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.     

Graphomotor Interpretation of the MMPI-2?

Although clinicians may attribute various personality features to patients who complete paper-and-pencil instruments (e.g., the MMPI-2) with notable neatness (compulsivity?) or sloppiness (oppositionalism?), such inferences have not been empirically examined. In our investigation, MMPI-2 protocols of 154 psychiatric inpatients (74 female and 80 male, M age = 36.7) were examined. A scoring system was developed to categorize the degree of neatness with which each patient had filled in the MMPI-2 response sheet (interrater Cohen Kappa = 0.86). Degree of neatness was not found to be correlated with clinical or content scales on the MMPI-2, with any Millon Clinical Multiaxial Inventory-II (MCMI-II) scales, or with various Rorschach (Comprehensive System) variables. These results imply that, clinical lore notwithstanding, clinicians should refrain from drawing unwarranted inferences about patients' personality features on the basis of the apparent neatness or sloppiness of patients' protocols.     

Graphomotor interpretation of the MMPI-2?

Although clinicians may attribute various personality features to patients who complete paper-and-pencil instruments (e.g., the MMPI-2) with notable neatness (compulsivity?) or sloppiness (oppositionalism?), such inferences have not been empirically examined. In our investigation, MMPI-2 protocols of 154 psychiatric inpatients (74 female and 80 male, M age = 36.7) were examined. A scoring system was developed to categorize the degree of neatness with which each patient had filled in the MMPI-2 response sheet (interrater Cohen Kappa = 0.86). Degree of neatness was not found to be correlated with clinical or content scales on the MMPI-2, with any Millon Clinical Multiaxial Inventory-II (MCMI-II) scales, or with various Rorschach (Comprehensive System) variables. These results imply that, clinical lore notwithstanding, clinicians should refrain from drawing unwarranted inferences about patients' personality features on the basis of the apparent neatness or sloppiness of patients' protocols.     

Brief Book,Software, and Test Announcements

After reviewing literature detailing the ubiquity of error in research and assessment data, I describe mistakes found with MMPI-2 and Rorschach scores in an earlier publication (Meyer, 1993). The mistakes emerged from several sources, including hand-scoring the assessment measures, manually retrieving scores from patient files, and manually entering information for statistical analyses. The proportion of erroneous scores in the original study (MMPI-2 = 5.88%, Rorschach = 1.56%) was relatively small and reliability coefficients between the original and corrected scales were uniformly high (i.e., > .940). Consequently, the findings detailed in the original publication were not greatly affected by the mistakes that were made. Nonetheless, because this will not always be the case, I discuss the discrepancies as a way to sensitize researchers, clinicians, and students to the presence of error and then suggest several strategies for minimizing its impact on assessment data and research.     

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.     

The MMPI-2 Restructured Clinical (RC) Scales and restraints to innovation, or "what have they done to my song?"

Rogers, Sewell, Harrison, and Jordan (2006/this issue) largely replicate in an independent clinical sample the MMPI-2 Restructured Clinical (RC) Scales developed by Tellegen et al. (2003). Nichols (2006/this issue) raises numerous concerns about the development and utility of the RC Scales, which on close appraisal did not change our view that the scales are well conceived and potentially valuable to researchers and clinicians alike. We present two case studies in which the RC Scales helped clarify complex MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles with multiple elevations on the Clinical, Content, Supplementary, and Personality Psychopathology Five (Harkness, McNulty, Ben-Porath, & Graham, 2001) scales. When interpretations refined by the RC Scales were discussed with the clients, each seemed to feel deeply understood. Reservations about instrument innovation can be appreciated as helping to counterbalance change and thereby ensure the MMPI-2's successful ongoing evolution. We discuss specific ways the MMPI-2 community could avoid polarization about the RC Scales.     

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.     

Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach

The goal of this study was to examine the incremental validity and the clinical utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach (Rorschach, 1942) with regard to differential diagnosis in a sample of adult inpatients with a primary psychotic disorder or a primary mood disorder without psychotic features. Diagnostic efficiency statistics have suggested that the Rorschach Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) was better than MMPI-2 scales in discriminating psychotic patients from nonpsychotic patients. We compared the 84% overall correct classification rate (OCC) for the PTI to an OCC of 70% for the MMPI-2 scales. Adding the MMPI-2 scales to the PTI resulted in a decrease in OCC of 1%, whereas adding the PTI to the MMPI-2 resulted in an increase in OCC of 14%. Sensitivity, specificity, positive predictive power, negative predictive power, and kappa were equal or higher with only the PTI in the model.     

Can sex offenders who minimize on the MMPI conceal psychopathology on the Rorschach?

Rorschach sensitivity to minimization is important in forensic evaluations of sex offenders because these individuals frequently deny psychological problems. To study Rorschach minimization, we divided alleged sex offenders according to whether they minimized on the MMPI (Hathaway & McKinley, 1943) or MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and compared their Rorschachs on indexes of distress, faulty judgment, interpersonal dysfunction, and cognitive distortions. We predicted there would be no differences between MMPI minimizers and nonminimizers on these indexes and that sex offenders of both groups would show greater psychopathology than normative adult samples. Results indicate that mini- mizers produce normal MMPI clinical profiles but still show evidence of psychopathology on the Rorschach. As predicted, sex offenders showed more Rorschach psychopathology than normative samples. Sex offenders' protocols that contained sexual content also showed perceptual distortions. These findings indicate that the Rorschach is resilient to attempts at faking good and may therefore provide valuable information in forensic settings where intentional distortion is common.     

Interrelationship Between MMPI-2 and Rorschach Variables in a Sample of Vietnam Veterans With PTSD

We examined interrelationships between theoretically related MMPI-2 and Rorschach variables in a sample of Veterans Affairs outpatients with Posttraumatic Stress Disorder (PTSD). Subjects were 20 White Vietnam combat veterans diagnosed with PTSD who completed the Rorschach and MMPI-2 as part of a comprehensive evaluation. Correlations were calculated for variables in three groups: validity, depression and anxiety, and thought disturbance. Results showed strong relationships between m, MOR, and t he Dramatic special score of the Rorschach and MMPI-2 indices of distress. Positive relationships were also found for some indicators of thought disturbance, whereas correlations for other depressive indicators were not significant. Findings are discussed with regard to implications for the clinical assessment of combat-related PTSD and future directions for assessment research.     

Rorschach Comprehensive System data for a sample of 283 adult nonpatients from the United States

This article presents an update on adult nonpatients living in central California previously described by Shaffer, Erdberg, and Haroian (1999). In this study an additional 160 nonpatients were administered the Rorschach for a total sample size of 283. Graduate students enrolled in a 2-year Rorschach research seminar administered the Rorschach (Exner, 1995), WAIS-R (Weschler, 1981), and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), and were provided with extensive supervision and ongoing quality control. All protocols were recoded by the first two authors and a psychologist with extensive Rorschach experience. Exclusion criteria are described. Interrater reliability statistics at the response level are presented along with scores for Rorschach Comprehensive System (CS), WAIS-R, and MMPI-2 variables.     

A taxometric analysis of the MMPI-2 Depression scales

The MMPI (Hathaway & McKinley, 1943) and MMPI-2 (Butcher et al., 2001) have long been used as measures of psychopathology. Both clinicians and researchers have noted the widespread existence of negative affectivity on the MMPI and MMPI-2 that may elevate scale scores and eclipse the tests' ability to differentiate depression from other clinical disorders. Using taxometric analyses, in this study we sought to test directly whether the MMPI-2 depression scales could differentiate patients with depressive symptoms from patients with other disorders. A large psychiatric sample (N = 2,000) was utilized and analyses were run separately for men and women. Taxometric analyses did not find a MMPI-2 Depression scale cut point that categorizes patients with depressive symptoms from other patients. Rather, these findings support previous studies finding an underlying dimensionality of depression. We discuss implications for MMPI-2 scale use and depression nosology in light of these findings.     

Therapeutic Assessment "on the Front Lines": comment on articles from WestCoast Children's Clinic

I comment on the articles by Mercer (2011/this issue); Guerrero, Lipkind, and Rosenberg (2011/this issue); and Haydel, Mercer, and Rosenblatt (2011/this issue), which describe their practice of collaborative and therapeutic psychological assessment in a community mental health setting. These articles demonstrate that collaborative and Therapeutic Assessment can be used successfully with clients from underprivileged, high-risk backgrounds. Such assessments are rigorous for both clients and assessors, and their success depends on the ability of clinicians to form trusting relationships with clients. In fact, empathic disruptions by assessors are almost inevitable during the collaborative assessment process, especially if assessors' backgrounds and contexts are quite different from those of their clients. However, if assessors receive enough support to "take off their white coats" and reach into their clients' worlds, such disruptions can be repaired, leading to positive changes in both clients and assessors. This kind of assessment work is not for the faint of heart, but it is immensely rewarding.     

The Susceptibility of the Rorschach Inkblot Test to Malingering of Combat-Related PTSD

The ability of subjects to alter their responses on the Rorschach and self-report measures to fake the symptoms of combat-related Posttraumatic Stress Disorder (PTSD) was investigated. Subjects were 40 White male undergraduates, randomly assigned to either a control or role-informed malingerer group, and 20 White Vietnam veterans with PTSD. Subjects were administered the Rorschach, MMPI-2 validity scales, and Mississippi Scale for Combat-Related PTSD. Results indicated that malingerers were able to achieve scores similar to the PTSD patients on the Mississippi Scale and some Rorschach variables. However, they evidenced significant differences on the MMPI-2 validity scales and several important Rorschach variables. Malingerers typically gave responses that were overly dramatic and less complicated, less emotionally restrained, and indicated an exaggerated sense of impaired reality testing as compared to PTSD patients. Behavioral differences were also noted between the groups. Findings are discussed in the context of the study's limitations and the practical detection of malingered PTSD in clinical settings.     

Relationship Between the Rorschach and the MMPI-2 in a Swedish Population: A Replication Study of the Effects of First-Factor Related Test-Interaction Styles

A sizeable amount of research literature has failed to demonstrate a stable relationship between self-report and the Rorschach (Exner, 1993). However, principal component first-factor related test-interaction style has been shown to moderate convergence. In this study 78 psychiatric patients completed the Rorschach and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Hathaway & McKinley, 1989). Practically no correlation was evident between the MMPI-2 and the Rorschach, measuring similar constructs, in all patients. Patients with similar test-interaction styles demonstrated positive intermethod correlations between both conceptually related and conceptually not directly related test indexes. The same scales were negatively correlated in patients with discordant test-interaction styles, and this difference between test-interaction style groups was significant. It is suggested that first-factor related test-interaction style moderates convergence. It is further suggested that test-interaction style moderates convergence between both conceptually related and conceptually not directly related measures of distress or psychopathology.     

Relationship between the rorschach and the MMPI-2 in a Swedish population: a replication study of the effects of first-factor related test-interaction styles

A sizeable amount of research literature has failed to demonstrate a stable relationship between self-report and the Rorschach (Exner, 1993). However, principal component first-factor related test-interaction style has been shown to moderate convergence. In this study 78 psychiatric patients completed the Rorschach and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Hathaway & McKinley, 1989). Practically no correlation was evident between the MMPI-2 and the Rorschach, measuring similar constructs, in all patients. Patients with similar test-interaction styles demonstrated positive intermethod correlations between both conceptually related and conceptually not directly related test indexes. The same scales were negatively correlated in patients with discordant test-interaction styles, and this difference between test-interaction style groups was significant. It is suggested that first-factor related test-interaction style moderates convergence. It is further suggested that test-interaction style moderates convergence between both conceptually related and conceptually not directly related measures of distress or psychopathology.     

Further validation of computer-assessed response time to emotionally evocative stimuli

Response time (RT) to stimuli from word association test items to Rorschach cards has long been held to be clinically important; especially when unusually long. Recently, Temple and Geisinger (1990) reported longer RT to personality test items previously rated evocative than to other items rated neutral. Our research replicated both Temple and Geisinger's (1990) methods and findings on 23 college students. Subsequent analyses revealed that this effect was found in 78% of all subjects at MMPI-2 item length. Implications for augmenting test validity are discussed.     

Relative user ratings of MMPI-2 computer-based test interpretations

There are eight commercially available computer-based test interpretations (CBTIs) for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), of which few have been empirically evaluated. Prospective users of these programs have little scientific data to guide choice of a program. This study compared ratings of these eight CBTIs. Test users were randomly assigned to rate either a single authentic CBTI report on one of their clients or a single CBTI report generated from a modal MMPI-2 profile for their clinical setting. In all, 257 authentic and modal CBTI reports were rated by 41 clinicians on 10 dimensions. Each of the authentic reports received substantially higher ratings than the modal reports, with ratings of perceived accuracy and opinion confirmation best differentiating between authentic and modal reports. Automated Assessment Associates' report received the highest overall ratings; reports published by Western Psychological Services, Pearson Assessments, and the Caldwell Report were also distinguished on one or more ratings dimensions.     

Journeys through the valley of death: multimethod psychological assessment and personality transformation in long-term psychotherapy

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is based on the assumption that an in-depth understanding of clients' underlying emotional, personality, and interpersonal patterns will facilitate their treatment. In this article I show how such an understanding can be achieved through multimethod psychological assessment, and how useful such information can be in long-term psychotherapy with high-achieving, successful clients who struggle with forming and maintaining intimate relationships. Such treatments are extremely difficult, because when these clients attach to their psychotherapists, many of them temporarily become more symptomatic. I illustrate these points with a detailed account of my long-term therapy with a resilient but highly traumatized young man. Repeated use of the Minnesota Multiphasic Personality Disorder-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach with my client helped guide us in our work, and also helped create an important therapeutic "opening" into the underlying traumatic material. This and other experiences have convinced me that it is extremely useful for psychologists to have training in both assessment and psychotherapy.