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(Download PDF) The Social Cognition and Object Relations Scale Global Rating Method Scors G A Comprehensive Guide For Clinicians and Researchers 1St Edition Michelle Stein Online Ebook All Chapter PDF
(Download PDF) The Social Cognition and Object Relations Scale Global Rating Method Scors G A Comprehensive Guide For Clinicians and Researchers 1St Edition Michelle Stein Online Ebook All Chapter PDF
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The Social Cognition and Object
Relations Scale-Global Rating
Method (SCORS-G)
The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) is a c linician-
rated measure that can be used to code various forms of narrative material. It is comprised of
eight dimensions, which are scored using a seven-point Likert scale, where lower scores are in-
dicative of more pathological aspects of object representations and higher scores are suggestive
of more mature and adaptive functioning. The volume is a comprehensive reference on the 1)
validity and reliability of the SCORS-G rating system; 2) in-depth review of the empirical
literature; 3) administration and intricacies of scoring; and 4) implications and clinical utility
of the system across settings and disciplines for clinicians and researchers.
Acknowledgments vii
Foreword ix
PART I
History and Empirical Research 1
1 Introduction 3
PART II
Scoring 35
PART III
Clinical Applications 199
14 Using SCORS-G Anchor Points in the Therapy and Supervisory Process 217
First, I want to thank Jenelle Slavin-Mulford, PhD, for undertaking this project with me.
Since 2006, we have been rating narratives together using the SCORS-G. Thank you for
rating literally thousands of narratives with me. You are my best friend and “EIR of 7.” We
complement and challenge each other in a way where I feel we both are better for it, and
I believe this is reflected in the present book. I could not imagine writing this without you.
Second, I have been fortunate to have incredible mentorship. I want to thank “The Marks”
of my life (in chronological order, Mark Hilsenroth, PhD, ABAP and Mark Blais, PsyD). You
have played such an integral role in helping me achieve what I have, both professionally and
personally. Thank you for gently pushing me when I needed to be pushed and at the same
time giving me the space to grow. Thank you both for believing and seeing things in me that
took me extra time to acknowledge. A third person I would like to thank is Caleb Siefert,
PhD. I have always admired how gifted you are at explaining challenging theoretical concepts
in such an experience-near and real-life way with varying levels of complexity based on your
audience. Thank you for your continued availability and eagerness to collaborate whether it
be to help me organize manuscripts, understand theory, calculate and analyze statistics, be my
sounding board and a source of support, and so forth. As with Jenelle, you have helped me to
grow and think about the SCORS-G in a deeper way. Most importantly, I feel fortunate that
through this, we have become close friends. Thank you Dr. Robert Jeff Slavin for taking the
photograph displayed on the cover of the book. We also appreciate your careful editing and
creative thinking regarding the organization of material presented in the book. Finally, I want
to thank my grandparents, Dr. and Mrs. Benjamin and Pearl Bernstein. While they passed
away toward the end of my graduate training and didn’t get to experience my shift from Long
Island to Boston, I continue to feel their warmth, love, and their unconditional belief in me.
Foreword
There continues to be a growing need in the psychology field to create measures that quantify
qualitative data in dynamically rich and meaningful ways. Psychodynamic/psychoanalytic and
personality assessment researchers are the dominant groups who have taken on this challenge.
In the empirical literature,1 The Social Cognition and Object Relations Scale-Global Rat-
ing Method (SCORS-G; Westen, 1995) is one of the measures that has a strong theoretical
foundation and displays the capacity to assess sophisticated underlying constructs, specifically
dimensions of object relations.
With regard to clinical research, the SCORS-G provides a wealth of information in un-
derstanding the multifaceted interactions between object relations and a variety of clinical
constructs (e.g., psychopathology and personality). Further, the SCORS-G rating system has
been effective in understanding the complex relationships between object relational processes
and the therapeutic process (e.g., alliance, therapeutic technique, and change). Empirical
findings are easily applied to the clinical encounter to inform one’s assessment and treatment
of patients. For example, I (MBS) have observed that some of the patients with whom I have
worked who had a severe childhood trauma tended to view other people’s behavior as highly
idiosyncratic and sometimes in quite illogical ways. With regard to one patient in particu-
lar, I remember her coherence and understanding of others was disrupted. This led me to
reflect on Dr. Slavin-Mulford’s (coauthor of this book) first publication (Slavin et al., 2007).
In this paper, she examined the relationship between childhood history of sexual abuse
and SCORS-G ratings of Early Memory (EM) narratives and found a negative association
between the dimension—Understanding of Social Causality (SC)—and the severity of abuse.
I began wondering in what ways this patient’s disrupted SC was negatively impacting her
life as well as how it was impacting her interpretation of me and her other treatment pro-
viders. In order to help her increase her SC, I began taking a psychoeducative stance in our
therapy. This included explaining to her that people could behave differently in different
situations for a variety of reasons and that people can act in ways counter to her expecta-
tions. At the same time, I acknowledged and appreciated that it is hard to feel that there are
other ways to interpret people’s intentions, behaviors, and actions given that these alternative
interpretations are outside of her experience. That is, it can be hard to feel that someone is
trying to be helpful when her experience has mainly been that people are hurtful. There
were occasions in the therapy where she also asked me about how I would interpret different
x Foreword
interactions she had encountered over the week. We adopted a curious stance together, which
led to productive conversations about a number of reasons why people may behave the way
they do. Ultimately, we were working on increasing her understanding of human behavior
(SC). I shared this patient with another clinician, and I remember the clinician asking me
in one of our team meetings what our work entailed, and my response was: “I am teaching
her about human behavior and the variety of reasons people behave the way that they do.” I
will not go into much more detail than this, but in this example, research findings directly
translated into my clinical practice. This informed my conceptualization of this patient, tech-
nique, and therapeutic stance.
While the above example illustrates how research findings inform clinical work, there is
little written about direct clinical applications of the SCORS-G rating system. One of the
many things that I find valuable about the SCORS-G is that it not only provides a dimensional
framework for understanding, identifying, and rating object relations, but it can also be ap-
plied to a number of psychological specialties. Since I began using the SCORS-G many years
ago, I have always seen this measure as more than a research tool. While to date, this measure
has been used mainly in research settings, the SCORS-G has informed my theoretical and
therapeutic identity, assessment, and clinical practice. Over time, each of my p sychological
disciplines has blended together, with the SCORS-G being a common thread. That is, while
I wear many different “hats” at my place of work (inpatient and outpatient psychologist,
psychological assessment psychologist, intake evaluator for the Dialectical Behavior Therapy
(DBT) group program, researcher in my “free” time, supervisor for the psychology internship
and psychiatry residency program, and so forth), I use the SCORS-G as a method to frame and
communicate my conceptual understanding to patients, staff, and trainees.
One of the advantages of the SCORS-G is that the structure and theoretical content provides
a systematic way for therapists to assess and understand underlying aspects of personality struc-
ture. The SCORS-G captures this through eight dimensions (also referred to subscales and vari-
ables). These dimensions include Complexity of Representations of People (COM), A ffective
Quality of Representations (AFF), Emotional Investment in Relationships, Emotional Invest-
ment in Values and Moral Standards (EIM), SC, Experience and Management of Aggressive
Impulses (AGG), Self-Esteem (SE), and Identity and Coherence of Self (ICS). Using this mea-
sure as a conceptual framework can be helpful to a variety of mental health p roviders across a
number of settings. It is important to mention that whether or not a clinician is familiar with the
SCORS-G rating system, many of the underlying dimensions that comprise this measure are
common elements that clinicians (of varying theoretical orientations) may either implicitly or
explicitly focus on (to varying degrees) when trying to understand how patients view themselves
in connection to others and the world and ultimately how this relates to current vulnerabilities.
One way we attempted to make the wealth of information provided by the SCORS-G
“user friendly” was to create a constellation of questions that correspond to every SCORS-G
dimension. These questions take the concepts in the SCORS-G and translate them into what
a clinician may ask herself 2 when trying to conceptualize patients and formulate treatment
plans. Many of these questions mental health providers are likely already familiar with and
utilize in their practice. However, the purpose of providing these questions to the reader is to
demonstrate how the SCORS-G rating system can provide a structured way of identifying
and understanding object-relational constructs. Although a full list of the questions will be
presented in Chapter 15, we are providing the “Global Eight” below. Each question corre-
sponds to one of the eight SCORS-G dimensions and provides a general overview of what
each dimension assesses. The purpose of this is to give the reader a sense of how this book may
aid in this process.
Foreword xi
Again, the purpose of these questions is not only to assess a patient’s interpersonal world,
but also to expand how these domains translate to actual behavior/functioning. Using the
SCORS-G rating system in this way provides a complementary approach to assessing p atients
beyond the symptom level. For example, there are a number of mnemonics the medical
community uses to assist clinicians in recalling the constellation of symptoms associated with
a particular clinical syndrome like depression (SIGECAPS) or mania (DIGFAST). While as-
sessing object relations is a bit more nuanced, using the SCORS-G’s dimensions in this way
affords clinicians the opportunity to examine the depth of a person’s object-relational world in
a more explicit fashion via the eight SCORS-G dimensions.
Overall, the SCORS-G possesses both the magnitude and depth needed to answer questions
that are very challenging to assess in research using both nomothetic and idiographic/qualitative
approaches. It can be flexibly adapted to different types of narratives across multiple domains
and is useful to both researchers and clinicians. Given that the SCORS-G is one of the few
clinician-rated measures, it helps to bridge the gap between research and practice. This book
will highlight the ways the SCORS-G is applied to research and can be adapted to clinical
encounters (intake, psychotherapy, and assessment) as well as training. Further, this book will
establish its applicability to a wide range of mental health providers across a variety of settings,
from trainees to experienced therapists, formal researchers to the everyday working clinicians,
across a variety of settings (i.e., academic institutions, private practices, and hospitals).
Notes
1 Empirical research findings are illustrated throughout this book.
2 While we are sensitive to issues surrounding gender, in order for ease of reading, we will refer to the
therapist, coder, and patient in the feminine (unless otherwise specified).
References
Slavin, J., Stein, M., Pinsker-Aspen, J. & Hilsenroth, M. (2007). Early Memories from Outpatients with
and without a History of Childhood Sexual Abuse. Journal of Loss and Trauma, 12(5), 435–451.
Westen, D. (1995). Social Cognition and Object Relations Scale: Q-sort for projective stories (SCORS–Q).
Unpublished manuscript, Department of Psychiatry, The Cambridge Hospital and Harvard Medical
School, Cambridge, MA.
Part I
Aims
The Social Cognition and Object Relations Scale (SCORS) rating system (Westen et al.,
1985/1987/1988/1989/1990; Westen et al., 1988/1990; Westen, 1993, 1995a, 1996a, 2002)
has become one of the most commonly used measures to code o bject-relational content via
narrative material. There have been three versions of the scale since its inception (SCORS,
SCORS-Q sort, and SCORS-Global Rating Method (SCORS-G)), with the SCORS-G
being the most recent edition. The SCORS and SCORS-G are the two versions that have
been most represented in the empirical literature. The main differences between the SCORS
and SCORS-G are as follows. First, the SCORS-G has eight dimensions, whereas the
SCORS only has four. Second, the SCORS-G is based on a 7-point scale as opposed to the
5-point Likert scale. Finally, the SCORS-G can be applied to any type of narrative data,
whereas with the SCORS, there are two versions of the scale based on the type of narra-
tive data used. That is, there is one version used to rate Thematic Apperception Test (TAT)
narratives (Murray, 1943) and a different version of the scale used to rate interview data.
These differences allow the SCORS-G to capture underlying dimensions of object relations
in a more comprehensive way than the original version of the SCORS. As such, this book
will focus on the SCORS-G. However, since there have been a number of important stud-
ies using the original version of the SCORS that lay the foundation for future SCORS-G
studies, Chapter 2 will provide an overview of all versions of this rating system (SCORS,
SCORS-Q, and SCORS-G).
To date, the SCORS-G has been used predominantly for clinical research. Following in
Drew Westen et al.’s footsteps, Hilsenroth, Stein, and Pinsker (2007) created a scoring manual for
clinicians and researchers to use in establishing inter-rater reliability. There have been updated
editions, with the most recent being Stein et al. (2011). Although the manual has been successful
in providing a basic framework for using the SCORS-G and teaching clinicians and researchers
how to establish inter-rater reliability in a step-by-step fashion, it is limited in scope. That is, while
it provides a number of narrative-based protocols (Early Memory (EM) and TAT narratives)
with ratings, it does not provide scoring rationale, nor does it represent all dimensional anchor
points. The clinician and/or researcher is required to intuit the reasons for scoring as opposed to
2
Empirical Research on the SCORS-G
A Review
This chapter provides a synopsis of the research that has been conducted on the Social Cognition
and Object Relations Scale (SCORS) rating system. Chapters 3–10 report detailed findings per
individual Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G)
dimension. As such, this chapter will not provide excessive details regarding each study. In-
stead, it will deliver an overview of how this measure has been used in the literature. While
this book focuses on the SCORS-G, in many cases empirical findings from earlier versions of
this measure (i.e., SCORS and SCORS-Q-sort) laid the foundation for current research with
the SCORS-G. Therefore, in this chapter, we felt it was important to include research that has
been completed with all versions of this rating system.1
Most of the research has been represented in the personality assessment as well as the
psychotherapy process and outcome literature. To maintain this consistency, this chapter is di-
vided into the domains of psychometric properties, psychopathology and personality, and psy-
chotherapy process and outcome. The last section of this chapter reviews the research that has
been conducted on non-clinical samples. Finally, there is a corresponding table in Appendix B
that summarizes the SCORS-G findings. Specifically, this table includes the authors and
date of publication, type of narrative data, study topic, level of care, age group, number of par-
ticipants, and how the SCORS-G dimensions were used. This table does not include research
on earlier versions of the scale.
Psychometric Properties
Developmental Continuum
There have been a number of studies using non-clinical samples that have demonstrated
that many of the SCORS/SCORS-Q dimensions follow a developmental trajectory. Three
of these studies examined developmental differences in children and adolescence using the
SCORS (Fantini et al., 2013; Westen et al., 1991a) and the SCORS-Q (Niec & Russ, 2002).
Findings from the Thematic Apperception Test (TAT) and interview data indicated that
A ffective Quality of Representations (AFF) is the only dimension which does not follow a
developmental path. Mittino and Maggiolini (2013) also examined adolescent development
16 Empirical Research on the SCORS-G
by analyzing SCORS ratings of TAT narratives on a sample of 12–19-year-old boys and girls
undergoing psychological assessment. They found that there was a broad range of responses
within SCORS dimensions, more so than was anticipated during this period of development.
To date, there has not been research that has examined this with the SCORS-G, particularly
the newer dimensions of Aggression (AGG), Self-Esteem (SE), and Identity and Coherence of
Self (ICS). On the other hand, research has established the temporal stability of the SCORS-Q
in adulthood (Bram, Gallant, & Segrin, 1999).
Internal Consistency
There have been a number of studies that have examined internal consistency (see Hibbard,
Mitchell, & Porcerelli, 2001; Huprich & Greenberg, 2003; Siefert et al., 2016 for more thor-
ough review). With respect to the SCORS-G, there have been approximately nine studies
that have documented alpha coefficients (Bram, 2014; Conway, Lyon, & McCarthy, 2014;
Haggerty et al., 2015; Richardson et al., in press; Siefert et al., 2016; Stein et al., 2009; Stein
et al., 2012; Stein et al., 2013, 2015). Seven of these nine studies exhibited alphas in the excel-
lent range for all dimensions. Alpha’s for Complexity of Representations of People (COM) and
Social Causality (SC) also have consistently been in the excellent ranges (.75 to .90). However,
there has been increased variability with the remaining dimensions. Emotional Investment in
Relationships (EIR) has ranged from good to excellent (.60 to .88). AFF (.59 to .92), Emo-
tional Investment in Values and Moral Standards (EIM) (.42 to .89), SE (.53 to .85), and ICS
(.56 to .86) alphas have ranged from fair to excellent, and AGG (.39 to .90) from poor to excel-
lent. Some factors that appear to contribute to the increased variability include stimulus pull,
the range of ratings and number of cards in a given protocol, sample size, and only certain vari-
ables having a default coding if the dimension is absent (e.g., AGG). However, future research
is needed to more comprehensively understand the increased variability for these dimensions.
Factor Structure
There have been a number of studies that have examined the factor structure of the SCORS/
SCORS-G. Earlier studies analyzed data by grouping the cognitive-structural (COM and
SC) and affective-relational dimensions (EIR/EIM) of the SCORS together, some of which
include the work of Hibbard et al. (1995) and Porcerelli, Cogan & Hibbard (1998). Building
on this work, there are a number of studies that have formally assessed the factor structure
of the SCORS-G (Bram, 2014; Lewis et al., 2016; Peters et al., 2006; Richardson et al., in
press; Siefert et al., 2017; Stein et al., 2012). (Please see introduction for further detail on the
SCORS-G factor structure.)
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