The status of the Rorschach in clinical and forensic practice: an official statement by the Board of Trustees of the Society for Personality Assessment

Can the Rorschach be Administered Remotely? A Review of Options and a Pilot Study Using a Newly Developed R-PAS App

The ongoing COVID-19 pandemic has required psychologists to adopt measures like physical distancing and mask wearing, though other safety procedures such as travel restrictions or prohibitions on in-person practice and research have fostered the use of tele-health tools. In this article, we review options for using the Rorschach task via videoconference and provide preliminary data from using a new electronic app for remote R-PAS administration to determine whether the remote administration in an electronic form yields different information than in-person administration with the cards in hand. As a pilot study, our focus is on the "first factor" of all Rorschach scores, i.e., complexity. Data were collected from 60 adult Italian community volunteers, and statistical analyses evaluated the extent to which the average complexity score significantly departed from R-PAS normative expectations (SS = 100), accompanied by Bayesian likelihoods for supporting the null hypothesis. Results suggest that the general level of complexity shown by the test-takers when administered the Rorschach remotely with the new R-PAS app closely resembles that previously observed using "standard" in-person procedures. Tentative analyses of other R-PAS scores suggested normative departures that could be due to the effects of the app, testing at home, or responses to the pandemic. We offer recommendations for future research and discuss practical implications.

Factors associated with utilization of emotion and personality instruments among neuropsychologists

Historically, assessment of emotion and personality functioning was not emphasized by clinical neuropsychologists, who instead focused almost exclusively on the evaluation of cognitive functioning. This study examined current practices regarding clinical neuropsychologists' usage of instruments for assessing emotion and personality, along with factors that may mediate their choice of measures and their beliefs about evaluating emotion and personality. Participants were 117 board-certified neuropsychologists as recognized by the American Board of Professional Psychology (ABPP-CN), many of whom had been practicing for over 20 years (39%). Participants generally indicated that examining emotion and personality is essential to evaluations. There was variability among participants as to whether assessment of emotion and personality functioning is challenging, as well as whether or not clinical interview was better suited than instruments. Patients' lack of self-awareness, purposeful over- and under-exaggeration, and lack of sensitivity and specificity of the assessment instruments for neurologic disorders/conditions were identified as the greatest challenges in this area of assessment. Results of the survey suggest that further advancement in the construction and availability of emotion/personality instruments is necessary.

Relationships Between Personality Features and the Rubber Hand Illusion: An Exploratory Study

The rubber hand illusion paradigm allows investigating human body ownership by inducing an illusion of owning a life-sized fake hand. Despite the wide consensus on the fact that integration of multisensory signals is the main interpretative framework of the rubber hand illusion, increasing amount of data show that additional factors might contribute to the emergence of the illusion and, in turn, explain the strong inter-individual differences of the illusory patterns. Here, we explored whether and how personality features contribute to the emergence of the illusion by administering to healthy participants the rubber hand illusion paradigm along with two well-known personality tests, i.e., the Personality Assessment Inventory (PAI) and the Rorschach test. Results showed that two Rorschach domains (i.e., "Perception and Thinking Problems" and "Self and Other Representation") were positively correlated with the illusory mislocalization of the own left hand toward the fake hand. Further analyses suggested that while the tendency to perceive unconventionally is related to mislocalizing the own hand toward the fake hand, the association of the RHI index and other personality features measured by the Rorschach remain uncertain. However, our findings in general suggest that personality features might have a role in the emergence of the rubber hand illusion. This, in turn, could explain the high inter-individual variability of the illusory effects.

A clinical guide to assessing level of ego development using psychological testing

This article presents a clinical guide for relating psychological test findings from the Minnesota Multiphasic Personality Inventory-2 and Rorschach Technique to various levels of ego development. The original three validity and 10 clinical scales from the MMPI and a selected group of traditional determinants from the Rorschach are employed. Expected testing results from these instruments are derived from both the authors' clinical experience and the research literature. These results are presented along a continuum of nine levels of ego development and their associated disorders. The nine levels of ego development are "normal" neurotic, neurotic trait, and neurotic symptom organization; high-, mid-, and low-level borderline organization; and affective, cognitive-affective, and cognitive psychotic organization. The relationships between typical testing responses and indices of personality functioning at each level of ego development would hopefully facilitate accurate diagnosis, which in turn would result in more effective treatment planning.

Human Movement Responses to the Rorschach and Mirroring Activity: An fMRI Study

It has been suggested that the Rorschach human movement (M) response could be associated with an embodied simulation mechanism mediated by the mirror neuron system (MNS). To date, evidence for this hypothesis comes from two electroencephalogram studies and one repetitive transcranial magnetic stimulation study. To provide additional data on this topic, the Rorschach was administered during fMRI to a sample of 26 healthy adult volunteers. Activity in MNS-related brain areas temporally associated with M responses was compared with such activity for other, non-M Rorschach responses. Data analyses focused on MNS regions of interest identified by Neurosynth, a web-based platform for large scale, automated meta-analysis of fMRI data. Consistent with the hypothesis that M responses involve embodied simulation and MNS activity, univariate region of interest analyses showed that production of M responses associated with significantly greater activity in MNS-related brain areas when compared with non-M Rorschach responses. This finding is consistent with the traditional interpretation of the M code.

Attachment Style and Internet Addiction: An Online Survey

BACKGROUND

One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction.

OBJECTIVE

The aim of this study was to examine people's tendency toward pathological Internet usage in relation to their attachment style.

METHODS

An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted.

RESULTS

In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style.

CONCLUSIONS

Pathological Internet use was a function of insecure attachment and limited interpersonal relationships.

Training and Consultation in Psychological Assessment With Professional Psychologists: Suggestions for Enhancing the Profession and Individual Practices

Once central to the identity and practice of clinical psychology, psychological assessment (PA) is currently more limited in professional practice and generally less emphasized in graduate training programs than in the past. Performance-based personality tests especially are taught and used less, even though scientific evidence of their utility and validity has never been stronger. We review research on training in PA and discuss challenges that contributed to its decreased popularity. We then review continuing education requirements for ethical practice in PA and recommend that PA should be reconceptualized as a specialty best practiced by psychologists who have the resources and time to maintain competency. We offer recommendations about how professional organizations concerned with PA can promote its practice and how individual expert clinicians can assist. We conclude by describing a collaborative model for providing group consultation in PA to practicing psychologists. If implemented widely, this model could help promote PA and raise its standard of practice.

Application of the Rorschach test in psychological diagnosis of personality disorders

<b>Background</b><br /> The paper presents the authors’ own research, which points to the possibility of applying the Rorschach test in the clinical diagnosis of personality disorders.<br /> <br /> <b>Participants and procedure</b><br /> The clinical research was conducted in the years 2010-2013 in the Neurosis Treatment Center and in the Mental Health Outpatient Clinic. The study population comprised individuals with a medical diagnosis of neurotic personality organization as well as patients with more severely disorganized personality structure. The research participants had never undergone psychological evaluation for personality disorders (for instance, they had never taken the Rorschach test), and therefore it seemed rather difficult to verify the accuracy of the medical diagnoses which they had received, concerning the level of personality destabilization. Eighty Polish individuals participated in the research. The study population comprised 38 males (47.50%) and 42 females (52.50%). The mean age of women was 30.40 (SD = 7.67). The men’s mean age was 35.10 (SD = 8.73). The examined females were somewhat younger than the male subjects. Methods: Rorschach test, clinical interview.<br /> <b>Results</b><br /> The statistical procedures applied in the present study allowed us to conduct empirical examination of the indicators of the investigated variables constituting the major psychological criteria for describing psychological functioning of personality, and thus to identify the main characteristics of neurotic as well as borderline level of personality organization. Analysis of the data obtained as a result of this research allowed us to distinguish two significantly different clusters in the group of 80 examined individuals.<br /> <br /> <b>Conclusions</b><br /> The results of the present investigation indicate that despite the fact that the examined individuals displayed symptoms of different medical diagnoses (F40 and F60), the subjects comprising cluster 1 exhibited a higher level of personality structure compared with the study participants belonging to cluster 2.

Suppression of aggressive rorschach responses among violent offenders and nonoffenders

This Rorschach study explored the suppression of aggression content when violent offenders and nonoffenders are asked to present themselves as not posing a threat of dangerousness in a court role-playing context. Aggressive content and complexity in this suppressive role-play context was compared to a neutral control condition. A total of 41 participants, approximately half violent offenders and half nonoffenders took the Rorschach under both conditions. Results indicate that both groups suppressed aggression content on the Rorschach without altering response complexity. This large effect size for testing condition may partly explain the inconsistencies across previous studies. It is possible that violent offenders have typically been tested in highly suppressive conditions whereas nonoffender or normative groups may have been tested in relatively low suppression conditions. If so, aggression score differences may be a reflection of the testing condition, not group differences. Both instructional sets produced similar levels of complexity, so that individuals do not simplify responses when they screen out aggressive attributions. Violent offenders did not differ from nonviolent offenders in terms of aggression content, but did produce more simplistic records. In addition, this study also undertook a semantic, textual analysis and found that individuals in the suppressive condition tended to eliminate many response elaborations, particularly those with negative of threatening connotations.

Challenges since Wikipedia: the availability of Rorschach information online and internet users' reactions to online media coverage of the Rorschach-Wikipedia debate

We conducted 2 studies to assess the availability of Rorschach information online and Internet users' attitudes since the inkblots were published on Wikipedia. In the first study, the authors conducted 2 Google searches for Web sites containing Rorschach-related information. The top 88 results were classified by level of threat to test security; 19% posed a direct threat. The authors also found Web sites authored by psychologists that divulged sensitive Rorschach information. In the second study, 588 comments to online news stories covering the Rorschach-Wikipedia debate were coded as expressing favorable or unfavorable opinions regarding the field of psychology, psychologists, and the Rorschach. Eight percent of comments described unfavorable opinions toward psychology, 15% contained unfavorable opinions toward psychologists, and 35% portrayed unfavorable opinions of the Rorschach. Common themes and popular misconceptions of the Rorschach contained in these comments are described. Implications and recommendations for practice are discussed. Limitations, including the second study's narrow sample and self-selection bias, are also detailed.

A comparison of rape and molest offenders in prison psychiatric treatment

Differences in offense history, brain functioning, and psychological functioning of rape (n = 45) and molest offenders (n = 15) who were receiving psychiatric treatment while in prison were evaluated. Significant differences were found in each of these domains. Rape offenders were more likely to have histories of high violence offenses other than sexual offense, including murder, serious juvenile offenses, and both juvenile and adult sexual offenses. Rape offenders were more likely to show lower intellectual functioning and diffuse brain dysfunction associated predominantly with temporal and prefrontal brain cortices. Rape offenders were also more likely to display psychological functioning associated with illogical thinking and disordered attachment but less immature self-focus and fewer feelings of alienation than demonstrated by molest offenders. Implications for treatment and social policy for sexual offenders are suggested. Logistic regression demonstrated that these neuropsychological measures resulted in 71.7% accurate prediction and Rorschach measures resulted in 79.2% accurate prediction in differentiating rape from molest offenders. Implications for theoretical understanding of sexual offending are discussed.

Invited commentary: applying psychodynamic developmental assessment to explore mental functioning in adolescents

Recent publications in the Journal of Youth and Adolescence present a variety of topics exploring adolescents' mental functioning in the twenty first century. Conceptually, many of the articles address the intriguing, though rarely explicit, question of developmental continuities and change from adolescence to adulthood. Such investigations, which are particularly prominent in articles that discuss personality dispositions such as impulsivity or lack of empathy and their relationship to emotionally disturbed or maladaptive interpersonal behaviors, examine interactional effects of these dispositions within the personality-context matrix. From a methodological perspective, however, the major tools used for assessing personality dispositions are self-report inventories while performance-based methods, previously defined as projective tests, are not used at all despite the wide range of empirical studies that provide support for their psychometric properties. This commentary suggests that applying a theoretically based, multi-method assessment procedure in empirical research would be most fruitful for any study aimed at exploring mental functioning in adolescents. As an example, I would use the Rorschach Inkblot Method, currently being internationally considered as the most frequently applied personality test for assessing adolescents. Implications for research, practice and policy decision-making are discussed.

Personality characteristics of multiple sclerosis patients: a Rorschach investigation

OBJECTIVE

There are many studies examining cognitive deficits in patients with multiple sclerosis (MS), while significantly less attention has been given to emotional and personality changes. A chronic neurological disorder brings many life stresses and affects the patient's ability to cope with them. This study explored the personality characteristics in a sample of MS patients.

METHODS

51 MS patients (13 male and 38 female, mean age: 42.6 years, mean EDSS: 3.2). All participants were administered the Rorschach Test coded by the Comprehensive System.

RESULTS

Our findings show that the patients in our sample perceive themselves as being less competent than others, at some cost to their self-esteem. A large percentage relies on an avoidant style of coping with problems.

CONCLUSION

These findings imply that MS patients might have special needs in terms of communication with healthcare providers, decision making and adherence to their treatment plans because of their simplifying style of information processing. We argue that it is important to consider personality as well as cognitive changes in neurological disorders such as MS.

Clinical observation of 12 farmers who believe themselves to have suffered from chronic pesticide intoxication

BACKGROUND/AIM

We assessed twelve cases of suspected chronic pesticide intoxication, with medically unexplained physical symptoms.

METHODS

Complete blood cell count (CBC), blood chemistry, routine urinalysis, chest X-ray, ECG, gastrofiberscopy, abdominal ultrasonography, neuroselective sensory nerve conduction threshold, and psychological assessment were performed on 12 farmers who believe themselves to have suffered from chronic pesticide intoxication.

RESULTS

No specific abnormalities were observed on CBC, routine urinalysis, chest X-ray, ECG, gastroscopy, abdominal ultrasonography, or peripheral nerve conduction velocity test. They persistently manifested helplessness, depression, and anxiety. The results of both psychological assessment and general physical examination revealed the following clinical features: depression (8 cases), multiple chemical hypersensitivity syndrome (2 cases), alcoholism (1 case), and religious preoccupation (1 case).

CONCLUSION

In those living in the western rural area of South Korea, depression is a prominent ongoing presentation in pesticide-exposed farmers, in addition to unexplainable physical symptoms.

Personality Assessment in Today's Health Care Environment: Therapeutic Alliance and Patient Satisfaction

This article addresses the role of personality assessment-specifically the Rorschach (Exner, 2002)-]in the context of the health care industry's increased focus on patient satisfaction. When providing psychotherapy, a challenge to providing patient-centered care turns on understanding and acting on the key aspects of the patient's personality that are crucial to forming an effective alliance. This article includes a description and examples of how personality assessment can enhance therapists' understanding of the ideational, affective, and self-control aspects of complicated patients' problem-solving styles. This enhanced understanding in turn can lead to improved therapeutic alliance between therapists and patients and to increased patient satisfaction with their care. How to provide feedback to the therapist also is addressed.

Thought disorder in euthymic bipolar patients: a possible endophenotype of bipolar affective disorder?

The search for psychological markers or for psychological endophenotypes for bipolar affective disorder has been frustrating, and the study of neuropsychological and neurocognitive functioning may be useful in this search. This article presents the results of a study comparing Rorschach protocols from a sample of adult euthymic bipolar patients (N = 18) and matched healthy controls (N = 8). Bipolar patients showed a higher proportion of immature responses and more instances of thought disorder; patients also showed significantly more severe thought disorder. These findings are discussed in the context of 2 related previous studies. We suggest that our modest series of studies using the Rorschach Inkblot Test provides preliminary evidence that certain variables-especially the measures of thought disorder but possibly also the lack of emotional responses under cognitive "control" and the excessive proportion of immature content responses-may represent a possible endophenotype of bipolar disorder.

Pesticide-initiated idiopathic environmental intolerance in South Korean farmers

This study was designed to study patients with intolerance to pesticide smells. Ten subjects chosen were complaining of vague symptoms such as headache, dizziness, fatigue, nausea, vomiting, abdominal pain, myalgia, flu-like symptoms, etc., whenever exposed to the pesticide smells even at low intensity. To determine whether the etiology of this kind of pesticide hypersensitivity was of organic or psychiatric nature, all the subjects underwent tests as follows: complete blood cell count, urinalysis, and blood chemistry as routine tests; esophogastroduodenoscopy and abdomen ultrasonography for the gastrointestinal symptoms; chest x-ray, pulmonary function tests, and electrocardiography for the respiratory and/or cardiac symptoms; nerve conduction velocity and brain magnetic resonance imaging (MRI) for peripheral and central nerve system symptoms; and K-WAIS, Rey-Kim memory test, Rorschach, Mini Mental State Examination (MMSE), and Minnesota Multiphasic Personality Inventory (MMPI) for psychoanalysis. Of the 10 cases in which the chief complaint was headache, symptoms of two cases were caused by maxillary sinusitis. Another two showed typical multiple chemical sensitivity (MCS) or idiopathic environmental intolerance (IEI). Six out of the 10 cases, whose symptoms closely resembled the others, did not conclusively meet the criteria of classic MCS or IEI. The subjects of this case shared vague fears, both fear of pesticides and hypochondriasis. Some subjects faced financial insecurity and social uncertainty; others felt uneasy about the future of their farming life. Thus, to help verify the causes of MCS or IEI, which is strongly suggestive of pesticide smells, diagnosis needs a dual approach: on the anima and soma. Psychoanalysis can delve into the mental status of the patients to see whether the patients are aware of their symptoms. Clinical tests can see through the physical structure and functions of the organs on which patients' complaints are centered.

Performance-Based Assessment in Schools

This article addresses a 2006 article by Hojnoski, Morrison, Brown, and Matthews on the use of performance-based measurement among school-based practitioners. Their results suggest that many of their survey respondents favor the use of this form of measurement. This line of research is important and addresses an important issue in current clinical practice. However, they offer a critique of this form of assessment, in response to which the author raises four issues. First, there is a difference between tests and techniques. Second, assessment tools do not make decisions or diagnoses; clinicians do. Third, actuarial prediction and clinical expertise are mutually enhancing. Last, the relationship between science and practice should be bidirectional and integrative. These points are discussed in terms of the utility and appropriateness of performance-based measurement tools and techniques for helping psychologists answer diagnostic, placement, and treatment questions in the school setting.

When a Psychometric Advance Falls in the Forest

Borsboom (2006) attacks psychologists for failing to incorporate psychometric advances in their work, discusses factors that contribute to this regrettable situation, and offers suggestions for ameliorating it. This commentary applauds Borsboom for calling the field to task on this issue and notes additional problems in the field regarding measurement that he could add to his critique. It also chastises Borsboom for occasionally being unnecessarily perjorative in his critique, noting that negative rhetoric is unlikely to make converts of offenders. Finally, it exhorts psychometricians to make their work more accessible and points to Borsboom, Mellenbergh, and Van Heerden (2003) as an excellent example of how this can be done.