Rorschach et Psychiatrie : à la découverte du malade derrière la maladie

The Rorschach Comprehensive System is a very powerful tool for understanding the dynamics of psychopathological conditions and describing personality. Recent literature indicates a promising new area of research, that of evaluating psychotherapy processes and outcome. Clinical psychologists can therefore bring a unique and complementary perspective to the traditional psychiatric field by introducing it to proper psychological diagnosis as opposed to psychiatric diagnosis. The validity and reliability of the method having today been well established in the USA, it is incumbent on French researchers and clinicians to verify them locally and eventually make the necessary adaptations.     

Rorschach-profile in panic disorder

The Rorschach test was applied to four groups: 41 Panic Disorder (PD), 14 Major Depression (MD), 11 Generalized Anxiety Disorder (GAD) and 18 normal subjects. The aims were to describe the test profile of PD patients and to discuss implications for cognitive processing ability and personality structure. A hypothesis of a borderline personality structure in PD patients, based on psychodynamic literature, was tested, but was not unambiguously supported. A "loose", borderline-like personality structure and disturbances in processing abilities, however, characterized PD-patients. The normal subjects surprisingly provided many Fabulized Combinations, a response type, considered suspect of borderline pathology, but also showed more signs of integrative and synthesizing abilities than the other groups.     

Assessment of substance abusers on the MCMI-III and the Rorschach

We examined 60 substance abusers (SA) on the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) and on eight Rorschach variables from the Comprehensive System (CS; Exner, 2003). On the MCMI-III, SA scored above the cutoff for clinical significance (M > or = BR 70) on Drug Dependence (94.77), Antisocial (82.95), Depressive (74.33), Self-Defeating (71.48), and Alcohol Dependence (70.70). On seven of the CS variables (M+,o,u, XA%, X-%, WSum6Lv2%, M-%, SumT%, and Pure H%) the scores of the SAs suggested significant more psychopathology compared to the scores of 60 university students, whereas the SA's scores on six of these variables (M+,o,u, XA%, X-%, WSum6Lv2%, SumT%, and Pure H%) suggested significantly less psychopathology compared to the scores of 36 schizophrenics. The effect sizes for the significant differences were in the small, medium and large range (d= 0.31 to d= 1.87).     

Aggressive content and related defenses in Rorschach responses of children ages 6–14

The aim of this study was to test the psychoanalytic notion that there is a gradual progression with age from primary to secondary process thinking. Three cohorts of children, age 6, 9, and 12, were administered the Rorschach procedure at yearly intervals—twice for the oldest cohort and three times for the two younger ones. No support was found for the developmental hypothesis in terms of aggressive content of the responses and the related defenses. The expectation of more aggressive content at earlier ages, as a reflection of more primitive aggressive drives, was not confirmed.     

Suicide Signs on the Rorschach

This paper reviews the literature concerning the assessment of suicide using the Rorschach and updates the important developments since Goldfried, Stricker, and Weiner's comprehensive review of the literature in 1971. Special attention is given to those indicators which show the most support in the literature and are most efficient to use. The presence or absence of any of these signs in a patient's record should not be taken to signify the presence or absence of suicidal ideation. However, the presence of even one of these indicators does provide a warning to the clinician, indicating that further exploration in this area may be warranted. Knowledge of the many suicidal indicators on projective tests places the clinician in a better position to predict such destructive behavior and intervene appropriately.     

Rorschach interrater agreement estimates: An empirical evaluation

A standardized estimation of Rorschach interrater agreement is needed. Percentage agreement, although widely used, is found to be unsuitable. Forty-one protocols from adults in both a normal and a psychiatric sample were scored by two or three scorers, making 85 scoring pairs. Percentage agreement, correlations (phi and Pearson's r ), and kappa were computed on single response, total score, and category level. Percentage agreement shows minimal variation. Even when exceeding 0.80, it can obscure major disagreements. Kappa and correlations both vary in a similar way with level of disagreement. Total score level does not give additional information compared to single score and category levels. Kappa proved to be conservative and reliable and is therefore suggested as a standard estimate.     

Période périnatale et Rorschach : normes,indicateurs, mentalisation et perspectives théorico-cliniques

ObjectiveThe perinatal period is a maturation phase characterised by the appearance of a radical psychological and identity crisis, little studied by projective methods, in particular the Rorschach inkblot test. The objective of this article is to offer a list of Rorschach norms and indicators adapted to the perinatal population. This is to comprehend the psychological modifications occurring during pregnancy.Materials and methodThe projective Rorschach inkblot test was presented to a representative sample of 54 pregnant primiparous French women. Based on the scoring and analysis methods of the Parisian School, the quantitative norms from the analysis of the psychogram, the chosen cards, and the mentalization indicators were compared to those of the general population.ResultsWith the exception of F +% and H%, all the normative data for the perinatal population are significantly different from those related to the general population (p .005). On a qualitative level, the interpretation of the data highlights the presence of major inhibition mechanisms, associated with a preconscious functioning stasis.ConclusionThe normative data in Rorschach of the perinatal population should be specifically used for the study and psychological support devoted to this population. It also allows a better understanding of the feminine psychologic modifications during pregnancy.     

Rorschach administration: a comparison of the effect of two instructions given to an inpatient sample of drug addicts

The effect of administering the Rorschach Inkblot Method under two instructional sets was compared on three classes of outcome variables: the frequency with which subjects asked questions about the test; the frequency of brief protocols (fewer than 14 responses); and 17 traditional Rorschach structural summary scores. Sixty subjects, obtained from three inpatient psychiatric clinics treating drug addicts, randomly received either the short pre‐testing instruction “What might this be?” originally developed by Herman Rorschach and recommended in the Comprehensive System, or a longer and more elaborated instruction, which for many years has been the standard instruction in Norway. Compared with the Norwegian instruction, the short instruction produced significantly more questions to the examiner about the test. For the other outcome measures no differences were observed.     

Disponibilité à la psychothérapie et à l’engagement dans les soins chez les patientes boulimiques : contribution du Rorschach

The instability of involvement in the care process and psychotherapy is frequent among bulimic women. The preliminary evaluation of the capacity of involvement helps to make the decision to begin specific care with these patients. We thus make the assumption that involvement in the care process can express itself in indexes of Rorschach when this test is part of a prior examination of orientation at the beginning of the care. These indexes concern the relationship dependence and the capacity of development of subjective expression. They appear in several analysis registers of the Rorschach protocol, which are: the scale of oral dependence (ROD); the index of expressive capacity (EX); the recurring object (ORec); contents in connection with the representation of dependence among bulimic women. A group of 34 bulimic women involved in multifocal care process, especially including a psychoanalytical-inspired psychotherapy (ES) is compared with a group of 34 bulimic women who precociously stopped this care or didn’t get involved in it (NES). The subjects of the ES group received care during at least 1 year. The comparison between the two groups shows significant differences in the pretherapeutic indexes (ROD, ORec). The interest and the limits of this type of analysis are debated.