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.     

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.     

The rorschach search for the borderline Holy Grail: an examination of personality structure, personality style, and situation

Much of the research on the use of the Rorschach to diagnose borderline disturbance has sought to discover a specific borderline pattern or Rorschach configuration. Given our increased understanding of borderline functioning representing a level of personality organization (or personality structure), this single pattern approach is excessively simplistic. It fails to consider the complex interaction between personality structure, personality style, and situational variables. An approach to the Rorschach assessment of borderline functioning is presented using a clinical example. The patient was tested at the onset of psychotherapy and then some 4 years into treatment. Results from the two testings were compared using Weiner and Exner's (1991) Rorschach variable clusters for assessing change in psychotherapy.     

Évaluation des enjeux narcissiques à partir du test de Rorschach au terme d’une psychothérapie

The goal of this study is to evaluate, using the Rorschach, the evolution of one patient's narcissistic investments after two years of psychoanalytically oriented psychotherapy. Both quantitative and qualitative measures of narcissism on the Rorschach were studied in depth in this test-retest study. Results indicate that quantitative measures of narcissism and egocentrism were decreased after two years of psychotherapy. The patient also presented doubt concerning her self-worth, as well as new perceptions of her vulnerabilities and her need for shoring up. Increased flexibility concerning narcissistic investments was evident, which weakened the patient's Ego and containing capacity; this facilitated work on depressive issues.     

Rorschach changes in long-term and short-term psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 2 1/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

Rorschach Changes in Long-Term Short-Term Psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 21/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: the Menninger Psychotherapy Research Project revisited.

Analyses of the data from the Menninger Psychotherapy Research Project (MPRP) have consistently indicated little difference in the therapeutic outcome between patients seen in psychoanalysis and those seen in psychotherapy. Reanalysis of the data from the MPRP, utilizing a distinction between two broad configurations of psychopathology (Blatt, 1974, 1990a; Blatt and Shichman, 1983), however, indicates that patients whose pathology focuses primarily on disruptions of interpersonal relatedness and who use primarily avoidant defenses (anaclitic patients), and patients whose pathology focuses primarily on issues of self-definition, autonomy, and selfworth and who use primarily counteractive defenses (introjective patients) differ in their responsiveness to psychotherapy and psycho-analysis. Based on recently developed procedures for systematically evaluating the quality of object representation on the Rorschach, reanalysis of the Menninger data reveals that anaclitic patients have significantly greater positive change in psychotherapy, while introjective patients have significantly greater positive change in psychoanalysis. These statistically significant patient-by-treatment interactions are discussed in terms of their clinical implications as well as the importance of differentiating among types of patients in studies of therapeutic outcome and of therapeutic process.     

Rorschach comprehensive system variables in relation to assessing dynamic capacity and ego strength for psychodynamic psychotherapy

Few studies have concerned the relation between Comprehensive System (CS; Exner, 1991, 1993, 2003) Rorschach variables, and suitability for psychodynamic psychotherapy. In this study, I predicted correlations between 17 rationally selected CS variables and suitability for psychotherapy as represented by ratings of Dynamic Capacity and Ego Strength. The participants were 52 psychotherapy applicants between 20 and 57 years old. The ratings were performed after clinical interviews and decisions concerning selection of the applicants. EA, FC, Blends, Zf, and MQo correlated positively and YFY negatively with Dynamic Capacity ratings, whereas EA, FC, and Blends correlated positively and YFY and F% negatively with Ego Strength ratings. EA, FC, YFY, Zf, MQo, and F% also differed between the applicants selected and those not selected for psychotherapy. Considering earlier research, the results for Blends, Zf, and F% were interpreted as replications and for MQo and EA as showing satisfactory consistency.     

Evaluation of ego strength based on certain Rorschach variables.

Despite the importance of the assessment of ego strength for appropriate assignment of clients for psychotherapy and/or rehabilitation, existing techniques have not fulfilled expectations. A method for assessing ego strength through the Rorschach Test independent of clinical criterion is proposed. In addition to certain variables of Klopfer's RPRS (M+, FM+, FC+ plus CF+), sharply preceived space responses are included. They constitute a highly intercorrelated global measure of ego strength and are also highly correlated to a relatively independent Rorschach variable of global ego efficiency, i.e. integrated whole responses. In accordance with prediction, non-controlled color responses as well as accuracy of form perception did not correlate in a non-clinical sample with either measure of ego strength.     

Assessing Male Batterers With the Personality Assessment Inventory

Despite the importance of the assessment of ego strength for appropriate assignment of clients for psychotherapy and/or rehabilitation, existing techniques have not fulfilled expectations. A method for assessing ego strength through the Rorschach Test independent of clinical criterion is proposed. In addition to certain variables of Klopfer's RPRS (M+, FM+, FC+ plus CF+), sharply preceived space responses are included. They constitute a highly intercorrelated global measure of ego strength and are also highly correlated to a relatively independent Rorschach variable of global ego efficiency, i.e. integrated whole responses. In accordance with prediction, non-controlled color responses as well as accuracy of form perception did not correlate in a non-clinical sample with either measure of ego strength.     

Some old and new directions in Rorschach testing

The perennial dispute between clinicians and researchers as to the validity of the Rorschach is discussed. It is suggested both groups are correct in that the Rorschach provides both poor psychometric data as seen by the researcher and rich idiographic data as seen by the clinician. The freedom of the Rorschach response process is viewed as largely responsible for both these situations. Some possible new directions for Rorschach usage and research are discussed which may improve on the quality of the idiographic information provided by the Rorschach test.     

Rorschach from quality: a comparison of the Exner and Beck systems

The Beck and Exner systems of assigning Rorschach form quality were compared, There are some inherent differences in the form quality tables of these two Rorschach systematizers. The Beck system is more extensive and seems slightly biased toward-or "poor" form quality in comparison to the Exner system. When the Rorschach records of psychiatric patients were scored for form quality, the Beck system yielded a significantly lower Extended F+% than the Exner system. This effect is probably related to the inherent differences in the respective form quality tables which resulted from the different procedures used in deriving these listings of form quality.     

Changes in Primary Process Thinking of a Prepsychotic Adolescent in Psychotherapy

The main goal of this study was to measure longitudinally change in thought processes and reality testing of a prepsychotic adolescent undergoing psychotherapy. The Holt scoring system for measuring primary process from Rorschach responses was the main measuring instrument. Four Rorschachs were administered over a period of three years. The results of the latter were compared with the clinical ratings of two psychiatrists. While clinical change in response to treatment was slight, there did appear to be a shift from primary to more secondary forms of formal thought processes as determined by the Rorschach.     

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.     

Quantitative research on the primary process: method and findings

Freud always defined the primary process metapsychologically, but he described the ways it shows up in dreams, parapraxes, jokes, and symptoms with enough observational detail to make it possible to create an objective, reliable scoring system to measure its manifestations in Rorschach responses, dreams, TAT stories, free associations, and other verbal texts. That system can identify signs of the thinker's efforts, adaptive or maladaptive, to control or defend against the emergence of primary process. A prerequisite and a consequence of the research that used this system was clarification and elaboration of the psychoanalytic theory of thinking. Results of empirical tests of several propositions derived from psychoanalytic theory are summarized. Predictions concerning the method's most useful index, of adaptive vs. maladaptive regression, have been repeatedly verified: People who score high on this index (who are able to produce well-controlled "primary products" in their Rorschach responses), as compared to those who score at the maladaptive pole (producing primary-process-filled responses with poor reality testing, anxiety, and pathological defensive efforts), are better able to tolerate sensory deprivation, are more able to enter special states of consciousness comfortably (drug-induced, hypnotic, etc.), and have higher achievements in artistic creativity, while schizophrenics tend to score at the extreme of maladaptive regression. Capacity for adaptive regression also predicts success in psychotherapy, and rises with the degree of improvement after both psychotherapy and drug treatment. Some predictive failures have been theoretically interesting: Kris's hypothesis about creativity and the controlled use of primary process holds for males but usually not for females. This body of work is presented as a refutation of charges, brought by such critics as Crews, that psychoanalysis cannot become a science.     

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.     

Disponibilité à la psychothérapie et à l’engagement dans les soins chez les patientes boulimiques : contribution du Rorschach

The instability of involvement in the care process and psychotherapy is frequent among bulimic women. The preliminary evaluation of the capacity of involvement helps to make the decision to begin specific care with these patients. We thus make the assumption that involvement in the care process can express itself in indexes of Rorschach when this test is part of a prior examination of orientation at the beginning of the care. These indexes concern the relationship dependence and the capacity of development of subjective expression. They appear in several analysis registers of the Rorschach protocol, which are: the scale of oral dependence (ROD); the index of expressive capacity (EX); the recurring object (ORec); contents in connection with the representation of dependence among bulimic women. A group of 34 bulimic women involved in multifocal care process, especially including a psychoanalytical-inspired psychotherapy (ES) is compared with a group of 34 bulimic women who precociously stopped this care or didn’t get involved in it (NES). The subjects of the ES group received care during at least 1 year. The comparison between the two groups shows significant differences in the pretherapeutic indexes (ROD, ORec). The interest and the limits of this type of analysis are debated.     

When Homer nods: an examination of some systematic errors in Rorschach scholarship

Considerable evidence has demonstrated that many scientists attempt to avoid disconfirmation of a favored theory. This tendency sometimes characterizes the scholarship of both those who favor the Rorschach (Exner, 2000) method and those who find it seriously flawed. Psychologists who use the Rorschach impressionistically are not deterred by the literature demonstrating that this procedure has thus far shown little established validity. Those who criticize the Rorschach dismiss the objectivity of the American Psychological Association (APA) Blue Ribbon Panel, which concluded that the test has proven validity, and by implication, they also dismiss the APA peer review process that approved the panel report. In addition, they ignore over 400 published studies showing the Rorschach has acceptable validity when responses are scored objectively.     

Evaluation des psychothérapies : l'apport du Rorschach (S.I.)

This paper reviews the use of the Rorschach (C.S.) in the field of psychotherapy outcome and process evaluation. It appears to be a valid and useful tool, able to measure changes following therapy and whatever the kind of therapy, based on infraclinical information about the patient. Its use requires precise and complex methodological designs which are described in this article, together with the main studies necessary to encourage future research on this topic.     

Prognostic validity of the Rorschach

Fifty adult stutterers entering therapy at the UCLA Psychology Clinic were administered the Rorschach, with a Klopfer method inquiry, scoring, form level rating, and calculation of scores on the Rorschach Prognostic Rating Scale (RPRS). On the basis of independent clinician ratings of attitudinal or psychotherapeutic improvement, subjects were divided into groups of Improved Most (n = 21) and Improved Least (n = 29). Subjects were also divided into Continued (n = 43) and Dropped (n = 7). Logistic regression was employed to compare groups on the following Rorschach dimensions: Prognostic Score (RPRS); Human Movement; Animal Movement; Inanimate Movement; Shading; Color; Form Level. The Improved Most group was significantly higher in M, FM, Shading, and Productivity. The finding that M and FM discriminates between improvement groups corroborates results obtained in a previous study (Sheehan et al., 1954). The Rorschach movement variables, particularly M and FM, seem to be stable indicators of capacity for improvement in psychotherapy.