John Exner and the Book That Started It All: A Review of The Rorschach Systems

This article is a review and a reassessment of Exner's (1969) The Rorschach Systems. The book reviews the history of the development of the Rorschach, primarily in the United States, including a detailed analysis of the progressive development of systems devised by Klopfer, Beck, Piotrowski, Hertz, Rapaport, and Schafer. The final versions of each system are compared with each other, and with Rorschach's own system. The development of the book is linked to Exner' s personal relationship with Klopfer, Beck, and Hertz. The book is described as the basic forerunner of Exner's Comprehensive System.     

Bruno Klopfer: A Rorschach Pioneer

Bruno Klopfer is perhaps best known for his pioneering work on the Rorschach Inkblot Test. His efforts in developing and popularizing projective techniques were to have a profound impact on the development of psychological personality testing. In fact, prior to the introduction of Exner's comprehensive Rorschach scoring system, the Klopfer scoring system was the most popular among practicing clinicians (Exner & Exner, 1972, p. 13). Professionals in clinical psychology and psychiatry are certainly very indebted to Bruno Klopfer.     

Effects of Alternate Modes of Administration on Rorschach Performance of Deaf Adults

This study examined two modes of administering the Rorschach Inkblot Technique to determine which was more appropriate for a college-educated, deaf population. Twenty-four prelingually deaf adults took the Rorschach in sign language and in written English, using a counterbalanced test-retest design, and their sign and written scores were compared to each other and to 1986 norms for Exner's Comprehensive System. Seventeen variables measuring such areas as perceptual accuracy, perceptual complexity, and self-focus were found to vary more than one standard deviation from Exner's norms. Differences between sign and written conditions on several affective variables were found. Written administration can be used by examiners who are informed about deafness and aware of variables that may be underreported by written inquiry.     

Bruno Klopfer,A Measure of the Man and His Work: A Review of Developments in the Rorschach Technique: volumes I,II, and III

This article reviews Bruno Klopfer's life and his contributions to the Rorschach, especially as they are represented in his three volume series: Developments in the Rorschach Technique, volumes I, II, and III. It emphasizes Klopfer's many contributions to Rorschach administration and interpretation, as well as his superior teaching and organizational abilities. Klopfer organized what eventually became The Society for Personality Assessment and began the journal that eventually became the Journal of Personality Assessment. His legacy is reflected in much of Exner's system of administration and scoring.     

One More Datum on Rorschach Form Quality

The central purpose of this work is to examine to what extent Form Quality (FQ) scoring of Rorschach responses, using Exner's (2003) Table A, is the reason for lower FQ to often be found in normative data outside the United States. The Rorschach protocols of 180 Portuguese boys and girls between 6 and 10 years of age were codified with respect to Form Quality in accordance with Exner's table of objects classified as ordinary, unusual, and minus, based on frequencies seen among U.S. adults and on an analogous Portuguese table (Table P) constructed from the protocols of 400 nonpatient children. Mean differences between the various FQ variables of the 2 tables were found to be insignificant. However, use of Janson's (2003) iota coefficient to evaluate agreement between the 2 approaches to scoring on the same protocols revealed that the more striking differences occurred in the FQu variable when agreement was assessed on the basis of each individual response. In view of these results, the authors recognize the possibility of Rorschach normative data to be universally applied, but still consider the possible advantage of each country or culture to build its own FQ table that will permit preservation of its particularities.     

The Validity of the Rorschach for Assessing Cognitive and Affective Changes

Exner's (1985) Rorschach norms of children 5 to 16 years old were used to test predictions based on developmental theory, previous cognitive studies, and Achenbach and Edelbrock's (1981) norms on behavior problems in children. In the cognitive realm, the Rorschach scores reflected the predicted increase in complexity, integration, and precision of thinking; richness of ideas; conformity to socially acceptable ways of thinking; and the concomitant decrease in unrealistic, egocentric ideas. In the affective realm, the Rorschach scores reflected the predicted decrease in uncontrolled expression of affect, increase in controlled expression of affect, and increase in inwardness. However, the Rorschach scores failed to reflect the predicted decrease in anxiety and increase in depression. Finally, tin, ere was no evidence of increased accuracy of perception.     

Projection, transitional phenomena, and the Rorschach

This article sheds light on the theoretical foundations of projective testing. Drawing on the psychoanalytic perspective, especially Winnicott's works, it elucidates the nature of projection and transitional relatedness, with particular reference to the Rorschach. This conceptualization of the Rorschach task is compared with Exner's more cognitive-behavioral orientation, which holds that the Rorschach is not a projective test. I suggest that Exner's Comprehensive System could become more truly comprehensive if it were integrated with a more complex understanding of the response process, allowing more importance to the role of stimuli from the inner world to counterbalance its focus on the processing of external stimulation. Clinical and research implications are discussed.     

Directory of Members of the Society for Projective Techniques as of March 1, 1964

The appearance of depressive features, as reflected by responses to the Rorschach test, were explored in two groups of children from divorced and nondivorced families (referred to here as divorce and nondivorce children). The relationships between the depression scores and the children's hostility, aggression, and anxiety levels were also studied. The Rorschach Inkblot Test was individually administered to a nonclinical sample of 108 Swedish school children between 10 and 12 years old. The subjects constituted two groups,, a divorce group (27 girls, 27 boys) and a nondivorce group (27 girls, 27 boys). Divorce children scored significantly higher on Exner's (1986) Depression Index than their nondivorce peers. Furthermore, divorce children with depressive features in their Rorschach responses were found to have a high level of hostility and aggression (as manifested in their Rorschach protocols), whereas no such associations were found among nondivorce children.     

A Rorschach Study of Narcissism Defense,and Aggression in Borderline,Narcissistic, and Cluster C Personality Disorders

We examined the differences between narcissism, mode of defense, and level of aggression on the Rorschach. We also investigated differences in borderline, narcissistic, and Cluster C personality disorders by examining responses to Rorschach content variables. The Lerner Defense Scale (P. Lerner & H. Lerner, 1980), the aggressive content section of the Holt (1977) method for assessing primary process manifestations, a modified version of Exner's (1986a) Egocentricity Index, Wagner's (1965) exhibitionistic M score, and grandiosity were scored on the Rorschach protocols of 17 borderline, I7 narcissistic, and 17 Cluster C personality disorders. Borderlines were found to employ primitive defensive structures to a greater degree and severity, show more intense and overall aggression as welt as more responses on the three forms of aggression in the Holt method, and have higher levels of grandiosity. Narcissists evinced significantly higher levels of egocentricity than borderlines and higher levels of idealization than the Cluster C group. Convergent validity was found on the measures of defense and aggression, which showed a strong relationship between primitive aggression and primitive defense.     

Rorschach Protocols From Children and Adolescents Diagnosed With Posttraumatic Stress Disorder

Rorschach protocols from 35 children and adolescents with posttraumatic stress disorder (PTSD) and 35 with oppositional defiant disorder (ODD) were compared. Both groups revealed significant differences from the normative tables on the same 12 variables: SCZI, DEPI, CDI, X+%, EgoC, Afr, T, EA, P, WSumC, RawSumSS, and WgtSumSS. However, as predicted, 4 of those variables, the Schizophrenic Index (SCZI) and 3 of the criterion tests that comprise it (X+%, RawSumSS, and WgtSumSS) were significantly different between the PTSD and ODD groups, with the PTSD group responding with more extreme scores. These findings contradict Exner's (1993) statement that only people with schizophrenia can be "defined or conceptualized as having both the problems of disordered thinking and inaccurate perception" (p. 356). Children and adolescents with PTSD also display these problems when trauma interrupts the child's naive belief that the world has predictable rules, the people in it are trustworthy and fair, and punishment and pain are consequences of bad behavior. When young victims cannot comprehend or make sense of what has happened to them, life becomes irrational, illogical, and confusing. Exner's SCZI does what it was designed to do: identify individuals with disordered thinking and inaccurate perception. Therefore, SCZI should be renamed the Perception and Thinking Index (PATI) to reflect its function rather than a diagnostic category.     

Rorschach Developmental Quality and Intelligence Factors

Research has demonstrated a relationship between cognitive development and the location and complexity of Rorschach responses. This study examined the association between the Wechler Adult intelligence Scale-Revised (WAIS-R) and Exner's Developmental Quality (DQ). This study had two objectives: to examine the relationship between DQ and WAIS-R intelligence factors and IQs and to determine whether the DQv/ + score taps a synthesizing visual-perceptual operation. An overall goal was determining the extent to which DQ represents Friedman's operationalization of Werner's orthogenetic principle. Subjects were 125 nonclinical volunteers. Findings suggest that DQ taps a visual-perceptual problem-solving skill in which complex whole responses make the most significant contribution. There was no evidence that DQv/+ responses represent visual-perceptual synthesis. It was concluded that DQ not an operationalization of Werner's orthogenetic principle and that developmental quality, at least in the sense that Werner or Friedman might have intended it, may be a misnomer.     

An Outcome Study: Changes in Rorschach Variables of Adolescents in Residential Treatment

Admission Rorschach variables were compared to 2-year reevaluation responses of adolescents (n = 50) in residential treatment using Weiner and Exner's (1991) 27 structural variables. Fifty adolescents who had previously failed to improve in outpatient treatment and multiple hospitalizations were subsequently placed in residential treatment. Following 2 years of residential treatment, they showed positive personality changes as indicated by a reduction in Rorschach indices of impaired functioning. Positive treatment changes in interpersonal awareness were discussed utilizing a social identification index formulated for this population. Results indicate the utility of the Rorschach test-retest method of assessing treatment outcome.     

Brief Rorschach Records With Children and Adolescents

In order to determine the frequency with which children and adolescents give brief Rorschach ( R < 14) records and to test the hypothesis that brief records represent a resistance to testing, the psychological evaluations of 439 admissions to an inpatient unit were reviewed. Of the records reviewed, 16.6% were found to contain less than 14 responses. When the complete test protocols of those subjects who provided brief records were compared with those of a matched group, it was found that the group with brief records failed to complete the other parts of the evaluation significantly more often than did those subjects who did not give brief records. There was no significant difference between the two groups on IQ scores or on self-report scores of depression, anxiety, and social desirability. Results are interpreted as supporting Exner's (1988) hypothesis that brief records represent a form of resistance to being tested.     

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.     

Correlates of the Egocentricity Index in Child and Adolescent Outpatients

This study examined the Rorschach and MMPI covariates of Exner's Egocentricity Index, 3γ + (2): R, in a sample of child and adolescent outpatients (n = 46). Consistent with previous findings on adult psychiatric inpatients (Barley, Doff, & Reid, 1985), significant positive correlations were obtained between the Index and M, FM, χ + %, and D when controlled for the number of protocol responses. The Egocentricity Index was negatively associated with lambda and, in a subsample of adolescents (n = 19), depression scores. The index bore no significant relationship to either Minnesota Multiphasic Personality Inventory (MMPI) validity or clinical scales, also congruent with earlier investigations. Implications for the interpretation of childrens' Egocentricity Indices are discussed.     

Low-End Specificity of Four Depression Measures: Findings and Suggestions for the Research Use of Depression Tests

Past research has found that very low scorers on the Beck Depression Inventory (BDI) tend to respond in a fake-good manner on the Minnesota Multiphasic Personality Inventory (MMPI) validity scales. This finding was interpreted as evidence of poor low-end specificity. This study replicated and extended this work by evaluating the low-end specificity of four popular depression measures. The evidence of problems with low-end specificity was strong for the BDI and marginal for the Profile of Mood States depression subscale. Interestingly, MMPI scores in the normal range were associated with fake-good responding, whereas very low and high scores were not. There was no evidence of an association between fake-good responding and scores on Exner's Depression Index for the Rorschach. Implications of these findings and guidelines for dealing with problems with low-end specificity in research are discussed.     

Perception and the Rorschach

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.     

LIFE RECEDES WHEN EXCHANGE FAILS: CLINICAL ANTHROPOLOGY AMONG TURKISH PATIENTS

This paper presents a multidimensional analysis of a young Turkish ill woman. The psychological interpretation is based on clinical data and on projective techniques, i.e., the Thematic Apperception Test and the Rorschach Test. The psychological interpretation is combined with a semantic interpretation of the symbolic cultural processes. This anthropological approach concentrates on the temporal and spatial aspects of the culturally established symbolic congruence between the subject's bodily acts and her socio-cultural environment (in particular the subject's family and their discourse).