The Rorschach in 2024?

[quickpsych]

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What would you say to psychologists who rely on the Rorschach for personality testing versus or alongside other personality assessment measures?

I find that most fellow psychologists I've worked with or talked with haven't used it in years if ever outside go grad school, but I still run into some who think it's the gold standard for personality testing.

 

[R. Matey]

It widely depends on whether these psychologists (a) understand the basic concepts of reliability and validity, (b) respect the value of research in their field, (c) are willing to actually read the research, and (d) have the emotional capacity to change their minds in light of "new" information. If a-d are true, I have articles.

 

[quickpsych]

It widely depends on whether these psychologists (a) understand the basic concepts of reliability and validity, (b) respect the value of research in their field, (c) are willing to actually read the research, and (d) have the emotional capacity to change their minds in light of "new" information. If a-d are true, I have articles.

Well said and please feel free to DM or share the articles here if you want.

 

[R. Matey]

Sure see below:

Classic critique by Lilienfeld: https://journals.sagepub.com/doi/full/10.1111/1529-1006.002?casa_token=m3vP49SKjyEAAAAA:7YznPTOamArOqh8oFBN0568AeBMfgOYcfEYq-cx3wPvIHd-Pl0D3e23V4qip78jNDdEn2ruiFvJtTQ

Classic review https://www.sciencedirect.com/scien...EbLUZdEjIh-dktkhluqMl58tcMDmQfsGAyNfiqTPwKe38

2013 Mihura Meta-meta on the CS: APA PsycNet

...and the comment APA PsycNet

...and the response to the comment: APA PsycNet

Summary:
In essence, there is little theoretical and empirical support to connect the dots between performance and personality constructs. When people have tried to develop scoring systems, they largely prove to (1) be unreliable, (2) overly pathologizing, and (3) non-discriminatory (i.e., criteria are too vague for accurate classification). Valid norms (especially now) are also an issue. Because of these issues, the Rorschach is no better at classification than other tools we already have at our disposal hence making it largely irrelevant to clinicians. Proponents will argue that some effects are reliable detectable in some scoring systems (CS; R-PAS) in some situations. Some will also argue that inter-rater reliability among those properly trained is acceptable. But that's different ball of wax than validity, for which the evidence is much weaker.

 

[Sanman]

I had an assessment professor that was a fan of the Rorschach. My view on it, or really any other projective test, is that I have never seen even the biggest proponents administer one without also administering a self-report measure. In an era or cost cutting and reduced admin time, I find it to have little utility in modern psych assessment. I have found the only thing a projective test can successfully predict is the type of position and setting in which the administering clinician practices.

 

[WisNeuro]

What would you say to psychologists who rely on the Rorschach for personality testing versus or alongside other personality assessment measures?

I find that most fellow psychologists I've worked with or talked with haven't used it in years if ever outside go grad school, but I still run into some who think it's the gold standard for personality testing.

I've only ever seen a Rorschach in the wild round these parts from a couple of the diploma millers from the now shuttered program. And, having seen their other work, the projective use is surprisingly the least worst that they are doing to patients.

 

[AcronymAllergy]

Personally, I'd be just be interested in hearing what they actually gain from administering it and ultimately why it seems worthwhile in terms of the invested resources (e.g., time).

 

[PsyDr]

A. It’s a personality test, alright. Just not for the patient.

“What might this be?”
“Large coasters. Wall art. Crappy frisbees. A testament to poor spending habits.”


B. From a perception standpoint, I think the Rorschach is a rudimentary approach to get some interesting, albeit clinically useless, information. I have no idea what someone's preference for negative space means on a pragmatic level. Your generic teenager discovering solipsism knows that individual differences in perception are something. "is your experience of the color blue the same as my experience of blue?" . It's an interesting idea, that really does not contribute to clinical practice.

 

[Doctor Eliza]

A. It’s a personality test, alright. Just not for the patient.

“What might this be?”
“Large coasters. Wall art. Crappy frisbees. A testament to poor spending habits.”


B. From a perception standpoint, I think the Rorschach is a rudimentary approach to get some interesting, albeit clinically useless, information. I have no idea what someone's preference for negative space means on a pragmatic level. Your generic teenager discovering solipsism knows that individual differences in perception are something. "is your experience of the color blue the same as my experience of blue?" . It's an interesting idea, that really does not contribute to clinical practice.

Haha. Good one. 🙂 It's funny because it is true.

 

[smalltownpsych]

I suspect there is a strong correlation amongst Rorschach, psychoanalysis, beards, and tendency to wear corduroy. That being said, one of my professors, who was quite impressive as a clinician and forensic expert, was also a big fan of the Rorschach and she did not fit that mold, but she did have a heavy accent. 😉

 

[R. Matey]

Personally, I'd be just be interested in hearing what they actually gain from administering it and ultimately why it seems worthwhile in terms of the invested resources (e.g., time).

Vibes?

I suspect there is a strong correlation amongst Rorschach, psychoanalysis, beards, and tendency to wear corduroy. That being said, one of my professors, who was quite impressive as a clinician and forensic expert, was also a big fan of the Rorschach and she did it fit that mold, but she did have a heavy accent. 😉

Can you comment on the length of her beard in gifs?

 

[AcronymAllergy]

Vibes?

I wish to find this CPT code for vibes. I will make good use of it.

 

[cara susanna]

I had to learn the Rorschach and Exener system during a grad school prac. Haven't used it since

 

[Sanman]

I had to learn the Rorschach and Exener system during a grad school prac. Haven't used it since

How much money do you think John Exner made off of all us having to be trained on something we never used again?

 

[R. Matey]

How much money do you think John Exner made off of all us having to be trained on something we never used again?

In fairness to Exner, I think his motives were genuine even if his methods turned out to be lemons. This was a person analyzing data right up until his death (per the AP obit anyways).

 

[Sanman]

In fairness to Exner, I think his motives were genuine even if his methods turned out to be lemons.

I don't blame Exner as much as I do a system that requires projective tests to be taught despite near zero utility in the real world. Meanwhile, I have a hard time finding interns and post-docs not specifically shooting for neuropsych that can even write a decent integrated report. Maybe let us update our focus a bit. Granted I graduated a long time a ago, but protectives were non-existent in the real world then too.

 

[ClinicalABA]

Very proud to say that me and classmate were the first students in the recorded history of our grad program to not take the Rorschach class as our Assessment 2 requirement. Meant that I had to come to campus an extra semester to take a child assessment course, but- you know- principles. Kind of worked out for me in the end though, given how I currently pay my bills. My observations- biased as they were- was that the others students got off a bit too much on the whole "secret and mysterious" nature of the whole projective thing, as well as the sense of doing something so classically "psychological." I was frequently labeled as being not very "psychologically sophisticated," as were the clients I typically got assigned to in the training clinic- you know, the ones who were actively seeking symptom reduction rather than attaining some higher level of personal understanding/being from interacting with a first year trainee in a sliding scale training clinic.

 

[R. Matey]

I don't blame Exner as much as I do a system that requires projective tests to be taught despite near zero utility in the real world. Meanwhile, I have a hard time finding interns and post-docs not specifically shooting for neuropsych that can even write a decent integrated report. Maybe let us update our focus a bit. Granted I graduated a long time a ago, but protectives were non-existent in the real world then too.

Agree. It's a huge waste of time to teach when other skills can and should be better developed.

 

[Ollie123]

Agree. It's a huge waste of time to teach when other skills can and should be better developed.

The system doesn't require it, its just certain schools not updating their curriculum and/or making sure their students are eligible for even the crappiest of internship sites.

My Rorschach training consisted of a single lecture where we discussed the merits of it and reviewed the reliability/validity data in contrast with other measures, then had a debate on its place in the field (a debate that was about as one-sided as you'd expect from a program where things like reliability/validity data are considered). Beyond that, they told us if we had personal reasons we needed to intern in NYC or another setting where Rorschach experience was expected, they would help us find an opportunity for us to conduct one. I only know of 2 people who took them up on that (in both cases because they were from NYC, really wanted to move back and wanted to cast a wider net for internship sites), so pretty much no graduates from my program were trained in it. Doesn't seem to have held anyone back🙂

 

[Sanman]

The system doesn't require it, its just certain schools not updating their curriculum and/or making sure their students are eligible for even the crappiest of internship sites.

My Rorschach training consisted of a single lecture where we discussed the merits of it and reviewed the reliability/validity data in contrast with other measures, then had a debate on its place in the field (a debate that was about as one-sided as you'd expect from a program where things like reliability/validity data are considered). Beyond that, they told us if we had personal reasons we needed to intern in NYC or another setting where Rorschach experience was expected, they would help us find an opportunity for us to conduct one. I only know of 2 people who took them up on that (in both cases because they were from NYC, really wanted to move back and wanted to cast a wider net for internship sites), so pretty much no graduates from my program were trained in it. Doesn't seem to have held anyone back🙂

I have not looked at the APA accreditation guidelines on curriculum in a long (since whenever it was my program when through an APA site visit for reaccreditation when I was a student). That said, the reasoning you discuss is interesting as someone that interned in NYC and never gave a Rorschach there. However, we had a lot of students from the tri-state area that wanted to move back. I do wonder if that played a role.

 

[R. Matey]

The system doesn't require it, its just certain schools not updating their curriculum and/or making sure their students are eligible for even the crappiest of internship sites.

Yeah, IIRC--there were some sites in Boston and surrounding areas that wanted people to have experience with projectives ¯\_(ツ)_/¯

 

[PsyDuck90]

Yeah, I went to school in the NY/NJ metro area. The professor who taught our assessment two class in prior cohorts was very focused on the Rorschach, to the point they apparently neglected to spend much time on other assessments throughout the semester. Our cohort was the first to switch to a new faculty member, and we spent maybe 1-2 classes on projective testing in general and moved on to other things. If people wanted more in-depth training on the Rorschach, they opened up an elective that students could take. I opted not to take that, so I completed all my pre-internship training without ever spending more than a few minutes even thinking about the Rorschach. It has not held me back in postdoc (then again, I’m neuro so others’ results may vary).

 

[Ollie123]

Just to clarify, I'm not saying one "needs" Rorschach experience to go anywhere in NYC. Just that NYC, Boston and a few other cities that are really the last remaining strongholds of psychoanalysis/projectives. Those sites also tend to be competitive due to location, so they usually advised applying to more sites than if one was applying more broadly. There were at least a few larger sites there that expected Rorschach experience so doing 1-2 opened some doors in those places.

Also keep in mind this was during the peak of the internship crisis, so match rates were meaningfully lower than they are now and there was a lot more anxiety about the process in general.

 

[docloufan]

If one wants to do this, it should be done during ("incidental to") the psychotherapy/counseling sessions. Essentially and extra hour or so of unbillable time for the provider. It's "grist for the mill" therapy stuff...if it is actually meaningful or beneficial at all. Seems to me that doing this would just "muddy the waters" more than is necessary most times though?

I don't understand how one can justify trying to bill the current Psychological Testing codes for this as they are currently defined?

 

[WisNeuro]

If one wants to do this, it should be done during ("incidental to") the psychotherapy/counseling sessions. Essentially and extra hour or so of unbillable time for the provider. It's "grist for the mill" therapy stuff...if it is actually meaningful or beneficial at all. Seems to me that doing this would just "muddy the waters" more than is necessary most times though?

I don't understand how one can justify trying to bill the current Psychological Testing codes for this as they are currently defined?

People will try to justify anything. Forever ago in my UR review days, I saw a provider try to claim it was necessary to include in an ADHD eval.

 

[AcronymAllergy]

People will try to justify anything. Forever ago in my UR review days, I saw a provider try to claim it was necessary to include in an ADHD eval.

Not to completely derail, but agreed. Back at VA when I would occasionally look at community care referrals, it was not unusual to see community providers request 15-20+ units of 96136/96137 and about half that for 96132/96133 for a standard outpatient neuropsych eval.

 

[Sanman]

Not to completely derail, but agreed. Back at VA when I would occasionally look at community care referrals, it was not unusual to see community providers request 15-20+ units of 96136/96137 and about half that for 96132/96133 for a standard outpatient neuropsych eval.

Can't get what you don't ask for...

 

[AcronymAllergy]

Can't get what you don't ask for...

Oh, yeah, it was always approved