When is the last time you administered a Rorschach?

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Sanman

Sanman

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For all those in practice, I was just curious if you had administered a Rorschach in practice and, if so, how recently. I was recently thinking about the Rorschach and it occurred to me that I have not administered one since grad school and cannot think of single clinician who has outside of a few academics. Yet it was a large chunk of my assessment training. I'm curious if others have used it in practice.
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August 2009. :)
 
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There is a poster here who is in PP for himself who says he uses it. I really dont know why one would torture themselves like that though, even if they did think it was mildly useful on occassion.
 
I have administered it twice throughout my graduate school training, as part of my training. Personally, I don't ever plan on using it when I go into independent practice. I have seen it used when an individual, due to impaired cognition, etc. can't complete an objective measure. Also, I have met a few die hard "Rorschachers" who insist on using it as a standard part of their assessment.
 
Having listened to a talk and read a few articles today, it really makes me wonder if graduate programs are a bit out of date when it comes to teaching skills used in modern clinical practice. Much of the brief therapy skills I utilize regularly, I learned on internship and little exposure to in graduate school. Yet, there are things like the Rorschah that I spent so much time learning (along with the Exner scoring system) that are largely irrelevant. My internship even required the ability to administer and score a Rorschach even though no one did and had not in years. It makes me wonder if the profession as a whole is sometimes too slow to respond to modern healthcare delivery issues.
 
Grad school, where we also reviewed the literature for and against. That lead me to the realization that there are briefer instruments with much better reliability and validity to measure what I need. I think people just use it out of habit and tradition these days.
 
I've referred two clients over the past two years specifically for the Rorschach. I'm not psychodynamic; I think the test can be useful when clients are incapable of verbalizing their thought processes. For both cases, therapy with the clients I referred had grown unproductive because I had no idea what the client was thinking or what lead up to the emotional outbursts they were experiencing. The Rorschach helped to clarify what was happening --e.g. helping to rule out psychosis, highlighting perceptual/cognitive limitations, seeing whether the clients were overly guarded, etc. I certainly don't intend to use the Rorschach all the time, but I don't think it deserves all the scorn newer clinicians tend to give it.
 
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There are far easier and faster ways to rule out psychosis. And there is scant evidence about the usefulness of it to identify cognitive limitations above and beyond categorically, best to use non-verbal neuropsych tests. If it had decent psychometric data, I'd use it. But, at its heart, it's just a really long test of psychosis that overpathologizes a variety of other indicators.
 
 
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WisNeuro said:
There are far easier and faster ways to rule out psychosis. And there is scant evidence about the usefulness of it to identify cognitive limitations above and beyond categorically, best to use non-verbal neuropsych tests. If it had decent psychometric data, I'd use it. But, at its heart, it's just a really long test of psychosis that overpathologizes a variety of other indicators.
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I have long been a skeptic but recently took a training by Erdberg/Viglione on the R-PAS--which builds on but improves/simplifies/provides an evidence base & international norms--so relative to Exner it seems a vast improvement. I can see useful applications when testing with an SMI population (or non-literate). What other non-verbal neuropsych tests do you perfer, WisNeuro? I am interested in trainees gaining proficiency in a set of practical tests that are regularly in use. And apparently there are still many internships that want/prefer Rorschach experience?
 
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docma said:
I have long been a skeptic but recently took a training by Erdberg/Viglione on the R-PAS--which builds on but improves/simplifies/provides an evidence base & international norms--so relative to Exner it seems a vast improvement. I can see useful applications when testing with an SMI population (or non-literate). What other non-verbal neuropsych tests do you perfer, WisNeuro? I am interested in trainees gaining proficiency in a set of practical tests that are regularly in use. And apparently there are still many internships that want/prefer Rorschach experience?
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Depends on the referral question. what are you trying to measure? And honestly, I haven't seen many reputable match internships in npsych that prefer experience in projectives. Many are going the way of empirically supported interventions and assessments, of which many projectives are shaky on at best.
 
WisNeuro said:
There are far easier and faster ways to rule out psychosis.
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WisNeuro, thanks for sharing the articles. I'll read them when I get the chance.

As I've stated before, I'm in the NYC area (where Exner practiced for 20+ years) and Rorschach is typically part of a standard clinical psychological battery at most sites (that my colleagues , supervisors, and I have attended for training and practice.). It is a projective test that should be combined with other psychometric exams,and not taken alone. So Sanman, this thread should be about the utility of all projective tests in general.

I have clinically administered many Rorschachs and the "data," taken as a whole, are quite interesting and coincide with data from WAIS, PAI, MMPI, to give a full and comprehensive snapshot of an individual's functioning and certainly helps to rule out/narrow in on psychosis in an individual. I do not know what other projective tests are comparable...TAT is fine; House-Tree-Person-Kinetic Family is fine (ideal for children), but ROR is certainly unique as KillerDiller notes below.

KillerDiller said:
I think the test can be useful when clients are incapable of verbalizing their thought processes.
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.
 
Just because it's used widely in select geographic areas doesn't mean that it automatically has reliability and validity. Where is the data that it provides significant incremental validity above and beyond the WAIS/PAI/MMPI?
 
Lot of conjecture here: I purposefully never said anything about the validity and reliability of the measure b/c I don't have quick access to that info right now, but I can get back with you about it. I also said nothing about the concurrent validity with the WAIS/PAI/MMPI. I simply pointed out that the ROR adds to comprehensive clinical picture of the patient.

I know NYC is not the epicenter of the world (uh...or is it? ;)It may be for fashion, business, immigration rights, multicultural issues...but not for mainstream psych b/c this geographically local is more psychodynamic than other parts of the U.S., I know.), I merely replied to original question on WHO uses it now.
WisNeuro said:
Just because it's used widely in select geographic areas doesn't mean that it automatically has reliability and validity. Where is the data that it provides significant incremental validity above and beyond the WAIS/PAI/MMPI?
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CheetahGirl said:
Lot of conjecture here: I purposefully never said anything about the validity and reliability of the measure b/c I don't have quick access to that info right now, but I can get back with you about it. I also said nothing about the concurrent validity with the WAIS/PAI/MMPI. I simply pointed out that the ROR adds to comprehensive clinical picture of the patient.

I know NYC is not the epicenter of the world (uh...or is it? ;)It may be for fashion, business, immigration rights, multicultural issues...but not for mainstream psych b/c this geographically local is more psychodynamic than other parts of the U.S., I know.), I merely replied to original question on WHO uses it now.
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Fair enough, I look forward to seeing valid, psychometrically sound data on the use of projective measures in clinical populations.
 
I had a site where the clinical services manager repeatedly requested that I consider administering it as part of all my assessments. I, thankfully, dissuaded him from this each time. I found it interesting that he didn't administer it himself but kept pestering me about it.
 
I had to learn it at one of my placements. I personally thought that the information it provided wasn't worth the time that it took to administer and score.
 
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Cara, I'm positive you are skilled at other techniques.

I'm only abstracting: If you don't like laparoscopic surgery or are not good at it...you don't do it. Same with this psychometric tool. It's not for everyone and you cannot learn it properly on externship placement didactics alone. You need to study it and practice administering before you personally find significance. Just like the WAIS. If you fumble with setting up the blocks, the patient may get unraveled and feel like "WTF, how is this going to say anything about me...I'm not 3 yo!?"

I've administered maybe 10 in training and about 8 clinically. Needless to say, I think it is unique and informative when corroborated with other measures.
cara susanna said:
I had to learn it at one of my placements. I personally thought that the information it provided wasn't worth the time that it took to administer and score.
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WisNeuro said:
Just because it's used widely in select geographic areas doesn't mean that it automatically has reliability and validity. Where is the data that it provides significant incremental validity above and beyond the WAIS/PAI/MMPI?
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Arguments about the overall reliability and validity with various populations aside….the limited/lack of incremental validity above and beyond other assessment measures I already utilize makes it a non-starter for me. The administration time, lack of reimbursement, and (what I consider to be a) steep learning curve, make it a hard sell even in the more supportive geographic pockets.

*edited to clarify*
 
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CheetahGirl said:
Cara, I'm positive you are skilled at other techniques.

I'm only abstracting: If you don't like laparoscopic surgery or are not good at it...you don't do it. Same with this psychometric tool. It's not for everyone and you cannot learn it properly on an externship placements. You need to study it and practice administering before you personally find significance. Just like the WAIS. If you fumble with the setting up the blocks, the patient may get unraveled and feel like "WTF, how is this going to say anything about me...I'm not 3 yo!?"

I've administered maybe 10 in training and about 8 clinically. Needless to say, I think it is unique and informative when corroborated with other measures.
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I administered 15 Rorschachs. I think that I got pretty good at it. I just find the Exner scoring system annoying and to me the Rorschach doesn't give enough information to justify the time spent. Especially given the research indicating that it has questionable validity. If you think that I need to study it more before fully appreciating it, fair enough, but as of right now I'm not a fan. If it helps, I dislike the TAT far more than I dislike the Rorschach.

Also, is there any empirical evidence to support the idea that perceiving color corresponds with processing emotions?
 
Again, for SDN's fact-checking, let me get back with you.

But Cara, ancedotally in response to "is there any empirical evidence to support the idea that perceiving color corresponds with processing emotions," I do feel blue when sad, and red when mad. ;)
 
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Besides the afomentioned, I just dont think its a viable practice/assessment practice in many settings. Certainly not in mine. The landscape is changing, as is the role and purpose of doctoral level clincians.

So, aside from the fact that there simply isnt time for such a thing in my clinic, any "assessment" I do do needs to be brief, quantifiable and targeted. Moreover, although I see it all (in terms of pathology), most of what i have to priortize is health related behavor changes. I am sure I would get some flavorful Rors in the people I see, but, frankly, its largely irreleavnt to me (and them). I feel confident that I can pick-up the sniff of possible psychotic disorder via interview queastions based upon research with much less hassle and as much of a confidene interval as I could with a Ror....which I would assume my patients would laugh at should I propose the idea.
 
Our training in it consisted of a debate over the merits of it given the evidence at present. For folks who are planning on pursuing the handful of internship sites in NYC or Boston that expect it, they do recommend we do one at some point but that's about it. Very few internship sites seem to expect it these days and with a handful of exceptions the ones that do aren't exactly the kinds of places I'd want to end up anyways (not just because of the Rorschach).

Haven't had a chance to pour through the R-PAS data yet so can't comment on that, but I generally agree with what has been said. Given the virtually infinite amount of material to learn it doesn't seem justifiable to spend time learning it given the incredibly shoddy evidence backing its use. If the best it can do is sometimes corroborate findings from other tests where if/when discrepancy is found one has to go with the other test because the data stinks...that's not exactly a ringing endorsement. I've also heard arguments its good for building rapport and/or generating behavioral observations, but a game of checkers can do so too. I think it will die out completely eventually, but we are an unusually slow-moving field so it takes time. I see some folks of the younger generation who "use" it but don't see too many people advocating strongly for it. Virtually none seem to be pursuing academic positions or likely to have the "research cred" to resurrect it, so I suspect once Viglione, Meyer, etc. retire we will see it die out completely. I do keep meaning to check the R-PAS data (though who has the time?) so maybe that will change my view, but I remain extremely skeptical.
 
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I hear the substantiates, corroborates or adds useful information to arguement alot. What about "disputes" or provides differential diagnosis or additional diganosis. In other words, when would you change your diagnosis based on it? Would people, even those very familar with its use and interpretation, really comfortable with this?
 
WisNeuro said:
Seriously kids, the Rorschach is a gateway test that just leads you to using shoddier tests like "Draw a Person" and the TAT. Just say no!
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That reminds me of my internship site during undergrad. They used the Draw a Person and Incomplete Sentences Test (among other oddities) to help determine how to classify the state's sex offenders.
 
paramour said:
That reminds me of my internship site during undergrad. They used the Draw a Person and Incomplete Sentences Test (among other oddities) to help determine how to classify the state's sex offenders.
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Clasify them how/in what way?
 
erg923 said:
Clasify them how/in what way?
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Their "level" to indicate whether or not they have to be listed in the state registry, their restrictions, etc.
 
Is the logic that there is some predictive power (of recidivism) from the test? Pretty ridiclous of course, but its used has to be based on something that some psychologist thought or said to them at one point.

And I thought a conviction was what put someone in a sex offender registry? I didnt think there was "wiggle room" on that one.
 
Again, Doctoral Candidates, Interns, and Licensed Psychologists, we are talking about PROJECTIVE tests here....they are not in the same category as other reliable and valid measures. If these tests are shoddy to you (and science) be part of the clan that sees them fade...if it enhances your clinical picture of another human, go for it.
 
Maybe I'm misunderstanding your point, but I'd strongly argue the fact that projectives are not being held to the same standards is precisely the problem.

Its fine to argue that their purpose is different, but then they need to be shown to have utility for that purpose - which has generally not been done.
 
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CheetahGirl said:
Again, Doctoral Candidates, Interns, and Licensed Psychologists, we are talking about PROJECTIVE tests here....they are not in the same category as other reliable and valid measures. If these tests are shoddy to you (and science) be part of the clan that sees them fade...if it enhances your clinical picture of another human, go for it.
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Well, thats the whole argument, isnt it? Does it? Or do you just think it does? Who's it valuable to..and for what purpose? What is gained from that "enhanced clinical picture?" Paul Meehl once wrote about his experience doing a summer clerkship administering Rors, mentioning how interesting it was and how well it paid, but questioning how much it helped any of the patients. Thats my point.

Moreover, "not the same category?" What does that even mean? Sensitivity and specificity can be calculated for the ror, no?
 
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CheetahGirl said:
Again, Doctoral Candidates, Interns, and Licensed Psychologists, we are talking about PROJECTIVE tests here....they are not in the same category as other reliable and valid measures. If these tests are shoddy to you (and science) be part of the clan that sees them fade...if it enhances your clinical picture of another human, go for it.
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The point we are trying to make is that clinicians are using projectives as diagnostic tests in clinical settings. This is poor science and clinical work if said measures do not actually do what they are purported to do. We are a science, not an art. If you want to debate the art of it, I have a plethora of empirical research on actuarial vs insightful judgment to show you.
 
I fundamentally disagree that clinical psychology is a science and not also an art....as well as philosophy, anthropology, theology, sociology, etc. Bring on your references. I'll read them. And I will continue to offer to administer the ROR to my treatment team. It's what I bring to the table. Call me left, but I can agree with you and add my perspective not take away. Feels a bit rigid to me and rigidity is not always the best when you are not unequivocally disproven. I'm no Jenny McCarthy here (basing my opinion on one unethical, falsified study), I know science intimately. I also have confidence in my armamentarium (including my projective tests) for my clinical practice, and those of my peers. And above all, I will never harm the patient.
WisNeuro said:
The point we are trying to make is that clinicians are using projectives as diagnostic tests in clinical settings. This is poor science and clinical work if said measures do not actually do what they are purported to do. We are a science, not an art. If you want to debate the art of it, I have a plethora of empirical research on actuarial vs insightful judgment to show you.
Click to expand...
 
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CheetahGirl said:
I fundamentally disagree that clinical psychology is a science and not also an art....as well as philosophy, anthropology, theology, sociology, etc. Bring on your references. I'll read them. And I will continue to offer to administer the ROR to my treatment team. It's what I bring to the table. Call me left, but I can agree with you and add my perspective not take away. Feels a bit rigid to me and rigidity is not always the best when you are not unequivocally disproven. I'm no Jenny McCarthy here (basing my opinion on one unethical, falsified study), I know science intimately. I also have confidence in my armamentarium (including my projective tests) for my clinical practice, and those of my peers. And above all, I will never harm the patient.
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What setting do you work in?

Do you concur that this instrument is not amenable in many settings in which psychologists are currently working?
 
There's a book called the forensic applications of the Rorschach, so there is some literature about this crap. It's followers have made me a fair amount of money.
 
erg923 said:
What setting do you work in?
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Usually, academic medical centers as a clinical psychology extern in the departments of general adult and pediatric psychiatry. I have also worked in community-based mental health clinics working with severe psychopathology and dually-diagnosed. And I spent several concurrent years at a college counseling center. All as clinical psych trainee. As a researcher, I've worked primarily in academic medical centers and one VA. More of my CV... I'm also a phlebotomist who worked in many medical centers, as well as a former receptionist/later surgery coordinator (promotion) for large private practice neurosurgery office (all prior to being a researcher). And I grew up with a Dad who was a vascular surgeon and all about "Show me the science. Is this valid & reliable data?" ever since kindergarten.

Not to jinx myself talking about it, but all recent internship interviews were at academic medical centers and one VA. :) Maybe I'll mature more after post-doc and licensure, but this is my perspective coming into the field.

erg923 said:
Do you concur that this instrument is not amenable in many settings in which psychologists are currently working?
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Yes.

PSYDR said:
There's a book called the forensic applications of the Rorschach, so there is some literature about this crap. It's followers have made me a fair amount of money.
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Potty-mouth.
 
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http://apsychoserver.psych.arizona....hl_Clinical_vs_actuarial_assessments_1989.pdf

http://www.psych.umn.edu/faculty/grove/112clinicalversusstatisticalprediction.pdf

Psychologists too often rely on their "art," which is vastly inferior to their science. I'd like to see data otherwise. This is why we rely on psychometrics and empirically supported interventions.

And, harm depends on how you define it. I imagine that patients are paying for assessments in some way. If you are billing for a lengthy instrument that doesn't do anything, or does something poorly that can be done very quickly with another instrument. You are doing harm to the patient. It would be like me using a memory test on a dementia evaluation that poorly predicted dementia, and took 3 hours to complete. Why do that when I can use a much more valid and reliable instrument like the CVLT-II or WMS LM that takes a fraction of the time and is much more psychometrically sound.
 
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CheetahGirl said:
Usually, academic medical centers as an clinical psychology extern in the departments of general adult and pediatric psychiatry. I have also worked in community-based mental health clinics working with severe psychopathology and dually-diagnosed. And I spent several concurrent years at a college counseling center. All as clinical psych trainee. As a researcher, I've worked primarily in academic medical centers and one VA. More of my CV... I'm also a phlebotomist who worked in many medical centers, as well as a former receptionist/later surgery coordinator (promotion) for large private practice neurosurgery office (all prior to being a researcher).

Not to jinx myself talking about it, but all recent internship interviews were at academic medical centers and one VA. :) Maybe I'll mature more after post-doc and licensure, but this is my perspective coming into the field.



Yes.

Potty-mouth.
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Fair enough. I think being in training explains some of this because you are likely shielded from some realities of clincial practice, especially practice outside academic training/acadmically-affiliated settings.

Outside of a "comprehensive psychological assessment"...which I have not done since internship btw, how woud this instrument be used in the predominant short-term treatment model used in most hospital and outpatient settings?

Even if I trusted it, and even if I had the time, which I dont (literally), I would have NO idea how to use all this process type inference ("enhanced clinical picture") in a 8 session treatment for depression and diabetes education. This Ror stuff is a very different world to me, and I imagine for alot of other psychologists, because I dont even have the time to give an MMPI in my world. While I have lemented this on occasion, somehow I have manged to get by on interview skills and focused inteventions that allow the next person accesss to MH services wihin this primary care clinic. The idea of sitting around with patients and jabbering about nonsensical inkblots has never occured to me and would be likely be sneared at by superiors if they got wind of it, as well as by the vets who agree to see the clinic shrink.
 
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Whoa. Taking the MMPI home?! How did you get away with that? Hope Pearson doesnt get wind of that! How is that reconciled with code 9.11?
 
Cheetah, for goodness sakes, if you were called to the stand/a deposition, you couldn't even testify that the patient was the one who actually completed it!!!
Not to mention you have BLATANLY violated 9.11 (they could take the damn thing to Kinkos for all you know). This sounds like a disaster waiting to happen. Please rethink this.

PS: Your practice ethics are dictated to you by APA.
 
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