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The Sentence Completion

Posted Oct 23 2008 11:54am

When working with children, many clinicians will utilize a Sentence Completion Form (SCF) in their assessment of a child's difficulties. This is essentially a list of incomplete sentences that the child is asked to fill-in with whatever comes to mind. A few items from the form might look like this:

Today I'd like to _____________.
______________ is dumb.
______________ makes me happy.

The theory behind this exercise is that the child will complete the sentences with words that reflect his own conflicts. This non-threatening activity, which is an example of what is known as Projective Testing, is thought by many to be an X-ray of the child's personality. So, if the child's answer's to the above were:

Today I'd like to stab my therapist.
Your face is dumb.
Dr. Rob dying makes me happy.


then I might consider that I am working with a very aggressive child who despises me more than all of my ex-girlfriends. Combined.

In graduate school, we were trained to use the form with adults as well. I never agreed with this idea and felt genuinely stupid asking the clients to fill it out. Most could immediately tell what the purpose of the instrument was, and some felt that their intelligence was being insulted. It probably was.

Despite my protests, I was forced to use the form with every new client who came into the university clinic. I never considered myself the most confident graduate clinician, but I'm sure I appeared like a stammering imbecile asking them to complete the form. "Would you...mind...filling out this semi-blank piece of paper?"

"Why?"

"Because it's...useful? I think?"

This feeling of buffoonery was exacerbated when I was being taped and/or watched live by my classmates. In graduate school, clients were notified of a camera in the upper corner of the room and told that they would be filmed and/or watched live for training purposes. It was common for them to feel skittish at first, but after being told that it was both a legal requirement (given that none of the students had a license to practice Psychology) and that the focus was on the student and not the client, most people quickly forgot that the camera was even there.

I drew the line on the SCF after my experience with an early 30's, middle-class man who came into therapy at his wife's behest for "passive-aggressive tendencies," which were getting under the wife's skin. "I don't want to get divorced, man, so I guess I have to come in and check this scene out." As part of the protocol for the first session, known as the Intake, I sat with him and talked about his current problems, relevant history, and pertinent medical information. I then blubbered through my little speech about how the SCF helps to provide a more rounded picture of a client's difficulties, how the information is used in treatment planning, and other silly clinical statements. He looked at the form, looked at me, raised an eyebrow, and said "You're serious?"

Unfortunately, I am."Yes please."

He chortled at this, I probably blushed, and he went to work on filling out the 20 incomplete sentences. Knowing that the other students and supervisor were watching me feeling and looking stupid, I considered flipping them off into the camera.

"Here ya go, Freud-to-be," he said, handing me the SCF, the way any real man would hand a completed Paint by Numbers to a pseudo-man.

I took the client's history form, sliding scale payment form and, of course, the SCF into the Audio/Visual room where my professor sat with a few of my classmates. Disgusted, I handed the professor the SCF, and he began to scan some of the items:

I will be happy when I'm Sixty-Four.
I feel Fine.

"Interesting," he said in that academic way people talk when they don't know what else to say. "No distinct pattern as of yet."

As he continued to read, the responses got less subtle:

I want To Hold Your Hand.
Happiness is A Warm Gun.

"There could be something worthwhile here, Rob, but I can't quite make out the arrangement just yet."

Finally, the last few hit him on the head:

I am The Walrus.
Today is A Hard Day's Night.
Yesterday I Saw Her Standing There.

After the professor had finished reading the last item, we looked at the T.V. monitor, only to see the client laughing out loud and pointing into the camera.

"Why that...boorish man!" bellowed the professor. "He's making a mockery of projectives! Using Beatles' songs no less!"

It was clever. "He's doing a pretty good job of it too," I noted.

"Wait! Don't you see?" said one of my classmates. "He's being passive-aggressive. Just like his wife said he was. The SCF was right!"

"But we already knew he was passive-aggressive." I said, holding up his intake form. "It says it right here where you write in "Presenting Problem." And we only needed one line to learn that, not an entire set list from England's greatest export."

"You go in there," the professor said, "and you confront this behavior immediately. This is therapy interfering behavior!"

"But I'm just a first-year, I'm only doing Intakes. I've never done therapy in my life," I protested.

"Dobrenski, get in there and assert your position as a man of integrity. If this man wants our help, he's going to have to respect us and, more importantly, the SCF."

During the professor's rant, the client must have left, because when I got back to the room, there was just a note:

Rob, you seem like an okay guy, but please understand that it's my wife who made me come here. That questionnaire was a joke. I don't want to waste any more of our time. I don't need "Help!" like she says I do. I've got my own "Ticket to Ride," so there's no need for you to "Carry That Weight."

"All my Loving,"

X

I've yet to meet a more Beatles savvy person than that client in the ten plus years since that incident. Was the client a sociopath? Probably not, although he clearly had some disdain for the SCF, and probably psychology in general. I don't use the SCF anymore, but I've seen them in child clients' charts over the years in various clinics and hospitals. And when I see responses like "I like doggies," I can't help but think, "Damn kid, you can't do any better than that?"

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