trait nervous depressive acti :i:/'::iii...
TRANSCRIPT
V
Code PR TAYLOR—JOHNSON TEMPERAMENT ANALYSIS® PROFILE
School Grade Degree. Major Occupation Counselor________________
Single— Years Married_
Answers made 4Fd or
Years Divorced ._ Years Widowed__ Children:
husband, wife, father, mother, son, daughter, boyfriend, girlfriend the person described.
B C D E F G H I Attitude (Sterl~
Mids 0 a 3 0 0 0 1 3:7 Total
Raw score .2 33 3? S, o 7 c jC Rawscóre
Percentile 3 in 74, 9/ ea, Percentile
TRAIT Nervous Depressive Active-I
Sympathetic Subjective Dominant Hostile disciplined TRAIT
95 -95
90 90 __________________ _____________ 85 __ -85
80 - ________ _________________ ____________ 80
----- .---.-- --75 75
I I :i:/'::iii - ___ --- 20
10
15
OPPOSITE Composed
heartedQuiet Inhibited Indifferent Objective Submissive Tolerant Impulsive
OPPOSITE
Excellent Acceptable Improvement desirable
Improvement needed
DEFINITIONS
TRAITS
Nervous - Tense, high-strung, apprehensive.
Depressive - Pessimistic, discouraged, dejected.
Active-Social — Energetic, enthusiastic, socially involved.
Expressive-Responsive - Spontaneous, affectionate, demonstrative.
Sympathetic - Kind, understanding, compassionate.
Subjective — Emotional, illogical, self -absorbed.
Dominant - Confident, assertive, competitive.
Hostile - Critical, argumentative, punitive.
Self-disciplined - Controlled, methodical, persevering.
OPPOSITES
Composed - Calm, relaxed, tranquil.
Light-hearted - Happy, cheerful, optimistic.
Quiet - Socially inactive, lethargic, withdrawn.
Inhibited - Restrained, unresponsive, repressed.
Indifferent - Unsympathetic, insensitive, unfeeling.
Objective - Fair-minded, reasonable, logical,
Submissive - Passive, compliant, dependent.
Tolerant - Accepting, patient, humane.
Impulsive— Uncontrolled, disorganized, changeable.
Note: Important decisions should not be made on the basis of this profile without confirmation of these results by other means.
Published exclusively by Psychological Publications, Inc. ) 290 Conejo Ridge Avenue, Suite 100, Thousand Oaks, California 91361-4928. Copyright © 1967, 1984 by Psychological Publications, Inc. All rights reserved. Reproduction in whole or pad prohibited. Taylor-Johnson Temperament Analysis® is a registered trademark of Psychological Publications, Inc. Printed in the U.S.A.
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MILLON CLINICAL MULTIAXIAL INVENTORY — II FOR PROFESSIONAL USE ONLY flj/e
ID NUMBER = 59 VALID REPORT PERSONALITY CODE = - ** - * 4 3 5 7 + 6A 63 1 SA 83 2 SYNDROME CODE = - ** - * // - ** - * // DEMOGRAPHIC = 59 /oT/M/34/--/D/C4/--/--/--/ ----- I--hO! ----- / 335000027
SCORE CATEGORY - PROFILE OF BR SCORES DIAGNOSTIC SCALES
RAW SR 35 60 75 55 100
x 240 25 . -
DISCLOSURE
H.......... .. Y 11 50 DESIRABILITY
Z 0 12 DEBASEMENT
11 34 SCHIZOID
2 4 7 AVOIDANT
3 25 67 . .. -- . . .- . .
_______ DEPENDENT
4 30 67 HISTRIONIC CE -
LRP
I S A s 31 62 NARCISSISTIC N O T I NT C A E 6A 21 58
- - - ANTISOCIAL
A L R :. .
L I N -
T ÔB 22 50 AGGRESSIVE/SADISTIC
7 31 62 COMPULSIVE
SA 13 33 PASSIVE .
SB 4 21 SELF-DEFEATING
P s 3 24
.
SCHIZOTYPAL SEA .- .. . ............ ERT V S H C 8 34 c- .:.... BORDERLINE ENL :.--- ........ .1:.:: RLO H T G P 15 54 PARANOID
A 0 20 - ANXIETY DISORDER
H 2 18 SOMATOPORM DISORDER
CS
N 17 48 BIPOLAR MANIC DISORDER
D 1 20 DYSTHYMIC DISORDER
L E B 10 36 ALCOHOL DEPENDENCE
T 14 38 '- N DRUG DEPENDENCE
SS 0 0 72'......
. ---.- ..............-. . 2.................- THOUGHT DISORDER
S Y - .--. E N H
V D CC 0 0 MAJOR DEPRESSION ER R E M PP 5 35 . - :.. .........- -.'?:.
- DELUSIONAL DISORDER H
MCMI-II reports are normed on patients who were in the early phases of assessment or psychotherapy because of emotional discomforts or social difficulties. Respondents who do not fit this normative population or who have inappropriately taken the MCMI-II for nonclinical purposes may have distorted reports. To optimize clinical utility, the •report highlights pathological characteristics and dynamics rather than strengths and positive attributes. This focus should be kept in mind by the referring clinician reading the report.
Based on theoretical inferences and probabilistic data from actuarial research, the MCMI-II report cannot be judged definitive. It must be viewed as only one facet of a comprehensive psychological assessment, and should be evaluated in conjunction with additional clinical data (e.g., current life circumstances, observed behavior, biographic history, interview responses, and information from other tests). To avoid its misconstrual or misuse, the report should be evaluated by mental health clinicians trained in recognizing the strengths and limitations of psychological test data. Given its limited data base and pathologic focus, the report should not be shown to patients or their relatives
- INTERPRETIVE CONSIDERATIONS
In addition to the preceding considerations, the interpretive narrative - should be evaluated in light of the following demographic and situational factors:.. This -34 year old divorced man with a college education, did riot identify specific problems and difficulties of an Axis I natue in completing the demographic portion of this test.
A distinct tendency toward avoiding self-disclosure is evident in this patient's response style. This nondisclosure may signify a characterological evasiveness or an unwillingness to divulge matters of-a personal nature, problematic or not. Also possible are broad deficits in introspectiveness and psychological-mindedness, owing to either emotional impoverishment or thought;vagueness. Adjustments made to compensate for these response tendencies are likely to be successful in producing a valid profile; however, some scores may have slipped beneath the effective discriminatory range.
NATIONAL . COPYRIGHT 1976; 1981, 1983, 1985, 1987 by Theodore Millon. This report COMPUTER COPYRIGHT 1991 by Theodore Millon. All rights reserved. Scored by SYSTEMS National Computer Systems, Inc. P.O. Box 1294, Minneapolis, MN 55440
3 Outpatient -" (never hospitalized)
3 outpatient ;_: . (previously hospitalized)
3 lnpatiemt (mental hospital):
jinpatient ' (general, hospital)
Correctional Inmate
tol Fog. Sudedt Counsel's .
Other - -.
S "A - - } n
E ... TATUS
? T7 - 3 Never Marrie&
J 3 First Marriage
M 5' 3 Remarried
3 Separated L E •Divorced
P Si3 widowed
3 Cohabitating F E D€ 3other
M
'I ''- ... fri White
I Hi hSchooi I I - KiXbO®© OBlack
S
3 Marital or Family
C Job) School 'Work 3 '3 Loneliness 3
3 Moodiness 3
3 SeIf-Confidende 3
3 itvrirea 3
3 Alcohol 3
3 Drugs 3
3 Sexual Problems 3 3 Anti-Social Behavior 3
Other. - 3 a
- . ScorForm'45120
a
— a
U-
(9(9! Hispanic
School Asian
American Indian
U •
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M(MIM11 Millon Clinicd Multiaxial Inventory-11
T.odereMiHon,PItD: Copyright © 1976. 1981, 1983, 985. 1987 - Theodore Milton. All rights reserved
DIRECTIONS FOR REFERRING CLINICIAN -, 1 Complete the following information and any demographic data 3 Note DURATION of current episode and period of therapy
not completed by the test taker in the section below. 4 Fill in SETTING/STATUS and IDENTIFICATION NUMBER
2 Record your best Axis I and II DX using DSM Ill codes (usually Social Security number)
DIAGNOSTIC CODE PRE-MCMI-3E.DX IMPRESSION
AXIS I AXISJI
@000000000
@0 0€
®®®® ®®®
1-DURATION OF RECENT AXIS IEPISODE
I —
2-PERIOD OF MOST RECENT THERAPY
Less than one week CO One to four weeks 0 0 One to thrpe - rnonths 00 Three to twelve months 0 0 Periodic; one to three years 0 0 Continuous: one to three years DO Periodic; three to seven years DO Continuous; three to seven years 00 More than seven years DO Cannot categorize —
In (0 LO C (0
DIRECTIONS FOR TEST TAKER - 1. Please fill in the circles that apply in each section below, with many types of problems. When you agree with a
Do not mark the special sections on the upper part of this ' " statefliont or decide that it describes you, fill in the to
page; this is for your doctor to complete. mart it true ( I. If you disagree with the statement or
2. Use a soft, black lead-pencil only- nd mfle a heavy, dark , decidetflatt does-not decribe you, fill in the ® to mark
mark when filling inthecircles. - ., it false (O• Try to.rnark every statement even if you
3. If you make a mistake or change your mind, please erase ' are not sure of your choice. lf -yoti'have tried your best and
the mark fully and then fill in the c.onebt circle, still canget decide, mark the ® for false...
4. The following pages contain ajist of statements that people 6. There is no time ,!i..itfor completing the inventory, but
use to describe themselves. They are printed here to help it is best to work as rapidly as is comfortable for you.
you in describing your feelings and attitudes. Try to be as 7. This fern, will be scored by computer and the results will
honest and serious as you can in markingthe statements be sent directly to your doctor where they will be kept
since the results will be used to help- your doctor in learning confidential .,.
about your problems and in planning,tg, help you. B. You may beginwith the first statement on the next page
5. Do net be concerned that a few of thestatements will after filling in the information requested in the boxes
seem unusual to you; they are included todsscflbe people below.
—
— 1 ®l always follow my own ideas
— rather than do what others expect
M of me.
— 2 (DO I've always found it more
— comfortable to do things quietly
— alone instead of with others.
— a®•Talking to other people has almost
-- always been difficult and painful
— for me.
— 4(DID believe in being strong willed and
— determined in everything I do.
— 5(DO In the last few weeks I begin to cry
— even when the slightest of things
— goes wrong.
— 6 Some people think of me as a
— conceited and self-centered
— person.
— iOSAs a teenager. I got into lots of
— trouble because of bad school
— behavior.
— a®lalways feel lam not wanted in a
— group.
— g (Do I often criticize people strongly if
— they annoy me.
— io®l am content to be a follower of
— others.
— 11 ®•l enjoy doing so many different
— r things that lcan't make up my mirm
M what to do first.
— 120• Sometimes I can be pretty rough
— and mean in my relations with my
— family.
— taOl have little interest in making
M friends.
— 14©• I think I am a very sociable and
— out-going person.
15Øl know I'm a superior person, so
I don't care what people think.
ifi(DO People have never given me
enough recognition for the things
I've done.
iiØl have a drinking problem that I've
tried unsuccessfully to end.
is®Lately, I get butterflies in my
stomach and break out in cold
sweats.
19Øl have always wanted to stay in
the background during social
activities.
211Øl will often do things for no reason
other than they might be fun.
zIOl get very annoyed with people
who never seem able to do things
right.
220(D If my family puts pressure on me.
I'm likely to feel angry and resist
doing what they want.
2300 1 often feel I should be punished for the things I have done.
24®•People make fun of me behind my
back, talking about the way I act
or look.
25OOther people seem more sure than
I am of who they are and what they
want.
26®l tend to burst out in tears or in
anger for unknown reasons.
21ØI began to feel lonely and empty
about a year or two ago.
280•l have a talent to be dramatic.
29O1 have a hard time keeping my
balance when walking.
30 1®1 enjoy intense competition.
31 (1) When I run into a crisis, I quickly
look for someone to help me.
32® 0 I protect myself from trouble by
never letting people know much
about me.
33®01 feel weak and tired much of
the time.
34OOther people get more angry
about bothersome things than
I do.
35®• My drug habits have often gotten
me into a good deal of trouble in
the past.
36 (TJ Lately. I find myself crying without
any reason.
31Ol think I'm a special person who
deserves special attention from
others.
38 OUnder.no circumstances dot ever let myself be tricked by people who
say they need help.
390(E)One sure way to make a peaceful
world is by improving people's
morals.
40®ØIn the past I've gotten involved
sexually with many people who
didn't matter much to me.
41101 find it hard to sympathize with
people who are always unsure
about things.
—
—
0
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a
a
a
a
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—
—
—
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—
—
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—
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—
—
—
—
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z -4 I
- tis011 have a great deal of trouble
trying to control an impulse to
— drink to excess.
— 1200l Most people think that I'm a
— worthless nothing.
—
1210* 1 can get very excited sexually
when fighting or arguing with a
loved one.
1221®l have succeeded over the years
in keeping my drinking of
alcohol to a minimum.
123011 have always "tested' people to
find out how much they can be
trusted.
t24OlEven when I'm awake. I don't
seem to notice people who are
near me.
125 S®lt is very easy for me to make
many friends.
tzsOli always make sure that my
work is well planned and
organized.
1210*1 very often hear things so well
that it bothers me.
12801 My moods seem to change a
great deal from one day to the
next.
129011 don't blame anyone who takes
advantage of someone who
allows it.
noOl I've changed jobs more than
three times in the past couple
of years.
13101 1 have many ideas that are
ahead of the times.
1320*For some time now I've been
feeling sad and blue and can't
seem to snap out of it.
133011 think it is always best to seek
help in what I do.
134011 often get angry with people
who do things slowly.
135*01 really get annoyed with people
who expect me to do what I
don't want to do.
13601ln the last few years, I have
felt so guilty that I may do
something terrible to myself. 3701 never sit on the sidelines when
I'm at a party.
iasl® People tell me that I'm a very
proper and moral person.
138011 sometimes get confused and
feel upset when people are kind
to me.
140®My use of so-called illegal drugs
has led to family arguments.
141011 am very ill-at-ease with
members of the opposite sex.
t4Z (DO There are members of my
family who say I'm selfish and
think only of myself.
143*0 1 don't mind that people are not
interested in me,
1440* Frankly, I lie quite often to get
out of trouble.
1450* People can easily change my
ideas, even if I thought my mind
was made up.
14601 Others have tried to do me in,
but I have the will power to
overcome them.
14101 My parents often told me that I
was no good.
148011 often make people angry by
bossing them.
149011 have great respect for those in
authority over me.
15001 1 have almost no close ties with
other people.
151 (DO People have said in the past that
I became too interested and too
excited about too many things.
15201 1 have flown across the Atlantic
thirty times in the last year.
153011 believe in the saying, "early to
bed and early to rise..."
1540*1 deserve the suffering I've gone
through in life.
15501 My feelings toward important
people in my life often swing
from loving them to hating them.
15601 My parents always disagreed
with each other.
167@0 on occasion I have had as many
as ten or more drinks without
becoming drunk.
lss01 1 n social groups lam almost
always very self-conscious and
tense.
1591®l think highly of rules because
they are a good guide to follow.
16009 Ever since I was a child, I have
been losing touch with the real
world.
161011 rarely feel anything strongly.
152011 used to be really restless,
traveling around from place to
place with no idea of where I
would end up.
163011 can't stand people who are late
for appointments.
164(9Sneaky people often try to get
the credit for things I have done
or thought of.
16510 1 get very irritated if someone
demands that I do things his -way-rather than my own.
166*01 have the ability to be successful
in almost anything I do.
isiOl Lately, I have gone all to pieces.
168011 seem to encourage the people
I love to hurt me.
lBsQlThere has never been any hair
on either my head or my body.
uol® When lam with others! Iiketo
be the center of attention.
litGjlPeople who I admired greatly at
first have often become real
disappointments to me later.
mGI I'm the kind of person who can
walk up to anyone and tell him
or her off.
113011 prefer to be with people who
will be protective of me.
174Qllve had many periods in my life
when I was so cheerful and used
up so much energy that I fell
into a low mood.
115011 have had difficulties in the past
stopping myself from over-using
drugs or alcohol:
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4200 lam a very agreeable and
submissive person.
4300 My own "bad temper has been a
big cause of my troubles.
44001 don't mind bullying others to get
them to do what I want.
For the past few years even minor
things seem to depress me.
4600 My wish to get things done just
perfectly often slows down my
work.
4701 I'm so quiet and withdrawn, most
people don't even know I exist.
I like to flirt with members of the
opposite sex.
490l I am a quiet and fearful person.
I'm a very erratic person, changing
my mind and feelings all the time.
510.01 feel very tense when I think of the
day's happenings.
szl® Drinking alcohol has never caused
me any real problems in my work.
5300 Lately, my strength seems to be
draining out of me, even in the
morning.
54001 began to feel like a failure some
years ago.
55 00 1 strongly resent big shots" who
always think they can do things
better than I can.
56001 have always had a terrible fear.
that I will lose the love of people
I need very much.
si® 01 seem to go out of my way to let
people take advantage of me.
58ØLately, I have begun to feel like
smashing things.
59011 have given serious thought
recently to doing away with myself.
600 (DI am always looking to make new
friends and meet new people.
61 t®l keep very close track of my money
so I am prepared if a need comes
up.
620•l was on the front cover of several
magazines last year.
saOlFew people like me.
640 lIf someone criticized me for making
a mistake, I would quickly point out
some of that person's mistakes.
ssOlSome people say I enjoy suffering.
66001 often let my angry feelings out and
then feel terribly guilty about it.
oiØLately, I feel jumpy and under
terrible strain, but I don't know why.
68001 very often lose my ability to feel
any sensations in parts of my body.
69001 believe there are people who use
telepathy to influence my life.
ieØTaking so-called illegal drugs may
be unwise, but in the past I found
I needed them.
11011 feel tired all the time.
12001 can't seem to sleep, and wake up
just as tired as when I went to
bed.
31® I've done a number of stupid things
on impulse that ended up causing
me great trouble.
14011 never forgive an insult or forget
an embarrassment that someone
caused me.
7500 we should respect earlier
generations and not think we know
better than they.
76001 feel terribly depressed and sad
much of the time now.
11011 am the sort of person that others
take advantage of.
18001 always try hard to please others,
even when I dislike them.
l901 Serious thoughts of suicide have
occurred to me for many years.
80001 quickly figure out how people are
trying to cause me trouble.
8101l've always had less interest in sex
than most people do.
82011 can't understand it. but I seem to
enjoy hurting persons I love.
8301A long time ago, I decided it's best
to have little to do with people.
841®l am ready to fight to the death
before I'd let anybody take away
my self-determination.
obOlSince I was a child, I have always
had to watch out for people who
were trying to cheat me.
8601When things get boring, I like to
stir up some excitement.
87011 have an alcohol problem that
has made difficulties for me and
my family.
8810lf a person wants something done
that calls for real patience, they
should ask me.
89011 am probably the most creative
thinker among the people I know.
9O0l have not seen a car in the last
ten years.
9101 1 don't see anything wrong with
using people to get what I want.
9201punishment never stopped me
from doing what I wanted,
93(D *There are many times, when for no
reason. I feel very cheerful and
full of excitement.
9401 1 ran away from home as a teenage
at least once.
95001 very often say things quickly
that I regret having said.
S 6 01ln recent weeks I feel worn out —
for no special reason.
97040For some time now I've been —
feeling very guilty because I —
can't do things right anymore. —
9801ldeas keep turning over and over —
in my mind and they won't go —
away. —
gill I've become quite discouraged —
and sad about life in the past —
year or two. —
100 0$Many people have been spying into
my private life for years. —
10101 1 don't know why, but I sometimes —
say cruel things just to make —
others unhappy. —
102011 hate or fear most people. —
103 1®l speak out my opinions about —
things no matter what others —
may think. —
104 01When someone in authority —
insists that I do something. I'm —
likely to put it off or do it poorly —
on purpose. —
iosØMy habit of abusing drugs has —
caused me to miss work in the —
past. —
10600 1 am always willing to give in to —
others to avoid disagreements. —
ioiOli am often cross and grouchy. —
108001 just don't have the strength to —
fight back anymore. —
tosOl Lately, I have to think things —
over and over again for no good —
reason. —
110011 often think that I don't deserve —
the good things that happen —
to me. —
111101 use my charm to get the —
attention of other people. —
11201When I'm alone, I often feel the —
strong presence of someone —
nearby who can't be seen. —
1130l feel pretty aimless and don't —
know where I'm going in life. —
114ØLately, I've been sweating a —
great deal and feel very tense. —
11501Sometimes I feel like I must do —
something to hurt myself or —
someone else. —
116(2)lIve been unfairly punished by —
the law for crimes I never —
committed. y2$- YES —
pOIlve become very jumpy in the —
last few weeks. —
11801 1 keep having strange thoughts —
that I wish I could get rid of, —
—
—
—
U- U • U U • 0
r Softcover Answer Sheet Handscoring
NATIONAL COMPUTER SYSTEMS
DIRECTIONS:
Please follow these directions when completing the identification areas on this page and responding to the MMP1-2 items on page 3.
1. Print your name, birth date, age, sex, and testing date In the area on the right side of this page.
2. Use a pencil only and make a dark malt when responding to the items on par 3.
3. If you make a mistake or change your mind, please erase the mark fully and than fill in the correct circle.
4. Please do not make any marks out" the circles. ---
?4,51rir xa"06wr Aotex Last Name First Middle
1/ 1/f9
4 Birth Date
Age Sex
5:, Lf4 Test Date
ISSIESOIA MULIIPI4ASIC PERSONALiTY INVENTORY-2
CapyIØl Oby THE REGENTS OF THE UNIVERSITY OF UVaNESOP. 1942. 1943 (r.a.w.d 1970), 1989. ThIs Ann., Shed 1909.
All Rights Rewnd.
OEtt.Sd Efl&,.Iy by NATIONAL COMPUTER SYSTEMS. INC. USsr Ucsm.. horn TM Unlnrtty of Mlnanct
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PIlatsd In II,. United Statsi of Anwlct
DO NOT SEND TO NATIONAL COMPUTER SYSTEMS USE ONLY FOR HANDSCORING
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t - —
S.K. Ha(liavav and,l.C. Mckinkv M M P I2ttt VR!N Scale (Variable Response Inconsistency) 3 50 39 ® Recording Grid 6 50 90 $®
9.® 5600 28®5 59®5
The VRIN scale consists of 49 pairs of specially selected items. The 31 ®5 299 Ø members of each VAIN item pair have either similar or opposite content; 32 ® @ 316 ® each pair is scored for the occurrence of an inconsistency in responses
40 ®., 176 • to the two items. The scale score is the total number of times item pairs 46 00 265 05 are answered inconsistently. (Refer to the MMP!- 2 Manual for Admini- 0 0 184 • ® stration and Scoring for directions on interpreting scale scores.)
5® 280 5® Directions for scoring: 73 05 377 Ot
81 05 284®5 1. Transfer responses to the item pairs from the answer sheet to the 83 5 ® 288
recording grid on the right by blackening the appropriate circle: 84 (Z)o 105 0 5 Example: If response to item 6 was false 6 Ø 86 5 ® 359 •
2. Place scoring template VAIN-i over the grid; in the blank provided ® 388 S® in the third column enter a "+' (plus sign) for each item pair in which ®• 138 ®5 both template boxes show a blackened response. 103 ®5 344
Example; The response 3 • 0 39 50 would receive a "+" 110 05 374 ® because both boxes of the scoring template show a 116 Q5 430 blackened response. 125 5® 195 05
3. Count the number of "+"s and enter the VAIN-i total. 135®,
136 ®5 507
482®e
®5 4. Do the same for scoring template VRIN-2. 152 •® 464 OS
161 ®Ø 185 ®5 5. Add the totals for templates VRIN-1 and VRIN-2 to obtain the VAIN 165 •® 565 ®
total score. 16605 268
167 243 ® NOTE. The TRIN and VAIN scales are a part of the restandardized MMPI 196 ® 415 05 test. Because separate copies of these recording grids are not available 199 • ® 467 50 from NCS at this time, permission is granted to the qualified purchaser 226 (2)0 267 Ø of these hand-scoring materials to photocopy these recording grids. This photocopying permission will terminate on December 31, 1992. No 259 ®5 333 05 rights to resell or to distribute these recording grids are granted. 262 5 ® 275 ®5 Photocopying permission is granted for the TRIN and VAIN recording 290 05 556 0 5 grids and NOT for any other MMPI-2 materials. 339 5® 394 0 ®
349 ®5 515
350 5® 521
353 5® 370 5® 36405 554 0€ 369 ®5 421 ®® 372 5® 405 5® 380 05 562 ®5 395 ® 396 ®® 403 (D It 411 ®5 485 ®5 472 05 533 0*
MINNESOTA MuLTIPHASIC PERSONALITY INVENTORY-2 491 509 ® e Copyright c by THE REGENTS OF THE UNIVERSITY OF MINNESOTA 1989. 506 ®Ø 520 ®Ø 1942, 1943 (renewed 1970), 1989. This Recording Grid
All Rights Reserved. 513 (Do 542 ® Distributed Exclusively by NATIONAL COMPUTER SYSTEMS, INC. Under License from The University of Minnesota. VBIN-1 TOTAL C
"MMPI-2" and "Minnesota Multiphasic Personality Inventory-2" are trademarks owned by The University of Minnesota. VRIN2 TOTAL
Printed in the united States of America.
VRIN TOTAL C
—
SR. Harliawav and IC. McKinley M M P I I tzt
—
TRIN Scale (True Response Inconsistency) Recording Grid
The TRIN scale is made up of 20 pairs of items that are opposite in content. If a subject responds inconsistently by answering True to both items of certain pairs, one point is added to the TRIN score; if the subject responds inconsistently by answering False to certain item pairs, one point is subtracted. (Refer to the MMPI-2 Manual for Administration and Scoring for directions on interpreting scores.)
Directions for scoring:
1. Transfer responses to the item pairs from the answer sheet to the recording grid on the right by blackening in the appropriate circle: Example: If response to item 3 was false: 3
2. Place the scoring template TRIN- 1 over the grid; in the blank provided in the third column, enter a 1+1 (plus sign) for each item pair in which both template boxes show a blackened response. Example: the response 3 • ® 39 • ® would receive a
because both template boxes show a blackened response.
3. Count the number of "+"s and enter the TRIN-1 total.
4. Place the TRIN-2 scoring template over the grid; in the blank provided in the third column, enter a "-" (minus sign) for each item pair in which both template boxes show a blackened response.
5. Count the number of '-"s and enter the TRIN-2 total.
6. Subtract the TRIN-2 total from the TRI N-i total and enter the result.
39 0• 9 4110
56 0• 12 &(D 166 0•
176 •0 4800 184 S®
127 0S 65 0* 95 .®
0t 239 0• 288 OS
0• 314 •® 125 0 ® 195 0S 140 •0 196 05 152 0 ® 464 OS 165 0* 565 05 209® 351 00 262 *0 275 05 265 0* 360 •0
367 0• 377 (Do 534 •0 556 0* 560 S®
II 1
TRIN-2
+9
TRIM TOTAL 7. Add 9 points to obtain the TRIN total.
Example: TRIN- 1 total 2 TRIN-2 total -i
+9 THIN Total Tb
NOTE. The TRIN and VRIN scales are a part of the restandardized MMPI test. Because separate copies of these recording grids are not available from NCS at this time, permission is granted to the qualified purchaser of these hand-scoring materials to photocopy these recording grids. This photocopying permission will terminate on December 31, 1992. No rights to resell or to distribute these recording grids are granted. Photocopying permission is granted only for the TRIN and VRIN recording grids and NOT for any other MMPI-2 materials.
MINNESOTA MULTIPHASIc PERSONALITY INVENTORY-2 Copyright ° by THE REGENTS OF THE UNIVERSITY OF MINNESOTA
1942, 1943 (renewed 1970), 1939. This Recording Grid 1989, All Rights Reserved.
Distributed Exclusively by NATIONAL COMPUTER SYSTEMS, INC. Under License from The University of Minnesota.
"MMPI-2" and "Minnesota Multiphasic Personality Inventory-2" are trademarks owned by The University of Minnesota.
Printed in the United States of America.
—
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LIFE HISTORY QUESTIONNAIRE
Please ans;er the following questionnaire, so that your psychologist can develop a comprehensive treatment plan. If you do not desire to answer any question- yo*j can write "do not care to answer."
Date
1. General Information:
Name: fl)mvc Address: 24
Telephone numbers: (day)53f-6"16'I (eve.) __ Age :11 Occupation: _fC rON5'ir4Wr
Who do you live with? (list people) 4y ?nifn'.rty
Marital Status: (circle one) Single,engaged, married, remarried, separated, CjNörëi widowed
If married, husband's (wife's) name, age, occupation:
2. Clinical:
a) Please describe th( nature of your main problems and their duration: -r /1#YF SteW .6-wwK âerUfal) OP f67Y4a fr' ,4Q0 I EflW6- in V
b) Give a summary of the history and development of your complaints (from onset to present):
(fl(g iN aAJ Q't'cP S. I /MV&)OT IflWMY (mY, n rntcw - fCCN oic
c) On the scale below, please estimate the severity of your problem(s):
mildly upsetting moderately severe__________________ very severe________________________ extremely severe a-_ fir k/Hal tie'Ff nlvçowc xvir tiff P#CIVO
Totally incapacitating AF mvm (criiva- ac'r
d) Whom have you previously consulted about your present problem(s)?
e) Are you taking any medication? If "yes," what, how much, and with what results? Ve
f) Please list dates of any previous psychotherapy or psychiatric hospitalizations:
dizziness stomach trouble fatigue take sedatives feel panicky conflict suicidal ideas sexual problems overambitious inferiority feelings short-term memory
problems long-term memory problems
loneliness often use aspirin
or painkillers
fainting spells anxiety ovrfl9II/ no appetite
- cc insomnia alcohol problems tremors take drugs shy WJWL
indecisive A. i cre home conditions bad 4. peot unable to have
a good time yea,
concentration difficulties
unusual eating habits preoccupation with weight
Page Two
3. Personal Data:
a) Date of birth:_______________ Place of birth: /$1M'A'e*tW.5.
b) Underline any of the following that applied during your childhood:
Night terrors fears bedwetting Nail biting airy childhood unhappy childhood Sleepwalking stammering Spec. Education classes Victim of Child Abuse
c) Health during childhood and adolescence? List illnesses: 5eep ny Ar .t 2 yr alt!
d) Any current medical problems? Please list.
e) Any surgical operations? (Please list them and give age at the time)
44 f) How much alcohol do you drink in an average week? Z4/otw
g) Any accidents and/or head injuries? If so, explain.
46 h) List your five main fears:
I) AJ g IMIM-' €- r aio..( rtrfllact d' ;eIt Jur,75 ovt .rlz ,2dYa v'"'' sLdI 'Lvc 1L0t.61 h4&r
ra r W45 f6 &c i) Underline any of the following that apply to you:
7c4,52 Iie., efrW ceeA, 7t Ja.ea1 rLw
headaches palpitations bowel disturbances anger nightmares tension depression inability to relax don't like weekends & vacations
can't make friends can't keep a job financial problems excessive sweating mood swings allergies excessive worrying
1%t 4$ /fl7 Sit Lt t7osc, A4 cat-i
A€ LAkd ;i& Acricti
Page Three
Others; Please list additional problems or difficulties here.
h) Underline any of the following words which apply to you:
Worthless, useless, a "nobody," "life is empty"
Inadequate, stupid, incompetent, naive, "can't do anything right"
Guilty, evil, morally wrong, horrible thoughts, hostile, full of hate
Anxious, agitated, cowardly, unassertive, panicky, aggressive
Ugly, deformed, unattractive, repulsive
Depressed, lonely, unloved, misunderstood, bored, restless
Confused, unconfident, in conflict, full of regrets
Worthwhile, s3mp2thetic1 intelligent attractive , E23i&iàDS.. considerate
i) Present interests, hobbies, and activities: S}oArs, &t'cA'N& 4tt1e'U
7kF ncvcc . — Ee,.niw 6
j) How do you spend your free time? LINFnIVN4Ta(_teTtyIIf*oFIrWIMo-c -AQ6cF
K) What is the last grade of school you completed? 4/ PA'.57 1c'ct'e'er
1) What kind of grades did you receive in high school? 4 1
1 ço,t_
m) What were your strongest subJects?MAj?
n) What were your weakest subjects? j. ,'
nijyaty o) If you did not complete high school, please state why:
p) Were you ever bullied or severely teased?___________________________
q) Do you make friends easily? Do you keep them?__________
r) Have you ever been arrested? ONec- If so, please provide details:
(Use back of paper if necessary) et or &f sd oer
4. Occupational Data 2 r4eJc o7ff at 6'a 1' c?.Ja4 'il
a) What are your career goals? _r hA ,,
jt.r 4,U.kA~
/ze fo,tJo'1 iS 5)4c.rt V',r o.'n toaA/14fl/efls+ )4w b) What is your plan to achieve these goals.
I- w,?/ ,- s-a ,s.4c5 chin, iii4.& ajtiL, A.
Page Four
c) Please list your last 3 jobs beginning with your current position:
Type of Position Dates of Employment
(cttt.i' .52itva. !4i?/? /t £prkvntr — , c -
3.
Reason for Leaving
/T2 -
10- i/Il arJtezfPCSE
iqif— ,Iv M,wIv/?ne/As4- .J_t.
d) What do you earn? ZT A4 m4ot'3SOcO/7c What does it cost you to live? o,
^V44 r4 ,0 7 ,49 oJ4f0,fl75, d 5. Sex Information
fZ€.4t 417 (ofl CL'y( 7' "c
aceS ci' r yseif4)o "
Wns ri5 M- 4
a) Parents attitudes toward sex? LA- MO$1ft.tCJ) j"c* Jid4 411A gSccj ,.
b) When and how did you derive your first knowledge of sex? N...\ iT Io-_1 1-4J1' —
c) When did you first become aware of your own sexual impulses?
AS 4... *enctv
,, b,yL. nkeal.'i d) Did you ever experience anxieties or guilt feelings related to sex? C!
-4 'sfl- 'iL # cw,-< c-fl c,cft - tiq'- p&Jd ,*S e) J,ease list any relevant details regaIding your sexual experiences.
.2 4,n. 4*4 A*ro;eA&./aL f) Is your present sex life satisfactory? (If not, please explain)
g) Provide information about any significant heterosexual and/or 94 homosexual interactions: r n-c n1 a/El flOcntaL. .e../-54."c hr.
h) Are you sexually inhibited in any way? rA14 an o% 46 5crC 04 J94ee.a 2
raAc&c JI/s Is Oftçkd- 44.€ z4re c&In,4 Ii17 6. Menstrual H
ce4L' fec/If 4k story WJ r 4ntc. ,t pç,)e ,c.-
Age at first period?
Were you informed or did it come as a shock?
Do your periods affect your moods?
7. Marital History
How long dj.d yo know your spqusq before getting married? 4$4 1 — i y r,114'-k.
How long have you been married? v-ere. fl'Av tarot ,cJpkoci '
Husband's/wife's age:
Occupation of hhband or wife: ttgit
a) Please describe the personality of your spouse:
b)In what areas is th74J7(,9.bilitY?
c) In what areas is there incompatibility?
Page Five
d) How ma children have you? Pjase list their sex and ages. J mA ffL.k
e) Do any of your children present special problems?
f) Any relevant details re ar/in scarriages or abortions?
g) Please list dates f ey/ioixChrriages:
h) Briefly describe circumstances of any separations or divorces: /vOt? t'ct qg/qe
8. Family Data
a) Father:
Occupation: 4fZ'/7
Health:
If deceased, your age at the time of his death?
Please describe your current relationship with your father; Iocco 1e1-wr6wcn iP — They v C IN /UCM/6mt' io -
b) Mother:
Occupation: ,9 Health: egvxq Please describe your current relationship with your mother:
t tire-its,
v/sirs. wCr
,q , s#tc
,*cf pit-itt'
6'oo ee- z'5e-vP - ywt- j,yf ,,v ,n,cg 7nc.'éfl, f,tr"C nj n.ec'/,
If deceased, your age at the time of her death?
c) Siblings:
Number of brothers: / Brothers' ages:_________________
Number of sisters: / - Sisters' ages:_
d) Give a description of your father' personality; £t dee, IOcSJJn e ,, C4', ,a41, qv'd
e) Give a description of your mother's fersonalftf: i, €'91 ffltlbfnt ofloan% VL-
f) In what ways did your parents punish you then you were a child?
5;*ntI9 7T. gp oc,c
g) Please describe your family atmosphere while you were growing up: (Include your relationship with parents & siblings)
Vet mucLI Lt'e ;•-&-- t',t$j us ct i-do //)LCtZ01 YL LU ses4. Ae(w. znitiesottJ/c ttL mlf 4 L t.S £ctus .1 ctcriAd n'liieJ
h) Did you feel loved and respected by your parents'. frosc 4_ vScj Lvç4., o,sky# toyed — 4nk/y , a,. <- tM'0t)4c Ac'ce
M4c4 12' tOWC2t /JJ *'cA 9i4c 4ecIrA wc we 4 iii pffcr,r 94
k flPFcml Lit et( 4,.Q cJavnac ei4e , h
94 writ
fr.-( VCr( a o.st -c.Ay/lh wedS.
r uc.
Page Six
1) Were you brought up by anyone other than your parents? If so, during what years?
j) Does any member of your family suffer from alcoholism, depression, epilepsy, or any other mental disorder?
k) Are there any other members of the family about whom additional information is relevant?
1) Please describe any fearful, distressing, or traumatic experiences not previously mentioned:
m) Have you ever lost control of your epiotions or behavior? If so,
please describe. )'g 9,.c C_
n) Please describe your personality and temperament: itt A,c4 4 ) 1 I't K-pfeiJ c boo.~uV Jecn'4'c P'4 -t
VERY tvehif*.pe4 *98 P6DEAJT, Vfty 5M4Th77 ',VX6 X o) Please describe your current social relationshi6s: .Jnice Iv a j 4 1A ,1s nis J eveI I
I JhckA I:)e4 J;ce'
Please add any additional inhrmation that is relevant to yo,yr l ife*
'yatv
Gue tt s;c{ee c0 I n..-. ti 4cs r e,a!S 0 ,,+ t'eil
9. Sentence Stems:
a) I am a person who 5 ver1 korcØ) Qc; r
b) Ever since I was a child J7tr enjcjee1 pia y nj. tJAnS
c) One of the things I feel proud of is Ob& o*44 L+Ii5 ,I44Q VJ(1d.
d) It's hard for me to admit t'M rcbcJIi nc+ Ft a5ohAc 'Lcf lcct '1'4 rv.'c wcts,
e) One of the things I can't forgive is c an 79L O& jS -frh4 L& 1rCL.
1) One of the things I feel guilty about is hit. La
g) If I didn't have to worry about my im.'ge I WnP9 ;
h) Sex tS
i) Mother was always
J) What I needed from mother and didn't get was
k) Father was always Jcn,cv4,n I
1) What I wanted from my father and didn't get was JOVe 4LICttCjYKI ccL'I A0 1 s
m) The worst thing that ever happened to me was U 2.
n) One of the things stopp1n me from making positive changes is