Card pull effects of the Thematic Apperception Test using the Social Cognition and Object Relations‐Global Rating Method on complex psychiatric sample

Abstract

In recent years, there has been growing interest in examining the stimulus pull effects on respondent narratives to the Thematic Apperception Test (Murray, 1943) using standardized coding methods such as the Social Cognition and Object Relations Scale–Global Rating Method (SCORS‐G; Stein, Hilsenroth, Slavin‐Mulford, & Pinsker, 2011; Westen, 1995). The present study expands on prior work by examining sources of variance in SCORS‐G dimensions and card pull effect patterns in an adult clinical sample characterized by high psychiatric comorbidity and clinical severity. A sample of 158 adult psychiatric patients in long‐term residential treatment provided narratives to 10 TAT cards (five of which have not previously been studied for pull effects). Cards 2 and 7BM pulled for significantly more adaptive narratives (positive pull), whereas Card 13MF pulled for more pathological stories (negative pull). Like prior studies, variance in cognitive dimensions of the SCORS‐G was most explained by person effects, whereas the largest source of variance for all other dimensions was best explained by a combination of the card and the person effects on the narrative. Finally, exploratory analyses of card pull effects within different gender groups were conducted. The implications of these findings for performance‐based future studies and possible clinical applications of card pull findings are discussed.

How narrative source impacts convergence of ratings from the Social Cognition and Object Relations Scale–Global Rating Method with psychotherapy process measures

“…Second, this finding suggests that cognitive features of narrative formation may be less likely to be shaped by different methods of narrative elicitation. This reasoning is consistent with previous TAT and Picture Story Exercise studies (i.e., Auletta et al, 2018;O'Gorman et al, 2020;Ridenour et al, 2021;Siefert et al, 2016;Stein et al, 2014), which have demonstrated greater stability of variance at the person level for the cognitive dimensions, even in clinically severe populations.…”

Longitudinal stability of Social Cognition and Object Relations Scale—Global Rating Method dimensional ratings, score ranges and narrative ‘blandness’ in a clinical sample

“…Five cards were selected for analysis from a standard nine card protocol administered to all patients: 1, 14, 13MF, 12M and 2. These cards were selected both because of their prevalence of use in clinical settings, as well as their relative balance of ‘pull’ for positive (Card 2), negative (Card 13MF) and neutral (Cards 1, 12M and 14) narrative themes according to recent card pull research within this population (Ridenour et al, 2021). All TAT narratives were recorded and transcribed verbatim and rated according to the SCORS‐G training manual (Stein & Slavin‐Mulford, 2018).…”

“…The cognitive dimensions of the SCORS‐G evaluate an individual's capacity to define, integrate and differentiate between the mental states of characters in their narratives (COM) and to logically articulate the flow of social interactions and outcomes (SC). Prior studies have shown that these dimensional scores are rated more consistently across TAT cards, reflecting systematic and enduring characterological approaches to organizing interpersonal content (Ridenour et al, 2021). In contrast, the affective–relational dimensions (AFF, EIR, EIM, AGG, SE and ICS) have been shown to be influenced by both characterological tendencies (i.e., ingrained expectations for interpersonal outcomes) and the stimulus properties of the TAT cards, with the latter reflecting patterns of responsiveness to the test stimuli itself (Siefert et al, 2016; Stein et al, 2014).…”

“…We hypothesized that the cognitive dimensions of COM and SC would be the most likely to evidence changes in mean scores over time, based on past research showing that ratings on these dimensions tend to be more consistent across cards and reflective of the mentalization capacities that are typically a focus in psychotherapy treatment (Ridenour et al, 2021; Siefert et al, 2016; Stein et al, 2014). An essential element in most therapies focuses on the patient's ability to take a step back and observe themselves and other people whether it be in the service of insight, emotion regulation and/or behaviour change (Linehan, 2015).…”

“…The Social Cognition and Object Relations Scale—Global Rating Method (SCORS‐G; Stein & Slavin‐Mulford, 2018; Westen, 1995) is a clinician‐rated measure of object relations and social reasoning. It has been applied to a range of narrative materials, including early memory protocols (Pinsker‐Aspen et al, 2007), psychotherapy transcripts (Mullin et al, 2017), the Picture Story Exercise (Galtieri et al, 2022) and Thematic Apperception Test (TAT) stories (Murray, 1943; see also Ridenour et al, 2021; Stein et al, 2014). Though the SCORS‐G has been investigated as a predictor of symptom remission and behavioural change in response to treatment (see Stein & Slavin‐Mulford, 2018 for extensive review), only a handful of studies have examined change in underlying object relations in and of itself over the course of treatment using the SCORS‐G (Fowler et al, 2004; Josephs et al, 2004; Mullin et al, 2017, 2018; Mullin & Hilsenroth, 2014; Porcerelli et al, 2006).…”