Rorschach dilema

[NeuroPsyStudent]

It is so popular to loath the Rorschach today, and I feel quite drawn into arguments against it. But at the same time I really want it to be useful because it is such a rich experience with a client (and the idea of the test is just so neat). I'm wondering how others feel about it. I have seen many a clinician use it poorly, coming to riduculous conclusions about patients. I think the determining moment of my really questioning the test was reading the Linus Pauling study where several famous Rorschachers were asked to independently assess his protocol. They came up with wildly different interpretations, many of them blatently contradictory. But then I have had a few personal experiences with it that have been quite striking and insightful. Will it have a future now that Exner is gone? Maybe re-norming and developing easier and more useful coding/variables? Or is it just a wizard's trick that will fade?

Btw, and I'm sure this will ruffle some feathers, my best experiences with the Rorschach have come from very general observations and sequence analysis of responses, not from the structural summary, though I can quote every SS variable for all of the training I've had! I also have appreciated the ways in which a comprehensive assessment with Rorschach, MMPI, and TAT/Roberts can create corroborating data. But then I wonder, am I just seeing things myself....

---

Members don't see this ad.

 

[RayneeDeigh]

I'm not sure how I feel about the Rorschach myself. It's always seemed really subjective and shady to me.

But at the same time, I am absolutely in love with the Myers-Briggs typology.

I think tests that attempt to categorize people are entertaining and minimally helpful, but I worry about them being used by clinicians for any type of treatment plan,

 

[50960]

How can you ? the rorschach and be Ok with the MBT?? At least the Rorschach has some attempts to make it have some kind of validity and reliability......

 

[RayneeDeigh]

How can you ? the rorschach and be Ok with the MBT?? At least the Rorschach has some attempts to make it have some kind of validity and reliability......

That's why I said "at the same time", as in "I hate spinach but I like lettuce, isn't that silly?"

I like the MBT, my experiences with it have been reinforcing. I would never use it or the Rorschach if I were in clinical practice though.

I prefer the MBT because it's less open to bias from the clinician. A Rorschach is only as good as the person interpreting it.

 

[Therapist4Chnge]

I happen to really like the Rorschach....as something to use in therapy, not really as a strict assessment tool. I like a more traditional psychodynamic interpretation of the Rorschach, as opposed to Extner. I think it definitely has value, though it isn't an absolute.

-t

 

[NeuroPsyStudent]

Oh, that's great. Do you use it with therapy patients at the beginning of therapy and then at various points to assess themes/progress? What are your favorite ways to look at your data? Sequence analysis? Quality of human figures/interaction?

 

[Therapist4Chnge]

Oh, that's great. Do you use it with therapy patients at the beginning of therapy and then at various points to assess themes/progress? What are your favorite ways to look at your data? Sequence analysis? Quality of human figures/interaction?

I use it more informally, as a way to see how they'd respond to something more abstract. I usually look at thematic content, interactions, bizarre responses, etc. It isn't something I'd write up in a formal report, but something I'd include in my notes. I actually really like the TAT2 for thematic stuff. I'd be more apt to give a full TAT2 than a full Rorschach.

-t

 

[psy86]

Frankly, I believe that decisions regarding which assessment instruments to use should be based on published data regarding validity and reliability as opposed to personal "gut feelings" about what's nifty and what's not.

 

[Logic Prevails]

Frankly, I believe that decisions regarding which assessment instruments to use should be based on published data regarding validity and reliability as opposed to personal "gut feelings" about what's nifty and what's not.

Why? You use yourself as an assessment instrument all the time... otherwise you are just a psychometrician. It frequently goes in the section of the report called "behavioral observations" and is used to supplement hypotheses generated by more objective measures. T4change already indicated that they would not use projectives on their own for interpretation - makes perfect sense to me.

At another level, it's hard for people to "fake" their responses on something like the TAT - you can get a lot of information that you might not get from objective, straightforward measures - but I think you'd always want to use interpretations tentatively and you should always try to ground them in the light of keen behavioral observation and more objective measures.

 

[Therapist4Chnge]

LP pretty much nailed it. The TAT2 is a nice way to get some ideas of how the pt. may perceive the world; I've run into less defensiveness going this route. As stated earlier, i'm not using the assessments for Dx'ing...i'm using it to collect more information.

-t

 

[Neuro-Dr]

Please read this as a question, not an attack. What evidence is there that someone can't fake a TAT, Rogers and other have routinely published on malingering of paych instruments and I would see no reason why someone could not easily fake this test.

 

[50960]

I know I could fake it...those um keys are a gun, and I want to shoot someone, that girl in the field is my wife who is cheating onme etc...

 

[NeuroPsyStudent]

NeuroDr. You are completely right. There seem to be very different groups using the Rorschach -- those in forensic positions where it is a test that may be used in legal decisions and those in a therapy planning setting where the results may reveal themes for therapy. There are some people using it as a measure of thought disorder for schizophrenia diagnoses and some rely on the suicide index/constellation. Personally, and my data here is based on the dirt the Wood has dug up on validity,I am uncomfortable using the Rorschach in a court setting. However, I do wonder about the schizophrenia uses (I know neuropsychologists who use it in this way) and also about the utility of the suicide scale. I've heard it is a decent predictor of future suicide attempts.

 

[positivepsych]

I can't believe it's 2007 and this is still being commonly used and discussed. I'm not going to say that it's absolutely useless, but I would like to see it die just for the image of the psychology field to move from the haunting influence of Freud to rigorous empirically-based practice.

Public perception of the field of psychology is important, and its hard to convince insurance companies and politicians to get equal reimbursements, salaries, and prescriptive authority if we're still using tools like the Rorschach. Image is everything...

 

[Therapist4Chnge]

I am uncomfortable using the Rorschach in a court setting.

From my understanding it is not admissible to court

I still think there are uses for it, but it is a mistake to try and slip it into a legal case. I think the major issues come with the range of conflicting research on the assessment. I happen to dislike the Extner method, and I think there is too much 'home cooking' in regard to the research. I think it is still a very effective tool in therapy, but is limited in a strictly assessment setting.


-t

 

[NeuroPsyStudent]

Positivepsych, I certainly can understand your concerns. Have you ever given a Rorschach, though?

Of course psychologists still give projective instruments. It is more an issue of how they manage/use the data they offer.

 

[Neuro-Dr]

Well, there are several points here...

The Rorschach is and has been admitted in court depending on the standards of the state. In a Frye state it would be admitted based on common use. I have heard of it meeting Daubert standards, but not reviewed a case as such.

The suicide index has resulted in at least one successful lawsuit for not being scored when a patient then committed suicide. Depending on the score, it's predictive value can be as high as 80% in the next 6 weeks.

There are several values on the Rorschach that have equal inter-rater reliability to the WAIS, and several with better predictive validity than some MMPI scores.

Having said that, it is easily feigned, with no published research on how, and how often. Since the base rates of malingering are 7% in non-forensic cases and up to 40% in case where the outcome of the evaluation has high stakes, this might include disability, I would be cautious with any test in any setting, not simply forensic.

As to why, we still talk about it... 60% of APPIC site diresctor require it for students, and it ranks 3rd on their list of required tests, behind the WAIS and MMPI. So....it still lives on with training sites and thus will still be used.

I just don't know who has the time to give, score and interpret it for what it gives you.

 

[NeuroPsyStudent]

Thanks Neuro-Dr. Those are really rich points. I am curious about your suicide constellation comment. I'd like to see the study about the 80% figure. I assume that is sensitivity and that the specificity would be much lower (meaning that it would pathologize much more often). What did you mean by some scores? I have heard that it is still our best predictor of suicide, though truth in this field is often difficult to determine, even with research "findings".

 

[Neuro-Dr]

This is nothing new. The Journal of Personality Assessment has published articles on this routinely since the early 90's. The high base-rate studies (inpatient) hover around .80 and adolescents around .65. These are OCC, not sensitivity variables. It should take you about a nano-second to do your own lit search on this.

As for reliability data, this too is pretty well published and Viglione has a couple articles in the past few years. The crux has been that the higher base-rate variables are pretty good (.84-.90). This suggests that like the WAIS, although we could all disagree on 1 or 2 for scoring a particular item, the end scale will be quite similar.

Journal of Personality Assessment
1996, Vol. 66, No. 2, Pages 308-320
Standardizing Procedures for Calculating Rorschach Interrater Reliability: Conceptual and Empirical Foundations
Claude McDowell, *Marvin W. Acklin*

Tam K. Dao*, Frances Prevatt*. (2006) A Psychometric Evaluation of the Rorschach Comprehensive System's Perceptual Thinking Index. Journal of Personality Assessment 86:2, 180-189
Online publication date: 1-Apr-2006.

Donald J. Viglione, Nicole Taylor*. (2003) Empirical support for interrater reliability of Rorschach Comprehensive System coding. Journal of Clinical Psychology 59:1, 111

Journal of Personality Assessment
2001, Vol. 76, No. 2, Pages 333-351
The Rorschach Suicide Constellation: Assessing Various Degrees of Lethality

Journal of Personality Assessment
1992, Vol. 59, No. 2, Pages 290-303
The Rorschach Test for Predicting Suicide Among Depressed Adolescent Inpatients
Joyanna Lee Silberg, *Judith G. Armstrong*