Some Comments on the Importance of Comparative Group Data for Interpreting Rorschach Findings

Abstract

This article is part I of a two part series. It discusses the interpretative importance of anchoring Rorschach data within a larger body of comparative (both nonpatient and clinical) group data.

Full text

SIS J. Proj. Psy. & Ment. Health (2021) 28: 67-73
Carl B. Gacono, PhD, ABAP, Maverick Psychology Training and Consultation, Asheville, NC,
drcarl14@aol.com; Jason M. Smith, PsyD, ABPP, jmsmithpsyd@gmail.com.
Key Words: Rorschach, interpretation, nomothetic, Comprehensive System
Some Comments on the Importance of Comparative Group Data
for Interpreting Rorschach Findings
Carl B. Gacono & Jason M. Smith
The Rorschach (RIM) provides information beyond what one gathers from self-report measures. In
addition to CS data, psychoanalytic theory has led to several valid and reliable supplemental
Rorschach scoring systems. When integrated, CS and supplemental RIM data increases the
conceptual understanding of a patient or group, allowing for highly nuanced insights into
personality functioning. In order to interpret Rorschach data one must understand that, for the most
part 1) Rorschach variables measure traits (dimensions) not diagnosis (categories), that 2) the
degree of pathology or health represented by a variable is determined in relationship to
comparative group data, such as non-patients, and assessed within the context of the entire
protocol or protocols (for group data), and, 3), confirming the presence or absence of a trait within
a given sample necessitates a comparison to other relevant groups both those that contain threshold
this article we
underscore the essential contribution of a nomothetic context (using comparative CS data) for
anchoring Rorschach interpretation.
Introduction:
The Rorschach is a perceptual-associative-
judgmental task that partially bypasses volitional
controls, yielding both structural and
psychodynamic data, some of which is projected
material (Bornstein &Masling, 2005; Exner,
2003). Rorschach data adds incrementally to,
and provides data well beyond, what can be
obtained with self-report measures (Bornstein
&Masling, 2005; Gacono & Evans, 2008;
Gacono & Meloy, 1994; Smith, Gacono, &
Cunliffe, 2021). The Comprehensive System
(CS) has an extensive research base, more than
adequate normative, clinical, and forensic
comparative datai (Exner, 2001, 2003, 2007;
Gacono & Evans, 2008; Smith et al., 2021), and
has been widely used in clinical and forensic
practice, meeting the standards of admissibility
and acceptance in court (Gacono et al., 2008;
McCann & Evans, 2008; Meloy, 2008;
Piotrowski, 1996a, 1996b, 2007, 2017).
Rorschach scoring begins with coding the
Comprehensive System variables (CS, Exner,
2003) and generating a sequence of scores and
structural summary. The experienced Rorschach
user can complete most if not all the actual
coding during the two phases (free association &
inquiry) of administration. Interpretation begins
in earnest by comparing the CS coding, indices,
and constellations to relevant comparative group
patient compare to inpatient depressives on
relevant variables such as DEPI? To non-
patients? This dual comparison (clinical group--
non-

68: Gacono & Smith
concerning both the nature and position of the
patient s self-reported depression.
In addition to CS generated data, psychoanalytic
theory has provided a foundation for several
other Rorschach supplemental reliable and valid
scoring systems. These include systems for
object relations (Blatt & Lerner, 1983; Kwawer,
1980), defenses (Cooper, Perry, &Arnow, 1988;
Lerner & Lerner, 1980), developmental
psychopathology (Urist, 1977), dependency
(Bornstein &Masling, 2005; Masling et al.,
1967), trauma (Armstrong & Loewenstein,
1990), aggressive drive derivatives (Gacono &
Meloy, 1994; Gacono, Gacono, Meloy, &Baity,
2008), and thought organization (Athey, 1974;
Meloy & Singer, 1991)ii. These additional
systems provide a useful complement to CS
scoring, allowing for the quantification of
important Rorschach content, traits, and
processes (Arnow&Reznikoff, 1976). Most of
these systems, including their reliability and
validity, have been summarized in five books
(Bornstein &Masling, 2005; Kissen, 1986;
Kwawer, Lerner, Lerner, & Sugarman, 1980;
Lerner & Lerner, 1988; Lerner, 1991).
Access to CS structural data, CS sequence data,
conceptual understanding of a patient or group
and allows for nuanced insights into levels of
personality functioning (unconscious,
preconscious, conscious; Gacono & Evans,
2008; Gacono & Meloy, 1994; Gacono & Smith,
2021; Meloy, Acklin, Gacono, Murray, &
Peterson, 1997; Stone &Dellis, 1960). While the
Comprehensive System (Exner, 2003), alone,
provides psychodynamic information concerning
self-esteem regulation, affect management,
defenses, object relations, and interpersonal
functioning, these supplemental systems deepen
our understanding of both individual and group
personality (Gacono & Smith, in press).
A Nomothetic Context:
When considering the context for forming
Rorschach research hypothesis or interpreting
individual or group data, three points emerge.
Point #1--, each disorder is inherently
dimensional, comprised of a cluster of specific
traits. When present in sufficient quantities the
traits reach a threshold whereby, they constitute
a category (syndrome or disorder). Several
disorders may share overlapping traits; however,
no disorder (category) is mistaken for the other.
In this manner the old Gestalt principle applies:
The whole is truly greater than the sum of its
parts. Paranoid and compulsive personality
disorders share similarities in their cognitive
style (focus on details, Dd). Narcissistic and
paranoid people evidence grandiosity and self-
reference, histrionic and narcissistic people share
a need for attention, and so on. The combination
of characteristics in sufficient quantities meets a
threshold that determines group inclusion
(diagnosis or category). For the most part,
Rorschach variables measure traits not disorders
per se. A specific disorder only begins to emerge
when a composite of Rorschach variables appear
that are linked to associated traits.iii
Gacono, Meloy, and Bridges (2000, 2008) study
of Rorschach reflection responses among sexual
homicide perpetrators (SHPs), psychopaths (Ps),
and non-violent pedophiles (PEDs), provides an
example. Similar frequencies of individuals from

Interpreting Rorschach Findings: 69
each group produced reflections. Reflection
diagnostic category, (psychopathy), rather the
authors correctly identified their presence as
being consistent with elevated self-focus (a trait-
-self-focus or narcissism; also see Smith,
Gacono, & Cunliffe, 2019). These findings were
consistent with theory, as elevated self-focus is a
trait associated with each of these syndromes.
Point #2--inferences made related to the
pathological nature of a Rorschach variable
(associated trait) must be considered relative to
frequencies and mean numbers found in non-
patients or other groups that either contain the
same trait or are hypothesized to lack the trait
(i.e., non-patients; lacking or low levels of the
trait). The nature of the trait must also be
assessed within the context of the entire
Rorschach protocol. For example, in comparing
reflection responses among male psychopaths
(Mean [M] = 0.72, Frequency = 44% produced
at least one), sexual homicide perpetrators (M =
1.11, 45%) and male nonviolent pedophiles (M =
1.23, 44%), Gacono et al. (2000, 2008) noted
that each group produced significantly more than
non-patients (M = 0.20, 12%; Exner, 2007).
Early on, Exner discovered that reflections relate
to self-focus (Exner, 2003). Consequently, the
Gacono et al. (2000, 2008) findings support high
levels of self-focus in these clinical groups. Non-
patients would not be expected to, and do not,
exhibit the same type of self-focus as measured
by reflections. Similar patterns for relevant
variables would be expected between an
avoidant personality and a narcissistic one or an
avoidant personality and non-patients. It should
be noted that even with a variable considered to
--FD (introspection) its
relative healthy (nature) can only be determined
within the context of the entire protocol. An FD
response produced with minus form and an
accompanying ALOG special score in a protocol
with reality testing and thinking problems,
would not be interpreted as indicative of heathy
introspection.
Point #3 -- involves how the clinician assigns a
trait to a group. For example, in the Gacono et
al. (2000, 2008) study about 50% of each group
member produced at least one reflection. Did
those without reflections lack pathological self-
produce reflections? The answer to the first
question is affirmatively NO. All the
psychopaths (PCL- PCL-R
Factor 1, which correlates with narcissism and
reflections (in males). They are all not only self-
focused but also pathologically narcissistic. The
PCL-R assesses narcissism in a global and direct
manner (observed attitude/behaviors), while the
Rorschach scores and patterns do so indirectly,
having the validity of variables been previously
established through linking them to traits by
demonstrating associated behavior(s). In the
Gacono et al. study, other evidence in the
history, PCL-R data, or other assessment
information (i.e., MCMI-II) confirmed the self-
focus demonstrated by the Rorschach for the
three clinical groups. In the manner that the
Rorschach can ferret out sub-groups within a
given sample, the reflection response does not
capture the pathological self-focus in all
subjects, rather sub-groups will present their
self-focus through the production of other
indices and patterns (e.g., W:M, PER responses,

70: Gacono & Smith
etc.). So, while not all male psychopaths produce
reflections, all male psychopaths are
pathologically narcissistic. In a related manner
none of the non-violent PEDs met the criteria for
ASPD or psychopathy. Reflections represent a
trait, and do not provide a one-to-one sign for a
category (reflections = self-focus, not
psychopathy). It is scientifically sound to
attribute self-focus to each of Gacono et al.
(2000, 2008) three groups based on a
comparison of reflections with the CS
non-patients (12% produce at least 1).
Rorschach Interpretation:
Competent Rorschach interpretation requires
examining scores and indices within a
nomothetic context (comparative group data). In
confirming the presence or absence of a trait
within a given sample, it is the comparison to
other relevant groups, both those that contain
the same trait, and those absent the trait, that
aids this determination. For example, in a
recent article contrasting the differing
personality styles of male (MP) and female (FP)
psychopaths, Rorschach CS and supplemental
coding related to malignant hysteria were found
to discriminate between the groups (Gacono &
Smith, in press). While the MPs had less indices
of affect, both groups were found to be
emotionally explosive (Pure C, MP, M = 0.70;
FP, M = 1.07; NP, M = 0.17; CD, M = 0.47).
Three variables (AB, Hx, & IMP
[Impressionistic response], Gacono, 1988),
representing the core of the hysterical,
impressionistic style (Shapiro, 1965), along with
a constellation of hysterical defenses,
differentiated between the groups. The FPs also
produced AB and Hx in greater quantities than
non-patients (Hx, FP = 39%, NP = 10%; AB, FP
The need for adequate nomothetic data is one of
several reasons that the CS is considered the
only validated primary system for Rorschach
coding and interpretation. The development of
newer alternate systems, such as the R-PAS
(Meyer, Viglione, Mihura, Erard, &Erdberg,
2011) must have similar data acquired with their
respective administration instructions prior to
being considered appropriate for applied use.
The supplemental systems offered in this article
have also been found to be useful related to their
validity findings but would benefit from
additional comparative group data. Dr. Smith
and I are attempting to create forensic
comparative samples of these scores by coding
them in the over 2000 forensic protocols from
our archives (Gacono & Evans, 2008; Smith,
Gacono, & Cunliffe, 2021). We welcome any
collaborators.
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Interpreting Rorschach Findings: 73
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iRorschach Workbooks for the CS (4th & 5th edition; Exner,
1995, 2001) included descriptive CS data for non-patient
adults (N=600-700; also listed by high Lambda, introversive,
extratensives, and ambitents), non-patient children and
adolescents (N = 1390; also listed by age), adult outpatients
(N=535), inpatient schizophrenics (N = 320), inpatient
depressives (N = 315), and character disorders (N = 180). A
new sample of 450 non-patients is also available (Exner,
2007). Descriptive group data is also available for over 2061
CS administered forensic protocols (Gacono & Evans, 2008;
Gacono & Meloy, 1994; Gacono & Smith, 2021; Smith,
Gacono, & Cunliffe, 2021).
ii Scoring the
Rorschach: Seven Validated Systems. While validated these
systems have relatively little comparative data as compared
to the CS. Due to their extensive usage in forensic samples,
the Gacono and Meloy (1994) Extended Aggression scores
may be an exception.
iii Rorschach data are useful in sorting out sub-groups within
any classification. As noted in psychopathy, every
personality style and/or disorder also contains some amount
of heterogeneity; with potentially identifiable subgroups
(Neumann et al., 2016).
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