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Objective: Personality pathology is difficult to measure. Current instruments have problems with validity and rely on a direct-question format that may be inappropriate for the assessment of personality. In addition, they are designed specifically to address current DSM-IV categories and criteria, which limits their utility in making meaningful revisions of those criteria. These problems suggest the need for consideration of alternative approaches to assessing and revising axis II., Method: This article describes the development and validation of an assessment tool designed to allow clinicians to provide detailed, clinically rich personality descriptions in a systematic and quantifiable form (the Shedler-Westen Assessment Procedure, or SWAP-200). A total of 797 randomly selected psychiatrists and psychologists used the SWAP-200 to describe either an actual patient or a hypothetical, prototypical patient with one of 14 personality disorders (one of the 10 DSM-IV axis II disorders or one of four disorders included in the appendix or in DSM-III-R) or a healthy, high-functioning patient., Results: The data yielded aggregated descriptions of actual patients in each diagnostic category (N = 530) as well as aggregated descriptions of hypothetical, prototypical patients (N = 267). SWAP-200 descriptions of patients with personality disorders showed high convergent and discriminant validity on a variety of criteria. The diagnostic procedure lends itself to both categorical and dimensional personality disorder diagnoses. Descriptions of individual patients resemble MMPI profiles, based on the degree of match between the patient's profile and a criterion group, except that they are based on clinician observation rather than self-report., Conclusions: The SWAP-200 represents an approach to the measurement and classification of personality disorders that has potential for refining axis II categories and criteria empirically in ways that are both psychometrically and clinically sound.

Using two samples, we developed and validated a hostility scale that can be scored from the California Psychological Inventory (CPI) and serves as an alternate for the Cook-Medley Hostility Scale (Ho; Cook & Medley, 1954). The CPI Hostility (H) scale consists of 33 items that are either duplicates or close equivalents of specific Ho items, and the two scales correlate at least .90 in samples differing in sex. The H and Ho scales show a similar pattern of correlations with conceptually relevant MMPI scales and with observer-rated personality attributes tapping Barefoot, Peterson, et al.'s (1991) five hostility categories of Hostile Affect, Cynicism, Aggressive Responding, Social Avoidance, and Hostile Attributions. These findings provide evidence for the equivalence of the two hostility scales, as well as external validation for those personality characteristics that are purported to underlie the construct of hostility as tapped by both the original Ho scale and the new CPI H scale.

This study explores clinicians' conceptions of optimal mental health as a function of target age and asks whether contemporary conceptions of optimal mental health differ from Block's (1961) earlier Q-sort model. Ten experienced clinicians from Northwestern University described the personality characteristics of optimally adjusted 25- and 50-year-old targets using the California Q-set. Item scores from these Q-sorts were aggregated to form 25-year-old, 50-year-old, and composite templates of optimal mental health. Using the Spearman-Brown formula, the reliability of the 10-judge composite was .97. The 3 templates were very highly correlated with each other and with Block's original template. Q-sort descriptions of optimal mental health are remarkably stable over 2 generations of clinicians and between young adulthood and mid-life.

With the development of the concept of community care there has been a significant expansion of the community psychiatric nurse (CPN) profession. The present study attempts to examine which aspects of their work CPNs currently find stressful. The study also examines the various strategies which CPNs feel to be useful in attempting to cope with such occupational stress. Forty-four CPNs in four health districts participated in this Q-methodological study which provided the opportunity for CPNs to construct their own concepts of stressors and coping strategies. The results obtained indicated that CPNs identified nine distinct areas of stress within their work, along with 12 distinct coping strategies which they considered useful in attempting to deal with such stress. The implications of these findings are discussed.

The present study identified, within psychiatric, medical and surgical care, patient and staff perceptions of the occurrence and importance of caring behaviours. A Swedish version of the 'CARE-Q' instrument, including 50 caring behaviours, was used for the assessment of importance, and the 'CARE-How often' questionnaire (containing the same behaviours) was used for the determination of occurrence. In psychiatric and medical care, but not in surgical care, staff considered several behaviours to occur more frequently than did patients. However, in each type of care, the groups agreed fairly well with respect to rankings of behaviours. 'Explains and facilitates' occurred rarely, and 'Monitors and follows through' occurred often, according to both patients and staff. Overall, patients and staff differed both with regard to perceived levels and rankings of the importance of behaviours. Psychiatric patients perceived 'Explains and facilitates' as most important, and somatic patients perceived 'Monitors and follows through' as most important, while staff in both somatic and psychiatric care considered 'Comforts' as the most important subscale. Neither patient nor staff perceptions of the occurrence of caring behaviours were well matched with their perceptions of the importance of these. Implications for nursing practice and for studying patient satisfaction with care are given.

The authors describe the development, reliability testing, and validation of a 17-item instrument that measures the level of functioning of chronically mentally ill persons living in the community. The Multnomah Community Ability Scale is designed to be completed by case managers. The instrument provides a measure of the consumer's severity of disability which can, in turn, be used to: (a) describe an agency's "case mix" of clients; (b) measure consumer progress; (c) assign clients to different levels of service; and (d) assist payors in determining reimbursement. The Multnomah Community Ability Scale is aimed specifically at persons with chronic mental illness, is sensitive to differences among individuals within this special population, and is quick and easy to complete. The scale's reliability and validity have been examined in detail. Inter-rater and test-retest reliability are good. Criterion variables such as length of psychiatric hospitalization and clinicians' global ratings correlated highly with scale scores. Finally, the instrument predicts subsequent state and local hospital admissions.

Seven judges described the personality characteristics of the primary psychopath by sorting the 100 items of the California Q-set in a forced-normal distribution. Item scores resulting from these sorts were aggregated across judges to form a Psychopathy Prototype. The reliability of the seven-judge aggregate prototype was .90. To examine the reliability of scores derived from the prototype, the personalities of 65 target subjects were described by two peer judges using the California Q-set (Block, 1961). For each subject, Psychopathy Prototype scores were derived by correlating each judge's Q-sort profile with the Psychopathy Prototype. Findings indicated that the peer-generated psychopathy scores correlated r = .61 between judges. Using the Spearman-Brown formula, Psychopathy Prototype scores have reliabilities of .75, .82, and .86 when aggregated over two, three, and four peer judges, respectively. To further explore properties of the measure, the Psychopathy Prototype was compared with independently developed California Q-set prototypes describing the narcissist and the female hysteric. The results revealed some interesting contrasts among these concepts and serve to support our contention that the Psychopathy Prototype has utility in regard to distinguishing between pathologies with overlapping features.

A quantitative taxonomy for the identification of patients with narcissistic pathology and with borderline personality disorders based on test results is presented. The quantitative identification of these subgroups was produced using a Q-factor analysis. Based on the correlation of the subjects by means of the 241 questions from the narcissistic inventory of Deneke and Müller [27], three subgroups could be defined. Two of these groups exhibited a pathology of the self-system which corresponded to the pathology described by Kernberg [24] for narcissistic and borderline personality disorders. The third group is characterized by reduced observable self-pathology traits from the narcissistic inventory. By means of the reclassification of these three taxonomical groups with the discriminant analysis, two discriminant functions could be calculated, using the weighting of the single test scales for a classification of new patients. These classification functions were used to examine 18 patients suffering from factitious disorders. The evaluation of test profiles with the reduced narcissistic inventory of Deneke and Müller [11] in order to identify the three taxonomical groups showed that 9 patients (50%) had a borderline personality disorder and 6 patients (33%) a narcissistic personality disorder, while 3 patients (17%) could be assigned to the subgroup without self-pathology. In summary, 83% of the examined patients with factitious disorders exhibited a disorder in self-regulation. The previous clinical observations of self-regulation for patients with factitious disorders could thus be confirmed. It becomes clear that different high levels of disorder in self-regulation (position in the sphere of the discriminant function) correspond to varying degrees of prognostic significance.

Objective: To examine the relationship of patient-perceived and nurse-perceived caring behaviors., Design: Descriptive., Setting: Three not-for-profit hospitals in a large metropolitan western city., Subjects: Thirty coronary care patients and 30 coronary care nurses., Method: Larson's nurse caring behaviors (CARE-Q) were rank ordered by the Q-sort method., Results: The patient's study group perceived behaviors that involved technology as most important, which differed from nurses, who perceived listening as the most important caring behavior., Conclusions: This study supports the findings of other researchers that patients' and nurses' perceptions of important nurse caring behaviors are divergent.

In an analysis of adult personality structure, types are defined as prototypes rather than as discrete categories. Using inverse factor analyses of archival Q-sort descriptions, 4 type factors were replicated in a cross-validation design. These prototypes are interpreted as Individuated, Traditional, Conflicted, and Assured and are related to Rank's (1945) theoretical analysis of different modes of adjustment. These prototypes capture particular combinations of personality dimensions, such as Ego Resiliency, Ego Control, and the Big Five, and converge with the types identified by Block (1971). Further analyses using 13 clusters of scales from 3 broad-band self-report inventories validated the Q-sort-based interpretations and showed a distinct and theoretically consistent patterning for each of the types.

The five-factor model of personality is a hierarchical organization of personality traits in terms of five basic dimensions: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. Research using both natural language adjectives and theoretically based personality questionnaires supports the comprehensiveness of the model and its applicability across observers and cultures. This article summarizes the history of the model and its supporting evidence; discusses conceptions of the nature of the factors; and outlines an agenda for theorizing about the origins and operation of the factors. We argue that the model should prove useful both for individual assessment and for the elucidation of a number of topics of interest to personality psychologists.

Three observer-based narcissism scales were developed from factor scores based on a California Q-set (CAQ) narcissism prototype. Each of the three scales--Willfulness, Hypersensitivity, and Autonomy--correlated with observer and self-report narcissism measures in the derivation sample of 105 women and a cross-validation sample of 175 men and 175 women. California Psychological Inventory (CPI), Adjective Check List (ACL), and Minnesota Multiphasic Personality Inventory (MMPI) correlates and partner ACL ratings suggested that the Willfulness scale represents self-assuredness, rebelliousness, and exhibitionism characteristic of overt or phallic narcissism. The correlates of the Hypersensitivity scale included depression and introversion along with rebelliousness and hostility, indicative of covert narcissism. The Autonomy scale was correlated positively with creativity, empathy, achievement-orientation, and individualism, and thus assesses a healthy variant of narcissism.

This study represents a contribution toward the systematic and empirical investigation of psychoanalytic treatments. The method used, the Q-technique, allows the transformation of clinical data into a form amenable to quantitative analysis, thereby providing an empirical means to test theoretically and clinically derived understandings of psychoanalytic process. The treatment hours of a six-year analysis were audio-recorded and transcribed, and blocks of ten sessions were selected at regular intervals throughout the course of the analysis. Transcripts of these hours were then rated in random fashion by clinical judges with a Q-set designed to provide a standard language for the description and classification of analytic process. These descriptions of analytic hours, as structured by the Q-set, proved highly reliable, demonstrating the method's promise for addressing the long-standing problem of achieving reliable clinical judgments. Results suggest that subjecting the traditional psychoanalytic case study to systematic inquiry can contribute to establishing an empirical science base for some psychoanalytic propositions.

Although already several decades old, the facet analysis (also called facet theory) has not been able to assert itself in the field of psychology. Here the reasons for the widespread uneasiness with the facet analysis will be presented starting with an outline of the approach. This will make it clear that the facet analysis does not represent a research method in the narrower sense and definitely not a "theory" but a method with the status of a logical principle of thought. In experimental psychology this principle has been used successfully for a long time in the form of multifactorial experimental designs. However, multifactorial measurement designs are still few and far between in differential and diagnostic psychology. This can be explained especially by the fact that an important aspect of validity--the validity of construct differentiations--has been ignored. Because of a principle rejection of factor analytic methods, even the proponents of the facet analysis have overlooked the central contribution of their approach with respect to the validity of measurement methods.