The Sentence Completion Test

Dr. Jane Loevinger, the Washington University Sentence Completion Test of “Ego Development,” and Why It Matters When You Find Yourself Abusing Alcohol, Suffering From “Alcoholism,” Considering Outpatient Treatment or Residential “Rehab,” and Wondering Why AA is Such a Dangerous Cult For Most of Us.

Beginning after WWII, Dr. Jane Loevinger of Washington University in St. Louis, began constructing a model and measure of “Ego Development” which became the W. U. Sentence Completion Test. She spend the next 50 years refining the test which is, essentially, a measure of emotional and psychological maturity – or lack thereof.

Loevinger described 8 stages of development, coded E-2 through E-9, beginning with Impulsive and continuing through Self-Protective, Conformist, Self-Aware, Conscientious, Individualistic, and Autonomous, to Integrated. Each of these stages has a chronologic age when it’s the appropriate level to be as one progresses through life, though no such progression may, in fact, occur. Both arrested and precocious development are common factors in substance abuse as well as the most important component of individual treatment design.

Understanding and using “ego development” as a tool efficiently and effectively assists us in rapidly establishing a therapeutic alliance with you, the client. This also facilitates designing a specific “mosaic” of components to incorporate into an effective treatment plan based on your underlying world view, coping skills, and presenting strengths.

To see how this is done, first consider the test itself which consists of 36 sentence stems. These are brief, consisting of a phrase similar to “When I am angry…” to be completed in a single, untimed session which usually runs between 30 minutes and two hours.

Once completed, each stem is rated on the same 8 point scale of Loevinger’s stages, using her Measuring Ego Development, Second Edition, as a guide. The number of responses at each level is then tabulated, and the results processed through her algorithm which gives a “Total Protocol Rating (TPR).

With the process completed it becomes possible to use the results in a number of ways.

First, the TPR tells us the level at which you are willing to operate at this specific time, in this setting, and under these circumstances. It is important to remember that E-levels are always “floors,” never ceilings, but we must still meet you, and work with you, at your preferred level. Therefore, we can adjust our level of interaction in order to be neither patronizing nor incomprehensible.

Next, the responses themselves can be analyzed with the highest rated reflecting those topics or themes which are of greatest interest to you. This makes it possible to begin discussion with those topics most apt to engage you and, therefore, promote the positive exchanges as we work together. Likewise, the lowest rated stems will identify topics or themes of little or no interest or concern and therefore can be safely avoided, at least for the time being.

The E-Levels also correspond to specific recommendations for treatment planning, client selection, and even marketing.

Specifically, Dr. Barnes and I work primarily with individuals – 70% women, 30% men – aged 40-70, and who rank at the top of Loevinger’s scale. Because you are precociously “mature” you are frequently lonely, isolated, and bored but don’t know why. Simply explaining that you have very few chronologic peers capable of the intimacy you seek helps. A little.

Knowing does help, but doesn’t fix anything. And this isn’t a case where “higher is better.” But it does explain why programs like AA are counter-productive and how the creation of unique solutions is possible. It also explains using alcohol for its regressive properties to drink one’s way down to others’ levels.

But that temporary regression is just that, temporary. Solutions mean learning how to find and identify others of similar developmental maturity. Again, individualization is required. Here too, you learns who to stay away from as well as how to find more compatible associates.

It is no surprise that higher level clients tend to be professionally successful but personally passive in their attempts to find intimacy. You are also frequently manipulated because of your ability to adjust and accommodate.

Among other things, this means eschewing groups and labels in favor of individual activities within semi-social situations. Many of our clients respond well to weight lifting, kick boxing, and other physically challenging exercise options that they would not have otherwise considered.

While that applies to our niche, and defines our work, web design, newsletters and other materials, the same SCT results can also be used to refer or treat clients at other levels.

For example, AA is most effective with clients whose development matches Loevinger’s E-4 Conformist Stage, and the E-3 Self-Protective.

Looking at the traits it is easy to extrapolate why. Conformists’ behaviors are dictated by whatever group they adhere to. By joining AA they are simply exchanging one reference group, active drunks, for another, “in recovery” alcoholics, enamored of slogans, medallions, exclusivity and in-group status.

Likewise the E-3s find, as Bill W. did, an endless supply of self-identified and very vulnerable targets for 13th Stepping and other forms of financial and emotional exploitation.

Additionally, AA also “works” for a tiny number of the rigidly Conscientious E-6 individuals who try their utmost to protect the “flock.” Referring to their protocols will help identify them by a lack of range in their responses. Healthier protocols will always have a range of responses, usually from E-4 to E-6 or 7, and a lack of range suggests an exhausting amount of inner tension and over responsibility.

Viewing efficacy from a maturity viewpoint also explains other aspects of traditional “recovery.”

For example, any number of individuals, particularly those at what Loevinger defined as normal in American society, the E-5 Self-Aware, go to AA, or rehab, and sober up long enough to overcome the regressive effects of drinking. With regression reversing, and depression eased, they begin to bounce back to their actual maturity levels – levels at which AA becomes an impediment to “getting a life.”

The result? They can either leave AA, or they can return to drinking in order to stay at the AA level. At this point a good counselor can help to deprogram them from 12 Step mythology and assist them in returning to a normal life unfettered by unfounded fears.

Then there are the people for whom AA never has had any appeal, the E-7’s, 8’s and 9’s of Loevinger’s model. These are the individuals – and at this level they truly are the “individuals” – and you make up the majority of our clients.

Helping you to escape society’s pervasive recovery mentality is the real first step in freeing you from the false mantra of powerlessness, the opposition to self-efficacy, the demand that one adhere to the group, and the negation of individuality. That is a 12 Step recipe for depression and/or suicide.

As you learn that there are good reasons, for your loneliness, boredom, and other common conditions associated with AOD abuse, you also learn that there is hope of ending these with planning that takes into account your uniqueness and that gives permission to create an equally idiosyncratic but satisfactory and productive life without regard for many of society’s conformist norms.

This all leads to the question, what causes some people to develop precociously while others are arrested at abnormally low levels? The answer has four parts:

  • Maturation requires that a person be reasonably intelligent, not a genius, but smart enough to understand, appreciate, and adapt to life’s complexities;
  • It also requires sensitivity – insensitive people have no motivation to develop the sophisticated coping skills that are the hallmarks of maturity;
  • Additionally, during childhood and adolescence, children need to have things happen, not necessarily traumatic, that they have to fix themselves. Those who are always rescued by helicopter parents, again have no motivation to grow up;
  • Finally, most people have a primary response to events that comes down to either fear or anger, the classic fight or flight conundrum from our ancient survival instinct. For maturation to occur, fear is a far better base than anger as it requires far more attention, processing, and development. Anger based people simply use aggression as their only coping skill, transforming any uncomfortable feelings into anger and acting out accordingly.

None of these, however, in isolation guarantees that a person will mature. Intelligence without sensitivity, and fueled by anger, simply gives us the E-3s like Richard Nixon, Bernie Madoff, and countless other politicians, con artists, and cult leaders.

The hierarchy can still be difficult to grasp, and clients, as well as the professionals we train, often ask for a concrete example. We usually use the question, “Why don’t you steal?”

Those at the higher levels will typically respond with, “Because stealing is unethical.” We then note that ethics are a completely internalized system of checks and balances on one’s behavior.

Farther down the scale, people will say, “Because stealing is immoral.” Here we suggest that morals are partially internalized and partially externalized behavior control systems, usually based on religion or a comparable belief system.

Dropping down to the Conformist level, the response is usually, “Because it’s illegal,” which shows a completely externalized control system.

Drop on down to the Self-Protective cons who usually say, “Because I might get caught!”

Notice that development is a process of increasingly assuming responsibility for one’s choices. It also means bringing more of our unconscious into consciousness, and developing an appreciation for differences rather than being afraid of them.

This latter, tolerance for ambiguity in Loevinger’s words, and finding idiosyncrasies interesting is anathema given AA’s abhorrence of “normal” people, strict regimentation to a black and white world, the propagation of such myths as “AA is the only way,” and an unwillingness to tolerate deviation from, or up-dating of, the Steps that have remained unchanged for three quarters of a century. Still, this segregation does in fact serve the immature individuals who make up the majority of the 12 Step “lifers,” and there is an obvious need to provide for them as well.

Understanding and using the Developmental Model allows us to individualize treatment to match you. It also usually means deprogramming you and your family from all of the pervasive rehab mythology – no small task.

Finally it also means giving up the “disease” model for the “symptom” model – i.e., alcohol abuse is a symptom of underlying dissatisfactions including loneliness, anxiety, boredom, unbalanced personal relationships, hormonal and life event changes, role losses, and other conditions that present a mosaic of factors to be addressed.

Skillful work allows us to provide a proportionate mix of CBT, assertiveness training, motivational enhancement, diet, exercise, and other considerations which will result in a comprehensive plan which we can then spend another 3 months sustaining, adjusting, and supporting.

Edward W. Wilson, Ph. D. and his colleague, Mary Ellen Barnes, Ph.D., created Your Empowering Solutions, Inc., which provides intensive outpatient treatment to alcohol abusing individuals and couples. Their practice is located on southern California’s Palos Verdes Peninsula and they serve clients from around the world.