Mental Health Awareness 2015: Dignity in Mental Health

The 10th of October was World Mental Health Awareness Day and the Graduate School of Psychology Assumption University of Thailand was happy to take  part along with the student volunteers to raise awareness about the importance of mental health and our responsibility as psychology students and counselors to help decrease stigma about seeking mental health support on this year's theme "Dignity in Mental Health."

In connection to this, we set up a booth at The Assumption University Bangna Campus to raise awareness among the undergraduate students and assist them with free testing and interactive activities.

This year it is also the aim of the world health organization to stop the stigma and that people with mental health condition can be able to live with dignity as well as provide them with sufficient support. The aim is to be able to provide healthcare professionals with appropriate and adequate training to be able to respond to every need.

Every year, the Graduate School of Psychology, Assumption University of Thailand helps create public awareness and reaches out to the younger generation so they can be informed about the importance of mental healthcare and to seek support when needed. 

Qualified volunteers assisted the students as well as some of the staff take free testing on stress, happiness and provided them with information and follow up assistance should there be any questions regarding the result of the test.

There was also a movie presentation about suicide prevention, body image and depression as well as information on how and where to seek help. We also hand out bookmarks with positive affirmation and useful school supplies to serve as positive reinforcements for their participation.

The students also took part in interactive activities such as writing positive affirmation and sharing it on our "what makes you happy" board. They also took part in our survey as well as come by the booth to ask and talk about mental health related issues and how can they, as young people be able to help raise awareness.

We were also graced with the presence of distinguished psychology professors and counselors from the student affairs who also provided us with more information regarding possible collaboration, workshops and symposiums which would benefit the students.

All in all, we are very happy for the positive outcome of the event. The students as well as some of the staff from Assumption University of Thailand Bangna Campus welcome the team with warmth and although the students were busy with their exams, some of them came by to show their support.

The team had a wonderful experience reaching out to the public, providing information about the importance of mental health and by showing that as future counselors we are prepared to take part on the band of mental health professionals help stop stigma and assure that people with mental health condition will be provided with appropriate support and too live with dignity. Job well done team! your effort and service are so much appreciated as well as to our professors and adviser who gave their support to make this event possible. 

“Life is a kaleidoscope. Turn your head a different angle and see it a whole new way.”
–Anonymous

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Reflection: Group Therapy Workshop

“Some of the most comforting words in the universe are “me too.” That moment when you find out that your struggle is also someone else’s struggle that you are not alone, and that others have been down the same road.”

Putting your wall down and telling strangers your struggles can be very intimidating. But suffering in silence and thinking that you may be the only one in the world who has to go through a difficult time can be even more severe.. Therefore group therapy offers a support network, where people of different backgrounds and personality come together to share and offer feedback to a common issue everyone is going through in a group.  Therefore, by talking about their experiences and sharing their feelings about it, people tends to bond towards the group hence finding support where they all gain strength through sharing.

However, I have noticed that for most of the members in a group, it is easy to assume the counselor's seat and to give advice rather than sharing their own feelings. So the challenge is how, as a facilitator can we encourage sharing among the group and avoid "group bonding" towards one person; which would rather make that one person thinks that he is the only one struggling, making that person feels that his private self has been violated which would often result to that person not wanting to share again.

Well, I am very new to the profession and to be honest, I still have so much yet to learn when it comes to the various kinds of counseling. But in particular, I believe that in group therapy, sharing is the support, rather than giving advice.

So, what is group therapy?

Accordingly, group therapy is where people come together to talk about issues that concerns them. It is a safe place where everyone shares and learn to interact with each other. It is where people freely shares, listens to each other and provide feedback. It is also where one learn so many ways on how to cope with difficulties by learning different ways how to cope with it. Therefore, it is very important that people in the group shares common issues and to openly discuss.

So my initial thoughts was, what is the role of the facilitator? what are the common challenges a facilitator faces while keeping the group together and be able to maintain a safe place for everyone. While there is no limit to the setting, there must be some kind of a goal so that each individual in the group can benefit from it as well as it can move on as a group, towards a common goal which to be able to find healing and yet again, support.

Well, it was my first time to actually come to a group therapy workshop. And my goal was, as a beginning Counselor, I wanted to know how to be able to facilitate the group as effectively as I can as well as know the role I am going to take in the group.

"Partly because I do trust the group, I can usually be quite loose and relaxed in a group even from the first. That's overstating it somewhat, for I always feel a little anxiety, perhaps, when a group starts, but, by and large, I feel, 'I don't have any ideas what's going to happen, but I think what's going to happen will be all right,' and I think I tend to communicate non-verbally that, 'Well, none of us seems to know what's going to happen, but it doesn't seem to be something to worry about.'" I believe that my relaxation and lack of any desire to guide may have a freeing influence on others."

And so my further study lead me to an article by Carl R. Rogers, where he sited 13 points to keep in mind when facilitating a group such as: Group Acceptance, Individual Acceptance, Emphatic Understanding, Operating in terms of feelings, Confrontation and feedback, Expression of my own problems, Avoidance of Planning and "Gimmicks", Avoidance of Interpretative or Process Comments, Physical movement and Contact, Trust in the therapeutic Potentiality of the Group, Being Aware of your own faults, Special Problems and  Non-Facilitative  Behavior.These key concept will help the facilitator become aware of the role he plays in the group therapy and his share of influence.

Therefore, it is noted that the role of the facilitator is to support and encourage self expression among the members. He is to assure that there is mutual trust and emotional safety within the group environment. The facilitator in all ways must display active and empathy skills and be able to use his counseling skills to facilitate should there be important issues or key themes to be addressed in the group. Importantly, the facilitator must ensure to help the group transition smoothly from an open process group to the psycho-educational part of the session.

In conclusion, as a facilitator, one must be willing to allow a member to participate or not to participate in a group. Every member should feel that they at some point can withdraw personal participation and not be coerced. Doing so, it will allow members to most likely open up on the next sessions knowing that they are not force to do or say something that they are not ready to express. It is also important for the facilitator to allow silence and observed if there is a presence of unexpressed pain or resistance. Also, we have to accept every statement at their face value and avoid judgement, that we are willing to believe what the person is saying rather than trying to "psycho-analyze" what it really means. The key is not to control the group and what happens within it but to assure that there is a sense of trust, and respect.

I still strongly believe that each one and every therapist, beginner or expert, unite to one solitary goal. And that is to provide an honest therapeutic environment where each individual finds healing and comfort in embracing being one with others. To let every member know that they are not alone and there are others who they can walk side by side with.

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BasicEffective Communication Skills for Counselors

“Fie, fie upon her! There's language in her eye, her cheek, her lip. Nay, her foot speaks; her wanton spirits look out at every joint and motive of her body.”  William Shakespear

 In today's society where everyone want to be heard, we at some point have forgotten how significant it is to listen with the purpose to understand. To pass our message across, we often find ourselves profusely talking, to eagerly share because we have too much information and we wanted to be heard. But as a counselor, a neophyte to the professional like myself, there is that strong need to learn the trade of being an active listener, to seek to understand rather than to be understood. So, by learning to decipher Nonverbal Communication Skills, it will somehow bridge the communication gap which we have often overlooked.

Non Verbal Communication is define as sending messages in various ways without using verbal codes or words. These are unconscious, unintentional or intentional gestures which are displayed as body language. As a beginning counselor, it is therefore very important to distinguish body languages in your clients as well as being aware of the messages that you also convey. Non Verbal Communication can be displayed as: paralanguage (sounds), smell, word choice or syntax, posture, intonation, dress, gesture, proximity, eye contact, vocal nuance, glance, volume, touch.

So what is the role of Nonverbal Communication Skills in the counselling practice? Dr. Maria Bella Bamforth, keynote Lecturer on Effective Communication Skills in Counseling stressed that in a study done on the Effectiveness of Spoken Communication  by Albert Mehrabian (UCLA), the meaning of the language consisted are derived of 7% spoken words, 30% paralinguistic and 55% facial expression and other body language. Julius Fast, author of Body language pointed out that, “We all, in one way or another, send our little messages out to the world... And rarely do we send our messages consciously. We act out our state of being with nonverbal body language. We lift one eyebrow for disbelief. We rub our noses for puzzlement. We clasp our arms to isolate ourselves or to protect ourselves. We shrug our shoulders for indifference, wink one eye for intimacy, tap our fingers for impatience, slap our foreheads for forgetfulness. The gestures are numerous, and while some are deliberate... there are some, such as rubbing our noses for puzzlement or clasping our arms to protect ourselves, that are mostly unconscious.”

One of the key point on good communication skill is active listening. By observing nonverbal communication skills a counselor can assess the reaction of the client to her words or actions. Also on her Lecture, Dr. Maria Bella Bamforth, keynote speaker on Effective Communication Skills, pointed out the importance of active listening. Active listening wherein a person is motivated to listen with intent and purpose. She further discuss that active listening requires that the listener focus on the words and the feeling of the speaker, use feedback to verify understanding and pay attention to the various meaning conveyed in the message. It is also important that the listener talk less, understand and analyze what is being said, must not be preoccupied with her own thoughts, able to control prejudices and keeps pace with the speaker.

Key Communication Skills for Counselor

Develop Rapport - It is very important to develop and build trust in clients so that an effective line of communication will be achieve and that issues will be discuss as soon as possible. 

Ask Appropriate Questions - In your conversation with the client. It is very important to use open-ended questions to encourage a wide range of possible answers. 

Reflect the clients feeling - This is when the counselor reflects back the feelings of the client. It can be attain by validating the clients words. A counselor can ask questions such as, "You feel that you are under valued in your job..." etc. 

Paraphrase Clients Words - Summarize the clients words in a clear and direct form. This is to show that you are keeping pace with your client and you seek affirmation that you have understood the client.

Use "Encouragers" - This is where the counselors uses verbal or nonverbal cues to encourage the client to continue talking. You can repeat keywords, use facial expressions or verbal affirmations.

Clarify Mixed Messages - This is where the counselor re-affirms, restate and paraphrase the client's words to clarify. *Clarifiers are often use to ensure that messages are understood both by the counselor and the clients.

Lead and Focus: In a conversation, it is very easy to get lost in so many topics and issues. The role of the counselor is to focus and direct client to issues which needs to be prioritize and be address as soon as possible.

Summarize - At the end of the session, it is important for the counselor to give a brief summary of what took place in the conversation. Review what the client have said and express in the conversation so that both the client and the counselor can move on.

To add, I as an aspiring counselor also learned the importance of Nonverbal Communications such as: Facial Expressions, Eye Accessing Cues, posture and gestures. The counselor will have more understanding of the message within the conversation through observing nonverbal communication clues. For example, the most "articulate" expression of body language is the eye movement. Accordingly one can tell so much about the person by looking through their eyes, after all, it is the window to the soul. 

Giving importance to Behavioral Responses is the fundamental factor to an effective communication. It is when your thoughts ceases, to welcome the thoughts of others. I once read a quote that says, "just once, when I say oh, I'm fine. I wan't someone to look me in the eye and say, Okay. now tell the truth." Our communication system has somehow overloaded, in fact, there are more ways than one means of communication; even which our text have also been replaced with emoticons which implies varied ways of how one feels. Voltaire once said, "one great use of words is to hide our thoughts.” As an aspiring counselor, I feel that there is so much for me to learn in terms of the technicalities of being an effective listener. But really, the challenge is how do we show our clients that we understand, that we feel that gap in their shoes, to just look them in the eye and tell them, "tell me about it"  without even saying a single world.

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An Overview of the Millon Clinical Multiaxial Inventory II-III

Testing and assessment have played a major role in defining human capabilities, skills and intelligence as well as to identify and categorize major mental disorders in order for practicing professionals employ proper diagnosis and treatment. Testing has also been used in the educational system more so as it is also deemed effective to use as a basis in choosing people for the right job to assisting individuals assess their capabilities in order to find a right career or aid them in choosing a respective course in the field of study of which they are more suitable. And also testing has been use to help people understand themselves better so that they become more efficient in coping with their everyday life.

There are a number of tests that have been widely used by clinicians as well as educators or practicing professionals. However, there are important factors for a test to be considered sufficient such as its validity and reliability and several important issues to consider such as; standardization, construction and judgments.

The following text will discuss one of the most widely accepted Assessment which is the Millon Clinical Multiaxial Inventory I-III (MCMI I-III) which was developed by Theodore Millon following the publication of his book Modern Psychopathology which had urged him to construct an instrument which was then called the Millon-Illonois Self Report Inventory (MI-SRI) which was used to measure the different dimensions of personality of which was then revised and was later incorporated to the personality disorders included and published in the Diagnostic and Statistical Manual of Mental Disorder (DSM).

An overview of the MCMI-III will be further discussed to be able to gain a better insight of the usefulness and the development of the test itself, its history and development, reliability and validity, assets and limitations, administrations as well as a comparison between the currently revised MCMI-III and the early version of the MCMI.

THE MILLON CLINICAL MULTIAXIAL INVENTORY

The Millon Clinical Multiaxial Inventory or MCMI (Craig, 1999) was developed to reinforced Millon’s model of psychopathology and it has been revised over the years to subsist with the advancement and modification of the different theories as well as to keep pace with the Diagnostic and Statistical Manual of Mental Disorder. It was introduced in 1997 and since then it has been considered one of the most accepted and widely researched and used instrument in clinical assessment and has been translated into several languages as well. The latest version (Growth-Marnat 2003) consist of 175 items that was scored which then produced 28 scales  known to be divided into six categories which was strongly associated with Millon’s Theory of Personally and the Diagnostic and Statistical Manual of Mental Health Disorder.

The five categories derived in the Millon Clinical Multiaxial Inventory (MCMI):

1. Modifying Indices
2. Clinical Personality Patterns
3. Severe Personality Pathology
4. Clinical Syndromes
5. Severe Syndromes

The MCMI I-III (Grohol, 2013) consists of 175 true-false test questions which would take duration of 30 minutes to complete by an average person. The test will then be scored produced from the 29 scales of which 24 are clinical and personality scales and 5 are to validate how the person took the test such as carelessness and choosing random answers. The MCMI is to the compared the MMPI which included a wider range of adult pathology that evaluates long standing clinical symptomatology and personality patterns. Also, (Growth-Marnat 2003) the MCM I-III is specifically used to assist in the diagnosis of mental disorders in Axix II. And it is often administers in clinical settings should there be a need of a diagnosis of personality dysfunction or mental health concern that is affecting the normal everyday and social function of an individual. However, it should be given into account that the instrument should not be the basis of the diagnosis but the information acquired is considered relevant in the diagnosis of mental issues. Moreover, the intent of the MCMI I-II Assessment is to diagnose problems in the psychiatric population and not for normal people and those who are considered to have a mild mental disturbance. (Grohol 2013) explained that base rate scores from the clinical and personality scale are calculated base on how the person responds to the administered test. Base scores between 75-85 considered to significantly determine a mental health concern. Whereas, base scores between 85 and higher determines a clinical concern or personality disorder.

RELIABILITY AND VALIDITY

Although a number of researchers argue that it would be better to use the MCMI I-II until more research and testing can be done for the MCMI I-III to be considered a sustainable instrument for assessment, studies on the validity and reliability of the MCMI as a tool can be considered that its consistency is predominantly strong and is a suitable psychometric instrument.

The alpha coefficient for the MCMI I-III exceeds .80 for the twenty (20) of the twenty six (26) scales of which depression has a high score of .90 and a low score for Compulsive of .66 (Growht-Marat 2003). On the test-retest reliability, it is reported that for a 5-14 day interval, it shows a median of .91 of which Somatoform got a highs score of .96 and debasement got a score of .82 which is the lowest. Further studies also concluded that personality scales shows higher stability than the clinical scales. However, some research also stated that there is a little difference when it comes to the difference between the mean of personality scales and clinical scales even after an extended re-test interval.

However, further studies indicate that MCMI shows a theoretical higher stability on the personality scales than the clinical scales in the MCMI I-III which shows a mean of .89 for personality scales and a higher score of .91 for clinical scales. Also, one of the issues when refers to evaluating MCMI and its validity is the fact that the previous validity studies of the old versions can be transferred and be combined to the current version.

In addition, Craig (1999) stated that psychometrist argue that the items are redundant and that the test is non-factorial which would result to factorial invariance. However, Millon strongly believes that covariation exist and is not particularly concern about the redundancy. It also be taken account that item overlap that resulted from the forced resemblance artificially increase correlations between the scales.

Also, in the study presented of the MCMI-I, it shows a four-factor structures which are:

-          General Adjustment

-          Paranoid behavior and thinking

-          Schizoid Behavior and Detachment

-          Social Restrain/Aggression

Millon however found 8 structures that Choca and Van Denburg labeled as:

-          General Maladjustment

-          Acting out/Self-Indulgent

-          Anxious and Depressed Somatization

-          Compulsive Defended/Delusional-Paranoid

-          Submissive/Aggressive-Sadistic

-          Addictive Disorder

-          Psychoticism

-          Self and other Conflictual/Erratic Emotionlaity.

The MCMI factor studies use a big sample size and different clinical population which consist of psychiatric patients/outpatients, criminal offenders and substance abusers of which used a varimax rotation to employ a principal component analysis.

In general, Craig (1999), stated that there is however an increase in stability in the reliabilities scale shown in every version of the test which suggest a more psychometrical good scale. Indeed, most of the scale in the MCMI-I and MCMI-III shows a sufficient reliability over test-retest intervals with reasonable exception of Dependent, Passive-Aggressive, Paranoid and Borderline scales. Overall, MCMI-III indicates good psychometrics and is therefore considered to be a valid and reliable test. Of which psychiatry patients are used as norms and a new weighted score was used.

However, Growth-Marat (2003) suggested that MCMI-III be used conservatively until further validity has been documented. Whereas, the MCMI-I demonstrates a good validity and reliability and has receive commendation as well as it is innovative. As a whole, the MCMI is a well developed test that provides a wide variety of information which focuses on the problematic personality disorder as well as the clinical symptomatology. The study also concluded that there is a good predictive power between .30-.80 which is also supported by further research.

DEVELOPMENT OF MCMI-II

Growth and Marat (2003), further discuss that the MCMI-II had mostly retained its original features from the MCMI. The need to further development the assessment is to be able to incorporate current research and finding on personality disorders while maintaining its alignment with the DSM III criteria. Apparently, the MCMI-II have reached a total of 175 items and 22 different scales and a rating of 1,2 and 3 were weighted on each individual items.

THE DEVELOPMENT OF MCMI-III

Currently, Growth-Marat (2003), state that there is an ongoing research on the development of the MCMI-III. Using the same procedures used with the MCMI and MCMI-II a 325 item test was developed where PTSD and Depressive Scale was added. There were 90 items from the MCMI-II which were changed but 85 of the items were retained.

MCMI-III Scale Categories and Reliability

Scale/Category Name	Abbreviation	No. of Items	Alpha
Modifying Indices Disclosure Desirability Debasement Validity	X Y Z V	NA 21 33 4	NA .85 .95 NA
Clinical Personality Patterns Schizoid Avoidant Depressive Dependent Histrionic Narcissistic Antisocial Aggressive (Sadistic) Compulsive Passive-Aggressive Self Defeating	l 2A 2B 3 4 5 6A 6B 7 8a 8b	16 16 15 16 17 24 17 20 17 16 15	.81 .89 .89 .85 .81 .67 .77 .79 .66 .83 .87
Severe Personality Pathology Schizotypal Borderline Paranoid	S C P	16 16 17	.85 .85 .84
Clinical Syndromes Anxiety Somatoform Bipolar: Manic Dysthymia Alcohol Dependence Drug Dependence Posttraumatic Stress Disorder	A H N D B T PT	14 12 13 14 15 14 16	.86 .86 .71 .88 .82 .83 .89
Severe Syndromes Though Disorder Major Depression Delusional Disorder	SS CC PP	17 17 13	.87 .90 .79

Source: Handbook of Psychological Assessment (4^th ed.), by Growth- Marnat, 2003, John Wiley and Sons, Inc

The table above shows the 28 scales which are divided into categories; of which the base rate scores are taken from the result of standardization sample done to 1,079 patients from different backgrounds and treatment settings.  In addition, some of the items were also retained where not taken out such as Sadistic Personality and Self defeating disorder even if they were already remove from the DSM IV.  Moreover, most items in the MCMI-III actually maintain its primary content and the changes are to present the increase in the severity of the symptoms. The reason for the changes is too also reduce and prevent people from endorsing items of which they expect that MCMI-III would be efficient and selective when it comes to the cause and effect of the disorder. Also, MCMI-III follows the following changes of which the weighing system was change to a 2 point system rather than the 3 point system which was originally included in the MCMI-II. The contents of the new publish version of the MCMI-II includes:

-          Three item validity index

-          Three modifier indices which is to assess bias in the response.

-          Fourteen Personality Scales

-          Ten Clinical Syndrome Scales.

Using the Cronbach’s alpha the consistency of the scale was predicted to be between .67 and .90 with a re-test stability of .84 ane .96 over five to fourteen days.

SUMMARY OF SCALE RELIABILITY MCMI-I to MCMI-III

MCMI-I	-          Personality Disorder Scales Passive Aggressive .19 t0 .91 Histrionic with a .71 median for all scales -          Clinical Syndrome Somatoform .45 to Bipolar Manic .67 with a .60 median value for all scales.	-          Avoidant and Dependent Scales (13 data sets) -          12 data sets for the remaining scales. -          5 days to 3 years Test-restest interval (with 3 months interval for most studies)
MCMI-II	-          Personality Disorder Borderline .62 to Compulsinve .78 with .74 median for all scales -          Clinical Syndrome Scales Somatoform .43 to Drug Dependent .72 with .66 median value for all scales.	-          Dependent Scale (8 data sets) -          7 data sets for the remaining scales. -          21 days to 4 months test-retest interval (with 2-3 months interval for most studies.
MCMI-III	-          Personality Disorder (base on three data sets) Depressive .58 to .93 Depressive with .78 median -          Clinical Syndrome Scale PTSD .44 to Major Depression .95 with .80 median value.	-          Two to three data sets depending on the scale -          5 days to 6 months test-retest interval -          Median correlation for clinical samples - reported later.

Source: Overview and Current Status of the Millon Multiaxial Inventory Journal by Robert J. Craig, 1999, Journal of Personality Assessment

INTERPRETATION PROCEDURE (Growth-Marat, 2003)

1. Determine Profile Validity

-          Random Responding – scores one or more from the three items on the MCMI-III Validity Scale.

-          Underreporting of difficulty – low score (less than 34) on Debasement and Disclosure. And high score on Desirability (over 75 base rate)

-          Faking good – It is advised to refer to the client’s history to be able to make a distinction.

-          Fake bad – high score (above 178) on Disclosure; high score (above 75) on Debasement.

-          Cry for help – moderate elevation

-          Increase Invalid Profile – progressive high score (base rate beyond 85)

2. Interpret the personality disorder scale

-          Elevation on the Severe Personality Disorder scale should be checked.

-          Elevated scale suggests one or more Clinical Pattern scale is elevated as well.

3. Interpret Clinical Syndrome Scale – The same with number two procedure.
4. Review Note Worthy Response

-          The MCMI-III included a series of Noteworthy responses that would guide practitioners to selectively note appropriate psychological report that would reflect the client’s behavior, affect and attitude.

5. Implications on Treatment and Recommendation should be elaborated

-          Target high problematic symptoms which have high elevation in the Clinical Syndrome scale as high priority. Such as, Substance abuse, Anxiety, depression. However, it is important for practitioners to understand the client’s pathology of personality patterns.

-          Treatment recommendation and suggestions are also provided in each of the personality disorder scale.

In conclusion, Craig (1999) stated that the MCMI is one of the extensively used assessment tool which provide a comprehensive theory and is coordinated closely with the DSM’s multiaxial format. Besides that it is easy to interpret, it also requires lesser time to administer the test. However, it is very important that one has to learn and familiarize the terminology used in the DSM to be able to conclude a more precise diagnosis.

Nevertheless, Craig (2006) advised that the MCMI should not be use as a single instrument for measurement although it has been widely accepted by practitioners.  In as much as it has its own strength, it is also important to recognize its limitations. He also added that the MCMI-III should only be use appropriately with adults being treated or evaluated in the mental health condition. The measurement also was design to identify clients with personality disorders and selected clinical syndromes. Moreover, he strongly advised that the assessment should not be employ with persons who are normal.

References

Gary, G.M. (2003). Handbook of Psychological Assessment 4^th Edition. John Wiley & Sons,     Inc. 311-353

John, M.G. (2013). Million Clinical Multiaxial Inventory (MMCI-III). Psychcentral.com. Retrived from http://psychcentral.co m/lib/millo n-clinical-multiaxial-invento ry-mcmi-iii/0006106

Robert, J.C. (1999). Overview and the Current Status of the Millon Clinical Multiaxial Inventory. Journal of Personality Assessment. 72(3). 390-406

Rober, J.C. (2006). Millon Clinical Multiaxial Inventory II/III. Psychological Assessment Resource. 1-7

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