Convergence in a multi-method study between Rorschach and self-report data of traumatized refugees assessed before and after psychotherapy.

Rorschach and self-report instruments represent methodologically different types of assessment, which together may yield incremental information about the test-taker. There is little evidence on whether and when results from these methods converge. OBJECTIVE: To examine possible convergences between Rorschach trauma-related personality variables and self-reported variables. METHOD: Before and after psychotherapy 22 traumatized adult refugee patients were assessed with the Rorschach Performance Assessment System (R-PAS), symptom checklists of posttraumatic stress, anxiety and depression, and a quality of life questionnaire. Correlational analyses between eight R-PAS variables and 10 self-reported variables were performed. RESULTS: The findings showed inconsistent and nonsignificant correlations pretherapy. Posttherapy, however, all R-PAS variables except Complexity correlated positively with symptoms of mental disorder, and negatively with the quality of life variables, as predicted. The R-PAS variables Mutuality of Autonomy-Pathology, Poor Human Representation, Critical Content, and Form Quality-minus%, converged significantly with most of the self-reported variables, with medium to large correlations. CONCLUSION: The finding of convergence only after psychotherapy, may tentatively suggest greater self-knowledge and internal consistency through the therapy experience, and increased trust and self-disclosure through the repeated meetings with the researchers. The findings represent a promising contribution to a cumulative validation process of convergence between Rorschach and self-report data.

Traumatized Refugees in Psychotherapy: Long-Term Changes in Personality, Mental Health, Well-Being, and Exile Life Functioning.

ABSTRACT: This pre- and posttreatment study of 22 severely traumatized adult refugees spanned a mean of 6.5 years. Changes in personality functioning, mental health, and well-being were examined using the Rorschach Performance Assessment System, Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the World Health Organization's Quality of Life-BREF questionnaire. A paired samples t-test revealed significant improvement after psychotherapy in traumatic ideation and initial severe disruptions in thought processes, reality testing, perception, self and other representations, and relational capacity (Cohen's d = 0.46-0.59). Symptoms of anxiety, depression, and posttraumatic stress were significantly reduced (d = 0.54-0.84), quality of life in the physical health and psychological health domains increased significantly (d = 0.87 and 0.97), and percentage of participants with exile language proficiency and work/study status increased significantly. The findings demonstrate the potential of psychotherapy to contribute to normalizing perceptual, cognitive, and relational capacities in severely traumatized refugees, paramount to well-being and functioning in exile.

Rorschach Assessment of Two Distinctive Personality States of a Person With Dissociative Identity Disorder.

This case study used test data from a patient with Dissociative Identity Disorder (DID; American Psychiatric Association, 2013 ) to illustrate how two main personality states of the patient ("Ann" and "Ben") seemed to function. The Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011 ) and the Inventory of Interpersonal Problems-Circumplex (IIP-64; Horowitz, Alden, Wiggins, & Pincus, 2000 ), administered to Ann and Ben in separate settings, exposed two diverse R-PAS and IIP-64 profiles. Ann's R-PAS profile suggested an intellectualized style of information processing with few indications of psychological problems. Ben's profile indicated severe perceptual, cognitive, and interpersonal difficulties combined with suspicion and anxiety. Ann's IIP-64 profile suggested minor interpersonal problems, whereas Ben's indicated serious relational difficulties. The findings were discussed in relation to the theory of trauma-related structural dissociation of the personality (van der Hart, Nijenhuis, & Steele, 2006 ), which implies an enduring split in the organization of the personality with more or less separate entities with their own sense of self, perception of the world, and ways of organizing emotional, cognitive, and social functions. The DID personality structure is seen as a defense strategy and as a pathway in the personality development producing serious psychological pain and symptoms.

Incarcerated Violent Offenders' Ability to Avoid Revealing Their Potential for Violence on the Rorschach and the MMPI-2.

Recently, Hartmann and Hartmann (2014) found that psychiatric outpatients, both with and without access to Internet-based information about the Rorschach Inkblot Method (RIM; Weiner, 2003 ) and the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989 ), were unable to imitate healthy test performance on these tests. We replicated the study by administering the RIM and the MMPI-2 to 63 incarcerated violent offenders using similar testing conditions. As in the previous study, comparisons were made not only among the 3 subgroups of incarcerated offenders, but also between these offender groups and the group of nonpatients examined in the previous study. On the RIM, Internet-coached and uncoached "faking good" offenders produced records with significantly higher F% and X-% and significantly lower M, m, SumC, X+%, P, AG, and COP than nonoffenders under standard instructions (effect sizes between d = 0.24 and d = 2.39). For AgC, AgPot, AgPast, and TCI% there were no significant differences between the faking offenders and the nonoffenders under standard instructions. On the MMPI-2 clinical scales, there were no significant differences between the faking good groups and the nonoffenders under standard instructions, except on Hs, Pd, and Sc. Both faking groups were identifiable by their high L scale scores. Although both faking groups managed to avoid giving responses with aggressive and generally psychopathological content on the RIM, they were unable to produce test profiles demonstrating healthy test performance on any of the tests; nevertheless, Internet-based test information might weaken test validity.

Relationship of Pretreatment Rorschach Factors to Symptoms, Quality of Life, and Real-Life Functioning in a 3-Year Follow-Up of Traumatized Refugee Patients.

Response to mental health treatment varies highly among refugee patients. Research has not established which factors relate to differences in outcome. This study is a follow-up of Opaas and Hartmann's (2013) Rorschach Inkblot Method (RIM; Exner, 2003) pretreatment study of traumatized refugees, where 2 RIM principal components, Trauma Response and Reality Testing, were found descriptive of participants' trauma-related personality functioning. This study's aims were to examine relationships of the RIM components with measures of anxiety, depression, posttraumatic stress, quality of life (QOL), employment, and exile language skills throughout 3 years. We found that impaired Reality Testing was related to more mental health symptoms and poorer QOL; furthermore, individuals with adequate Reality Testing improved in posttraumatic stress symptoms the first year and retained their improvement. Individuals with impaired Reality Testing deteriorated the first year and improved only slightly the next 2 years. The results of this study imply that traumatized refugee patients with impaired Reality Testing might need specific treatment approaches. Research follow-up periods should be long enough to detect changes. The reality testing impairment revealed by the RIM, mainly perceptual in quality, might not be easily detected by diagnostic interviews and self-report.

Identification With a Violent and Sadistic Aggressor: A Rorschach Study of Criminal Debt Collectors.

This study examined personality functioning in a group of 27 incarcerated criminal debt collectors as assessed by the Rorschach Inkblot Method (RIM; Rorschach, 1921/1942) and the Psychopathy Checklist-Revised (PCL-R; Hare, 2003 ). To explore whether these individuals represent a distinct subgroup within the violent offender population, we compared them to a group of incarcerated homicide offenders (n = 23) without a previous history of significant violence and a group who had committed less serious violent crimes (n = 21). Results revealed significantly more Rorschach indicators of past trauma (Trauma Content Index), aggressive urges (Aggressive Potential) and identification (Aggressive Content) among the debt collectors than the 2 other groups. In addition, debt collectors displayed significantly more interpersonal interest (Sum Human content), and significantly higher scores on the PCL-R. Our findings suggest that the debt collector might be viewed as a hostile variant of psychopathy.

The impact of exposure to Internet-based information about the Rorschach and the MMPI-2 on psychiatric outpatients' ability to simulate mentally healthy test performance.

To examine the impact of Internet-based information about how to simulate being mentally healthy on the Rorschach (Exner, 2003) and the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 87 psychiatric outpatients completed the tests under 4 conditions: uncoached and Internet-coached outpatients under faking healthy instructions (faking patients and Internet-faking patients) and patients and nonpatients under standard instructions (standard patients and standard nonpatients). On the Rorschach, faking patients and Internet-faking patients did not manage to portray healthy test performance and, like standard patients, revealed a significantly greater number of perceptual and cognitive disturbances than standard nonpatients. Faking patients scored in the psychopathological direction on most variables. Internet-faking patients produced constricted protocols with significantly higher F% (57%) and lower use of provoking and aggressive contents than the other groups. On the MMPI-2, faking patients and Internet-faking patients were able to conceal symptoms and, like standard nonpatients, scored in the normal range on the clinical scales. The validity scale L successfully detected the faking patients and the Internet-faking patients, whereas the F scale only distinguished the Internet-faking patients and K only the faking patients. We conclude that Internet-based information could threaten test validity.

Self-protective strategies, violence and psychopathy: theory and a case study.

Although it has been proposed that attachment is a key factor in psychopathy and violence, conceptualization of its potential role remains limited. This article uses the dynamic-maturational model of attachment and adaptation (DMM; Crittenden, 2008 ) and a case study to illustrate an etiological model of psychopathy and violence. The Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984 -1996), coded according to the DMM system (Crittenden & Landini, 2011 ), was used to identify the participant's self-protective attachment strategies, and to explore indexes indicating opportunities for change. To allow a more elaborated understanding of this participant's personality, AAI findings were compared and contrasted with the Rorschach method (Rorschach, 1921 /1942). The AAI indicated unresolved loss and trauma, alternation between delusionally idealizing dismissive (Type A) and menacing-paranoid entangled (Type C) strategies, possible depression, and the potential for reorganization. The Rorschach showed many similarities with the AAI findings. Implications for the understanding of psychopathy, violence, and treatment are presented.

Rorschach assessment of traumatized refugees: an exploratory factor analysis.

Fifty-one multitraumatized mental health patients with refugee backgrounds completed the Rorschach (Meyer & Viglione, 2008), Harvard Trauma Questionnaire, and Hopkins Symptom Checklist-25 (Mollica, McDonald, Massagli, & Silove, 2004), and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL Group, 1998) before the start of treatment. The purpose was to gain more in-depth knowledge of an understudied patient group and to provide a prospective basis for later analyses of treatment outcome. Factor analysis of trauma-related Rorschach variables gave 2 components explaining 60% of the variance; the first was interpreted as trauma-related flooding versus constriction and the second as adequate versus impaired reality testing. Component 1 correlated positively with self-reported reexperiencing symptoms of posttraumatic stress (r = .32, p < .05). Component 2 correlated positively with self-reported quality of life in the physical, psychological, and social relationships domains (r = .34, .32, and .35, p < .05), and negatively with anxiety (r = -.33, p < .05). Each component also correlated significantly with resources like work experience, education, and language skills.

Rorschach variables and dysfunctional attitudes as measures of depressive vulnerability: a 9-year follow-up study of individuals with different histories of major depressive episodes.

Forty-six individuals with different histories of major depressive episodes (MDEs) completed the Rorschach (Exner, 2003 ) and the Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978) at 2 assessment points (T1, T2) over a 9-year follow-up. At T1, history of MDE and the Rorschach variable MOR (associated with negative self-image) emerged as significant predictors of number of MDEs over the follow-up. At T2, Rorschach markers of depressive vulnerability and scars were identified (i.e., WSum6, related to illogical thinking; X+%, related to conventional perception and social adjustment; X-%, linked to erroneous judgments; MQ-, associated with impaired social relations; and MOR). Test-retest analyses displayed significant temporal stability in Rorschach variables, with r ranging from .34 to .67 and in the DAS, r = .42. Our findings highlight MDE as a recurrent and serious disorder, number of MDEs as a risk factor for future depressions, and Rorschach variables as markers of depressive vulnerability and scars.

Under Skinner's skin: gauging a behaviorist from his Rorschach protocol.

Behaviorism and psychodynamic psychology have been regarded as polar opposites. Contrary to popular belief, B. F. Skinner took an interest in Freud and many of his concepts, and agreed to be tested with the Rorschach method and the Thematic Apperception Test by Roe in her study of scientists (Roe, 1953 ). We looked for signs of creativity defined as complex responses, an intriguing emotional tone, novelty, and liveliness. Skinner displayed an enormous number of responses characterized by simplicity, an intellectualized tone, a driven quality rather than creative complexity, and a sense of strained social relationships and lack of liveliness. The findings are in line with Roe's study of other scientists. Skinner's intellectual productivity and high ambition fits well with the commanding figure history describes.

The role of maternal attachment in children's attachment and cognitive executive functioning: a preliminary study.

The influence of maternal attachment on children's attachment and executive functioning skills through maternal sensitivity and decentered tutoring were studied in 40 middle-class mother-child dyads. Infant attachment security in the Strange Situation Procedure was related to maternal attachment security, evaluated with the Adult Attachment Interview. When the children were six-seven months of age, maternal sensitivity was evaluated. When the child was six years old, maternal decentered tutoring and the children's executive functioning were evaluated. Regression analyses indicated that maternal tutoring accounted for the association between maternal attachment and child cognitive functioning, whereas maternal sensitivity accounted for the association between maternal and child attachment.

Rorschach variables and Big Five scales as predictors of military training completion: a replication study of the selection of candidates to the naval special forces in Norway.

We tested 140 male candidates at the Naval Special Forces (NFS) of Norway on the Rorschach (Exner, 2003; Rorschach, 1921/1942) and the Norwegian version of the Big Five personality dimensions (Engvik & Føllesdal, 2005). Rorschach variables significantly correlated with training completion (effect sizes of r(e) = .14-.25), whereas none of the Big Five factors or facets did. The combination of Rorschach and Big Five variables framed in the illusory mental health concept provided strong predictive ability. Testing under stress produced slightly higher predictive validity coefficients between the Rorschach variables and pass-fail than under calm testing. The findings support the results of Hartmann, Sunde, Kristensen, and Martinussen (2003), indicating that Rorschach variables and indications of good mental health may be valid predictors of NFS training.

Assessment of substance abusers on the MCMI-III and the Rorschach.

We examined 60 substance abusers (SA) on the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) and on eight Rorschach variables from the Comprehensive System (CS; Exner, 2003). On the MCMI-III, SA scored above the cutoff for clinical significance (M > or = BR 70) on Drug Dependence (94.77), Antisocial (82.95), Depressive (74.33), Self-Defeating (71.48), and Alcohol Dependence (70.70). On seven of the CS variables (M+,o,u, XA%, X-%, WSum6Lv2%, M-%, SumT%, and Pure H%) the scores of the SAs suggested significant more psychopathology compared to the scores of 60 university students, whereas the SA's scores on six of these variables (M+,o,u, XA%, X-%, WSum6Lv2%, SumT%, and Pure H%) suggested significantly less psychopathology compared to the scores of 36 schizophrenics. The effect sizes for the significant differences were in the small, medium and large range (d= 0.31 to d= 1.87).

Psychopathic and nonpsychopathic violent offenders on the rorschach: discriminative features and comparisons with schizophrenic inpatient and university student samples.

We examined discriminant and convergent validity of theoretically relevant Rorschach Comprehensive System (CS) variables (Exner, 2003) and Meloy and Gacono's (1992) aggression variables in distinguishing between imprisoned violent offenders (VO) who were psychopathic (P-VO) and nonpsychopathic (NP-VO) under psychiatric treatment, schizophrenic inpatients (ISs), and university students (USs). A total of 7 of 12 variables discriminated significantly between P-VO and NP-VO, which suggests more aggressive, cognitive, and interpersonal disturbances among P-VO. We also found significant differences between VOs, ISs, and USs. Logistic regression analyses revealed that AgPast accumulated incrementally in the classification of P-VO versus NP-VO, and AgC accumulated incrementally in the classification of VO versus IS when entered after CS variables. The findings support the view that psychopathy is a distinctive form of antisocial personality disorder (Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) organized at a more severe pathological level.

Depression and vulnerability as assessed by the Rorschach method.

We examined clinically depressed (CD; n = 16), previously depressed (PD; n = 19) and never depressed (ND; n = 18) individuals on 13 theoretically selected Rorschach (Exner, 1993; Rorschach, 1942) variables and on the Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979). The group assignment was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). We tested 2 contradictory models for depressive vulnerability, Beck's (Clark & Beck, 1999) and Miranda and Persons's (1988; Persons & Miranda, 1992), in a planned comparison design with focused contrasts. The CDs significantly contrasted the combined group of NDs and the PDs in a pathological direction on 8 of the 13 Rorschach variables and on the BDI. However, the combined group of CDs and PDs also significantly contrasted the NDs in a pathological direction on 3 of these Rorschach variables and on the BDI. In addition, logistic regression analyses indicated that Rorschach indexes significantly improved the prediction of major depression above and beyond that achieved by the BDI. The findings show that the Rorschach method was able to identify (a) cognitive and aggressive disturbances that are present in individuals who are actively depressed but not in individuals who have been depressed in the past or never been depressed and (b) affective and coping disturbances that are present in depressed individuals and to some degree in PD individuals but not in individuals who have not experienced depression. We discuss the scanty evidence of psychological disturbances in PD individuals, as measured with the Rorschach, in relation to the mood-state dependent hypothesis of Miranda and Persons (1988; Persons & Miranda, 1992).

Rorschach administration: a comparison of the effect of two instructions given to an inpatient sample of drug addicts.

The effect of administering the Rorschach Inkblot Method under two instructional sets was compared on three classes of outcome variables: the frequency with which subjects asked questions about the test; the frequency of brief protocols (fewer than 14 responses); and 17 traditional Rorschach structural summary scores. Sixty subjects, obtained from three inpatient psychiatric clinics treating drug addicts, randomly received either the short pre-testing instruction "What might this be?" originally developed by Herman Rorschach and recommended in the Comprehensive System, or a longer and more elaborated instruction, which for many years has been the standard instruction in Norway. Compared with the Norwegian instruction, the short instruction produced significantly more questions to the examiner about the test. For the other outcome measures no differences were observed.

Psychological measures as predictors of military training performance.

The predictive validity of 7 ability tests, the Big Five, and the Rorschach method administered to 71 male applicants at the Naval Special Forces (NSF) of Norway was evaluated based on pass/fail results in training. The findings showed: (a) small correlations between the ability tests, the Big Five scales, and the success criterion; (b) Rorschach variables measuring stress tolerance, reality testing, cognition, and social adjustment correlated significantly (r =.25 to.48) with pass/fail results in training, and (c) logistic regression analysis revealed that 3 of the Rorschach variables accumulated incrementally in the prediction of training completion when entered after the ability tests and the Big Five scales, thus supporting the merit of using Rorschach variables for predicting NSF training performance

Motivations and concerns of women considering genetic testing for breast cancer: a comparison between affected and at-risk probands.

Since the discovery of the BRCA1 and BRCA2 genes, there has been an increasing demand for breast cancer risk assessment programs. In an effort to understand and serve the population such programs target better, several studies have identified factors influencing high-risk women to pursue breast cancer risk assessment and genetic testing services; none, however, has focused on how the motivations and concerns of at-risk women may differ from their previously affected counterparts, who are typically the initial members of their families to undergo genetic testing. The majority of both previously affected and unaffected women felt that preventative surgery decisions, surveillance practices, the assessment of children's risks, and increased breast cancer anxiety were "more important" or "very important" issues regarding their thoughts about genetic testing. Significantly more affected women deemed family members' opinions "more" or "very important" (p < 0.01). Opinions concerning insurance and employment discrimination did not vary significantly between groups; however, a larger percentage of affected women felt this issue was of importance. Although all issues above should be addressed with women seeking cancer risk assessment and genetic testing, this research may help health care providers to gain a greater understanding of how the motivators and concerns of high-risk women can differ with personal cancer status so that referral, counseling, and education can be executed optimally.