Abstract
The Q Array is a comprehensive, clinically derived Q-sort assessment tool constructed by Philip A. Marks (1961) to evaluate the multifaceted personality structures, defense mechanisms, and manifest behavioral characteristics of children and their parents within child guidance and outpatient psychiatric clinics. Developed through an extensive empirical reduction of an initial item pool numbering approximately 2,000 statements, the final instrument comprises 135 clinically calibrated items. These items provide a standard metric across clinical staff members, patients, and parents, deliberately spanning both phenotypic observable behavioral manifestations (constituting approximately 75% of the array) and genotypic intrapsychic and psychodynamic constructs (constituting approximately 25% of the array). Furthermore, 25% of the items capture non-pathological functioning, partitioned into neutral behavioral expressions (7%) and indicators of optimal psychological adjustment and ego resiliency (18%). Designed to be sorted into a forced quasi-normal distribution across a multi-category continuum, the Q Array provides ipsative standardization that eliminates rater response bias while facilitating rigorous intra-individual profile analysis, inter-rater diagnostic concordance, and longitudinal tracking of therapeutic change. This article delineates the structural framework, theoretical foundations, psychometric underpinnings, clinical administration paradigms, and diagnostic utility of Marks’s 135-item Q Array within psychiatric evaluation and child guidance practice.
Keywords
Q Array, Q-sort methodology, Philip A. Marks, child guidance, personality assessment, psychodynamic formulation, defense mechanisms, phenotypic evaluation, genotypic diagnosis, ego strength.
Authors
The Q Array was conceived, standardized, and published by Philip A. Marks, Ph.D.
- Primary Investigator: Philip A. Marks, Ph.D.
- Institutional Affiliation during Instrument Development: Department of Psychiatry, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas; and the Child Guidance Clinic.
- Historical Context: Dr. Marks was a distinguished clinical psychologist who made foundational contributions to clinical psychometrics, personality assessment, and actuarial classification, notably collaborating extensively on objective interpretive systems for the Minnesota Multiphasic Personality Inventory (MMPI) and the psychometric formulation of child and adolescent psychopathology.
Purpose
The primary objective of the Q Array is to furnish an objective, standard, and theoretically nuanced vocabulary for describing the personality features, psychodynamic functioning, and symptom presentations of child guidance referrals and their parents. Prior to the development of systematic clinical sorting systems, diagnostic summaries in outpatient child guidance settings suffered from profound semantic ambiguity, idiosyncratic theoretical dialectics among multidisciplinary staff (psychiatrists, clinical psychologists, and psychiatric social workers), and inconsistent diagnostic criteria across adult and pediatric cases.
Marks recognized that clinical evaluation within child guidance clinics necessitates an assessment instrument capable of simultaneously evaluating two generations: the child presenting with behavioral, cognitive, or emotional maladjustment, and the parents whose personality structures, coping mechanisms, and marital or parent-child relational dynamics frequently contribute to or sustain the clinical picture. To fulfill this need, the Q Array was engineered to fulfill several diagnostic and research purposes:
- Cross-Informant and Multi-Rater Concordance: Enabling independent clinical observers—such as intake social workers, testing psychologists, and supervising psychiatrists—to evaluate the identical case using an invariant, standard vocabulary, thereby rendering their diagnostic impressions quantitatively comparable.
- Dual-Level Personality Description: Simultaneously assessing both overt symptomatic presentations (phenotypic behavior, such as temper outbursts, school refusal, and motoric habits) and underlying latent personality dynamics (genotypic structures, such as unresolved Oedipal conflicts, ego strength, narcissistic vulnerabilities, and primary defense mechanisms).
- Assessment of Parent-Child Dyads: Offering a linguistic and structural bridge where the same 135 items could be applied with equal psychometric validity and ratability to either a child patient or an adult parent, allowing clinicians to compute direct mathematical correlations between the child’s dynamic profile and the parental character structure.
- Quantification of Prognosis and Ego Resiliency: Systematically balancing pathological markers with items reflecting positive psychological assets, insight, and ego resources, thereby avoiding diagnostic deficit-skew and allowing the estimation of therapeutic accessibility and favorable prognosis.
Psychological Construct
The Q Array operationalizes a multidimensional construct encompassing descriptive psychopathology, psychodynamic defense configurations, structural personality organization, and interpersonal adaptation. The 135 items of the instrument sample four primary conceptual realms:
1. Phenotypic Symptom Manifestations and Observable Behavior (approx. 75% of items)
This category encapsulates overt emotional, cognitive, somatic, and behavioral patterns accessible through direct interview observation, behavioral tracking, or informant report. Representative dimensions include:
- Internalizing and Affective Disturbances: Items evaluating depressive mood (Item 30), overt tearfulness (Item 107), feelings of hopelessness (Item 10), hypochondriacal and somatic conversions (Items 6, 38, 119), generalized worry and phobic inhibitions (Items 16, 124), and motoric indicators of tension and startle reactivity (Items 69, 111, 114).
- Externalizing and Impulse Control Difficulties: Items reflecting nonconformity and rebellion (Item 40), rule-stretching and limit-testing behavior (Item 67), verbal acting out (Item 113), undercontrolled impulse expression (Item 105), provocative conduct (Item 134), and unmodulated emotional reactivity (Item 88).
- Cognitive and Attentional Processing: Items capturing concentration impairments (Item 1), ruminative ideation (Item 2), obsessive preoccupations (Item 3), and thought disorder presentations extending from bizarre associations (Item 41) to explicit delusional ideation (Item 25).
- Interpersonal Stance and Social Functioning: Items characterizing interpersonal detachment and evasiveness (Items 32, 73), submissiveness and suggestibility (Items 39, 71), demanding or entitled attitudes (Item 20), and social ease or extraversion (Items 5, 23).
2. Genotypic Formulations and Structural Defense Mechanisms (approx. 25% of items)
Genotypic items penetrate beneath manifest behavioral morphology to evaluate the inferred intrapsychic dynamics, primary conflicts, and defensive architecture characteristic of psychoanalytic ego psychology. These include:
- Ego Defenses and Adaptation: The identification of prominent defensive mechanisms, specifically projection (Item 54), rationalization (Item 58), intellectualization (Item 61), acting out (Item 45), regression (Item 47), and repression (Item 126), alongside the evaluation of whether these defenses are functionally adequate (Item 59) or intrinsically pathogenic and symptom-producing (Item 132).
- Dynamic Conflicts and Characterological Traits: Formulations addressing intrapsychic conflicts over dependency (Item 44), self-assertion (Item 52), sexuality (Item 43), giving and retention (Items 49, 56), and unresolved Oedipal triangulation (Item 94).
- Diagnostic Personality Genotypes: Explicit ratings of foundational character genotypes, including psychopathic (Item 79), schizoid (Item 80), hysteroid (Item 81), paranoid (Item 82), and obsessive-compulsive (Item 83) character organization.
3. Ego Strength, Insight, and Integrative Capacities
The construct deliberately integrates ego psychological indices of positive psychological health, reality testing, and integrative synthesis. Dimensions include global ego strength (Item 130), resilience under acute stress or trauma (Items 63, 64), tenuousness of reality contact (Item 98), maturity of the superego (Item 102), and the distinction between superficial “diagnostic” insight (Item 18) versus genuine verbal-cognitive insight paired with emotional resonance (Item 50).
4. Nonpathological and Optimal Adjustment Dimensions (25% of items)
To avoid ceiling effects on healthy dimensions and enable full-range profile descriptions, the construct incorporates neutral descriptors (e.g., rapid personal tempo, Item 14; conventional social framing, Item 12) and explicit markers of superior psychosocial adaptation, such as genuine empathy (Item 76), non-judgmental acceptance of others (Item 75), rewarding socialization history (Item 62), and absence of psychological illness (Item 135).
Theoretical Framework
The theoretical foundation of the Q Array rests upon the synthesis of two major mid-twentieth-century psychological paradigms: William Stephenson’s Q-methodology and classical psychoanalytic ego psychology, further informed by the pioneering personality assessment traditions of Jack Block and the Institute of Personality Assessment and Research (IPAR) at the University of California, Berkeley.
Stephenson’s Ipsative Measurement Paradigm
Stephenson (1953) formulated Q-technique as an alternative to normative (R-methodological) testing. In traditional normative psychometrics, individual differences on isolated traits are measured across a population of respondents. In contrast, Q-methodology inverts the data matrix: the population of items is sorted by a rater to model the unique internal configuration of an individual person. By forcing the items into a predefined, quasi-normal distribution, Stephenson’s technique standardizes response variance, forces critical clinical discriminations, and eliminates universal rater response biases, such as halo effects, extreme-response style, and central-tendency bias.
Ego Psychology and Diagnostic Integration
Marks’s construction of the Q Array was grounded in the clinical necessity of translating psychodynamic formulations into quantifiable psychometric terms. Heavily influenced by Heinz Hartmann, Anna Freud, and David Rapaport, the clinical diagnostic process at the University of Kansas Medical Center conceptualized clinical dysfunction as an equilibrium between id impulses, ego control structures, superego demands, and environmental reality pressures. Marks deliberately bridged the chasm between behavioral phenomenology (what the patient does) and psychoanalytic structuralism (how the patient’s mind is organized) by operationalizing both phenotypic behavior and genotypic character traits into a single deck of cards that could be systematically sorted by clinicians of varying therapeutic persuasions.
Validity
The diagnostic and construct validity of the Q Array was established through empirical clinical investigations conducted within the child guidance setting (Marks, 1961).
Content and Face Validity
The initial domain pool consisted of approximately 2,000 candidate items extracted from patient case records, clinical intake summaries, diagnostic interview protocols, psychiatric nomenclature, and psychological testing reports. A panel of multidisciplinary clinic staff (psychiatrists, clinical psychologists, and psychiatric social workers) iteratively reviewed, edited, condensed, and eliminated redundant or unratable items. The criteria for item retention required that every statement:
- Represented a distinct, clinically meaningful personality or behavioral attribute;
- Demonstrated direct relevance to the operational functioning of outpatient child guidance;
- Possessed high ratability by clinicians relying on standard intake evaluation protocols;
- Maintained adequate intersubject variability across both pediatric patients and adult parental figures.
The final 135 items demonstrated robust clinical content validity across diagnostic spectra.
Construct and Criterion-Related Validity
Marks (1961) demonstrated construct validity by evaluating inter-judge concordance, clinical discrimination between clinical diagnostic subtypes, and correlation with established actuarial profiles. Clinicians who completed independent Q Array sorts on the same cases following intake interviews achieved statistically significant levels of diagnostic concordance. When sorted profiles were compared across distinct diagnostic categories (e.g., aggressive conduct problems versus internalized neurotic inhibitions versus borderline/psychotic states), the Q Array successfully differentiated the dynamic configurations of these patient cohorts.
Furthermore, convergent validity was established by comparing Q Array sort profiles with objective psychometric instruments administered concurrently, such as the MMPI for adult parents and standard projective techniques (Rorschach and TAT) for children. Criterion-related predictive validity was illustrated by items evaluating therapeutic accessibility (e.g., Item 90, “Presents a favorable prognosis”; Item 100, “Would be threatened by interpretations given early in therapy”), which demonstrated strong correlations with subsequent clinical engagement, treatment retention, and therapeutic outcomes.
Reliability
Because the Q Array uses a forced-choice ipsative distribution across 135 items, standard normative metrics of internal consistency (such as raw coefficient alpha calculated across persons) are theoretically inappropriate due to the fixed item-mean and item-variance constraints imposed by the sorting grid. Instead, reliability is established through inter-judge sorting reliability and test-retest stability.
Inter-Rater Reliability
In Marks’s (1961) foundational child guidance investigation, inter-rater reliability was determined by calculating Pearson product-moment correlation coefficients between the completed Q-sort arrays generated by independent clinical diagnosticians observing the same patient or clinical record. Inter-judge correlations across diverse clinical cases typically ranged from r = .65 to r = .82, establishing high descriptive and interpretative consensus among clinical raters when presented with sufficient intake observational and historical data.
Profile Stability and Sensitivity to Change
Test-retest assessments evaluating the stability of clinical formulations across brief pre-treatment intervals yielded stability coefficients generally exceeding r = .75. Over prolonged intervals involving active psychotherapeutic intervention, Q Array profile correlations shifted systematically, reflecting measured personality reorganization, symptom amelioration, and defense restructuring, thereby affirming both instrument reliability and sensitivity to therapeutic change.
Factor Analysis
Within the methodological tradition of Q-technique, factor analysis is performed by factoring the correlation matrix of persons (Q-factor analysis) rather than the correlation matrix of items (R-factor analysis). Marks (1961) utilized inverse factor analytic methods to identify latent clinical typologies and parent-child interactional syndromes.
Q-Type Factor Structure
In analyzing Q Array profiles across child guidance samples, Q-factor analytic solutions consistently revealed major clinical configurations, capturing distinct syndromes of childhood psychopathology and parental personality organization:
- Factor I: Neurotic Inhibition and Internalized Distress: Defined by high positive loadings on items reflecting subjective anxiety (Item 69), feelings of hopelessness (Item 10), intropunitive frustration handling (Item 46), shyness and inhibition (Item 92), and obsessive-compulsive traits (Item 83), combined with negative loadings on verbal acting out (Item 113) and nonconformity (Item 40).
- Factor II: Antisocial Acting Out and Externalizing Conduct: Characterized by high loadings on limit testing (Item 67), undercontrolled impulsivity (Item 105), provocative conduct (Item 134), verbal and physical acting out (Items 45, 113), and psychopathic genotypic traits (Item 79), alongside negative loadings on conscious guilt (Item 109) and mature superego functioning (Item 102).
- Factor III: Somatization and Hysteroid Defense: Defined by somatic conversion of psychological conflicts (Items 119, 38), hypochondriacal concerns (Item 6), secondary gain mechanisms (Item 66), histrionic emotional displays (Item 7), and pervasive denial of psychological distress (Items 24, 120).
- Factor IV: Ego Resiliency and Adaptive Mastery: Marked by superior ego strength (Item 130), adaptive stress organization (Item 63), empathy (Item 76), genuine emotional insight (Item 50), and favorable prognosis (Item 90).
Instrument / Measurement Tool
- Instrument Name: Q Array
- Author: Philip A. Marks, Ph.D.
- Publication Year: 1961
- Test Format: Standardized Clinical Q-Sort
- Number of Items: 135 clinically calibrated statements printed on individual index cards
- Target Population: Child guidance patients (children and adolescents) and their adult parents
- Raters / Observers: Mental health professionals (clinical psychologists, psychiatrists, psychiatric social workers) following diagnostic intake interviews, clinical observations, or comprehensive chart reviews
- Sorting Methodology: Clinicians arrange the 135 cards into a forced quasi-normal distribution along a continuous subjective dimension ranging from “Least Characteristic / Most Untrue” to “Most Characteristic / Most True” of the subject being evaluated.
- Standard Category Distribution (Typical 9-Category Grid):
- Category 1 (Least Characteristic): 5 cards
- Category 2: 8 cards
- Category 3: 12 cards
- Category 4: 20 cards
- Category 5 (Neutral / Ambivalent / Salience-Free): 45 cards
- Category 6: 20 cards
- Category 7: 12 cards
- Category 8: 8 cards
- Category 9 (Most Characteristic): 5 cards
- Scoring and Interpretation: Each item receives the numerical value of the category pile in which it is placed (e.g., 1 to 9). Completed arrays are evaluated via direct item-placement inspection, profile correlation against prototypical criterion arrays (e.g., “Optimal Child Adjustment,” “Schizoid Character”), or inter-profile correlation between family members (e.g., maternal array correlated with child array).
Permissions & Fee and Test Year
- Year of Development: 1961
- Original Publication: Psychological Monographs: General and Applied, Vol. 75, No. 3, Whole No. 507, published by the American Psychological Association.
- Copyright & Intellectual Property Status: The original instrument was published in an academic monograph for the purpose of research and clinical dissemination. Academic researchers and clinical practitioners may utilize the scale for educational, clinical, and scientific research purposes, provided proper citation of the source monograph is maintained. Commercial reproduction, incorporation into fee-for-service software platforms, or mass distribution requires formal licensing permission from the American Psychological Association or the copyright holder.
- Associated Fees: No per-administration royalty fees apply for independent academic research and clinical training use using the published items.
References
- Block, J. (1961). The Q-sort method in personality assessment and psychiatric research. Charles C Thomas. https://doi.org/10.1037/13141-000
- Marks, P. A. (1961). An assessment of the diagnostic process in a child guidance setting. Psychological Monographs: General and Applied, 75(3), 1–41. https://doi.org/10.1037/h0093768
- Marks, P. A., & Seeman, W. (1963). Actuarial description of abnormal personality: An atlas for clinicians and researchers. Williams & Wilkins.
- Stephenson, W. (1953). The study of behavior: Q-technique and its methodology. University of Chicago Press.
Items of the Scale
- Reports difficulty in thinking (e.g., cannot concentrate).
- Tends to be ruminative and overideational.
- Obsessive thinking present.
- Is perfectionistic: is compulsively meticulous.
- Is socially extraverted (outgoing).
- Manifests hypochondriacal tendencies, i.e., is excessively concerned about physical condition and
- Is self-dramatizing: histrionic.
- Is excitable.
- Complains of weakness or is easily fatigued.
- Has feelings of hopelessness.
- Has a high aspiration level for self: is ambitious, wants to get ahead.
- Judges self and others in conventional terms like “popularity,” “the correct thing to do,” “socialpressures,” etc.
- Tends to arouse liking and acceptance in people.
- Has a rapid personal tempo: thinks, talks, moves at a fast rate.
- Is cheerful.
- Is vulnerable to real or fancied threat: generally fearful, is a worrier.
- Experiences difficulty in giving orders or making demands and requests of others.
- Has “diagnostic” insight: awareness of the descriptive features of own behavior. (Examples: that certain symptoms are neurotic, that one is not liked by others, that one tends to distort in certain ways; that one is depressed, that one shows poor judgment in such-and-such ways, that one underachieves.)
- Exhibits good heterosexual adjustment.
- Is demanding: tends to take the attitude “the world owes me a living,” “I have a right to be taken care of,” etc.
- Is unpredictable and changeable in behavior and attitudes.
- Is egocentric, self-centered, selfish: seeks need-gratifications (“how will this affect me?) with little regard for the happiness and well-being of others.
- Appears to be poised, self-assured, socially at ease.
- Is defensive about admitting psychological conflicts: tries to avoid revealing self as having psychological conflicts and emotional distresses.
- Delusional thinking is present.
- Has grandiose ideas (extreme is delusions of grandeur).
- Seeks out and tries to relate to parent figures.
- Is resentful.
- Exhibits psychotic tendencies.
- Exhibits depression (manifest sad mood).
- Tends to delay or avoid action: fears committing self to any definite course, is indecisive, vacillating.
- Is evasive.
- Is irritable.
- Tends to transfer blame.
- Demands sympathy from others.
- Behaves considerately towards others.
- Is argumentative.
- Presents self as being physically, organically sick.
- Is suggestable: overly responsive to other people’s evaluations rather than own.
- Tends to be rebellious and nonconforming.
- Thinks and associates in unusual ways: has unconventional thought processes (extreme is illogical, confused, or bizarre).
- Is apathetic.
- Has inner conflict about sexuality (distinguish from reality problems in this area).
- Has inner conflict about emotional dependency (distinguish from reality problems in this area).
- Utilizes acting out as a defense mechanism.
- Reacts to frustration intropunitively (i.e., punishes self).
- Utilizes regression as a defense mechanism.
- Exhibits evidence of narcissism (latent or manifest).
- Has conflicts about giving,
- Has good verbal-cognitive insight into own personality structure and dynamics, and has a real “feeling” for these insights. Insight not defended against by isolation intellectualization.
- Has a need to affiliate with others: i.e., to form friendships and associations, to greet and converse sociably with others, to join various groups, etc.
- Has inner conflicts about self-assertion (distinguished from reality problems in this area).
- Fears loss of control, feels need to keep rigid check on own emotional responses: cannot “let go” even when appropriate.
- Utilizes projection as a defense mechanism.
- Has a need to achieve: to overcome obstacles, to exercise power, to strive to do something difficult as well and as quickly as possible (this is an elementary ego need which may alone prompt action or be fused with any other need).
- Is retentive: has a need to retain possession of things; to refuse to give or lend; to hoard; to be frugal, economical, and miserly.
- Places value on intellectual and cognitive activities, skills, and attitudes.
- Utilizes rationalization as a defense mechanism.
- Defenses are fairly adequate in relieving psychological distress.
- Tends toward overcontrol of needs and impulses: binds tensions excessively, delays gratification unnecessarily.
- Utilizes intellectualization as a defense mechanism.
- Life has included rewarding socialization experiences.
- Would be organized and adaptive when under stress or trauma.
- Has a resilient ego-defense system: has a safe margin of integration, adequate self-control.
- Values wealth or material possessions and judges self and others in terms of them.
- Gets appreciable “secondary gain” from symptoms (i.e., symptoms function to get person out of painful, difficult, or stressful situations in a socially acceptable way or are otherwise rewarding via their manipulations of external-relations).
- Characteristically pushes and tries to stretch limits: sees what can be gotten away with.
- Is self-defeating: places self in an obviously bad light.
- Is nervous, tense in manner: trembles, sweats, or shows other manifest signs of anxiety.
- Is distrustful of people in general: questions their motivations.
- Is readily dominated by others: is submissive.
- Spends a good deal of time in personal fantasy and daydreams: fictional speculations.
- Keeps people at a distance: avoids close interpersonal relationships.
- Is sensitive to anything that can be construed as a demand.
- Accepts others as they are: is not judgmental.
- Is able to sense other person’s feelings: is an intuitive, empathetic person.
- Is protective of those close to self (placement of this item expresses behavior ranging from overprotection through appropriate nurturance to laissez-faire, unstructuring attitudes).
- Is critical, not easily impressed, skeptical.
- Genotype has psychopathic features.
- Genotype has schizoid features.
- Genotype has hysteroid features.
- Genotype has paranoid features.
- Genotype has obsessive-compulsive features.
- Shows concern over reputation.
- Feels there is social stigma attached to clinic contact.
- Is a serious person who tends to anticipate problems and difficulties, and to look at the “dark side” of things.
- Is concerned about the qualifications of various staff members.
- Seems unable to express own emotions in any modulated, adaptive way.
- There are many “positives” in this case.
- Presents a favorable prognosis.
- Is overanxious about minor matters and reacts to them as if they were real emergencies.
- Is a shy, anxious, and inhibited person.
- Resorts to escape into fantasy.
- Has unresolved Oedipal problems.
- Tends to be flippant both in word and gesture.
- Is open and frank in discussing problems.
- Has a need to think of self as an unusually self-sufficient person.
- Has a tenuous hold on reality.
- Has shown ability to talk about conflicts in most areas.
- Would be threatened by interpretations given early in therapy.
- Is suffering from feelings of rejection.
- Has a relatively mature superego.
- Tends not to become involved in things: passively resistant.
- Is stereotyped and unoriginal in approach to problems.
- Undercontrols own impulses: acts with insufficient thinking and deliberation.
- Gets along well in the world as it is: is socially appropriate in own behavior, keeps out of trouble (to be considered as conceptually separate from person’s intrapsychic state).
- Is tearful and/or cries openly.
- Emphasizes oral pleasures: is self-indulgent.
- Is consciously guilt-ridden: self-condemning, self-accusatory.
- Doesn’t seem to be particularly afraid of anything.
- Is tense, high-strung, jumpy: has an over readiness to respond with startle or apprehension to unexpected stimulation.
- Consistently avoids being put in any situation where own performance will be inferior to that of the others.
- Expresses impulses by specific verbal “acting out” (e.g., scolding, yelling, cursing, etc.).
- Exhibits manneristic behavior (tapping on table, biting lips, biting nails, wringing hands, etc.).
- Is afraid of emotional involvement with others.
- Has a wish (conscious or unconscious) to kill people who thwart self in any way.
- Has a wish (conscious or unconscious) to take others’ possessions from them.
- Undervalues and consistently derogates the opposite sex.
- Psychic conflicts are represented in somatic symptoms.
- Handles anxieties and conflicts by refusing to recognize their presence.
- Possesses a basic insecurity and need for attention. Search for “love” is a compulsive or neurotic search for security.
- Overreacts to danger or makes emergency responses in the absence of actual danger.
- Is made anxious or disturbed by impulses to commit a criminal act or hostile act (e.g., desire to stab, beat, or kill someone, to set a fire, to mutilate an animal).
- Fears of phobias present (include all the common fears such as claustrophobia, school phobia, etc.). Continuum ranging from slight anxiety to severe inhibition of activity because of the fears.
- Has superior intellectual ability (based on clinical observations of functioning level only ).
- Repressive mechanism functions adequately.
- Easy to talk to and get along with in this kind of relationship.
- Has the capacity for forming close interpersonal relationships.
- Has an exaggerated need for affection.
- Ego strength (continuum ranging from severe ego weakness through moderate strength to exceptionally strong ego development).
- Has obsessional character problems.
- Has developed defenses which themselves cause suffering.
- Is a reliable informant.
- Is provocative.
- Is “normal,” healthy, symptom free (psychologically).