Clinical considerations in the psychological evaluation of gestational surrogates: uses of narrative assessment

Potential risks and ethical considerations inherent in surrogacy arrangements place tremendous responsibility on mental health professionals performing the necessary assessments, yet there is little discussion and no consensus on the best testing protocol. In the U.S., the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) are the most common psychological measures used to screen gestational surrogates (GSs), although these self-report symptom inventories reveal tendencies to underreport, deny problems and present positive impressions that may conceal important clinical information. This study examines the utility of a multi-method approach in the psychological evaluation of GS candidates. A total of 43 women cleared to be GSs completed the PAI and an abbreviated protocol of a narrative construction assessment measure (The Thematic Apperception Test (TAT)) as part of the psychological screening process. Findings of the study show that utilising a multi-method approach in the psychological consideration of a GS can address the limitations inherent in a single-measure assessment approach. Including a narrative measure such as the TAT that is less affected by defensiveness found on self-report scales may allow for more subtleties in interpretation, helping assessors to identify women who may have particular psychological vulnerabilities. These might then be addressed through implications counselling.