Rorschach training in grad school

[erg923]

I would just like to take a poll on how many people learn the Rorschach in their graduate program. I do NOT mean are just exposed to it or have it mentioned (everyone probably). I mean learning it in-depth, the Exner system, interpretation, and possibly even having to write formal report from an administration (mock case client or real administration to someone you know); the whole shebang.

You can jump into all the usual debates if you wish regarding its validity and clincial utility, BUT, I am more interested in knowing what advantages you think it will (has) pose to your development as clinician, irrespective of whether or not you buy into the projective theory formally. For example, although I can only imagine wanting to do it in certain circumstances, I have found that learning about the Rorschach has allowed me too understand psychoanalytic theory at much deeper level. Especially in regards to object representations, manifest vs latent content recognition, and "theme spotting." Whether or not you "buy" into this, or find it all that useful, I cant help but feel that I gained enormous insights and simply learned alot of new things that will help me to become a more critical and analytic (not necessarily in the Freudian sense) therapist and diagnostician. Any thoughts?

PS: Perhaps any disadvantages to learning it also?

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[KillerDiller]

I'm only a day into my elective class on the Rorschach and it was only one of numerous tests taught in my adult assessment class, so I am by no means an expert. However, I believe after doing this week's readings that the Rorschach is not really a psychoanalytic measure even though it was used frequently by those who joined Freud's camp. In fact, it predates psychoanalysis as a personality measure. I'm not really sold on the Rorschach nor opposed to it yet and am trying to remain open minded. It does have empirical support in the literature. Also, it seems its detractors mostly come from one specific pool of psychologists, which makes me wonder a little. More than anything, I'm learning it because it seems to be widely used in the prison systems and I have an interest in forensic assessment.

 

[psy86]

Interesting poll, erg.

I'm going to refrain from rehashing all of the 'con' arguments/ usual debates. Particularly since I am in a program that is basically rabidly anti-Rorschach, I have attempted to keep an open mind about the Rorschach and examine all of the pro/ con evidence for myself. For me, the most damning problem, which I cannot seem to get past, is the duplication of the protocols in Exner's normative data. (Exner has admitted that 221 of the original 700 protocols were duplicated in the original adult norms, i.e. there were really only 479 protocols, and then 221 of those were duplicated, but stats were performed as if there were 700 distinct protocols).

It is obvious to me that this makes the original norms invalid (and I am not sure whether new norms have been issued since Exner identified the problem in 2001). Moreover, it highlights the fact that there has been insufficient external review of Exner's data. It is hard for me to imagine how one possibly duplicates 221 protocols without realizing it. (Reference, in case anyone is unfamiliar with this problem: Wood, Nezworski, Garb, & Lilienfeld, 2001).

If anyone out there from a pro-Exner camp can explain to me how this is not a big deal, so I can understand how Exner prononents are thinking about this, I'd actually really appreciate it.

 

[Ollie123]

We had one lecture entirely devoted to it, and that's the extent of exposure I'm likely to get to it in my program. None of the faculty use it and I'm fairly certain they won't even allow students to work at a practicum site where they are used. They told us if we want to go to Boston or someplace similar for internship, they can track down some way for us to do one, but otherwise not to bother.

Unless the research on it does a u-turn in the future I can't foresee any reason I'd ever need to do one so I'm not worried about it having any practical implications on my career. The time it takes to learn thing is just not worth the incremental validity it gets you over other tests. Its hard for me to answer the clinical development question because clinical work isn't a goal for me. As you mentioned, it might help improve analytic skills, but there are many ways to do that. I also haven't been able to find any empirical support for it that was actually done well. I admit I didn't exactly search the entire literature on it, but I was not impressed by the ones I did read.

 

[Therapist4Chnge]

I'm not really a fan of the Extner system, and the research is shaky.....but we have to learn it. We spend most of the time in the proj. assessment class with it, in addition to having an (optional) elective dedicated to it. I have seen quite a few internship sites that require it.....so if I wanted to apply to them I better be comfortable with it. In the end I think it is a better clinical tool using a trad. interpretation, than it is an assessment tool using the Extner system, assuming the person is very comfortable with the assessment. My prof. joked that it took him a couple hundred administrations to really get comfortable with it.

 

[JockNerd]

I'm pretty skeptical, but I have heard some people whose intelligence I respect say it can be good. We don't learn it in assessment but our prof said it can be super-useful. I, like Ollie, wonder about that training though. Trips to DC and hundreds of administrations?

Plus, the Rorshach is kind of a part of culture and the stereotypical therapy experience. If I *were* administering a projective, I think I'd go with the TAT or other test that fewer people know about.

 

[Therapist4Chnge]

Plus, the Rorshach is kind of a part of culture and the stereotypical therapy experience. If I *were* administering a projective, I think I'd go with the TAT or other test that fewer people know about.

😀

I'm all about the TAT2, though I've gotten flack from some supervisors because they think it is outdated (some of the pics are dated because of clothing, etc), though I find the TAT2 cards far more useful than the Rorschach approach.

 

[erg923]

None of the faculty use it and I'm fairly certain they won't even allow students to work at a practicum site where they are used. They told us if we want to go to Boston or someplace similar for internship, they can track down some way for us to do one, but otherwise not to bother.

I think its used more than you think. Still not alot at all, but there is no way a program should "ban" a site just because the potential is there. Its used in VAs a fair amount and I doubt they are going to ban VA medical centers for its students. I think thats rather uinfair actually, does this mean you cant get any psychdynamic therpay exposure or prac experience in your program?

 

[Ollie123]

I think its used more than you think. Still not alot at all, but there is no way a program should "ban" a site just because the potential is there. Its used in VAs a fair amount and I doubt they are going to ban VA medical centers for its students. I think thats rather uinfair actually, does this mean you cant get any psychdynamic therpay exposure or prac experience in your program?

Oh, I'm well aware its still used quite a bit, I just don't think any of our faculty use it. They definitely encourage us not to look at internships/postdocs/jobs that are big proponents of it since the general consensus is that there are incredibly few situations where they feel its use is justified. They're totally open about being a research program (i.e. Our interview opened with, "If practice is your goal, you probably shouldn't come here" or something like that)

I do think its important to note that since my program is super-research-oriented, I'd bet part of the aversion to the rorschach is just that it takes so darn long to learn to do correctly, and that's a x hours that could have been spent in the lab. Obviously people have different goals coming in, but generally speaking we do more experimental than treatment research here and coupled with the research focus, clinical work as a whole is not emphasized beyond getting a solid grounding.

As for whether or not we can get psychodynamic practicum experience...some supervisors and sites are obviously more eclectic than others. I know people work at the VA, but I don't know enough about the site to know what goes on there. From everything I've heard, our practicum supervisors need a heavy empirical focus. If a student was interested in one that wasn't, would they absolutely refuse to let them work there? That I don't know. I do know that numerous practicums have been removed from the list because they weren't "evidence-based" enough. Its not like the mere mention of Freud gets you excluded, but if a site was training students to do rorschach's as a primary diagnostic tool....I have a really hard time imagining that going over well at all.

 

[KillerDiller]

It is obvious to me that this makes the original norms invalid (and I am not sure whether new norms have been issued since Exner identified the problem in 2001).

I believe it was renormed in 2003 (not 100% sure on that, though).

Its not like the mere mention of Freud gets you excluded, but if a site was training students to do rorschach's as a primary diagnostic tool....I have a really hard time imagining that going over well at all.

Nor should that go over well. From my understanding, the Rorschach was never meant to be used as a diagnostic tool, but rather as a personality assessment.

 

[Cosmo75]

We learned the Rorschach in my program as part of a broader assessment course. I think we spent 3 classes on it. But we were required to learn the Exner system, give it to a few test subjects, interpret and write the report. It's a very time consuming process, especially if you do the whole thing manually. There is software which saves some time, but it's still considerable compared with other diagnostic tools. With that being said, I didn't use it at all on practicum. The training director for my internship (VA) uses it, but he doesn't supervise me for therapy. I don't think he requires who he does supervise to use it either. There were a few internship sites I'd heard were more rigid about its use, and I shyed away from those. Even though I've been trained to use it, I don't buy into its supposed diagnostic specificity. I think it's interesting, and perhaps an adjunctive tool to use in a broader diagnostic process. But considering the time it takes to administer and score it, I'm not sure that the benefit outweighs the cost.

 

[Therapist4Chnge]

....the Rorschach was never meant to be used as a diagnostic tool, but rather as a personality assessment.

I've been told it should only be used as an assessment if give with a battery of other assessments, and shouldn't be the primary tool to diagnose for personality, but it can help support other assessments like the MMPI, etc.

 

[Neuropsych2be]

My program requires us to get trained in the Exner system. As part of our pre-internship evaluation, we have to present an assessment case using the Rorschach. I am pretty fond of the Rorschach, especially in cases where the client's objective testing data is a bit thin. I have a good sense of the person after administering it. I'd hate to use it in a forensic case due to some of the criticisms. I am using the Rorschach at my practicum site fairly frequently. It is time consuming and a real pain to score using Exner's system. Thank God I have the scoring software!

 

[KillerDiller]

I've been told it should only be used as an assessment if give with a battery of other assessments, and shouldn't be the primary tool to diagnose for personality, but it can help support other assessments like the MMPI, etc.

This is pretty much what I have been told as well.

 

[erg923]

I brought this up because I used to hold strongly to the conviction (and was initially taught) that: "If you buy the premise, you buy the joke." Meaning, if you don't buy into analytic theory, you will not find the test or anything it gives you useful. I really have changed my mind about this, and what I have found is that it has increased my ability to think outside the stringent DSM and CBT conceptualization "box" we are often trapped in as grad students in this day and era.

PS: Thought this was interesting, but small Ns:

J Pers Assess. 1996 Feb;66(1):65-80 Can psychosis be malingered on the Rorschach? An empirical study. Ganellen RJ, Wasyliw OE, Haywood TW, Grossman LS.

Can psychosis be faked on the Rorschach? We examined this question by comparing 2 groups of subjects with a high incentive to malinger, persons accused of serious crimes. All subjects were administered both the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach and were assigned to honest (N = 35) and malingered (N = 13) groups on the basis of MMPI validity scales. The Rorschach protocols of these 2 groups were compared to assess how successfully malingerers could deliberately produce records that appeared psychotic on empirically derived Rorschach indices of psychosis. Despite an attempt to portray themselves as psychotic on the MMPI, subjects in the malingered group did not differ from honest responders on Rorschach variables that distinguish psychotic from nonpsychotic patients, but did differ in the number of dramatic responses produced. Our data suggest that the combination of the MMPI and Rorschach provides a powerful psychometric technique for detecting deliberate malingering of psychosis.

 

[erg923]

Ollie:
Don't you have a neuropsych concentration there? If I remember correctly? It may be heavy on the research, but its seems like they would stress heavy prac work and application for the neuropsych concentration people, since most people in those concentrations want to be clinicians and need alot of applied experiences (even if they eventually want to do research in clinical neuro as a career)?

 

[Ollie123]

Ollie:
Don't you have a neuropsych concentration there? If I remember correctly? It may be heavy on the research, but its seems like they would stress heavy prac work and application for the neuropsych concentration people, since most people in those concentrations want to be clinicians and need alot of applied experiences (even if they eventually want to do research in clinical neuro as a career)?

No formal concentration. We do have one quite respected neuropsychologist on staff, and a sizable number of connections to the neuro community - so people who DO want lots of prac work in that area have the opportunity to do so.

That said, since its primarily one faculty member who does clinical neuro they aren't exactly an overwhelming percentage of the students. I'll probably be getting some neuro experience through them since I definitely prefer assessment to therapy and do some EEG/ERP work in my area (realize its not the same as clinical neuro, but certainly related!) Though I'm sure you're right that the neuro folks probably end up with more clinical experience than most. I may be a bit biased in this since my lab is particularly heavy on research, but I definitely feel like while we have many great clinical opportunities, it definitely stays secondary to research. Maybe its different for the neuro folks, but I can't imagine I would have decided to come here if I was looking for a clinical career. The main reason I DID come here was because they made the heavy emphasis on research clear from the interview, whereas the other program I was interviewing at did not.

 

[Neuro-Dr]

This is not the only source, but I think students should consider looking at some of the APPIC surveys on these subjects.

http://www.appic.org/news/Newsletter/November2003/77712-001-032.pdf

 

[The2abraxis]

on the subject of projective tests, are there any of these that are directly used for pinpointing out belief systems?? maybe the rorschach and the TAT kind of do this (i know only a little about them), but I was wondering if there was one designated for finding out certain beliefs a person would hold, and how they "project" it into the way they view the world.

 

[Cosmo75]

on the subject of projective tests, are there any of these that are directly used for pinpointing out belief systems?? maybe the rorschach and the TAT kind of do this (i know only a little about them), but I was wondering if there was one designated for finding out certain beliefs a person would hold, and how they "project" it into the way they view the world.

The Rotter Sentence Completion Blank (or similar tests) is intended to get at attitudes/beliefs.

 

[The2abraxis]

The Rotter Sentence Completion Blank (or similar tests) is intended to get at attitudes/beliefs.

ah that would be a good one. i have never seen the questions used on that test (i have seen a few fill in the blanks, but they didnt seem to represent the beliefs too well).

what kind of questions (if its allowed 😀) would be used to pinpoint out the beliefs?

 

[erg923]

eh....I dont even know if that's copyrighted really, but that is still a violation of ethics code to disclose test items

 

[The2abraxis]

eh....I dont even know if that's copyrighted really, but that is still a violation of ethics code to disclose test items

ya i didnt think it was very ethical. i guess I will find out maybe in my clinical class or sometime in the future 🙁

 

[positivepsych]

A guest lecture on the Rorschach in assessment class. If people are interested, they can take an optional class on it to become trained to use it.

I think the Rorschach, even with the Exner system, is a bunch of garbage, and wouldn't go to an internship site that required it. Even with the questionable pscyhometrics aside, the sheer amount of time/training it takes to become proficient in the Exner system is not pragmatic. Most of all, I'm more appalled by the fact that we're still stuck on using such an old instrument in the field.

I think clinical psychologists, from a public opinion perspective, should ditch the Rorschach since we're trying to promote ourselves as both allied health professionals and clinical practitioners of empirically-supported treatments. If we want full acceptance from the mainstream medical community and the lay public, it would go a long ways to bury the Rorschach, along with classical psychoanalysis. That's my two cents.

 

[erg923]

I hate to be picky here, but it always bugs me when people say psychanalysis is not empirical. "Empirical" just means through observation. Psychoanalysis is NOT experimental or quantitative. I think Meehl and some of his buddies tried for years to figure out ways to test the paradigm experimentally, but just couldn't do it. I doubt it can be ever be done. The Rorschach is actually all of these things, it just a poor discriminator most of the time, and we can get alot of the same info using briefer and more cost effective instruments.

As I sated before, I simply think it is educational, and helps you become a more observant, analytic clinician.

 

[erg923]

I'm more appalled by the fact that we're still stuck on using such an old instrument in the field.

I see your point here, but ALL of our tests are old! The MMPI was developed in the 30s, WAIS-IV still works from the same principles set forth from the Wechsler-Bellvue, Trail Making has its roots in the army tests from WWI, and the CVLT is an expansion of experimental list learning tests give to us by our cognitive psych colleagues in the 60's. Everything we use is old.....they just get new norms.....

 

[positivepsych]

Well, you have a point about the roots of may of the tests. However, though a lot of our tests are old, many of the items are updated.

How many actual items from the WAIS-IV are from the original version?
If I'm not mistaken, the 10 inkblots used in the Rorschach are from the original 10 than Herman Rorschach created in a 1921 monograph. We're talking 87 years here! Has anyone bothered to see whether those are the best possible pictures to use for a projective test?

It seems that because there is a big push to replicate and validate results, the negative side of that is that it does not encourage innovation in assessment. Other tests seem to go through evolution, while the Rorschach seems to be a dinosaur that never dies.

 

[Therapist4Chnge]

Other tests seem to go through evolution, while the Rorschach seems to be a dinosaur that never dies.

I think there are some things more prone to "dating" and a need for change/evolution. One of the knocks on the TAT2 is that some of the dress is dated (which I agree with), but would a change produce a significant change in the outcome? Something like the WAIS uses more concrete things that can be dated, so it makes more sense that not updating it could adversely effect the results.

 

[BamaPsych]

I'm an undergrad, but the clinical PhD program here devotes a week of training to the Rorschach in the Personality Assesment class. I was actually surprised, judging by what I do know of the program here.

 

[erg923]

A week is about enough time to get to know the history and theoretical underpinnings of the test. Exner's system is a tedious pain in the butt. We had a whole class devoted to the thing and I obviously did not get proficient in interpretation or scoring even in that amount of time.

 

[BamaPsych]

erg, just curious - by one class do you mean one class session, or a class over the course of a semester?

 

[Therapist4Chnge]

Our Projectives class was spread over 15 weeks, though we also touched on HTP and the TAT2. There was an advanced elective on the Rorschach too....but I didn't take it.

 

[erg923]

an entire 15 week class.