Contextual Interpretation of the MCMI-IV: Using a Case Study

– [Presenter] Good afternoon, or whatever time it may be in your locale at the moment. Good afternoon everybody. And welcome to our webinar, which is the, probably the most advanced, the third in a series of three webinars that we are currently circulating for the MCMI-IV. Those of you who are not as familiar

With the Millon instruments, or the MCMI-IV, this is the most recent incarnation of the instrument that was first published in 2015, the MCMI, of course, dating back to 1977. So this was our 40th anniversary year for the Millon line of instruments. And the trainings that we have been doing,

One has been more or less an overview. Some of you may have already partaken in that, and if you haven’t, it’s worth just getting the basics from that one. There’s another that goes a little more in depth in terms of the specifics of how you utillize the MCMI-IV in more of a clinical,

Therapeutic sort of a fashion. And this one is a particular favorite of mine, actually. This is one where we take a case study, and I’ll talk about this particular case, it’s got some history to it as well. We’ll be talking about that later on.

But this is a fictionalized version of a true case. And we take it apart to utilize a lot of what I cover in the other two webinars in order to, really, kind of get the best possible view of how to put some of the details, some of the data that you get,

And particularly the theory behind the instrument, how you really operationalize and utilize that therapeutically, and utilize that in your feedback, as well as any interpretive reports that you are producing for whatever the assessment is. That being said, let’s take a look a little bit more specifically

At what it is we will be covering in today’s webinar. As I’ve alluded, we’re going to be moving beyond the basics here. We’re going more fully implement clinical knowledge gleaned from a deeper understanding of the Millon evolutionary theory in order to augment the interpretive power of the instrument.

In doing this, we’re going to discuss diagnostic considerations to a degree. However what I really want to emphasize is that the major focus is more on description than labeling. So we will be using the diagnoses and diagnostic precision and how you can get very specific about that again, to a degree

But we’re really going to be delving into the rich theoretical backbone to develop meaningful interpretations for those people who are being assessed, as well as working on content for your feedback and report. So by participating today, you’re going to be introduced to information that can help you first and foremost,

Describe the individual personality patterns, in terms that will hopefully spark interest in the person, in terms of their own longstanding conflicts and challenges. We’re also going to focus on the clinical syndromes identified by the MCMI-IV, and help them relate their referral questions, which are usually embedded in those clinical syndromes,

Back to the personality patterns. Finally we’re going to give some attention to identifying directions and actions in more of a therapeutic context. So before we get started in the content portion of what we’re doing today, what I’d like you to do is to respond briefly

To the question that you see in front of you. Have you used the MCMI? I want to tailor our remarks to some degree to the audience that we have, or the participants today. And also to be able to get some idea as to how much detail we need in any particular area.

So if you have used the MCMI-IV, just mark that. If you’ve only used the MCMI-III, but not the IV, only mark that. And again, if you’re new to the instruments, if you’re here gathering some information, you haven’t used either instrument at this point, just mark it that way.

And we’ll give a few moments for people to come in and tally. Total response is 21, I just want to take a quick look at how many we have here today. Please everybody, don’t be shy, go ahead and respond. I see 35 people here but that also includes us, so.

A couple of more folks that might be holding off. I’m going to mark ahead the MCMI-IV. Okay, this may shift a little bit as we begin to talk about that. But from what I see here, the people who are here may be relative newcomers to the MCMI-IV, from what I’m looking at.

Relatively even number, actually a full even number, of people who have used a Millon instrument, particularly the MCMI, likely the MCMI-III, and those who are completely new to it. So I will do a little bit more detail with what we’re discussing today. But again, people who haven’t used it,

It’s really well worth your while to look either at the Pearson website on the MCMI-IV page, to maybe go through the introductory webinar, or join us for when that’s coming up in one of the next cycles. Okay, so we have people that have some background in Millon inventories, something of a majority here,

Who have used the instruments, either the III or the IV. The theory is, in large part, the same between the two. It was updated and the MCMI-IV uses the more updated theory. But there’s a lot that’s applicable to both instruments. I’ll point that out as we go along here as well.

So let’s take a brief overview of the instrument. So before we get to the theory and the more complex interpretation strategies of the MCMI-IV, I want to give you a little overview of the instrument itself, noting the very sections and how it is that they interrelate.

I’m going to begin by just looking at the different, what we call the sections, of the instrument. These are some of the major cutting areas and categories of what’s covered within the instrument. What you see here, and it’s not particularly in the order that it is presented, are six areas.

Some of them are very closely related to one another, for example, Clinical Personality Patterns and Severe Personality Pathology, are different, are different levels of the same overall class of information, that is they all relate to personality. The difference between the two being that the Severe Personality patterns that include Schizotypal, Borderline,

And Paranoid personalities, are set apart in a way that allows you to see that there is more structural compromise to those particular personalities. And we tend to look at elevations, even when they’re not clinically elevated, to be able to tell something about the overall cohesiveness of the personality.

Although if they are some of the higher elevations, we do then consider them to be, we consider them as possibilities for diagnostic considerations. The Clinical Personality Patterns, Schizoid, Avoidant, Melancholic, and so on, mostly others that you can think of, some of which are theoretically produced, but not in the current DSM,

Make up the other 12 scales of the MCMI. Likewise, the Clinical Syndromes and the Severe Clinical Syndromes are kind of within their own class as well. One of the ways that we try to make this an integrated picture, is to put those Clinical Syndromes right with the Clinical Personality Patterns,

On the same page. So you start to see how the two classes of information interrelate. But just contained to the Clinical Syndromes, Anxiety, Depression, and so on, there are Clinical Syndromes and Severe Clinical Syndromes, and again, there is a similar relationship there, in that those that are considered to be more severe

And that pull for some of those areas that we consider to be, pretty much primary clinical targets, are included as well so you can see how one may affect the other. And then there a grouping of basically validity indicators, Modifying Indices and Random Response Indicators. Modifying Indices on the MCMI

And all the Millon instruments, tend to utilize Disclosure, Desirability, and Debasement. Those are different sorts of approaches to the task of taking a test. For those of you that are familiar with the MMPI, there are roughly akin to the LFK scales. And then Random Response Indicators, they’re much like the varenn and trend.

There are two of them. One is based in a scale, and the other is not. The other one, in validity, is essentially there are three very unusual items, such as I have not seen a car in the past 10 years, which would expect people not to endorse.

The other grouping would be a scale made up of statistically and semantically related items. Where for most people we would be expecting endorsements in the same direction, although we have a system for understanding how it is that some people may endorse in an opposite direction and actually have some meaning to that.

So there is a schematic for that as well. So that more or less covers the main sections. It does not cover the facet scales, which I’ll talk about a little bit, a little bit later, and does not cover the noteworthy responses which are not scales in their own right,

But listings of items where we want to pay clinical attention either because we believe that there’s something of an emergent issue, or because some of the patterns that we see may indicate that there might be something going on, outside of what the MCMI actually measures. An example of that would be adult ADHD.

The test doesn’t really cover that in an organized fashion, in more of a scaled fashion, but some of the cognitive difficulties that you might see that are measured by the MCMI may be explained by ADHD, and if they tend to cluster in some way

That’s kind of an indication to say you might want to do a more thorough definitive diagnosis to rule out some of these other areas. Moving on from these, let’s cover briefly what those scales are. Coming down to the actual scale names, this is the grouping of what we call the Clinical Personality Patterns.

There’s 12 personality patterns here. You might notice if you’re familiar with the MCMI-III, but not the IV, the name of scale 2B has been changed from Depressive to Melancholic. There’s also a new scale, that is scale 4B. This diagnostic scale captures an individual who is typically energetic and buoyant

And who may become overly animated, possibly scattered and in more extreme cases, manic. An individual whose personality is on this spectrum may present with an Ebullient style, which would be a somewhat energetic style kind of in the normal range. People who, you know, have a lot of energy

And a lot of focus and tend to bring people into their world and into their endeavors. An Exuberant type, which is a bit more troubled that way, that is that the energy tends to be somewhat at odds with some of the people around them and they may run into difficulties

Because people really can’t keep up with them. And then finally, a Turbulent disorder. That would be where a person has really kind of lost their reality base with other people, expecting them to keep up with them, expecting them to be able to be right aligned with whatever their very rapid thoughts

And their very excited demeanor might be, and eventually isolating themselves and running into clinical difficulties, in part because of some of these sorts of difficulties with personality. You might have also noticed as I describe those three, and that there is kind of three classes,

And I will say a little bit more about this later, but three classes of information, sort of degrees of difficulty or pathology, from the normal style, to the abnormal type, and then finally to the clinical disorder. As I describe those, the Ebullient style, Exuberant type, and Turbulent disorder,

That roughly equates with base rates of 60, 75, and 85 on the MCMI, and is an indicator of how much difficulty a person might have. And that is true for all of the Personality Scales, the Clinical Personality Patterns, as well as the Severe Scales which we will take a look at next.

So this next grouping, I spoke of a little bit here, these 15 Personality Scales also include the three Severe Personality Pathology Scales. These scales are retained from the MCMI-III, they are essentially identical. There’s some updates in the norming as well as the items themselves. There were however new names with everything else

Added to identify a label for normal style, abnormal type, and clinical disorder. For example here, and as we talked about before, for Borderline, as identified by normal style, unstable which is represented by U, in that word over there by the parentheses, UBCycloph. The abnormal type of Borderline, that is represented by the B,

And the clinical disorder, Cyclophrenic, which is in this case, the last of those three, these three being more pathologically oriented what we really consider to be the clinical disorder is more in the middle and then there is room for a less functional variant, like Cyclophrenic, sort of disorder.

All of these scales, these three, as well as the last grouping, all have these kinds of abbreviations that you see here, such as ESSchizoph, UBCycloph, and MPParaph. The others have that as well. One of the new features of the MCMI-IV is that you have the option to print a profile page

That utilizes these abbreviations, rather than the full scale names. One of the reasons that we decided to provide that was so that those clinicians who may work in a style where they may want to utilize the graphic, to be able to show different levels of what’s going on with different areas in personality,

But also are aware that a high elevation does not necessarily mean that a person has that particular personality disorder. We know that nothing actually creates a diagnosis, it’s all, you know, any test really only creates incremental validity for that. Though we’re more free to be able to show this to clients

Without them making a false positive kind of an assumption, that what does that mean that this person is, or that this test is calling me Dependent, or calling me Histrionic, or anything like that. So that leaves more power for the clinician to be able to describe that in better detail.

That becomes very important when you go into feedback, and I’ll be demonstrating something that speaks directly to that as we get into our case today. Moving on from here, we have the Spectra. We now have 15 of the Personality Spectra, and this is going to be a little bit repetitive,

But I’ll go through this again. In terms of how it is that we identify, and how it is that we put together the Normal, Abnormal, and Clinical Disorder. So, everything is listed here. And what you see, to be able to put this into something of an order,

In the Clinical Disorder column, you recognize most of the personality scales from the MCMI-III, some are new. We now have names for each Spectrum that’s based on abbreviation which includes all three of these classes, Normal, Abnormal, and Disorder. So some examples here, DFM would capture Dejected style, Forlorn type,

And Melancholic disorder, on scale 2B. The EET Spectrum, Ebullient style, Exuberant type, and Turbulent disorder, are indicators of scale 4B, which I just showed you on the other slide. And for an example down below, you might notice that, like I indicated before, those on the bottom here,

The last three being the more severe personality patterns, for the Schizotypal, we have Eccentric, Schizotypal, and Schizophrenic, noticing again that what we are familiar with in terms of the DSM labels and labels from MCMI-III, and now IV as well, are more within that 75 to 85 range, an adjustment that allows us

To be able to look at higher functioning variant of somebody who may fit this criteria versus somebody who is more compromised in the personality structure, that being the descriptors that Dr. Millon reintroduced at the end, Schizophrenic, not to be confused with the Clinical Disorder, but how it was described in personality styles

A long time ago, as well as Cyclophrenic and Paraphrenic. The next section refers to the clinical area of what’s measured by the MCMI. One sec, there we go, okay. These seven more moderate Clinical Syndrome scales are listed here. You might notice a few changes from the MCMI-III.

These changes are mostly along the lines of terminology changes for the DSM-5. Here, as with the Severe Syndromes, we have introduced an abbreviation system similar to the Personality Spectrum Patterns. This was done to facilitate an added feature in the MCMI-IV that many clinicians may find useful in delivering that feedback.

So you now have that option to be able to present all of that information, not only in the Personality Patterns, but also with the Clinical Symptomotology. And you are able to describe if you see something that is a combination of factors that you know to be not directly reflective

Of perhaps the Bipolar Spectrum, to take one for example here, where you might see some fluctuations in energy, but it might be more along the lines of Cyclophrenic kind of a presentation, or less than that, but you see an elevation. But you also see perhaps, post traumatic stress

Or perhaps one of the substance use scales lit up, and that may be affecting things. So therefore, you are able to describe these different kinds of combinations more effectively here as well. Now let’s take a look at the Severe Symptomatology Scales. Like the more structurally compromised Severe Personality Scales,

These three represent something of a shift toward a greater level of dysfunction. So Schizophrenic Spectrum, which was called Thought Disorder on MCMI-III, Major Depression, and Delusional Disorder, are all assessed separately, and then together with the other Clinical Syndrome Scales. Finally, these are actually at the top of the Profile Page,

We have what contextualizes personality in syndromal scales, those are the Modifying Indices I mentioned before, as well as the Random Response Scales. So now let’s take a look at the scores provided by the MCMI-IV. And the interpretive approach describes in the manual, as well as going beyond the manual to an interpretive sequence

That I’ve developed over the course of some years and I’d like to encourage people to consider the use of. To form the platform for interpretation, it’s helpful to understand the metrics behind the MCMI, and all the Millon inventories. They differ in a key way from many of the other inventories,

That measure the similar classes of information. The MCMI-IV provides two types of normative scores. These are Base Rates, or BR scores, the most commonly held component of the MCMI scoring system, as well as Percentile Ranks, which is something new that we begun using on the MCMI-IV

And have also started to adapt for the MACI-II, which is now in preparation. Base Rate scores are the primary type of the standardized score used in the MCMI. These differ from T scores, or other commonly used converted scores on many other assessments, which standardize all scales in the inventory

To the same mean and standard deviation in the inventory’s normative sample. This then makes and implicit assumption that all Personality Patterns and Clinical Syndromes fall into the same normal distribution as do Intelligence, or other related measures. That’s actually not so. Instead, Base Rate, or BR scores, reflect the differing prevalence rates

Of the characteristic measured by the inventory. So Percentile Ranks, then, those are also now available for Personality Patterns, Clinical Syndromes, and the Grossman Facet Scales. They’re an indicator of rarity and signify the percentage of the normative population that scored at or below a given Base Rate score.

For example, a Percentile of 96 would mean that 4% of the norm sample attained a Base Rate score higher than the Base Rate score in question. Because MCMI-IV scores have varying distribution shapes, the relationship between Base Rate scores and Percentile Ranks varies across the scales. Just to give an example of this,

A Base Rate score of 74 on scale 2B, the Melancholic scale, would correspond to a Percentile Rank of 67. That same Base Rate score, that score of 74, on scale S, the Schizotypal, corresponds to a Percentile Rank of 90. You can make some meaningful interpretations and differences utilizing that system

And understanding what it means across these distributions. So interpretation with the MCMI relies largely on the BR score paradigm. The MCMI seeks to align with the percentage of individuals who are actually found to be disordered, or reflect attributes of a given measurable characteristic across clinical settings.

These data provide a basis to ensure that the frequency of generated diagnoses and profile patterns would be comparable to representative clinical prevalence rates. Base Rate scores are anchored to prevalence rates of the characteristic being measured. So the Base Rate is designed to anchor the cut-off points of 75 and 85

To the prevalence of a particular attribute in the psychiatric population. Base Rate scores define a continuum of the pervasiveness and severity of any psychological attribute against which any individual can be evaluated. Using this continuum is acknowledgement that the difference between a clinical disorder and normal functioning is really one of degree,

Rather than kind. The interpretation of the MCMI-IV Base Rates reflects the reality that normality of pathology in personality, as well as clinical symptomatology, really exists on this continuum, whereas Dr. Millon’s most recent writing specified on a spectrum. A Base Rate of between 60 and 74 would describe a Personality Style

That is considered generally adaptive in a psychiatric population, exhibiting some defining characteristics related to clinical disorder criteria, but usually more functional in nature. A Base Rate between 75 and 84 reflects a Personality Type in a psychiatric population, where in problematic personality attributes and patterns are present and are likely to be related predictably

With either or both egosyntonic or egodystonic difficulties. Finally a Base Rate of 85 and above would reflect a pattern that may constitute a Personality Disorder. One of the most important functions of a psychological inventory is to draw out information that is relative to treatment. Too often, however, the assessments do a fine job

Of contributing incremental validity to our clinical observations, but the assessment process stops there. Oftentimes this is a function of how it is we tend to divide ourselves in this field. We often assume the role of either assessor or therapist. And even sometimes go to great lengths

To assure we are one or the other, without really looking at the connection between the two. Some of us, of course, do both. But even then, and even with some good rationale, we often compartmentalize the two functions. What we need to consider is that the person is receiving this information from our assessment,

And there is good reason for feedback to lend greater self-understanding for the patient, and not just to make sure we’ve articulated our points to whomever gets the information next. Astute clinicians understand this, and utilize assessment information in sensitive ways, whether more classical in approach, that is, assuming the role of psychological expert

Who is disseminating the information that is coming out from the testing, or whether you are more collaborative in approach, which is really my preferred way of interacting with people, and that is assuming more that the patient is the expert on themselves, and your job then would be to create the dialogue

Where they’re more free to incorporate your expertise on the test. So wherever you may fall on that continuum, a vital part of your communication comes from a thorough understanding of where this assessment information fits in the context of the individual’s concerns. And Millon’s theory provides a lot of useful information

In terms of contextualizing that MCMI information for that person. So as we’ve noted in other webinars, the MCMI-IV remains a multiaxial instrument, despite the fact that the DSM-5 has moved away from that multiaxial model. This is very important in understanding how things interact and how a person can understand

Whatever their difficulty is in context with what their Personality Profile says for them. The MCMI was derived from an integrated approach to psychopathology in personality, and then its interpretive logic preserves the goal of achieving an understanding of the person and his or her experience as an integrated entity,

Rather than just an aggregation of diagnoses. What is the role of personality in mental wellness when a patient experiences clinical syndrome, such as depression and anxiety, and psychosocial stressors, such as health concerns, financial woes, and relational difficulties. Dr. Millon always contended that the personality is the key to the patient’s psychological well being.

It’s the psychological construct of personality that is psychology’s equivalent of medicine’s immune system. The structure and style of psychic processes that represent our overall capacity to perceive and to cope with our psychosocial world. This multiaxial model was composed to encourage integrative conceptions of the individual’s manifest symptoms in terms of the interaction between

Longstanding coping styles and psychosocial stressors. The MCMI-IV’s interpretive process continues to use this integrative conception of psychopathology, that does not merely diagnose or document a person’s clinical syndromes, but instead contextualizes these manifest disorders in terms of the larger context of the individual’s style of perceiving, thinking, feeling, and behaving.

So with that in mind I want to take a look at the theory. In a rather basic form, consider this to be something of a process in understanding Millon’s evolutionary theory. It’s by no means comprehensive, but it does give you the structural framework to help you understand what we’re talking about

When we call this, what we call an evolutionary theory and what I like to refer to it as an understanding of a person’s deeper motivations. How it is that we look at an individual and their natural shared with the rest of the environment, their natural way of being able to think,

Feel, understand, cope with, respond to, and experience their inner world along certain lines. So when we look at any given personality scale on the MCMI, whether that be Schizoid, Avoidant, Melancholic, any of them for the most part we are containing our discussion to the 12 basic personality patterns.

The three that are more dysfunctional, that are more non-cohesive in their overall structure, are affected by this system as well, but it is kind of an overlay and I’ll talk a little bit about that when we get into the interpretive process. But the basics of the theory go like this.

That a person, an individual, and really any organism shared with the entire living world, needs to be able to answer for and respond to three basic motivations or demands or imperatives in their natural world. The first of these are represented by the first line. The question of how it is the person exists.

First a person, an individual, must exist. Organisms are able to do this by either subscribing to one or another motivation, one would be a pain or rather more accurately a pain avoidant motivation. That is, being able to steer clear of those things that are potentially life ending, so therefore continuing to exist.

Pain avoidance, then, on a more physical level would mean not being eaten by a predator. On more of a psychological level, it’s the avoidance of conflict, it’s trying to stay relatively safe, whether by good coping skills or not so good coping skills, really trying to be as psychologically safe as possible,

Versus pleasure or life enhancement strategies on the other side. In organisms, those more or less take over everything around them and try to enhance as much as possible. For human beings, being those are much more along the lines of not concerning themselves with particular safety issues,

But just trying to get as much out of life as possible. The thing is, basic organisms could probably survive at a rather static point along that continuum. Human beings are much more complex, and our demands are much more complex. And there’s a constantly a need to be able to make adjustments,

Even if we have a preferred mode, a preferred way of being, along that line, that we can show some adaptiveness and flexibility to be able to respond to different demands, knowing when it’s important to play safe and knowing when it’s important to try to get more out of life

And possibly take some risks, or stick your neck out in some way. The more disordered an individual, the more you’ll find there’s either a conflict or some kind of a difficulty or there’s a staticness, there’s a non-flexibility and someone’s stuck at one point or another on that continuum.

The next level that creates a personality then, is the idea of how it is that a person interacts with their environment. Generally speaking there are two ways of doing this. There is the more active, modifying variant, where it is that an individual will go into an environment, making changes to the environment

As that individual sees fit, saying that they are going to make it work for them, versus the more passive approach. And a passive personality would then go into an environment, but essentially make changes to the self rather than to anything within the environment. That is, fit in as best as possible without creating

Any kind of new sense within the environment, modifying the self, passively accommodating. You just look at those two continua for the beginning here. You can begin to see different personality patterns emerge. If you were to describe an Avoidant personality, and this is how the scale is ultimately constructed,

You would look at somebody who is very active in their orientation, they are very alert to possible difficulties, to people or things that might harm them. So they are very geared towards the pain side of the continuum and that’s the main way that they are described, is that active pain orientation.

Always on guard, always withdrawing, always making sure that their environment is safe, they’re not actually going out and changing anybody else’s environment. They’re creating their environment to be one where they are very insular, they’re very protected. And if you would compare that to scale 2B, which is the Melancholic,

There’s a lot of the same factors involved in terms of pain, of their focus on pain, or wanting to avoid pain, but more of a passive approach is taken. There’s a withdrawal, but it’s more of a giving up, a giving in, an acceptance in a way that everything is going to be painful

And the best way through it is to just let it be, and not really do much of anything about it other than experience it as painful. In that way, there’s some ways to be able to cope, not necessarily effectively of course, but to cope and to be able to understand the environment

In a different sort of a way. So there are just two of the 15 patterns, and they all include all three of these motivations. Some emphasize some more than others. The next level and the final level of this basic personality structure is the self versus other polarity. This is based in evolutionary biology.

And a good way to describe this is really our strategy versus case strategy. In the natural world I can take a look at different organisms, different members of our animal kingdom are very different this way. Oysters represent the R strategy. They will produce possibly upwards of 5 million offspring in eggs.

They will lay 5 million eggs over a lifetime. But they do virtually nothing in terms of parenting. There’s enough of those eggs that there will be enough to propagate the species. Compare that with the great apes, all the way up through all the mammals and human beings.

A much more limited number of offspring by comparison. But there’s a parenting process involved. We take care of our young, we nurture our young to be able to make it to adulthood, over a much longer period of time. So when put all three of these different motivations together,

You begin to understand how it is that a person might be able to see their world, interact with it in a very specific way, and really understand, if you see this combination in the scales, you see a combination of different motivations. You can see where somebody might be conflicted

In one direction or another. You might be able to see where somebody is really stuck, in one of these modes. You might be able to see where there’s almost like a spring of pushing back, I’m thinking particularly of the sadistic and masochistic constructs, where there’s a reversal on the polarities,

Where they start to experience pain as something pleasurable. There’s all kind of different possibilities that way in terms of just understanding people and what their motivations are, and getting good at understanding each scale. There are graphics available and I’ll tell you a little bit about where you can get some of those

That can help you. You’ll have something of a road map, to see if there’s an elevation on the avoidance scale, what does that mean? It’s more of an active pain orientation. To be able to really relate to a person without utilizing the labels, without putting them sort of in a box

And to be able to ask questions. Such as you seem to really get exhausted just taking care of yourself in a very basic sort of way. Now, that’s a question that begins a therapeutic conversation. Towards the bottom you see another class of information and that is the expression of those three motivating aims

In terms of what we see on different levels. Behavioral, pretty self-explanatory. More or less those things that we can measure, that we can see, that we can observe that are more direct. And that includes both interpersonal modes as well as just what we would call emotional expression.

That is that behavior is coming out of an emotional need. So we infer an emotion through what we see in just the individual’s behavior. We also have the Phenomenological level. Here we have both functional and structural domains, and I will make the distinction there. Functional are those sorts of expressions

Of psychological constructs that we can see, that we can look at as a kind of an action in some way. We have cognitive style there. And Structural more having to do with the inner world, and more having to do with what we have to infer. Here we might look at one

Of the Phenomenological pieces of self image. We then have two other levels. Intrapsychic which is much more underneath. There is one that more functional, Intrapsychic Dynamics is more or less what we would call defense mechanisms. That’s another way of describing that. Underneath Structurally Intrapsychic Content, which roughly equates to object representations

Or object relations theory, as well as Intrapsychic Architecture, having to do with how the inner world is constructed, how strong, how fragile.

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