Clinical assessment of object relations and social cognition using stories told to the picture arrangement subtest of the WAIS-R.

For many years clinicians have supplemented the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) Picture Arrangement (PA) subtest by asking subjects to "tell the story" made by the sequence of cards. Doing so allows assessment of the underlying reasoning behind the subject's response and adds a projective element to the task. This article describes a method for systematically assessing several dimensions of object relations and social cognition from the stories subjects tell to the PA subtest. Six scales, which have been validated in several studies, are described: Episode Integration, Accuracy of Causal Attributions, Affect-Tone of Relationship Paradigms, Capacity for Emotional Investment in Relationships and Moral Standards, Complexity of Representations, and Accuracy of Character Ascriptions. Evidence for convergent and discriminant validity is presented by comparing PA scale scores of reliably diagnosed borderline inpatients, depressed inpatients, and normal comparison subjects, with scores from self-report instruments measuring symptomatology and social adjustment. Clinical use of the scales is then illustrated by applying them to PA story texts of a borderline patient and a normal subject.