The Research Base, Psychometric Properties, and
Clinical Uses of the MMPI-2 and MMPI-A
JAMES N. BUTCHER
University of Minnesota
KENNETH S. POPE
Los Angeles, California
Abstract
The Minnesota Multiphasic Personality
Inventory (MMPI) has become the most
widely used personality assessment
instrument and is used in a broad variety of
clinical assessment settings. In the decades
since it was introduced, problems with the
instrument, such as the datedness of the item
wording, problems with some items, and
narrowness of the norms, have become
apparent. After considerable evaluation and
discussion, these problems led to a recent
revision and expansion of the instrument in
order to eliminate problems and to develop a
more sound psychometric instrument for
clinical assessment. This article describes the
revision of the instrument and summarizes
some of the main features of the MMPI-2.
After fifty years of service to applied psy-
chology, the MMPI has undergone its first
major revision. Why alter a popular and
widely-used clinical personality
assessment instrument, which is still
providing substantial service, and run the
risk of damaging it by making changes?
The need to correct serious problems had
become increasingly obvious and press-
ing, as documented in numerous books
and articles (e.g., Butcher and Tellegen,
1966; Butcher, 1972; Butcher and Owen,
1978; Colligan, Osborne, Swenson, and
Offord, 1983; Faschingbauer, 1979; Nor-
man, 1972).
Canadian Psychology/Psychologie canadienne, 1992, 33:1
First, published critiques have noted
problems at the item level. The sexist
wording and assumptions of various
items in the original instrument have been
offensive to many and might introduce
bias (influencing, for example, test-taking
attitude and the rapport and trust estab-
lished — or thwarted — between client and
clinician). Other items may unintentional-
ly embody different (e.g., racial) forms of
bias, prejudice, or discrimination. Erdberg
(1988), for example, reports that in one
research study of a rural population, one
MMPI item, taken by itself, perfectly dis-
criminated all Black test-takers from all
Caucasian test-takers. Still other items
have become increasingly archaic. For
example, a childhood game popular over
fifty years ago may be unknown to most
people taking the test in the 1980's. Still
other items are objectionable to some test-
takers (e.g., these items are offensive to
those of certain religious faiths).
Second, critiques have noted problems
with the norms. The normative sample,
collected in the late 1930's, on which the
MMPI scales were developed, did not
include those from Asian, Black, Hispanic,
Native American, and various other eth-
nic groups, and were unrepresentative of
the American population in other signifi-
cant ways. Furthermore, Colligan et al.
(1983) found that the norms of the 1930's
are so dated that they are inappropriate
for use with contemporary individuals:
"These MMPI changes are not only statis-
tically significant but are also of clinical
importance" (p. xv). Faschingbauer (1979)
summarized some of the problems with
norms in vivid terms:
62 Butcher & Pope
The original Minnesota group...seems to be an
inappropriate reference group for the 1980s.
The median individual in that group had an
eighth-grade education, was married, lived in
a small town or on a farm, and was employed
as a lower level clerk or skilled tradesman.
None was under 16 or over 65 years of age,
and all were white. As a clinician I find it
difficult to justify comparing anyone to such a
dated group. When the person is 14 years old,
Chicano, and lives in Houston's poor fifty
ward, use of original norms seems sinful,
(p- 375)-
Third, critiques have noted psychometric
problems in the customary ways in which
the T-scores are interpreted. Greene
(1980), for example, called attention to
inconsistencies among various raw score
and T-score tables. The T-scores on the
standard profile sheet are based upon the
purified sample; the T-scores based on
norms provided in the Handbook and most
of the other MMPI references, however,
were derived from the original sample.
Greene (1980) notes that "this discrepancy
can be the source of considerable con-
fusion" (pp. 21-22). As another example,
Colligan et al. (1983) noted the
widespread misconception that the profile
sheet's standard scores represented nor-
malized T-scores (i.e., that they are based
upon the normal probability curve) rather
than a linear transformation. The linear
transformation maintains the considerably
skewed distribution of some raw scores.
"Thus, scale elevations of similar degree
in terms of T-scores unfortunately, do not
have equivalent meanings in terms of
deviation from the mean (this, is, percen-
tile rank)" (pp. xiv-xv).
When psychologists become aware that
an assessment instrument's content and
wording embody sexist assumptions, that
the selection process for normative
reference samples was racially biased
(even if such discrimination was uninten-
tional), or that similar problems exist with
the instrument and its empirical base, the
need to address these issues promptly
and rigorously and to implement correc-
tions is a clear clinical, scientific, and
ethical mandate (Pope & Johnson, 1987;
Pope & Vasquez, 1991).
Formation of The MMPI Revision
Committee
Some people have asked why it has taken
so long to revise the MMPI. A number of
factors prevented the instrument from
being revised earlier. Of course, the cost
of revising a major instrument like the
MMPI is staggering and no provision for
revision had been made in the original
publication arrangements. Since the MMPI
is an owned and copyrighted instrument,
only the owner or a designated party can
alter the test. The test authors themselves
did not participate in the revision since
one of the test authors (McKinley) was
deceased and the other (Hathaway) had
retired in the early 1970s.
The most likely reason why the MMPI
was never revised in the past is that it
was widely used and performing well.
Why change something that is so success-
ful? Given its continued success, it was
apparent that any revision of the MMPI
had to include the goal of keeping some
aspects of the instrument intact, at least
the valid and still appropriate aspects,
while making necessary changes and
launching an expansion of the scope of
the instrument.
Once the editorial staff of the University
of Minnesota Press, the copyright holder,
became convinced that a revision was
needed they appointed a committee com-
posed of James Butcher, John R. Graham,
W. Grant Dahlstrom, and Auke Tellegen
to conduct the restandardization study
and develop new norms for the MMPI-2.
The project, initiated in 1982, was funded
by the University of Minnesota Press out
of general revenues from the MMPI and
from the Minnesota Report, a computer
scoring and interpretation service distrib-
uted by National Computer Systems

(NCS). NCS collaborated in the
restandardization by providing test scor-
ing and data processing.
Goals of the MMPI Restandardization
First, the Committee members
unanimously agreed that the revision of
the MMPI should be a "conservative" one
in that the basic measures, on which the
MMPI's reputation has been built — the
validity and clinical scales — should be
kept relatively intact in order to preserve
the half century of research supporting
their use. The items making up those
scales, except a few objectionable items of
a few scales, were kept in the revised
instrument in order to maintain continuity
with the original instrument.
Second, the Committee agreed to collect
extensive normative and clinical data
(using an expanded 704 item booklet
containing all original items plus 154 new
items) to evaluate and justify any changes
made to the instrument and to serve as
information to be used in the expansion of
the MMPI.
With these two basic premises for the
revision, the Committee then established
a number of goals in order to:
a) Develop a new, broadly representa-
tive, normative sample for use for
improving the MMPI norms and for serv-
ing as a more relevant population for new
scale development.
b) Modernize the MMPI booklet by
deleting objectionable, non-working, or
obsolete items and expanding the item
pool to include additional items address-
ing contemporary clinical problems such
as treatment readiness, suicide, alcohol
and drug problems, and so forth. The goal
of keeping the final MMPI-2 booklet at
about the same number of items as the
original was accomplished. The MMPI-2
contains 567 items; the clinical and valid-
ity scales, however, can be obtained by
administering the first 370 items.
c) Maintain the continuity of the
original validity and clinical scales by
MMPI 63
keeping them intact, that is, comprising
the same items as the original scales.
d) Develop new MMPI norms that
would better reflect clinical problems and
would resolve the problem of non-uni-
formity in percentile classification.
e) Collect new clinical data for evalu-
ating changes that needed to be made in
the items and scales.
f) Develop new scales that address
additional clinical problems that were not
covered in the original MMPI.
g) Develop an additional form of the
MMPI that would be appropriate for use
with adolescents. The MMPI-A, which has
new norms for adolescents aged 14
through 18, includes items from the orig-
inal validity and clinical scales as well as
a number of new items specific to adoles-
cent problems.
The MMPI-2 Normative Sample
The MMPI-2 normative sample comprises
2600 individuals (1,462 women and 1,138
men) who were selected from seven
regions of the United States (California,
Minnesota, North Carolina, Ohio,
Pennsylvania, Virginia, and Washington).
Efforts were made to balance the norma-
tive sample according to gender, age,
ethnic group membership, education, and
place of residence. For example, 2.4% of
the male sample and 2.1% of the female
sample were drawn from among Native
American adults residing on a federal
reservation. The final normative sample
matches the demographic mix of the
national population well on most vari-
ables.
The MMPI-2 normative sample is more
appropriate for contemporary subjects
because it is balanced for demographic
variables such as ethnic group member-
ship. The new normative sample reflects
a higher educational level than the dated
original sample. It is important to exam-
ine this shift carefully from two perspec-
tives: historical and psychometric.
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Historically, there has been an increase
in the educational level of the population
since the 1930's (see Butcher, 1990c). The
average education of the United States
population is currently over 13 years (i.e.,
high school plus around one year of
college) whereas the mean education of
the population in the 1930's, when the
original MMPI norms were collected, was
about ninth grade. Thus, the new MMPI-2
norms more closely match the educational
backgrounds of individuals taking the test
today than do the original norms.
Psychometrically, however, the educa-
tional level of the individual taking the
test does not greatly influence the MMPI-2
scores. Inspection of the group mean
profiles of the MMPI-2 normative subjects
from different levels of education in Fig-
ures 1 and 2 clearly shows that the aver-
age profiles are almost indistinguishable
across the five educational levels (Butcher,
1990a). Interpretation of profiles of indi-
viduals from different educational back-
grounds does not require the special
considerations needed with the original
MMPI. The "mental adjustments" for
education — adjustments that were not
well calibrated empirically and thus
weakened the actuarial or empirical basis
of the instrument — that needed to be
made when interpreting the original
MMPI Mf and K scores do not need to be
made when interpreting those two scores
on the MMPI-2. The only cautions needed
are when interpreting Mf scores of men
with very low or very high educational
levels.
Individuals were randomly sollicited,
initially contacted by letter, and asked to
come to a prearranged testing site for
completion of the test battery. In addition
to the 704 item experimental version of
the MMPI (Form AX), all individuals
were administered a biographical history
questionnaire and a life events question-
naire. In addition, a portion of the sample
(822 couples) were given the Dyadic
Adjustment Questionnaire (Spanier &
MMPI 65
Filsinger, 1983) and asked to complete a
personality rating form on their spouse.
This information has provided valuable
data as initial validity correlates for the
MMPI-2.
Why Does Today's Normative Group
Appear to Have More Pathology than the
Original Minnesota Normative Group?
When individuals in the contemporary
normative group are given the MMPI and
scored on the original MMPI norms, their
scores are typically elevated on all of the
clinical scales at about a half standard
deviation above the mean. Does this mean
that people today are more afflicted with
pathological states, traits, or symptoms
than people were fifty years ago when the
test was originally standardized? Have
people today deteriorated in their mental
health compared to those from the last
generation?
Actually, a comparison of item response
differences between today's normative
sample and the original MMPI normative
sample does not show many consistent
item response differences to support an
interpretation of increased psycho-pathol-
ogy in the society at large.
Why then are there MMPI scale differ-
ences between the original Minnesota
normative group and a contemporary
sample of individuals drawn from the
community? One contributing factor is
that the instructions that the original
standardization sample followed in taking
the test were different from those we
employ in administering the instrument
today. Hathaway and McKinley (1940)
allowed test-takers to omit items of which
they were unsure or which they felt did
not apply to them. Many individuals
omitted a considerable number of items,
typically more than 30 items. In practice
today, we encourage those who take the
inventory to try to answer all of the items.
This results in the endorsement of more
items that are scored on the clinical scales,
hence, more scale elevation on average.
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Fig. 2 Group mean MMPI-2 profiles for females summarizing scores for each level of education found in the MMPI-2. Restandardization sample.

The new MMPI-2 normative responses
were collected using the same instruc-
tional set used in clinical practice. The
individuals in the normative group were
encouraged to try to answer all items.
Most individuals omitted fewer than 2
items.
The MMPI-2 Norms
Originally, Hathaway and McKinley
(1940, 1943) developed the MMPI norms
using a linear T-score transformation. As
noted earlier, scores were assigned a
mean of 50 and a standard deviation of
10, even though the underlying distribu-
tions were somewhat skewed.
Other researchers (Colligan, et al., 1983)
have recently recommended the use of a
different transformation approach: nor-
malized T-scores to compensate for the
skewed scale distributions. This trans-
formation approach, however, produces
T-score distributions that are quite differ-
ent from the original Hathaway and
McKinley T-scores. This has the effect of
pulling all scores toward the mean and
not allowing outlying scores to appear as
"visually extreme" on the profile as they
would in the original Hathaway-McKinley
T-scores.
Graham & Lilly (1986) showed that
normalized T-scores produce MMPI dis-
tributions that are not comparable to the
linear Ts in the original MMPI. Actually,
there is nothing "wrong" with normalizing
these MMPI scale distributions except that
clinicians are not accustomed to interpret-
ing such low ranging distributions and
would likely not find the normalized
distributions as easy to interpret as the
original MMPI T-scores developed by
Hathaway and McKinley.
The MMPI Restandardization Commit-
tee chose to follow, to some extent,
Hathaway's linear T-score approach,
except that some modification was made
in order to make the distributions for the
MMPI scales uniform with regard to
percentile value. That is, the percentile
MMPI 67
rank would be equivalent for each T-score
level for each scale. The MMPI-2 T-scores,
referred to as uniform T-scores, were
developed by using the eight clinical
scales to form a composite distribution.
For the eight clinical scales, separated
by gender, a transformation was derived
for converting each scale's raw scores into
the corresponding uniform T-scores. This
was achieved by regressing raw scores on
percentile-equivalent uniform T-scores.
Uniform T-scores were developed for the
8 clinical scales and the 15 MMPI-2 con-
tent scales. Tables for converting these
raw scores into uniform T-scores are
provided in the MMPI-2 Manual (Butcher,
Dahlstrom, Graham, Tellegen &
Kaemmer, 1989).
Interpretation of MMPI-2 Scores: A Shift
in Level of Clinical Significance
When interpreting profiles with the orig-
inal MMPI, clinicians usually considered
a T-score of 70 to be the point at which
clinically significant elevation was
obtained, that is, the clinical range of
scores began at the T-score of 70. Theor-
etically, this T-score level fell at a percen-
tile score of 95, although as we have
seen,this did not occur in practice since
percentile equivalents for a given T-score
were not uniform.
With MMPI-2, the 92nd percentile mark
falls at a T-score of 65 on all of the clinical
scales. Consequently the MMPI-2 Com-
mittee has made the recommendation that
a T-score of 65 or greater demarcate the
"clinical range" (Butcher, Dahlstrom,
Graham, Tellegen & Kaemmer, 1989). In
clinical practice, the 65 T-score level
appears to be optimal for separating
known clinical groups from the MMPI-2
normative sample.
In order to illustrate the importance of
the 65 T-score cut off score for the clini-
cally interpretable range, data from two
studies are presented in Figures 3 and 4.
Keller & Butcher (1991) found that the
optimal separation for chronic pain
68 Butcher & Pope
Percent of Sample
30 40 50
Normative (N-1462)
Fig. 3 Uniform T-Score Distibutions for HS: Normative Sample vs. Pain Sample (Women). (Source: Keller &
Butcher, 1991).
patients to be at about the 65 T level on
the Hs scale (see Figure 3). Butcher
(1989b) found the 65 T-score to be a valu-
able cut off score for separating depressed
inpatients from the normative sample (see
Figure 4).
What do the MMPI-2 Validity and Clini-
cal Sales Measure?
The MMPI-2 clinical and validity scales
are virtually identical to the original scales
and therefore they measure what they
have always measured. Recently a psy-
chologist, using the MMPI-2 Pd scale in a
study, provisionally concluded that the
scale did not seem to measure "Pd
behavior" in the same way as the original
MMPI Pd scale. His preliminary
conclusion was that the scale was possibly
not as "valid" as the original Pd scale.
This criticism is based on a misunder-
standing of the MMPI revision. The Pd
scale measures "Pd behavior" in exactly
the same way as the original scale did
since it is exactly the same scale. No items
have been dropped and no items added.
60 70 80 90 100 110
T-Score
Chronic Pain (N=234)
If one makes a comparison of the original
MMPI Pd raw scores and the MMPI-2
raw scores, the correlates of differences
will be exactly the same. Most statistical
comparisons in research studies employ
raw scores for psychometric analyses
(Butcher & Tellegen, 1978).
There is a difference, however, in the
way in which this raw score is interpreted
through comparing the scores with the
new T-score distributions based upon the
MMPI-2 norms. There will be a difference
in the elevation of the Pd score for a
given individual if the score is compared
to the new versus old norms. The same
raw score will produce a different T-score
elevation in the old versus the new
norms. This change in relative elevation
using new T-scores comes about by the
use of more contemporary reference
groups which, as we have seen, is more
appropriate for contemporary compari-
sons.
It is possible for practitioners to exam-
ine profiles of individuals on the original
norms who were tested on the MMPI-2

Percent of Sample
20 30 40 50
T-Score
Normative (N=1138)
Fig. 4 Uniform T-Score Distributions for D. (Source: Butcher, 1989b).
version of the instrument. The MMPI-2
manual (Butcher, Dahlstrom, Graham,
Tellegen & Kaemmer, 1989) allows for the
transformation of MMPI-2 raw scores into
original T-scores. This transformation
procedure will be of value in making
comparisons on MMPI norms for individ-
uals who were tested on the MMPI-2.
Reliability of the MMPI-2 Validity and
Clinical Scales
Data were collected on the test-retest
reliability of the traditional validity and
clinical scales (Butcher, Dahlstrom,
Dahlstrom, Graham, Tellegen &
Kaemmer, 1989). An average of 8.58 days
(median of 7 days) elapsed between the
first and second administration. The
length of the interval produced no trends.
For male adults, the retest coefficients
ranged from r = 0.67 (standard error of
measurement = 1.63) for Paranoia to r =
0.89 (standard error = 2.24) for
Psychasthenia. For female adults, the
retest coefficients ranged from r = 0.58
(standard error = 1.98) for Paranoia to r =
MMPI 69
60 70 80 90 100
~ * ~ Depressive (N=43)
0.91 (standard error = 2.86) for Schizo-
phrenia.
Congruence Between MMFI and MMPI-
2 Scale Scores and Profile Codes
A natural question of anyone who has
grown accustomed to the MMPI and
perhaps has baseline MMPI data in his or
her patient or research files is: Do the
MMPI-2 scores and codetypes have a low
congruence with the original MMPI vari-
ables? The extensive research has shown
a high congruence.
First, it should be remembered that the
MMPI validity and clinical scales have
been preserved relatively intact in the
MMPI-2. Most of the scales contain exactly
the same items as the original MMPI
scales. Ben-Porath and Butcher (1989), in
a test-retest study in which participants
were given either two administrations of
the original MMPI or administrations of
both the MMPI and the MMPI-2, found
that MMPI-2 scales have the same degree
of relationship to the original MMPI
scores as the original MMPI scales have
7O Butcher & Pope
with themselves in subsequent adminis-
trations of the test. The MMPI-2 has been
shown to be a highly reliably measure of
the original MMPI variables. (It is obvi-
ously important that any such compari-
sons utilize adequate comparison groups
and procedures. An experimentally naive
researcher, for example, might simply
administer an MMPI and then, after a
brief period, administer the MMPI-2 for
comparison. Such research would leave
uncontrolled or unexamined such con-
founding variables as test-retest effects,
order effects, statistical regression, etc.).
Recently, Graham and Ben-Porath
(1990) found that the MMPI-2 scales and
profile codes are highly congruent (94%
for men and 95% for women in the
restandardization sample; 82% for men
and 94% for women psychiatric patients)
with the original MMPI scales and profile
codes if they are well defined (i.e., if the
scales or codes have a difference of 5 T-
score points between the next higher
score). Graham and Ben-Porath further
found that in a psychiatric sample only
about 14% of profile codes change when
scored on the two different norms. Even
when the profile codes are comprised of
different scales, at least 91% had the same
highest scale in the two codes, indicating
that a congruent interpretation is likely to
be made with the MMPI-2 and MMPI
codes.
Finally, Graham and Ben-Porath (1990)
found that in the few cases where a dif-
ferent MMPI and MMPI-2 code emerges,
validity data (from personality rating
studies) indicate that the MMPI-2 code
tends toward being more accurate in
prediction than the original MMPI code.
New MMPI-2 Content Scales
Assessing content themes has become an
important part of clinical MMPI inter-
pretation over the past twenty years.
Clinicians find that homogeneous content
scales are relatively easy to interpret and
to explain to others (Bursich, 1984). Some
content measures from the original MMPI,
for example the Harris-Lingoes Scales or
the Koss-Butcher Critical Items, are avail-
able, virtually intact, in the MMPI-2.
Others, particularly the Wiggins Content
scales, are not available in MMPI-2 since
many of their items were deleted because
they contained objectionable content and
the Wiggins scales are no longer represen-
tative of the MMPI-2 item pool since new
items were incorporated.
A new set of MMPI-2 content scales
was developed by Butcher, Graham,
Williams, and Ben-Porath (1989) to assess
the main content dimensions in the
MMPI-2. The scales were derived by a
multimethod, multistage strategy involv-
ing both rational and statistical
procedures to assure rational content
relevance and strong statistical properties.
The 15 content scales assess important
personality factors (e.g., Antisocial Prac-
tices or Obsessiveness), symptomatic
behavior (e.g., Depression, Anxiety) or
address important clinical problem areas
(e.g., Family Problems, Negative Treat-
ment Indicators).
The 15 scales are:
(1) Anxiety
(2) Fears
(3) Obsessiveness
(4) Depression
(5) Health Concerns
(6) Bizarre Mentation
(7) Anger
(8) Cynicism
(9) Antisocial Practices
(10) Type A
(11) Low Self-Esteem
(12) Social Discomfort
(13) Family Problems
(14) Work Interference
(15) Negative Treatment Indicators.
The MMPI-2 Content Scales have been
shown to have considerable appeal for
clinical practice since they cover a broad
range of problems and are intuitively
understandable. In addition, they show
strong internal psychometric characteris-

tics and external validity. The external
validity of the MMPI-2 Content Scales
have been shown to be equal to or greater
than the original MMPI clinical scales
(Butcher, Graham, Williams, and Ben-
Porath, 1990).
New Validity Measures in the MMPI-2
Assessing the validity and applicability of
a particular patient's profile has always
been viewed as an important facet of
profile interpretation. Appraisal of the
validity scales must be done to assure the
adequacy of the individual's self report.
The traditional MMPI validity scales
(Cannot Say, L, F, and K) have been
maintained in the MMPI-2 and operate in
the same manner (Graham, Watts &
Timbrook, 1991).
In addition, several other measures
have been incorporated to assess more
adequately the individual's test taking
attitudes. These scales are:
THE F(B) SCALE
Since all of the F scale items of the orig-
inal MMPI appear in the first 370 items in
the booklet, there is not a measure of
symptom exaggeration for items toward
the end of the item pool. An additional
infrequency measure, the F(B) scale was
developed for the MMPI-2 to detect poss-
ible deviant responding to items located
toward the end of the item pool. The 40
item F(B) Scale was developed following
the same procedures as the original F
scale, that is, by including items that had
low endorsement percentages in the nor-
mative sample. This scale is particularly
valuable in interpreting the MMPI-2 Con-
tent Scales that require valid response to
the full item pool.
MMPI-2 CONSISTENCY SCALES
In addition to the original MMPI validity
scales (L, F, and K) which enable the
practitioner to assess client motivation to
distort responses, two new scales have
been developed for the MMPI-2 to assess
MMPI 71
inconsistency of responding. These scales,
True Response Inconsistency (TRIN) and
Variable Response Inconsistency (VRIN),
assess the extent to which the individual
has endorsed semantically related items in
a consistent fashion. For example, if the
following two items were both marked
true or were both marked false, the
individual's responses would be inconsist-
ent: "Most of the time I feel blue" and "I
am happy most of the time." The response
in consistency scales will enable the
clinician to determine if the individual has
answered in a non-content oriented man-
ner (e.g., using a random response set).
VRIN raw scores exceeding 12 and TRIN
raw scores of less than 6 or more than 12
form rough criteria for significantly incon-
sistent responding (Butcher, Dahlstrom,
Graham, Tellegen & Kaemmer, 1989).
CONTROVERSIAL "SUBTLE-OBVIOUS" SCALES
In the past, some investigators have relied
upon the Weiner-Harmon (Weiner, 1948)
"subtle" scales to assess test validity
(Greene, 1980). These scales have been
somewhat controversial and a number of
researchers have cautioned against reli-
ance upon them (Graham, 1987). Scoring
keys for the Weiner-Harmon subtle scales
are available in the MMPI-2 for those who
plan to continue to research them,
although the MMPI Restandardization
Committee was not unanimously support-
ive of their inclusion (Butcher, Dahlstrom,
Graham, Tellegen, and Kaemmer, 1989).
Research employing the MMPI-2 nor-
mative data and a clinical study of
couple's in therapy (Hjemboe & Butcher,
1991) has shown that the subtle scales are
poor psychometric instruments in that
they have low alpha coefficients compared
to those of the obvious items and the full
MMPI score (Butcher, 1989a). Moreover,
Weed, Ben-Porath, and Butcher (1990)
have shown that the subtle items failed to
predict external correlates (spouse behav-
iour ratings). The obvious items on the
MMPI scales showed higher external
72 Butcher & Pope
validities than even the full MMPI score.
This study showed that the subtle items
actually reduce the validity of the clinical
scales.
THE REVISED ADOLESCENT FORM OF THE
MMPI (MMPI-A)
Even though the original MMPI was
developed for use with adults, it has been
one of the most popular instruments for
assessment of adolescents. Numerous
studies detail the effectiveness of the
instrument with adolescent populations,
for example: In psychiatric settings
(Archer, Gordon, Giannetti & Singles,
1988; Dudley, Mason & Hughes, 1972;
Marks, Seeman & Haller, 1974), medical
settings (Colligan & Osborne, 1977); cor-
rectional settings (Gold & Petronis, 1980;
Hathaway & Monachesi, 1963), and drug
and alcohol settings (Wisniewski,
Glenwick & Graham, 1985; Wolfson &
Erbaugh, 1984). Moreover, Hathaway and
Monachesi (1963) conducted an extensive
study examining the performance of the
MMPI with normal teenagers in a public
school setting.
Several limitations have been noted for
the use of the MMPI with adolescent
populations. The items on the original
MMPI were oriented toward adult sub-
jects both in terms of the wording of the
items and in the range of relevant content;
few scales were developed specific to
adolescent problems; broad base norms
for the MMPI clinical scales have not been
available; and interpretive information has
been limited and mostly involves a down-
ward extension of adult interpretive strat-
egies.
The MMPI Restandardization Commit-
tee initiated a revision and expansion of
the MMPI for adolescents in 1982. The
MMPI item pool was revised and
broadened by incorporating new adoles-
cent specific items. New adolescent norms
have been collected on 805 boys and 815
girls from several states: Minnesota, Ohio,
North Carolina, California, Pennsylvania,
Virginia, Washington State, and New
York and the samples were balanced for
age and ethnic group membership. The
revised version of the MMPI for adoles-
cents (MMPI-A) contains 478 items with
objectionable and adolescent-irrelevant
items removed (Butcher, Williams,
Graham, Archer, Tellegen, Ben-Porath &
Kaemmer, in press). The validity and
clinical scales have been kept virtually
intact in MMPI-A; however, Mf and Si
have been reduced in length.
The MMPI-2 content scales (Butcher,
Graham, Williams & Ben-Porath, 1990)
have been expanded and validated for use
with adolescent populations. The MMPI-A
content scales that parallel the MMPI-2
content scales are: Anxiety (anx),
Obsessiveness (obs). Depression (dep),
Health Concerns Qiea), Bizarre Mentation
(biz), Anger (ang). Cynicism (cyn), Low
Self Esteem (fee), Social Discomfort (sod),
Family Problems (fam), and Negative
Treatment Indicators (TRT). In addition,
four new content scales were developed
that focus upon specific adolescent prob-
lems. They are Conduct Problems (con),
Alienation (aln), Low Aspirations (las),
and School Problems (sch). Although these
scales were developed according to a
combined rational and statistical scale
development strategy, they were found to
have strong external validities when
evaluated against external correlates
(Child Behavior Checklist, Deveraux
Adolescent Behavior Rating Scale, and
clinical behaviors) in a clinical validation
study (Williams, Butcher, Ben-Porath &
Graham, in press).
The MMPI-A is likely to be useful to
adolescent clinical assessment programs
since the inventory is shorter than the
original instrument, contains more rel-
evant adolescent content, and incorporates
several new scales that focus upon adoles-
cent problems in addition to the tradi-
tional validity and clinical scales.

Clinical and Ethical Issues
As with any assessment instrument, there
are pitfalls likely to plague the
inadequately trained or careless clinician.
Unfortunately, the process of assessment
itself forms the basis of a disappointingly
significant percentage of the malpractice,
ethics, and licensing complaints against
psychologists (Pope, 1989a). Pope and
Vasquez (1991) discuss some of the more
general problem areas. In this article, we
will highlight a few issues directly rel-
evant to the MMPI-2, although they are
relevant also to the more general use of
psychological tests.
KEEPING PACE WITH DEVELOPMENTS
Psychology takes justifiable pride in itself
as an empirically-based profession.
Approaches to clinical work are constant-
ly subjected to research and are validated,
refined, or discredited. Those who enter
the field assume a crucial though some-
times burdensome responsibility to keep
abreast of empirical findings relevant to
their areas of practice. This professional
responsibility is especially significant in
the field of testing in which data regard-
ing norms, validity, reliability, and applic-
ability are constantly redefining our
understanding of effective assessment.
Erdberg (1988), Fowler (1988), and Weiner
(1988), for example, have each stressed
that anyone whose knowledge of assess-
ment instruments and procedures has not
been significantly updated in the last five
years is practicing in an incompetent and
unethical manner.
Clinicians utilizing the MMPI need to
obtain a solid working knowledge of the
current norms and psychometric prop-
erties as well as the evolving empirical
base of this inventory. Continued use of a
dated version of a test —particularly one
involving such problems as sexist word-
ing of items and the exclusion (even if
unintentional) of racial minorities from
the normative sample — seems hard to
justify scientifically, clinically, and
MMPI 73
ethically when a revised version that
addresses these problems is available.
THE REQUIRED READING LEVEL
Although the inventory provides internal
checks to ensure that this criterion is met,
clinicians should ensure that individuals
to whom they administer the test current-
ly have at least a sixth grade reading level.
The method of reading level determina-
tion originally used in the evaluation of
the MMPI-2 items suggested that an
eighth grade reading level was needed
(Stenner, Horabin, Smith & Smith, 1988).
This conclusion has recently been ques-
tioned, however, and other reading level
determination programs have suggested
that a 6th grade reading level is more
appropriate.
CAREFUL ADMINISTRATION
It is tempting for any of us, as busy
clinicians, to look for short cuts in the
testing process. This inventory, however,
requires the same rigorous care appropri-
ate to any standardized instrument.
Supervision of the testing process is
especially important. Among the reasons
for carefully monitoring a client's comple-
tion of the inventory — rather than, for
example, allowing the client to take it
home and complete it whenever he or she
finds time — are the following.
First, individuals both in the original
MMPI normative sample and in the cur-
rent version's contemporary normative
sample took the test under carefully
monitored conditions. Altering the admin-
istration process can significantly influ-
ence the results of a standardized test, the
power of which is dependent upon main-
taining the standard format of administra-
tion. As Faschingbauer (1979), for
example, wrote:
We know, for example, that the MMPI can
provide false information when the usual
mental health testing environment is altered.
Hence, we were taught as students to be
74 Butcher & Pope
concerned about the settings in which tests are
administered. Some of us had this point per-
sonally accentuated when we sneaked off to
take the MMPI in our offices only to be
startled by the unusually high elevations this
private setting produced. To be reliable and
valid any test should be administered in a
setting close to that employed in the normative
studies, (p. 384).
Second, in reporting assessment results
psychologist should explicitly address
testing circumstances that may affect the
validity or reliability of the test results.
How could psychologists who fail to
monitor the circumstances under which
the client completes the inventory fulfill
this obligation?
Third, clients who are directed to fill
out the inventory in an unsupervised
setting may be influenced by others while
they are pondering the questions. In some
cases, test data obtained in the ordinary
course of clinical work may later become
crucial (e.g., as baseline data establishing
the client's condition prior to a trauma) in
civil or criminal litigation. If the psychol-
ogist cannot establish clearly that the
assessment was monitored, the data may
be discredited or excluded and the client
may be deprived of acceptable and reli-
able clinical information to which he or
she is entitled.
Fourth, when psychologists fail to
monitor the administration of a standard-
ized test such as the MMPI, they are
violating the published finding of APA's
Committee on Professional Standards
(1984). When a complaint was filed with
the Committee regarding a psychologist
who had given his client an MMPI to take
home, the Committee found that when-
ever a psychologist
does not have direct, first-hand information as
to the condition under which the test is taken,
he or she is forced (in the above instance,
unnecessarily) to assume that the test
responses were not distorted by the general
situation in which the test was taken (e.g.,
when the client consulted others about test
responses). Indeed the psychologist could have
no assurance that this test was in fact com-
pleted by the client. In the instance where the
test might be introduced as data in a court
proceeding it would be summarily dismissed
as hearsay evidence, (p. 664).
One of the authors observed a patient
taking the MMPI in an outpatient waiting
room while the psychologist worked in
his office. Frequently when the patient
marked down a response, the patient's
spouse, who was reading along,
commented, "now that's not you!" or
"That's not what you believc.Change that
answer!" The patient would re-read the
item, reconsider, and they dutifully
change the answer.
John R. Graham (personal communica-
tion) reported an intriguing phenomenon
at a psychiatric hospital. He noticed that
at frequent but irregular intervals a large
group of patients who had assembled in
the dayroom raised their hands high in
the air. When he investigated, he found
that a psychologist had given an MMPI to
one of the patients, telling him to com-
plete the form and then return it to the
psychologist's office. The patient had
asked for help from his fellow residents.
As the patient read aloud each of the
items, the assembled group would raise
their hands to vote on whether the item
should be answered true or false.
Pope, Tabachnick, and Keith-Spiegel
(1987, 1988) have published national sur-
vey data concerning both the practices
and beliefs of psychologists in regard to
"having clients take tests (e.g., MMPI) at
home" as well as to related assessment
issues such as "not allowing a client
access to a testing report."
MMPI-2 TEST RESULTS AS HYPOTHESES
Clinicians must constantly keep in mind
that the results of an actuarially-based
instrument such as the MMPI do not

constitute conclusively authoritative pro-
nouncements but rather generate hypoth-
eses that the clinician must then evaluate
in light of other sources of data.
CLINICAL USES AND REFERENCE GROUPS
Clinicians must be acutely aware of the
degree to which certain clients to whom
they administer the inventory may differ
(e.g., in terms of background experiences)
from those who have participated in
either the original normative sampling or
the subsequent research. Similarly, they
must be alert to the ways in which the
uses to which they put the MMPI-2 may
differ from the uses validated or explored
in the accumulated research. For example.
Pope and Bouhoutsos (1986) described the
utilization of the MMPI in screening
patients (who had been sexually abused
by a prior therapist) for admission to
group therapy in UCLA treatment pro-
grams. The traditional MMPI indicators
for suitability for group therapy appeared
to lack predictive validity for this particu-
lar subset of patients. In some of the most
extreme instances, sexually abused
patients whom the MMPI results seemed
to indicate were unable to participate
meaningfully in — let alone benefit from
— outpatient group therapy were never-
theless able to respond positively in this
treatment modality.
Another example of a subset who
would warrant special consideration are
psychologists who have engaged in sexual
intimacies with a patient (see Pope, 1989b,
1990a, 1990b; Pope & Vetter, 1991); indi-
viduals who are familiar with the test and
may have administered and scored it
literally hundreds or thousands of times
may differ in crucially significant ways
from the sample of individuals involved
in the normative and subsequent research.
When used with appropriate reference
groups, the MMPI-2 has shown excep-
tional usefulness in assessment and treat-
ment planning (Butcher, 1990b).
MMPI 75
USE OF AUTOMATED SCORING AND INTER-
PRETATION SERVICES
Research indicates that computer-based
test scoring and interpretation services
have been widely accepted by psychol-
ogists;fessthan 40% report never "using a
computerized test interpretation service"
(Pope, Tabachnick, and Keith-Spiegel,
1987, 1988). Those who rely upon such
services should clearly understand the
decision rules by which raw data are
transformed into interpretive statements
and the evidence regarding the validity,
reliability, and related psychometric prop-
erties of the instrument and program.
Those providing the computerized
services have a clear ethical, scientific, and
professional responsibility to provide a
written presentation of this information.
Psychologists who provide services
include scoring and interpretation of tests
must be able to demonstrate (i.e., through
producing appropriate evidence) the
validity of the programs and procedures
upon which the service is based. Test
users must be given the original scores
from which interpretive statements are
derived, must also be given access to the
matrix of original scores, and the manual
or interpretive report must set forth how
the interpretive statements are developed
from the original scores. Clinicians must
adequately understand the tests they are
using in their practice and the ways in
which inferences are drawn from those
tests. If they lack this understanding, they
are functioning outside their area of com-
petence (Pope & Vasquez, 1991).
Conclusion
Change is inherent in an empirical disci-
pline, a fact recognized by those who
initiated and supported the creation of the
inventory. Both the original developers of
the MMPI and the holder of the copyright
recognized the need to update the instru-
ment and to address certain serious prob-
lems with the original version. MMPI-2 is
76 Butcher & Pope
the long-overdue revision of what has
been perhaps the most widely used and
most widely researched standardized
psychological assessment instrument.
Sections of this article were previously pub-
lished as "MMPI-2: A Practical Guide to Clini-
cal, Psychometric, and Ethical Issues" in the
Independent Practitioner (1990, vol. 9, #1, pp. 33-
40).
Correspondence concerning this article may
be addressed to James N. Butcher, Ph.D.
Department of Psychology, University of
Minnesota, j<j East River Road, Minneapolis,
MN 55455.
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DISCUSSION
The MMPI-2 Considered in the Contexts of Personality
Theory, External Validity, and Clinical Utility
PETER HORVATH
Acadia University
Butcher and Pope's article offers a concise
and valuable description of the revision of
one of the most important psychometric
instruments available for psychological
practice and research. The MMPI-2
(Butcher, Dahlstrom, Graham, Tellegen, &
Kaemmer, 1989) promises to be a substan-
tial improvement over its predecessor and
is a major contribution to the field of
personality assessment. Much of the for-
mer research and the clinical experience
that one has accumulated over the years
will continue to be applicable to the
MMPI-2. I am somewhat surprised that
the revision of the basic scales was not a
more substantive one. Based on the
research literature, psychometric consider-
ations, and clinical needs, a more funda-
mental revision may have been appropri-
ate.
The Improvements in the MMPI-2
Many weaknesses in the MMPI have been
eliminated in the MMPI-2, including
revision of some items that may have
introduced bias, the extension of the
representativeness of the normative
sample, and the development of current
norms to transform raw scores into T
scores. Researchers have kept intact the
original clinical and validity scales but
objectionable and obsolete items have
been removed. A new and more broadly
representative normative sample was
balanced on a number of key variables.
Canadian Psychology/Psychologie canadienne, 1992, 33:1
including ethnic membership. Education
level does not appear to influence the Mf
and K scores and the interpretation of
these scales, therefore, will be easier. Two
new validity scales are available to assess
consistency of responding that, in con-
junction with the other validity scales like
F, may make it easier to detect faking bad
and other types of invalidity that have
plagued clinical interpretation. The scale
T scores now have uniformity in percen-
tile distribution which also promises to
make interpretation among scales more
comparative.
The MMPI-2 scales and profile codes
appear to be highly congruent with the
original MMPI scales and profile codes,
permitting application of the wealth of
research and information on the MMPI to
the new instrument. A new set of 15
content scales have been developed that
address clinical problems not previously
covered. A new adolescent form, the
MMPI-A was developed with adolescent
specific items and new norms for youth
aged 14 through 17.
Possible Limitations in the MMPI-2
The renormalization of the MMPI-2 has
resulted in narrower ranging distributions
for all scales that may initially present
some difficulties for clinical interpretation.
A T score of 65 or greater is now inter-
preted to be clinically significant. Making
the distribution of T scores uniform, how-
ever, assumes that the different scales
measure similar types of psychological
phenomena with similar distributions in
the population. The clinical scales are
mixtures of traits, states, and clinical
80 Horvath
symptoms. These are very different types
of psychological phenomena and ordinar-
ily can be expected to show different
types of distributions. It is only because
the scales of the MMPI are a mix of such
variables that the uniformity of T-score
distributions may be viable methodologi-
cally. The underlying theoretical assump-
tions, however, are questionable.
The limitations of the revised inventory
are not much dealt with in the MMPI-2
Manual or in the Butcher and Pope article.
Issues of validity, such as empirical corre-
lates and clinical applications of the basic
scales, need detailed examination. Some
discussion of such issues is appropriate
because they put the revisions into the
larger context. It can also lead to a useful
re-evaluation of the role of psychological
inventories in clinical assessment and
diagnosis.
The authors of the MMPI-2 state that
most of the items of the validity and
clinical scales were retained in order to
preserve the vast amount of research that
has accumulated on the MMPI. Was this
decision, however, justified on an empiri-
cal basis? What do the findings of past or
present research point to, a revised instru-
ment based on much the same items, or a
more updated and empirically based
selection of new items? The authors of the
MMPI-2 obviously chose the former route,
as others have recommended, in order to
preserve the wealth of information accu-
mulated on the MMPI. The authors fail to
discuss the issue of revising the items
based on empirical keying. This is surpris-
ing in view of the fact that the original
MMPI broke new ground because of its
empirical keying approach to item selec-
tion. Are there substantial reasons why a
more fundamental revision of the inven-
tory in some way, or an item selection
based on an empirically derived set of
new items, should have been considered
or at least discussed? I will try to outline
some of the issues that I feel could have
been considered in this regard.
Changes in Diagnoses and Clinical
Utility of the MMPI
In some areas there have been notable
changes in symptom frequencies and
diagnoses in the population in the past
sixty years (Blum, 1978; Morrison, 1974;
Silverstein, Warren, Harrow, Grinker, &
Pawelski, 1982). Is it possible that a new
set of empirically based items might have
been more successful in achieving the
original purpose of the MMPI, which was
to diagnose psychiatric symptoms and
syndromes? Problems with the MMPI as
an instrument for diagnosis have led to
substantial changes in its use. Differential
diagnosis proved to be difficult based on
single high point scales. New codes have
been developed but these codes are still
not exclusionary, that is, they are not
specific to single diagnostic categories.
The use of the MMPI for clinical diag-
nosis has presented problems. In some
studies the correspondence of MMPI basic
scales and code types (Holland, Levi, &
Watson, 1981; Winters, Weintraub, &
Neale, 1981); and of MMPI decision rules
(Klinger, Johnson, Giannetti, & Williams,
1977; Rogers, Wasyliw, & Dolmetsch,
1982) to clinical diagnosis has been less
than satisfactory. Other studies have
found the MMPI to reach clinical utility
for the diagnosis of some disorders, such
as schizophrenia (Patrick, 1988). The
usefulness of the MMPI as a tool for
clinical diagnosis has been somewhat
disappointing because in practice the
inventory is often used to address differ-
ential diagnosis among various possible
syndromes, which was not the basis of its
construction. In the literature, particular
MMPI high point and code types are
often common to a number of different
diagnoses (see Vincent et al., 1983). Expla-
nations for some relationships are not
always obvious and can become some-
what of a stretch in rationalization. It
must be pointed out, however, that the
MMPI is probably still better than most of

its psychometric rivals for the purpose of
diagnosis (Patrick, 1988).
Clinical Diagnosis and Personality
Theory
In their current assigned clinical tasks, the
MMPI basic scales and codes have been
relatively more successful in the differen-
tial diagnosis of the broader categories of
DSM-III personality disorders (e.g.,
anxious and fearful vs. dramatic, emo-
tional, or erratic), of affective disorders
with codes in which scale 2 appears, of
s c h i z o p h r e n i a , and of global
psychopathology (Patrick, 1988; Vincent et
al., 1983). The success of the MMPI in the
differential diagnosis of personality dis-
orders (see Morey, Blashfield, Webb, &
Jewell, 1988; Morey, Waugh, & Blashfield,
1985; Vincent et al., 1983) may be related
to the fact that responses to scales that are
mixtures of symptoms, traits, and states,
are likely to be distributed along continu-
ous dimensions. Consequently, the MMPI
may be more compatible with
conceptualizations of psychopathology as
extremes along continuous or normal
dimensions (Eysenck & Eysenck, 1975)
than with conceptualizations of
psychopathology as discrete and qualitat-
ively different aberrations from normal as,
found in psychiatric diagnoses (Foulds,
1965). The factor structure of the MMPI-2
also suggests that several scales load on
both personality and symptom factors
(Butcher et al., 1989). Thus, there may be
an inherent clash between the basic scales
of the MMPI and differential diagnosis of
clinical syndromes because they are con-
ceived within different universes of dis-
course. This may not be the case for the
measurement and diagnosis of personality
disorders.
The MMPI also has a prominent role as
a measure of personality based on its
behavioural correlates. As a personality
measure, however, it has substantial
theoretical and methodological
weaknesses. As already mentioned, many
MMPI-2 Considered 81
of the basic scales are mixtures of symp-
toms, t r a i t s , and states. The
intercorrelations among scales are sub-
stantial. The meaning of low scores is
unclear.
The MMPI-2 also has some
shortcomings because of its close similar-
ity to the MMPI. For example, it retains
some of the unresolved ambiguities of the
MMPI in its development, scoring, and
interpretation (Horvath & Jonsdottir-
Baldursson, 1990). As instruments of
personality and behaviour the scales of
the MMPI, and consequently the MMPI-2,
are not based on a consistent rationale for
scale construction. The items of the basic
scales of the MMPI were not selected to
measure specific personality and
behavioural criteria, but to differentiate
among rather broad categories of abnor-
mality or clinical syndromes. A theoretical
or rational strategy was not used in the
construction of the basic scales of either
the MMPI or MMPI-2, as seen in the
construction of some other measures of
psychopathology (e.g., Jackson, 1989).
External and Construct Validity
Overall, the MMPI accounts for a moder-
ate and adequate amount of variance in
external criteria (Atkinson, 1986; Parker,
Hanson, & Hunsley, 1988). Some studies,
however, have found that the size and
specificity of the behavioural correlates of
MMPI-based categories are rather low
(Hedlund, 1977; Lane & Lachar, 1979).
Other studies have been more successful
in demonstrating expected behavioural or
clinical correlates (Keane & Gibbs, 1980;
Williams & Butcher, 1989). The MMPI
scales can have strong specific
behavioural correlates such as the length
of hospital stay (Glosz & Grant, 1981).
Many of the scales, therefore, do seem to
show adequate criterion and construct
validities. Inconsistencies in the correla-
tion of the scales with gender appear to
be frequent enough for concern. Perhaps
the major problem, expressed by Hedlund
82 Horvath
(1977), is that symptoms and behaviours
tend to correlate with several basic scales
rather than show specificity to a single or
few scales. The application of clinical
descriptors to older populations has also
been questioned (King, 1978).
The MMPI-2 scales present moderate
criterion validity coefficients in expected
directions (Butcher et al., 1989). Data
presented by Graham (1990), however,
suggest that among the restandardization
samples, the size of the external correlates
of the MMPI-2 were modest to low and
not always as expected. The same pattern
is observed among psychiatric patients
and their symptom descriptors. There
were also many and important differences
between the correlates of males and
females in both samples. These findings
suggest that the MMPI-2 may present
some similar concerns about validity as
did the MMPI.
Conclusions
All of the above issues suggest that
changes in the traditional format of the
MMPI should be considered in the future
and a more fundamental revision may
have been appropriate. The question is
how is this to be done? The authors of the
MMPI-2 faced a number of difficult
choices, one of which was whether to
alter substantially an instrument with so
much research, use, and an adequate
amount of reliability and validity overall.
They seem to have chosen two difficult
and perhaps incompatible tasks, namely,
to retain and improve a popular instru-
ment and also to create a new one. To a
large extent they appear to have
succeeded. They have improved the
inventory and the new content scales they
developed show much promise and may
point the way toward the future assess-
ment of psychological disorders. The new
MMPI-2 has so many advantages that, no
doubt, it will have a great impact on the
field of applied and clinical psychology.
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Tellegen, A., & Kaemmer, B. (1989). Minne-
sota Multiphasic Personality Inventory
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MMPI-2 Considered 83
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DISCUSSION
Ringing in the New: The MMPI-2
G. CYNTHIA FEKKEN
Queen's University
The Minnesota Multiphasic Personality
Inventory (MMPI; Hathaway & McKinley,
1943) has long been a dominant instru-
ment in the field of personality assess-
ment. So it was with great interest that
practitioners and psychometricians alike
watched the unveiling of its first major
revision in 1989. In a timely paper entitled
"The Research Base, Psychometric Prop-
erties and Clinical Uses of the MMPI-21',
Butcher and Pope guide test users and
researchers toward an understanding of
the updated MMPI by summarizing its
key features.
A central reason for revising the MMPI,
according to Butcher and Pope, was the
need to edit specific items for ambiguity,
complexity, and outmoded or sexist word-
ing. At the same time, the MMPI revision
committee committed itself to a "conserva-
tive" revision with the goal of keeping the
basic scales relatively intact. The authors
attribute the adoption of a conservative
strategy to a desire to ensure the
continued relevance of the vast MMPI
research base. They could have argued
further that the success of the original
MMPI attests to the clinical usefulness
and heuristic value of the basic scales.
Despite its merits, however, the conserva-
tive approach would also appear to have
certain drawbacks to which MMPI users
should be alerted.
The conservative approach prevented
the MMPI revision committee from cor-
recting some well-known psychometric
shortcomings associated with the basic
Canadian Psychology /Psychologie canadienne, 1992, 33:1
scales. First, some items are still keyed in
opposite directions on different scales,
such as item 32 which is keyed both true
on the Schizophrenia scale and false on
the Social Introversion scale. Hence, any
valid response a test-taker might give to
such an item will be interpreted as indica-
tive of psychopathology. Second, the
degree of item overlap among the basic
scales is essentially unchanged. Thus,
scale intercorrelations on the revised
MMPI remain difficult to interpret and
not entirely appropriate for multivariate
analytical techniques. Third, apparently
no formal attempts were made to deal
with response styles on the MMPI-2.
Scales are still not balanced with respect
to keying; many items still tend to elicit
responding in terms of social desirability.
The cost of correcting these sorts of prob-
lems would be to reduce the one-to-one
comparability of the MMPI and MMPI-2;
the potential benefit would be further
increases in the relative discriminant
validity of the MMPI-2 scales.
Butcher and Pope might also have
commented directly on the implications of
revising the MMPI items from the per-
spective of test construction theory. The
MMPI is probably the preeminent
example of an instrument developed
according to an empirical approach to test
construction (Burisch, 1984; Wiggins,
1973). That is, items were originally
selected for an MMPI scale (e.g., the Psy-
chopathic Deviate or Pd scale) because the
items discriminated between a "normal"
group and a criterion group, such as
diagnosed psychopaths. Given that the
overall validity of an empirically derived
scale is determined by the relationship of
its items with an external criterion, chang-

ing the items on a scale should necessarily
affect the scale's validity.
Butcher and Pope address the validity
issue head on by offering this illustration:
"The Pd scale measures "Pd behavior" in
exactly the same way as the original scale
did since it is exactly the same scale." But
the Pd scale is not exactly the same scale.
Adding or deleting items from a scale is
not the only issue, as the authors imply.
Four of the items on the Pd scale were
modified (Butcher, Dahlstrom, Graham,
Tellegen, & Kaemmer, 1989). From the
empirical viewpoint, an item that
discriminates between psychopaths and
"normals" due to its outdated wording or
complex grammar is as appropriate as an
item that discriminates on the basis of
content. Any item modification has the
potential to affect the correlates of the
item, and hence, the validity of the scale.
Whether modifications such as item
changes do affect the validity of the
MMPI-2 scales is in fact an empirical
question. For example, using a group of
university students who had responded to
both the MMPI and the MMPI-2,
Duckworth (1990) found some of the
largest mean scale score differences
occurred on the Pd scale. In fairness, the
use of different normative groups for
scoring the MMPI and MMPI-2 may have
contributed to this finding, and a single
study cannot confirm or disconfirm the
validity of a scale. Nonetheless, such data
do not support the assertion that Pd scales
on the MMPI and MMPI-2 scales measure
the same thing, and changes to the items
may be part of the explanation.
Butcher and Pope breath a "sigh of
relief" because research has generally
shown a high congruence between scale
scores and code types on the original
MMPI and those on the MMPI-2. They
report data to support their point based
on well-defined profile codes. Unfortu-
nately, high congruence is not always
reported in the literature (e.g., Duckworth,
1990) for MMPI - MMPI-2 profile com-
Ringing in the New 85
parisons based on the unselected profiles
test users and researchers are most likely
to encounter. Nevertheless the authors
need not despair; they have set
themselves a very difficult task in looking
for congruence between MMPI and
MMPI-2 profiles. The data show that the
test-retest stability of code types based on
two administrations of the original MMPI
itself is at best modest, especially for
higher order code types (Graham, 1987).
This comes as no surprise because code
types are based on extreme scale scores
which will be affected by regression
towards the mean as well as the well-
known tendency of retest profiles to show
less psychopathology than the original
profile (Windle, 1954).
The very search for high congruence
between MMPI and MMPI-2 profiles is to
justify generalization of the validity data
on the original MMPI to the MMPI-2.
Then again, the revision of the MMPI was
presumably undertaken to produce an
MMPI-2 that would be more valid than
the original. Validity data on the MMPI-2
will take years to accumulate but an
overview of the initial validity studies
(e.g., those reported in the MMPI-2 Man-
ual) would have helped to convince
readers directly that MMPI-2 scales
measure what they are supposed to
measure. Moreover, some direction on
how to compare the anticipated body of
research on the validity of the MMPI-2
with the existing body of research on the
validity of the MMPI would be a welcome
addition to the literature.
The internal consistency of an empiri-
cally derived scale is generally considered
to be secondary to its test-retest reliability
because such a scale is constructed to
predict a criterion, not to measure a
homogeneous construct. Butcher and Pope
report retest coefficients that clearly show
that the MMPI-2 scales have considerable
stability. In practice, however, individual
differences in MMPI scale scores have
always been interpreted to differentiate
86 Fekken
among individuals, and one may expect
that MMPI-2 scale scores will be used in
a similar fashion. Thus, the internal con-
sistency of the scales provides relevant
information to test users as well and bears
mention.
The MMPI-2 Manual (Butcher et al.,
1989) shows coefficients alpha for the
basic scales that range from .34 to .85 for
males and from .37 to .87 for females. At
least three basic scales have coefficients
below .60 for both males and females,
attesting to the heterogeneity of the items
making up the scale. These scales may be
useful for diagnosis but are unlikely to
yield unambiguously interpretable indi-
vidual differences. Again, a conservative
approach to test revision would have
precluded any attempts to enhance the
content of these scales. Nonetheless, in
view of the practice of interpreting scale
scores, some cautions by the authors in
their section on the reliability of the
MMPI-2 would seem to have been war-
ranted.
In addition to discussing the basic
scales, Butcher and Pope state that the
MMPI-2 includes 15 scales constructed to
measure the main content dimensions of
the MMPI. More published information
on their derivation would be desirable
because the presence of these scales on
the MMPI-2 is likely to determine in part
what dimension practitioners assess and
what dimensions researchers study. An
explanation of how the content dimen-
sions were conceptualized would help
users compare the construct measured by
the scales to other indices of the construct.
For example, the items on the MMPI-2
Type A scale appear not to tap the three
components traditionally associated with
Type A behaviour, but rather appear to
focus on only those aspects of Type A
behaviour identified by meta-analyses as
toxic for cardiac problems.
By merely listing the names of the
content scales, Butcher and Pope miss an
opportunity to add to the overview of the
content scales presented in the manual.
How were the 15 content dimensions on
the MMPI-2 determined? Were they
empirically derived, for example, from the
factor structure of the original MMPI?
Were they rationally selected to reflect
dominant themes in personality research?
Given the popularity of the MMPI and
given the interactive relationship between
assessment and theory, the MMPI-2 con-
tent scales may well have a gradual influ-
ence on what dimensions are seen as
comprising psychopathology or even
personality. A description of the evolution
of these dimensions would help keep
things in perspective.
Personality assessors have generally
come to depend on validity and consist-
ency indices to help them establish the
interpretability of an MMPI profile for an
individual. To that end, the MMPI-2
includes an alternate form of the F scale
and two new consistency measures in
addition to scoring keys for the Weiner-
Harmon subtle scales. The authors
describe the limitations of the Weiner-
Harmon scales, expressing reservations
about their use; but by their lack of com-
ment they imply that the other three
measures will work. Establishing useful
measures of test protocol adequacy is
more difficult than would appear. At a
conceptual level, elevated validity indices
are not readily interpretable. For example,
high scores on the F scale may reflect
exaggerated responding or high levels of
psychopathology; low levels of consistent
responding to pairs of semantically
related items may reflect confusion or
perhaps weak verbal skills, indecision or
random responding.
At a practical level, test users might be
relatively unconcerned about the meaning
of validity and consistency indices if such
indices accurately identified uninter-
pretable protocols. The success of consist-
ency indices is mixed, however. To illus-
trate: Neither of the two indices on the
original MMPI, namely, the TR index and

the Carelessness scale, could predict the
retest stability of profiles based on the
MMP1 basic scales, although both were
marginally related to the number of
MMPI items changed from test to retest
(Fekken & Holden, 1987). Restriction of
range on these original MMPI indices
surely contributed to their low predictive
utility. It is encouraging that the consist-
ency indices on the MMPI-2 are consider-
ably longer than the original indices.
Moreover, the MMPI-2 indices were con-
structed to reflect recent theorizing about
the nature of consistent responding (see
Tellegen, 1988). Still, their usefulness
needs to be demonstrated empirically and
until then, some cautions are in order.
Change within a profession, including
psychology, is always slow. Each pro-
fessional will have evolved a set of pro-
cedures that match his or her theoretical
persuasions and practical needs. To
replace the popular MMPI even with a
conservative revision will require psychol-
ogists to make various procedural and
conceptual adjustments. Papers like the
one written by Butcher and Pope remind
us of our obligation to remain current in
our practice and research. We may wish
that they had given us even more infor-
mation in their overview of the MMPI-2,
but this should not detract from the obvi-
ous: It is time to usher out the MMPI and
to ring in the MMPI-2.
Correspondence concerning this article should
be addressed to Dr. G.C. Fekken, Department
of Psychology, Queen's University, Kingston,
Ontario, CANADA K7L 3N6
Ringing in the New 87
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DISCUSSION
Response to Drs. Horvath and Fekken
JAMES N. BUTCHER
University of Minnesota
KENNETH S. POPE
Los Angeles, California
Horvath and Fekken have made a sub-
stantial contribution to the evolution of
MMPI-based assessment by providing
thoughtful evaluations of key issues in the
revision. We appreciate both their
endorsement of the improved aspects as
well as the questions and critiques they
skillfully raise. In the limited space
allotted to us, we will try to respond to
the major issues.
First, both Horvath and Fekken, while
noting the ways in which MMPI-2
improves the original instrument, point
out apparent deficiencies in the original
instrument that were not eliminated. For
example, Horvath observes that "most of
the items of the validity and clinical scales
were maintained" and Fekken observes
that "the degree of item overlap among
the basic scales is essentially unchanged."
Both authors place these observations in
proper context by accurately stating that
the choices (to retain many of the aspects
of the original instrument) were made, in
Horvath's words, "as others have recom-
mended, in order to preserve the vast
amount of information accumulated on
the MMPI." Regardless of its psychometric
ugliness and somewhat archaic aspects,
the MMPI worked extremely well as a
screening instrument for psycho-pathol-
ogy. The Restandardization Committee
strongly believed that the test earned its
place as the most frequently used measure
(Lubin, Larsen & Matarazzo, 1984)
Canadian Psychology/Psychologie canadienne, 1992, 33:1
through its demonstrated validity, and
that this extensive validational base was
well worth preserving. There needed to be
a clear tie to the past but there was also
ample room, with the addition of new
content, to use advances in the impressive
psychometric technology that has evolved
over the past 50 years. Unfortunately,
some information about these develop-
ments, much of which has been recently
published and some of which is still in
press, was not available to Horvath and
Fekken when they wrote their commen-
tary. For example, many of Fekken's
suggestions regarding new content scales
were actually incorporated in the develop-
ment of the MMPI-2's content scales (e.g.,
Butcher, Graham, Williams & Ben-Porath,
1990). Horvath accurately predicted that
the MMPI-2 Content Scales would add
significantly to the Clinical Scales' ability
to identify and distinguish various patient
populations. Ben-Porath, Butcher and
Graham (in press), for example, found
that the MMPI-2 Content Scales enable
more accurate discrimination between
depressed and schizophrenic individuals
in inpatient psychiatric settings and actu-
ally outperform the clinical scales in dif-
ferential diagnosis.
Second, Fekken raises an important
concern about the validity:
Drs. Butcher and Pope address the validity
issue head on by offering this illustration: The
Pd scale measures "Pd behavior" in exactly the
same way as the original scale did since it is
exactly the same scale" But the Pd scale is not
exactly the same scale. Adding or deleting
items from a scale is not the only issue... Four
of the items on the Pd scale were modified...
From the empirical viewpoint, an item that

discriminates between psychopaths and "nor-
mals" due to its outdated wording or complex
grammar is as appropriate as an item that
discriminates on the basis of content. Any item
modification has the potential to affect the
correlates of the item, and hence, the validity
of the scale.
Two published studies address the issue
of modified items (i.e., those in which the
content is retained while outdated word-
ing or complex grammar is eliminated).
Ben-Porath and Butcher (1989b) examined
the psychometric stability of the 68
rewritten MMPI-2 items by comparing
their contribution to the relevant scales
with the contribution of the originally
worded items. A subsequent study evalu-
ated the effects of changes introduced in
the MMPI-2 on the stability of the 13 basic
scales and 8 supplemental scales that were
retained in the MMPI-2, and found the
clinical scales of the two versions of the
test to be basically equivalent (Ben-Porath
and Butcher, 1989a).
Third, Fekken cites the work of
Duckworth which reports apparent "dif-
ferences" between the profiles of some
participants who took both the original
and revised MMPI. According to the
written report of this research
(Duckworth, in press), there were 85
participants. This diverse group included
13 clients, 31 undergraduates, 23
counseling psychology graduate students,
and 18 friends. Some but not all of the
testing was conducted by students in an
advanced level assessment course. Unfor-
tunately, Duckworth's report fails to
address a fundamental prerequisite of
experimental design: the test-retest vari-
able. That is to say, in order to discover
the amount of variance due to the two
forms of the test, one must first discover
and control for (e.g., use as a baseline) the
(test-retest) variance due to two adminis-
trations of the same form. This potential
confounding variable was taken into
account in the previously cited research
Response 89
conducted by Ben-Porath and Butcher
(1989a), in which 189 participants com-
pleted both the original and revised forms
of the MMPI while 188 other participants
completed the original form twice. (Note:
research data concerning expected differ-
ences in administering the MMPI-2 on
subsequent occasions was published in
the MMPI-2 Manual.) Conditions of
administration were held constant for all
participants. Had Duckworth used a more
complete research design, it is likely that
she would have seen that responses to the
same form varied in the way that she
found MMPI and MMPI-2 responses
varied.
Fourth, Horvath, in his critique of the
original MMPI, questions validity general-
ization. For example, he cites a study by
Winters, Weintraub, and Neale (1981)
which concluded that the MMPI was
ineffective in diagnosing schizophrenia.
However, this research did not study the
original MMPI instrument but rather an
abbreviated derivation or approximation
of the test, the Minimult, which utilizes
only 81 of the original MMPI items. The
Minimult is indeed notoriously inaccurate
in predicting MMPI clinical scores
(Hoffman & Butcher, 1975). Research
utilizing the MMPI itself has been quite
heartening in this regard. Cross-cultural
research — in which an instrument is
translated into another language and
culture — poses one of the most gruelling
and telling tests of an instruments gener-
alization validity. How has the MMPI
fared? Research in Greece by Manos
(1985) and in Turkey by Savacir and Erol
(1990) has shown substantial cross-cul-
tural usefulness of MMPI scales in clinical
diagnosis. A recent review of the use of
the MMPI in China (Cheung & Song,
1989), for example, reported 20 recent
studies on the MMPI for schizophrenia in
the Peoples Republic of China; most
showed strong cross-cultural
generalizability of Scale 8 among Chinese
individuals suffering from schizophrenia.
90 Butcher and Pope
Fifth, both Horvath and Fekken note
occurately that there are additional
aspects about the revision process, the
psychometric properties, and the applic-
ability of the MMPI-2 that were not
addressed in our original article. These
are significant issues that deserve a much
more detailed response than we can ren-
der in this brief response. However, these
issues have been and continue to be
addressed in the research literature. In
addition to those already cited, the follow-
ing works, representing only a small
sample, may be of interest to readers
seeking information:
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Ben-Porath, Y. S., Butcher, J. N., Graham, J. R.
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Butcher, J. N. (1989a). User's guide for the
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Keller, L. S. & Butcher, J. N. (1991). Use of the
MMPI-2 with chronic pain patients.
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Lees-Haley, P. R., English, L. T., & Glenn, W.
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de Labry, L., Workman-Daniels, K., & Bosse,
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(1984). Patterns of psychological test usage
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92 Resume
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(1990). Failure of the Weiner-Harmon MMPI
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RESUME
Le nouveau MMPI
Le "Minnesota Multiphasic Personality
Inventory" (le MMPI) est devenu un des
instruments d'evaluation de la
personnalite auquel on a le plus souvent
recours et dont on se sert dans une
grande variete de contextes cliniques
d'evaluation. Depuis son introduction, il
y a quelques decennies, plusieurs
problemes, tels que la nature demodee de
certains termes employes, sont devenus
apparents. Apres evaluation et dis-
cussion, ces problemes ont resulte en la
revision et le developpement recents de
l'instrument afin d'eliminer certains
problemes et de creer un instrument
psychometrique plus adequat pour
revaluation clinique. L'article de Butcher
et Pope decrit la revision de l'instrument
et offre un resume de quelques-uns des
principaux elements du MMPI-2.
Butcher, Pope, Graham, Williams, et
Ben-Porath (1989) ont developpe une
nouvelle serie d'echelles de contenu afin
d'evaluer les principales dimensions de
contenu du MMPI-2. Us ont developpe
ces echelles a partir de procedures a la
fois objectives et statistiques. Les 15
echelles de contenu evaluent les facteurs
importants de la personnalite, le compor-
tement symptomatique, ou s'appliquent a
des domaines cliniques problematiques
importants. Les 15 echelles sont:
(1) l'anxiete
(2) les craintes
(3) l'obsession
(4) la depression
(5) les inquietudes sur la sante
(6) les pensees bizarres
(7) la colere
(8) le cynisme
(9) les activites contre la societe
(10) la personnalite du type A
(11) une mauvaise opinion de soi
(12) la gene en societe
(13) les problemes familiaux
(14) les problemes au travail
(15) les mauvaises reponses aux traite-
ments
Les echelles de contenu du MMPI-2 se
sont montrees tres utiles dans le domaine
de la pratique clinique car elles couvrent
une vaste gamme de problemes et
peuvent se comprendre de fagon intuitive.
Les chercheurs qui ont developpe le
MMPI-2 avaient remarque que
l'instrument original etait un des instru-
ments les plus populaires pour
1'evaluation des adolescents malgre le fait
que la plupart des elements de cet instru-
ment s'adressaient aux adultes et qu'il n'y
avait que tres peu d'echelles s'adressant

aux problemes des adolescents. La
nouvelle version adolescente de l'echelle,
le MMPI-A, comprend des elements ayant
rapport a l'adolescence. En plus des
echelles cliniques du MMPI-2, la version
adolescente contient quatre nouvelles
echelles de contexte qui mettent l'accent
sur les problemes des adolescents. Ce
sont: les problemes de comportement,
l'alienation, le manque d'ambition et les
problemes associes a l'ecole.
Butcher et Pope sont d'avis que les
psychologues cliniques devraient se servir
du nouveau MMPI-2 plutot que de
l'instrument original. Us maintiennent
qu'il est contraire a la deontologie de se
servir d'une version demodee d'un test,
surtout un test tel que le MMPI qui
presentait des problemes de langage
sexiste et d'exclusion de minorites raciales
de l'echantillon original.
Dans leurs critiques du MMPI-2,
Horvath et Fekken se demandent tous
deux pour quelles raisons les revisions
n'etaient pas plus importantes, etant
donne les multiples faiblesses qu'on avait
identifiees dans le MMPI original.
Butcher et Pope repondent que
l'instrument original etait extremement
efficace en tant qu'instrument de
depistage de la psychopathologie, et qu'il
etait important de garder les aspects du
MMPI qui s'etaient montres utiles.
Horvath fait remarquer que les echelles
cliniques mesurent en fait des melanges
de traits, d'etats et de symptomes
cliniques. Ce sont des types de
phenomenes psychologiques tres
differents et, d'apres lui, les hypotheses
sous-jacentes qui permettent ces melanges
sont contestables. II croit que l'emploi du
MMPI comme instrument de mesure de la
personnalite n'est pas sans faiblesses: les
correlations entre les echelles sont
Le nouveau MMPI 93
importantes et la signification de resultats
peu eleves n'est pas claire. II fait remar-
quer que le MMPI est un instrument
decevant en ce qui concerne les diagnos-
tics cliniques. II est peu probable que ces
problemes puissent s'eliminer par une
strategic conservatrice de revision. Hor-
vath soutient que ceux qui ont revise le
MMPI semblent avoir entrepris deux
taches difficiles et peut-etre incompatibles:
retenir et ameliorer un instrument
populaire et, en meme temps, creer un
nouvel instrument. Neanmoins, il tire la
conclusion que le MMPI-2 est destine a
avoir un impact important dans le
domaine de la psychologie appliquee.
Fekken maintient que l'approche
conservatrice a la revision a laisse
subsister dans le MMPI-2 plusieurs des
defaillances de l'instrument original.
Pour certaines questions, des reponses
"oui" et "non" comptent sur des echelles
differentes, de sorte que n'importe quelle
reponse est interpretee comme un indice
de la psychopathologie. Elle conteste
egalement l'affirmation de Butcher et
Pope selon laquelle l'instrument revise
retiendrait les avantages du MMPI ori-
ginal. Fekken fait remarquer que toute
modification, meme a la terminologie
demodee et au langage sexiste, pourrait
changer la validite de l'echelle. Elle
soutient que la validite du MMPI-2
dependra des recherches entreprises a
l'avenir et qu'on ne peut pas prendre cette
validite pour acquise, seulement parce
que les revisions faites a l'instrument
original ont ete de nature conservatrice.
Dans leur reponse aux critiques de
Horvath et de Fekken, Butcher et Pope
terminent en disant que le MMPI s'est
montre tres fiable dans le domaine des
recherches interculturelles, en Grece, en
Turquie et en Chine.