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.     

Concepts of Development and the Rorschach: The Contributions of Paul Lerner and John Exner in Historical Context

The Rorschach Test has been approached from 3 fundamentally different developmental perspectives: those growing out of the empiricist tradition, psychoanalysis, and the developmental psychologies of Piaget and Werner. In this article, I highlight the distinctive characteristics of each perspective, explore how they have shaped approaches to Rorschach theory and practice, and examine the contributions of Paul Lerner and John Exner in this context.     

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.     

The susceptibility of the Rorschach to malingering: a critical review

Empirical studies of malingering on the Rorschach are reviewed. Results from these studies are to this point inconsistent and inconclusive. Although several indices are related to malingering in individual studies, no specific malingering pattern has been found that replicates across studies. A methodological problem specific to this literature is discussed and future research designs are recommended.     

The role of verbalization in the Rorschach response process: a review

Traditional Rorschach theory has consistently overlooked the linguistic aspect of the response process. Most conceptualizations focus on the perceptual and cognitive aspects of the process, never examining the subject's need to find a linguistic representation for the inner, perceptual process. This review examines the traditional formulations and suggests that new research from information-processing, neuropsychological, and dual-coding memory theory paradigms offer new possibilities for Rorschach research that would incorporate an appreciation of the unique cognitive demand of the test--the linking of percept with language.     

Rorschach assessment of primitive defenses: a review

The Lerner & Lerner Scale for assessing primitive defenses is reviewed. According to its conceptual roots, initial studies assessed the scale's efficacy in distinguishing groups of borderline patients from groups of other diagnostic entities. Later studies extended the use of the scale to assess various clinical groups assumed to have a borderline personality structure. Results from several studies indicate a high level of reliability as judged by degree of interrater agreement. In a host of studies, the scale was found to be valid in distinguishing borderline patients from other types of patients, eating disordered patients from normal controls, and gender disturbed children from normal controls. Another Rorschach scale for assessing primitive defenses was also reviewed and compared.     

The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index: a review

This review focuses on the diagnostic efficiency of the new versions of the Rorschach Comprehensive System Depression Index (DEPI) and the Schizophrenia Index (SCZI). Clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders was chosen as the external validation criteria. The sensitivity, specificity, and overall classification rates for the indices were presented from the studies or computed from the data when possible. The positive and negative predictive validity was estimated at three different base rates. As regards the DEPI the results showed a large variation in diagnostic performance as the index seemed to have relatively more success in identifying nonpsychotic and unipolar depression than psychotic and bipolar depression. The DEPI did not successfully identify depression among adolescent patients. As regards the SCZI the results more consistently indicated that the index effectively discriminates between psychotic and nonpsychotic patients and the predictive validity of both a positive and negative SCZI was found to be high.     

The uncertainty of it all

The amygdala is clearly implicated in the processing of biologically relevant stimuli, particularly those that can lead to a state of fear. A new study by Herry, Bach and colleagues using both mouse and human subjects seemingly throws a wrench in the spokes by demonstrating that the amygdala is sensitive to non-biologically relevant stimuli (i.e. tones) when they occur in an unpredictable fashion. The implications of this finding for understanding the role of the amygdala in vigilance, threat assessment and anxiety are considered here.     

Temporal stability in the Rorschach method: a meta-analytic review

The temporal stabilities of the Rorschach method scoring systems were investigated. A comprehensive literature search was conducted to find all test-retest studies, both regular and from control samples in therapy evaluation studies. Meta-analyses were conducted for samples, individual entries, and variables in 36 samples. Separate analyses were made for 10 samples using the Comprehensive System (CS; Exner, 1993). The temporal stability was high, especially those obtained from regression model predictions. The CS consistently shows higher stability than other systems, whereas increasing retest intervals leads to decreasing stability. Shortcomings of the available studies are highlighted and discussed, and recommendations are given for design and methodology.     

Piotrowski's enduring contributions to the Rorschach: a review of Perceptanalysis

Zygmunt A. Piotrowski (1904-1985), one of the early pioneers with the Rorschach technique, developed a method for Rorschach analysis described in the text, Perceptanalysis. Based on clinical, teaching, research, and supervisory experiences, the author selected three aspects of the text for review for their enduring contributions to clinical personality analysis. The three areas are: (a) the scientific and philosophical framework of the system; (b) the Human Movement response, M; and (c) the shading responses--light shading, c'R, and dark shading, c'R. The reader is also introduced to other works by Piotrowski, including scales for cerebral dysfunction and schizophrenia.     

Construct validation of scales derived from the Rorschach method: a review of issues and introduction to the Rorschach rating scale

I suggest the main goal of Rorschach validation should be a refined understanding of what each score means. Toward this end, I review general issues in construct validity, hurdles unique to the Rorschach, and general limitations with validation criteria. I then recommend two approaches for improving criteria so they can begin approximating the gold standards that are necessary for a refined understanding of what scores actually measure. The first is a method for improving expert clinical judgment, and the second is a method for aggregating data across diverse judges. Finally, the Rorschach Rating Scale (RRS) is presented as a criterion tool to be used with either of these approaches to validation. The RRS is a fairly comprehensive summary of the constructs thought to be measured by various Rorschach scoring systems. The utility of the RRS for research and training are discussed, as are other practical, theoretical, and psychometric issues in its application.     

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 injustice of it all: caring for the chronically ill

...While Spiegelberg emphasizes these "cosmic" -- perhaps more accurately, ontological -- features of birth and undeserved inequalities, it seems to us not inappropriate to suggest that what Douard terms "outrage" and Annas "instinct" go in the same direction. When impairment occurs without desert, something should be done to help. This is all the more true when, as in cases of chronic affliction that concern Douard or the case of the Siamese twins that fascinates Annas, something helpful can be done. Then, in Spiegelberg's words, what is "undeserved" demands redress. In these terms, each of these authors points to a deeply rooted sense of our common human lot. Or, in Albert Schweitzer's apt phrase, to witness such undeserved misfortune is to awaken "a moral sense that is usually dormant but that on special occasions can be brought to the surface." Chronic illnesses, we suggest -- no less than the "accidents of birth" that concern Spiegelberg -- are just such "special occasions" for awakening that "moral sense" suggested by Douard in his appeal to the "outrage" of doing nothing for, or refusing to help, the chronically ill.     

Scoring the Rorschach: a constructive critique of Exner's Comprehensive Rorschach System

John Exner's rationale for scoring the Rorschach and his decision to score "blend" responses by assigning equal weights are critically reviewed. The resultant exclusion of new responses made during the Inquiry of the Free Association responses is viewed as a major deficiency in the Comprehensive Rorschach System. A change to Klopfer's "Main-Additional" scoring method is recommended as a corrective.     

The architect as person: a Rorschach image

Analysis of the Rorschachs of 40 eminent male architects collected in 1959 revealed a highly consistent personality profile. The picture that emerges is of a person who appears to be ambitious, highly sensitive, intellectually and emotionally energetic, and reasonably well adjusted socially. His thinking is well oriented in reality. He prefers large scale conceptualizing to mundane 'concerns. There is evidence of conflict, tension, and a concern with emotional control. Feminine and exhibitionistic interests are exceptionally high and sources of inspiration appear to reside in unresolved sexual conflicts. The attitude toward the world is positive. The eminent male American architect at the turn of the Sixties believed in his own ability to create a truly superior environment. His conscious concerns were with creation rather than with self-confrontation.     

The effect of inquiry on the Exner Comprehensive System

The effect of inquiry on the Comprehensive System was tested by scoring 130 protocols of patients and normals with and without inquiry. The absence of inquiry significantly reduced the means for Developmental Quality-vague (DQv), Form Quality-unusual (FQu), the sum of color responses (SumC), the sum of shading responses (Sum Shading), and the weighted thought disorder measure (W Sum6 SP SC), but significantly increased pure form (F). The effect for W Sum6 SP SC was strongest for schizophrenic protocols. Liberalized scoring rules were established in an attempt to restore the interpretative validity of the scoring categories distorted by the lack of inquiry. The new rules significantly improved the accuracy of color and shading categories, but did not improve the special scores measure of thought disorder.