Interobserver agreement, intraobserver reliability, and the Rorschach Comprehensive System

Interrater agreement and reliability for the Rorschach have recently come under increasing scrutiny. This is the second report examining methods of Comprehensive System reliability using principles derived from observational methodology and applied behavioral analysis. This study examined a previous nonpatient sample of 20 protocols (N = 412 responses) and also examined a new clinical sample of 20 protocols (N = 374 responses) diagnosed with Research Diagnostic Criteria. Reliability was analyzed at multiple levels of Comprehensive System data, including response-level individual codes and coding decisions and ratios, percentages, and derivations from the Structural Summary. With a number of exceptions, most Comprehensive System codes, coding decisions, and summary scores yield acceptable, and in many instances excellent, levels of reliability. Limitations arising from the nature of Rorschach data and Comprehensive System coding criteria are discussed.

Behavioral science foundations of the Rorschach test: research and clinical applications

Never without its critics, the Rorschach Test continues to be widely used in clinical settings. The test continues to be criticized vigorously. Rorschach critics appear to fall into two broad groups: those leveling valid methodological concerns about the test s behavioral science foundations and method critics who appear to deny the validity of the test on strictly a priori or theoretical considerations. Many critics do not appear to be acquainted with the extensive Rorschach research literature. The current paper provides an overview of several domains of applied and laboratory Rorschach behavioral science, including statistical power analysis, interobserver agreement and interrater reliability, Rorschach assessment of thought disorder, and emerging research linking Rorschach variables with diagnostic criteria from the DSM-IV, as a means of educating both adherents and detractors alike concerning the test s scientific track record and applicability to clinical assessment.

Contributions of Cognitive Science to the Rorschach Technique: Cognitive and Neuropsychological Correlates of the Response Process

This article presents an understanding of the Rorschach Technique in terms of emergent models from cognitive science. We propose a linkage between cognitive psychology and neuropsychology in understanding the operations that underlie the Rorschach response process. Contemporary information processing models are described. The Rorschach Technique is conceived of as a complex process involving all areas of the cerebral hemispheres, encompassing various aspects of visual attention and perception, object recognition, associative memory, language production, and executive functioning. Exner's model of the response process is delineated, including both Association and Inquiry phases, in terms of requisite underlying neuropsychological abilities and anatomical substrates. The question of the Rorschach Technique's status, utility, and potential as a neuropsychological assessment, tool is discussed. Understanding the Rorschach in terms of contemporary cognitive psychological and neuropsychological models heightens appreciation of the technique's complexity and provides a heuristic and conceptual foundation for empirical research.

Standardizing procedures for calculating rorschach interrater reliability: conceptual and empirical foundations

Although the Rorschach test has demonstrated significant refinements in reliability, validity, and statistical power as a result of the procedural standardization and scoring innovations introduced by Exner's Comprehensive System, the issue of Rorschach interrater reliability remains unexplored. This article examines the psychometric foundations of Rorschach interrater reliability and applies notions from applied behavioral analysis to the treatment of Rorschach data. We empirically compare 3 methods of quantifying interrater agreement, their accuracy in estimating interrater agreement, and efficiency in reducing error in Rorschach research. Results indicate that the magnitude of differences between methods of quantifying interrater agreement and the associated reductions of error are significant. We propose a standard method for quantifying interrater agreement in Rorschach research.

Rorschach assessment of the borderline child

After nearly two decades of intensive investigation, adult borderline disorders have achieved wide currency, including a substantial psychological literature. The literature on the diagnostic psychological assessment of borderline children is, in contrast, quite sparse. This paper examines manifestations of childhood borderline conditions on the Rorschach, discusses them in light of current theoretical conceptualizations of adult borderline psychopathology, and explores the relationship between child and adult borderline disorders and the genesis of these conditions.

Psychodiagnosis of personality structure. II: Borderline personality organization

The borderline conditions have been the focus of considerable debate and controversy for over 30 years. This article, second in a series of three articles focusing on Kernberg's (1975, 1984) psychostructural diagnosis of personality organization, examines Rorschach contributions to the description and diagnosis of borderline personality organization. Rorschach approaches integrating nomothetic and idiographic data are applied to borderline personality functioning and appraised in light of the Rorschach's contribution to the clarification of the controversial and poorly delineated borderline diagnosis.

Alexithymia in panic disorder and simple phobia: a comparative study

The authors found that 14 (46.7%) of 30 patients with panic disorder had alexithymia, compared with four (12.5%) of 32 patients with simple phobia. Consistent with the conceptualization of alexithymia as a psychological deficit affecting emotion regulation, the patients with panic disorder had significantly less ego strength and independence and significantly higher levels of anxiety and somatic complaints than the patients with simple phobia.

Integrating the Rorschach and the MMPI in clinical assessment: conceptual and methodological issues

The Rorschach and Minnesota Multiphasic Personality Inventory (MMPI) are among the most widely used personality assessment tools. However, there is little guidance in the literature about their combined use. In this article, I discuss conceptual and methodological issue of combining these widely used psychological tests, including the use of the test battery and the necessity of rationales for test utilization. Methodological approaches to integrating the test findings are discussed, including score, construct, test by test, and theory-based integrative approaches. The value of a person-centered interpretive and integrative focus is affirmed.

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.

Statistical Power and the Rorschach: 1975-1991

The Rorschach Inkblot Test has been the source of long-standing controversies as to its nature and its psychometric properties. Consistent with behavioral science research in general, the concept of statistical power has been entirely ignored by Rorschach researchers. The concept of power is introduced and discussed, and a power survey of the Rorschach literature published between 1975 and 1991 in the Journal of Personality Assessment, Journal of Consulting and Clinical Psychology, Journal of Abnormal Psychology, Journal of Clinical Psychology, Journal of Personality, Psychological Bulletin, American Journal of Psychiatry, and Journal of Personality and Social Psychology was undertaken. Power was calculated for 2,300 statistical tests in 158 journal articles. Power to detect small, medium, and large effect sizes was .13, .56, and .85, respectively. Similar to the findings in other power surveys conducted on behavioral science research, we concluded that Rorschach research is underpowered to detect the differences under investigation. This undoubtedly contributes to the inconsistency of research findings which has been a source of controversy and criticism over the decades. It appears that research conducted according to the Comprehensive System for the Rorschach is more powerful. Recommendations are offered for improving power and strengthening the design sensitivity of Rorschach research, including increasing sample sizes, use of parametric statistics, reduction of error variance, more accurate reporting of findings, and editorial policies reflecting concern about the magnitude of relationships beyond an exclusive focus on levels of statistical significance.

Alexithymia and somatic complaints in psychiatric out-patients

This study investigated the prevalence of alexithymia and its relationship with somatic complaints in a sample of 118 general psychiatric out-patients. Of the sample 39.8% scored in the alexithymic range of the Toronto Alexithymia Scale. Compared with the non-alexithymic patients, the alexithymic patients scored significantly higher on several Minnesota Multiphasic Personality Inventory (MMPI) scales that collectively measure a diverse and extensive range of somatic symptoms and bodily concerns. In addition, the alexithymic patients had significantly higher levels of anxiety, depression, and general psychological turmoil. Although the alexithymic and non-alexithymic patients did not differ on the MMPI Repression and overall Hysteria Scales, which reflect the defenses of denial and repression, the alexithymic patients had significantly less ego strength and were significantly more dependent and more likely to engage in impulsive and acting out behaviours. The overall pattern of results is consistent with the view that alexithymic individuals are prone to both 'functional' somatic symptoms and symptoms of emotional turmoil because they are not well equipped psychologically.

Psychodiagnosis of personality structure: psychotic personality organization

Recent developments in Rorschach psychology, including nomothetic approaches focused on scores, ratios, and indices and idiographic approaches focused on content emerging from psychoanalytic theory, offer the Rorschach clinician a rich and potent interpretive methodology. This article examines the structural diagnosis of personality organization with a focus on psychotic personality structure. Rorschach approaches to the differential diagnosis of psychotic personality organization are presented. The Rorschach is viewed as indispensible in the differential diagnosis of personality organization, especially in the so-called "borderline" cases.

Early memories as expressions of relationship paradigms: a preliminary investigation

Earliest childhood memories (EMs) have been utilized as expressions of relationship paradigms, but few empirical studies have been conducted. This study outlines the construction and development of an EM relationship scoring system and scale utilizing nonclinical and clinical samples. It was hypothesized that relationship episodes could be reliably coded using EMs and that they would demonstrate convergent validity with measures of attachment style (Separation-Individuation Test of Adolescence), mood (Profile of Mood States), and clinical symptomatology (Symptom Checklist 90-revised [SCL-90-R] and the Minnesota Multiphasic Personality Inventory [MMPI]). The hypotheses received broad support. Findings indicate that relationship episodes may be reliably coded from EMs. Associations between individual EM variables, the EM relationship scale, and objective measures suggest that the quality of relationships expressed in EMs is associated with degree of general maladjustment. Suggestions for further research are discussed.

Predicting depression using earliest childhood memories

In order to investigate the utility of earliest childhood memories (EMs) in clinical assessment, this study investigated the value of EMs in predicting naturally occurring depressive mood states. Of interest were those features of EMs that discriminate depressed from nondepressed individuals. Subjects were 212 undergraduate volunteers who completed the Beck Depression Inventory, the Profile of Mood States, and a self-administered EM questionnaire. Utilizing thematic predictors derived from cognitive and psychodynamic theories of depression, depressed subjects were differentiated from nondepressed subjects at a rate significantly greater than chance, p less than .001, with a highly respectable estimate of cross-validation shrinkage. The findings demonstrate the phenomenon of mood dependent recall in autobiographical memory, namely, that memory attributes are strongly influenced by current mood state. Consistent with psychodynamic theories of depression and in contrast to cognitive theory, depressive mood states appear to facilitate retrieval of memory schemas involving deprivation and disturbing human interaction. Schemas involving loss of control, failure, or reactions to noncontingent reinforcement (perceptions of the self as agent) appear less salient than relationship schemas (perceptions of the self as related) in depressive experience.

Alexithymia and somatization. A Rorschach study of four psychosomatic groups

The construct of alexithymia has been postulated as a predisposing factor in psychosomatic illness. The alexithymia construct has achieved wide currency in psychosomatic research and theorizing despite its doubtful psychometric foundations. Also, the question of between-group variability in alexithymia has not been addressed. In this study we proposed and tested a Rorschach measure of alexithymia on four groups of psychosomatic patients (back pain, gastrointestinal, dermatology, migraine headache). It was hypothesized that psychosomatic groups would be more alexithymic than nonpatients. To examine the question of between-group variability in alexithymia, it was hypothesized that back pain patients would be more alexithymic than other psychosomatic groups. Both hypotheses were supported. Additionally, exploratory comparisons between psychosomatic groups revealed a number of differences between the groups in basic personality processes. The findings show promise for the use of the Rorschach test as an alexithymia measure. Based on the current study, heterogeneous grouping of psychosomatic patients in research designs and treatment programs appear to be a highly questionable procedure.

Depression, alexithymia, and pain prone disorder: a Rorschach study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.

Adult maturational processes and the facilitating environment

The psychoanalytic theory of religion has been seriously limited in its development, largely owing to Freud's emphasis on religion's neurotic elements and an overemphasis on the infantile origins of religious development. This paper offers a conceptual framework and advances the thesis, based on contemporary psychoanalytic, developmental theory, that 1) Erikson's concept of epigenesis has applicability across the life span; 2) that beyond-the-self identity is constituent to human maturation and self-completion; 3) that successful adult maturation requires a mirroring-facilitating environment; and 4) that religious values, meanings, images, and communities play an essential role-as-elements of the facilitating environment of later life.

The role of religious values in coping with cancer

The relationship between transcendent meaning attribution, religious orientation, and psychological well-being was studied in cancer and noncancer patients to test the hypotheses that intrinsic religious values and life meaning enhance coping and well-being during the course of the life-threatening illness. Subjects were 44 patients receiving medical treatment for cancer and noncancer medical conditions. In the cancer group, higher levels of attributed life meaning were positively linked with intrinsic religious orientation, and associated with lower levels of despiar, anger-hostility, and social isolation. Cancer patients scored higher than noncancer patients on depersonalization, suggesting the presence of psychic numbing in response to their illness. Noncancer group results were characterized by positive correlations between the two groups in coping styles and salience of life meaning attribution. A rationale for the observed differences in coping styles between the two groups is presented, highlighting perceived life threat as a key differentiating variable.