Research on the clinical usefulness of the Rorschach: 2. The assessment of cerebral dysfunction

A review of research on the use of the Rorschach in the assessment of cerebral dysfunction indicated that the Rorschachs of patients with cerebral dysfunction do not manifest any characteristic response in terms of percentages, ratios, or any unique response to any one of the stimulus determinants of the blots (color, shading, the stimulus for movement). The patient with cerebral dysfunction does manifest a unique style of thinking; responses tend to be concrete, perseverative, and stereotypic. This finding is similar to that found with schizophrenics where research, summarized by Frank in 1990, also indicated no uniquely 'objective' response style but reflected a unique cognitive style. These two reviews taken together suggest that the better way to use Rorschach data in clinical work is as an opportunity to assess patients' thinking as opposed to the Rorschach being used as a psychometric device, yielding 'numbers.'     

Responses of schizophrenics and nonpatients to a tachistoscopic presentation of the Rorschach

Three groups of 36 subjects each, two of nonpsychiatric subjects and one of first admission schizophrenics, were administered the Rorschach tachistoscopically. Each group was subdivided into three subgroups to permit a variation in exposure times for the blots. Intervals of 200ms, 400ms, and 600ms were used; however, the differences in exposure times did not produce significant differences within any of the groups. Thus, the data were compared by groups. The results indicate no significant differences across the groups for accuracy of from (X + %). The schizophrenic group did give significantly more Special Scores related to cognitive slippage. They also gave a much higher proportion of pure form responses and substantially more card rejections than either of the nonpsychiatric groups. The results are discussed in the context of research on information processing and the early operations in the Rorschach response process.     

A Comparison of New and Revised Rorschach Measures of Schizophrenic Functioning in a Serbian Clinical Sample

We empirically evaluated indexes derived from the Rorschach Comprehensive System (CS) and the Rorschach Performance Assessment System (R–PAS) that are used for the assessment of psychotic functioning in schizophrenia. We compared the Perceptual Thinking Index (PTI) and the Ego Impairment Index (EII–2) with their revised versions: Thought and Perception Composite (TP–Comp) and EII–3. We evaluated their predictive validity for differentiating schizophrenic from nonschizophrenic patients in a Serbian sample. The sample consisted of 211 (109 men and 102 women, 18–50 years old) inpatients in Serbia who were divided into 2 groups: schizophrenic (100) and nonschizophrenic (111). Test administration, coding, and form quality classification followed CS guidelines. Logistic regression analysis indicated that the new indexes TP–Comp and EII–3 have slightly better predictive power than their counterparts, PTI and EII–2, in identification of schizophrenia, and that TP–Comp performed better than other indexes, although all 4 indexes were successful in differentiating these groups. The results supported the use of TP–Comp in diagnosis of schizophrenia and generally provided evidence for the utility of the Rorschach in evaluating psychosis and for its use in a cross-national context.     

Rorschach indices for discriminating between two schizophrenic syndromes

Thinking disturbance and disorder of affects may be different in two subtypes of schizophrenia, the "florid" and the "withdrawal" syndromes. In Exner's approach to the Rorschach system, the diagnostic indicators of disordered thinking may point out large differences not only between schizophrenic and control subjects but also between different types of schizophrenics. The Rorschach protocols of 45 subjects (15 "florid" schizophrenics, 15 "withdrawn" schizophrenics, and 15 controls of the same age and education, matched by sex) were examined on several Exner indices. Compared with the control group, both schizophrenic types confirmed an impairment of perceptual accuracy and of reality testing as well as a reduced emotional control. Compared with the "withdrawn" group, the "florid" schizophrenic subjects showed significantly higher indices of poor perceptual functioning, of an inadequate organizational activity (more Whole and Z responses characterized by negative Form Quality) and greater disordered ideational production.     

Follow-up Validation of Rorschach Tempo and Color Use Indicators of Schizophrenia

Two to five year psychiatric follow-ups through a case register of original cross-validating samples for some Rorschach tempo and color use indicators of schizophrenia found subsequent diagnosis of schizophrenia associated (a) beyond the .001 level with certain deviations from normative tempo and (b) beyond the .01 level with presence of pure C or two or more of the following: 1–2 CF, Sum C 1.5–3.0, CF without C. Combined classification by the tempo and color variables was accurate in 90% of schizophrenic and 80% of nonschizophrenic cases manifesting neither or both variables. These findings, occurring within a population of psychiatric patients referred for testing, recommend the clinical utility of the variables.     

Response selection on the Rorschach Test

After discussion of some theoretical speculations concerning the nature of the Rorschach process, two experimental manipulations of the Rorschach task are presented. Three groups of normal (n = 6) and schizophrenic subjects (7 paranoid and 7 nonparanoid) participated. Their mean age was 30.7 yr. In the first experimental version of the Rorschach, simplified inkblots (sections of the standard cards) were used to verify the influence of stimulus complexity on response for the three groups. In the second, an experimental version of the Rorschach task was created to highlight the influence of the selection process among different associations to blots. To this end, a list including responses both of positive and negative form quality to each card, was provided each subject. Data are discussed, highlighting the minimal differences obtained by the experimental manipulations and relating these to theoretical speculations.     

Amphetamine on Rorschach Measures in Normal Subjects

Twenty-two normal undergraduate men were administered either d-amphetamine (0.2 mg/kg or 0.4 mg/kg) or placebo in a double-blind, counterbalanced design. The test sessions were exactly three weeks apart and included, among other measures, the Rorschach test. Rorschach anxiety and thought disorder variables were measured under drug and placebo conditions. The results suggest that amphetamine causes an increase in Rorschach anxiety indices but does not elevate Rorschach indices of thought disorder. The observed dissociation of anxiety and thought disorder on the Rorschach has implications for the role of the Rorschach in studying anxiety disorders and schizophrenic disorders.     

A comparison of Rorschach developmental level and form-level systems as indicators of psychosis.

Psychotic and nonpsychotic psychiatric inpatients were tested on the Rorschach. "Reality-testing" was measured by four form-level scoring systems designed by Beck, Mayman, Becker, and Wilensky. The psychotic subjects were dichotomized on three diagnostic dimensions: schizophrenia, paranoia, and premorbid social adjustment. No significant differences were found for the Beck system. With the other systems, psychotics showed significantly poorer reality testing than nonpsychotics. No differences were found for the schizophrenic and paranoid dimensions. The Phillips premorbid adjustment score was negatively correlated with all four measures of "reality-testing." The conclusion drawn was that Rorschach measures of "reality testing" are associated with psychotic and poor premorbid functioning, but do not differentiate schizophrenic from nonschizophrenic psychotics or paranoid schizophrenics from nonparanoid schizophrenics.     

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.     

Eleventh Annual Meeting of the Society for Projective Techniques

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

Symposium: Research In Projective Techniques

Psychotic and nonpsychotic psychiatric inpatients were tested on the Rorschach. "Reality-testing" was measured by four form-level scoring systems designed by Beck, Mayman, Becket, and Wilensky, The psychotic subjects were dichotomized on three diagnostic dimensions: schizophrenia, paranoia, and premorbid social adjustment. No significant differences were found for the Beck system. With the other systems, psychotics showed significantly poorer reality testing than nonpsychotics. No differenced were found for the schizophrenic and paranoid dimensions. The Phillips premorbid adjustment score was negatively correlated with all four measures of "reality-testing." The conclusion drawn was that Rorschach measures of "reality-testing" are associated with psychotic and poor premorbid functioning, but do not differentiate schizophrenic from nonschizophrenic psychotics or paranoid schizophrenics from nonparanoid schizophrenics.     

Impact of Card Rotation on the Frequency of Rorschach Reflection Responses

This study examines evidence for boundary disturbances in depressive, borderline, and schizophrenic hospitalized inpatients. Certain thought disorder signs on the Rorschach are reconceptualized as indices of boundary formation, which is defined as the capacity to create particular distinctions along women bipolar coordinate of experience where previously no distinction was possible, and which defines each cluster of experience through a maintenance of differential functioning. The borderline group scored significantly high on the indices of laxness and moderately severe inner-outer boundary formation. The schizophrenic group scored significantly higher on indices of self-other and somewhat higher on severe inner-outer boundary disturbance. Schizophrenics may be organized at a level of self-other boundary formation which subsumes inner-outer boundary formation, while the borderline group is organized at a level of inner-outer boundary formation.     

The problems of R in clinical settings and in research: suggestions for the future

It has been suggested that we control for R in the interpretation of individual Rorschach records. A related, but distinctly different issue concerns controlling for or equating R in research. I suggest we should not control for R in interpreting individual records. There are also some research paradigms in which controlling for R does not seem advisable. In other types of research, I argued that some method of controlling for or equating R appears appropriate. The distributions of many Rorschach factors are markedly non-normal, and in some cases the shapes of the distribution for a particular factor may be different among different populations. In these instances, when attempting to control statistically for R, improper model specification may lead to erroneous findings. Finally, I argue for a theory-based, empirical approach to all future Rorschach research.     

The rorschach assessment of borderline defenses: a concurrent validity study

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

Boundary disturbance in borderline and psychotic states

This study examines evidence for boundary disturbances in depressive, borderline, and schizophrenic hospitalized inpatients. Certain thought disorder signs on the Rorschach are reconceptualized as indices of boundary formation, which is defined as the capacity to create particular distinctions along wome bipolar coordinate of experience where previously no distinction was possible, and which defines each cluster of experience through a maintenance of differential functioning. The borderline group scored significantly high on the indices of laxness and moderately severe inner-outer boundary formation. The schizophrenic group scored significantly higher on indices of self-other and somewhat higher on severe inner-outer boundary disturbance. Schizophrenics may be organized at a level of self-other boundary formation which subsumes inner-outer boundary formation, while the borderline group is organized at a level of inner-outer boundary formation.     

Personality assessment with children of superior intelligence: divergence versus psychopathology

The perceptual and cognitive functioning of children with intelligence quotients greater than 135 was examined with the Rorschach Inkblot Test. A criterion measure, the Child Behavior Checklist, was also administered so as to determine whether deviations for Rorschach variables from age-appropriate norms indicated the presence of psychopathology or were evidence of nonentrenched, novel, or creative styles of encoding and processing information. Rorschach variables indicative of intellectual sophistication, nonentrenched thinking or inaccurate reality perception, and cognitive slippage were reliably elevated for this sample versus norms. Results for the Child Behavior Checklist demonstrated that the incidence of psychopathology in the intellectually superior and average samples were comparable. There was a lack of covariance between Rorschach makers of inaccurate reality perception, cognitive slippages, and schizophrenia, and the sum of behavior problems on the Child Behavior Checklist. Results for the Rorschach and Child Behavior Checklist variables were comparable for children with intelligence quotients greater than 150 versus between 136 and 140. It was concluded that the intellectually superior children did process the Rorschach stimuli in a manner that was nonentrenched and reliably different from norms, but that these differences should not routinely be considered as indications of psychopathology.     

Personality Assessment With Children of Superior Intelligence: Divergence Versus Psychopathology

The perceptual and cognitive functioning of children with intelligence quotients > 135 was examined with the Rorschach Inkblot Test. A criterion measure, the Child Behavior Checklist, was also administered so as to determine whether deviations for Rorschach variables from age-appropriate norms indicated the presence of psychopathology or were evidence of nonentrenched, novel, or creative styles of encoding and processing information. Rorschach variables indicative of intellectual sophistication, nonentrenched thinking or inaccurate testily perception, and cognitive slippage were reliably elevated for this sample versus norms. Results for the Child Behavior Checklist demonstrated that the incidence of psychopathology in the intellectually superior and average samples were comparable. There was a lack of covariance between Rorschach markers of inaccurate reality perception, cognitive slippages, and schizophrenia, and the sum of behavior problems on the Child Behavior Checklist. Results for the Rorschach and Child Behavior Checklist variables were comparable for children with intelligence quotients > 150 versus between 136 and 140. It was concluded that the intellectually superior children did process the Rorschach stimuli in a manner that was nonentrenched and reliably different from norms, but that these differences should not routinely be considered as indications of psychopathology.     

Trends in research on the Rorschach: Review and recommendations

Meta-analyses have shown that the Rorschach and the Minnesota Multiphasic Personality Inventory (MMPI) have roughly equivalent psychometric properties. Assessment continues to be stressed in psychological training, and the Rorschach continues to be emphasized in courses on assessment. The most frequently used test battery includes the Wechsler Adult Intelligence Scale-Revised or Wechsler Intelligence Scale for Children-Revised, the MMPI, and projective devices such as the Rorschach or Thematic Apperception Test. A survey of the literature from 1983 to 1991 showed that research on the Rorschach concerns mainly issues of formal diagnosis and evaluation of the psychometric properties of the instrument. Such research does not evaluate the Rorschach as it is usually employed to arrive at decision about individuals. More appropriate research models are recommended, in which Rorschach data are added to or deleted from other assessment information in order to evaluate the influence of the inclusion of the Rorschach on judgments made by competent clinicians about relevant issues in individual cases.     

The role of perceptual laws in the Rorschach test

The purpose of this study is twofold: to ascertain the perceptual deficits in schizophrenic subjects and to test the assumption that the Rorschach is mainly a perceptual task. Forty-eight subjects participated in the study, distributed in six groups of eight subjects each: normals, affective disorders, and four groups of schizophrenics (chronic paranoid, chronic nonparanoid, acute paranoid, and acute nonparanoid). They were given a perceptual test developed by Fernández-Trespalacios, Bermudez, and Luna (1979). Contrary to previous findings, no differences in the perceptual test were found among the groups. In the second part of the study, a group of schizophrenic subjects was given the Rorschach and the perceptual test in a balanced order. Subsequently, subjects in the experimental group were trained in the perceptual laws they had failed. Comparison of the Rorschach protocols obtained before and after this training failed to show any significant differences in the expected direction, thus questioning the perceptual nature of this test. Interestingly, an increase in negative categories of the Rorschach subsequent to the perceptual training was observed.