Concepts of Development and the Rorschach: The Contributions of Paul Lerner and John Exner in Historical Context

The Rorschach Test has been approached from 3 fundamentally different developmental perspectives: those growing out of the empiricist tradition, psychoanalysis, and the developmental psychologies of Piaget and Werner. In this article, I highlight the distinctive characteristics of each perspective, explore how they have shaped approaches to Rorschach theory and practice, and examine the contributions of Paul Lerner and John Exner in this context.     

Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients

The study of mental representations on projective tests such as the Rorschach has made substantial contributions to our understanding of psychopathology. It is not clear, however, whether the representations of paranoid schizophrenics can be differentiated from those of normals and whether the Rorschach is the best test for such comparison. Object representations on the Rorschach and a role-playing (Johnson & Quinlan, 1980, 1985) test were studied in groups of normal (n = 31) and schizophrenic subjects (divided into paranoid [n = 16], intermediate [n = 11], and nonparanoid groups [n = 16]). Developmental levels of representation on both tests were measured with the widely used system of Blatt, Brenneis, Schimek, and Glick (1976), derived from Werner's concepts of differentiation, articulation, and integration. Generally the groups were not differentiated on these measures on the Rorschach. The role-playing test showed greater discriminatory power than the Rorschach, possibly due to its explicit demand to produce representations of humans in interaction. Results of the role-playing test showed differentiation and integration scores were negatively correlated with measures of psychotic symptoms. Nonparanoids differed from the other three groups on differentiation measures, and paranoid and normal groups scored higher on integration measures than did the intermediate and nonparanoid groups. Paranoid subjects scored higher than nonparanoids on functional articulation and higher than intermediates on perceptual articulation; however, paranoid subjects were not differentiated from normals on any developmental measure. Differences between the schizophrenic sample and normals were explained entirely by the nonparanoid subgroup, supporting the paranoid-nonparanoid distinction and raising questions regarding the nature of the deficit in paranoid schizophrenia.     

Sweet sorrow: the color-shading response in an adult cystic fibrosis population

Research on the color-shading response on the Rorschach has been limited previously to its use as a predictor of suicide. The theoretical understanding of this response was addressed by some of the major Rorschach authors. Adult cystic fibrosis patients were administered a battery of psychological tests, including the Rorschach. While these patients face a premature death, none of these patients were suicidal. A higher than usual incidence of color-shading responses occurred. Rapaport's hypothesis that the color-shading response is an expression of a simultaneously conflicting emotion, or similar to "sweet sorrow," was suggested as a possible hypothesis.     

Piagetian cognitive development and primary process thinking in children

On the hypothesis that, as children develop from the preoperational to the concrete level of operations, there would be a corresponding increase in the effective control of primary process ideation, 37 white, middle-class children, from 5 to 8 years old, were individually tested on eight Piagetian tasks and the Rorschach test. Piagetian Development was significantly correlated with Holt's Primary Process Manual measures of (a) Form Level, (b) Defense Effectiveness, (c) Adaptive Regression, (d) Primary Process Level 2, (e) Content Level 2, (f) Control/Defense Plus, and (g) Control/Defense Total. An analysis of variance demonstrated significant primary process differences between preoperational, transitional and concrete operational groups. Correlations between the eight Piaget tasks and the constructed mean Piaget score ranged from .65 to .91. The negative findings of other researchers, which contrast with the positive results in this study, may be explained by the narrower age ranges of their samples.     

A replication of Rorschach and MMPI-2 convergent validity

We replicated prior research on Rorschach and MMPI-2 convergent validity by testing 8 hypotheses in a new sample of patients. We also extended prior research by developing criteria to include more patients and by applying the same procedures to 2 self-report tests: the MMPI-2 and the MCMI-II. Results supported our hypotheses and paralleled the prior findings. Furthermore, 3 different tests for methodological artifacts could not account for the results. Thus, the convergence of Rorschach and MMPI-2 constructs seems to be partially a function of how patients interact with the tests. When patients approach each test with a similar style, conceptually aligned constructs tend to correlate. Although this result is less robust, when patients approach each test in an opposing manner, conceptually aligned constructs tend to be negatively correlated. When test interaction styles are ignored, MMPI-2 and Rorschach constructs tend to be uncorrelated, unless a sample just happens to possess a correlation between Rorschach and MMPI-2 stylistic variables. Remaining ambiguities and suggestions for further advances are discussed.     

Psychological measures as predictors of military training performance

The predictive validity of 7 ability tests, the Big Five, and the Rorschach method administered to 71 male applicants at the Naval Special Forces (NSF) of Norway was evaluated based on pass/fail results in training. The findings showed: (a) small correlations between the ability tests, the Big Five scales, and the success criterion; (b) Rorschach variables measuring stress tolerance, reality testing, cognition, and social adjustment correlated significantly (r =.25 to.48) with pass/fail results in training, and (c) logistic regression analysis revealed that 3 of the Rorschach variables accumulated incrementally in the prediction of training completion when entered after the ability tests and the Big Five scales, thus supporting the merit of using Rorschach variables for predicting NSF training performance     

A survey of Rorschach teaching in APA-approved clinical graduate programs.

A questionnaire on teaching of the Rorschach technique was sent to all APA-approved graduate clinical psychology programs in the United States and Canada. The questionnaire asked for the degree of emphasis placed on the Rorschach in the primary assessment course, the Rorschach teaching experience of the respondent and the respondent's evaluation of the technique as a clinical tool, a teaching aid and a research instrument. The respondent in each case was the faculty member teaching the major diagnostic assessment course. There was a 100% return of the questionnaires. The major results show that (1) 81% of the programs place major emphasis on the Rorschach Technique in the assessment course; (2) only 24% of the programs offer the course for a full year; (3) respondents with more than 10 years teaching experience rated the Rorschach higher than respondents with less experience, and (4) respondents as a group rated the Rorschach highly as a clinical tool and teaching aid, but gave it generally low ratings as a research instrument.     

Rorschach predictors of therapeutic outcome in a child psychiatric inpatient service

This study tested the hypothesis that Rorschach indicators of psychological instability and perceptual sensitivity are predictive of therapeutic outcome in a child psychiatric inpatient service. Thirty-four children, matched for age, were divided into two groups, Improvers and Decliners, based on changes in behavioral problems over 60 days of hospitalization. The groups were not distinguishable by scores on intellectual tests, sex, or the initial quality or severity of psychological disturbance. Analyses of Rorschach protocols indicated that children who obtained higher ep, ep-EA, Blends, Zf, and Z sum and lower Lambda had improved in treatment. The results suggest that children who are less stabilized and manifest perceptual sensitivity do achieve the greatest gains.     

P. A. News & Notes

A case study of a Vietnam combat veteran with episodic rage attacks is discussed with emphasis on Rorschach formal scoring and content analysis. Rorschach data suggest a near neurotic level of ego organization with massive repression in the form of dissociated violent outbursts. Vietnam combat trauma appears to be a precipitant. Developmental differences between preoedipal splitting and higher level dissociation are discussed. Dissociative states are posited to represent a developmental level of ego organization midway between borderline and neurotic levels and are not easily encompassed by either borderline or neurotic classifications.     

An empirical approach to the study of defense mechanisms: I. Reliability and preliminary validity of the Rorschach Defense scales

Despite widespread use of the Rorschach for the study of defense mechanisms, few recent Rorschach scales have been developed for the study of defensive functioning. We critically review previous empirical research and describe the Rorschach Defense scales. These scales provide criteria for rating both lower level defense mechanisms, such as splitting and primitive idealization, as well as higher level defenses, such as intellectualization and isolation. The scales utilize a broad range of content including all Rorschach responses, associative content, and verbalization of the tester-patient relationship. Data on interrater reliability and preliminary validity are presented.     

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.     

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 Rorschach and structured tests of perception as indices of intellectual development in mentally retarded and nonretarded children

In a study of the developmental significance of certain perceptual activities, the Rorschach and four structured tests of perception were administered to five groups of children at various CA, MA, and IQ levels. All three Rorschach measures were significantly related to MA, as were all four of the structured tests. The Childrens' Embedded Figures Test was the best predictor of MA; it accounted for 52% of the variance, while the six remaining measures yielded nonsignificant increments to a multiple regression equation. In a factor analysis the four structured tests loaded on one factor (51% of total variance), while the three Rorschach variables loaded on a second (17%); MA loaded on both (.669 and .447, respectively). In an additional finding, Zigler's “developmental” hypothesis that level of development and not IQ determines cognitive competence, received partial support from 13 of 14 statistical tests.     

Predicting DMS-IV cluster B personality disorder criteria from MMPI-2 and Rorschach data: a test of incremental validity

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed alimited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p <.05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.     

Test-induced anxiety with children.

Thirty-five elementary school children received the WISC, Rorschach, CAT, and Sentence Completion Test in counterbalanced order with a test-test interval of approximately 24 hours. State and trait anxiety measures were assessed immediately prior to and immediately following each test administration. Results indicated that state anxiety measures increased significantly following administration of the more ambigious and school related assessment tests, namely the Rorschach and WISC. In contrast, the more structured, less amorphous CAT and Sentence Completion Test, did not induce any significant changes in state anxiety. In all cases, trait anxiety measures remained relatively stable. Implications for assessment techniques with children were discussed.     

Comparative Diagnostic Judgments from the Rorschach and the MMPI

Three experienced psychologists made diagnostic judgments from the Rorschach, the MMPI, and gave an overall diagnostic impression for 50 male and 48 female patients. Judgment on the first test viewed was given before looking at the second test. Order of viewing the tests and sex of patient were counterbalanced. The results indicated (a) the judges consistently rated the tests on a given individual as agreeing on diagnostic impression significantly more often than disagreeing; (b) interjudge agreement was low but significant for the MMPI and overall impressions, not significant for the Rorschach impressions; (c) in cases of disagreement, there was a highly significant tendency for the Rorschach to be seen as indicating more pathology than the MMPI.     

Hostility of asocial youth as measured by the TAT and Rorschach.

23 boys and 13 girls, aged 13 to 17 yr., from two homes for delinquents were given the Thematic Apperception Test. Girls were also given the Rorschach. The 1960 Hafner and Kaplan TAT and Rorschach hostility indices were related to the 1977 Luukkonen indices (aggression-inward, aggression-outward, fantasy-aggression, oral, anal and phallic content), to the Pruitt and Spilka empathy index, and to the Neiger reality index. The TAT hostility index for boys was significantly higher than that for girls; boys expressed more physical and girls more verbal hostility in TAT stories. On the Rorschach, aggression outward and inward correlated significantly with Rorschach hostility, phallic and oral themes.     

Thought Disorder on the WAIS-R Relative to the Rorschach: Assessing Identity-Disordered Adolescents

Clinical researchers have noted that compared with other diagnostic groups, adults with Borderline Personality Disorder tend to demonstrate relatively more thought disorder on unstructured projective tests (e.g., Rorschach) than on structured objective tests of cognitive performance (e.g., Wechsler Adult Intelligence Scale; WAIS). Using archival data, our study found evidence that adolescents with Identity Disorder tend to exhibit this same phenomenon. The records of 62 adolescent inpatients who had been administered the WAIS or WAIS-R and the Rorschach were examined. Of the 62 cases, 25 were diagnosed with Identity Disorder, 14 with Conduct Disorder (Group Type), 15 with Oppositional Defiant Disorder, and 8 with Schizophreniform Disorder. For each participant, the WAIS or WAIS-R and the Rorschach were scored according to the Thought Disorder Index (TDI; Johnston & Holzman). Adolescents with Identity Disorder revealed a significantly larger discrepancy between TDI scores on the WAIS or WAIS-R and TDI scores on the Rorschach than did adolescents with other diagnoses. The findings suggested that the discrepancy between the degree of thought disorder on structured versus unstructured psychological tests (i.e., differential decompensation) is related to diagnosis.     

Rorschach records of Nazi war criminals: a reanalysis using current scoring and interpretation practices

The Nuremberg trials focused worldwide attention on 22 Nazi war criminals. Rorschach Inkblot tests were administered to these Nazi leaders in an attempt to understand the Nazi personality. Past studies which have described and interpreted these Rorschach records have made at least two types of errors in their analyses. One is that of overinterpretation and excessive inference. A second common error has been the failure to detect meaningful distinctions between protocols that represent significant differences in personality style. This latter error is shown in repeated attempts to group all Nazi protocols into one distinct "Nazi personality." This investigation attempted to quantify the analysis of these Nazi Rorschach records, specifically those Nazi leaders who were sentenced to life imprisonment or execution for their war crimes against humanity, by utilizing Exner's (1985a) standardized Comprehensive Scoring System as well as computerized objective interpretation software based on the Exner system (1986). This modern analysis of the Rorschach records demonstrates that the Nazi war criminals cannot be grouped together into one specific mental disorder that would adequately characterize these diverse individuals. The varying degrees of psychopathology of the Nazi leaders are illustrated by analyses of individual Rorschach protocols.     

Predicting DSM-IV Cluster B Personality Disorder Criteria From MMPI-2 and Rorschach Data: A Test of Incremental Validity

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed a limited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p < .05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.