Assignment: Clinical Personality Assessments

Chapter 11

RORSCHACH INKBLOT METHOD

The preceding five chapters have presented the most commonly used self-report inventories for assessing personality functioning. As noted in Chapter 1, inventories of this kind differ in several respects from performance-based personality measures. Self-report inventories provide direct assessments of personality characteristics in which people are asked to describe themselves by indicating whether certain statements apply to them. Performance­ based measures are an indirect approach in which personality characteristics are inferred from the way people respond to various standardized tasks. Self-report and performance­ based methods both bring advantages and limitations to the assessment process, as discussed in Chapters 1 and 2, and there are many reasons personality assessments should ordinarily be conducted with a multifaceted test battery that includes both kinds of measures (see pp. 13-15 and 22-26).

This and the following three chapters address the most widely used performance-based measures of personality functioning: the Rorschach Inkblot Method (RIM), the Thematic Apperception Test (TAT), figure drawing methods, and sentence completion methods. These and other performance-based personality measures have traditionally been referred to as projective tests and are still commonly labeled this way. As pointed out in concluding Chapter 1, however, "projective" is not an apt categorization of these measures, and con­ temporary assessment psychologists prefer more accurate descriptive labels for them such as performance-based.

NATURE OF THE RORSCHACH INKBLOT METHOD

The Rorschach Inkblot Method (RIM) consists of 10 inkblots printed individually on 6 %" by 9 %" cards. Five of these blots are printed in shades of gray and black (Cards I and IV-VII); two of the blots are in shades of red, gray, and black (Cards II and III); and the remaining three blots are in shades of various pastel colors (Cards VIII-X). In what is called the Response Phase of a Rorschach examination, people are shown the cards one at a time and asked to say what they see in them. In the subsequent Inquiry Phase of the examination, persons being examined are asked to indicate where in the blots they saw each of the percepts they reported and what made those percepts look the way they did.

These procedures yield three sources of data. First, the manner in which people structure their responses identifies how they are likely to structure other situations in their lives. People who base most of their responses on the overall appearance of the inkblots and pay little attention to separate parts of them are likely to be individuals who tend to form global impressions of situations and ignore or overlook details of these situations. Conversely,

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people who base most of their responses on parts of the blots and seldom make use of an entire blot are often people who become preoccupied with the details of situations and fail to grasp their overall significance-as in "not being able to see the forest for the trees." As another example of response structure, people who report seeing objects that are shaped similarly to the part of the blot where they are seeing them are likely in general to perceive people and events accurately, and hence to show adequate reality testing. By contrast, people who give numerous perceptually inaccurate responses that do not resemble the shapes of the blots are prone in general to form distorted impressions of what they see, and hence to show impaired reality testing.

As a second source of data, Rorschach responses frequently contain content themes that provide clues to a person's underlying needs, attitudes, and concerns. People who consistently describe human figures they see in the inkblots as being angry, carrying weapons, or fighting with each other may harbor concerns that other people are potentially dangerous to them, or they may view interpersonal relationships as typified by competition and strife. Conversely, a thematic emphasis on people described as friendly, as carrying a peace offering, or as helping each other in a shared endeavor probably reveals a sense of safety in interpersonal relationships and an expectation that people will interact in collaborative ways. In similar fashion, recurrent descriptions of people, animals, or objects seen in the blots as being damaged or dysfunctional (e.g., "a decrepit old person"; "a wounded bug"; "a piece of machinery that's rusting away") may reflect personal concerns about being injured or defective in some way, or about being vulnerable to becoming injured or defective.

The third source of data in a Rorschach examination consists of the manner in which individuals conduct themselves and relate to the examiner, which provides behavioral indi­ cations of how they are likely to deal with task-oriented and interpersonal situations. Some of the behavioral data that emerge during a Rorschach examination resemble observa­ tions that clinicians can make whenever they are conducting interview or test assessments. Whether people being assessed seem deferential or antagonistic toward the examiner may say something about their attitudes toward authority. Whether they appear relaxed or ner­ vous may say something about how self-confident and self-assured they are and about how they generally respond to being evaluated.

The RIM also provides some test-specific behavioral data in the form of how people handle the cards and how they frame their responses. Do they carefully hand each card back to the examiner when they are finished responding to it, or do they carelessly toss the card on the desk? Do they give definite responses and take responsibility for them (as in "This one looks to me like a bat"), or do they disavow responsibility and avoid commitment (as in "It really doesn't look like anything to me, but if I have to say something, I'd say it might look something like a bat")?

To summarize this instrument, then, the RIM involves each of the following three tasks:

1. A perceptual task yielding structural information that helps to identify personality states and traits

2. An associational task generating content themes that contain clues to a person's underlying needs and attitudes

3. A behavioral task that provides a representative sample of an individual's orientation to problem-solving and interpersonal situations

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In parallel to these three test characteristics, Rorschach assessment measures personality functioning because the way people go about seeing things in the inkblots reflects how they look at their world and how they customarily make decisions and deal with events. What they see in the inkblots provides a window into their inner life and the contents of their mind, and how they conduct themselves during the examination provides information about how they usually respond to people and to external demands.

By integrating these structural, thematic, and behavioral features of the data, Rorschach clinicians can generate comprehensive personality descriptions of the people they examine. These descriptions typically address adaptive strengths and weaknesses in how people manage stress, how they attend to and perceive their surroundings, how they form concepts

and ideas, how they experience and express feelings, how they view themselves, and how they relate to other people. Later sections of this chapter elaborate the codification, scoring, and interpretation of Rorschach responses and delineate how Rorschach-based descriptions of personality characteristics facilitate numerous applications of the instrument. As a further introduction to these topics and to the psychometric features of the RIM, the next two sections of the chapter review the history of Rorschach assessment and standard procedures for administering the instrument.

HISTORY

Of the personality assessment instruments discussed in this text, the Rorschach Inkblot Method has the longest and most interesting history because it was shaped by diverse personal experiences and life events. The inkblot method first took systematic form in the mind of Hermann Rorschach, a Swiss psychiatrist who lived only 37 years, from 1885 to 1922. As a youth, Rorschach had been exposed to inkblots in the form of a popular parlor game in tum-of-the-century Europe called Klecksographie. Klecks is the German word for "blot," and the Klecksographie game translates loosely into English as "Blotto." The game was played by dropping ink in the middle of a piece of paper, folding the paper in half to make a more or less symmetrical blot, and then competing to see who among the players could generate the most numerous or interesting descriptions of the blots or suggest associations to what they resembled. According to available reports, Rorschach's enthusiasm for this game, which appealed to adolescents as well as adults, and his creativity in playing it led to his being nicknamed "Klex" by his high school classmates (Exner, 2003, chap. 1).

From 1917 to 1919, while serving as Associate Director of the Krombach Mental Hospital in Herisau, Switzerland, Rorschach pursued a notion he had formed earlier in his career that patients with different types of mental disorders would respond to inkblots differently from each other and from psychologically healthy people. To test this notion, he constructed and experimented with a large number of blots, but these were not the accidental ink splotches of the parlor games. Rorschach was a skilled amateur artist who left behind an impressive portfolio of drawings that can be viewed in the Rorschach Archives and Museum in Bern, Switzerland. The blots with which he experimented were carefully drawn by him, and over time he selected a small set that seemed particularly effective in eliciting responses and reflecting individual differences.

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Rorschach then administered his selected set of blots to samples of 288 mental hos­ pital patients and 117 nonpatients, using a standard instruction, "What might this be?" Rorschach published his findings from this research in a 1921 monograph titled Psychodi­ agnostics (Rorschach, 1921/1942). The materials and methods described by Rorschach in Psychodiagnostics provided the basic foundation for the manner in which Rorschach assessment has been most commonly practiced since that time, and the standard Rorschach plates used today are the same 10 inkblots that were published with Rorschach's original monograph.

Rorschach's monograph was nevertheless a preliminary work, and he was just beginning to explore potential refinements and applications of the inkblot method when he succumbed a year after its publication to peritonitis, following a ruptured appendix. The monograph itself did not attract much attention initially, and the method might have succumbed along with its creator were it not for the efforts of a few close friends and colleagues of Rorschach who were devoted to keeping the method alive. Their efforts were facilitated by the fact that Switzerland in the 1920s was a Mecca for medical scientists and researchers, who visited from many parts of the world to study with famous physicians at Swiss hospitals and medical schools. Some of these visiting scholars and practitioners heard about Rorschach's method while they were in Switzerland and took copies of the inkblots home with them. As a result, articles on the Rorschach were published during the 1920s in such diverse countries as Russia, Peru, and Japan.

Turning to how the Rorschach came to the United States, an American psychiatrist named David Levy went to Zurich in the mid-1920s to study for a year with Emil Oberholzer, a prominent psychoanalyst who had been one of Rorschach's good friends and supporters. Levy returned to the United States with several copies of the inkblots, and that is how the Rorschach came to America. Levy's interests lay elsewhere, and the Rorschach materials languished for a time in his desk at the New York Institute of Guidance. Then, in 1929, Samuel Beck, a graduate student at Columbia University who was doing a fellowship at the Institute, mentioned to Levy that he was looking for a dissertation topic. Levy told Beck about the Rorschach materials he had brought back from Switzerland and suggested that Beck might do a research project with them. Acting on this suggestion, Beck earned his doctorate with a Rorschach standardization study of children. While collecting his data, Beck published the first two English language articles on the method in 1930 (Beck, 1930a, 1930b). He followed these articles 7 years later with Introduction to the Rorschach Met hod, which was the first English language monograph on the Rorschach, and in 1944 with the first edition of his basic text, Rorschach's Test: I. Basic Processes (Beck, 1937, 1944). Throughout a long, productive career, Beck remained an influential figure in Rorschach assessment, and his contributions became internationally known and respected.

In 1934, Beck went to Switzerland for a year's study with Oberholzer, and his departure coincided with the arrival from Zurich of another Rorschach pioneer, Bruno Klopfer. Klopfer had received a doctorate in educational psychology in 1922 and by 1933 had advanced to a senior staff position at the Berlin Information Center for Child Guidance. He also had become interested in Jungian psychoanalytic theory and was in the final phases of completing training as a Jungian analyst. However, the restrictions being placed on Jews in Adolf Hitler's Germany at that time led Klopfer to an advisedly dim view of his future professional prospects in Berlin, and he decided to move to Zurich. Without a job in Zurich, he was helped by Carl Jung to obtain a position as a technician at the Zurich

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Psychotechnic Institute. Klopfer's responsibilities at the Institute included psychological testing of applicants for various jobs, and the Rorschach was among the tests he was required to use for this purpose. He had no previous interest or experience in testing, but

he soon became intrigued with the ways in which Rorschach responses could reveal the underlying thoughts and feelings of the people he was testing.

Klopfer was dissatisfied with his low status as a technician and soon began looking for other opportunities. His search resulted in his being appointed as a research associate in the Department of Anthropology at Columbia University, where he began working in 1934. Having learned of his arrival on campus, a group of psychology graduate students asked their department to arrange for Klopfer to give them some Rorschach training. Unimpressed with Klopfer's credentials, the department declined to hire him for this purpose. The students were not deterred, however, and they approached Klopfer privately about offering some evening seminars for them in his home, which he agreed to do.

Giving these seminars for this and subsequent groups of students and professionals produced a network of Klopfer-trained psychologists who were eager to keep in touch with each other and continue exchanging ideas about the Rorschach. In response to this interest, Klopfer in 1936 founded the Rorschach Research Exchange, which has been published regularly since that time and evolved into the contemporary Journal ofPersonality Assessment. In 1938, Klopfer founded the Rorschach Institute, a scientific and professional organization that continues to function actively today, and more broadly than Klopfer envisioned, as the Society for Personality Assessment. Klopfer's first Rorschach book, The Rorschach Technique, appeared in 1942, but it was not until 1954 that he published his definitive basic text, Developments in the Rorschach Technique: Volume 1. Technique and Theory (Klopfer, Ainsworth, Klopfer, & Holt, 1954; Klopfer & Kelley, 1942).

Because one of them needed a dissertation topic and the other needed a job, then, these two Rorschach pioneers were drawn into a lifetime engagement with the inkblot method. Like Beck, Klopfer gained international acclaim for his teaching and writing about Rorschach assessment. Regrettably for the development of the instrument, Beck and Klopfer approached their work from very different perspectives. Having been educated in an experimentally oriented department of psychology, Beck was interested in describing personality characteristics and was firmly committed to advancing knowledge through controlled research designs and empirical data collection. He stuck closely to Rorschach's original procedures for administration and coding, and he favored a primarily quantitative approach to Rorschach interpretation. With respect to the distinction between nomothetic and idiographic approaches in personality assessment discussed in Chapters 1 (pp. 12-13) and 2 (p. 34 ), Beck was very much in the nomothetic camp.

Klopfer, on the other hand, was a Jungian analyst at heart and an enthusiast for idiography. He had a strong interest in symbolic meanings and with umaveling the phenomenology of each person's human experience. He employed qualitative approaches to interpretation that Beck considered inappropriate, and he added many new response codes and summary scores on the basis of imaginative ideas rather than research data, which Beck found unacceptable.

These differences in perspective led Beck and Klopfer to formulate and promulgate distinctive Rorschach systems that involved dissimilar approaches to administering, scoring, and interpreting the test. Divergence in method did not stop with these two pioneers, however. In the early 1930s, Beck talked about his Rorschach research with Marguerite Hertz, the wife of an old friend of his, who was working on her doctorate in psychology

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at Western Reserve University in Cleveland. Hertz became an ardent enthusiast for the value of Rorschach assessment, especially in working with children. She developed some distinctive variations of her own in Rorschach administration, scoring, and interpretation, and, in the course of a long and productive life as a university professor, she taught her approach to many generations of graduate students and workshop participants.

Klopfer's first seminar group included several psychology graduate students and a friend of one of these students who had encouraged him to sit in. This friend was Zygmunt Piotrowski, who at the time was a postdoctoral fellow at the Neuropsychiatric Institute in New York. Piotrowski had received a doctorate in experimental psychology in Poland in 1927 and was in the United States for advanced study in neuropsychology. Aside from curiosity, he had little interest in Rorschach assessment when he joined Klopfer's seminar group. However, he soon began to contemplate the possibility that persons with various kinds of neurological disorders might respond to the inkblots in ways that would help identify their condition. Piotrowski subsequently pioneered in conducting Rorschach research with brain-injured patients, and he developed many creative ideas about how the inkblot method should be conceived, coded, and interpreted. These new ideas coalesced into a Rorschach system that Piotrowski called Perceptanalysis (Piotrowski, 1957). Like Beck, Klopfer, and Hertz, Piotrowski worked productively throughout a long life during which his courses, publications, and lectures introduced a loyal following to his particular Rorschach system.

This early history of the Rorschach in America came to a close with the arrival in the United States of another refugee from Europe, David Rapaport, a psychoanalytically oriented doctoral-level psychologist who fled his native Hungary in 1938. In 1940, Rapaport joined the staff of the Menninger Foundation in Topeka, Kansas, where 2 years later he became head of the psychology department His responsibilities at the Foundation included mounting a research project to evaluate the utility of a battery of psychological tests for describing people and facilitating differential diagnosis. The Rorschach was part of this test battery, and Rapaport's collaborators in the project included Roy Schafer, who was an undergraduate psychology student at the time and completed his doctoral studies several years later at Clark University, after moving from the Menninger Foundation to the Austen Riggs Center in Massachusetts (see Schafer, 2006).

Rapaport's psychoanalytic perspectives and many original ideas that he and Schafer formed about how to elicit and interpret Rorschach responses resulted in their using a modified inkblot method that differed substantially from any of the previous methods. Publication of a 2-volume treatise based on the Menninger research project and subsequent influential books by Schafer established the Rapaport/Schafer system as another alternative for practitioners and researchers to consider in their work with the Rorschach (Rapaport, Gill, & Schafer, 1946/1968; Schafer, 1948, 1954).

By 1950, then, there were five different Rorschach systems in the United States, each with its own adherents. Moreover, even though the Beck and Klopfer systems had become well-known abroad, the Rorschach landscape also included distinctive systems developed in other countries and popular among psychologists in Europe, South America, and Japan. This diversity of method made it difficult for Rorschach practitioners to communicate with each other and almost impossible for researchers to cumulate systematic data concerning the reliability of Rorschach findings and their validity for particular purposes. This problem persisted until the early 1970s, when John Exner undertook to resolve it by standardizing

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the Rorschach method in a conceptually reasonable and psychometrically sound manner. Having conducted a detailed comparative analysis of the five American systems (Exner, 1969), Exner instituted a research program to measure the impact of the different methods of administration used in the systems and to identify which of their response codes could be explained clearly and coded reliably. Drawing on what appeared to be the best features of each of the five American systems, Exner combined them into a Rorschach Comprehensive System (CS) that he published in 1974 (Exner, 1974).

The Rorschach CS provides specific and detailed instructions for administration and coding that are to be followed in exactly the same way in every instance. Now in its fourth edition (Exner, 2003), the CS has become by far the most frequently used Rorschach system in the United States as well as in many other countries of the world. Widespread adoption of the CS standardization has made possible the development of large sample normative standards and international collaboration in examining cross-cultural similarities and differences in Rorschach responses. The cross-cultural applicability of Rorschach assessment has provided a unique large-scale opportunity to compare and understand different cultures from all over the world (see Shaffer, Erdberg, & Meyer, 2007).

Standard Rorschach procedures have also fostered systematic collection and comparison of data concerning intercoder agreement, retest reliability, and criterion, construct, and incremental validity, both in the United States and abroad, which are reviewed later in the chapter. The advent of the CS has additionally allowed clinicians who use it to exchange information about Rorschach findings with confidence that these findings are based on the same method of obtaining and codifying the data. The next two sections of the chapter provide an overview of the CS administration and coding procedures.

ADMINISTRATION

To preserve standardization for the reasons just mentioned, Rorschach examiners should follow as closely as possible the administration and coding procedures delineated for the CS by Exner (2003). Prior to beginning the testing, as discussed in Chapter 2, the examiner should have discussed with the person being evaluated such matters as the purposes of the assessment and how and to whom the results will be communicated. People are entitled to information about these matters, and even a brief discussion of them can be helpful in establishing rapport, reducing concerns the person may have about being examined, and clarifying misconceptions about the testing process. Typically, the RIM is part of a test battery that can be introduced in general terms such as the following: "As for the tests we 're going to do, I'll be asking you questions about various matters and giving you some tasks to do; let's get started, and I'll show you what each of these tests is like as we do them."

In preparing to administer the RIM, the examiner should have the cards face down in a single pile where they can be seen but not easily reached by the examinee. The examiner should also sit alongside the person or at an angle that is at least slightly behind the examinee and out of the person's direct line of vision. This arrangement makes it easy for people to show the examiner where on the blots they are seeing their percepts. Avoiding face-to-face administration also minimizes the possible influence on test responses of an examiner's facial expressions or other bodily movements. The Rorschach administration should begin

352 Performance-Based Measures

with the following type of explanation:

The next test we're going to do is one you may have heard of. It's often referred to as the inkblot test, and it's called that because it consists of a series of cards with blots of ink on them. The blots aren't anything in particular, but when people look at them, they see different things in them. There are 10 of these cards, and I'm going to show them to you one at a time and ask you what kinds of things you see in them and what they look like to you.

No further explanation should routinely be given of Rorschach procedures or of what can be learned from Rorschach responses. Should examinees ask, "How does this test work?"

they can be told the following: "The way people look at things says something about what they are like as a person, and this test will give us information about your personality that should be helpful in ... [some reference to the purpose of the examination]." Should examinees say something on the order of "So this will be a test of my imagination" or "You want me to tell you what they remind me of?" the perceptual elements of the Rorschach task should be emphasized by indicating otherwise: "No, this is a test of what you see in the blots, and I want you to tell me what they look like to you." If there are no such questions or comments that examiners must answer first, they should proceed directly after their explanation by handing the person Card I and saying, "What might this be?"

People will usually take Card I when it is handed to them and should be asked to do so if necessary. Having people hold the cards promotes their engagement in the Rorschach task, and, as mentioned, the manner in which they handle the cards can be a source of useful behavioral data. In other respects, the individual's task during the Response Phase of the administration should be left as unstructured as possible. In response to questions ("How many responses should I give?" "Can I tum the card?" "Do I use the whole thing or parts of it as well?"), examiners should provide noncommittal replies ("It's up to you"; "Any way you wish"). Should the person begin by saying "It's an inkblot," the examiner should restate the basic instruction: "Yes, that's right, but what you need to do is tell me what it looks like to you, what kinds of things you see in it."

Occasionally, some additional procedures may be necessary to obtain a record of suffi­ cient but manageable length. A minimum of 14 responses is required to ensure the validity of a Rorschach protocol. Records with fewer than 14 responses are too brief to be entirely reliable and rarely support valid interpretations. To decrease the risk of ending up with a record of insufficient length, persons who give only one response to Card I should be prompted by saying, "If you look at it some more, you'll see other things as well." If the person still does not produce more than one response, the single response should be accepted and the card taken back. However, individuals who have given just one or two responses to Card I, and then handed back or put down Cards II, III, or IV after only a single response, can be offered the following indirect encouragement, should they seem disengaged from their task and on their way to producing a brief record with fewer than 14 responses: "Wait, don't hurry through these; we're in no hurry, take your time." Should the Response Phase for all IO cards yield fewer than 14 responses, despite such prompting and encouragement, the examiner should implement the following instructions:

Now you know how it's done. But there's a problem. You didn't give enough answers for us to learn very much from the test. So let's go through them again, and this time I'd like you to give me more responses. You can include the same ones you've already given, if you like, but give me more answers this time through.

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There is also a standard procedure for not taking more responses than are necessary for interpretive purposes. If a person has given five responses to Card I and appears about to give more, the examiner should take the card back while saying, "Okay, that's fine, let's go on to the next one." This procedure can be repeated on each subsequent card, should the person continue to give five responses and appear ready to give more. However, if on any card the person gives fewer than five responses, the limiting procedure should be discontinued and not resumed, even if the person later on gives more than five responses to some card. Exner (2003, pp. 52-56) identifies some unusual circumstances that might warrant departing from these standard guidelines for increasing or curtailing response total, but the procedures presented here suffice with few exceptions to direct the Response Phase of the administration.

Of additional importance in conducting both the Response Phase and the subsequent Inquiry Phase is verbatim recording of whatever the examiner and the examinee say. Accurate coding and thorough interpretation depend on having a complete account of exactly how people expressed themselves and precisely what they were told or asked by the examiner. Most examiners rely on a system of abbreviations to simplify the task of recording a verbatim protocol; for example, using "II a bfly" for "Looks like a butterfly" or "enc" to indicate when they have used the encouragement prompt after getting only one response on Card I. Some examiners tape-record Rorschach administrations to ensure preservation of the verbatim record. Whatever means is used, adequate Rorschach administration demands maintaining the integrity of the raw data. To this end, examiners should write down how examinees behave during the administration as well as what they say (e.g., "laughed," "big sigh," "detached, looking at ceiling") to provide the behavioral data that emich Rorschach interpretation.

Following completion of the Response Phase, the examiner should introduce the Inquiry Phase of the administration as follows:

Now I want to take a moment to go through these cards with you again, so that I can see the things you saw. I'll read back each of the things you said, and for each one I'd like you to tell me where you saw it and what made it look like that to you.

The examiner should then hand the cards to the person one at a time, say for each response something on the order of "On this one you saw ..." or "Then you said ... " or "Next there was ... ," and then complete this statement with a verbatim reading of the person's exact words. Nondirective prompts should then be used as necessary to help people comply with the inquiry instructions by clarifying what they have seen, where on the blot they saw it, and why it looked as it did to them. With respect to what the person has seen, appropriate prompts would include such statements and questions as "I'm not sure what it is you're seeing there," "Is it the whole person or just part of the person?" or "You said it could be a butterfly or a moth-which does it look more like to you?"

To inquire about where the person has seen a percept, the examiner might ask, "How much of the blot is included in it?" or say, "You mentioned a head and a tail, and I'm not clear which part of the blot is which." Should the response to such questions or statements leave unclear where a percept has been seen, examinees should be asked to outline with their finger the area of the blot they were using for it. Inquiry about what made a percept look as it did can take the form of such questions as "What made it look like that to you?" "What helped you see it that way?" or "What about the blot suggested that to you?" In

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each of these aspects of the Inquiry Phase, examiners should strive as much as possible to eliminate ambiguity concerning the what, where, and why of a response, because such ambiguities in responses are the main source of uncertainty in deciding how to code

them. As these nondirective questions and statements illustrate, a paramount principle of con­

ducting a Rorschach inquiry is to avoid leading the examinee or providing clues to what may be expected or desired. For example, "Are the people doing anything?" and "Did the color help you see it that way?" are inappropriate questions, because they can convey that movement and color are important for the person to note. Such messages can influence individuals to articulate more movement or color determinants during the course of an inquiry than they would have otherwise. As a similar precaution against conveying unin­ tended messages, examiners should avoid the question "Anything else?" Asking "Anything else?" can suggest that more is expected from the person, or that something has been left out, either of which can lead individuals to say more than they would have otherwise and thereby detract from the standardization of the administration.

A second guiding principle in conducting the Inquiry Phase concerns its basic purpose, which is to enable accurate coding of the response. With this principle in mind, examiners should stop inquiring about a response once they have obtained enough information to code it. For example, "Two people standing there" is clearly a human movement response that, as indicated in the next section, warrants coding an M. It is neither necessary nor appropriate to ask, "What makes it look like two people standing there?" The additional question in this instance would not generate any information necessary to code an M. Asking such unnecessary questions violates CS standardization and may have the unwanted consequence of eliciting response elaborations that, however interesting, would not have occurred if standard procedures had been followed.

Should a person report, "Two funny-looking people picking up a basket," there is no need to inquire about the human movement, but two other inquiry questions would be called for: "What suggests that the people are funny-looking?" and "What helped you see this part as a basket?" The first question illustrates the importance of inquiring about key words in an individual's responses, particularly nouns, adjectives, verbs, and adverbs that give responses a potentially distinctive flavor. Consider the following examples, with the key words shown in italics: "Two witches dancing" [Inquiry: What suggests they are witches?]; "Two old people dancing" [Inquiry: What makes them look like old people?]; "Two people arguing or fighting" [Inquiry: What helps you see them as arguing or fighting?]; "Two people walking along slowly" [Inquiry: What gave you the idea that they're walking slowly?]. The second question illustrates the importance of inquiring about each part of a complex response. Thus "Animals climbing a tree" requires clarifying the where and the why for both the animals and the tree, "A jet plane with exhaust coming out the back" must be inquired sufficiently to code both the plane and the exhaust, and so on.

CODING AND SCORING

The scoring of a Rorschach protocol is a two-step process. The first step consists of assigning each response a set of codes that identify various features of how the response has been formulated and expressed. The second step consists of combining these response

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This guideline does not preclude person-specific features of card pull that may influence a person's behavior or responses on Card IX. The popular human figures may in some instances pull an impression that they are fighting, in which case Card IX could arouse some concerns about aggression. Similarly, the resemblance of the lower middle red detail of Card IX to female genitals could evoke some sexual concerns that affect a person's manner and responses while looking at this card. Neither of these possible Card IX pulls is as strong or common as the other card pulls identified in this section.

CardX

The broken appearance of Card X and its array of loosely connected but rather sharply defined and colored details give it a close structural resemblance to Card VIII. At the same time, the sheer number of variegated shapes and colors on Card X imbue it with the same type of uncertainty and complexity posed by Card IX. Although Card X is usually seen as a pleasant stimulus and offers examinees many alternative possibilities for easily seen percepts, the challenge of organizing it effectively makes it the second most difficult card to manage, after Card IX. Particularly for people who feel overwhelmed or overburdened by having to deal with many things at once, responding to Card X, despite its pleasant appearance and bright colors, may be a disconcerting experience that they dislike and are happy to complete.

Finally of note is the position of Card X as the final card. Just as the initial response in a record may be a way for people to sign in and introduce what they feel is important about themselves, the last response may serve as an opportunity to sign out by indicating, in effect, "When all is said and done, this is where things stand for me and what I want you to know about me." As a parallel to the example given earlier of a sign-in response, consider the contrasting implications of the following responses for the present status of two depressed persons. The first one concluded Card X by saying, "And it looks like everything is falling apart"; the second one concluded, "And it's brightly colored, like the sun is coming up."

APPLICATIONS

In common with the self-report inventories presented in Chapters 6 through I 0, the RIM is an omnibus personality assessment instrument, in the sense that it provides information about a broad range of personality characteristics. As elaborated in discussing the interpretive significance of Rorschach findings, these data shed light on the adequacy of a person's adaptive capacities in several key respects, on the types of psychological states and traits that define what the person is like, and on the underlying needs, attitudes, conflicts, and concerns that may be influencing the person's behavior. Such information about personality functioning serves practical purposes by helping to identify (a) the presence and nature of psychological disorder, (b) whether a person needs and is likely to benefit from various kinds of treatment, and (c) the probability of a person's functioning effectively in certain kinds of situations.

By serving these purposes, the RIM frequently facilitates making decisions that are based in part on personality characteristics. Such personality-based decisions commonly

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characterize the practice of clinical, forensic, and organizational psychology, the three contexts in which Rorschach assessment finds its most frequent applications.

Clinical Practice

Rorschach assessment contributes to clinical practice by assisting in differential diagno­ sis and treatment planning and outcome evaluation. With respect to differential diagnosis, many states and traits identified by Rorschach variables are associated with particular forms of psychopathology. Schizophrenia is usually defined to include disordered thinking and poor reality testing, and Rorschach evidence of these cognitive impairments (low XA % and WDA %, an elevated WSum6) accordingly indicates the likelihood of a schizophrenia spectrum disorder. Similarly, because paranoia involves being hypervigilant and interper­ sonally aversive, a positive HVI suggests the presence of paranoid features in how people look at their world. Depressive disorder is suggested by Rorschach indices of dysphoria ( elevated C', Col-Shd Bids) and negative self-attitudes ( elevated V, low Jr+ 2/R), obsessive­ compulsive personality disorder is suggested by indices of pedantry and perfectionism (positive OBS), and so on. To learn more about these and other applications of Rorschach findings in differential diagnosis, readers are referred to articles and books by Hartmann, Norbech, and Gr11mner!?)d (2006), Huprich (2006), Kleiger (1999), and Weiner (2003b).

The applications to which the RIM contributes by measuring personality characteristics identify its limitations as well. In assessing psychopathology, Rorschach data are of little use in determining the particular symptoms a person is manifesting. Someone with Rorschach indications of an obsessive-compulsive personality style may be a compulsive hand washer, an obsessive prognosticator, or neither. Someone with depressive preoccupations may be having crying spells, disturbed sleep, or neither. There is no isomorphic relationship between the personality characteristics of disturbed people and their specific symptoms. Accordingly, the nature of these symptoms is better determined from observing or asking directly about them than by speculating about their presence on the basis of Rorschach data.

Likewise, Rorschach data do not provide dependable indications concerning whether a person has had certain life experiences (e.g., been sexually abused) or behaved in certain ways (e.g., abused alcohol or drugs). Only when there is a substantial known correlation between specific personality characteristics and the likelihood of certain experiences or be­ havior having occurred can Rorschach findings provide reliable postdictions, as mentioned. The predictive validity of Rorschach findings are similarly limited by the extent to which personality factors determine whatever is to be identified or predicted.

As for treatment planning, Rorschach findings measure personality characteristics that have a bearing on numerous decisions that must be made prior to and during an intervention process. The degree of disturbance or coping incapacity reflected in Rorschach responses assists in determining whether a person requires inpatient care or is functioning sufficiently well to be treated as an outpatient. Considered together with the person's preferences, the personality style and severity of distress or disorganization revealed by Rorschach findings help indicate whether treatment needs will best be met by a supportive approach oriented to relieving distress, a cognitive-behavioral approach designed to modify symptoms or behavior, or an exploratory approach intended to enhance self-understanding. Whichever treatment approach is implemented, the maladaptive personality traits and the underlying concerns identified by the Rorschach data can help therapists determine, in consultation

Rorschach Inkblot Method 397

with their patients, what the goals for the treatment should be and in what order these treatment targets should be addressed (see Weiner, 2005b).

Some predictive utility derives from the fact that certain personality characteristics mea­ sured by Rorschach variables are typically associated with ability to participate in and benefit from psychological treatment. These personality characteristics include being open to experience (Lambda not elevated), cognitively flexible (balanced a:p), emotionally re­

sponsive (adequate WSumC and Afr), interpersonally receptive (presence of T, adequate SumH), and personally introspective (presence of FD), each of which facilitates engage­ ment and progress in psychotherapy. By contrast, having an avoidant or guarded approach to experience, being set in one's ways, having difficulty recognizing and expressing one's

feelings, being interpersonally aversive or withdrawn, and lacking psychological minded­ ness are often obstacles to progress in psychotherapy (Clarkin & Levy, 2004; Weiner, 1998, chap. 2).

In a research project relevant to the utility of the RIM in guiding therapist activity once treatment is underway, Blatt and Ford (1994) used Rorschach variables to assist in categorizing patients as having problems primarily with forming satisfying interpersonal relationships (called anac/itic) or primarily with maintaining their own sense of identity, autonomy, and self-worth ( called introjective). In the course of their subsequent psychother­ apy, the anaclitic patients studied by Blatt and Ford were initially more involved in and responsive to relational aspects of the treatment than the introjective patients, who were more attuned to and influenced by their therapist's interpretations than by attention to the treatment relationship.

By helping to identify treatment goals and targets, Rorschach assessment can also

be helpful in monitoring treatment progress and evaluating treatment outcome. Suppose that a RIM is administered prior to beginning therapy and certain treatment targets can be identified in Rorschach terms (e.g., reducing subjectively felt distress, as in changing D < 0 to D = O; increasing receptivity to emotional arousal, as in bringing up a low Afr; promoting more careful problem solving, as in reducing a Zd < -3.5). Retesting after some period of time can then provide quantitative indications of how much progress has been made toward achieving these goals and how much work remains to be done on them. Rorschach evidence concerning the extent to which the goals of the treatment have been achieved can guide therapists in deciding if and when termination is indicated. Similarly, comparing Rorschach findings at the point of termination or in a later follow-up evaluation with those obtained in a pretreatment evaluation will provide a useful objective measure of the effects of the treatment, for better or worse.

Both research findings and case reports have demonstrated how Rorschach assessment can be applied in treatment outcome evaluation. In studies reported by Weiner and Exner (1991) and Exner and Andronikof-Sanglade (1992), patients in long-term, short-term, and

brief psychotherapy were examined at several points during and after their treatment. The data analysis focused on 27 structural variables considered to have implications for a person's overall level of adjustment. The results of both studies showed significant positive changes in these Rorschach variables over the course of therapy, consistent with expectation, and the amount of improvement was associated with the length of the therapy. These findings were considered to demonstrate both the effectiveness of psychotherapy in promoting positive personality change and the validity of the RIM in measuring such change.

398 Performance-Based Measures

In a study with similar implications, Fowler et al. (2004) monitored the progress of a group of previously treatment-refractory patients who entered a residential treatment center and were engaged in psychodynamically oriented psychotherapy. After a treatment duration averaging 16 months, these patients showed significant improvement in their

average behavior ratings on scales related to social and occupational functioning, and

these improvements were matched by significant changes for the better in their average scores on three Rorschach scales based on response content. With its thematic imagery

as well as its structural variables, then, Rorschach assessment has been shown to provide valid measurement of treatment progress, while helping to demonstrate the effectiveness of the treatment. Readers are referred to Weiner (2004a, 2005a) for additional discussion of

Rorschach monitoring of psychotherapy and a detailed case study that illustrates positive Rorschach changes accompanying successful psychotherapy.

Forensic Practice

In the clinical applications just discussed, diagnostic inferences derive from linkages be­ tween personality characteristics that typify certain disorders and Rorschach variables that measure these characteristics. In similar fashion, forensic applications of Rorschach as­ sessment in criminal, civil, and family law cases derive from a translation of legal concepts into psychological terms.

In criminal law, the two questions most commonly addressed to consulting psychologists concern whether an accused person is competent to proceed to trial and whether the person can or should be held responsible for the alleged criminal behavior. Being competent in this context consists of having a rational and factual understanding of the legal proceedings one is facing and being able to participate effectively in one's own defense. These principal

components of competency are commonly translated into specific questions such as (a) whether defendants appreciate the nature of the charges and possible penalties they are facing, (b) whether they understand the adversarial process and the roles of the key people in it, (c) whether they can disclose pertinent facts in their case to their attorney, and (d) whether they are capable of behaving appropriately in the courtroom and testifying relevantly in their own behalf (Stafford, 2003; Zapf & Roesch, 2006).

With respect to dimensions of personality functioning, these aspects of competence are most closely related to being able to think logically and coherently and to perceive people and events accurately. Disordered thinking and impaired reality testing, in combination with the poor judgment and inappropriate behavior typically associated with them, can interfere with a person's ability to demonstrate competence. Accordingly, the same Rorschach indices of disordered thinking and impaired reality testing just mentioned in connection with differential diagnosis (low XA % , low WDA % , elevated WSum6), although not sufficient evidence of incompetence, serve two purposes in this regard. They alert the examiner to a distinct likelihood that the defendant will have difficulty satisfying customary criteria

for competency to stand trial, and if a defendant appears incompetent with respect to the applicable criteria, these Rorschach findings help the examiner explain to the court why the person is having this difficulty.

Criminal responsibility refers in legal terms to whether an accused person was legally sane at the time of committing an alleged offense. In some jurisdictions, insanity is defined as a cognitive incapacity that prevented the accused person from recognizing the criminality

Rorschach Inkblot Method 399

of his or her actions or appreciating the wrongfulness of this conduct. Insanity in other jurisdictions is defined either as this type of cognitive incapacity or as a loss of behavioral control, such that the person was unable to alter or refrain from the alleged criminal conduct at the time (Goldstein, Morse, & Shapiro, 2003; Zapf, Golding, & Roesch, 2006).

With respect to personality functioning, cognitive incapacity is measured on the RIM by the previously mentioned indices of disordered thinking and poor reality testing. Behavioral dyscontrol is suggested by Rorschach indices of acute and chronic stress overload (minus D-score, minus AdjD-score), which are commonly associated with limited frustration toler­ ance, intemperate outbursts of affect, and episodes of impulsive behavior. However, because legal sanity is defined by the person's state of mind at the time of an alleged offense, and not at the time of a present examination, Rorschach findings suggesting cognitive impairment or susceptibility to loss of control must be supplemented by other types of information (e.g., observations of defendants' behavior by witnesses to their alleged offense and by the law enforcement officers who arrested them) to serve adequately as a basis for drawing conclusions about criminal responsibility.

In civil law cases involving allegations of personal injury, personality assessment helps to determine the extent to which a person has become emotionally distressed or incapacitated as a consequence of irresponsible behavior on the part of another person or some entity. As prescribed by tort law, this circumstance exists when the potentially liable person or entity has, by omission or commission of certain actions, been derelict in a duty or obligation to the complainant, thereby causing the aggrieved person to experience psychological injury that would otherwise not have occurred (see Greenberg, 2003).

Emotional distress caused by the irresponsible actions of others is often likely to be reflected in Rorschach responses, most commonly in indications of generalized anxiety, stress disorder, depressive affect and cognitions, and psychotic loss of touch with reality.

Persons with Posttraumatic Stress Disorder tend to produce one of two types of Rorschach protocols. Those whose disorder is manifest primarily in the reexperiencing of distressing events and mental and physical hyperarousal tend to produce a flooded pro­ tocol that is notable for the incursions of anxiety on comfortable and effective functioning. The implications of the minus D-score and minus Adj D-score for stress overload can be particularly helpful in identifying such incursions, as can a high frequency of content codes suggesting concerns about bodily harm (e.g., AG, An, Bl, MOR, Sx; see Armstrong & Kaser-Boyd, 2004; Kelly, 1999; Luxenberg & Levin, 2004). Those anxious or traumatized persons whose disorder is manifest primarily in efforts to avoid or withdraw from thoughts, feelings, or situations that might precipitate psychological distress tend to produce a con­ stricted Rorschach protocol that is notably guarded or evasive. Such hallmarks of a guarded record as a low R, high Lambda, low WSumC, andD = 0 tend to increase the likelihood that a person who has been exposed to a potentially traumatizing experience is experiencing a stress disorder characterized by defensive avoidance.

However, neither flooded nor constricted Rorschach protocols are specific to anxiety and stress disorder, nor do they provide conclusive evidence that such a disorder is present. Given historical and other clinical or test data to suggest such a disorder, they merely increase its likelihood. Moreover, as in the case of evaluating sanity, the results of a present personal injury examination are useful only if they can be interpreted in the context of past events. Personal injury cases require examiners to determine whether any currently observed distress predated the alleged misconduct by the defendant and whether this distress

400 Performance-Based Measures

constitutes a decline in functioning capacity from some previously higher level prior to when the misconduct occurred.

Similar considerations apply in the assessment of depressive or psychotic features in plaintiffs seeking personal injury damages. As noted, the DEPI and its several components are helpful in identifying the presence of dysphoric affect and negative cognitions, but they do not provide a dependable basis for ruling out these features of depression. A psychotic impairment of reality testing is indicated by a low XA% and low WDA%, and psychosis can usually be ruled out if these variables fall within a normal range. Lack of evidence of psychosis would counter a plaintiff's claim to have suffered psychological injury, but present indications of psychosis would give little support to such a claim unless other reliable data (e.g., previous testing, historical indications of sound mental health) gave good reason to believe that this person was not psychotic prior to the alleged harmful conduct by the defendant.

Personality assessment also enters into family law cases, in the context of disputed child custody and visitation rights. In determining how a child's time and supervision should be divided between separated or divorced parents, judges frequently make their determination partly on the basis of information about the personality characteristics of the child and the parents. Similarly, in deciding whether persons should have their parental rights terminated, courts often seek information about their personality strengths and weaknesses as identified by a psychological examination. There are no infallible guidelines concerning which of two persons would be the better parent for a particular child, nor is there any perfect measure of suitability to parent. However, certain personality characteristics as measured by the RIM are likely to enhance or detract from parents' abilities to meet the needs of their children. These characteristics pertain to the presence or absence of serious psychological distur­ bance, the adequacy of the person's coping skills, and the person's degree of interpersonal accessibility.

Although having a psychological disorder does not necessarily prevent a person from being a good parent, being seriously disturbed or psychologically incapacitated is likely to interfere with a person's having sufficient judgment, impulse control, energy, and peace of mind to function effectively in a parental capacity. As indicated in presenting interpretive guidelines for the RIM and as previously mentioned in this section on applications, several Rorschach variables help identify such serious disturbance. These include indices of signif­ icant thinking disorder and substantially impaired reality testing (elevated PT/), pervasive dysphoria and negative cognitions (elevated DEP[), overwhelming anxiety (a large minus D-score), and marked suicide potential (elevated S-CON).

As for coping skills, good parenting is facilitated by capacities for good judgment, careful decision making, a flexible approach to solving problems, and effective stress management. Conversely, poor judgment, careless decision making, inflexible problem solving, and inability to manage stress without becoming unduly upset are likely to interfere with effective parenting. Rorschach findings often cast light on the adequacy of a person's skills in each of these respects, as noted in discussing interpretive guidelines: XA% with respect to judgment; Zd with respect to decision making; a:p with respect to problem­ solving approach; and D-score with respect to stress management. This is by no means a definitive or exhaustive list of coping skills relevant to quality of parenting or of Rorschach variables that might prove helpful in evaluating parental suitability. The list nevertheless

Rorschach Inkblot Method 401

illustrates important respects in which Rorschach assessment can be applied in family law consultation.

Finally, with respect to interpersonal accessibility, the quality of child care that par­ ents can provide is usually enhanced by their being a person who is interested in people and comfortable being around them, a person who is nurturing and caring in his or her relationships with others, and a person who is sufficiently empathic to understand what other people are like and recognize their needs and concerns. Conversely, interpersonal disinterest and discomfort are likely to detract from parental effectiveness, as is being a detached, self-absorbed, or insensitive person. In Rorschach terms, then, the likelihood of a person's being a good parent is measured in part by the interpersonal cluster of variables discussed earlier, which means that good parenting is often, though not always, associated with the following seven Rorschach findings:

1. SumH > 3

2. H > Hd + (H) + (Hd) 3. /SOL< .25

4. p <a+ 2

5. T >0

6. COP> 1

7. Accurate M > 2 and M- < 2

In drawing these inferences about interpersonal accessibility, examiners must always keep in mind that such Rorschach findings may suggest how parents are likely to in­ teract with their children, but they are never conclusive. The test data identify probable parental strengths or limitations in interpersonal accessibility that should be considered as evaluators proceed to observe and obtain reports of how parents are functioning. Integra­ tion of Rorschach indications of adjustment level and coping skills with these behavioral observations and reports should always precede coming to conclusions about a person's effectiveness as a parent. Further elaboration of these and other substantive guidelines in forensic Rorschach assessment is provided by Erard (2005), Gacono, Evans, Kaser-Boyd, and Gacono (in press), Johnston, Walters, & Olesen (2005), and Weiner (2005a, 2006, 2007, in press).

Whatever the nature of a forensic case, attention must be paid not only to the substantive interpretation of Rorschach findings, but also to whether testimony based on these findings is admissible into evidence in courtroom proceedings. Applicable criteria for admissibility vary, depending on the particular federal or state jurisdiction in which a case is being tried, and judges have considerable discretion in determining what types of testimony are allowed. As established by published guidelines and case law, the criteria used in individual cases involve some combination of the following considerations: whether the testimony is relevant to the issues in the case and will help the judge or jury arrive at their decision (Federal Rules of Evidence); whether the testimony is based on generally accepted methods and procedures in the expert's field (Frye standard); and whether the testimony is derived from scientifically sound methods and procedures (Daubert standard; see Ewing, 2003; Hess, 2006).

402 Performance-Based Measures

The RIM satisfies criteria for admissibility in all three of these respects. The usefulness of Rorschach-based testimony in facilitating legal decisions is demonstrated by the frequency with which this testimony is in fact welcomed in the courtroom. In a survey of almost 8,000 cases in which forensic psychologists offered the court Rorschach-based testimony, the appropriateness of the instrument was challenged in only six instances, and in only one of these cases was the testimony ruled inadmissible (Weiner, Exner, & Sciara, 1996). Among the full set of 247 cases in which Rorschach evidence was presented to a federal, state, or military court of appeals during the half-century from 1945 to 1995, the admissibility and weight of the Rorschach data were questioned in only 10.5% of the hearings. The relevance and utility of Rorschach assessment was challenged in only two of these appellate cases,

and the remaining criticisms of the Rorschach testimony were directed at the interpretation of the data, not the method itself (Meloy, Hansen, & Weiner, 1997).

More recently Meloy (in press) has examined the full set of 150 published cases in which Rorschach findings were cited in federal, state, and military appellate court pro­ ceedings during the 10-year period from 1996 to 2005. These 150 cases over a 10-year period indicate an average of 15 Rorschach citations per year in appellate cases, which is three times the annual rate of citation found by Meloy et al. (1997) for the preceding 50 years. Along with this greatly increased use of the RIM in appellate courts, the percentage of cases in which these courts recorded criticisms of Rorschach testimony decreased from 10.5% during 1945 to 1995 to just 2% during 1996 to 2005. In not one of these 1996 to 2005 appellate cases was the Rorschach method ridiculed or disparaged by opposing counsel.

The general acceptance of the Rorschach method is reflected in data concerning how frequently it is used, taught, and studied. Surveys over the past 40 years have consistently shown substantial endorsement of Rorschach testing as a valuable skill to teach, learn, and practice. Among clinical psychologists, the RIM has been the fourth most widely used test, exceeded in frequency of use only by the Wechsler Adult Intelligence Scale (WAIS), the Minnesota Multiphasic Personality Inventory (MMPI), and the Wechsler Intelligence Scale for Children (WISC), in that order (Hogan, 2005). Surveys also indicate that over 80% of clinical psychologists engaged in providing assessment services use the RIM in their work and believe that clinical students should be competent in Rorschach assessment; that over 80% of graduate programs teach the RIM; and that students usually find this training helpful in improving their assessment skills and their understanding of the patients and clients with whom they work (see Camara, Nathan, & Puente, 2000; Viglione & Hilsenroth, 2001).

With respect to assessment of young people, 162 child and adolescent practitioners surveyed by Cashel (2002) reported that the RIM was their third most frequently used personality assessment measure, following sentence completion and figure drawing meth­ ods. Among 346 psychologists working with adolescents in clinical and academic settings, Archer and Newsom (2000) found the RIM to be their most frequently used personality test and second among all tests only to the Wechsler scales.

Surveys of training directors in predoctoral internship sites have also identified widespread endorsement of the value of Rorschach testing. Training directors report that the RIM is one of the three measures most frequently used in their test batteries (along with the WAIS/WISC and the MMPI-2/MMPI-A), and they commonly express the hope or expectation that their incoming interns will have had a Rorschach course or at least arrive with a good working knowledge of the instrument (Clemence & Handler, 2001; Stedman, Hatch, & Schoenfeld, 2000).

Rorschach Inkblot Method 403

Survey findings confirm that Rorschach assessment has gained an established place in forensic as well as clinical practice. Data collected from forensic psychologists by Ack­ erman and Ackerman (1997), Boccaccini and Brodsky (1999), Borum and Grisso (1995), and Quinnell and Bow (2001) showed 30% using the RIM in evaluations of competency to stand trial, 32 % in evaluations of criminal responsibility, 41 % in evaluations of personal

injury, 44% to 48% in evaluations of adults involved in custody disputes, and 23% in eval­

uations of children in custody cases. Consistent with these earlier surveys, a more recent report by Archer, Buffington-Vollum, Stredny, and Handel (2006) indicated Rorschach us­ age for all purposes combined by 36% of the forensic psychologists participating in their survey.

As for study of the instrument, the scientific status of the RIM has been attested over many years by a steady and substantial volume of published research concerning its nature and utility. Buros (1974) Tests in Print II identified 4,580 Rorschach references through 1971, with an average yearly rate of 92 publications. In the 1990s, Butcher and Rouse ( 1996) found an almost identical trend continuing from 197 4 to 1994. An average of 96 Rorschach research articles appeared annually during this 20-year period in journals published in the United States, and the RIM was second only to the MMPI among personality assessment instruments in the volume of research it generated. For the 3-year period 2004 to 2006, PsycINFO lists 350 scientific articles, books, book chapters, and dissertations worldwide concerning Rorschach assessment.

There is in fact a large international community of Rorschach scholars and practitioners whose research published abroad has for many years made important contributions to the literature (see Weiner, 1999). The international presence of Rorschach assessment is reflected in a survey of test use in Spain, Portugal, and Latin American countries by Muniz, Prieto, Almeida, and Bartram (1999) in which the RIM emerged as the third most widely used psychological assessment instrument, following the Wechsler scales and versions of the MMPI. The results of surveys in Japan, as reported by Ogawa (2004 ), indicate that about 60% of Japanese clinical psychologists use the RIM in their daily practice. An International Rorschach Society was founded in 1952, and triennial congresses sponsored by this society typically attract participants from over 30 countries and all parts of the world.

With respect to the scientific soundness of Rorschach assessment, the final section of this chapter reviews extensive research findings that document the adequate intercoder agreement and retest reliability of the instrument, its validity when used appropriately for its intended purposes, and the availability of normative reference data for representative samples of children and adults. Significantly in this regard, Meloy (2007) reported in his previously mentioned review, "There has been no Daubert challenge to the scientific status of the Rorschach in any state, federal, or military court of appeal since the U.S. Supreme Court decision in 1993 set the federal standard for admissibility of scientific evidence" (p. 85).

Despite widespread dissemination of this information, some authors have contended that Rorschach assessment does not satisfy contemporary criteria for admissibility into evidence and have discouraged forensic examiners from using the RIM, even to the point of calling for a moratorium on its use in forensic settings (Garb, 1999; Grove & Barden, 1999). These Rorschach critics have not presented any data to refute previous surveys in this regard or to support their contention that the RIM is unwelcome in the courtroom. The ways in which Rorschach assessment has been demonstrated to assist in forensic decision

404 Performance-Based Measures

making are amplified further in contributions by McCann (1998, 2004), McCann and Evans (in press), Ritzier, Erard, and Pettigrew (2002), and Hilsenroth and Stricker (2004).

Organizational Practice

Rorschach assessment in organizational practice is concerned primarily with the selection and evaluation of personnel. Personnel selection typically consists of determining whether

a person applying for a position in an organization is suitable to fill it, or whether a person already in the organization is qualified for promotion to a position of increased respon­ sibility. Standard psychological procedure in making such selection decisions consists of first identifying the personality requirements for success in the position being applied or aspired to, and then determining the extent to which a candidate shows these personality characteristics.

A leadership position requiring initiative and rapid decision making would probably not be filled well by a person who is behaviorally passive and given to painstaking care in coming to conclusions, as would be suggested by Rorschach findings of p > a + I and Zd > + 3.0. A position in sales or public relations that calls for extensive and persuasive interaction with people is unlikely to be a good fit for a person who is emotionally withdrawn and socially uncomfortable, as would be suggested by a low Afr and H < Hd + (H) + (Hd). Among persons being considered for hire as an air traffic controller or a nuclear power plant supervisor, it would support their candidacy to find evidence on personality testing of good coping capacities and the ability to remain calm and exercise good judgment even in highly stressful situations-in Rorschach terms, a person with a high EA, D > = 0, and XA % in the normal range.

Personnel evaluations may also involve assessing the current fitness for duty of persons whose ability to function has become impaired by psychological disorder. Most common in this regard is the onset of an anxiety or depressive disorder that prevents people from continuing to perform their job or practice their profession as competently as they had previously. Impaired professionals seen for psychological evaluation may also have had difficulties related to abuse of alcohol, drugs, or prescription medicine. Because Rorschach data can help identify the extent to which people are anxious or depressed and whether they are struggling with more stress than they can manage, the RIM can often contribute to determining fitness for duty and assessing progress toward recovery in persons participating in a treatment or rehabilitation program.

Violence in the workplace has also given rise in recent years to frequent referrals for fitness-for-duty evaluations, usually in the wake of an employee's making verbal threats or acting aggressively on the job. Estimation of violence potential is a complex process that requires careful consideration of an individual's personality characteristics, interper­ sonal and sociocultural context, and previous history of violent behavior (Monahan, 2003 ). Personality characteristics do not by themselves provide sufficient basis for concluding that someone poses a danger to the safety and welfare of others. However, there is reason to believe that certain personality characteristics increase the likelihood of violent behavior in persons who have behaved violently in the past and are currently confronting annoying or threatening situations that on previous occasions were likely to provoke aggressive reac­ tions on their part. Following is a list of personality characteristics and Rorschach findings

Rorschach Inkblot Method 405

identified earlier in the chapter that help identify them (see also Gacono, 2000; Gacono & Meloy, 1994).

1. Being a selfish and self-centered person with a callous disregard for the rights and feelings of other people and a sense of entitlement to do and have whatever one wants (e.g., Fr+ rF > 0 and Jr+ (2)/R elevated).

2. Being a psychologically distant person who is generally mistrustful of others, avoids intimate relationship, and either ignores people or exploits them to one's own ends (e.g., HVI, T = 0, low SumH, COP = 0 with AG > 2).

3. Being an angry and action-oriented person inclined to express this anger directly (e.g., S > 3, a > p, extratensive EB).

4. Being an impulsive person with little tolerance for frustration, or a psychologically disturbed person with impaired reality testing and poor judgment ( e.g., D < 0, AdjD < 0,XA% and WDA% low).

Neither these personality characteristics nor the Rorschach variables associated with them are specific to persons who show violent behavior. Even among people who exhibit all these characteristics and Rorschach findings, moreover, many or most may never consider physically assaulting another person. However, in persons with a history of violent behavior who are exposed to violence-provoking circumstances, each of these characteristics and findings increases violence potential risk. The more numerous these characteristics and findings, and the more pronounced they are, the greater is the violence risk they suggest.

PSYCHOMETRIC FOUNDATIONS

As mentioned in discussing the history of Rorschach assessment, the blossoming of vari­ ous Rorschach systems in the United States and abroad enriched the instrument for clinical purposes, but at a cost to its scientific development. The many Rorschach variations cre­ ated by gifted and respected clinicians limited cumulative research on the psychometric properties of the instrument prior to Exner's 1974 standardization of coding and adminis­ tration procedures in the Comprehensive System (CS). Subsequent widespread use of the CS in research and practice has fostered substantial advances in knowledge concerning the psychometric soundness of the RIM, particularly with respect to its intercoder agreement, retest reliability, validity, and normative reference base.

Intercoder Agreement

In constructing the Rorschach CS, Exner included only variables on which his coders could achieve at least 80% agreement, and subsequent research confirmed that the CS variables can be reliably coded with at least this level of agreement. However, measuring intercoder reliability by percentage of agreement is a questionable procedure, because this method does not take account of agreement occurring by chance. With this consideration in mind, Rorschach researchers began in the late 1990s to assess intercoder reliability with two statistics that correct for chance agreements, kappa and intraclass correlation coefficients

416 Performance-Based Measures

Major Rorschach indices of psychological disturbance include the X-% (an index of im­ paired reality testing) and the WSum6 (an index of disordered thinking). If X-% and WSum6 are valid measures of disturbance, they should increase in linear fashion across these four reference groups-and they do, as shown by the Exner (2001, chap. 11) reference data.

A second example of construct validity demonstrated by the normative reference data concerns developmental changes in young people. The previously noted increasing stability of Rorschach structural variables from childhood into adolescence, consistent with the grad­ ual consolidation of personality characteristics, is a case in point. Among specific changes occurring with maturation, young people are known to become less self-centered (less egocentric) and increasingly capable of moderating their affect (less emotionally in­ tense). The RIM Egocentricity Index is conceptualized as a measure of self-centeredness, and the balance between presumed indices of relatively mature emotionality (FC) and relatively immature emotionality (CF) is conceptualized as an indication of affect moderation.

If these variables are valid measures of what they are posited to measure, their average values should change in the expected direction among children and adolescents at different ages-and they do. In the CS reference data, the mean Egocentricity Index of .67 at age 6 decreases in almost linear fashion to .43 at age 16, which is just slightly higher than the adult mean of .40. The mean for FC increases steadily over time from 1.11 at age 6 to 3.43 at age 16 (compared with an adult mean of 3.56), while the mean for CF decreases from 3.51 to 2.78 between age 6 and 16 (the adult mean is 2.41).

The present chapter has been concerned mainly with the Rorschach assessment of adults and older adolescents. In closing the chapter, it is important to note that the RIM can also be used to good effect in evaluating children and early adolescents. Assessors working with young people will profit from consulting Erdberg (2007), Exner and Weiner (1995), and Leichtman ( 1996) in this regard.

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