The Rorschach and Section 9.02

[Kristi Lynn]

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Hello. For an ethics class assignment, I am interested in learning what people think of the Rorschach as an assessment measure. Would you feel comfortable using it in clinical and/or forensic practice, especially in light of section 9.02 in the ethical code, which states:

9.02 Use of Assessments
(a) Psychologists administer, adapt, score, interpret, or use assessment techniques, interviews, tests, or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques.

(b) Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation.

(c) Psychologists use assessment methods that are appropriate to an individual's language preference and competence, unless the use of an alternative language is relevant to the assessment issues.

I've heard opinions from a lot of the psychodynamic and CBT folks and am really interested in hearing what you all think of using the Rorschach in light of section 9.02. If I use your responses, it will be anonymous.

 

[lazure]

My understanding is that the Exner system for scoring the Rorschach is reasonably well researched and empirically supported. Personally, I was never formally trained in it but one of my supervisors will testify in court based on the assessments that include the Rorschach.

 

[PublicHealth]

My understanding is that the Exner system for scoring the Rorschach is reasonably well researched and empirically supported.

If you read Exner's manuals closely, you'll notice that most of the data on the "empirical validity" of the Rorschach was never published.

"What might this be?"

 

[lazure]

If you read Exner's manuals closely, you'll notice that most of the data on the "empirical validity" of the Rorschach was never published.

Fascinating 🙂 I'm not a big fan of projectives...

 

[Kristi Lynn]

So in light of the ethical code cited above, if the Rorschach does not have reliability or validity that is as impressive as, say, the MMPI, do you guys think it is unethical to use the Rorschach over the MMPI?

 

[LM02]

So in light of the ethical code cited above, if the Rorschach does not have reliability or validity that is as impressive as, say, the MMPI, do you guys think it is unethical to use the Rorschach over the MMPI?

I was not trained on projectives, so I (obviously) do not use them in practice.

However, my understanding is that there *is* some reasonable reliability and validity data for the use of the Exner System to identify psychotic disorders. However, the quesiton then becomes one of incremental validity. It doesn't really offer much over and above other tools we have for identifying psychosis (e.g., unstructured clinical interview). Given the time it takes to administer and score the thing, it really isn't worth administering at that point (in my opinion).

The MMPI-2 is a useful tool, but I wouldn't rely on it alone to generate a clinical conceptualization and treatment plan. I would interpret it in light of the clinical information gathered in a clinical interview.

 

[PublicHealth]

I was not trained on projectives, so I (obviously) do not use them in practice.

However, my understanding is that there *is* some reasonable reliability and validity data for the use of the Exner System to identify psychotic disorders. However, the quesiton then becomes one of incremental validity. It doesn't really offer much over and above other tools we have for identifying psychosis (e.g., unstructured clinical interview). Given the time it takes to administer and score the thing, it really isn't worth administering at that point (in my opinion).

The MMPI-2 is a useful tool, but I wouldn't rely on it alone to generate a clinical conceptualization and treatment plan. I would interpret it in light of the clinical information gathered in a clinical interview.

👍 👍

 

[Kristi Lynn]

Excellent. I agree. Anyone else have an opinion on this matter?

I was not trained on projectives, so I (obviously) do not use them in practice.

However, my understanding is that there *is* some reasonable reliability and validity data for the use of the Exner System to identify psychotic disorders. However, the quesiton then becomes one of incremental validity. It doesn't really offer much over and above other tools we have for identifying psychosis (e.g., unstructured clinical interview). Given the time it takes to administer and score the thing, it really isn't worth administering at that point (in my opinion).

The MMPI-2 is a useful tool, but I wouldn't rely on it alone to generate a clinical conceptualization and treatment plan. I would interpret it in light of the clinical information gathered in a clinical interview.

 

[Ms Tatiana]

I'm not a huge fan of Projectives either, but learned how to administer several in a required class for my MA. Obviously, their validity/reliability is questionable, but I wouldn't discount them entirely, particularly when used with young children who are victims of sexual or physical abuse. They provide a nice fuel for discussion (in particular, the HTP).

As for Exner, I know in this class we were taught his methods were sound because of the empirical support out there. But between the months it would take the master that thing, plus the specialized course you have to take to be certified to even interpret it in 6-8 hours on a GOOD day, the whole thing is rather daunting.

 

[50960]

Reliability is dismal, therefore it should not be used. There is really no defense for using the Rorschach anymore...plus it takes too long!!! 😉

 

[PsychEval]

http://www.division42.org/MembersArea/IPfiles/Spring05/features/rorschach.php

I was trained in the Exner System, and we used software on internship for interpretation, with the computer providing a 10 page report. However, the whole process is too time consuming for an acute inpatient facility. What I do like about the Rorschach is that patients are not aware what they are "giving up" which is not always the case with a M & M (MMPI/MCMI). Usefulness? Aid in treatment planning? How comfortable would I be explaining my test selection to a judge? Well, I have not administered one since internship.

 

[Flutterbyu]

As with all assessments, the Rorshak should not be used in isolation, but as part of a battery it provides a nice complement to some fuzzy cases. We have the option of learning it in my program and almost everyone does just to be able to have it in our toolkit if needed. I think the best use of the Rorshak is when there is uncertainty or confusion in diagnosing. Obviously the test is a qualitative test, but Exner's scoring system has been quantified- this blend of qualitative and quantitative give you a nice mix to help make difficult calls. Also, maybe to learn the interpretation it takes 6-8 hours, but once you are comfortable with it, that time frame is crazy. I know many clinical psychologists in all different specialties that use the Rorshak and all of them have told me it is a great test to learn.

 

[50960]

If it has poor interrater and test-retest reliability, how can one ethically defend using it??

 

[JatPenn]

No reliability, thus no validity, thus no thanks.

 

[JatPenn]

As with all assessments, the Rorshak should not be used in isolation, but as part of a battery it provides a nice complement to some fuzzy cases. We have the option of learning it in my program and almost everyone does just to be able to have it in our toolkit if needed. I think the best use of the Rorshak is when there is uncertainty or confusion in diagnosing. Obviously the test is a qualitative test, but Exner's scoring system has been quantified- this blend of qualitative and quantitative give you a nice mix to help make difficult calls. Also, maybe to learn the interpretation it takes 6-8 hours, but once you are comfortable with it, that time frame is crazy. I know many clinical psychologists in all different specialties that use the Rorshak and all of them have told me it is a great test to learn.

I was under the impression that the Rorschach was not intended to be used as a diagnostic tool in any case. 😕

 

[Flutterbyu]

I was under the impression that the Rorschach was not intended to be used as a diagnostic tool in any case. 😕

I haven't taken the class yet, but even if it is not used as a diagnostic test, it is always better to know more about your patient and the underlying psychopathology when formulating a diagnosis.

 

[PsychEval]

I was under the impression that the Rorschach was not intended to be used as a diagnostic tool in any case. 😕

We used it in the hospital primarily to determine a more subtle psychotic process.

 

[LM02]

I haven't taken the class yet, but even if it is not used as a diagnostic test, it is always better to know more about your patient and the underlying psychopathology when formulating a diagnosis.

I don't agree with this statement as an argument for the use of the Rorschach. Although using multimethod assessment and knowing your patients as well as you can are important clinical goals, you also have to factor in efficiency.

Let's say you have sufficient information to generate a working conceptualization and treatment plan. Is it really in the patient's benefit to then undergo additional lengthy assessments when the time could be better spent on actual treatment? I don't think so. Besides, a good treatment plan is going to include continued assessment anyway.

 

[psychgeek]

No reliability, thus no validity, thus no thanks.

First of all the Rorschach does not have poor inter-rater reliability. Most of the structural summary variables have good to excellent inter-rater reliability (.80 +) when scored by trained clinicians using the Exner system. Item level IRR is not very good but there is no item level analysis in the Exner system. Also, these estimates come from recent published studies in well respected journals like JPP and JCP. Test-retest reliability is similarly good for the structural summary variables that are hypothesized to be stable. Many of them aren’t, and these are not terribly stable.

It is definitely a pain and I never use it if I don’t have to, but there are situations in which it can be awfully handy. For example, it is the only test for psychosis that does not require literacy. Also, the positive predictive power of the S-CON is sufficient to justify its use in risk assessment for this variable alone. The MMPI-II and PAI both tend to generate profiles that are questionably valid with the chronically mentally ill so I often find myself using the Rorschach to confirm results from the self-report.

People’s opinions about the Rorschach always seem unnecessarily extreme. In my experience it is a good addition to some testing batteries, useless in others, and misleading in a few.

 

[50960]

You are correct about Exner's system. I was referring to using the test as a projective which is how it was originally used, and still used quite frequently by practitioners who claim they know the test so well they do not need reliability coeffecients. It is Exner's system that is reliable, not the test itself. I personally do not use it at all, but have and think it can be very informative. I specialize in kids and medical/health psych so it is not a tool I find useful. 🙂

 

[JatPenn]

First of all the Rorschach does not have poor inter-rater reliability. Most of the structural summary variables have good to excellent inter-rater reliability (.80 +) when scored by trained clinicians using the Exner system. Item level IRR is not very good but there is no item level analysis in the Exner system. Also, these estimates come from recent published studies in well respected journals like JPP and JCP. Test-retest reliability is similarly good for the structural summary variables that are hypothesized to be stable. Many of them aren’t, and these are not terribly stable.

It is definitely a pain and I never use it if I don’t have to, but there are situations in which it can be awfully handy. For example, it is the only test for psychosis that does not require literacy. Also, the positive predictive power of the S-CON is sufficient to justify its use in risk assessment for this variable alone. The MMPI-II and PAI both tend to generate profiles that are questionably valid with the chronically mentally ill so I often find myself using the Rorschach to confirm results from the self-report.

People’s opinions about the Rorschach always seem unnecessarily extreme. In my experience it is a good addition to some testing batteries, useless in others, and misleading in a few.

you can have reliability without validity, so I'm not too impressed by Exner. certainly inter-rater reliability is going to be high on the Rorschach when its being rated by several folks trained exactly the same way.

 

[psychgeek]

I was referring to using the test as a projective which is how it was originally used, and still used quite frequently by practitioners who claim they know the test so well they do not need reliability coeffecients.

People still do this!! 😱 I thought item content analysis died with the draw a house/person/tree test.