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Handbook of Psychological Assessment 2ed - Gary Groth-marnat

Handbook of Psychological Assessment 2ed - Gary Groth-marnat

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Level of environmental supportrefers to the presence of a strong cohesive family and a
secure form of employment. These external means of support can often modify the im-
pact of other forms of stressors. High social support has also been associated with a fa-
vorable response to treatment (Mallinckrodt, 1996), as well as the ability to maintain
the gains made through treatment (Zlotnick, Shea, Pilkonis, Elkin, & Ryan, 1996). Not
only are the treatment gains higher for persons with high social support, but also they
achievedthese gains in a shorter period (Moos, 1990). In contrast, clients with low
social support required more time to benefit from therapy.
Informal assessment of social support can be achieved by noting the following


•The extent to which the client feels trusted and respected by the people in his or

her life.


•The extent and quality of people he or she can confide in.

•Level of experienced loneliness.

•The extent he or she feels abandoned by family or friends.

•The extent to which the client feels a part of his or her family network.

•The number of friends the client has common interests with.

It should be stressed that assessing social support should not consider merely the num-
ber of people available for the person, but the quality the client feels regarding this
support. It is one thing to be living with a large number of people and quite another to
actually feel that it is possible to confide in those people.
There are also a number of more formal strategies for assessing social support. Prob-
ably the most frequently used scale is the Social Support Questionnaire (Sarason,
Levine, Basham, & Sarason, 1983). Additional information related to social support
might be the relative elevation of MMPI-2 scale 0 (Social Introversion). High scores
suggest an inhibited, shy person who may find it difficult to have a large network of
friends. In addition, elevations on 6 (Paranoia) and 8 (Schizophrenia) suggest that both
the number, as well as the quality, of social support may be low. High scores on 1
(Hypochondriasis) and 3 (Hysteria) may indicate that, although the number of supports
may be high, the quality of these supports may be poor. MCMI-III elevations may also
provide useful information related to social support. High scores on Schizoid, Avoidant,
Schizotypal, Paranoid, and Thought Disorder each might indicate both a low number, as
wellas low quality, of social support. Other scale elevations including Dependent,
Histrionic, Narcissistic, Passive-Aggressive (Negativistic), Self-Defeating, and Border-
linemay have moderate to high social supports but these supports are also likely to be
quite conflicted. For example, Dependents may have social supports but have achieved
these supports through sacrificing their autonomy and sense of personal competence.
Theyare also likely to experience some anxiety related to fears that this social support
may not be permanent. The Narcissistic may similarly need extensive social supports
but needs to manipulate others to maintain these supports, and there may be extensive
hostility if there are any threats to the admiration he or she expects from others.

High Social Support

High social support suggests a shorter duration of therapy. Long-term intervention
may even be contraindicated. Therapeutic gains are likely to occur relatively rapidly
and be maintained. Therapies that enhance the quality of relationships are likely to be
particularly effective, presumably because they are enhancing skills the person al-
ready has. In contrast, cognitive and behavioral therapies are likely to be less effective
(Beutler etal., 2000).

Low Social Support

Low support suggests cognitive behavioral therapy is more effective than therapies de-
signed to enhance relationships (Beutler etal., 2000). Both longer duration of therapy
and the possibility of medication are indicated. It may be possible that a supportive
group intervention would be useful in providing sufficient support to activate additional
more relationship/interpersonal types of therapies.

608Psychological Assessment and Treatment Planning

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