The Rorschach response process

To resume a stalled psychotherapy? Psychological testing to understand an impasse and reevaluate treatment options

Clinical wisdom holds that psychological testing is a useful tool for consultation when there is a need to untangle and resolve a psychotherapeutic impasse. However, there has been a lack of empirical research in this area, and only a few cases have been published demonstrating how psychological testing can be used toward this end. In this article, the author offers a case illustration of the application of testing with a patient who sought to resume psychotherapy following a previous impasse and premature termination. Specific referral questions for the evaluation are explicated followed by discussion of the test data that answered each of them. The findings pointed not only to intrapsychic and object relational characteristics of the patient that contributed to the impasse but, importantly, alerted the author-therapist to his contributions as well. Treatment implications of the findings are also highlighted.

[Anatomical contents in the Rorschach test: comparison between a population of nurses and a control group]

INTRODUCTION

The study of answer contents to a Rorschach test leads to numerous debates and controversies. From a pragmatic point of view, the recurrent question is to understand the meaning of a content (or its repetition) in a protocol. From a discursive and perceptive point of view, it is hazardous to give an interpretation other than descriptive and contextual. Indeed, no single interpretative theory or analysis method is able to determine with certainty and rigor a strict correlation between people's psychological functioning and the contents they perceive.

METHODS

In this empirical context, we studied the "anatomy" answers (frequencies and formal qualities) in a population of nurses (n=38) matched with a control group (non-medical subjects, n=38). The Rorschach test was administrated according to the recommendations of the Integrated System.

RESULTS

The average of An+Xy answers was clearly and significantly higher in the nurse population (3.58) than in the control group (0.89) and than in the three comparative norms that we selected (from 0.96 to 1.83). Concerning the formal quality, the repeated-measures analysis of variance showed a significant interaction effect: although subjects in the control group gave a similar number of ordinary, unusual and minus forms for An+Xy answers, the nurses gave more erroneous (minus) forms (1.79) than unusual forms (1.21) and finally than ordinary forms (0.58).

DISCUSSION

Two hypotheses may be suggested in order to explain our findings. On one hand, it is highly probable that our results are linked to the everyday body confrontation in a nurse's job. On the other hand, we suggest that by giving An+Xy answers, nurses tend to reveal some idiosyncratic characteristics in order to show their own identity. Indeed, our nurse subjects were selected because of their job, and so they complied with the social identity that was implicitly expected. This is congruent with the complex functioning in social reality: in a social group, people will not verbalize all of their perceptions; they will preferentially verbalize perceptions that define their social identity. Conversely, if some perceptions do not comply with the subject's identity, these perceptions will be less frequently verbalized, despite the fact that they were perceived. Concerning the second main finding, the inadequate formal quality of answers given by nurses emphasizes a visual misrepresentation conditioning due to one's job. This effect is interesting from a psychological point of view because it suggests that this tendency to perceive more anatomical contents arises to the detriment of the "reality". Finally, our findings allowed us to suggest the hypothesis of the role of identity in answer contents to a Rorschach test according to the context, and to formulate some recommendations about the content use in the Rorschach interpretation.

Scoring the Rorschach: A Constructive Critique of Exner's Comprehensive Rorschach System

John Exner's rationale for scoring the Rorschach and his decision to score "blend" responses by assigning equal weights are critically reviewed. The resultant exclusion of new responses made during the Inquiry of the Free Association responses is viewed as a major deficiency in the Comprehensive Rorschach System. A change to Klopfer's "Main-Additional" scoring method is recommended as a corrective.

The impact of administration and inquiry on Rorschach Comprehensive System protocols in a national reference sample

We investigated the impact of administration and inquiry skills on Rorschach Comprehensive System (CS; Exner, 1974, 1991, 1993) protocols collected for the Italian adult nonpatient reference sample. The same research team collected CS protocols on two occasions. The initial reference sample (N = 212; Lis, Rossi, & Priha, 1998) was collected under the supervision of experienced psychologists who carefully studied CS administration and scoring procedures (Exner, 1986, 1990, 1993). The second sample (N = 101; Lis, Zennaro, Calvo, & Salcuni, 2001) was collected after the team obtained additional and sustained CS training from Rorschach workshops certified instructors. Both samples were scored, reliably but they showed large differences on many codes, with protocols from the second sample being richer and more complex than the first. The results indicate that administration skills can have a dramatic impact on CS protocols and may contribute to variations in samples collected by different investigators. Training standards should be devised to insure uniform administration procedures are followed when collecting CS protocols.

Methodological problems in Rorschach research

Comprehensive System of Rorschach interpretation is considered as nomotetic system that makes possible using of projective method in research projects. However, research use of Rorschach method besides of appropriate knowledge of assign procedures and interpretation rules, means a knowledge of specific methodological issues. The Rorschach indicators are nor independent, as they are a part of specific net, so in some research it is necessary to control basic variables not to get artifacts in our research. This is basically relied on researches where we compare groups, as well as in normative studies where through cross-cultural we compare Rorschach indicators. .

Differential patterns of responding among three groups of chronic, psychotic, forensic outpatients

Elements of response style were examined among three groups of chronic, psychotic, forensic patients: paranoid schizophrenics (N = 89); undifferentiated-disorganized schizophrenics (N = 38); and schizoaffective patients (N = 53). Forensic patients with elevated MMPI-2 L Scales produced increased percentages of Pure Form (F%) on the Rorschach. A similar relationship occurred when the Rorschach was used as the independent measure. Schizoaffective patients reported more psychotic symptoms on the MMPI-2 and lower F% (Rorschach) than both schizophrenic groups. Although undifferentiated schizophrenics evidenced the most psychopathology on the Rorschach (impaired reality testing and perceptual accuracy disturbance), all three groups produced lower than expected frequencies for Rorschach variables commonly associated with thought disorder and poor reality testing (Exner, 1995b). The clinical importance of using the MMPI-2 and Rorschach in tandem with forensic psychiatric patients is discussed. Our empirical findings suggest the need for forensic evaluators to consider the important relationship between psychiatric diagnosis and response style (defensiveness, denial, illness chronicity, medications, and concurrent Axis II psychopathology) when interpreting often-constricted psychological testing protocols in chronic forensic patient populations.

Remarks on method for MMPI-Rorschach studies

An impressionistic list of methodological considerations that may be of consequence in Minnesota Multiphasic Personality Inventory (MMPI)-Rorschach studies is presented. These include the potential effects of the multidimensionality of the basic clinical MMPI scales in comparison studies, issues of deception and response style in such studies, and the rote of theory in guiding the selection of variables in the search for MMPI-Rorschach correspondences. The recently established necessity of controls for the total number of Rorschach responses provides the basis for suggestions for further controls in MMPI-Rorschach studies, including those for level of distress and for the minimization/exaggeration of psychopathology. An effort is made to contrast these two instruments in terms borrowed from information theory as a way of illuminating their complementary aspects, and suggesting means by which each may contribute to an enhanced understanding of the other.

Data and issues to Consider in Reconciling Self-Report and the Rorschach

Archer and Krishnamurthy (1993a, 1993b) systematically reviewed the Minnesota Multiphasic Personality Inventory (MMPI)-Rorschach research and found that there is minimal if any association between the two tests. In response to this review, data are reported demonstrating a positive association between various Rorschach variables and objective criteria. Data gleaned from published and yet unpublished sources suggest that the Rorschach is related to various self-report, other-report, and behavioral criteria, with children and adults, for psychosis and other constructs. Data are also presented suggesting that part of the disagreement between the two tests may be due to different types of response bias and positive self-presentations on the two tests. Research findings pertinent to differential validity as a function of the number of Rorschach responses protocol are also explored. I conclude with research recommendations regarding test-specific understandings of response bias and Rorschach protocol complexity as a moderator variable.

A Review of MMPI and Rorschach Interrelationships in Adult Samples

The MMPI and Rorschach are consistently ranked among the most widely used psychological assessment instruments across adolescent and adult clinical settings. Although there is an extensive research literature available on each instrument individually, relatively little research attention has been focused on the interrelationships between these measures. This article reviews the literature derived from 37 studies that have reported interrelationships between MMPI and Rorschach variables in adult populations. The results of these studies generally indicate limited or minimal relationships between the MMPI and Rorschach. A number of methodological issues, however, prevent drawing firm conclusions from the literature at this time. Directions for future research are discussed, including consideration of issues related to sources of alpha and beta error and the need for studies examining the incremental validity of combinations of Rorschach and MMPI data in prediction to relevant external criteria.

The impact of response frequency on the Rorschach constellation indices and on their validity with diagnostic and MMPI-2 criteria

I first examined the effects of response frequency (R) on the Comprehensive System's constellation indices (Exner, 1991). R is significantly associated with 26 of the 29 constellation criteria that are based on raw numbers and significantly correlated with total scores on each of the constellations. I then examined how R impacts the external validity of the constellations. The ability of the Schizophrenia Index and the Suicide Constellation to discriminate diagnostic groups appears to be impaired when protocols deviate from average length, whereas the Hypervigilance Index (HVI) appears most diagnostic of a paranoid condition when it is relatively elevated in brief records. R also clearly mediates the relationship between the Rorschach and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) criteria. In lengthy protocols, many of the cross-method convergent correlations between appropriate MMPI-2 scales and the Depression Index, Obsessive Style Index, and HVI are quite high and approach the maximum found in personality research. In brief protocols, there are strong negative correlations between these constellations and self-reports of depression and interpersonal distress. Implications from these findings for the integration of assessment methods are discussed.

Response Frequency Problems in the Rorschach: Clinical and Research Implications With Suggestions for the Future

This article focuses on clinical and research problems associated with response frequency (R) being a variable in the Rorschach. Despite the fact that variations in R directly contribute to 50% of the explainable variance among Rorschach raw scores, there is a dearth of empirical evidence to document what R actually measures. Furthermore, in the practical use of the Rorschach's structural data, R is considered to be a nuisance variable that is controlled and not deemed interpretively significant. Given this information, two research agendas are proposed. The first is to more thoroughly determine whether R measures anything of substantial clinical importance. The second is to evaluate systematically the relative merits of making R a constant rather than a variable through use of an R-controlled method of Rorschach administration. This strategy would resolve many of the psychometric problems related to R. Introducing greater structure and clearer expectations to the task may also sharpen the Rorschach's ability to assess and predict important aspects of personality. However, significant disadvantages would also result from this change in administration. Both sides of the issue are discussed in some detail.

Response selection on the Rorschach Test

After discussion of some theoretical speculations concerning the nature of the Rorschach process, two experimental manipulations of the Rorschach task are presented. Three groups of normal (n = 6) and schizophrenic subjects (7 paranoid and 7 nonparanoid) participated. Their mean age was 30.7 yr. In the first experimental version of the Rorschach, simplified inkblots (sections of the standard cards) were used to verify the influence of stimulus complexity on response for the three groups. In the second, an experimental version of the Rorschach task was created to highlight the influence of the selection process among different associations to blots. To this end, a list including responses both of positive and negative form quality to each card, was provided each subject. Data are discussed, highlighting the minimal differences obtained by the experimental manipulations and relating these to theoretical speculations.

Responses of schizophrenics and nonpatients to a tachistoscopic presentation of the Rorschach

Three groups of 36 subjects each, two of nonpsychiatric subjects and one of first admission schizophrenics, were administered the Rorschach tachistoscopically. Each group was subdivided into three subgroups to permit a variation in exposure times for the blots. Intervals of 200ms, 400ms, and 600ms were used; however, the differences in exposure times did not produce significant differences within any of the groups. Thus, the data were compared by groups. The results indicate no significant differences across the groups for accuracy of from (X + %). The schizophrenic group did give significantly more Special Scores related to cognitive slippage. They also gave a much higher proportion of pure form responses and substantially more card rejections than either of the nonpsychiatric groups. The results are discussed in the context of research on information processing and the early operations in the Rorschach response process.

Simulation of psychosis on a multiple-choice projective test

The ability of a new multiple-choice group Rorschach instrument to differentiate 62 undergraduate students asked to simulate psychosis from 75 students and 55 schizophrenics given standard instructions was investigated. For each of 50 responses to miniature inkblots, normals and psychotics chose one of four alternative answers as most descriptive of what the stimulus looked like. Simulators responded as they thought a psychotic or insane person would. As hypothesized, simulators chose significantly more "good form but bizarre wording" responses than normals or psychotics, suggesting that the test is promising as a practical clinical indicator of attempts to simulate psychosis.

The Rorschach: does it have a future?

Recent evidence suggests that in spite of an increasingly critical attitude by many clinicians towards the use of projective techniques, the use of these techniques has not faltered over the years. Insofar as the Rorschach continues to be the most popular projective instrument, its scientific status is critically examined in the present paper. The problems inherent in examining an instrument which has engendered a number of quite distinct scoring systems are noted, and the conclusion is advanced that notwithstanding such problems there seems little likelihood that the Rorschach will experience any significantly diminished popularity in the future.