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Friday, April 19, 2013

Rorschach Test Presentation Summary


Outline of inkblot test administration example

  • Hi, I’m ________ and I will be presenting the Rorschach test
  • My presentation will contain information on both the traditional and modern approaches to administering, scoring and interpreting Rorschach test results, but first I want to tell you a little about why and how the Rorschach test was created
    • Rorschach never mentioned how much he knew about previous research pertaining to the inkblot technique, but he was interested in art and had a father who taught drawing
    • He expressed an interest in a children’s game called Blotto (recap from class)
      • Many people have speculated why Rorschach decided to use inkblots for more than entertainment purposes and among these people was his wife. According to his wife, Rorschach’s interest in using blotto for psychological purposes was sparked by his former classmate, who became a teacher and used inkblots to encourage his students engage in creative writing. Rorschach’s wife thought that the children’s responses made him wonder how  they were related to personality traits
      • Rorschach worked with adolescents in a psychiatric hospital and thought it was interesting that the kids he worked with provided different responses to the same inkblots when playing Blotto
      • Wanted to see what people with schizophrenia saw in inkblots that he had randomly created made 20 inkblots for this purpose and paid a publisher to reproduce 10 of the inkblots and his test manuscript not all black like original (funny b/c the concept of analyzing responses w/shading was later introduced)
    • Rorschach died in 1922 multiple administration, scoring and interpretation methods Popular in clinical psychology in the 1940s and 1950s clinicians said test subjective and projection-based Exner Comprehensive System (David Rapport, Bruno Klopfer, Marguerite Hertz, Zygmunt Piotrowski and Samuel Beck helped)
  • The traditional and modern approaches to the Rorschach test are similar in the sense that they both use the same materials. Color was added to 5 of the inkblots in 1950, but other than that, the inkblots remained the same
    • Test materials
      • 10 inkblots:
        • Standardized size, color and order in which they are presented
        • All inkblots are symmetrical
        • All inkblot shapes were accidentally created that way
        • These inkblots were chosen from a larger collection of inkblots because Rorschach noticed individuals gave more overall responses and a wider variety of responses when given these particular inkblots
        • Currently, some inkblots are gray, some have gray and red and others are multicolored (Prior to 1950, none of the inkblots featured color)
        • All inkblots appear on white, glossy plates that are approx. 7 in. by 9 ½ in.
        • All inkblots are presented to participants in the same position
        • Believed to have form (color, size, etc.) and content
      • Need a Stopwatch:
        • Discretely used by the test proctor to time responses
        • The stopwatch was started when the test proctor handed the participant the inkblot and gave them brief instructions
  • Next I’d like to give you some info about the Traditional Method. I want to apologize in advance for the lack of specific stats regarding the reliability and validity of results using the traditional method, as they were not mentioned.
    • 3 Individuals contributed to the Rorschach training manual:
      • Dr. James A. Brussel: Was a captain (turned major) in the army medical corps, chief of neuro-psychiatry at the Fort-Dix State Hospital in New Jersey and the assistant-director of the Willard State Hospital in 1950
      • Kenneth S. Hitch: was the Fort-Dix Station Hospital’s chief of psychologist, consulting psychologist in Tacoma, Washington and the Tacoma Board of Education’s director of research in 1950
      • Dr. Zygmunt A. Piotrowski: was the chief clinical psychologist at the State Psychiatric Institute in New York and was a professor at both New York University and Columbia University
    • Editions:
      • 1st edition: the first training manual was untitled and published in 1942 by The State Hospital Press. It was comprised of two articles: (1) “The Rorschach  Method and Its Uses in Military Psychiatry” written by Brussel and Hitch and (2) “A Comparative Table of the Main Rorschach Symbols” written by Piotrowski (revised in 1947 and 1950). The price of this training manual was 50 cents
      • 2nd edition: published in 1947 and included the revised version of the articles that made up the first edition training manual, which included civilian mental health issues. Note: Piotrowski retitled his article “Rorschach Compendium”  most likely because he completely re-wrote it and it was thus a different article than the original. The price of this training manual was 50 cents
      • 3rd edition: published in 1950 and included the most current versions of the articles in editions 1 and 2. Piotrowski’s article was lengthened and altered to better teach and train others- it went from 23 to 54 pages between the 1947 and 1950 versions. This edition featured 10 ink-blots, some of which were in color. The price of this training manual increased to 75 cents- mostly because it was much longer than the previous two editions
  • Theory The 1950 training manual reports that the Rorschach test was not based on theory because the goal of personality theory (to identify how personality is made) was not consistent with the goal of the test
      • Goal of the Rorschach test= to explain why factors within responses uncover certain personality traits
  • Uses: The Rorschach method was originally used as a way to see how individuals’ current personality traits were unconsciously uncovered by their responses to inkblots and to help identify psychological disorders. The funny thing was that Rorschach saw his work as preliminary research, but others began to use his technique as if it were a test. The Rorschach method, like other psychological measurement tools, was popularized during WWII and used by the German military and the British and Canadian armies- it was later employed by the U.S. military. By 1944 the Rorschach method was widely accepted by clinicians. Prior to the 1940s, the Rorschach test was believed to not only help identify illness in people with mental health issues and differences in personality for people considered to be “normal”, it was thought to act as an intelligence test. At one point in time the Rorschach test was also used to test imagination, thought processes and reflex hallucinations
  • Between 1942 and 1949 the Rorschach test was used as a clinical method of diagnosis, specifically for military-related psychiatric and psychological exams (it is important to note that the Rorschach was not considered a true psychometric measure- however, response scoring and interpretation did involve percentages and ratios)
    • Traditional Test Phases (see Appendix A for additional details):
      • Administration:
          • Instructions + inkblots + exact responses + bxs are recorded + inquiry
        • There weren’t standardized instructions, but I’d like to read you the instructions that were suggested for use in the 1950 training manual: Read Instructions from training manual then grab inkblot and pretend to present it
        • Exact responses were recorded and participants’ behavior (hesitations, pauses, differences in pitch and volume, movement in the chair, motor reactions and inkblot manipulation) were recorded. The time it took to provide each response was also recorded.
          • Participants were sometimes encouraged with praise and a smile if they seemed insecure about their responses
        • 2nd round of instructions were more specific and aimed at identifying what elements of the inkblot were used to form responses: “Now I want to find out exactly where and how you see things.” Please outline the area [form] that you based your response on with your finger or an eraser… (ask about each of the 4 main elements of scoring)
      • Scoring/tabulation: (example provided in Appendix B)
        • Rorschach originally only coded for movement (M), Content (C), and Form (F), his coding scheme didn’t account for shading differences or active and passive movement
        • Soon after Rorschach passed away in 1922, responses began to be coded based on 4 main scoring elements
          • 1) Where the response is located
            • Ex: W= whole card (ex: a bat), D= details that are commonly used to form responses by healthy individuals, d= details that are not commonly used in responses from healthy individuals, S= space responses like responses that include the white space around the inkblot
          • 2) How the inkblot was perceived (the quality of the perceptions)
    • Ex: M= responses involving movement that (a) include a feeling of muscular tension and (b) describe humans or animals acting like humans (eg: people sleeping, someone holding onto a cliff), C= responses that are partially or completely based on the color of the inkblot (eg: bright butterflies, clouds at sunset, blood or fire), Shading- symbols varied from author to author (eg: Black butterfly, shadow of a monster), F= form/when a response is based solely on the outline or shape of the area a response is based on, Form responses are considered to be verbal reactions to visual stimuli (eg: butterfly, bat, etc)… good form= if a response fits the area its based on as well as or better than responses that are common, Abnormal responses: Cont= Contamination: When one response cue prompts another that is completely different and the two get intertwined even though they are based on different observations (Ex: perception1: “a bear” perception2: “green” response= “a grass bear”),  Conf= Confabulation: When a major response contains something that isn’t in the inkblot + bad form (usually) (Ex: “A horse race and here is the winner of the race”), and  POS= Positional: When a specific section of an inkblot prompts overall responses that have poor form (Ex: The light blue fingers b/t the green and pink of card IX may be called “teeth” resulting in the upper part of the card being called the face and head of a tiger)
          • 3) The content of the responses (H- human, A- animal, etc)
          • 4) The degree of originality (P= % responses that were popular among others’ responses, O= % of unique responses, I= unique response)
            • Not all response elements are equivalent. Rorschach, for example, did not place as much importance on the content of responses as he did movement
            • Some traits (e.g. D, d) fluctuate more than others (e.g. W)
        • Codes & definitions of the codes are modified from Rorschach’s original codes, such that they are more comprehensive. They are, however, consistent with Rorschach’s original codes and definitions. Responses assessed for abnormalities: abnormal forms, succession, preservation, inkblot rejection, color shock, chiaroscuro shock, abnormal content, other various abnormalities and response time (1st response to each inkblot and total response time)
          • Responses assessed for Piotrowski’s 10 signs of a C.N. S. Disorder:
            • 1) R: less than 15 total responses (normal is approximately 34 responses)
            • 2) T: each response takes more than an average of one minute
            • 3) M: responses include only one movement, if any
            • 4) Cn: responses identify one or more colors
            • 5) F+%: the percentage of good form is less than 75%
            • 6) P%: the percentage of popular responses is less than 25%
            • 7) Rpt: response repetition
            • 8) Imp: providing a response when it is understood that the response is inadequate
            • 9) Pix: distrust in ones ability to respond
            • 10) AP: automatic phrases
      • Interpretation
        • Calculating + weighting + contrasting + qualitatively assessing responses
          • Responses are compared to norms based on test takers’ gender and age to identify how intense certain traits are
          • Piotrowski suggests it takes at least 2 years of intense studying of the Rorschach test before one can efficiently interpret Rorschach test results using the traditional method
        • 4 approaches to justifying interpretations
          • 1) The Ouija Board Approach: use intuition to justify interpretations of Rorschach responses
          • 2) The Authoritative Approach: use opinions and recommendations of inkblot method authority figures to justify interpretations of Rorschach responses
          • 3) The Empirical Approach: use research evidence to justify interpretations of Rorschach responses
          • 4) The Conceptual Approach: use aspects of personality functioning to justify interpretations of Rorschach responses
  • Traditional Validity evaluation:
      • 1.) Rorschach conducted 2 blind case studies. In the blind case studies, a patient’s responses were analyzed without knowledge of his/her age, sex, personality, symptoms or history. Agreement between the Rorschach test interpretation for these 2 individuals and independent records concerning these 2 individuals’ traits were compared. Overall, the test responses and records were consistent.
      • 2) Fort-Dix study conducted by Lt. Kenneth S. Hitch (1943)(co-author of 1950 training manual): Neruro-psychiatrists’ established patients’ original diagnoses and psychologists independently conducted the Rorschach test. Clinical diagnoses of patients were compared to the patients’ results acquired via the Rorschach method
        • Population: 50 young male patients (18-33 years old) who were diagnosed with various psychiatric conditions and receiving neuropsychiatric services at the Station Hospital at For-Dix (a military institution)
          • Psychosis, Psychoneurosis, Psychopathic Personality, Mental deficiency, Organic disorders
            • Agreement: Patient diagnoses given by the Neuro-psychiatrists were found to be in at complete agreement with results from the Rorschach test (administered by psychologists) for only 33 of the 50 cases or 66% of the time, essential agreement 20% of the time, partial agreement 12% of the time and non-agreement 2% of the time. Conservative evaluation was used, such that doubt about the degree of agreement led to the comparison being deemed essential agreement instead of complete agreement
      • 3) Results of the Fort-Dix validity evaluation were compared to results obtained from non-military samples (e.g. Piotrowski’s studies & Klopfer’s studies)- valid for use with non-military samples
    • Overall, the validity of the traditional method was not adequately established
      • Problems:
        • 1) Limited generalizability- the blind case studies only took two individuals into account and Hitch’s sample population consisted of young males from one hospital in one geographic location
        • 3) The validation analysis of the Rorschach method was incomplete
    • Traditional Reliability Evaluation:
      • 1) 2 blind case studies
      • 2) Piotrowski believed that the Rorschach test was reliable as long as the test takers participated and weren’t already familiar with the test prior to taking it- we now know that was not the case
      • In my opinion, using present standards for reliability evaluation, the reliability of the traditional method was not adequately demonstrated
      • Most reliable factors:
        • Of the response factors used in the scoring procedure, the following are considered some of the most reliable indicators of personality: size, location, color type and shading
          • They are less variable
          • It was believed they could not be consciously controlled
          • They are not typically altered by environmental changes
      • Problems:
        • 1) Piotrowski believed that test analyses conducted by individuals who are more familiar with psychopathology and personality will be more thorough than analyses conducted by individuals who are less familiar with these fields thus the reliability of this test may be impacted by the users
        • 2) Observed traits were believed to be based on social relations of the test taker, so if certain traits are not important to or shared freely by the test taker, they cannot be observed or analyzed  
  • Advantages to the traditional method
      • According to Harrower:
        • 4) It can help support a diagnosis of shell shock
      • According to Piotrowski:
        • 5) the personality traits captured by the Rorschach test were relatively permanent and therefore wouldn’t change much if participants took the test multiple times
        • 6) It’s difficult to formulate responses that are not one’s own
  • Disadvantages of the Traditional Method
      • It’s difficult to identify how much of the interpretation is based on the Rorschach method as opposed to the test proctor’s ability to interpret responses ccording to Zubin (1965)
      • Instructions are often inconsistent
      • Too much unstructured interaction b/t test proctor and test takers can alter responses (ex more responses if encourage with a smile)
        • 1) Not an objective method and it didn’t typically yield acceptable interrater agreement
        • 2) Unsatisfactory internal consistency via test-restest
        • 3) Not enough evidence for clinical validity
        • 4) The scoring categories didn’t adequately relate to diagnosis
        • 5) Unsatisfactory predictive validity concerning future behavior
        • 6) Groups of normal individuals produced different results
        • 7) The relationship between Rorschach results and intelligence/creative ability wasn’t found
      • According to Fiske and Baughman (1953)
        • 8) Ratio scores couldn’t be accurately interpreted because responses varied too much
        • 9) The length of the method protocol alters the indices. The difference in protocol length was considered one of the biggest limitations of the Rorschach
      • According to Holtzman et al. (1956)
        • 10) Response interpretation was not consistent
  • Now I’d like to take some time to focus on the modern approach to the Rorschach test
    • Between 1950 – Present: the Rorschach test was used in psychiatric and psychological exams aimed at assessing both individuals’ with and without mental health issues personality type and reactions to life situations and demands. The Rorschach was typically used as a subjective measure of total personality as opposed to isolated mental functions, despite the availability of more objective methods of interpretation. The Rorschach test has also been used in therapy projections, child adjustment analyses, procedures for screening prisoners and in public schools.
    • Modern Test Phases: The Comprehensive System
      • 5 editions:
        • 1) 1974, (2) 1986 (3) 1993 (4) 2003 (5) not sure of date
          • Each edition featured updated norms to which individual’s responses  could be compared to
      • 10 inkblots, response forms (space for card number, response number, actual response, and info gathered during inquiry), location sheets (showed structural aspect of response location), structural summary blank (for summary of responses), and a script (instructs proctor on what to say for instructions and when questions are asked)
      • Despite modern approaches being available, many practitioners still use the traditional scoring and interpretation methods, which are associated with lower reliability and validity than the modern approach
      • Administration: instructions have been modernized
      • Scoring/tabulation: more structured scoring instrument
          • Response characteristics to code:
            • 1) Structural: characteristics of the physical inkblot (e.g. “two people”). See Appendix E for a structured response location chart
            • 2) Thematic: looking beyond the structure of the inkblot and describing something that is not obviously represented by the inkblot structure (e.g. “Two people just standing there”)
            • 3) Behavioral: how people approach situations in which problem-solving and interpersonal skills are utilized (e.g. comments about the test tasks
            • An interpretive strategy called sequence analysis can be used to identify structural, thematic and behavioral response characteristics and to help identify how the interplay between these characteristics proceeds to influence other responses. This process provides a summary of responses using calculations (ratios, percentages, etc)
      • Interpretation: interpretation is based on the more structured scoring instruments & takes into account personality research involving characteristics of personality that are deemed to be related to various responses
        • The current “Comprehensive System Search Strategy” groups Rorschach variables into clusters and identifies which order the variables within the clusters should be looked at (See Appendix F)
          • Seven clusters of variables were identified by Exner (via a cluster analysis) that tied structural variables to personality functions: (1) Information-processing: how people observe the world, (2) cognitive mediation: how people perceive objects, (3) ideation: how perceptions are conceived, (4) control and stress tolerance: how people cope with stress and demands using adaptive resources, (5) affective features: how people handle emotional situations and express their feelings, (6) self-perception: how people see themselves and (7) interpersonal perception: how people see and connect with others
            • Another set of variables (that were uncorrelated and hence not a true cluster), named situation-related stress, also contribute to the interpretation of responses
            • Sequential search strategy: interpretations should be the same no matter which order the clusters are examined in, provided they are examined thoroughly without skipping around
            • The number of responses did not load on any of the seven clusters, so it was not included in the steps of analysis, but it does play a factor in whether or not test results are valid (<14 responses = invalid)
          • Personality style & strengths/weaknesses can be identified for use in clinical assessments using an adaptation model with six dimensions of human behavior (similar to the Comprehensive System clusters):
            • (1) how people attend to experience: indicated by the location of responses, (2) how they form and relate ideas, (3) how they regulate emotion, (4) how they handle stress, (5) how they see themselves: indicated by types/characteristics/anatomy of people, animals and objects (6) how they relate to others: indicated by types/characteristics of people and animals in responses and the activity in which those people and animals engage in (Weiner, 1998, p. 105, 194-203)
              • See Appendix D for a visual representation of the relationship between adaptation dimensions, comprehensive system variable clusters and personality functioning issues
            • Any theory that is applicable can be used to make inferences about personality functioning
  • Modern Validity Evaluation
      • 1) Meta-analyses by Atkinson (1986) and Parker, Hanson and Hunsley (1988):
        • Theory-based studies of the Rorschach variables yielded higher validity coefficients than non-theory based studies- which isn’t all that surprising
          • The results indicated the Rorschach method is valid when properly used
        • Rorschach validation studies based on concepts yielded validity coefficients similar to those for the MMPI
          • Parker et al. (1988): 411 studies yielded population estimates of convergent validity coefficients of .41, which is typical since most tests don’t account for more than 50% of the variation in criterions (the MMPI yielded validity coefficients of .46, which is comparable to that of the Rorschach). Just a recap- convergent validity is a subcategory of construct validity that basically means that all variables that should be correlated actually are correlated (ie all variables that represent a specific construct are highly correlated).
      • 2) Meta-analysis by Myer and Handler (1997):
        • Looked at the predictive validity of the Rorschach Prognostic Rating Scale (developed by Klopfer, Kirkner, Wisham and Baker in 1951) and found that it was a valid predictor of the outcome of psychotherapy and successfully predicted behavior change for adult and child patients in inpatient and outpatient environments
      • 3) Successfully applied to a variety of populations external validity
        • Individuals in U.S.
        • Individuals in Europe
        • Individuals in primitive and urban tribes
        • Individuals of different age, SES, gender, cultural backgrounds and ethnicity
      • 4) Individuals’ records that include less than 14 responses are typically considered invalid because it is unlikely they provide reliable information
      • Beliefs:
        • 1) Using the structured scoring system, the Rorschach method is often viewed as a valid way to describe some aspects of an individual’s personality structure and dynamics, help diagnosis individual’s with conditions that feature distinct patterns of personality functioning, identify treatment goals and potential obstacles of psychotherapy progress, help with the selection of appropriate treatment forms and keep track of change and improvements over time
        • 5) The Rorschach method typically identifies the same personality characteristics despite the test taker’s age, but interpretations of personality characteristics may vary between different age groups (when implying something about an individual based on responses, age needs to be considered)
        • 6) The same personality characteristics are found in males and females and interpretations are not different based on gender, but gender-related differences may be present and need to be considered when assessing the implications of personality characteristics
        • 7) Cultural differences should be analyzed when: determining the degree to which the Rorschach results represent personality characteristics, the degree to which response codes are influenced, the effect language has on response delivery and comprehension and the consequences for inferring an individual has certain personality characteristics
        • 8) Socioeconomic status, national origin and ethnicity do not alter the meaning of Rorschach variables, but they may have different implications for the individual
        • The basic point is that overall, the modern Rorschach method is believed to be valid for the purposes I just described and externally valid/generalizable (with the exception of the implications of interpretation)
    • More Modern Reliability Evaluation
      • 1) Interrater agreement using the Comprehensive System
        • Research has indicated that this system can yield relatively high interrater reliability (raters tend to code responses the same), however, specific interrater reliability coefficients were not provided
      • 2) Retest studies (using the Comprehensive System) with children and adults for which the retest intervals ranged from one week to three years
        • 3 years time-lapse between tests:
          • The internal consistency of 13 main variables (e.g. active movement, affective ratio, etc.) was .80 for 100 non-patient adults, which is pretty good
          • The consistency of 6 main variables (e.g. passive movement, popular, etc.) was .70 for the same 100 individuals, which is acceptable, but not excellent
        • 1 year time-lapse between tests:
          • For 50 non-patient adults, a variety of variables had reliability coefficients above .80 (e.g. pairs, reflections, etc.), which is pretty good
          • For the same individuals, a handful of variables had reliability coefficients above .70, which is again acceptable, but not excellent (e.g. the Isolation Index, the Intellectualization Index, etc.)
      • Problems:
        • 1) No reliability coefficients were mentioned for kids, although it was suggested that they exist and are promising.
        • 2) Being exposed to a test more than once may lead to a faster response time or other response alterations
  • Advantages of the Modern approach
      • 1) The test is more standardized higher interrater reliability
      • 2) The norms have been improved
      • 3) Used a cluster analysis to identify response factors
  • Disadvantages of the modern approach
      • According to Dubey (1982)
        • 2) Interpretations of responses are still often subjective
3) Coding is still time consuming
        • 4) The norms aren’t always replicable

Common responses
IF enough time:

  • Common Perspectives Regarding the Rorschach Test
    • Objective VS Subjective
      • The most prevalent perspective identifies the Rorschach test as a test that has both objective and subjective properties
      • Rorschach never intended the test to be subjective in nature
    • Perception VS Association approach
      • The most prevalent approach to interpreting responses involves a mixture of both perception and association
      • Using one approach over another or a combination of both is seen as a personal preference
        • Perception is when responses are based on observable physical characteristics of the inkblots
          • These responses are usually based on card pull (inkblot characteristics that make individuals more likely to base responses on specific parts of the inkblot)
        • Association is when an individual relates something personal to the inkblots
          • These responses are usually based on projection
    • Nomothetic (tendency to generalize similarities) VS Idiographic (tendency to specify differences) approach
      • Currently the most prevalent approach to interpreting responses is to combine these perspectives, however, they are a popular topic of debate
        • Nomothetic approaches to interpreting responses are based the perspective that an individual represents a specific group of individuals (can be norm referenced)
        • Idiographic approaches to interpreting responses are based on the perspective that each individual is unique and has traits that represent him/her that are different from other individuals
    • Assessment of Personality Structure VS Personality Dynamic
      • Scientific investigations have identified that both personality structure and dynamic interpretations are valid
        • Personality structure is when individuals’ current thoughts and feelings (personality states) and current disposition (personality traits) are believed to define who the person is
        • Personality dynamic is when individuals’ underlying needs, attitudes, conflicts and concerns that contribute to their thoughts, feelings and actions influence them in different ways at different times and in different situations
    • Test VS Method
      • Traditionally the Rorschach was viewed as a test and is commonly still referred to as a test
      • It was once debated whether or not the Rorschach test should be considered a method because it was hard to show that it was valid and reliable, but it was considered useful, which made this argument less important. Additionally the Comprehensive System greatly improved the reliability and validity of the Rorschach test, making it qualify to be categorized as a test
      • Ainsworth proposed that the Rorschach was more than a test and suggests a need for users consider it a method instead without forgetting that the Rorschach test, using the Comprehensive System, qualifies as a test

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