The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.     

The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample

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.     

Group-as-a-whole concepts and the therapeutic milieu on the inpatient psychiatric unit

This paper focuses on large group process on the inpatient psychiatric unit. General systems theory and group-as-a-whole concepts are used to understand the dynamics of the therapeutic milieu. Using this information as a tool, the therapist can make various interventions on an individual and group level that will help patients understand and deal with their own psychopathology. Another benefit of this process is that it will develop a community on the psychiatric unit where patients help each other to get well. Three clinical examples are used to illustrate the relevance of this concept. With the advent of short-term psychiatric hospitalization, the therapeutic milieu has shown a drastic decline. Emphasis has been placed on the individual as opposed to the group and a valuable therapeutic tool has been lost. Using a group-as-a-whole concept can help reverse this trend and make the milieu on the inpatient psychiatric unit instrumental in the recovery of the patient.     

Behavioral assessment and analysis of mechanical restraint utilization on a psychiatric,child and adolescent inpatient setting

A behavioral assessment and analysis of mechanical restraint utilization on a child and adolescent psychiatric inpatient unit was performed to identify contextual variables associated with implementation. The most frequent antecedent conditions correlated with restraint were when staff initiated physical contact towards a patient and when a patient refused to go to, or remain in, the “quiet room” when instructed. These interactions were seen as staff-initiated encounters that elicited aggressive responses from patients and increased the likelihood of restraint because the physical intervention and “quiet room” procedures were implemented in the absence of a comprehensive treatment formulation, and without reference to behavior-specific guidelines. Recommendations to reduce the use of mechanical restraint with child and adolescent inpatients by isolating functionally controlling variables are presented. © 1998 John Wiley & Sons, Ltd.     

Single-sign Rorschach suicide indicators: a validity study using a depressed inpatient population

This study attempted to test the validity of using single responses on the Rorschach as indicators of current suicidal risk. Forty-one depressed inpatients were administered the Rorschach along with a concurrent measure of depression and suicidality. Appelbaum and Holzman's (1962) color-shading sign was found to be related to low suicidal risk, whereas Blatt and Ritzler's (1974) transparency sign was found to be unrelated to current suicidal risk, but still related to a past history of suicide attempts. Patients who saw these signs while depressed were also likely to see them when recovered, suggesting that the signs may indicate a "suicidal personality" who may or may not be in any immediate danger of committing suicide.     

Sequences of staff-child interactions on a psychiatric inpatient unit

Six psychiatry inpatients were observed during mealtimes to determine and evaluate staff intervention techniques. To extend and further elaborate the findings of a previous work (Pines, Kupst, Natta, & Schulman, 1985), staff behaviors (positive, punitive, isolating, and neutral) were investigated for their potential relationship to subsequent child behaviors (positive, negative, and inactive) via a lag sequential analytic approach. Staff punitive and isolating behaviors tended to be associated with significant increases in the likelihood of subsequent child negative behaviors and with significant decreases in child positive behaviors. Staff positive behaviors tended not to be related to a subsequent increase or decrease in any of the coded child behaviors. Findings demonstrate the utility of assessing conditional probabilities of sequences of staff-child behaviors in psychiatric inpatients.     

The concurrent validity of child Rorschach interpretations

Rorschach records were obtained by 10 examiners from 59 preschool children. These records were reliably scored and interpreted. Interpretation consisted of preparing a list of Rorschach concepts for each child. An additional number of Rorschach concepts of equal frequency in this sample were added to each child's list of concepts. Half of the concepts on each child's list were checked for agreement by school personnel. The children were described with consistency across judges and over time by the same judges. The school personnel were able to differentiate concepts that described each child from nonrelevant concepts. The Rorschach concepts provided data that was validated by teacher perception of these children. This methodology for Rorschach validation makes use of interpretive concepts derived directly from data rather than from reports.     

Conversational skills training with a chronically hospitalized psychiatric inpatient

While conversational skills training has been conducted with select psychiatric populations, it has rarely been used with severely debilitated inpatients. The purpose of this study was to use a multiple baseline design across conversational components to evaluate the effectiveness of a conversational skills training package to enhance the conversational repertoire of a severely impaired inpatient. Audiotaped conversations with a standard confederate were evaluated for the frequency of questions, self-disclosures, and reinforcing/acknowledging comments. Generalization probe conversations to novel partners were also obtained. Training effects were noted for the 3 conversational units. Mixed results were obtained for generalization and follow-up.     

The Rorschach Comprehensive System Egocentricity Index in psychiatric inpatients

This paper reports an exploratory study of potential correlates of Exner's Rorschach Egocentricity Index, a measure of self-focusing, in a sample of 70 psychiatric inpatients. We examined the relationship of the Index of the MMPI Ego Strength scale and to other MMPI and Exner Comprehensive System Rorschach variables, using Pearson Product-Moment correlations with partialling of the number of Rorschach responses. There were seven meaningful significant correlations between the Index and Rorschach variables: M, FM, X +%, F +%, Lambda, D, and A%. The Index-MMPI correlations were not significant. Sex differences and differences between these intercorrelations and some reported by Exner (1983) are discussed.     

Distribution of DSM-II diagnoses in a child psychiatric setting

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.The authors are indebted to James H. Johnson for his valuable contributions in all phases of this study and to Peggy Louro for her assistance in data collection.     

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric inpatients

This study tested the hypothesis that the Last-Weiss (Last & Weiss, 1976) Rorschach Ego-Strength Scale would predict outcome among a representative sample of first-lifetime psychiatric admissions. One hundred seventeen patients were assessed with structured symptom, psychiatric history, and social data interviews at hospital admission, and 2-year follow-up. Outcome measures included a multidimensional variable involving rehospitalization time, social and work functioning, and recent symptom level and symptom measures. Unexpectedly, the Last-Weiss Sum E variable correlated significantly with negative multidimensional outcome, a result that was strengthened when any possibly confounding effects of social class, IQ, and number of Rorschach responses were partialled out. It was found that Sum E's predictive value for poorer outcome was due to the space response (S+) component of the ego-strength variable. Possible explanations of the findings and implications for the previously validated Klopfer's Rorschach Prognostic Rating Scale are discussed.     

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.     

Rorschach personality predictors of weight loss with behavior modification in obesity treatment

Weight loss outcome for 49 obese patients after 6 months treatment in a behavior modification program was related to Rorschach personality characteristics according to the Comprehensive System (Exner, 2003), also including the Rorschach Oral Dependency Scale (Bornstein, 1996; Masling & Rabie, 1967). Less weight loss was predicted by signs of perceptual and cognitive distortions indicated by the Schizophrenia Index. More weight loss was predicted by Food Contents, suggesting a food preoccupation and possibly a benign dependency orientation. Patients with a focus on food and dependent needs could benefit above all from the treatment program implying learning how to handle food and eating in a supportive setting, as evidenced by more weight loss. Distortions in perception and cognition could constitute more profound difficulties in weight reduction important to recognize in obesity treatment.     

Letter-writing practices in a child and family service

This study examined the letter-writing practices in a child and family psychology service. Utilizing a grounded theory approach to data collection and analysis, six clinical psychologists (including one pilot study) were interviewed about their letter-writing practices in relation to direct clinical work and in correspondence with other professionals. Analysis of the data yielded five themes: typical practices, use of clinical and micro skills, letters addressing the relationship with the family, messages to other professionals, and beliefs about the family. Findings suggest that letters are used in a variety of ways including being an aide-mémoire of the contents of face-to-face meetings, directly addressing the therapeutic relationship with the client, demonstrating respect, and informing other professionals of psychological practices and views regarding clients and their presenting problems. It emerged that letter-writing is seen to exist in the wider context of social relationships, between the referrer, clinician and client. The results are discussed in relation to clinical practices and future areas of study.