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The Gardner Children's Projective Battery A Diagnostic Instrument for the Assessment of the Child's Psychodynamics
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HIGHLIGHTS
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INTRODUCTION Most therapists appreciate the importance of a proper psychological evaluation before proceeding upon a treatment course. If the child's problems are predominantly psychogenic (the most common situation), then a proper evaluation must include an in-depth assessment of the psychodynamic factors that underlie the child's symptomatology. The failure to conduct such an evaluation places the examiner in a significantly compromised position regarding the determination of the proper treatment program. This is in line with the ancient medical dictum that proper diagnosis must precede treatment. I use the word diagnosis here in the ancient Greek meaning of the word, namely, to know through, or to know in depth (dia: through or in-depth; gnosis: knowledge). Accordingly, I am not referring here merely to a diagnostic label (such as would be found in DSM-IV) which, however, generally gives little, if any, information regarding the underlying psychodynamic factors that have brought about a particular child's problems in the realm being labelled by the diagnosis. For example, a conduct disorder may be easy to diagnose. But there are a wide variety of psychological problems that can result in a child's developing a conduct disorder. Without eliciting information about the specific psychodynamic factors that are operative in that particular child's conduct disorder, the therapist is seriously compromised in the attempt to conduct effective therapy. TRADITIONAL ASSESSMENT INSTRUMENTS Traditional assessments for children often involve free picture drawing, The Draw-a-Person Test, The House-Tree-Person Test Kinetic Family Drawings The Children's Apperception Test (CAT), and, for older children, The Thematic Apperception Test (TAT). Sometimes The Rorschach Inkblot Test is included (even for children as young as five). Some examiners even include The Bender Visual Motor Gestalt Test as a source of information about psychodynamics, even though the instrument was designed to assess for the presence of organic brain dysfunction. There are even examiners who routinely administer an intelligence test, such as The Wechsler Intelligence Scale for Children-III (WISC-III) with the claim that psychodynamic information can be obtained in addition to information about the child's intelligence. It is also common for an evaluator to have a particular battery that is routinely given to all children. The battery described here is the one that I have gradually developed over the years since I first began treating children in 1957. I have selected those instruments and questions that I have found particularly useful for eliciting the specific psychodynamic factors that are operative in the child being evaluated for therapy. It does not include instruments such as the Thematic Apperception Test (TAT) and the Children's Apperception Test (CAT), which I consider highly contaminating (especially the CAT). These instruments present the patient with a picture that is designed to serve as the focus for psychological projections. The problem with these instruments is that they are quite specific and thereby contaminating of free associations. Generally, one can identify the number of individuals depicted, the gender, the approximate age, and the activity that the figure is engaged in. The universe of possible projections is thereby narrowed considerably, so much so that they are of low yield with regard to providing useful information about the specific psychodynamic processes operative in the child being assessed. For example, the first card of the TAT depicts a boy looking down at his violin, which is resting on a table. Common responses include the boy's concerns about practicing and/or fantasies of becoming a great violinist someday. The card pulls the child down into a specific set of associations, associations that may be very remote from the issues that are problematic for the child. The information thus elicited is usually of a very low yield regarding what is going on at that time in the mind of a child being assessed. The Rorschach Inkblot Test also has serious limitations for determining the specific psychodynamic patterns operative in the child being evaluated. The child's responses are compared to other individuals--assessed to be "normal" (whatever that means) or allegedly properly diagnosed--and statements are made regarding the presence of symptomatology and diagnostic category. Usually, the evaluator's report includes a wealth of data, so much so that it may be mind-boggling to the reader who can only wonder which of the multiplicity of symptoms, diagnostic possibilities, and psychological processes are most relevant and which are less relevant to the patient being assessed. Accordingly, the instrument may not be particularly useful for ascertaining the specific psychodynamic patterns operative in the patient being evaluated. Another problem with the administration of the TAT, CAT, and the Rorschach is that they are typically administered in a single session, one card presentation after the other. This is injudicious and can result in extremely unreliable responses, especially for the TAT and CAT. It is unreasonable to expect a child to continually provide self-created fantasies, one after the other. The human brain cannot deal well with such demands. Even an adult would find it difficult to comply with this request. Children, under these circumstances, begin to "lift" stories from other sources, e.g., television, videotapes, books, movies and reality experiences of their own as well as others. The examiner might not appreciate that he (she) is being duped (I do not hesitate to use that word) under these circumstances. Examiners rarely review these stories with the parents prior to writing their reports. (And most do not even review these stories with the parents after the report has been completed.) Those who do "check out" the stories with parents will often learn that a significant percentage of the stories extracted under such circumstances are not genuinely self-created and are derived from the aforementioned sources. Rorschach instructions typically take into consideration "contaminants" that are derived from one's profession, e.g., physicians (especially surgeons) are likely to provide medical percepts that might be considered morbid and atypical for the nonphysician, but typical for the doctor. The same principle, however, will hold for just about every examinee whose primary day-time activities are likely to be spinning around in his (her) brain in the course of the testing and thereby affect the projections. The Gardner Battery circumvents this problem by recommending that the evaluator provide no more than two to four projective stimulus cards at a time from the same set, thereby lessening the likelihood of eliciting nonself-created stories. The Kinetic Family Drawings also have the drawback of constriction, because the instructions direct the child to draw figures that are involved in specific actions. If the child were just instructed to draw a family, a wider variety of possible responses would be obtained. Evaluators utilizing The Draw-a-Person Test generally comment on the specific meaning of the figure parts per se and often give little, if any, attention to any fantasies, stories, and other projections about the figure that the child might provide. There have never been satisfactory studies that provide reliable interpretations of these figure drawings. It is often open territory for evaluators, each of whom may speculate differently regarding the meaning of the drawn figure. In courts of law it is not uncommon for different examiners to provide entirely contradictory explanations for the same figure drawing. Of course, speculations could also surround the meaning of a story the child provides. The story, however, is likely to be idiosyncratic and is subject, thereby, to fewer interpretations. Moreover, if the story's theme is repeated in response to other projective instruments, the examiner's interpretations are likely to be placed on a firmer foundation. WHAT'S UNIQUE ABOUT THE GARDNER BATTERY (GCPB)? The Gardner Children's Projective Battery (GCPB) attempts to circumvent and avoid the problems intrinsic to the utilization of the aforementioned traditional assessment instruments. Each of the 18 items in the Gardner Battery is designed to enable the examiner to elicit from the child the widest variety of possible responses with the least contamination, restriction, or canalization by the eliciting stimulus. The battery is designed to take about three hours to administer, preferably divided up into three or even four sessions. It is not necessary that the instruments be presented in any particular sequence, i.e., the examiner should not consider it necessary to start with Item #1 and proceed in orderly sequence to Item #18. In fact, as will be elaborated upon below, with some of these instruments, it is undesirable to administer all the elements in the item at one time. Rather, they should be spread out in order not to tax the child's unconscious processes in one realm to a significant degree. For example, one would not want a child to create 15 or 20 stories from The Storytelling Cards (Item #3), one after the other without interruption. It is unreasonable to expect a child to create so many original stories one after the other. It would be a rare child who could possibly comply meaningfully with such demands. Under such circumstances the child is likely to repeat the same story, tell stories about real events, or "lift" stories from books, television, and/or videotapes. Rather, only a few such cards should be utilized at a time (for example, two to four), then again later in the session, and then in the second or third meeting. The GCPB can generally be administered in about three to four hours, which is usually the time it takes to administer the kinds of traditional batteries described above. It is highly preferable that the administration be divided over three to four sessions in order not to tax the child. Obviously, data elicited when the child is in a state of fatigue is not likely to be valid. However, when the examiner has completed the GCPB, much more psychodynamic information will have been obtained than that which might have been elicited by the utilization of the aforementioned instruments. One reason for this is that the items in the GCPB are far less constricting and contaminating than the traditional instruments used for eliciting projections. Another reason is that each of the 18 items is designed to assess the individual psychodynamics of the particular child being evaluated without any attempt to compare that child with others. An important aspect of the Gardner Battery is the utilization of token rewards that serve to enhance the child's motivation to provide responses. We see here a good example of how a behavior modification technique can enhance the diagnostic process. The use of token rewards is not being used therapeutically here. Behavior therapy involves the use of token reinforcements to change behavior at the manifest level. When such treatment is being conducted, the examiner may have little, if any, concern about the underlying psychodynamics that may be operative in bringing about the target symptoms. In the GCPB, the token rewards are being utilized to enhance the child's motivation to provide psychodynamically meaningful material, which will then serve as a foundation for the psychotherapeutic process. The assessment kit in the GCPB includes a manual that provides examiners with detailed instructions for administering the Battery. Examiners must rely upon their training, knowledge, and experience to assess the meaning of the material provided by the child. The book Clinical Utilization of the Gardner Children's Projective Battery provides the examiner with numerous clinical examples and guidelines for the interpretation of the material provided by the GCPB. Clinical examples are provided from Dr. Gardner's own experience, examples that are likely to enhance the examiner's ability to assess reasonably the meaning of the child's productions. |