Rorschach evaluation of adolescent bulimics

It has become apparent that the excessive dieting engaged in by many girls when they reach puberty frequently serves as an impetus for the later development of eating disorders. While the existence of bulimia nervosa has been well documented in late-adolescent girls, only minimal research has been devoted to delineating the personality characteristics that distinguish bulimics from normal adolescents. The present study utilized the Rorschach to contrast 12 DSM-III-R diagnosed adolescent bulimics with 12 female adolescent controls. Exner's (1986) Comprehensive System was used for scoring the protocols. Statistically significant group differences were detected on both the overall Depression and the Schizophrenia Indices, as well as on several subcomponents of each. Additionally, bulimics averaged a greater number of aggression responses. The data suggested that the adolescent bulimics were more depressed, self-punitive, and negativistic than their peers, and that they had more disordered thoughts, inaccurate perceptions, and impaired judgment. The cognitive disturbances were not limited to the areas of food and weight. The results are alarming for this young population, particularly since the severity of symptoms certainly will increase over time if left untreated. Recommendations are made for early symptom identification and intervention.     

Rorschach assessment of borderline children

Projective testing may provide the clinician with a valuable context in which childhood borderline conditions may be investigated. The purpose of this study was to determine if Rorschach scores could be useful in diagnosing borderline disorders. Rorschach scores from a group of 13 borderline children and 10 conduct disorder children were compared using a step-down discriminate analysis. The results indicated that children in these two groups could be correctly classified beyond chance levels using Rorschach scores. Three variable, content analysis, human movement, and animal movement were the strongest contributors in separating the two groups. The Rorschach measure of form quality (i.e., adequacy of perception) was notable in that it failed to produce any independent discriminatory power in this analysis. As in the case of adult borderline testing using the Rorschach, novel scoring procedures, used in conjunction with standard scoring procedures may lead to further clarification of childhood borderline disorders.     

Current perspectives on psychoanalytic Rorschach assessment

In this article, I present as clear and as updated an account as possible of several of the essential features that comprise a psychoanalytic approach to the Rorschach. Specific attention is accorded the assessment frame, the language of assessment, sources of assessment information, and differing approaches to the interpretation of Rorschach data. The article comes out of a Rorschach tradition begun by Rapaport, extended by Schafer and Mayman, and presently being updated by Leichtman and Smith.     

The future of Rorschach in personality assessment

This article considers the Rorschach and its prospects for the next century in the context of two broad issues in psychology, as well as some test specific challenges confronting those interested in the Rorschach and its applications. The broad issues are the matters of personality as a topic of study in psychology, and the relation of findings about personality to treatment planning. The specific issues concern the definition of the Rorschach, research about the test stimuli, and the expansion of information concerning the interpretive usefulness of some structural variables that are poorly conceptualized or for which interpretation may be overly generalized. Some recommendations concerning collaborative research efforts are also offered.     

Rorschach assessment of primitive defenses: a review

The Lerner & Lerner Scale for assessing primitive defenses is reviewed. According to its conceptual roots, initial studies assessed the scale's efficacy in distinguishing groups of borderline patients from groups of other diagnostic entities. Later studies extended the use of the scale to assess various clinical groups assumed to have a borderline personality structure. Results from several studies indicate a high level of reliability as judged by degree of interrater agreement. In a host of studies, the scale was found to be valid in distinguishing borderline patients from other types of patients, eating disordered patients from normal controls, and gender disturbed children from normal controls. Another Rorschach scale for assessing primitive defenses was also reviewed and compared.     

Constructivism and the projective assessment of meaning in Rorschach administration

Constructivist perspectives on the Rorschach are outlined. I discuss ways in which constructivism complements and adds to existing Rorschach methodologies. It is suggested hat the constructivist emphasis on personally and socially constructed meanings is very consistent with many of the ways the Rorschach has been used and resonates with recent emphases on the Rorschach as a representational task. Furthermore, constructivist perspectives on Rorschach also provide an opportunity to supplement Exner's (1993, 1995) efforts to standardize and norm the Rorschach in a way that maintains the instrument's historic and admirable attention to relational elements of assessment and psychotherapy. I present a variety of meaning-based techniques for conducting Rorschach assessment, incorporating both the constructivist and social constructionist perspective.     

Conceptual and empirical perspectives on the Rorschach assessment of psychopathology

Conceptual and empirical perspectives on the Rorschach assessment of psychopathology are described and placed in a complementary perspective that stresses the value of conceptual formulations and the necessity of empirical data. Empiricism without concepts fails to explain adequately why Rorschach assessment yields useful information; conceptualization without empirical support fails to document adequately the psychometric soundness of Rorschach inferences. Used in tandem, explanatory concepts and supportive data enhance the scientific stature and professional utility of Rorschach assessment.     

Rorschach assessment of psychological functioning in sexually abused girls

We measured psychological functioning in a group of 79 Black females between the ages of 5 and 16 and a comparison group of nonabused girls using the Rorschach. In addition to Exner's (1985) Comprehensive System, the Elizur (1949) Rorschach Content Test Scale (RCT), the Mutuality of Autonomy Scale (MOA; Urist, 1977; Urist & Shill, 1982), and the Barrier and Penetration Scales (Fisher & Cleveland, 1968) were used. Sexually abused girls were found to show more disturbed thinking, to experience a higher level of stress relative to their adaptive abilities, to describe human relationships more negatively, and to show more preoccupation with sexuality than the comparison group. The distress experienced by the victimized children was more related to internal mediating variables then to abuse characteristics. Sexually abused girls who are cognitively and emotionally active also experienced high levels of distress compared to abused girls who are psychologically constricted.     

The Rorschach in the context of performance-based personality assessment

In this article, I draw on literature concerning the current status of the Rorschach Inkblot Method (Exner, 2002), performance-based personality measurement, direct versus indirect personality assessment, and dual-process models to suggest a reconceptualization of the Rorschach. The goal is to offer an updated conceptual framework for thinking about the Rorschach that can potentially be used both to enhance the image of the method and to provide direction for future research on the validity of specific Rorschach scores.     

Rorschach assessment of malevolence in sexually abused girls.

Clinical samples of sexually abused and nonabused girls were compared on COP/AG, a proposed Rorschach index of malevolence. Defined as the co-occurrence of COP and AG in a single response, this variable is introduced as a Rorschach analog of a measure of malevolence devised for use with narrative material. Sexually abused girls scored significantly higher on COP/AG than did nonabused girls (p < .01), with no group differences emerging for either COP or AG alone. These findings provide empirical support for the salience of malevolence in the interpersonal perceptions and expectancies of victims of childhood sexual abuse. Clinical implications and directions for future research are discussed.     

Psychological characteristics of dieters and bulimics.

Two studies examined the continuum and discontinuity models of the relation between dieting and bulimia nervosa. In Study 1, 21 dieters, 19 bulimics, and 33 nondieting controls were compared on 24 measures. Multivariate analyses revealed that each of the groups differed significantly from the other two. Univariate analyses found 18 significant differences between bulimics and dieters and 1 significant difference between dieters and controls. In Study 2, 86 subjects completed measures of psychological functioning, dieting, and bulimia nervosa. On the basis of regression analyses using factor scores from the psychological variables as predictors, high scores on a psychopathology factor and low scores on a defensiveness factor predicted both bulimia and dieting. Low self-concept scores also predicted bulimia. These data indicate that both continuity and discontinuity characterize the relation between dieting and bulimia.     

MCMI characteristics of DSM-III-R bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.     

Rorschach assessment of changes following psychotherapy: a meta-analytic review

I examined Rorschach assessment of personality changes following psychotherapy. I conducted a comprehensive literature search to find all studies using the Rorschach method at least twice for the same participant in connection with psychotherapy. I conducted meta-analyses for 38 samples, and I performed regression analyses to identify moderating factors. Across all Rorschach scores, the total weighted sample effect size was r = .26, and nearly half the variables obtained effect sizes higher than .30. Several moderating factors were found. Most important, effect sizes increased with longer and more intensive therapy. More concern for interscorer reliability was associated with larger effect sizes, whereas a higher degree of scorer blinding was associated with smaller effect size magnitudes. Predicted levels of change based on the regression models indicated substantial increases in effect size with longer therapies. The data indicate that many elements in the Rorschach are valid indicators of change despite the poor reputation the method has acquired within psychotherapy research.     

On the integration of personality assessment methods: the Rorschach and MMPI

Despite being the most studied and used personality assessment tools, data from the Rorschach and MMPI generally disagree (Archer & Krishnamurthy, 1993a, 1993b). Independence is proposed to result from at least 3 factors: (a) the methods tap unique levels of personality, (b) personality has a complex organization, and (c) response styles generate considerable method variance that must be considered in nomothetic research. These ideas led to 5 hypotheses, each of which received support. Rorschach and MMPI response styles are uncorrelated, although response styles are quite consistent within a method family. MMPI-2 and Rorschach constructs of dysphoria, psychosis, or wariness are uncorrelated when response styles are ignored. However, robust convergent validity is evident when patients have similar response styles on each method (e.g., for dysphoria, M r = .59) and dysphoria is expressed in opposing ways on each method when response styles are discordant (i.e., M r = -.54). Data from the latter analyses were correlated with genuine clinical phenomena and implications were discussed for clinical practice and research.     

Rorschach score validation as a model for 21st-century personality assessment

Recent conceptual and methodological innovations have led to new strategies for documenting the construct validity of test scores, including performance-based test scores. These strategies have the potential to generate more definitive evidence regarding the validity of scores derived from the Rorschach Inkblot Method (RIM) and help resolve some long-standing controversies regarding the clinical utility of the Rorschach. After discussing the unique challenges in studying the Rorschach and why research in this area is important given current trends in scientific and applied psychology, I offer 3 overarching principles to maximize the construct validity of RIM scores, arguing that (a) the method that provides RIM validation measures plays a key role in generating outcome predictions; (b) RIM variables should be linked with findings from neighboring subfields; and (c) rigorous RIM score validation includes both process-focused and outcome-focused assessments. I describe a 4-step strategy for optimal RIM score derivation (formulating hypotheses, delineating process links, generating outcome predictions, and establishing limiting conditions); and a 4-component template for RIM score validation (establishing basic psychometrics, documenting outcome-focused validity, assessing process-focused validity, and integrating outcome- and process-focused validity data). The proposed framework not only has the potential to enhance the validity and utility of the RIM, but might ultimately enable the RIM to become a model of test score validation for 21st-century personality assessment.     

The Rorschach and MMPI: toward a more scientifically differentiated understanding of cross-method assessment

Reasons for Minnesota Multiphasic Personality Inventory (MMPI) and Rorschach disagreement at the nomothetic level are explored. Building on an understanding of measurement distinctions from other sciences, it is proposed that the Rorschach and MMPI procedures are differentially sensitive to unique manifestations of personality. By necessity, each method is then also recognized as having a limited scope of effectiveness, such that neither can provide a complete picture of personality in its full complexity. Drawing on the more extensive self-report literature, the idiosyncracies and limited scope of the self-report method are documented. Finally, an ideographically rooted, cross-method, configural model is proposed for validation research in personality assessment. Several examples consistent with this approach are drawn from the assessment literature and discussed.