuller understanding of both the empirical and the theoretical components of the instrument really help you in terms of where do you go from here and how do you get as close to the person&#39;s experience as possible so that&#39;s a major focus of a new instrument and of course the major focus of where we&#39;re going today so let&#39;s talk a little bit now about what&#39;s changed what&#39;s new in this instrument what were our overall thoughts some of which I&#39;ve alluded to already well go into a little bit more detailed and how does that compare with where we&#39;ve been in the past with the MC mi 3 as well as some of the other some of the legacy MC mi instruments as well as the others so in terms of what we were trying to do we were trying to stay with the same general intended clinical population that we have had and has been the focus of all the MC mi instruments an early pilot study however we really wanted to try to see would it be possible to combine the best of both worlds to be able to expand the range of the MC mi to include possibly some non clinical groups people that were not necessarily presenting for clinical counseling or psychological psychiatric difficulties and the results of that really showed that it wasn&#39;t as possible it intended to disc to discolor sort of the the focus that we were after to try to get that much of a range however we did include some of that data from the early pilot group in order to be able to help broaden the to the point where we can say that there&#39;s a range that we can look at that is generally speaking a fairly adaptive population but these people do show some personality attributes that can tend to become problematic when they&#39;re psychologically distressed so we were able to do that and broaden that range and include that as well in terms of the general overall normative population which we collected from the fall of 2014 to early 2015 and these were at many different sites that were clinical in their orientation as the instrument has been in the past it&#39;s an adult instrumental that&#39;s designed for ages 18 to 65 and above there&#39;s a fairly robust representation for those above that but we generally describe the instrument as a general range of adults leading up to approximately retirement age there are five validity indices I&#39;ll go into a bit of detail on that most people are familiar with at least the three disclosure desirability in the basement as well as one which is the invalidity index that has been with the instrument for multiple iterations and not as many are as familiar with the inconsistency scale which was first introduced in the MCM i3 in the late 2000s there are now 15 personality scales this is up from 14 from the MCM i3 there is a new one that I&#39;ll go into some detail about called the turbulent personality and there are 10 clinical syndrome scales that roughly equate with the same syndrome scales from the MCM i3 some with a little bit different formulation at this point these are as always scales that are designed to assess the syndrome but also to look at those clinical features primarily in context with the person who is this person and how does that affect what their symptom ology is how is an anxiety experience differently when you have a mix of perhaps avoidant and melancholic characteristics versus say schizoid and anti-social characteristics you&#39;re going to see a very different kind of anxiety or depression or somatoform difficulty and so on as always we&#39;ve retained the base rates base rate system that we have used rather than T scores throughout the life of most of the melanda inventories this is a system that is anchored to the prevalence data for a particular disorder that is that each disorder really falls on its own sort of normative distribution rather than just assuming a regular normal distribution as you might in the overall population there&#39;s no assumption here of a normal curve there are the ketosis for example of obscured soit personality is very different from the normal curve so we find that this is a better reflection we have started to include however $10 which we thought to be important information to be able to give to the clinician to describe in general how many people in the population fall below this particular mark so we&#39;ll talk a little bit about that today as well again as always the scales have been designed to close the coordinate to DSM constructs and finally one of the features one of the things that we always want to try to do with them a lot of instruments is to try to keep the overall length of the instrument relatively reasonable and it continues to be one of the shorter instruments of its kind throughout the entire field coming in at 195 items which is up just a bit from the 175 from the MCM i3 so there are definitely numerous enhancements to the MCM i-4 which will go into some detail about and one of the things that we always want to clarify and continue to encourage people to really understand as best as they possibly can again for its clinical utility is the anchoring that the MCM I and all the Milan inventories have to dr. Milan&#39;s personality theory that&#39;s based an evolutionary sort of a framework so to look over this just in general we have updated norms on the MCM I four as well as new test items I&#39;m trying to recall exactly what the number was in terms of new items that we have put in I believe it&#39;s in the 80s and I don&#39;t recall the exact number offhand but I believe it&#39;s about 87 new items combined with other items that have been in the MCM i3 and all of which really trying to update and really get to the point where we&#39;re speaking the same language of the 2010 2020 s and possibly into 2030 of the language that&#39;s popular that language - that is a good vernacular for the widest range of people in any given population whether that&#39;s the United States or some of the other some of the other language norms that we have it&#39;s all as always aligned with the DSM the currently dsm-5 criteria as well as the icd-10 criteria there are some changes to some of the scales so some of you who are familiar with a few of the nomenclatures from the MCM I 3 you&#39;ll see a couple of differences here at times that also represents a bit of a reformulation but will point out what&#39;s new what&#39;s not new as we go along as related to we have the turbulent scale that is a new personality scale and it&#39;s based in kind of an older idea the idea earlier on before we had bipolar disorder even before we really describe manic depressive disorder as a psychiatric disturbance we had sort of this hypomanic personality that&#39;s in the old psychoanalytic literature that&#39;s been updated along with notions that have come out of some of the popular writings most notably Kay Jameson&#39;s work who has written quite a bit about the idea of exuberance with in life and that extends from relatively well-functioning individuals all the way through to people who really have significant difficulties with that a major upgrade that we wanted to try to put into the MCM I for is really trying to get it as close to therapeutic practice as we possibly could really emphasizing this this has always been a part of the understanding of the MCM eyes as they&#39;ve gone through the different iterations but we really wanted to put this really up front that what we&#39;re trying to do is to give clinical information that&#39;s going to help the therapeutic enterprise and the final point that we put into the new instrument one I&#39;m not sure people are as familiar with us they might be but if you&#39;re like me and you&#39;ve had some experience with using the MCM eye profile page with a client and you see all these psychiatric diagnostic labels they can be pretty intimidating they can also possibly lead to false positives so there&#39;s now an option on the MCM eye for to utilize abbreviated scale names that are derived from dr. Milan&#39;s latest iteration of the theory which is the 2011 book Disorders a personality third edition that really introduced the idea of the spectrum he utilized an abbreviation system that I&#39;ll introduce you to that you can now print out so that you can more freely utilize this profile page to be able to show the client the relationship between the different scales without there being as much emphasis on a particular label and I think that&#39;s really an important clinical utility item we&#39;ll talk again a little bit more about that as we get closer as I show you this abbreviated scale name system so overall we also wanted to look at what&#39;s been happening in our field what sorts of changes have come about since the early 1990s and as we all know that&#39;s quite a bit some there&#39;s been some major paradigm changes in terms of our understanding of different populations in terms of our sensitivity to certain kinds of issues and in terms of how it is that that the APA and other leading forces within our field have encouraged us to speak with clients for example an APA MCM I has always been tied to the DSM diagnosis and has always been historically kind of a notion that we don&#39;t discuss exact results and we kind of refrain away from utilizing this language whereas APA really wants us to be more transparent at this point to be able to say here are the results this is what these results mean and let&#39;s be a lot more forthcoming in terms of that so the APA standards have shifted the idea of a clinical population I think was a more constricted idea one time and at one time and we&#39;ve also wondered what does that mean what is a clinical population when people think of the MCM is I think there&#39;s a tendency for a lot of people to say well that&#39;s the really highly dysfunctional sort of clinical population the ones with severe personality disorders whereas really what we&#39;re talking about is a mid-range to a higher range and the range does extend to that higher range of difficulties that people experience and if you were to ask yourself really in terms of the clinical population that you may work with let&#39;s say it&#39;s people in independent practice we&#39;re coming because they&#39;ve got relational difficulties or they have what you think of as perhaps simple psychiatric symptoms that you&#39;re working with or an adjustment disorder how does who they are affect that we want to capture more that so that we wanted to capture a broader range of personality difficulties which if you really think about there&#39;s very few people in the world that don&#39;t have any and I think that&#39;s actually kind of a misnomer in a lot of ways so we really wanted to be able to say this should be applicable to people who are experiencing these difficulties that may extend into the clinical range and then finally one of the big field trends that we were looking at and has really become more of a standard now are gender differences and we&#39;ve really come a very long way in terms of understanding gender is a much more fluid kind of construct and how most of us have thought about it in the past likewise across the field and in many if not most of the psychological instruments that have been updated in the last several years inclusive of the MMPI to RF and the end to a RF we have really begun as a field to try to put the norms together rather than having separate male and female gender norms which helps in terms of making gender not a specific entity in terms of what it is we&#39;re measuring and that has a lot of implications one of which obviously is that we&#39;re not going to see any difference in scales because a person is male or female or not suspended the other is that we rice elating that as a different part of our overall enterprise and the MCM I for as well as what&#39;s being worked on now that Maki - are really trying to address that much more clearly as well so overall we wanted to really kind of bring the MCM i-4 up to current standards some constructs have been redefined particularly along the lines of how diagnostic changes have occurred for DSM and we also wanted to address something that I think had been a bit of a shadow over some of the earlier Malad instruments in terms of some of the questions about empirical robustness there&#39;s always been a challenge in using a base rate system as well as a challenge and leading off with a theoretical kind of a construct that people have questioned you know there are some of the scales from the earlier instruments where we don&#39;t see as robust of an empirical backbone and we&#39;ve really wanted to address that to a much greater degree and the instrument has gone through more steps in terms of really being able to back itself statistically using some of the newer statistical measures to really figure out all these constructs really what we&#39;re saying that they are and are they robust out of giving us the right kind of information all of this has gone into the overall understanding and the overall design of the new instrument this point I think is really one of the most important enhancements that we have here in terms of the MCM I wear as the MCM i3 and all the legacy MCM eyes have really tried to illuminate more of a dimensional capacity where it&#39;s fallen short in the past is that there was sort of a cutoff point where we set up until this point we&#39;re talking about adaptive personalities and at this point it&#39;s maladaptive that&#39;s kind of an arbitrary point in a lot of ways and what we found him and how dr. Millan has described it in the latest version of the theory and what we wanted to put into the instrument was really about trying to get a full picture of who the person is secondly what syndromes what complaints was a person experiencing and combine those aspects with level of personality functioning or non functioning and using much more of the continuum and breaking it down into different levels of functioning that I&#39;ll describe in just a moment all trying to get at this larger bandwidth than what has been reputation which is a much more compromised personality dysfunction so in doing so dr. Mullen now describes theory in terms of different levels of functioning so as you might know from the connection from the theory to the test the each one of the scales really represents a prototype or a textbook model in a lot of ways in terms of what&#39;s described for this particular personality prototype which most of them have a fairly clear connection to DSM criteria we&#39;ve broken it down a little bit further now so for each one of these prototypes we now have three different levels rather than just functional or non-functional we broaden the range and these are tied to specific base rate scores on the instrument normal style which is generally adaptive any patterns this is what we&#39;re measuring when we see someone coming in between the base rate of 60 and 74 there&#39;s then in that normal trade or type where we start to see moderately maladaptive attributes that is that this person evidences personality difficulties more readily not really at the point of a disorder at this point but with some predictability we can say that these personality attributes are more directly connected to the level of distress that might be going on for them or perhaps for somebody within their social circle and then finally and that&#39;s that&#39;s the range of 75 to 84 and then at a range of 85 and above we have the clinical disorder range that is a greater likelihood of personality dysfunction it would probably in and of itself be something that is distress oriented either to that person individually or it&#39;s more along the lines of ego-syntonic but difficult for the people around them creating more of a social familial difficulty to describe these three different levels dr. Millan put out three different descriptors for each in most cases the the final one being the clinical terminology that we&#39;re used to there&#39;s now for example and this is the abbreviation system that I was talking about a C a narc spectrum the C would stand for confident efore egotistical and an for narcissistic can be abbreviated to cen as well but often times utilizing the extra letters gives you some more ian tation - - which prototype we&#39;re really talking about and again this major goal was to more adequately capture this broader range this is more for your reference than anything else so hopefully you have downloaded the this live material that was provided in the email and we&#39;ll go into a lot of detail about this this is the overall okay of all the different 15 personality spectra as well as their descriptions across those three different levels of functioning I do want to draw your attention though however to the last three these are as has been typically has been used in the nomenclature and in theory as three of the 15 that are considered to be more structurally compromised those are schizotypal borderline and paranoid where if you look at the theory what we&#39;re really talking about here are more dysfunctional variants of the other 12 personality functions so what we have there is the idea that there really isn&#39;t a more adaptive variant of these three in that normal style range you would see nomenclature that&#39;s more representative the abnormal type eccentric unstable and mistrustful the middle range really being what we&#39;re familiar with in terms of the functioning level of these particular three and dr. Millan has reintroduced some of the older terminology to describe the clinical disorder range meaning at a much higher level of dysfunction schizophrenic personality ciclo frantic personality and paraphernalia t meaning that the entire range in these three tends to shift to some degree now if you take one of the other webinars that we offer actually two of them will go into more detail about that is the therapeutic applications webinar as well as the case study webinar I go into a bit more detail in terms of the overall system for integrating any kind of a and elevation on these three scales in terms of how it is that you read those together with other elevations from the other 12 that is they colorize the other 12 it&#39;s a level of personality functioning so you can get an idea whether a person&#39;s overall personality compromise may have for example with this gets a tipple range more of a wavering orientation within the evolutionary polarities with a borderline more conflicts and with a paranoid more of a lockdown more of a constricted nasaw will hit that a little bit in the later part of today but just to give you that idea those three are a little bit different we have a couple of scale level changes we have that new personality scale talked about the turbulent again coming out of the idea of the hypomanic personality and being the first if you&#39;re familiar with the theory I&#39;ll just describe it briefly here but I&#39;ll go into more detail later the first of all the personality prototypes we&#39;re a major motivational orientation is towards seeking pleasure or seeking life enhancement possibly to a degree that really is is a much more dysfunctional at the higher range a couple new distinctions on scale names depressive because we&#39;ve expanded some of the nomenclature we&#39;ve wanted to now have the scale to be represented by a more unique and not as confused with other measures on this instrument new term actually an older term now called the melancholic personality and in the syndrome all scales what was called the thought disorder scale on the MCM I three we&#39;ve now made the schizophrenic spectrum in this way what we&#39;ve tried to do I think the old scale had some elements of soft neurological difficulties such as memory lapses and such as attentional problems that did not create quite as clear of a picture and it wasn&#39;t adequately capturing those areas which are really outside of the purview of the MCM I if you&#39;re thinking about really what you&#39;re trying to measure so this is more of a distilled specific schizophrenic spectrum kind of a scale at this point it&#39;s only moderately really recalibrated but in its clearer picture on one and the bottom grouping here are seven of the new noteworthy response categories they are added to the existing six that have always been part of the instrument that are moderately changed in some cases in terms of the terminology but we wanted to capture a number of other areas that are somewhat related these are not these kind of fall into two informal groups the ones of one such as an adult ADHD in autism spectrum as well as prescription drug abuse these are roughly speaking kind of differentials that is that they share some attributes with some of the more robust measures of the MCM I but they&#39;re not areas that the MCM is known for has ever really been a robust measure it&#39;s never really been the intentive for example to try to do any kind of a full assessment of autism spectrum it&#39;s outside the range of what we&#39;re trying to do but there are certain characteristics particularly in the schizoid personality as it&#39;s a tipple personality and a couple of the other other measures having to do with some soft signs where you say if there&#39;s enough of these you might want to do more of a differential others are more like the classic use of the noteworthy responses and that is they&#39;re not scale measures but there&#39;s their alerts to the clinician that you may need to do more of a tertiary intervention for perhaps vengefully prone which can be related to some people really trying to trying to act out on others maybe an individual basis more made or perhaps maybe on mass and some of these also are kind of a combined grouping of both of those particular areas and to kind of wrap up this section right now we have the interpretive reports and some improvements that have been made to these as most tests do is they go into new versions they really try to update the language because as a society we tend to change our language to some degree so we really try to clarify an update and bring that language up to up to sort of modern-day vernacular in terms of the overall usage of language within our interpretive material that is inclusive of clinical information as well as language that&#39;s used for descriptors that might be used in terms of feedback the main change that we&#39;ve made here is that we&#39;ve really tried to really try to improve the therapeutic guide so the same descriptions that are there that are really dr. Milan&#39;s language from his early conceptions on through his later thoughts about how do you describe different kind of personality attributes and add mixtures that&#39;s all there the therapeutic guide has always been something of a case conceptualization sort of a framework and one of my major difficulties with that was that it wasn&#39;t really including much in terms of the therapeutic directive leading up to the MC mi4 and it was really kind of my charge to really try to take that language and add something to it and that and the results of that are expanding on the process orientation really trying to get to the idea of not only here&#39;s the conceptualization but here&#39;s what you might be expecting and this might be some possible in road to be able to relate to the person on a deeper level I&#39;ve also tried to integrate that with much of the theory using some of the theoretical language and translating that to the language that a client might understand so that if you have somebody who really was very active in their orientation who was always trying to keep their guard up and always trying to make themselves protected that translates to an active pain orientation in the theory and what I really try to do is introduce language that was related to the clients experience and put that into the therapeutic guide it still involves the personality domains all of the different areas of the theory that it always has but I&#39;ve reordered it to a good degree to try to follow the treatment process a little bit more chronologically so we can understand a little bit more about how it is that a person might initially react to some of the information that yet and what some of the early defenses might be in terms of addressing the difficulties that they bring to the table and then as best as possible because everybody is going to have something of a different treatment trajectory to some degree see how those might loosen up at times what you might be able to do if you&#39;re seeing certain kinds of a fallback of different kinds of resistances that show up later on and try to match that as best as possible to the experience of therapy that we might be able to project moving forward okay we&#39;re going to switch gears a little bit and I want to speak more specifically in the time that we have left to the theory and how that relates into the instrument itself so a little bit about where the theory is placed here what most people think of as the reasons for why somebody is walking in the door syndrome all kinds of complaints anywhere from an adjustment disorder to a major depressive disorder or those kinds of psychiatric complaints that are not directly derived from the theory themselves they are they are introduced in the MC mi4 they are measured in in good detail there but there&#39;s a refinement that takes place with that level of information that is really and goes in terms of what the theory is after and that is who is this person and how does that affect how they experience a depression or an anxiety and how does anxiety or depression affect them as a human being that component of it is the major emphasis of the MCM I and all the Millan inventories that is that these are enduring personality characteristics so that&#39;s really upfront and each one of the scales in that section of the test is directly derived from the theory it is an operational measure of a personality prototype that is within the theory there&#39;s something that&#39;s called a dependent personality for example that dependent personality has a theoretical structure and that theoretical structure is really a textbook example of what would be with this particular constellation when you get to each one of the scales then you look between the different scales and say how does one affect the other and I like to use the example of a color wheel let&#39;s say somebody is highly elevated on a dependent scale and also on the avoidance scale that person that would not necessarily be described as a dependent personality or avoidant personality in the same way that orange is not a primary color that&#39;s the admixture of red and yellow and there are really separate entities and what we&#39;re trying to do is get as close to the person as possible and there&#39;s a method for doing that and there is a basic motivational pattern that&#39;s part of the overall Milan theory that develops each one of these individual scales and then gives you a framework to be able to combine things and this is probably the most important component of the theory in general you can do a lot more reading on this is a lot more information available but really what everything boils down to is a comparison with the rest of the living world around us and what we as human beings in terms of our personality and I would really call this more motivation than anything else and these are in fact called motivating aims how those motivations are similar to motivations that are out in the natural world every entity every living organism first at the top of this page has to exist very simple sort of a orientation that is a person exists or doesn&#39;t exist an entity an organism exists or doesn&#39;t exist they live or they die and at this very basic motivational level what we have are two different orientations simpler organisms may fall directly at one point or another the more complex the organism the more we get into mammals and up through human being the more that this is more of a dynamic entity and that is that we have our preferences for but a range of behaviors for either trying to enhance our lives that is trying to get as much out of life as possible not with a direct concern for or making sure that we are existing versus pain or really pain avoidance that is avoiding those things that might be harmful to us more of a life sustaining sort of a strategy a more adaptive functional human being will probably have a favored place along this line but we&#39;ll show a range of possible motivations based on what&#39;s out there in the world one of the demands a less functional person or less functional personality will probably show some kind of unique characteristic along here whether that means that they are much more adhered to one side versus the other or whether it is that they feel some conflict between these two the more disorder the more difficult that may be and that&#39;s the case for all of them moving forward on at the second level once we exist we some have to interact with our environment as do all organisms and generally speaking we have either a passive or accommodating kind of an motivation which is finding the environment that works well enough for the individual and if anything changing the individual to fit the environment versus the other side and that is modifying that is making sure that the environment really fits the needs of the individual in changing or acting on modifying the environment to fit the needs of the individual same admonition applies here better flexibility is generally going to be better at adaptivity as long as it&#39;s fairly well defined in some ways and then finally the idea that we are not organisms that are going to live forever we need to continue to propagate who it is that we are we have the self for more independently oriented person versus the other or dependent orient person how it is that we nurture our offspring based on evolutionary biology sorts of characteristics such as our strategy versus case strategy translated to personality really comes to something that&#39;s relatively self-explanatory do we try to get the most for ourselves to be nurtured self or do we put most of our emphasis on other people letting other people define us or working for others or working for something that is out there in the environment and this basic strategy really shows how it&#39;s possible to combine different elements to be able to show how it is that a particular scale is developed so then those polarities combine to then become the personality disorder scales many of which corresponds to the DSM and again for your reference I won&#39;t go into detail on the interest of time on this but this is the overall schematic of the evolutionary model and where each of the different personalities or personality disorders you see in the lower part of this figure where it is that they tend to go up to coalesce what different elements go into each and I&#39;ll give you a couple examples of these as we go along so now we&#39;re going to go through the scales of the instrument and tying in the theory as we go along to kind of give you the idea of all what&#39;s here those of you who are familiar with with the legacy instruments you know the disclosure desirability and distended basement structured in different ways whether that be a combination of scores that going to disclosure scale to show how much information a person may be giving us on a test desirability debasement somewhat self-explanatory using items from the overall Haddon pool to evidence how it is that a person may paint themselves or portray themselves positively or negatively we then have scale V which has always been a part of the CMI which are three very unlikely items if one of them is just as endorsed then we want to look at the the overall protocol is potentially invalid but not necessarily invalidating it two or more we would consider it to be invalid and of more recent iterations borrowing from techniques from other instruments is the inconsistency scale which was introduced towards the latter part of the MCM I threes run which is really about looking statistically and semantically at combinations of items that really should be endorsed in some form of a consistent manner but which there&#39;s a fairly conservative kind of a approach in terms of how many of those would constitute a problematic response I don&#39;t have the exact figures here but I believe it&#39;s up to six is not a problem six to believe nineteen is where we want to say questionable validity and then if they endorse more than that we would say that the overall response is invalid I&#39;ve alluded to before we have the schizotypal borderline and paranoid scales which are the severe personality pathology where the overall structure of the person of the personality is really something that&#39;s at question at that point so with these they may be the primary diagnostic skills that they&#39;re among the highest or they may be something that informs you in terms of the overall structural integrity of the personality such that for example borderline which in the overall evolutionary structure shows a conflict between all of those different motivating aims if you see that as something that&#39;s elevated but perhaps not the most elevated you would want to say that perhaps this person has extra onic and perhaps negativistic sorts of characteristics and those are the the highest elevations you also want to consider that they&#39;re experiencing more conflict than they would otherwise that is more conflict within the overall sense of self but it still may be primarily more of a histrionic and negativistic presentation we then go into the main clinical personality patterns and as we talked about before the melancholic scale has a new name it was formerly depressive scale in the MCM i3 and we have the new scale the turbulent the others should be familiar to you from BMC mi3 they&#39;re largely unchanged although they&#39;ve been reformulated to some degree to have some new items that are shared among all different new items that have come on to this test we then move on to the clinical syndromes we have the three severe clinical syndromes drawing attention to as I spoke to about before the schizophrenic spectrum which was thought disorder at MCM I three somewhat reformulated as long as well as the other two that had been there from earlier iterations and then the grouping of clinical syndromes some changes here because of the nomenclature change persistent depression replaces dysthymic disorder is that&#39;s the new term from the DSM and I also like to point out and I got this question actually yesterday from a customer about the bipolar spectrum it was really called bipolar the bipolar scale before and the decision was made to really broaden the spectrum there as well mainly because the MCM i3 and earlier versions really focused on symptom ology that was higher up in terms of the overall bipolar spectrum more towards manic symptoms II more towards bipolar one and a person would have to have good insight into their diagnosis already to be able to discern that if they match that what we found more useful and we found clinicians would find more useful is if we have some mood dysregulation from cyclothymic disorder through two different bipolar disorders at the higher level that we might be able to capture more that here in this scale the others again are updated but largely unchanged we also have a representation and this might be something that you&#39;ve used in the MC mi3 that is the basis for the formulation of the facet scales and that is eight domains file under each one of the prototypes in terms of the theory the three most salient are identified through facet skills which I&#39;ll get to in a moment but I want to introduce you to functional and structural domains that make up each one of the overall prototypes functional being those that you can find that you can measure that you can observe to some degree in structural being those that you might need to infer to a greater degree they also tend to cover the different schools of thought from psychotherapy some of these are very behavioral some more cognitive some more psychodynamic others being more of a biophysical kind of a kind of an entity when you have a system such as this what you can do then is utilize a chart that organizes them across each of the spectra which you see on the left hand side going down in the column as well as across the rows which describe each one of the functional domains so that if you have add mixtures on this instrument you might be able to look at this and better discern from the facet skills as well where it is that a person may show more the emotional expression of one of their elevations but perhaps a cognitive style of another and be able to get to put together more of a molecular structure overall to how it is that you are assessing this person we have gone a little bit long-winded in terms of our timing so I&#39;m going to be rather selective in this next section that I want to get to a couple questions as time permits so we&#39;re going to skip ahead a bit what I&#39;m going to do is move ahead just a little bit to the new scale so that I can demonstrate for you not only this new scale but also how it is that a particular prototype may play out what we see here is sort of a graphic of those motivating aims from the evolutionary polarities and where it is that the different emphases are placed in general we have on the turbulent scale scale for B which is the newest scale we have as I inferred earlier very high sort of an emphasis on the enhancement or pleasure oriented end inspector and very active in orientation so when you combine these two and you&#39;re looking at that is the primary way of defining a turbulent prototype we have a person who is very strongly oriented towards getting as much out of life as possible without much concern for what the cost might be so there&#39;s very little emphasis in pain without much ability to kind of have the shutoff valve and not very passive but always looking for opportunities when you break that down to the dimensions the larger the dimension the more it tends to be kind of central to the construct with the three that are in shades the ones that were most evident in the MCM I themselves so if you look across these you have different kind of characteristics for the different domains we have there so we have material mood a scattered cognitive style and then some of the others that are important here are an exalted self-image feeling like there&#39;s nothing a person can&#39;t do high spirited interpersonal conduct meaning lots of energy in terms of how they socialize and impetuous &#39;no sin terms of their overall behavior with the others creating more of the overall structure and filling in some of the details of that particular personality we&#39;re going to have to skip this component right now in terms of interpretation but be happy to answer questions as they may come in if we don&#39;t get to them today we will make every effort to try to answer questions that come up in terms of scoring and interpretation but I am going to move forward through these and move on to one of the resources that I want to point out that&#39;s now available that has been published recently and that is the essentials of MCM I for assessment where we really go into much more detail the rings of myself and colleague of mine dr. Mendel ace where you might be able to get much more information on how it is that you transform this information from theory into therapeutic utility and what we really want to emphasize again is that more so than just trying to be diagnostically specific we want to be as person specific as possible and this was the major emphasis in terms of putting this book together as a rapid reference for the MCM I in general also want to mention briefly that the MCM I for is but one of a family of different instruments that utilize the same kind of methodology and much of what you understand from the MCM I can be applied to the various other instruments that are aimed at different populations as you see here and with very little time left I want to see if we can get to a question or two I&#39;m going to turn it over to Vendetta and thank you very much for your time Ennis thank you dr. Grossman for the Dory helpful presentation we had a couple of questions come in can you talk a little bit more about the applications of DMC mi4 and forensic evaluation please for forensic evaluations there&#39;s kind of two questions that come up one is the most recent most robust kind of information that we can use that&#39;s mostly relevant and that is and the other being the relevance of a normative group itself there has not yet been a specific study that looks at different areas of forensic populations we&#39;re hoping to do that for Corrections the MCM I three still has the corrections report which is specific to that population for other areas and I&#39;m thinking particularly those where you want to make sure that you&#39;re using the appropriate instrument I&#39;m thinking particularly like an example of family law an issue that pops up there quite a bit is we have to make an assumption of some sort but a person is appropriate for use and an assessment with VMC mi4 we want to know independently that there is a clinical question involved not necessarily personality disorder but I would want to be able to defend the notion that you know based on the evaluation the safari you believe that there&#39;s a clinical question to be differentiated here and I think that&#39;s one of the things that in general would be sort of a precaution to begin use of the MCM i foremost forensic settings thank you everybody for joining we don&#39;t have big run out of time we don&#39;t have time for other questions we will respond to any unanswered questions via email with the next couple of days we also have a useful information about the MCM I for mentioned on the Pearson wonderful Chrome web page and we also have a free trial that they&#39;re offering writing up at the MCM I for if you haven&#39;t used it before so thank you again dr. Rosen for the really helpful presentation and thank you everybody for attending this webinar we hope to see you again one of our future webinars thank you

Transcript for:Lecture on the MCMI-IV

Transcript for:
Lecture on the MCMI-IV