A conceptual model and case study for the psychological assessment of hysterical pseudo-seizures with the Rorschach

Conceptual models are being increasingly utilized to guide psychological assessment of complex clinical problems. In this article, I present a conceptual model to direct the assessment of personality processes involved in producing hysterical pseudo-seizures. Pathological personality processes present in hysterical reactions are outlined. Rorschach parameters that have been validated and that are therefore considered good indicators of the relevant personality processes are presented. A case study of a patient with both documented genuine and hysterical pseudo-seizures demonstrates use of the model. I offer a treatment plan that is related to the psychological structure of the patient. Use of this model may improve psychological consultation in medical settings.     

Toward a construct validation of the Rorschach

The debate over the validity of the Rorschach has been lengthy but unresolved. Major reasons for the lack of consensus and conclusion are the absence of agreement about, how validation research should be conducted and the failure to identify appropriate criteria for subsequent evaluation. A construct validation model for the Rorschach is presented, with guidelines for proper implementation. The difficulties in establishing the optimal relationship between theory, research design, and clinical practice arc discussed. Recommendations for a resolution of these difficulties are presented.     

A study of nonpatient preadolescent Rorschach protocols

There is a paucity of peer-reviewed, nonpatient Rorschach studies in psychological journals, particularly for children. This study examined 100 preteenage children, using the Comprehensive System to code their Rorschach protocols. The participants were also evaluated with the Conners Parent Rating Scale-93 (Conners, 1989) and 5 exclusionary behavior criteria. The 100 participants demonstrated better than average behaviors. The results presented include all the ratios and indexes found in the nonpatient statistics for the Comprehensive System. We discuss interrater reliability issues and offer recommendations for further cross-validating research.     

On the Rorschach M response and monotheism

The Rorschach human movement (M) response has recently been debated (Exner, 1991a, Kramer, 1991a, 1991b) with additional wider implications for Rorschach psychology. The objective of this discourse is twofold: (a) to elaborate on the contributions of perceptanalysis (Piotrowski, 1957) to this debate and (b) to develop the thesis that diversity is desirable for the long-term advancement of the field of Rorschach psychology and personality assessment. These motifs are illustrated with an interpretation of a clinical case example and with rationale from the theoretical literature and implications for interpreting short Rorschach protocols. The conclusion is proffered that some degree of diversification is more beneficial than requiring the adoption of a single Rorschach approach (i.e., monotheism).     

A role-play Rorschach procedure.

Rorschach responses of three subjects were used to stimulate the type of role-playing popularized by Fritz Perls' Gestalt therapy. The standard Rorschachs were given first. Afterwards, each subject was presented with certain of his or her own images as a stimulus for the role-playing. The subjects consisted of a 19-year-old female with severe anxiety attacks, an 11-year-old lad diagnosed as having minimal cerebral dysfunction, and a 46-year-old man who had undergone two years of successful psychotherapy. It is proposed that the resulting data are valuable in expanding and clarifying the psychological meaning of the Rorschach images. Further, the procedure can be utilized, if desired, as a spur to therapeutic involvement.     

Construct validation of scales derived from the Rorschach method: a review of issues and introduction to the Rorschach rating scale

I suggest the main goal of Rorschach validation should be a refined understanding of what each score means. Toward this end, I review general issues in construct validity, hurdles unique to the Rorschach, and general limitations with validation criteria. I then recommend two approaches for improving criteria so they can begin approximating the gold standards that are necessary for a refined understanding of what scores actually measure. The first is a method for improving expert clinical judgment, and the second is a method for aggregating data across diverse judges. Finally, the Rorschach Rating Scale (RRS) is presented as a criterion tool to be used with either of these approaches to validation. The RRS is a fairly comprehensive summary of the constructs thought to be measured by various Rorschach scoring systems. The utility of the RRS for research and training are discussed, as are other practical, theoretical, and psychometric issues in its application.     

A one-year concurrent validity study of the Rorschach prognostic Rating Scale

A study was conducted of one year's referrals to a Juvenile Court Clinic, comparing the ratings of psychiatrists and social workers regarding a child's prognosis for psychotherapy with ratings from the Rorschach Prognostic Rating Scale (RPRS). The RPRS proved to be highly reliable and to correlate significantly with psychiatric ratings. Intelligence did not appear to be a confounding factor, and no difference was suggested in RPRS prognosis for Caucasian or Negro subjects.     

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.