When is the last time you administered a Rorschach?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Sanman, Feb 6, 2014.

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  1. erg923

    erg923 Psychologist 10+ Year Member

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    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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  3. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    .
     
    Last edited: Feb 7, 2014
  4. erg923

    erg923 Psychologist 10+ Year Member

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    Ok. Well, none of that made much sense (to me anway), but none of it attempted to defend your actions either (obviously you can't know if your patient was the one who actually completed the MMPI if they are instructed to complete it at home and obvioulsy you can't KNOW that they didn't make a hundred copies of it- e.g., code 9.11), so I will assume you are rethinking this practice? If so, we can now move on.
     
  5. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    Ok. The kinks just came singing "paranoia, the destroyer" ...so I edited my last couple of posts. :cool: And I've rethought it.
     
  6. Neuropsych2be

    Neuropsych2be 7+ Year Member

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    I am doing my internship (APA accred) at a large inpatient psych facility that is part of a regional medical center. The facility primarily treats the SPMI population. They are located in a rural area in the south. Much to my surprise, they are very fond of the Rorschach. But the site is very open to psychodynamic work. I am administering about 2 or 3 per month. I have tons of prior experience with the Rorschach and like the technique (I don't actually consider it a test per se but rather a technique). I am experienced enough with it that I can basically code most of the the responses in my head. The other predoctoral interns think its real creepy! :) :) I view it as a rich source of hypotheses about the patient. But like most techniques, its only a source of highly tentative hypotheses that may need to be explored further. I'd love to get R-PAS training because there are many things about Exner that are cumbersome. Of course it helps to have a copy of the scoring software because to derive a structural summary by hand is a real mf''er! That would make the Rorschach unworkable in the modern fast paced world of clinical psychology because of the time constraints.
     
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  7. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Whoah, apparently I missed some action last night. N2Be, if it is a technique, what exactly does this technique do in a clinical setting? And where is the research to back that up?

    More specifically, what kinds of hypotheses are you getting that you wouldn't get in a good clinical interview?
     
    Last edited: Feb 8, 2014
  8. paramour

    paramour 7+ Year Member

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    Not sure it really matters, but I should clarify that I *believe* most of the professionals administering the interviews, projectives, etc. were social workers. There WAS some other data that reviewed in making their decisions, but there also were enough references to the projectives in decision-making that flabbergasted me. Regardless, I still cringed (even during undergrad) while entering this data. I'd review 200+ page records of these folks, including very descriptive accounts of their crimes, and then notice that some of the arguably worst of the bunch were reduced to the lowest "level," whereas some of the milder situations were really slapped with a lot. It made absolutely no sense to me.

    As far as a conviction being the only requirement that sticks someone on the registry, I have found this to be a fairly common belief. Typically during conversations along "oh, I didn't find anyone on the state registry when searching for offenders near my home," so we're all safe. Not so.

    At least in the state where I worked (other states likely have their own requirements), one could be convicted for any variety of crimes of sexual misconduct and not be on "the list." Our sex offenders were evaluated and assigned to different risk levels on/after their conviction. Depending on their risk level, they may or may not be on the registry. There also are those on the registry who would typically not be on it HAD they been evaluated but for whatever reason skipped their evaluation. It really isn't the be all & end all of every sex offender in the state. They may be registered, or they may not be.

    For registered sex offenders, they are required to report any relocation. So, if they are convicted in the state of X and move to the state of Y, they are required to report that information so that the registries in both states can be updated. But, this does NOT necessarily mean that there is additional "monitoring" of them on an ongoing, regular basis as some might think. Their daily movements aren't being tracked, just their place of residence.

    AGAIN, I fully recognize that other states may handle their classification, registries, policies & procedures re: offenders differently. This was simply my experience in ONE state.
     
  9. psychologyman

    psychologyman

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    Psychology will never be considered a science, no matter how hard we try.
     
  10. erg923

    erg923 Psychologist 10+ Year Member

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    Psychology is, by definition, a science. Feel free to look it up.

    The practice of applying its principles to human suffering will always have both aspects, but we are masters of our own destiny when it comes to our own practice standards, no? Perhaps if more practitioners used more of the science and less of the art? What do you think?
     
    Last edited: Feb 8, 2014
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  11. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    *edit* found this:

    the Ethics Code and the Standards require that:

    • All test administrators receive proper training (Ethics Code 9.07; Standards 12.8)
    • Tests not be administered by unqualified persons (Ethics Code 9.07; Standards 12.8)
    • All examinees receive proper informed consent (Ethics Code 9.03; Standards 12.10)
    • Test data be kept confidential and secure (Ethics Code 9.04; Standards 12.11)
    • Assessment techniques be protected from disclosure to the extent permitted by law (Ethics Code 9.11; Standards 12.11)
    Let me mull over what was done, wasn't done and will be done in the future. Thanks for discussion.
     
    Last edited: Feb 8, 2014
  12. erg923

    erg923 Psychologist 10+ Year Member

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    Your ethical obligations supersede a hospital policy that allows this sort if thing, Cheetah! Its doesnt matter that they "allow" something or not, or that they "suggest" it or not. Please see code 1.03. What does this tell us?

    As far as insurance fraud, it is fraud to both overbill AND underbill time. Your post indicated you (your org) was doing this to save time within the evaluation? No? So, in fact, this was NOT part of your evaluation since you did not use your professional time for it (they did it at home at their leizure). If you billed for the time, its fraud. Conversely, you have essentially artificially underreported time spent for the evaluation. That is fraud.
     
    Last edited: Feb 8, 2014
  13. erg923

    erg923 Psychologist 10+ Year Member

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    What do you mean you just found this? Aren't you applying for internship? With all due repect, this is day one (year one) type stuff here.

    With regard to the "reasonable doubt" comment you made before, its more than reasonable if there is any incentive for the patient to present in a particular way. Right? And, that's a sizeable chunk of clinical evaluations, actually. Right? Moreover, if you can't even swear under oath that the responses actually came from the client, what the hell is the point in using and then interpreting that measure?! It thows the integrity of the whole evaluation off, or at least into serious question. Your whole expert testimony would crash before it even begins.
     
    Last edited: Feb 8, 2014
  14. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    Understood. I had not committed code 9.11 to memory (so I meant I just found the code # with procedure). These codes are consistent with my training. I responded quickly last night wanting to address the issue of the time to administer the ROR. I'm going to drop this conversation now. There's a wonderful proverb my husband says: "It's better to keep quiet and (maybe) look like a fool, then to open your mouth and remove all doubt."

    I'm certainly no fool but feeling foolish by continuing this online conversation, k?
     
    Last edited: Feb 8, 2014
  15. erg923

    erg923 Psychologist 10+ Year Member

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    Fair. I suppose it just concerns me that, given you seem to have been doing alot of assesment pracs, supervisors wouldn't have absolutely hammered section 9 into your head, if not the entire ethics code, frankly. Assessment is a litigous practice setting.
     
  16. PSYDR

    PSYDR Psychologist 10+ Year Member

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    Cheetah, all billing is done for face to face time and report writing. If you are writing anything about a take home mmpi, you are committing insurance fraud. I can't tell what you wrote, but I would sure writing an admission of a federal crimson ack outer that logs your home ip and mac addresses is a bad idea.
     
  17. erg923

    erg923 Psychologist 10+ Year Member

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    My addition to this would again be, while I think its jut wonderful that you are getting so many "rich," process-oriented and/or diagnostic hypothoses from these Ror sessions, this aint about you. I can say all 50 states in alphabetic order in under 30 seconds, by whoop, wanna fight about it? Unfortunatley, I have not been able to find an actual use/application for this amazing skill. So, unless you can translate all this stuff into useful treatment info for the patient...well, you get the idea.

    In my experience talking with Ror folks (or reading reports that include it), 90% of the interpetation/"valuable info" is NOT applied to treatment plans or even potentially useful in treatment, especially focused treatments, which, like it or not, is what the clincial scientist kids are doing these days. In other words, the patient is no worse for ware with or without it in most cases. And that is really the important part that I think is getting lost here.

    Here is the quote from Paul Meehl's bio that I referenced earlier. Turns out it was about the TAT:

    "I did some T.A.T.’s on Dr. B. C. Schiele’s well-heeled private patients, which was interesting and paid well but left me wondering just how much it helped the patient."
     
    Last edited: Feb 8, 2014
  18. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    Yeah, I'm a little pissed...not at you, erg923, or PSYDR, but at the whole convoluted crap (now I'm the potty mouth) in general. I love assessment (thankfully I like practicing therapy more), but this one point we've been discussing does make me rethink what's going with the legality of it all versus actual practice. I suppose I should refer back to WisNeuro's acturial vs insightful judgment article.

    And PSYDR, I'm not that paranoid. I doubt Medicaid will search and secure my ip address (is that what you were saying?) to plan a coup against my institutions. But, thank you for your concern as I now politely zip it.
     
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  19. erg923

    erg923 Psychologist 10+ Year Member

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    Last post on this, promise.

    Look, I dont know what settings you have been in, but NONE of this is convoluted at all. Its pretty black and white as far as ethical concerns come in this field. You have an obligation to know when you are violating an ethics code and an obligation to inform the instituition of that their policy or "suggestions" violate one of your ethics standards of practice (and fight it to best your ability). APA Code-1.03 The breech of code 9.11 is crystal clear in the practice you describe. There is no real room for debate there. I suppose there could be some debate about this practice violating 9.06, but to me its pretty clear it does. Billing for time that was not face-t0-face and done during your professional time with the patient is clearly fradulent. That is also very clear. Again, NONE of this is convoluted or ambigious.
     
    Last edited: Feb 8, 2014
  20. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    *Last reply, too, and thanks again for the discussion. I would much rather discuss this here than with a new internship director who is like "Oh Lord, who is this clueless wonder?" Which I am not, but appeared to be in past posts.*

    My reference to convoluted has to do with what is 'legal and ethical' and what is done in training at some institutions. I agree that the law is black and white, but humans in practice are not (which is with we back up practice with science). I understand my obligations as a clinician (albeit, thus far in training), and I have always maintained the highest ethical standards, but when you are in training and instructed to follow protocol, it is blasphemous when some avoidable errors are made. I can assure you under oath that nothing fraudulent occurred. Perhaps errors were made 1% of the time, but nothing so severely egregious that it warrants my defensive replies...I'm just trying to make sense of what we've been discussing and, now debating/doubting what I previously reported in haste.

    Have a terrific afternoon. I'll head off to the comfort of my pack and lick my wounds.
     
    Last edited: Feb 8, 2014
  21. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Exactly. Now, I believe certain, outdated aspects of psychology, are not science. But, our empirically supported interventions and our empirically supported assessment techniques are just as much science as many medical diagnostic tests and treatments. In fact, we have MUCH better sensitivity/specificity than some widely used medical diagnostics.
     
  22. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    And if we're going to talk about other fields, I'm sure chemists say that physics isn't a real science, physicists say biology isn't a real science, and all of them say theoretical mathematicians are off their rockers.
     
  23. PhDToBe

    PhDToBe 7+ Year Member

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    I couldn't see all of the posts, but what about when we send assessments to teachers for them to fill out (via mail or parent)...technically we can't say for sure that the teachers definitely filled them out, right? Are we supposed to go to the teachers' houses or schools and have them do it in person? I am just wondering. I don't normally work in settings like the one I just described and don't plan to in the future, but I know that this has been done. It just seems somewhat similar to what has been discussed.
     
  24. erg923

    erg923 Psychologist 10+ Year Member

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    I will be honest in that I am not really an assessment person, so I wasnt aware this was a practice that was done. Its is not something I would do. Any collateral information I have ever collected/used, or seen done by supervsiors was in either in-person or via phone call initaited by me.
     
    Last edited: Feb 8, 2014
  25. futureapppsy2

    futureapppsy2 Postdoctoral fellow Gold Donor SDN Moderator 7+ Year Member

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    A behavior checklist=/=something like the MMPI or the WAIS or WISC. They operate under two very different levels of test security.
     
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  26. Sanman

    Sanman O.G. 10+ Year Member

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    Wow, I step away from this thread for a day and it has become quite the discussion. Regarding test security, as futureapppsy mentioned, behavior checklist designed to be given to teachers are a bit different. That said, one may still contact the teacher and mail the checklist directly to them. If a school psychologist is using it, obviously it can be given directly to the teacher. Very little of those answers affect an assessment. Most are to ensure that the behaviors seen are in more than one setting as required for certain diagnoses.
     
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  27. Neuropsych2be

    Neuropsych2be 7+ Year Member

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    I call the Rorschach a technique because the task does not lend itself to the derivation of important psychometric measures like validity and reliability because each administration is unique with a different number of responses and potentially a limitless number of unique responses to the stimuli. In my opinion you can't really call it a psychological test per se, so I conceptualize it as a task or technique. Exner strongly disliked it being called a projective test and preferred to call it a cognitive-perceptual task. It falls on the idiothetic rather than the nomothetic end of things. The point can be made that every assessment technique does not need to be, nor should be, a nomothetic measure. Kelly's repertory grid technique comes to mind as an example of a purely idiothetic measure..

    As far as hypotheses, they involve things such as available ego strength, psychological resources, how the respondent manages affect, cognitive style, what is their reality testing like, is the person a suicide risk etc ... There is a significant body of published research exploring the validity of some of the Rorschach indices one example being the suicide scale. Others have very little research conducted on them What is exciting about the new R-PAS scoring and interpretative system is that they are including only those indices that has a strong evidence base. Can the Rorschach give me more information than a clinical interview??? Probably not. However, it would need to be a be very long interview or set of interviews. :) But there are situations where a respondent's defenses are such that other things like an MMPI-2 or PAi just don't yield much information.

    That being said, the technique has limitations. The results do not yield a diagnosis but rather a complex description of personality function. The Rorschach also does not lend itself to targeted interventions particularly well. This is another weakness.
     
    Last edited: Feb 9, 2014
  28. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    But, if there are no correlates of the Rorschach responses to anything reliable and valid, how do you even know that those hypotheses you are making are accurate in any way? At best, it seems like you are using it to confirm some ideas that you may already have about the person, perhaps leading to a confirmation bias. Again, I posit the question, why should this be used in any clinical context, especially where there is some aspect of patient care and billing going on?>

    Also, the Rorschach predictors are not very good at picking up on suicide over and above the BDI. Considering it is a low base rate behavior, we are terrible at picking up on it anyway, but that particular instrument, technique, whatever, does not do a good job over and above shorter, more reliable and valid measures.
     
  29. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    As promised. This article sums up my original debate (not the latter argument, but former viewpoint). Author holds a doctorate in biomedical engineering (which is not psychology, but he holds an interesting perspective about the Rorschach). I had some of the same references to share, so here's the online text below. The underlines of are courtesy of me. ;) It all boils down to what is the clinical/evaluation referral question and what is your focus? For my intended purpose (protective technique/instrument for personality assessment), it is a good measure. For you WisNeuro, maybe not so much. Different foci.

    Source cited: http://www.brainmaster.com/kb/entry/489/

    Title: The Rorschach - Reliability and Validity

    Author: Thomas F. Collura

    The Rorschach is a psychometric tool that uses a series of inkblots shown to a subject, and elicits verbal responses as to what the individual sees in the images. It is administered by an examiner who asks questions and records answers. Based upon the subject responses, a set of variables can be determined, which are used to define their personality along a set of various axes. It is intended to elicit accurate information of diagnostic value in clinical work. There is an enormous literature on the Rorschach, yet it remains, after nearly 100 years, a controversial instrument. This report discusses the reliability and validity of the Rorschach, based upon a review of relevant literature.


    Based upon published reports, the Rorschach can be regarded as a reliable and valid psychometric instrument, given that certain conditions are met. One is that it is administered by an experienced, competent, and trained examiner. Another condition is that a known and structured method of assessment be used. Of the structured methods, there are more than one option. The most widely recognized system is the Comprehensive System (CS) described by Exner (1993). A final condition is that it be applied with a suitable population and with an appropriate purpose of diagnosis or assessment, for which validity has been demonstrated.

    Reliability depends on the ability to achieve a given measurement consistently (Weiner & Greene, 2008). Viglione and Taylor (2003) specifically examined this issue using the Comprehensive System. They reported that in their own study, among 84 raters evaluating 70 Rorschach variables, there was a strong inter-rater reliability, particularly for the base-rate variables. They also reviewed 24 previously published papers, all reporting various inter-rater reliabilities. Most of these studies reported reliabilities in the range of 85% to 99%. Aside from inter-rater reliability, test-retest reliability is another important consideration. Exner (as cited in Groth-Marnat, 2009, pp. 389-90) reported reliabilities from .26 to .92 over a 1-year interval considering 41 variables; four of them were above .90, 25 between .81 and .89, and 10 below .75. However, the most unreliable variables were attributed to state changes. It was further noted that the most relied upon factors, ratios and percentages, were among the most reliable. Therefore, it can be concluded that the Comprehensive System can yield high reliability when used under the conditions applied in these studies.

    Validity depends on the ability of a test to measure the constructs that it is purported to measure (Wiener & Greene, 2008). Validity in this case can be evaluated by comparing the Rorschach with clinical data or with other established tests of personality. Weiner (2001), for example, stated that the Rorschach has a validity effect size “almost identical” to the MMPI (Weiner, 2001, p. 423). Groth-Marnat (2009, p. 391) has pointed out that results of validity studies on the Rorschach have been mixed, but are confounded by various factors including the “type of scoring system, experience of the scorer, and type of population.” Early studies produced validity scores of .40 to .50, but later studies found scores as low as 0.29. However, such studies were further confounded by variables such as age, number of responses, verbal aptitude, education, and other confounding factors that were not controlled.

    More recent studies of validity have met with mixed results. Smith et al. (2010) evaluated the validity of the Rorschach in assessing the effects of trauma using a different system, the “Logical Rorschach” developed by Wagner (2001, as cited in Smith et al., 2010). They found “equivocal” findings, but indicated that the LR “may have some validity in the assessment of trauma-related phenomena.” Wood et al. (2010) evaluated the Rorschach using a meta-analysis of 22 studies including 780 forensic subjects, in an attempt to separate psychopaths from nonpsychopaths. They reported a mean validity coefficient of 0.062 using all variables, and a validity of 0.232 using the Aggressive Potential index. They concluded that their findings “contradict the view that the Rorschach is a clinically sensitive instrument for discriminating psychopaths from nonpsychopaths.” (Wood et al., 2010, p. 336). Another result was reported by Lindgren, Carlsson, and Lundback (2007) in which they found no agreement between the Rorschach and a self-assessed personality using the MMPI-2.

    This leaves the question then, that if the Rorschach is relatively reliable, what is it measuring if it is not the same dimensions as, for example, the MMPI, or forensic psychopathology? Hilsenroth, Eudell-Simmons, DeFife, and Charnas (2007) did find, for example, that the Rorschach was effective in differentiating psychotic disorder patients from non-patients, as well as from personality disorder patients. They concluded that the test had clinical meaningfulness for diagnosis and assessment in this population. In another study, Liebman, Porcerelli, and Abell (2005) reported a validity coefficient of 0.71 in 150 adolescents when comparing the Rorschach aggression variables with the Violence Rating Scale – Revised. Porcelli and Mihura (2010) evaluated the Rorschach Alexithymia Scale (RAS) as a specific index to identify alexithymia in a psychiatric population. They studied 219 patients and reported a hit rate of 92%, sensitivity of 88%, and a specificity of 94%. These findings taken together confirm the validity of the Rorschach, but also highlight the importance of identifying the scoring system and population when evaluating the validity of the Rorschach.

    The Rorschach has certainly had its detractors. Grove, Barden, Garb, and Lilenfeld (2002) presented a particularly negative summary view of the Rorschach, and concluded that it should not generally be admitted in court testimony. They based this conclusion largely on a meta-analysis of a large number of studies, and made use of such observations as that it is “engulfed in intense scientific controversy,” that there have been “heated exchanges between advocates and critics,” and “a majority (indeed, in all likelihood, a substantial majority) of the relevant scientific community does not view the RCS as a reliable system.” They cite weaknesses such as inadequate norms, overestimation of psychopathology and maladjustment, and unacceptable reliabilities in the .45 to .56 range. However, these global indictments do not necessarily apply to a particular practitioner or group using the Rorschach in a consistent manner with a particular population, with adequate control of variables. This analysis would also have included earlier studies which, as pointed out by Rose, Kaser-Boyd and Maloney (2001), used nonstandard administration and different scoring systems. Therefore, these conclusions apply more to inadequacies in the existing base of published literature and the possibility of widespread inconsistency in Rorschach research and application, not to the lack of potential reliability and validity of the test when it is properly applied.

    Therefore, the conclusion can be made that the Rorschach is reliable when evaluated using a defined rating scale and an appropriate set of examiners. Inter-rater reliability and test-retest reliability can be acceptable under these conditions. Validity can also be demonstrated, but it depends on further factors that relate predominantly to the population and intended use. In certain cases such as forensic psychopathology or as an alternative to the MMPI, it has been demonstrated to have questionable validity in studies. In other cases, such as trauma, it has been shown to have some demonstrated validity. In still others, such as psychiatric issues of psychosis and perception or violent adolescents, it has greater demonstrated validity. My summary conclusion is that the Rorschach, when properly used, can be reliable. Its validity depends on the specific population and intended use, and this can vary from relatively poor to quite good. Weiner (2001, p. 423) therefore makes a fair and applicable statement when he concludes that the Rorschach “works very well for its intended purposes.”

    References

    Exner, J.E. (1993) The Rorschach: A comprehensive system: Vol. 1. Basic foundations (3rd ed.). New York Wiley.

    Groth-Marnat, G. (2009). Handbook of psychological assessment (5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

    Hilsenroth, M. J., Eudell-Simmons, E. M., DeFife, J. A., & Charnas, J. W. (2007). The Rorschach Perceptual-Thinking Index (PTI): An Examination of Reliability, Validity, and Diagnostic Efficiency. International Journal Of Testing, 7(3), 269-291. doi:10.1080/15305050701438033

    Rose, T., Kaser-Boyd. N., & Maloney, M. P. (2001). Essentials of Rorschach assessment. New York: John Wiley& Sons, Inc.

    Liebman, S. J., Porcerelli, J., & Abell, S. C. (2005). Reliability and Validity of Rorschach Aggression Variables With a Sample of Adjudicated Adolescents. Journal Of Personality Assessment, 85(1), 33-39. doi:10.1207/s15327752jpa8501_03

    Lindgren, T., Carlsson, A., & Lundbäck, E. (2007). No agreement between the Rorschach and self-assessed personality traits derived from the Comprehensive System. Scandinavian Journal Of Psychology, 48(5), 399-408. doi:10.1111/j.1467-9450.2007.00590.x

    Musewicz, J., Marczyk, G., Knauss, L., & York, D. (2009). Current assessment practice, personality measurement, and rorschach usage by psychologists. Journal Of Personality Assessment, 91(5), 453-461. doi:10.1080/00223890903087976

    Porcelli, P., & Mihura, J. L. (2010). Assessment of alexithymia with the Rorschach comprehensive system: the Rorschach Alexithymia Scale (RAS). Journal Of Personality Assessment, 92(2), 128-136. doi:10.1080/00223890903508146

    Viglione, D. J., & Taylor, N. (2003). Empirical support for interrater reliability of rorschach comprehensive system coding. Journal Of Clinical Psychology, 59(1), 112-121.

    Weiner, I. R. (2001). Advancing the science of psychological assessment: The Rorschach Inkblot Method as exemplar. Psychological Assessment, 13(4), 423–432.

    Weiner, I. B., & Greene, R. L. (2008). Psychometric foundations of assessment. In Handbook of personality assessment (1st ed., pp. 49–75). Hoboken, NJ: John Wiley & Sons,Inc. Copyright 2008 by John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc. in the format electronic usage via the Copyright Clearance Center.

    Wood, J. M., Nezworski, M., Allen, K., Lilienfeld, S. O., Garb, H. N., & Wildermuth, J. L. (2010). Validity of Rorschach Inkblot Scores for Discriminating Psychopaths From Nonpsychopaths in Forensic Populations: A Meta-Analysis. Psychological Assessment, 22(2), 336-349. doi:10.1037/a0018998

    Smith, S. R., Chang, J., Kochinski, S., Patz, S., & Nowinski, L. A. (2010). Initial validity of the logical rorschach in the assessment of trauma. Journal Of Personality Assessment, 92(3), 222-231. doi:10.1080/00223891003670174
     
  30. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    That just rehashes the whole "Rorschach is good at "diagnosing" schizophrenia" argument and doesn't provide much detail or go into covering the main criticisms of Wood and Lilienfeld. I'm still curious as to it's concurrent validity for use as a personality assessment device. What might this give you, empirically supported, that you are using to guide or revise your treatment approach?
     
  31. LivingOffLoans

    LivingOffLoans 2+ Year Member

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    I have heard of several instances where the administration of a Rorschach and/or TAT, when used in combination with other assessments that demonstrate good reliability and validity, really helped to pull all of the data together. In these instances, I imagine it was worth the headache involved in scoring and interpreting the data. It really all depends on the person being assessed, their presenting issue, what the assessment is being used for, etc...

    Side note: Does anyone else notice the interesting 'Similar Threads' topics below? ;)
     
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  32. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Where is the data for this though? One of the major critiques of the projectives is that practitioner "projects" onto them. More specifically, they use them to come up with conclusions that they already believe in, they just interpret these instruments to coincide with those already drawn conclusions.
     
  33. LivingOffLoans

    LivingOffLoans 2+ Year Member

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    I am going off of memory from an assessment class I took in a master's program, and several cases we reviewed in class with an excellent neuropsychologist who also teaches at the doctoral level. I honestly couldn't, and did not claim to be able to, support the idea that projectives are useful in combination with standardized assessments according to the literature. But if there is literature on this, I would be just as interested to see it as you would.

    I personally am not of the group that believes projectives are useless, but then again, I do not have doctorate level training at this point. So, who am I to say?
     
  34. erg923

    erg923 Psychologist 10+ Year Member

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    I think there are exceedingly few instances where this notion of a "rick, deep, and comprehensive understanding of personality function" is needed or useful, frankly. Sorry grad students, but its true.

    Forensic cases, in which case a measure where the sensitivity and specificity is unknown (supposedly) would not be appopriate, and preparing for a couple years on the couch. Thats about all that I can think of. Not that we shouldn't try to understand our patients and continue to gather info throughout treatment, but I find the above notion to be shaky (on empirical grounds) and not a particularly necessary ingredient for sucessful treatment in most cases. It's certainly not a mindset that psychologist can or should bring to intergrated primary care/mental healthcare system. Its just not pragmatic.
     
    Last edited: Feb 10, 2014
  35. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    In line with what erg, WisNeuro, and others have mentioned, I think the main question being asked here (and that honestly needs to be asked with every assessment, every time) is this--does the Rorschach (or insert other instrument name) justify its use, in the context of such things as the costs associated with administering and scoring it, by reliably/validly providing enough information above and beyond what we would expect to gain with the other instruments included in our assessment, and in a way that leads to direct benefit for the patient?

    In a more neuropsych-oriented example, could I administer the full Halstead-Reitan (or maybe even just something like the TPT) to a particular patient? Sure, I could. But what's the point? What do I hope to gain by administering that measure that I wouldn't gain by my other measures, and if the person's performance falls in the impaired or not impaired range, how is that actually going to influence my conclusions (if at all)?
     
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  36. Sanman

    Sanman O.G. 10+ Year Member

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    I think that this is the question I had in mind when starting this thread and it really extends to other areas of clinical practice as well. Is there any real world utility to the Rorschach today? I have not seen any in the settings I work in, but have been curious about the experience of others. Is it just the given due to clinician preference rather than any clinical utility it might add to improve treatment? From my experiences, while it may be helpful in a few isolated cases, I have yet to see any reason to use it.
     
  37. Jake0006

    Jake0006

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  38. Jake0006

    Jake0006

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    I've heard of this too, years ago when I was doing music therapy with a sex offender program. It seemed to work for the clinician who was working with that population. It can be said that there are a lot of strange things about this work, but the use of the polygraph is pretty strange too. They use the polygraph to identify add'l victims which have been undisclosed, but of course there is a "high" level of people who can beat the poly. I say "high" because it's one out of 20 or something like that, but in real practice, that is a lot.
     
  39. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    We're not too different from other medical/academic disciplines in that a small proportion of our people still practice things that are irrelevant, outdated, or have been long proven to be pseudoscience.
     
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  40. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    Did I write that above?

    What's up with this thread?

    I still stand behind my words above if talking about the ROR, as "It is a projective test that should be combined with other psychometric exams, and not taken alone."
     
  41. psych.meout

    psych.meout

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    There be necromancers afoot.

    One thing I actually like about users resurrecting long-dead threads is that I get to read old stuff I would have otherwise missed entirely.
     
  42. CheetahGirl

    CheetahGirl Clinical Psychologist 10+ Year Member

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    Yeah, I suppose. I must've had some extra time, to be copying and pasting like I did up. Yikes.
     
    Last edited: Jul 16, 2017
  43. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    FTFY ;)
     
  44. Jake0006

    Jake0006

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  45. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    People are taught a smattering of everything in many programs. We had to administer and score it in my program, then we read all of the pro/con literature on it. It's still used in several pockets here and there, but seems to be slowly dying the death it so rightfully deserves with the other parlor games of psychology past.
     
  46. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    I've seen it provide relevant information a handful of times (when administered by others, as I'm no expert), which lines up with other assessment data, but as the research suggests, it's very possible that this information could've been obtained via less-onerous methods. For better or worse, it still seems to hold a bit of a mystique. Especially with treatment-resistant and/or malingering-suspected cases.
     
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  47. smalltownpsych

    smalltownpsych 2+ Year Member

    I believe there is some truth to the concept of projection in that how we interpret things relates to prior experiences and current emotional states and there is a wealth of literature to support that. Addressing some of that is part of what psychotherapy is about. Nonetheless, I don't find the Rorschach to be an effective instrument for assessing that as opposed to exploring core beliefs and perceptions of real world situations in the patients life or even in the therapy room.
     
  48. Jake0006

    Jake0006

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    It is really a useful part of the psychodynamic perspective, the whole phenomenological view, experience (vicarious and direct) contributing to the person's belief system, thus their projections (or cognitive and cognitive distortion). It seems the literature is growing to show that the more projection, regardless of its truth, the less happiness the individual is likely to experience, generally considered a part of the mindfulness-CBT perspective addressing 'lack of presence.' Mindfulness is an absence of projection and reticence to access beliefs unless they're absolutely a great fit for the moment and are useful. Reviewing the literature on mindfulness in such circumstance, the assessments they're using to measure this still seem a work in progress (at least to me). When it is being said that the ROR isn't a great way to measure this projective mechanism within the patient, what are the assessments that are eclipsing the ROR in modern practice? I'm not familiar with a good, specific measure, I have always just addressed such through addressing cognitive distortions.
     
  49. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 5+ Year Member

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    Wow, old thread. Slow summer I guess?

    I'm glad I never had to learn projective testing except in a historical context.

    I have been on the receiving end of a Rorschach during a consultation. It was my first time seeing this psychologist and I had no clue she'd pull that out. That, and some other behaviors, made it hard for me to take her seriously and I didn't go back.
     
  50. smalltownpsych

    smalltownpsych 2+ Year Member

    I don't know if there is a measure to assess how much a person distorts reality. I don't find the Rorschach to be more sensitive or specific to this than my own subjective assessment or better yet comparing patient's reports to more objective facts. For me a test is useful when it provides information that I could not easily obtain some other way and the Rorschach doesn't appear to meet that from my view. I often don't find other personality measures to be that useful; for a similar reason.
    These are the kind of threads I find to be an enjoyable distraction from the actual stressors of real-world practice. :)
     
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  51. psych.meout

    psych.meout

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    The problem with polygraph tests is not one of sensitivity, i.e. false negatives failing to identify actual lies. The true problem is with specificity, i.e. false positives that people are lying. People who are not lying are perceived to be lying because of certain patterns in their autonomic physical responses. There isn't good construct validity that these autonomic responses are indicators of lying, especially as they are also clearly correlated with anxiety and stress. You know, like the anxiety and stress people have when they are assessed, especially when there are legal consequences like incarceration or even capital punishment.

    What? Mindfulness is the absence of projection and reticence to access beliefs? Do you have a source for this?

    Wouldn't mindfulness be the lack of attachment to projections, not their absence? One would notice that projections, cognitive distortions, and other cognitions are occurring just as they would other sensory impressions, like sights, sounds, pain, etc.
     

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