PSYCHOANALYTIC THEORY AS A

UNIFYING FRAMEWORK FOR 21ST

CENTURY PERSONALITY ASSESSMENT
Robert F. Bornstein, PhD
Adelphi University
Psychoanalysis represents a valuable unifying framework for 21st century
personality assessment, with the potential to enhance both research and clinical
practice. After reviewing recent trends in psychological testing I discuss how
psychoanalytic principles can be used to conceptualize and integrate personality
assessment data. Research from three domainsthe role of projection in shap-
ing Rorschach responses, contrasting patterns of gender differences in self-
report and free-response dependency measures, and the use of process dissoci-
ation procedures to illuminate test score convergences and divergences
illustrates how psychoanalytic concepts may be combined with ideas and
ndings from other areas of psychology to offer unique insights regarding
assessment-based personality dynamics.
Keywords: psychoanalysis, psychoanalytic, personality assessment, Rorschach,
self-report
Although most people associate clinical psychology primarily with psychotherapy, per-
sonality assessments history is at least as long as that of psychological treatment. The rst
formal use of the term mental test (Cattell, 1890) occurred just before Freud published his
initial psychoanalytic writings (Breuer & Freud, 1896/1955); a century later personality
assessment continues to play a major role in structuring treatment and guiding research.
Moreover, unlike many clinical activities, personality assessment is a uniquely psycho-
logical endeavor. As Groth-Marnat (1999) pointed out, there are at least 35 different
categories of mental health professionals who treat mental disorders, but only psycholo-
gists are trained and qualied to conduct personality assessments.
Clinicians often use the terms diagnosis and assessment interchangeably, but in fact
these terms mean very different things. Diagnosis involves identifying and documenting
Robert F. Bornstein, PhD, Derner Institute of Advanced Psychological Studies, Adelphi University.
Portions of this paper were presented at the annual meeting of the Rapaport-Klein Study Group,
Stockbridge, MA; June 14, 2008.
Correspondence concerning this article should be addressed to Robert F. Bornstein, PhD,
Derner Institute of Advanced Psychological Studies, 212 Blodgett Hall, Adelphi University, Garden
City, NY, 11530. E-mail: bornstein@adelphi.edu
Psychoanalytic Psychology 2010 American Psychological Association
2010, Vol. 27, No. 2, 133152 0736-9735/10/$12.00 DOI: 10.1037/a0015486
133
a patients symptoms to classify that patient into one or more categories whose labels
represent shorthand descriptors of psychological syndromes (e.g., bulimia nervosa, schiz-
oid personality disorder). Assessment, in contrast, involves administering one or more
personality tests (and sometimes intellectual and neuropsychological tests as well) to
disentangle the complex array of dispositional and situational factors that combine to
determine a patients subjective experiences, core beliefs, emotional patterns, motives,
traits, defenses, and coping strategies. Put another way, diagnosis is key to understanding
a patients pathology; assessment is key to understanding the person with this pathology.
Framed in this manner, it becomes clear that personality assessment isor should
bea task strongly inuenced by psychodynamic principles. After all, personality as-
sessment not only involves describing a patients surface presentation, but also requires
the assessor to draw conclusions regarding underlying dynamics that shape this presen-
tation. Moreover, in addition to documenting convergences between patterns obtained on
different psychological assessment tools, personality assessment identies divergences as
wellinstances wherein the patient produces contrasting patterns (or discontinuities) on
measures that tap different domains of experience (e.g., self-report vs. free-response tests;
see Bornstein, 2002; Meyer et al., 2001).
1
During the middle decades of the 20th century, personality assessment was in fact
shaped primarily by psychoanalytic concepts (see Holt, 1966; Klopfer, 1960; Mayman,
1959; Rapaport, Gill & Schafer, 1945, 1968; Schafer, 1954), with the understanding that
patients often had limited insight into underlying motives and conicts, so administration
of an array of measures using diverse methods to tap different levels of functioning was
critical. That era has ended. In most inpatient and outpatient settings today personality
assessment consists primarily of the administration and interpretation of self-report tests
whose theoretical underpinnings are decidedly unanalytic (e.g., the Beck Depression
Inventory [Beck & Steer, 1993], the Personality Assessment Inventory [Morey, 2003]).
When free-response tests such as the Rorschach Inkblot Method (RIM) are employed, they
are typically scored and interpreted using systems that emphasize actuarial scoring of
structural features (e.g., Exners, 1991, Comprehensive System) in lieu of the traditional
psychodynamic emphasis on content. Even in psychoanalytic training institutes interest in
psychological assessment has declined, and few analytic candidates now receive system-
atic training in the administration and interpretation of personality tests. Most analytic
practitioners do little or no formal psychological assessment as part of their clinical
practice (cf., Gabbard, 2000; Huprich, 2009).
Despite these challenges, in recent years clinicians and researchers have attempted to
strengthen connections between psychodynamic principles and personality assessment.
For example, Handler and Hilsenroth (1998) reviewed the myriad ways in which psy-
choanalytic ideas can be used to interpret the results of psychological tests from a variety
of domains (e.g., intellectual tests, self-report questionnaires, free-response measures,
gure drawings, neuropsychological screens). Sugarman and Kanner (2000) described
four functions that psychoanalytic theory brings to psychological testing: (a) an organizing
function; (b) an integrative function; (c) a clarifying function; and (d) a predictive function
1
Because the degree to which projection plays a role in shaping responses to ambiguous
stimuli like Rorschach inkblots and Thematic Apperception Test (TAT) cards remains controversial,
I use the term free-response test rather than projective test to describe these instruments (see Meyer
& Kurtz, 2006, for a detailed discussion of this issue). Although Bornstein (2007c) recently
proposed that the term free-response test be replaced with the more precise label stimulus attribution
test, this new terminology has not yet been widely adopted.
134 BORNSTEIN
(see also Sugarman, 1991, 1992). Most recently Bornstein and Masling (2005) identied
seven well-validated, clinically useful RIM scoring and interpretation systems, each of
which is based, in whole or in part, on psychodynamic principles.
The purpose of this article is to contribute to the ongoing dialogue regarding the value
of psychoanalytic theory in psychological testing. I argue that psychoanalysis represents
a valuable unifying framework for 21st century personality assessment, with the potential
to enhance both research and clinical practice. I begin by reviewing recent trends in
personality assessment, then discuss how psychoanalytic constructs can be used to help
conceptualize personality assessment data. Drawing upon research using self-report and
free-response measures of interpersonal dependency, I offer examples from three do-
mainsthe role of projection in shaping RIM responses, contrasting patterns of gender
differences in self-report and free-response dependency measures, and the use of process
dissociation procedures to illuminate test score convergences and divergencesto show
how psychoanalytic principles may be combined with ideas and ndings from other areas
of psychology to offer unique insights regarding personality dynamics.
Recent Trends in Personality Assessment
Contemporary personality assessment is characterized by a number of features that
simultaneously reduce the quality of empirical research in this area and undermine the
appropriate use of assessment data in clinical settings. Four stand out.
A Near-exclusive Focus on Self-report
Several decades ago, psychological assessment almost invariably included a comprehensive
test battery consisting of measures designed to tap different domains of adaptation (e.g., trait
scales and intellectual tests), and different levels of functioning and experience (e.g., ques-
tionnaires and free-response measures; see Allison, Blatt, & Zimet, 1968; Rapaport et al.,
1945, 1968). Attributable in part to the demands of managed care (Sperling, Sack, & Field,
2000), and in part to the dominance of atheoretical, descriptive approaches to personality such
as the ve-factor model (McCrae & Costa, 1997), assessment now consists primarily of the
administration, scoring, and interpretation of questionnaires.
Equating Self-report of a Construct With the
Underlying Construct
Exclusive reliance on self-reports, in and of itself, limits the inferences that may be drawn from
personality test data; this situation is exacerbated by the fact that in both research and clinical
settings, self-reports of traits and symptoms are often conceptualized as veridical indices of these
traits and symptoms. The equating of self-report with actual behavior occurs even for those domains
wherein lack of insight is regarded as a hallmark of the construct being assessed (e.g., personality
pathology). When Bornstein (2003) conducted a systematic survey of personality disorder research
published in ve major journals between 1991 and 2000, he found that over 80% of published
studies relied exclusively on self-report data (only 4% assessed oberservable behavior).
2
2
Personality researchers are not alone in their overreliance on self-reports. In fact, a systematic
survey of articles published in psychologys seven most widely subscribed journals indicated that
questionnaire outcome measures were used in 65% of all published studies, ranging from a low of 37%
in Developmental Psychology to a high of 93% in the Journal of Personality and Social Psychology
(Bornstein, 2001a). Overreliance on self-report data is a pervasive problem in contemporary psychology.
135 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
Overemphasis on Test Score Convergence
Following the tradition established by Campbell and Fiske (1959), personality assessment
research has focused primarily on documenting the convergence of scores on different
measures of the same construct, even when the measures use very different methods to
quantify these constructs (see Messick, 1995). However, as several researchers have
noted, scales that employ markedly different formats should show only modest test score
intercorrelation (Archer & Krishnamurthy, 1993a, 1993b; Meyer, 1996, 1997). Moreover,
test score divergence for measures that use different methods to measure similar con-
structs can be as informative and meaningful as test score convergence, sometimes more
so (Bornstein, 2002; Meyer et al., 2001).
Shifts in Personality Assessment Training
Given these trends, it is not surprising that the attention given to nontraditional personality
assessment methods in graduate-level assessment courses has declined in recent years,
with a concomitant increase in time devoted to self-report tests (Stedman, Hatch, &
Schoenfeld, 2001). When Childs and Eyde (2002) surveyed the curricula of 84 clinical
doctoral programs, they found that only 44% included a required course in personality
assessment, with most of these courses emphasizing self-report instruments. When Pi-
otrowski and Belter (1999) surveyed directors of 84 American Psychological Association-
approved predoctoral internship programs, the only area of assessment that had dimin-
ished in emphasis during the preceding ve years was free-response (e.g., Rorschach)
testing.
Psychoanalytic Theory as a Unifying Framework for 21st Century
Personality Assessment
Pedagogical and economic (e.g., managed care) issues notwithstanding, a key factor in the
shift from integrative, multimodal personality assessment to assessment based primarily
on self-report test data has been the absence of a unifying framework within which
psychologists may conceptualize and integrate information from different personality
assessment instruments. Psychoanalytic theory represents the most useful overarching
framework, for three reasons.
A Focus on Process
To a greater extent than other theoretical models, psychoanalysis focuses on the psycho-
logical processes that occur as individuals respond to internal stimuli (e.g., memories,
thoughts, emotions) and external events (e.g., novel experiences, familiar and unfamiliar
people, personality test items). In part these processes are shaped by the individuals
coping and defense style (Cramer, 2000, 2006; Lerner, 2005), but psychoanalytic theorists
and researchers have also examined how the processing of informationeven neutral,
conict-free informationis shaped by individual traits, motives, and need states (see
Erdelyi, 1985; Weinberger & McClelland, 1990). Many of these analyses are derived from
Hartmanns classic concept of conict-free spheres of the ego (see Hartmann, 1964), but
in recent years relational psychoanalysts have explored the ways in which language
affords shared meaning and consensus between analyst and analysand, revealing aspects
of underlying psychological process that would otherwise remain hidden (see Laplanche
& Pontalis, 1974, and Stern, 2004, for discussions of intersubjectivity in relational
psychoanalysis).
136 BORNSTEIN
Psychodynamic models are also unique in articulating the role that underlying psychic
structures play in personality development and dynamics. For example, psychoanalytic
theorists have described the ways in which mental representations of self and signicant
others (sometimes referred to as introjects or schemas) inuence motives, thought pat-
terns, and emotional reactions (Greenberg & Mitchell, 1983). Theorists and researchers
have also explored the impact of variations in infant-caregiver mirroring on personality
development and emotion regulation (Kohut, 1971; see also Beebe & Lachmann, 2002).
Most recently psychodynamic principles have been integrated with ndings from neuro-
imagery (e.g., functional magnetic resonance imaging) studies to delineate links between
cortical activity patterns and psychological processes such as memory distortion, confab-
ulation, and the retrieval of formerly inaccessible memories (see Gallo, Kensinger, &
Schacter, 2006).
Multiple Levels of Awareness
Psychoanalytic theory is unique in the degree to which it has developed formal models
describing the ways in which individuals process information on multiple levels, and with
contrasting degrees of awareness. The most inuential such perspective is derived from
Freuds (1900/1953) topographic model, which conceptualizes human information pro-
cessing in terms of three broad domains (conscious, preconscious, and unconscious), but
the topographic model is not the only framework used by psychoanalysts to conceptualize
the interplay of conscious and unconscious mental processes. In recent years other
complementary and competing psychodynamic conceptualizations of levels of awareness
in information storage and processing have emerged (e.g., Epstein, 1998; Erdelyi, 2006;
Westen, 1998). These alternative conceptualizations help illuminate the ways in which
cognitive and affective information is transformed as it emerges into consciousness
(Bucci, 1997, 2000), and the unique inuence of material that is neither fully conscious
nor completely unconscious, but exists on the fringes of consciousness (see Pyszczyn-
ski, Greenberg, & Solomon, 2000). Psychodynamic researchers have examined the role of
the self-representation in distinguishing memories accessible to conscious awareness from
those that are not, and the manner in which information may be processed on multiple
levels simultaneously (Bargh & Morsella, 2008). With respect to this latter issue, Erdelyi
(2004, 2006) has articulated in detail the psychological processes and situational variables
that underly temporal shifts in awareness as stimuli move among different levels of
consciousness.
Introspection Versus Experience
From its inception, a core tenet of psychoanalytic theory has been that individuals have
limited introspective access, so it is important to distinguish the persons private, subjec-
tive experience from his or her ability to turn attention inward and describe that experience
(Bornstein, 1993, 1999; Stern, 2004). Many techniques in psychodynamic therapy are
directed toward increasing introspective access and making unconscious material con-
scious. These include Freuds traditional free association method, dream analysis, and
other strategies for inducing hypermnesia for previously inaccessible memories (Erdelyi,
1985; Sperling et al., 2000). In this context psychodynamic theorists have discussed the
value of deconstructing core conictual relationship themes as a method for increasing
introspective awareness (Luborsky & Crits-Christoph, 1990); other clinicians emphasize
the value of transference (and countertransference) analysis to uncover aspects of private
experience that would otherwise remain hidden (see Weiner & Bornstein, 2009).
137 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
As Bornstein (2002) and others (e.g., Huprich, 2009; Meyer et al., 2001) have pointed
out, exploration of divergences between information that is accessible via introspection
and information that shapes behavior reexively and mindlessly can yield important
information regarding underlying personality structure, coping, and defense (see also
McClelland, Koestner, & Weinberger, 1989). Because certain personality tests (e.g.,
self-report scales) are designed to tap the end-products of testees introspective efforts
whereas others (e.g., free-response measures) tap experience more than introspection, a
psychodynamic perspective is particularly useful in contrasting and combining the results
of self-report and free-response test data.
Toward a More Unied Unifying Framework: Integrating Psychoanalysis With
Other Areas of Psychology
As several researchers have noted (e.g., Bornstein, 2005; Bucci, 2000; Masling, 1990), a
central challenge confronting psychoanalytic theorists and practitioners today involves
integrating into their ideas and therapeutic techniques ndings from other areas of
psychology. For example, psychodynamic models of memory and information processing
are enhanced when they incorporate concepts from cognitive science (e.g., Bargh &
Morsella, 2008; Campanella & Belin, 2007). Psychoanalytic writings on the perception of
self and others benet from attention to social psychological research on this topic
(Kammrath, Mendoza-Denton, & Mischel, 2005; Newman, Duff, & Baumeister, 1997).
The psychoanalytic literature is replete with examples of constructs that conict with
well-established empirical ndings in neighboring elds (Bornstein, 2001b), and analysts
tendency to ignore nonanalytic writings has led to the wholesale co-opting and reinvention
of some seminal psychoanalytic concepts by researchers in other areas (Bornstein, 2005).
Thus, a truly unied unifying framework must not only draw upon psychoanalytic
principles, but should also embed these principles in a nomological network of nomothetic
research ndings from outside psychoanalysis. In the following sections, I combine an
overarching psychoanalytic perspective with ideas and ndings from social, developmen-
tal, and cognitive psychology to illustrate the ways in which psychoanalytic theory can be
used to conceptualize and integrate personality assessment data.
Integrating Psychodynamic and Social Perspectives:
Projection in the Rorschach
Although most psychologists (analysts included) conceptualize projection primarily as a
means by which people disavow and externalize undesired feelings and impulses, Freud
(1913/1955) made clear that projection is both a defensive strategy and a method for
structuring external perceptions and inferences. Thus, Freud (1913/1955, p. 64) wrote:
Projection . . . . also occurs where there is no conict. Under conditions whose nature has not
been sufciently established internal perceptions of emotional and thought processes can be
employed for building up the external world, though they should by rights remain part of the
internal world.
There have been surprisingly few attempts to document empirically the role that
projection may play in shaping Rorschach responses (Exner, 1989; Murstein, 1956;
Murstein & Wolf, 1970; Porcelli & Meyer, 2002), and each of these studies produced
inconclusive results. These ambiguous ndings did not stem from faulty empirical
138 BORNSTEIN
methods, but from an exclusive focus on outcome, assessed using correlational designs
(i.e., an exclusive emphasis on quantifying RIM score-external criterion links). By
combining psychoanalytic principles with models of social projection (e.g., Newman et
al., 1997) it is possible to understand more completely the mental operations that occur as
people disavow undesired traits and use internal perceptions and predispositions to
structure external stimuli.
Figure 1 illustrates the sequence of psychological processes that leads to projection of
an undesired trait. As this gure suggests, when people are faced with evidence they might
possess a trait they would rather not see in themselves (e.g., hostility, dependency,
narcissism), they try to avoid thinking about this trait. When trait-relevant thoughts
emerge into consciousness, the person attempts to suppress these thoughts, and push them
out of awareness (Newman et al., 1997; Schimel, Greenberg, & Martens, 2003). Over
time, this ongoing avoidance/suppression process leads to two results: one intended, one
unintended. On the positive side, vigilant avoidance of thoughts related to an undesired
trait enables people to maintain the (conscious) belief that they do not possess this trait.
On the negative side, however, frequent suppression of thoughts regarding an undesired
trait renders this trait chronically accessible (Wegner & Erber, 1992). Research has shown
that chronically accessible traits are easily primed (i.e., brought into working memory)
when the suppressor perceives behavior in others that resembleseven remotelythe
undesired trait (see Bargh, 1994; Higgins & King, 1981).
In considering the implications of this avoidance/suppression dynamic for personality
assessment, it is important to note that suppression-based misperceptions are not limited
to social contexts. Although we are predisposed to overperceive undesired traits and
motives in other people, in part because we devote considerable cognitive resources to
inferring others intentions and motives (Maner et al., 2005; Schimel et al., 2003), we may
Conscious Perception
Of Self as Not
Evidence of Avoidance and Possessing Undesired
Undesired Suppression of Trait
Trait in Trait-Related
Oneself Thoughts Chronic Accessibility
Of Undesired Trait



Overperception of
Undesired Trait in
Others (people,
animals, abstract
entities)
Figure 1. Projection from a socialcognitive perspective. According to this view, avoidance
and suppression of thoughts related to an undesired trait will lead to chronic accessibility of
trait-related concepts and a tendency to misattribute the unwanted trait to others. Originally
published as Figure 1 in Might the Rorschach be a Projective Test After All? Social
Projection of an Undesired Trait Alters Rorschach Oral Dependency Scores by Robert F.
Bornstein (Journal of Personality Assessment, Volume 88, pages 354367). Copyright 2007
by Lawrence Erlbaum Associates, Inc.
139 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
also misattribute undesired traits (e.g., hostility) to nonhuman organisms (e.g., shy cats,
stray dogs), or even abstract entities (e.g., the government). A suppressed trait concept,
once primed, nds expression in myriad ways.
Using this framework, Bornstein (2007a) explored the effects of undesired trait
feedback on Rorschach Oral Dependency (ROD) scores (see Bornstein & Masling, 2005,
for a review of evidence on the validity of ROD scores as an index of implicit dependency
strivings). To begin, a large sample of introductory psychology students completed the
ROD scale, along with the Interpersonal Dependency Inventory (IDI), a widely used
self-report measure of dependency (Hirschfeld et al., 1977). Students who obtained very
low or very high IDI scores were then called back for a follow up session by an
experimenter unaware of these students ROD scores. When these high-IDI and low-
IDI students arrived at the laboratory they were told they were taking part in a study of
personality and self-perception. Then came the key manipulation: Half the high-IDI
participants and half the low-IDI participantsthose in the dependent feedback condi-
tionwere told that they had in fact obtained very high dependency scores during the
earlier prescreening. They were shown a printout illustrating their dependent personality
prole, and while they viewed this printout they received verbal feedback from the
experimenter (see Bornstein, 2007a, p. 359), who said:
These are your percentile scoreshow high you scored on each scale relative to other college
students. Your highest score was on the insecurity scale. Your other high scores are on the
vulnerability and low self-condence scales, and you also scored somewhat high on the reliance
on others scale. These scores indicate that youre a dependent person, and insecure in social
situations.
The other half of the participants received control feedback, where they were shown
a low dependent printout and told:
These are your percentile scoreshow high you scored on each scale relative to other college
students. You didnt score high on any of the scales, which indicates that youre basically an
independent person, and condent in social situations. As you can see your scores on these
subscales are right in line with the norms.
After receiving either dependent or control feedback each participant completed
the ROD scale again, so their post-feedback scores could be compared with their
scores from the initial screening.
The central results of this experiment are summarized in Figure 2, and as this gure
shows, the only participants who showed a signicant increase in dependent Rorschach
imagery from Time 1 to Time 2 were those who: (1) initially described themselves as
autonomous and independent on the IDI; then (2) received feedback that indicated that
they were actually insecure and highly dependent. Participants who received control
(irrelevant) feedback showed no ROD increase (regardless of their IDI scores), nor did
participants in the dependent feedback condition who initially had elevated IDI scores
(having described themselves at Time 1 as being highly dependent). Apparently being told
we possess a trait wed rather not see in ourselves really does cause us to overperceive this
trait in things around useven in inkblots. Thus, combining psychodynamic principles
with ideas and methods from social psychology helped generate the rst direct evidence
that a projection-like dynamic shapes Rorschach responses, at least under certain condi-
tions. Additional studies are needed to determine the generalizability of these patterns to
other Rorschach scoring dimensions.
140 BORNSTEIN
Integrating Psychodynamic and Developmental
Perspectives: Gender and Gender Role
Who shows higher overall levels of interpersonal dependency, women or men? When
asked, psychologists (e.g., Cadbury, 1991) and laypersons (Bornstein, Rossner, Hill,
& Stepanian, 1994) respond similarly, believing that in general, women are more
dependent. A meta-analysis of research on gender differences in self-report depen-
dency tests (Bornstein, 1995) produced results consistent with the widespread per-
ception that women show higher levels of expressed dependency: Women scored
higher than men on every self-report measure wherein gender differences have been
assessed (N of comparisons 94), and when these gender differences were combined
statistically women obtained self-report dependency scores that exceeded those of
men by .41 standard deviations (d .41, combined z 19.22, p .000001). These
results are summarized in the top portion of Table 1.
A very different pattern emerged for free-response dependency scales. In most
individual studies women and men produced comparable free-response dependency
scores, but when these data were combined using meta-analytic techniques (N of
comparisons 26), men actually showed higher levels of underlying dependency than
1
2
3
4
5
6
2 E M I T 1 E M I T
TIME OF TESTING
R
O
D

S
C
O
R
E
High IDI, Dependent Feedback
Low IDI, Dependent Feedback
High IDI, Irrelevant Feedback
Low IDI, Irrelevant Feedback
Figure 2. Effects of Interpersonal Dependency Inventory (IDI) score (high vs. low),
feedback condition (dependent vs. irrelevant), and time of testing (Time 1 vs. Time 2) on
ROD scale scores. Adapted from Table 2 in Might the Rorschach be a Projective Test After
All? Social Projection of an Undesired Trait Alters Rorschach Oral Dependency Scores by
Robert F. Bornstein (Journal of Personality Assessment, Volume 88, pages 354367).
Copyright 2007 by Lawrence Erlbaum Associates, Inc.
141 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
did women (d .11, combined z 1.93, p .05). These patterns are summarized in the
bottom portion of Table 1. A d of .11 (approximately one-ninth SD) might seem modest, and
it is indeed considered a small effect size (Cohen, 1988). However, a d of this magnitude is
not trivial, and exceeds the effect sizes associated with the impact of a daily aspirin
regimen in reducing heart attack risk in men (d .02), and the effect of chemotherapy on
enhanced likelihood of recovery from breast cancer in women (d .03). This d is also
larger than that linking tobacco use with increased risk for developing lung cancer (d
.08), and is identical to the effect size associated with combat exposure and PTSD risk in
Vietnam veterans (see Meyer et al., 2001, for a listing of representative effect sizes in
psychology and medicine).
How can we understand these contrasting patterns of gender differences in
self-report and free-response dependency tests? Consistent with psychodynamic mod-
els of early childhood development (Beebe & Lachmann, 2002; Galatzer-Levy &
Cohler, 1993; Russ, 1996; Silverstein, 2007), McClelland et al. (1989, pp. 698699)
argued that free-response tests provide a more direct readout than do self-
reports. . ..because implicit motives are built on early, prelinguistic affective experi-
ences whereas self-attributed motives are built on explicit teaching by parents and
others as to what values or goals it is important for a child to pursue. Supporting
McClelland et al.s theoretical conceptualization, in a subsequent meta-analysis
Table 1
Gender Differences in Dependency: Self-report Versus Free-response Measures
Measure
Number of
effect sizes
Combined effect
size (d)
Combined
z p
Self-report measures
DEQ 18 .37 8.13 .00001
IDI 16 .42 6.20 .00001
Dy Scale 12 .50 10.91 .00001
MCMI 8 .46 5.29 .00001
DP Scale 7 .39 5.03 .00001
EPPS 5 .48 3.98 .0001
SAS 4 .60 4.42 .00001
LKDOS 3 .61 3.38 .0005
PDQ-R 2 .16 0.90 NS
Other 20 .33 7.17 .00001
Free-response measures
ROD 17 .17 2.08 .02
TAT 3 .09 0.74 NS
HIT 2 .17 0.54 NS
Other 4 .07 0.12 NS
Note. DEQ Depressive Experiences Questionnaire Dependency Scale; IDI Interpersonal Dependency
Inventory; Dy Scale MMPI Dependency Scale; MCMI Millon Clinical Multiaxial Inventory Dependency
Scale; DP Scale Dependence Proneness Scale; EPPS Edwards Personal Preference Survey Succorance
Scale; SAS Sociotropy-Autonomy Scale; LKODS Lazare-Klerman Oral Dependency Scale; PDQ-R
Personality Disorder Questionnaire-Revised Dependency Scale; NS not signicant; ROD Rorschach Oral
Dependency Scale; TAT Thematic Apperception Test Dependency Scale; HIT Holtzman Inkblot Test
Dependency Scale.
Adapted from Table 1 in Sex Differences in Objective and Projective Dependency Tests: A Meta-Analytic Review
by Robert F. Bornstein (Assessment, Volume 2, pages 319331). Copyright 1995 by Psychological Assessment
Resources, Inc.
142 BORNSTEIN
Bornstein, Bowers, and Bonner (1996b) found signicant positive correlations be-
tween self-reported dependency and femininity, and signicant negative correlations
between self-reported dependency and masculinity, in both women and men. Free-
response dependency scores were unrelated to gender role orientation regardless of
participant gender.
These patterns suggest that gender differences in self-reported dependency are, at
least in part, the product of womens and mens efforts to present themselves in
gender-consistent ways on psychological tests.
3
But what accounts for the higher
levels of implicit dependency in men relative to women? Self-presentation cannot
account for these results, and two possibilities seem plausible. First, it may be that
men simply experience stronger underlying dependency strivings than do women,
with certain masculine attitudes and behaviors representing a sort of reaction forma-
tion against feelings of helplessness and vulnerability, a possibility that has been
raised by both psychoanalytic (Coen, 1992; Fuerstein, 1989) and feminist (Gilbert,
1987; Lerner, 1983) theorists. Alternatively, it may be that mens efforts to conceal
dependent urges and feelings cause these unexpressed urges to build up and reveal
themselves indirectly on free-response tests. Such an interpretation would be consis-
tent with Bornsteins (2007a) ndings regarding the impact of avoidance and sup-
pression of self-relevant information on Rorschach responding (see also Wegner &
Erber, 1992), but a denitive test of this interpretation of gender differences in
dependency has not yet been conducted.
Integrating Psychodynamic and Cognitive Perspectives:
Process Dissociation
Psychoanalytic theory provides a unique perspective on cross-method inconsistencies in
psychological test data because, alone among theoretical models of personality, psycho-
analysis explicitly links the degree of structure provided by different assessment tools with
personality factors (e.g., impulse control, reality testing) that should lead to differential
performance on more versus less structured tests. For example, psychoanalytic researchers
have found that patients with borderline pathology often perform quite well on measures
with a high degree of structure (e.g., intelligence tests) while performing poorly on
unstructured instruments like the Rorschach (Carr & Goldstein, 1981). Along somewhat
different lines, Bornstein (1998) demonstrated that individuals with dependent personality
disorder traits and symptoms scored high on both self-report and free-response measures
of interpersonal dependency whereas individuals with histrionic personality disorder traits
and symptoms obtained high free-responsebut low self-reportdependency scores (see
Bornstein, 1998, for a discussion of the implications of these ndings for the psychody-
namics of dependent and histrionic personality pathology).
To date, most investigations of test score inconsistency have contrasted performance
across two or more instruments in a particular patient group (Carr & Goldstein, 1981),
and/or contrasted the performance of two or more participant groups for a particular subset
of assessment tools (Bornstein, 1998). By integrating into these studies experimental
manipulations designed to alter one set of test scores but not the other, researchers can
learn more about the psychological processes engaged by different assessment instru-
ments, and draw rmer conclusions regarding the dispositional and situational factors that
3
See Goffman (1959) for the classic sociological analysis of strategic self-presentation, and
Higgins and Pittman (2008) for a contemporary psychological discussion of this phenomenon.
143 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
lead to test score discontinuities. The rst step involves understanding as fully as possible
the phenomenology of self-report and free-response teststhe private, subjective expe-
riences of test-takers as they respond to different types of test items.
Consider the following two items from the IDI: I would rather be a follower than a
leader, and I have a lot of trouble making decisions by myself. Both statements are
rated by the testee on Likert-type scales anchored by the terms not at all true of me and
very true of me. At least three psychological processes occur as people respond to these
IDI items. First, testees engage in introspection, turning their attention inward to deter-
mine whether the statement captures some aspect of their feelings, thoughts, motives, or
behaviors. Second, a retrospective memory search occurs, as testees attempt to retrieve
instances wherein they experienced or exhibited the response(s) described in the test item.
Finally, testees may engage in deliberate self-presentation, deciding whether, given the
context and setting in which they are being evaluated, it is better to answer honestly, or
modify their response to depict themselves in a particular way. Typically these efforts are
aimed at faking good (i.e., attempting to portray oneself as healthier than is actually the
case) or faking bad (attempting to portray oneself as unhealthy and exaggerate pathol-
ogy), depending upon the testees self-presentation goals.
Contrast this set of psychological processes with those that occur as people complete
the ROD scale. Here the testee is asked to provide responses to the 10 Rorschach inkblots;
these responses are then scored to derive the overall proportion of oral and dependent
imagery contained in the percepts (Bornstein & Masling, 2005). Unlike the IDI, the
fundamental challenge for an individual completing the ROD scale is to create meaning
in a stimulus that can be interpreted in multiple ways. To do this testees must direct their
attention outward (rather than inward), and focus on the stimulus (not the self); they then
attribute meaning to the stimulus based on properties of the inkblot and the associations
primed by these stimulus properties. Once a series of potential percepts (or stimulus
attributions) is formed testees typically sort through these possible responses, selecting
some and rejecting others before providing their description (see Exner, 1991, and Weiner,
2004, for general overviews of stages in Rorschach responding, and Bornstein, 2007a, for
stages involved in generating ROD scores).
With this as context, Bornstein (2002) utilized ideas and ndings from cognitive
psychologists who employ experimental manipulations to disentangle the psychological
and neurological underpinnings of implicit versus explicit memory (e.g., Jacoby & Kelley,
1991; Schacter, 1987), combining these ideas with psychoanalytic principles to develop
the process dissociation approach to personality assessment. The process dissociation
strategy involves identifying naturally occurring inuences on test scores (e.g., testee
motivation or mood state) then deliberately manipulating these inuences to illuminate
underlying response processes.
In the rst study using this approach, Bornstein et al. (1994) administered the IDI and
ROD scale to a large, mixed-sex sample of college students under three different
conditions. One-third of the participants completed the two measures under a negative set
condition; prior to completing the IDI and ROD scale these participants were told that
both were measures of interpersonal dependency, and that the study was part of a program
of research examining the negative aspects of dependent personality traits (following
which several negative consequences of high levels of dependency were described).
One-third of the participants completed the two measures under a positive set condition;
these participants were told that the study was part of a program of research examining the
positive, adaptive aspects of dependency (following which several positive features of
dependency were described). The remaining participants completed the two measures
144 BORNSTEIN
under standard conditions, wherein no mention is made of the purpose of either scale, or
the fact they assess dependency.
Bornstein et al. (1994) found that relative to the baseline (control) condition, partic-
ipants IDI scores increased signicantly in the positive set condition, and decreased
signicantly in the negative set condition; ROD scores were unaffected by instructional
set. These patterns reect the contrasting processes that occur as participants complete the
IDI (introspection, retrospection, deliberate self-presentation) and the ROD scale (atten-
tion directed outward, focus on stimulus rather than self, attribution of meaning to
ambiguous inkblots), and illustrate the utility of the process dissociation approach in
delineating the factors that lead to self-report/free-response test score discontinuities. In a
follow-up investigation Bornstein, Bowers, and Bonner (1996a) examined the impact of
induced mood state on IDI and ROD scores, asking participants to write essays regarding
traumatic events, joyful events, or neutral events to induce a corresponding mood
immediately prior to testing. Bornstein et al. (1996a) found that, as expected, induction of
a negative mood prior to testing led to a signicant increase in RODbut not IDIscores
(see Bornstein, 2002, and Cogswell, 2008, for descriptions of these and other process
dissociation studies involving self-report and free-response dependency scales).
Discussion
The present review illustrates the utility of psychodynamic principles in illuminating the
psychological processes that underlie free-response tests in elucidating the effects of
naturally occurring variables (e.g., gender role) on personality test data, and in contrasting
and integrating results from different personality assessment tools. Although these initial
studies all involved the assessment of interpersonal dependency, the principles and
strategies that guided these investigations should generalize to other traits as well (e.g.,
impulsivity, narcissism, need for achievement; see Craig, Koestner, & Zuroff, 1994, and
Koestner, Weinberger, & McClelland, 1991, for examples). Studies conducted to date
suggest that psychoanalysis can function as a unifying framework for integrative person-
ality assessment, and because the results of these investigations help inform clinicians and
researchers about the underlying dynamics that shape test responses, the reverse is also
true: Just as psychoanalysis represents a potential unifying framework for personality
assessment, integrative personality assessment represents a useful tool for studying
psychodynamic processes (see Handler & Meyer, 1998, and Sugarman & Kanner, 2000,
for discussions of this issue).
Askeptic might argue that although psychodynamic principles can be used to explain these
patterns, the present results may also be interpreted using alternative frameworks that do not
draw upon psychoanalytic concepts. For example, certain ndings described in this review
(e.g., gender differences in self-reportbut not free-responsedependency test scores)
might be attributable in part to self-presentation effects, reecting womens willingness
(and mens unwillingness) to acknowledge dependent attitudes, urges, and feelings.
Similarly, the impact of mood on free-response test data might reect the well-
documented priming effects of mood on affectively congruent memories.
Although certain ndings described herein can indeed be explained using alternative
frameworks, some cannot, and taken together these patterns are most parsimoniously
conceptualized in psychodynamic terms. For example, the impact of feedback regarding
disavowed traits on free-response test scores cannot be accommodated by a straightfor-
ward self-presentation model, and can only be fully explained within a framework that
145 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
explains why unwanted and disavowed personal characteristics are externalized and
misattributed to objects in the environment. Other patterns (e.g., mens elevated score on
measures of implicit dependency strivings) also lend themselves readily to a psychody-
namic interpretation, and are not easily explained by competing models of personality and
psychopathology (e.g., cognitive, behavioral, humanistic). As discussed, three qualities
unique to psychoanalytic theoryits focus on process, on multiple levels of awareness,
and on introspection versus experiencecombine to create a context within which
personality test score convergences and divergences can be usefully interpreted, and
within which different forms of personality test data can be integrated. No other extant
model has these three qualities. Thus, although other theoretical frameworks (e.g.,
cognitive, behavioral, humanistic) can help explain specic personality test results and
particular test score interrelationships, only the psychodynamic model offers the kind of
overarching framework that allows the broad spectrum of ndings in this area to be
integrated within a single theoretical perspective.
As research on the utility of psychodynamic principles in conceptualizing and inte-
grating personality test data continues to accumulate results from these investigations can
begin to move from laboratory to clinic. Three guiding principles will help facilitate this
transition.
Principle 1: A Focus on Process Is Critical for
Effective Interpretation of Personality Assessment Data
As noted at the outset of this review, several distinguishing features of psychoanalytic
theory make this theory particularly useful in conceptualizing personality assessment data
(i.e., its focus on process, multiple levels of awareness, and introspection vs. experience).
As Meyer and Kurtz (2006) noted, integrating test data from measures that employ
different methods and formats has long been a compelling challenge for assessment
psychologists (cf., Archer & Krishnamurthy, 1993a, 1993b), in part because most validity
studies to date have focused on outcome (i.e., test score-criterion correlation) rather than
underlying process. A process-focused approach can help resolve some longstanding
questions in this area, and as Bornstein (2007c) noted, such an approach also allows
clinicians to make ner distinctions among (and derive more accurate descriptive labels
for) widely used personality assessment tools. For example, traditionally measures like the
Draw-a-Person test and Kinetic Family Drawing have been grouped with the RIM and
TAT under the broad heading of projective instruments, but scrutiny of the mental
processes that occur as testees complete these measures suggests that what were formerly
known as projective drawings are better described as constructive tests, while measures
like the RIM and TAT may be more accurately described as stimulus attribution tests (see
Bornstein, 2007c, Table 1, for a complete listing of personality tests by process-based
category).
Principle 2: Clinical and Laboratory Assessment
Studies Provide Complementary and
Synergistic Results
A key assumption of the process dissociation approach is that subtle, naturally occurring
inuences on test scores (e.g., testee motivation or mood state) can be used to illuminate
underlying response processes. Thus, a process focused model reconceptualizes test score
confounds (and threats to validity) as opportunities for insight into the psychological
dynamics that shape peoples responses to personality test items and stimuli. Put another
146 BORNSTEIN
way, the process dissociation strategy reverses the usual procedure for dealing with
potential test score confounds: Rather than attempting to minimize or eliminate these
confounds in the laboratory and in vivo (a difcult challenge as best; see Messick, 1995)
the researcher leans into them, exploits them, and deliberately manipulates them to
increase or decrease their impact and see how test results are affected. Although histor-
ically experimental methods have not played a primary role in testing psychoanalytic
hypotheses (Bornstein, 2007b), or in validating personality assessment tools (Bornstein,
2002), the process focused approach blends psychoanalytic concepts with nomothetic
research methods to obtain unique insights into underlying personality dynamics.
Principle 3: Personality Assessment Is Fundamentally
Analytic, but Personality Testing Is Behavioral
The present results suggest a fruitful convergence between psychodynamic and behavioral
principles in personality assessment. As Handler and Meyer (1998, pp. 45) noted in
contrasting psychological testing and psychological assessment:
Testing is a relatively straightforward process wherein a particular test is administered to
obtain a particular score or two. Subsequently, a descriptive meaning can be applied to the
score based on normative, nomothetic ndings. . . . Psychological assessment, however, is a
quite different enterprise. The focus here is not on obtaining a single score, or even a series
of test scores. Rather, the focus is on taking a variety of test-derived pieces of information,
obtained from multiple methods of assessment, and placing these data in the context of
historical information, referral information, and behavioral observations to generate a cohe-
sive and comprehensive understanding of the person being evaluated.
Put another way, psychological testing requires precision, objectivity, and the kind of
scientic detachment that facilitates accurate data-gathering. Psychological assessment
involves integration, synthesis, and clarication of ambiguouseven conicting
evidence obtained during the testing process.
Thus, the competent tester must be (at least for that moment) a staunch behaviorist,
understanding the contingencies that dene the testing situation and using this knowledge
to maximize the validity and generalizability of test data. Once these data are gathered the
behavioral tester must transform into a psychodynamically informed assessor, able to
combine dynamic concepts with research ndings from other areas of psychology to
interpret test results in the context of referral information, life history information, and
behavioral observations made during testing. Wachtel (1977, 1997) discussed the ways
that psychodynamic and behavioral principles can be combined to enhance the effective-
ness of insight-oriented psychotherapy; the present analysis suggests that the same may be
true of psychological assessment.
Conclusion
If a single theme cuts across the various issues taken up in this review, that theme is
integration. Not only does effective psychological assessment combine behavioral and
psychodynamic principles, but it also requires that the clinician integrate different types
of test data (e.g., self-report and free response), integrate psychoanalytic concepts with
ndings from other areas of psychology (e.g., social, cognitive), and integrate knowledge
regarding test score outcome (i.e., convergent validity) with information regarding the
psychological processes that occur as patients engage different tests. Ultimately person-
147 PSYCHOANALYSIS AND PERSONALITY ASSESSMENT
ality test data must also be integrated with information that emerges over time during
treatment, and as this occurs some heretofore unnoticed aspects of the assessment results
may well turn out to be salienteven keypieces of evidence, enabling the clinician to
maximize therapeutic efcacy and gain a deeper understanding of the patients underlying
dynamics and surface presentation. Integration is a process that begins during assessment,
but continues through treatment and beyond.
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