A Five-Year Follow-up on the Temporal Stability of the Ego Impairment Index

Ego Impairment Index (EII-2) as a predictor of outcome in short- and long-term psychotherapy during a 5-year follow-up

Objective

This study examined the predictive ability of the Rorschach‐based Ego Impairment Index (EII‐2) on outcome of psychotherapy in different types and durations of therapy.

Method

A total of 326 outpatients suffering from depressive or anxiety disorders were randomized into receiving solution‐focused (n = 97), short‐term psychodynamic (n = 101), or long‐term psychodynamic psychotherapy (n = 128). Psychotherapy outcome assessments during the 5‐year follow‐up period covered psychiatric symptoms, social functioning, and work ability.

Results

Lower EII‐2 values, which indicate less problematic ego functioning, were found to predict faster improvement in both short‐term therapies as compared to long‐term psychotherapy.

Conclusion

The results provide preliminary support for the utility of EII‐2 as a complementary measure to interview‐based methods for selecting between short‐ and long‐term therapies.

Critical review of the use of the Rorschach in European courts

In relation to the admissibility of evidence obtained using projective personality tests arose in F v. Bevándorlási és Állampolgársági Hivatam (2018). The Court of Justice of the European Union has held that an expert's report can only be accepted if it is based on the international scientific community's standards, but has refrained from stipulating what these standards are. It appears timely for European psychologists to decide what standards should be applied to determine whether or not a test is appropriate for psycholegal use. We propose standards and then apply them to the Rorschach because it was used in this case and is an exemplar of projective tests. We conclude that the Rorschach does not meet the proposed standards and that psychologists should abstain from using it in legal proceedings even in the absence of a clear judicial prohibition.

Reassessment (after 15 Years) of Non-Patient Adults by the Rorschach Method

The investigation of personality using the Rorschach Method has been historically established, however, its proper use requires continuous study, especially in regard to reliability, validity and normative references. This study's objective was to verify stability indicators of Rorschach (French Approach) through a reassessment (after 15 years) of non-patient adults previously addressed in the normative study by Pasian (1998). A total of 88 adults, aged between 34 and 69 years old, of both sexes, with different socio-economic and educational levels, were reassessed in 2013 in the state of São Paulo, Brazil. The responses were independently rated by different judges, with adequate precision. The average results obtained collected in 1998 and 2013 were analyzed to determine if these two sets of data were significantly different from each other (Student's t test, p ≤ .05) and the following variables were compared: Productivity indices, Apprehension Modes/Location, Formal Quality, Determinants, Contents and Banality. The overall stability level in these variables is considerable (mean r = .28, ± SD = 0.21). We discuss the theoretical approach of the Rorschach method regarding structural aspects of personality and developmental issues in personality assessment.

The Scientific Status of Projective Techniques

Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psychometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instruments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summarize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psychologists regarding projective techniques.

Association between the Rorschach Ego Impairment Index and the Level of Personality Organization interview assessment in depressive and anxiety disorder patients

The level of personality functioning, relevant for treatment planning, can be evaluated by the Rorschach Comprehensive System (CS) Ego Impairment Index-2 (EII-2) and by interview assessment of the severity of personality pathology. However, few studies on the association between these assessment methods have been reported. This study examines the strength of association between the EII-2 and its subcomponents with the interview-based Level of Personality Organization (LPO) assessment scale, and investigates their mutual associations with psychiatric symptoms, diagnoses, and history. Altogether, 315 mood or anxiety disorder outpatients without severe personality pathology were assessed with the LPO and tested with the CS, on which the EII-2 and its subcomponents (FQ-, WSum6, Critical contents, M-, PHR, GHR, and R) were calculated. Significant, but weak association between the EII-2 and the LPO was found. The WSum6, a measure of thought disorder, was the only EII-2 subcomponent significantly associated with the LPO. Both measures were consistently associated with psychiatric symptoms, diagnoses and history. The findings partially support the EII-2 and the LPO as consistently associated, relatively independent measures of the severity of personality pathology. More research on the incremental benefits of the measures is needed in clinical populations, covering non-severe and complex psychopathology.

Differentiating adolescents at clinical high risk for psychosis from psychotic and non-psychotic patients with the Rorschach

This study was designed to assess cognitive functioning in a clinical sample of adolescents with heterogeneous psychiatric diagnoses, with a specific focus on patients at clinical high risk (CHR) for psychosis. The sample comprised 22 patients identified at CHR for psychosis, 67 psychotic and 187 non-psychotic, non-CHR patients. Neuropsychological assessment was conducted as part of the clinical examination and treatment, including Wechsler Intelligence Scale for Children (WISC)-III and/or Wechsler Adult Intelligence Scale (WAIS)-III measures of verbal comprehension, perceptual organisation, working memory and processing speed, Wisconsin Card Sorting Test (WCST) measures of executive function, and the Rorschach Comprehensive System measures of perceptual and thinking accuracy. Patients at CHR for psychosis did not significantly differ from other patient groups in terms of intellectual or executive functions. The Rorschach Perceptual Thinking Index (PTI) distinguished patients at CHR for psychosis from those diagnosed as having non-psychotic disorders, but not from those diagnosed as psychotic. Our results suggest perceptual and thought disturbance as an important indicator of vulnerability to psychosis.

A Method to Optimize the Response Range While Maintaining Rorschach Comprehensive System Validity

Brief and lengthy Rorschach records have been identified as common problems in protocol administration. Clinicians have debated how to prevent overly short and long records, but they have been reluctant to alter standardized administration for fear of introducing bias. The present study examines a nonintrusive method for constraining responses by prompting for an extra response when only one is offered per card and by removing the card after four responses are given. Among patients who typically produce brief records, consisting of a residential sample of civil and forensic patients with a range of disordered thinking, the alternative administration method demonstrated improved Comprehensive System validity in assessing thought disorder and eliminated the need to readminister the test due to fewer than 14 responses. The findings have clinical implications for protocol administration with thought-disordered populations that typically produce brief records.

Associations of awareness of illness in schizophrenia spectrum disorder with social cognition and cognitive perceptual organization

Although impairment in flexibility of abstract thought has been linked to poor insight in schizophrenia, little is known about the association of other cognitive processes to insight. To explore the possibility that social cognition and perceptual organizational capacity are linked to insight, we assessed awareness of illness and administered the Thematic Apperception Test and Rorschach Inkblot Test to 31 adult participants with schizophrenia. Partial correlations controlling for perseverative errors on the Wisconsin Card Sorting Test revealed that lesser capacities to organize and make sense of ambiguous stimuli, to distinguish between one's own and other's perspectives, and to formulate logical accounts of behavior and social exchange predicted poorer awareness of psychiatric symptoms. With replication, results may suggest that to attain awareness of illness, some with schizophrenia may need assistance making sense of the social world and organizing the complexities of their experience of illness.

A Rorschach Stability Study in a Nonpatient Adult Sample

The objective of this study was to provide new primary data on Rorschach Comprehensive System stability levels. To achieve this, we tested 75 French nonpatient adults twice on the Rorschach with a 3-month interval between the tests. Interrater reliability was in the excellent range for most of the variables studied. The overall stability level in a selected set of previously studied variables was below expectations (median r = .53). Personality, cognitive or self/relational variables yielded higher test-retest correlations than emotional and coping variables. Moderators of stability could be identified: (a) overall level of Task Engagement (TE) in F, m, FM + m, a, FC, Sum C', Sum V, Sum Shd, Fr + rF, INC + FAB, COP, es, Adj es, EGO, and Blends; (b) variations in TE in F, FM, and p; (c) state distress in Zd, m, FM + m, a, C, CF + C, WSumC, FD, and es; (d) variables derived from the number of responses impacted stability in P, Zf, m, FC, CF + C, Sum C', Sum V, MOR, EA, es, and Blends. These results provide further support for the reliability of several measures. Examiner effects as an influence on productivity and TE were identified as an important area for future research.

Reanalysis of the Gronnerod (2003) Rorschach Temporal Stability Meta-Analysis Data Set

I reanalyzed the Grønnerød (2003) Rorschach temporal stability meta-analysis data with a theoretically driven hierarchical regression analysis. I also examined the intrarater reliability of initial coding decisions and verified their consistency. In the new regression analyses, retest period strengthened its influence on stability, whereas methodological factors showed a tendency toward influence. The new results are more in line with the results from Grønnerød's (2004) psychotherapy change meta-analysis results.

Diagnostic possibilities of three Rorschach indexes for cognitive functioning assessment

The study presents theoretical and empirical comparison of the three indexes in Rorschach Comprehensive System that were developed for psychotic functioning assessment: the Schizophrenia Index (SCZI), the Ego Impairment Index (EII) and the Perceptual Thinking Index (PTI). In spite of the conceptual and nominal differences, these indexes significantly overlap and includes common indicators. The study compared a discrimination value of these three indexes, as well as and theirs indicators and based on the obtained results, tried to formulate a new index as a composite of the best predictors.

Refinements in the Rorschach Ego Impairment Index incorporating the human representational variable

The Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure of psychological impairment and thought disturbance developed from the empirical and theoretical literature on the Rorschach. In this article, we summarize reliability and validity data regarding the EII. Our major goal was to present the rationale and empirical basis for recent refinements in the EII. Among the subcomponents of the original EII was the Human Experience variable (HEV), which has recently been revised and replaced with the Human Representational variable (HRV; Viglione, Perry, Jansak, Meyer, & Exner, 2003). In this study, we replaced the HEV with the HRV to create the EII-2. This was accomplished by recalculating the factor coefficients with a sample of 363 Rorschach protocols. We present additional validity data for the new EII-2. Research recommendations and interpretive guidelines are also presented.

The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.

Modifying the Rorschach Human Experience Variable to create the Human Representational Variable

The Human Experience Variable (HEV; Perry & Viglione, 1991) provided information about interpersonal perceptions not previously available within the Comprehensive System (CS; Exner, 1993). Research data suggests that it was related to interpersonal functioning and as a result, psychological impairment and health. In this article, we present the rationale and empirical basis for recent psychometric refinements to the HEV, consequently renamed the Human Representational Variable (HRV). Research addressing the reliability and validity for the HRV is summarized. Based on data and experience with the HEV, this study summarized some small modifications to the original algorithm. The refined variable, the HRV, has been added to the CS (Exner, 2000). Data presented here suggest that the HRV has improved psychometric properties compared to the HEV and that it is simpler to understand. Research recommendations and interpretive suggestions are also presented.

Temporal stability in the Rorschach method: a meta-analytic review

The temporal stabilities of the Rorschach method scoring systems were investigated. A comprehensive literature search was conducted to find all test-retest studies, both regular and from control samples in therapy evaluation studies. Meta-analyses were conducted for samples, individual entries, and variables in 36 samples. Separate analyses were made for 10 samples using the Comprehensive System (CS; Exner, 1993). The temporal stability was high, especially those obtained from regression model predictions. The CS consistently shows higher stability than other systems, whereas increasing retest intervals leads to decreasing stability. Shortcomings of the available studies are highlighted and discussed, and recommendations are given for design and methodology.

A critique of Lilienfeld et al.'s (2000) "The scientific status of projective techniques"

Lilienfeld, Wood, and Garb (2000) published a largely negative critique of the validity and reliability of projective methods, concentrating on the Comprehensive System for the Rorschach (Exner, 1993), 3 systems for coding the Thematic Apperception Test (TAT; Murray, 1943) cards, and human figure drawings. This article is an effort to document and correct what I perceive as errors of omission and commission in the Lilienfeld et al. article. When projective measures are viewed in the light of these corrections, the evidence for the validity and clinical usefulness of the Rorschach and TAT methods is more robust than Lilienfeld et al. represented.

The use of the Ego Impairment Index across the schizophrenia spectrum

The goal of this study was to assess perceptual and thought disturbance, as indexed by the Ego Impairment Index (EII; Perry & Viglione, 1991), a Rorschach-derived measure, across the schizophrenia spectrum. We hypothesized that there would be an increase in EII scores (indicating increased disturbance) across the spectrum from nonpatients to severely disturbed, hospitalized schizophrenia patients. Normal comparison participants (n = 66), students with elevated scores on either the Perceptual Aberration/Magical Ideation or the Physical Anhedonia Scales (n = 24), first-degree relatives of schizophrenia patients (n = 36), participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) schizotypal personality disorder (n = 36), outpatient schizophrenia participants (n = 33), and hospitalized schizophrenia patients (n = 56) were studied. As hypothesized, we found increased EII scores in all of the schizophrenia spectrum groups when compared against normal comparison participants. Furthermore, the EII was significantly different between the schizophrenia patients and the other schizophrenia spectrum groups. These findings support the use of the EII as a sensitive measure of perceptual and thought disturbance across the schizophrenia spectrum that yields specific information regarding the type of thinking problems that occur within schizophrenia spectrum subgroups.

Empirical support for interrater reliability of Rorschach Comprehensive System coding

Although a great deal of data has been published in the past 20 years supporting the interrater reliability of the Rorschach, recently commentators have raised anew concerns over the interrater reliability of this well-known and frequently used measure. An analysis of the literature reveals that these concerns are based on a selective review of the literature. The current study reports interrater reliability statistics for 70 interpretive Rorschach variables (n = 84), breaking down intraclass correlations statistics by base rate. Results confirm the strong empirical evidence of the interrater reliability of this measure when scored by a well-trained and diverse group of researchers and clinicians. Reliability is especially strong and consistent for the high base-rate variables from which clinicians often base their interpretations. These data further suggest that large samples are needed for stable reliability estimates of low base-rate variables and that estimates of the reliability of low base-rate variables are subject to error.

An examination of interrater reliability for scoring the Rorschach Comprehensive System in eight data sets

In this article, we describe interrater reliability for the Comprehensive System (CS; Exner. 1993) in 8 relatively large samples, including (a) students, (b) experienced re- searchers, (c) clinicians, (d) clinicians and then researchers, (e) a composite clinical sample (i.e., a to d), and 3 samples in which randomly generated erroneous scores were substituted for (f) 10%, (g) 20%, or (h) 30% of the original responses. Across samples, 133 to 143 statistically stable CS scores had excellent reliability, with median intraclass correlations of.85, .96, .97, .95, .93, .95, .89, and .82, respectively. We also demonstrate reliability findings from this study closely match the results derived from a synthesis of prior research, CS summary scores are more reliable than scores assigned to individual responses, small samples are more likely to generate unstable and lower reliability estimates, and Meyer's (1997a) procedures for estimating response segment reliability were accurate. The CS can be scored reliably, but because scoring is the result of coder skills clinicians must conscientiously monitor their accuracy.

Assessing disturbed thinking and cognition using the Ego Impairment Index in older schizophrenia patients: paranoid vs. nonparanoid distinction

OBJECTIVE

We compared thought-disturbance via the Rorschach-derived Ego Impairment Index (EII) between DSM-IV paranoid vs. nonparanoid (undifferentiated and disorganized) subtypes of older schizophrenia patients.

METHODS

44 DSM-IV medically stable outpatients with schizophrenia (27 paranoid, 17 nonparanoid) and 45 normal comparison participants aged 45-100 years were assessed using the EII, a Rorschach-derived cognitive-based measure of disturbed thinking. Group differences on the EII and the relation of this measure to key demographic and clinical variables were examined.

RESULTS

Nonparanoid schizophrenia patients demonstrated significantly greater impairment on the EII than their paranoid counterparts. The EII performance of paranoid patients was similar to normal comparison participants. Furthermore, the paranoid patients displayed better premorbid intellectual functioning, less negative symptoms, and better global cognitive performance than nonparanoid patients. Finally, greater impairment on the EII was correlated with poor performance on a global measure of cognitive ability.

CONCLUSIONS

The present findings substantiate previous work suggesting that nonparanoid patients have a form of the illness characterized by worse premorbid functioning and greater disturbed thinking and cognition than their paranoid counterparts.

Incremental validity of the Ego Impairment Index: a re-examination of Dawes (1999)

This article examined the incremental validity of the Ego Impairment Index (EII), a Rorschach measure of cognition, perception, and reasoning. R. M. Dawes (1999) borrowed 2 previously published data sets to assess the incremental validity of the EII. Dawes determined that in order for the EII to be considered a valid measure, the overall EII score should "outperform" 2 of the variables that compose the index. Using this approach, Dawes reported that the EII had "deficient" (p = .059) incremental validity. In this study, the incremental validity of the EII was re-examined using 1 of the data sets used by R. M. Dawes (1999). Applying the same strategy as Dawes, the author tested the incremental validity of the EII in predicting positive symptoms of schizophrenia, a more appropriate and clinically relevant criterion measure of impairment. The EII significantly predicted positive symptoms (p < .005) even after the 2 EII variables selected by Dawes and the measure of social competence were 1st entered into the equation. The results suggest that the EII adds meaningful information in the assessment of thought disturbance.

Brief psychosocial assessment of a clinical sample: an evaluation of the Personal Problems Checklist for Adults

In light of the requirements for managed health care organizations to use assessment instruments that are psychometrically sound, cost and time efficient, and theoretically useful, the present study examined the psychometric properties of one such potential instrument, the Personal Problems Checklist for Adults (PPCA). Designed to measure problems in 13 areas of everyday functioning, the PPCA along with the Brief Symptom Inventory were completed by 132 individuals in an outpatient drug rehabilitation program. Counselor ratings on the Adjective Check List were also obtained. Results clearly showed that personal problems as measured by the PPCA were related to self-reported psychological symptoms and to perceptions by their counselors. The PPCA proved to have good psychometric properties and warrants greater attention by testing psychologists given its potential to meet criteria set forth by managed health care.

Schizotypy and leadership: a contrasting model for deficit symptoms, and a possible therapeutic role for sex hormones

Associational loosening, slow and faulty information processing, poor gating of irrelevant stimuli, poor ability to shift attention, poor working memory, passivity, ambivalence, anhedonia, and impaired motor coordination are cardinal features of schizophrenia but, unlike delusions and hallucinations, they are related more to negative/deficit symptoms. As summarized by Bass, numerous studies have correlated leadership with 'ambition, initiative and persistence' (opposite of passivity), 'speed and accuracy of thought', 'finality of decision,' or decisiveness (the opposite of ambivalence), 'mood control, optimism and sense of humor' (opposite of anhedonia), etc. Andreasen et al postulate that a disruption in the circuitry among nodes located in the prefrontal regions, the thalamic nuclei, and the cerebellum produces 'cognitive dysmetria', meaning difficulty in prioritizing, coordinating, and responding to information, and that it can account for the broad diversity of symptoms of schizophrenia. A relationship between cognitive processes and cerebellar and basal ganglia functions, and a role of neocerebellum in rapidly shifting attention, have been demonstrated. The cognitive styles, including a proficiency to quickly shift attention, of several famous leaders are used as examples of this contrasting model. Julius Caesar and Napoleon, for instance, could dictate to up to six secretaries simultaneously, using their exceptional working memories, and proficiency in quickly and effortlessly shifting attention while flawlessly gating irrelevant external and internal stimuli. It is suggested that specific brain imaging studies could illustrate this contrast. Gray et al noted positive correlations between 'dominance', an important leadership trait, and serum levels of dehydroepiandrosterone (DHEA) and testosterone (T), but not of more potent dihydrotestosterone (DHT), in over 1700 older men. Though not scientifically rigorous, the author noted positive correlations (P = 0.0162) between the self-rated ratings of voice depth (promoted by T) and of leadership, but none between those of body hair (DHT dependent) and of leadership in 47 male US National Academy of Sciences members. And 43 male US Senators had deeper voices than 36 male House members (P<0.01) who, in turn, had deeper voices than either of two groups (numbers 102 and 72) of male scientists (P<0.01). Therapeutically, before chlorpromazine, DHEA had been used in young schizophrenics with modest success in improving deficit symptoms. DHEA, or other sex hormones, or some of their natural and synthetic derivatives may prove to be valuable to treat deficit symptoms of schizophrenia in both sexes.

Interobserver agreement, intraobserver reliability, and the Rorschach Comprehensive System

Interrater agreement and reliability for the Rorschach have recently come under increasing scrutiny. This is the second report examining methods of Comprehensive System reliability using principles derived from observational methodology and applied behavioral analysis. This study examined a previous nonpatient sample of 20 protocols (N = 412 responses) and also examined a new clinical sample of 20 protocols (N = 374 responses) diagnosed with Research Diagnostic Criteria. Reliability was analyzed at multiple levels of Comprehensive System data, including response-level individual codes and coding decisions and ratios, percentages, and derivations from the Structural Summary. With a number of exceptions, most Comprehensive System codes, coding decisions, and summary scores yield acceptable, and in many instances excellent, levels of reliability. Limitations arising from the nature of Rorschach data and Comprehensive System coding criteria are discussed.

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.

The relationship of information-processing deficits and clinical symptoms in schizotypal personality disorder

Individuals with schizotypal personality disorder (SPD) are thought to be phenotypically related to individuals with schizophrenia. This assumption is partially supported by the fact that SPD patients have deficits on biological markers similar to those found in schizophrenia. Visual backward masking (VBM) performance and critical stimulus duration (CSD), measures of information processing found to be abnormal in schizophrenia patients, were assessed in 14 SPD and 21 comparison subjects. There was no significant difference between groups in VBM performance; however; there were significant correlations between VBM deficits and the number of SPD symptoms, as well as elevated scores on the Ego. Impairment Index (EII). Additionally, there was a trend (p = 056) toward elevations in CSD in the SPD versus the comparison group and CSD inflation appears to be most prominent in individuals with a greater number of social deficit symptoms and elevated physical anhedonia scores. These findings suggest an important relationship between symptoms of SPD and neurophysiologic deficits.

The Rorschach Ego Impairment Index in heterogeneous psychiatric patients

There is a need for test measures of ego functioning that identify treatment needs and predict treatment response. Perry and Viglione's Rorschach Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure assessing reality testing, thought process, defensive regulation, and object relations. It has been shown to correlate with Minnesota Multiphastic Personality Inventory (MMPI; Hathaway & McKinley, 1943) scales and subscales and other measures of psychosis in a schizophrenic sample and to predict antidepressant treatment of outcome in a depressed sample. This investigation examined the EII as a measure of ego impairment in a sample of 85 heterogeneous psychiatric inpatients and outpatients. In this sample, the EII did discriminate between inpatients and outpatients; it did not discriminate between psychotic and nonpsychotic patients, though there was a trend in this direction and one of the EII's object relations variables (Good H) did so. The EII did not generally show significant relations with MMPI indices of ego impairment (Ex or Scale 8), though there were some significant patterns of relation with with Scale 8 subscales. The study provides some, though not unequivocal, support for the EII as measure of ego impairment and for its utility compared to other measures and adds credence to earlier suggestions of the importance of object relations measures to ego functioning assessment.

An ego-psychological approach to the Rorschach

This presentation is an extension and amplification of the ego-psychological assessment of Rorschach data initiated in 1946 by Rapaport, Gill, and Schafer whose focus was on the quality of the perception of reality and the assessment of defence. A more contemporary view of ego psychology not only includes an expanded view of defence but also of the nature of self- and object representations and the nature of object relations. An assessment of the synthesizing function of the ego was also discussed. The present purpose was to present a comprehensive assessment of Rorschach data from the point of view of contemporary ego psychology.