Rorschach Performance Assessment System : administration, coding, interpretation, and technical manual 9781937450007, 1937450007, 9781937450038, 1937450031

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Rorschach Performance Assessment System Administration, Coding, Interpretation , and Technical Manual

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Rorschach Performance Assessment System Administration, Coding, Interpretation,and TechnicalManual

Gregory J . Meyer University of Toledo

Donald J. Viglione Alliant International University San Diego

Joni L. Mihura University of Toledo

Robert E. Erard Psychological Institutes of Michigan, Pc .

Philip Erdberg Masonic Center for Youth and Families, San Francisco

Copyright © 2011 Rorschach PerformanceAssessment System, LLC All rights reserved worldwide. Published by Rorschach Performance Assessment System, LLC P.O. Box 12699 Toledo, OH 43606 Reproducing,storing in a retrieval system, transmitting, or adapting this work, in whole or part, by any process whatsoever, mechanical or electronic, except as permitted below and by Section 107 or 108 of the 1976 United States Copyright Act, is not only a violation of copyright law, but also is unethical and unprofessional unless prior written authorization has been obtained from the copyright owner.

Limited License to Photocopy

The Publisher grants to individual purchasers of this book non-assignable permission to reproduce those pages on which permission to copy is explicitly provided in writing. Such pages are identified with the statement "Users are granted p ermission to photocopy or otherwise reproduce this page." This permission is limited to you, the individual purchaser, to use for yourself or with your own students or research assistants. It does not extend to additional colleagues or associates in your university, hospital, clinic, or other setting, nor does institutional purchase constitute a site license. The license does not grant the right to reproduce these materials for resale or redistribution, for articles or books, or for any commercial purpose. Permission to use these materials for these and any purpose other than personal use as specified herein must be obtained in writing from the PermissionsDepartmentof RorschachPerformance Assessment System, LLC.

Printing by Homewood Press. Eighth Softcover Printing Front and back covers and title page designed by Andrew Williams with Gregory Meyer. Rorschach Performance AssessmentSystem®and R-PAS®are trademarks owned by Rorschach Performance AssessmentSystem, LLC. Scoring services and further information about R-PAS®are available at www.r-pas.org. Rorschach®is a worldwide registered trademark owned by Verlag Hans Huber, Hogrefe AG, Bern, Switzerland, 1921, 1948, 1994. Images of Rorschach®stimulus plates are used with permission of the trademark owner. ISBN 978-1-937450-03-8 Library of Congress Control Number: 2011911587 Printed in the United States of America

Acknowledgments We gratefully thank those who have co-authored chapters or sections of this manual, as well as our internationalresearch collaboratorsand other contributors. Chapter or Section Co-Authors

Robert F. Bornstein, Nicolae Dumitrascu, Ramona Dumitrascu, Elizabeth Koonce, Helena Lunazzi, Fabiano Koich Miguel, Fatima Miralles, Regina Sonia Gattas Fernandes do Nascimento,Ricardo Primi, Norma Lottenberg Semer, Yoriko Takahashi, Anna Elisa de Villemor-Amaral, and Latife Yazigi Research Collaborators Reference Data Argentina : Helena Ana Lunazzi, Maria Ines Urrutia, Marta Garcia de La Fuente, Diana Elias. Favia

Fernandez, Soledad de La Fuente Belgium: Christian Mormont, Maud Thommessen, Celine Kever Brazil: Regina Sonia Gattas do Nascimento, Latife Yazigi, Anna Elisa de Villemor-Amaral, Ricardo

Primi Denmark: Jan Ivanouw Finland: Carl-ErikMattlar, Camilla Forsander, Anette Carlsson, Laila Norrlund, Paivi Vesala, Tarja

Leppanen, Ann-Sofi Oist, Juhani Maki, Erkki Alanen France: Serge Sultan, Damien Fouques, Gilles Lemmel, Christian Mormont, Christian Reveillere, ThomasSa'ias Greece: Stamatia Daroglou Israel: Ety Berant Italy: Adriana Lis, Laura Parolin, Silvia Salcuni, Alessandro Zennaro Portugal: Antonio Pires Romania: Nicolae Dumitrascu Spain: Vera Campo, Nancy Vilar United States: Thomas W. Shaffer, Philip Erdberg, John Haroian Form Accuracy Ratings: Translation &/or Leading Data Collection Brazil: Latife Yazigi, Regina Sonia Gattas Fernandes do Nascimento, Anna Elisa de Villemor-Amaral China: Wei-Cheng (Wilson)Hsiao Portugal: Danilo Silva Finland: Heikki Toivakka Romania: Elena Vladislav. Nicolae Dumitrascu Israel: Shira Tibon, Lily Rothschild Taiwan: Wen-So Su, Wei-Cheng (Wilson)Hsiao Italy: Adriana Lis, Silvia Salcuni Turkey: Tanya Ozbey Japan: Naoko Ogura, Mitsue Tomura, Saori US: Janelle Mason, Katrina Patrick

Bezouska, Maki Fukishimi, & 1 Anonymous Significant Research Contributions, Typically in Multiple Ways

Leah Abraham, George Bombel, Christina Boudreaux, Daniel B. Charek, Gregory L. Converse, Kristin L. Dean, Elisa Delvecchio, Nicolae Dumitrascu, Joshua J. Eblin, Kirstin Filizetti, Luciano Giromini, Robert A. Graceffo, Sandra L. Horn, Wei-Cheng (Wilson)Hsiao, Ryan Jordan, Natasha Kalaida, Nicholas J. Katko, Elizabeth Koonce, Joseph M. McCullaugh, Raeanne C. Moore, Tonya Oliver, G. Tanya Ozbey, Katrina Patrick, Ana Christina Resende, Christina Saltman, Michael L. Stanfill, Wen-So Su, Aaron Upton, Andrew Williams. (continued)

Additional Contributors Who Assisted with Editing or Formatting the Manual, Coding Records or Managing Protocols Databases

Christina Boudreaux, Sarah Carpenter, Eva Christiansen, Elizabeth Crawford, Ramona Dumitrascu, Nicolae Dumitrascu, Sara Greene, Danielle Hammer, Gregory Keith, Christine Kimmel, Jonathan Kruse, Vanessa Laughter, Amy Blume-Marcovici, Forrest Masminster,Heidi Miller, Kate Shevchik, Clare Viglione, Michael Viglione, Andrew Williams, Lauren Wunderlich.

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TABLE OF CONTENTS CHAPTER 1 INTRODUCTION Why the Rorschach? Background and History The Rorschach Performance Assessment System Using the Manual

CHAPTER 2 ADMINISTRATION Purpose and Underlying Principles Basic Components of the Administration: Overview Four Underlying Principles Guiding the Administration The Essentials: Administration Detailed Administration Instructions Make Initial Preparations: Materials, Logistics, and Seating Establish Rapport and Explain the Assessment Process Introduce and Initiate the Response Phase Sample Respondent Questions and Suggested Responses Questions Related to the Response Process Administer the Test: The Response Phase The Essentials: Managing the Response Phase Introduce and Initiate the Clarification Phase Task Asking Clarification Phase Questions to Finalize Coding Document the Responses and Task Behaviors Figure 2.1 Examples of Paper and Pen Documentation Figure 2.3 Example of Completed Location Sheet, Cards I through V only Miscellaneous Documentation Conventions Summary Sheet of the Essentials for R-PAS Administration and Clarification Introducing the Task Coping with Possible Coaching or Motivated Distortion in Responding Managing the Response Phase Managing the Clarification Phase Clarification Phase: The Basic Instructions Documentation

CHAPTER 3 BASIC CODING Coding Principles Data Entry with the R-PAS Computerized Scoring Program Table 3.1 The R-PAS Response Level Codes Coded Response Phase Behaviors Card Orientation (, @) Prompts (Pr) and Pulls (Pu) Location and Space Codes Location Space Content Codes Object Qualities Synthesis and Vagueness Pair (2) Form Quality Popular

1 1 2

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Determinants

Movement (M, FM, m) Active versus Passive Movement (a vs. p, or a-p) Color (FC, CF, C) Achromatic Color (C') Shading: Diffuse Shading (Y), Texture (T), and Vista Form Dimension (FD) Reflection (r) Pure Form (F) Blend Coding the Response for Determinants

44 44

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Cognitive Codes

Deviant Verbalizations (DVl, DV2) Deviant Responses (DRl, DR2) Peculiar Logic (PEC) Incongruous Combinations (INCl , INC2) Fabulized Combinations (FABl, FAB2) Contaminations (CON) Coding the Response for Cognitive Codes Thematic Codes

Abstract Representation (ABS) Personal Knowledge Justification (PER) Cooperative Movement (COP) Mutuality of Autonomy Health (MAH) and Pathology (MAP) Aggressive Movement (ACM) Aggressive Content (AGC) Morbid Content (MOR) Oral Dependent Language (ODL) - Coded Only in the Response Phase Coding the Response for Thematic Codes A Note on Human Representation Codes An Overview of the Origins of R-PAS Codes A Recommended Sequence for Coding a Response

CHAPTER4 ADVANCEDCODING

45 45 45

46 46 46 47 47 47

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Coded Response Phase Behaviors

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Card Orientation (, @) Prompts (Pr) and Pulls (Pu)

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Location and Space Codes

Location Codes Procedures for Coding Location Illustrations Space Reversal (SR) and Space Integration (SI) Is Space Included at All? Content Codes

Additional Human and Animal Coding Considerations Object Qualities

Synthesis and Vagueness Additional Considerations for Sy Coding Pair (2) Form Quality

Form Quality None (FQn) Single Object Responses (FQo, FQu, or FQ-) Multiple Object Responses (FQo, FQu, or FQ-) Extrapolation: Three Basic Principles

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Extrapolation Procedures for Single Object Responses Extrapolation Procedures for Multi-Object Responses Popular Basic Coding Criteria Additional Coding Clarifications Determinants Movement (M, FM, m) Active versus Passive Movement {avs. p, or a-p) Color (FC, CF, C) Achromatic Color (C') Shading: Diffuse Shading {Y), Vista M, and Textrne (T) Form Dimension (FD) Reflection (r) Pure Form (F) Blend Cognitive Codes Levels of Severity for Cognitive Codes Multiple Cognitive Codes Deviant Verbalizations (DVl, DV2) Deviant Responses (DR!, DR2) A Threshold for the DR Circumstantial Response: The "Two Step" Guideline Peculiar Logic (PEC) Incongruous Combinations (INCl, INC2) Fabulized Combinations (FABl , FAB2) Contaminations (CON) Level 1 versus Level 2 Distinctions DV vs. INC vs. No Cognitive Code Multiple Cognitive Codes Thematic Codes Abstract Representation (ABS) Personal Knowledge Justification (PER) Interrelated Affective or Interpersonal Codes (COP, MAH, AGC, AGM, MOR, & MAP) Cooperative Movement (COP) R-PAS Coding for the Mutuality of Autonomy (MA) Scale Aggressive Movement (AGM) Aggressive Content (AGC) Morbid (MOR) Oral Dependent Language (ODL) - Coded Only in the Response Phase A Note on Good and Poor Human Representations (GHR, PHR) Response Count and Boundaries Guidelines The Problem The General Solution Table 4.14 Coding "This-or-That" Responses for Mutually Exclusive or Competing Codes Response Count and Boundary Problem Examples Ambiguities Introduced by Response Phase and Clarification Phase Inconsistencies Guidelines for Coding Information Appearing Anew in the CP Examples of CP Elaborations That Are Coded Examples of CP Elaborations That Are Not Coded

CHAPTER 5 ADVANCED CLARIFICATION Introduction and Scope Principles Additional Considerations The Challenges of the Clarification Phase

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Additional Clarification Guidelines and Procedures with a Focus on Determinants Three Ways to Suggest a Determinant: Communication, Prototypical Imagery, & Card Location The Determinant Convergence Principle Additional Clarification Issues Table 5.8 Examples of Acceptab le Clarification Questions and Probes with Commentary Table 5.9 Examples of Unacceptable Clarification Questions and Probes with Commentary Table 5.10 Annotated Responses to Illustrate Clarification and Coding Decision-Making

CHAPTER 6 FORM QUALITY TABLES An Overview of the Development of the Form Quality Tables Elements of the Form Quality Tables Card I Locations Card II Locations Card III Locations Card IV Locations Card V Locations Card VI Locations Card VII Locations Card VIII Locations Card IX Locations Card X Locations

CHAPTER 7 CODING PRACTICE

161 162 166 169 173 174 175

179 179 180 182 190 196 204 210 216 224 230 238 246

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Table 7.1 One Hundred Responses for Coding Practice Ordered by Difficulty Level Figure 7 .1 Location Sheets for Practice Responses

256 267

Table 7.2 CodingKey for PracticeResponses

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Table 7.3 Coding Rationale for Practice Responses

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CHAPTER 8 RESPONSE-LEVEL TO PROTOCOL-LEVEL CONVERSION Structure and Basic Terminology Figure 8.1 The Code Sequence Page Figure 8.2 The Protocol-Level Counts & Calculations Page Technical Notes on Percentages and Proportions. Protocol-Level Counts and Calculations Responses & Administration Location Space Content Object Qualities Form Quality and Popular Determinants Cognitive Codes Thematic Codes Table 8.2 Algorithm for Classifying Human Representational Responses as Good or Poor Other Calculations Table 8.3 Counts & Calculations Summary Table

CHAPTER 9 NORMATIVE REFERENCE DATA Establishing Reference Data Table 9.1 Card Level: Mean Responses Per Card in the Target and Modeled Samples Table 9.2 Protocol Level: Descriptive Statistics in the Target and Modeled Samples Putting R-PAS Reference Data on a Common Metric

283 283 283 284 285 286 286 286 287 287 288 288 289 291 291 293 294 297

299 299 300 300 300

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Complexity Adjusted Reference Data Tables of Modeled and Non-Modeled Reference Data Table 9.4 R-Optimized Modeled Reference Sample (N = 640): Descriptive Data Table 9.5 R-Optimized Modeled Reference Sample (N = 640): Frequency Data Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data Table 9.7 Non-Modeled Reference Sample {N= 1396): Frequency Data

303 303 304 309 310 315

CHAPTER 10 RECOMMENDATIONS FOR INTERPRETATION

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Interpretive Principles Interpretive Procedures Integrating Rorschach Data with Other Tests and Sources of Information The Response Process as a Behavioral Foundation for Interpretation Overall Response Process and Task Considerations Table 10.1 Responses and Administration Behaviors Location & Space Object Qualities Form Quality and Popular Determinants Cognitive Codes Thematic Codes Protocol Level Interpretation Summary Scores on the Page 1 Profile Administration Behaviors and Observations Engagement and Cognitive Processing Domain Perception and Thinking Domain Stress and Distress Domain

Selfand OtherRepresentationDomain

317 321 329 330 330 331 332 337 338 339 343 344 347 347 347 348 357 360

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Summary Scores on the Page 2 Profile Table 10.14 Engagement and Cognitive Processing Domain Table 10.15 Perception and Thinking Domain Table 10.16 Stress and Distress Domain Table 10.17 Self and Other Representation Domain

366 366 370 371 373

CHAPTER 11 CLINICAL CASE ILLUSTRATION

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Background and Assessment Goals Table 11.1 RM's Rorschach Responses Figure 11.1 RM's Location Sheet Pre-Interpretation Activities Figure 11.2 RM's Code Sequence Page Figure 11.3 RM 's Counts and Calculations Page Interpretation of the Profile Summary Pages Additional ldiographic Interpretation with Response Process and Content Summary of Major Findings Engagement and Cognitive Processing Perception and Thinking Problems Stress and Distress Self and Other Representation Integration with Other Test Findings Answers to RM 's Questions about Himself Figure 11.4 RM's Page 1 Profile Plotting Raw Scores Figure 11.5 RM's Page 2 Profile Plotting Raw Scores Figure 11.6 RM 's Page 1 Raw (Round Icons) & Complexity Adjusted Scores (Square Icons) Figure 11.7 RM's Page 2 Raw (Round Icons) & Complexity Adjusted Scores (Square Icons)

377 378 384 385 386 387 388 398 400 400 400 400 401 401 402 404 405 406 407

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CHAPTER 12 R-OPTIMIZED ADMINISTRATION Problems with the Distribution of R in the CS Research Leading to R-Optimized Administration Conclusion for R-Optimized Administration

CHAPTER 13 DEVELOPING THE FORM QUALITY TABLES Overview ffi Figure 13.1 Example of Form Accuracy Rating Form with Designated Location Area Depicted

Frequency U.S.-Based FQ Tables Integrating New Fit and Frequency Data with Older FQ Data Table 13.2 Objects Classified by Fit, Frequen cy, and FQ

Comparing the R-PAS and CS FQ Tables Table 13.4 FQ- Related Scores in Normative Proto cols Coded using Both FQ Tables

Initial Validity Data for the R-PAS FQ Tables Table 13.5 Correlations of FQ Variables with Criteria in the Dean and Chicago Samples Table 13.7 Effect Sizes (d) Contrasting the Nonpatie nt and Patient Samples

Conclusion

CHAPTER 14 RELIABILITY Interrater Reliability Background and Existing Literature Two Samples of R-PAS Modeled Records Table 14.2 Intraclass Correlations of Interrater Reliability in Three Data Sets A Sample of R-PAS Records R-PAS Coding of New Varia bles in the Normative Sam ple Limitations Associated with the R-PAS Interrater Reliability Studies

Temporal Consistency Reliability

CHAPTER 15 VARIABLE SELECTION AND VALIDITY Variables Included in R-PAS Table 15.1 Selection Rationale and Validity Comments for R-PAS Variables

Rorschach Variables that were Considered but Not Included in R-PAS Comprehensiv e System (2003) Variables Other Rorschach Variables Considered

Relationships of Complexity and R with Other Variables

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Table 15.3 Correlations of Variables with Complexity and R in Four Samples

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CHAPTER 16 GENERATING NORMATIVE REFERENCE DATA

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Overview Modeling R-Optimized Administration Table 16.4 R Distribution in the Modeled Sample Compared to the Target R-Optimized Sample Table 16.5 Protocol-Level Descriptive Statistics for R

Reference Data for Prompts and Pulls A Summary of the Different Reference Data Samples The Impact of Modeling R-Optimized Administration on Reference Values Converting Raw Scores to Percentiles and Standard Score Equivalents Creating Complexity Adjusted Reference Data Table 16.11 Example of How Complexity Adjusted Reference Data are Calculated Table 16.12 Coefficients to Predict Scores from Complexity in the R-Optimized Reference Data

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APPENDICES

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Appendix A: Appendix B: Appendix C: Appendix D: Appendix E : Appendix F : Appendix G:

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Glossary CS vs. R-PAS Administration CS to R-PAS Codes-Coded vs. Not Coded CS Terms and Their R-PAS Counterparts Per centile Conversions To Standardized Scores Form Accuracy Judges by Country Guide to the R-PAS online scoring program

492 493 494 498 499 502

REFERENCES

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SUBJECT INDEX

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Introduction

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CHAPTERI INTRODUCTION Why the Rorschach? Hermann Rorschach first published his carefully selected and artistically enhanced set of ten inkblots 90 years ago. The stimuli are complex and they are structu red to provid e multiple suggestive but incomplete or imperfect perceptual likenesses that form competing visual images. The task requires respondents to examine the stimuli, and to answer the question, "What might this be?" The answer to this question provides both a visual attribution to the stimulus , as well as a verbal explanation or elaboration. Based on this, the task provides a standardized, in vivo sample of problem -solving behavior that can be understood from multiple viewpoints , including: direct observation of task behavior; comparison of numerous dimensions of visual and verbal performance with normative expectations; and analysis of the content , imagery, and sequence of responses . Administering the Rorschach ®task allows the examiner to observe and assess the behavioral performance of the respondent - to see what the person does, not what the person says he does. This performance assessment provides a demonstration of the respondent's solutions to the challenging visual, cognitive, and perceptual problems in the blot stimuli - what we call observing "the personality in action." The Rorschach task has been in continuous clinical use si nce it was published, in part because it is a reasonably brief , portable , behavioral experiment that can be readily administered in various clinical settings (e.g., a private office, hospital room, jail ceilJ). At its core, the Rorschach is a behavioral task that allows wide latitude for ideographically unique responses in which the enacted behaviors are an expression of one's personality features and processing style. As a behavioral assessment task , the best or most valid interpretations are those in which the coded behaviors observed in the microcosm of the task generalize to parallel mental, verbal, and perceptual behaviors in the external environment. Rorschach scores identify personality characteristics that are based on what people do , which is a complement to the characteristics they consciously recognize and willingly endorse on a self-report instrument. As such, the Rorschach is able to assess implicit characteristics that may not be recognized by the respondent him or herself. Because task performance and self-report are very different ways of assessing personality, it is not surprising that Rorschach results are, at best, modestly correlated with self-report data. Because of this, however , valid Rorschach scores provide unique information about the personality that can add incrementally and meaningfull y to self-reported or introspectively-assessed information. As is true in general for implicitly assessed traits, the behavioral expressions of Rorschach assessed characteristics are most likely to emerge spontaneously over time and to be expressed in relatively unfamiliar and unstructured situations in which individuals must rely on themselves for direction . The Rorschach offers both nomothetic and idiographic techniques for evaluating test takers ' performance. Particular strengths of the Rorschach are its ability to permit standardized, in vivo observation and coding of perception and its conventionality (aka reality testing), probl em-solving and coping style, information processing and thinking , and interpersonal behavior ; its sensitivity to characteristic representations of self and others and schemas for their interactions ; its sampling of salient concerns, meanings and preoccupations ; and its capacity to yield rich , multi -faceted descriptions with considerable idiographic content.

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Chapter 1

Backgroundand History Hermann Rorschach 's overall approach to understanding responses to the inkblots in 1921 is essentially the same as that used in the present day. However , many specific systems for administering, coding , and interpreting responses have come and gone. During the period in which the R-PAS was developed, the most widely used Rorschach system was the Comprehensive System (CS), developed by the late John Exner. Exner designed and introduced the CS in 1974 to incorporate the best and most valid aspects of the five major U .S systems available at that time. In 1997, he founded the Rorschach Research Council (RRC; Exner, 1997a, 1997b), whose mission was to advance and synthesize the research foundations for the CS, as a means to guide improvements in the system. Four of the five authors of this Manual served on the RRC, and many of the innovations that distinguish RPAS were originally initiated or discussed by the RRC as possible modifications to the CS. However, at the time of Dr. Exner' s death, there was no clear documentation to allow the CS to evolve with new research so as to make it more useful to future users. One might say that the developmental work accomplished from 2006 to 2011 for R-P AS was, in large part, a continuation of the efforts and projects inaugurated by the RRC. Beginning around the same time the RRC was founded, several psychologists published a series of criticisms of the Rorschach , raising doubts about various aspects of its psychometric foundations. Many of their criticisms were unfounded and uninformed (e.g., suggesting that coding reliability may be no better than chance agreement), but some had research support and raised legitimate concerns that became more obvious over time as additional data accumulated. Based on our review of the existing evidence , surveys of experienced users and new learners , our own research , and our experience as teachers , clinicians, and researchers, we became particularly concerned with the following issues: variations across examiners and training sites in conventions followed for administration and coding ; error variance introduced by differences in the respondent's degree of task engagement and in the number of responses given to the task; inconsistency between how a score is interpreted and its empirical evidence base and/or the psychological operations involved in producing the coded task behaviors (i.e., the response process); inaccurate and sometimes overpathologizing normative reference data; and overreliance on negative or clinically unhealthy interpretations of variables. We were also concerned about matters of parsimony and efficiency. Many clinical training programs and assessment professionals in the field considered the test too complex and timeconsuming to learn and to use. Also, we believed it was important for Rorschach testing to stay abreast of current developments in assessment psychology, such as attention to international considerations and the increasing use of modem statistical techniques and data-processing methods. We concluded that the Rorschach was in need of a broad reformulation to reduce examiner variability, align it with its evidence base, and , where possible , to simplify its procedures and presentation of data.

The RorschachPerformanceAssessmentSystem To address these issues and to allow Rorschach -based assessment to evolve with emerging research, we developed the Rorschach Performance Assessment System® (R-PAS) as an evidence-focused , internationally-oriented approach to using the inkblot task based on the latest available research. Conceptual and empirical rigor is especially needed within health-care and academic environments that are increasingly evidence -based . The system seeks to take advantage of the Rorschach' s unique strengths as a highly portable complex behavioral task that provides a means of systematically observing and measuring personality in action. Our focus is on enhancing the psychometric and international foundation of the test, while allowing examiners to interpret the rich communication ,

Introdu ction

3

imagery, and interp ersonal behavior within that strong psychometric foundati on. Specificall y, R-PAS® is designed to enhance the utility of Rorschach-based inkblot assessment by: 1) Selecting and highlighting those variables with the strongest empirical, clinical , and response process/behavioral representational support , while eliminating those with insufficient support. 2) Comparing test takers' scores to a large internation al reference sample , using a graphic array of percent iles and standard score equivalents . 3) Providing a simplified , uniform , and logical syste m of terminolog y, symbols, calculations, and data presentation , in order to reduce redundancy and increase parsimony. 4) Describing the empirical basis and psychological rational e for each sco re that is to be interpreted. 5) Providin g a stat istical procedure to adjust for the overall complexity of the record and a graphical illustration of its impa ct on each varia ble. 6) Optimizing the numb er of responses given to the task in order to ensure an interpretable and meaningful protocol, while drastically reducing both the number of times the task needs to be re-administered because of too few respo nses and the likelihood of inordina tely long and taxing administrations because of too many responses. 7) Developing new and revised indices by applying contemporary statisti cal and computational approaches. 8) Offering access to a scoring progr am on a sec ure, encrypted web -platform from any device that can interface with the Internet (e.g., PC , Notebook , smart phon e, iPad) .

Using the Manual This Manual is intended as a comprehensive resource, providing all the information needed to administer , code, and interpret the Rorschach task. The manual is supplemented by our online scoring program that calculates the summar y scores and plot s them using standard scores. Naturally, as with any assess ment or therapy method , in order to develop proficiency in the use of the syste m, some additional instruction and supervis ed practice is desirable . In order to minimize examiner variability in administration, coding, and interpretation , the Manual offers detailed and specific guidance. New users may find this level of detail difficult to assimilate on first acquaintance , but by referring to it frequentl y as a referenc e in teaching or applied practic e, it should gradually be internali zed and become increasingly useful. The Manual is divided into four main sections. The Examiner 's Manual contains two sections , Administration and Response Level Coding (Chapters 2-1), and Proto col Level Scores and Interpretation (Chapters 8-11). The Technical Manual is its own section (Chapters 12-16), and it is follow ed by the Appendices in the final section. Chapter 2 Administration provides a description of how to administer the test and document the respondent 's communication. Mastering this chapter and the basic coding procedures found in Chapter 3 Basic Coding should allow both new learners and experienc ed Rorschach users to practice administration. Chapter 3 also provides information about how to use the online scoring program found at www.r-pas.org in order to enter coded response informa tion. Chapter ./ Advanced Coding is a more detailed and sophisticated treatment of coding that also function s as a reference guide to help resolve coding ambiguities. Chapter 5 Advanced Clarification is an extended , systematic treatment of the complexities and subtleties of reliable and effective response clarification. Chapter 6 Form Quality Tables presents tables of response objects by card and location that are classified by a combination of the two key elements of perceptual accuracy: fit and frequency. Chapter 7 Coding Practice provide s Rorschach responses to use for coding practice. The responses are acco mpanied by our rationale for the proper coding. Chapter 8 Response-Level to

4 Chapter 1

Protocol-Level Conversion delineates the calculations and transformationsneeded to prepare the

quantitative data and codes for interpretation.In other words, it specifies the terms, symbols, and calculationsfor the protocol-levelvariables that are interpreted in the system. It also provides additional information about using the online scoring program. Chapter 9 Normative Reference Data provides descriptive statistics for the R-PAS reference samples, using protocols that are either modeled to reflect an R-PAS administrationor not. Both sets of reference data are used in the online programand can also be used if one calculates summary scores by hand. Chapter I 0 Recommendations for In terpretation provides the rationale, background,and principles and procedures for producing meaningful inferences for using the test in practice. Chapter 11 Clinical Case Illustration applies these principles and procedures to the case of a young man struggling with his sexual identity. The Technical Manual (Chapters 12- 16) presents technicaland statistical information about the psychometricand normative foundationsof the test and an overview of the evidence concerning the reliability and validity of its variables. Appendix A provides a general R-PAS Glossary. Appendices B, C, and Dare intended to help former CS users learn R-PAS. They compare R-PAS administrationprocedures, codes, and terminology. Appendix F provides a list of the manyjudges from various countries who participatedin the Form Accuracy project that was used to help refine Form Quality classifications.Finally, Appendix G is a guide to using the R-PAS online scoring program.

Administration

5

CHAPTER2 ADMINISTRATION Purpose and UnderlyingPrinciples Administering the Rorschach allows the examiner to observe the behavioral performance of a respondent solving challenging visual, cognitive, and perceptual problems - or what we call "the personality in actio n." The respondent articulates his or her solutions to the task "What might this be?" through a series of ten semi-ambiguous yet evocative inkblot stimuli . This type of standardized behavioral information is not readily available through self-report or observer-report personality assessment method s. Proper administration and documentation are crucial to this effort , so that both the quantitative and qualitative aspects of the respondent 's performance are captured accurately with minimal influence from the examiner. Using sound administration techniques maximize s protocol reliability and validity. Basic Components of the Administration: Overview Four Underlying Principles Guiding the Administration

1. 2. 3. 4.

Administration is standardized. The respondent takes the lead; the examiner is non-directive . The goal is to capture the respondent's performance accurately. Administration focuses on the visual representat ion and problem-solving components of the task.

The instruction s and procedural rules for administration derive from these four principles. For example, the examiner gives the test and documents the performan ce in the same way with all respondents (Principle 1). Within the basic structur e of the test administration procedures, examiner interventions are non-directive so that the respondent takes the lead in organizing the task and responding to its demands. Thu s, the examiner says as little as possible during the test and sits outside of the respondent' s direct field of view so as not to inadvertently reinforce or shape her approach to the test. Clarification questions are open -ended and are framed as much as possible using the respondent 's words. For example , the examiner often uses the answer, "It' s up to yo u," in reply to the respondent 's queries or requests for guidance (Principle 2). To code the test accurately , the examiner needs to resolve ambiguities and to document the res ponse as it is being described (Principle 3). Thus the examiner focuses on and records what the respondent communicates by word and gesture (Principle 4). There are two phases to administration: (1) the initial Response Phase (RP) during which the examiner asks the respondent to answer the question "What might this be?" and (2) the Clarification Phase (CP), during which questions are posed to reso lve coding ambiguitie s. Thus , the examiner goes through the cards twice with the respondent. After introducin g the test, he or she initiates the RP by simply handing the first card to the respondent and asking , "What might this be?" The answers to this question are the responses, which are transcribed verbatim. The examiner manages the number of responses by saying at the outset that two or possibly three responses are desired for each card, by prompting for a secon d response if only one is given, and by providin g a reminder and moving on to the next card if four are given (i.e., pulling the card). After presenting all ten cards, the examiner

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gathers enough information to code the responses by going through the cards a second time. In this CP, the examiner asks questions about how the response was seen and identifies the locations used. During the entire administration, the examiner must stay alert to ensure that the respondent's communication and behavior, both verbal and nonverbal, are accurately observed and documented so that subsequent coding and interpretation are valid. To achieve these goals, we describe procedural details organized into the five sections listed in the text box. The Essentials: Administration J. Make initial preparations: Materials, logistics, and seating.

2. Establish rapport and explain the assessment process. 3. Introduce and initiate the task. 4. Administer the test: a. The Response Phase. b. The Clarification Phase. 5. Document the responses and task behaviors.

Detailed Administration Instructions Make Initial Preparations: Materials, Logistics, and Seating Proper preparation is important , so the examiner needs to have enough material s (e.g., paper, location sheets, laptop battery charge) to accommodate the rare long or complex protocol. Of course, the materials should be organized so that they are easily accessible when needed . Uncertainty about materials can be anxiety -provoking for both the examiner and the respondent. The Essentials: Initial Preparation

Schedule I to I½ hour timeframe. 2. Bring writing materials. 3. Provide a quiet work area. 4. Arrange side-by-side seating. I.

Time frame. Typically an examiner should plan for the administration to take almost an hour. The maximum number of responses is 40, so it is very rare for a testing session to last longer than an hour and a half. Writing materials. The examiner should be prepared with writing materials (i.e., pen and paper or a laptop). If using paper, it is necessary to have enough for the longest possible record , which is one with 40 elaborated responses. The examiner should also have two location sheets for use in the CP. These should be kept face down, with the inkblot images not visible.

Wod area. The work area should be quiet and without notable distraction s. It may not be optimal to be facing, for example, a window, a colorful painting, or a bookcase, as these may influenc e the respond ent's replies. The cards should be clean and placed in order upside down (with the blots not visible). They should be within easy reach for the exami ner but not for the respondent. As the

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respondent finishes and hand s back the card, the examiner should simply place it at the bottom of the same stack so they remain in order. While the respondent handl es the cards one-by-one, most examiners prefer to store the stack of remainin g cards face down in their lap or on a table away from the respondent.

Side -by-side seating. Seating should be side-by-si de to reduce the impa ct of inadverte nt nonverbal cues from the exami ner about what might be expected and so that the exam iner can see the card as the respondent holds it. Because most sessions will not start with both parties sitting side-by-side, the examiner can make the transition by saying something like: "To do the Rorschach (or inkblot test), we need to sit side-by-side, so that I can see the cards as you hold them." As some people find this form of seating to be awkward , it may be helpful to add a brief explanatio n, such as, "Also, I do not want to interfere as you look at the card, so I am going to sit off to the side here ." The new examiner may be more anxious than the respondent about moving chairs into the side-by-side position. The respondent typically experiences it as a standard, insignificant procedure. Cultural considerations regarding seating. Side-by-s ide seati ng is considere d more intimate than corner-to-co rner and opposite seating across a range of Western cultures. Comfoti with side-by-si de seating can vary by culture and examiners sh ould be sensitive to the cultural conventions where they practice. In certain cultures an examiner may need to address this practice more fully by acknowledging that the seating arrangement is not common while explaining the need to main tain standardized administration despite its awkwardness. Establish Rapport and Explain the Assessment Process

The Essentials:Beginningthe Assessment 1. Provide general information about the assessment process. 2. Establish rapport during the warm-up period. Provide general infonnation about the assessment As with all assessment procedures, it is import ant to orient the respondent to the purposes of the testing , the referral question s, and the overall procedures of the assess ment. The respondent should always be informed about who will receive the results and in what form they will be given - information that is routinely covered in the informed consent process . Obtaining verbal (in addition to written) inform ed consent by discussing the purpo ses of the assessment and what is to come demons trates respect for the respondent and helps build trust in ways that increase the va lidity of the exam . Generally, the examiner will have already discussed these issues with the referring professional and asked him or her to discuss with the client the purposes of the assessme nt and how feedback will be provided . Establishing rapport At the outset of any assessment it is important to take some time buildin g rapport and establishing a positive working relationship. This should be done before initiating a Rorschach administration. To foster this working relationship, one might ask both informal and neutral informational questions (e.g., "What has it been like for you here?" "Ho w have things gone for you today?" "ls there anything you want to tell me or ask me bej(>rewe get started?" ), in addition to the general orientation mention ed above. Other reasonable ways to establish rapport and trust includ e completing an intervi ew-base d demographic or biographical form , a drawing task, or a simple neuropsychological screening measure that the respondent should find easy to complete. It is almost always helpful to ask the respondent what he or she hopes to discover or to learn from the testing.

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On the other hand , it is probably best not to address personally loaded and anxiety-provoking topics or to review in detail the person 's symptoms of psychopathology immediately before the Rorschach . Such discussions could build rapport but could also stimulate imagery that might carry over to the test. If a clinical interview provoke s such material, it may be best to add a short intervening neutral task or discussion before starting the test. The goal of this warm-up period is to establish a positive working relationship by engaging in nonthreatening assessment activities or by exploring question s that are salient for the respondent and that allow the examiner to know the person better. Demon strating curiosity and sincere interest communi cates respect and concern for the person and helps build trust. It is likely that durin g this warm-up period , seating will be in the traditional face-to-face arrangement, and will be rearrang ed to side-by-side seating when it is time to move on to the testing. Introduce and Initiate the Response Phase When introducing the Rorschach, one follows the principl e of letting the respondent take the lead. Once the overarching framework for the task has been established, the examiner provides as little guidance and structure as possible. Discussions about the test itself should be brief , so that the respondent does not erroneously infer expectations and cues. Once discussion about the test itself is initiated , one should move reasonabl y quickly to the RP.

The Essentials: Introducing the Task

To introducethe task, say: "We're readyfor the Rorschach(or inkblot) test now. Have you heard ofit, seen it, or taken it b~fore?"

•

If the answer is "No," say: "It's a series of inkblot designs that I'll show you and I want you to tell me what they look like to you."

•

If the answer is "Yes," briefly discuss their experiences and then establish the correct response set by saying: "As you know then, it is a series of inkblot designs that I will show you. All I want you to do is to tell me what they look like to you ."

Next, say: "Okay, now we are ready to start . I will hand the inkblots to you one at a time. Your task is to look at each card to answer the question 'What might this be?' Does that make sense ?" • If the answer is "Yes," say: "Good, we can get started then. Try to give two responses ... or maybe three, to each card. That is, for each card try to see two different things; possibly three. [Hand Card I in the upright orientation to the respondent. ] What might this be?''

If the answer is "No," then respond to specific questions (see below for examples). Briefly explore O,e client's experience will, O,e test. Given that most people have heard something about the Rorschach, many have seen the cards on the Internet or elsewhere, and some have taken it, it is important to dispel any false notions about the test. When ready to start the test, one can say: "We 're ready for the Rorschach (or inkblot) test now. Have you heard of it, seen it, or taken it before?"

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If the person denies having heard about it or seen it. say: "It's a series of inkblot designs that I' ll show you and I want you to tell me what they look like to you."

If the person says yes, indicating having heard of it , seen it, or taken the Rorschach before , the examiner should ask a few questions about his or her understanding of and previous experience with the test (e.g., "Where did you see the cards?" "Whal was the purpose or context/or the assessment?" "What do you remember about it?") . There are two main goals for any questions about the past: the first is finding out what prompted any previous assessment and the second is to appraise the likelihood of exposure to biasing information. However, discussion s of past experiences should not dwell on discovering any potential misconc eptions about the task. Rather, once the reason behind a previous testing or exposure is briefly addressed, the examiner should focus on the current administration and the proper set of expectations for completing the tas k. For people who have been tested before , the examiner can say something like: "As you !mow then, it is a series of inkblot designs that I will show you. All I want you to do is to tell me what they look like to you." For people who have seen the images on the Internet, the examiner can say something like: "As you know then, it is a series of inkblot designs that I will show you. In order for this to be useful, all I want you to do is to tell me what they look like to you." To initiate the administration, the examiner can say, "Okay, now we are ready to start. 1 I will hand the inkblots to you one at a time and your task is to look at each card to answer the question 'What might this be?' Does that make sense?" If the answer is no, the examiner should find out what is unclear and

addressthe issue. The paragraphsbelow provideguidelines and standardresponses to dealwith areas of confusion and questions . If the respondent agrees that the instructions make sense, or after any confusion is resolved , the examiner should say the following: "Good, we can get started then. Try to give two responses ... or maybe three, to each card ." The emphasis should be on the word "two ," with a pause as indicated , and less emphasis on "or maybe three." It may be helpful to emphasize that the responses should be different , "That is, for each card try to see two different things; possibly three." Next, hand Card I in the upright position to the respond ent and say just these four words: "What might this be?" The instruction to give "two responses ... or maybe three " is designed to help optimize variation in the number of responses so as to maximize validity and! utility. Relatively short records (approximately R < 18) or relatively long records (approximately R > 27) are less useful than records in the optimal range of R from 18 to 27. The "prompt " and "pull" procedure s described below serve the same goal.

Additional considerations when introducing the task. If specific questions arise , they should be addressed. Consistent with the principle that the respondent should take the lead, answers should be truthful, straightforward , simpl e, and brief, but also non-dir ective. In all cases, answers should serve to maintain the proper problem-solving set. Avoid adding information that might influence the way the respond ent makes decisions on what to report. Below is a list of questions and answers that frequently occur before or after the test is started. The exact wording of an answer can be tailored to suit the specific situation and context or to maintain rapport.

1

Of course, the wording of this transitional statement might differ as a function of what was discusse d immediat ely beforehand .

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Sample Respondent Questions and Suggested Responses

General questions about the test or testing process. For general questions about what is expected (e.g., "Should I see anything in particular?" "Can I turn the card?" or "Should I use the whole thing?"), the preferred answer is "ft 'sup to you."

R: "How are they made?" E: "Typically inkblots are made by putting ink on a piece of paper and folding it over. These were made that way too, though Hermann Rorschach artistically changed them so that the test worked better ."

R: "How can you get anything meaningful from inkblots?" E: "We all see the world a bit differently and this task allows us to understand some of how you see things ."

R: "Does everybody look at different ones?" or "Are there different inkblots?" E: "No, it's a standard set; everyone gets the same ones." R: "Why am I doing this?" E: "It provides some information that should help me understand you so we can better [address the referral question]." One would complete the previous sentenc e based on the specific circumstances of the assess ment (e.g., " .. . plan your therapy," " ... understand the conflicts you are having with your wife/husband," " ... recognize what might be associated with the anxiety you regularly feel," " ... address the issues brought up in your case," " ....help to understand the problems you are having in

school/athome," "... helpyou andyour parentsfigure out what to do next"). In manysituations the simplest rationales are best , such as "It helps us get to know you better so that we can help you more." R: "What does it mean?" or "H ow will the information be used?" or " What does it mean to see a ... ?" E: "That's a good question . Let 's discuss that in more detail once the testing is completed." or "If you'd like, we can talk about that when we 're done." Answer ing these kinds of questions more directly during the test could distort the respon se set and results. Questions Related to the Response Process Respondent s may ask questions that can interfere wit h the optimal approach to the task. In these cases , briefly explain or repeat the appropriate instruction or guideline .

R: "Is there a right answer?" or "What do most people see?" E: "Different people see different things." This is a multi-purpose , truthful , brief, non-directive answer.

R: "How many should I see?" or "Am I supposed to see a lot of things?" E: "Try to see two different things on each card,· possibly three." · ?" or "Shou ld I see a .....?" R: "Can I turn zt. E: "It's up to you ." This is a commonly used multi-purpose, truthful , brief, non-directive answer.

R: "Do you see that?" E: If this occurs during the RP, say "Let 's come back to that in a little bit after we go through all the cards first ." If this occurs during the CP.j ust respond truthfu lly; e.g., "Yes, I see that," or if yo u need more information to code the response, "No, not yet . What there makes it look like ... ?"

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R: "Should I tell you the first thing that comes to my mind?" or "Should I tell you how they make me 1• ldlb . an d. imagmatzve. . . .. ?" or "S'nou . e creatzve E: "J want you to tell me what they look like to you ."

fieel .?"

R: "Should I give you as many responses as possible?" E: "No; just try to give two answers for each card; maybe three ." R: "What if I am thinking something and don't want to say it?" E: "Jt 's up to you ." Some things to avoid saying or doing •

Avoid using the words "ambiguou s" or "unstructured" when describing the Rorschach images because that is misleading. The images have considerable structure built into them.

•

Avoid saying that there is no right or wrong answer. This is not entirely correct, as there are more and less healthy responses, and introducing the concepts "right " and "wrong " may make the respond ent begin to emphasize this distinction in formulating answers.

•

Avoid saying that "most people" can or should be able to do somet hing , like give another response. Terminology like this establishes a comparative framework and may leave some respond ents feeling like they are lacking as compared to others.

•

Do not mislead the client into thinking that imagination or creativity is being tested.

Prior exposure and the potential for bias, coaching, or malingering. Because the inkblot images are on Wikipedia and other web sites, and also on clothing and household items like mugs and plates , it is useful for examiners to know that simply having previou s exposure to the inkblots does not compromise an assessment. For example, clinical patients are often retested to evaluate the effect of treatment. Test -retest reliability studies demonstrat e that Rorschach codes are reasonably stable over time. Thus , exposure itself to the inkblot images is not a problem. What can be problematic is exposure accompanied by recommendations concerning what are good, common, or healthy responses versus poor, uncommon, or unhealthy responses. This kind of information can allow for motivated distortio n. Because some response content is fairly easy to inhibit or to accentuate (e.g., respondents can decide to report or not report content like blood , sex, and aggressive activity), examiners should address suspected response distortion. The Essentials: Coping with Possible Coaching or Motivated Distortion in Responding I. One can ask directly about preparation for the testing. 2. If the respondent admits to preparing for the test, make a clinical determination about whether to proceed. 3. If choosing to proceed, ask the respondent whether he or she is willing to be honest and spontaneous (and regardless of the answer, treat the protocol cautiously) . .:/. Try to be familiar with current publicly available coaching materials.

If an examiner thinks a respondent may be trying to manipulate the assessment either positively or negatively, this should be addressed openly and directly. Most often efforts to manipulate test results occur in a high stakes or adversarial context where positive or negative consequences are linked to the test findings, such as a custody evaluation or mitigation in a criminal trial. If one is completing an assessment in this kind of context, prior to administering the Rorschach - or any other test - one will

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want to know whether the respondent had prepared for the assessment and if so, how this was done. For instance, in addition to the general question we recommended earlier about prior exp osure, the examiner could ask , "Have you done anything to get prepared for the testing today?" 2 or "Have you looked up information about these kinds of assessments on the Internet or in any books?" If the answer is affirmative , the examiner should try to find out about the specifics of what was learned .

If one enco unters evidence of potential motivati on to bias the results , sound clinical jud gmen t will be required to determine what the next steps should be for the assess ment. If the examiner decides to proceed with the testin g, he or she should encourage honest and spontane ous responding by saying some thing like, "Well, there is a lot of information available [on the Internet I in books} and some ofit is correct; but some of it is really incorrect or misleading. Regardless of what you hope may come from this assessment, the best strategy is to be honest and spontaneous. Will you be able to do that?" Regardless of the answer, the examin er shou ld be cau tious about the record and keep this inform ation in mind when considering its validity. In addition , it would behoove the examiner to know what kind of information - and misinformation is most readily available on the Intern et about the Rorschach. Especially for high stakes assessments, one could prepare a checklist of assertions from sites like Wikipedia in order to evaluate protocols for evidence of their utili zation.

Administer the Test: The Response Phase When respondents follow all directions by focusing on the task, giving the optimal number of responses , and explaining how they see them , administration is straightforward. Even in these cases, howeve r, it demands vigilance, rapid inform ation processing, good working memory , and multi tasking by the examiner. Such demands become much easier with experience and familiarity with the test. Thu s, typical administration, particularl y with a healthy , cooperative adult , becom es relatively routine and uneventfu l for the experienced examiner. When respondents are unwilling or unabl e to accommodate to the examiner 's requests, administration can be mor e complex and demandin g. The detail and elaboration in the next sections address these situations.

How often to say " What might this be?' As not ed earlier , the Rors chach task is introduced with the simple question , " What might this be?" when handin g the first card to the respond ent. Afterward, the examiner might repeat this question when handing over the next card or two. However, typically by the third or fourth card , this question is not necessary and the examin er does not need to repeat it unless there is a good reason, for example , if, after the third card, the respondent appears to be at a loss in terms of what to do or was not attending to the task. At the same time , such a situation wo uld also call into questio n the usefulness of con tinuin g with further testing. The examiner 's role . The examiner has two primary roles during the RP. The first is to provide a sta ndardi zed structure for the task, which includ es fostering an accepting atmosphere that keeps the respondent focu sed on the task while minimi zing the examiner's influence on the respondent's problem solving set. The seco nd is to document the respondent 's performance, which includes the respo nses as communicat ed by wor d and gest ure, as well as other notable behaviors. 2 Caveat:

In many jurisdictions, training or coaching about psychologica l tests by the responde nt' s attorney may be protected by attorney -client privilege. Explicit demands by the examiner in forensic contexts that the respondent disclose the contents of conversations with his or her attorney may be ethically or legally objectio nable. If a respondent begins to describe conversatio ns with his or her attorney concerning the tests, the pruden t examiner will remind the respondent that these conversations are privileged an d need not be disclosed.

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The Essentials: Managing the Response Phase

1. The instruction, "What might this be ?" is typically needed only on the.first couple of cards. 2. The examiner's role: a. Keep the respondent focused, b. Document the respondent's performance (verbiage and relevant behaviors), c. Provide some structure regarding the extent of his or her responding, d. Use "promp t for two, pull after four" procedure. 3. When only one response per card is given: a. Prompt for another, b. Thefirst time it's needed provide a reminder to give two responses, maybe three, c. Make sure additional responding is not just an elaboration of thefirst response, d. Use only one prompt per card (a second response is not required). 4. Re-engage the respondent when needed. 5. ff it is ambiguous whether there is one response or two, wait until the Clarification Phase. 6. Whenfour responses per card are given: a. Thank the respondent and ask for the card back, b. Remind the respondent of the instructions to give two responses, maybe three, c. Only allow the respondent to give another (fit is essential to maintain rapport. 7. Do not accept card rejections. 8. If there are 15 or fewer total responses: a. Go back through and request more responses, b. Do not re-administer the whole test. c. Do not discard previously obtained responses.

Prompts and pulls. In the subsequent section we focus on the structure of the examinee 's task, which comes in the form of prompting to provide enough but not too many responses to each card. We call this the "prompt for two, pull after four" procedure. In combination with the initial guidance to give two or maybe three responses, these procedures constitute the R-Optimized administration procedure, which is discussed with more depth in Chapter 12.

Prompts. Prompts are given when only one response is offered to any card. The first time this occurs request another response by saying , "We would like two, or maybe three, responses to each card, so please try to give another." Like all communications , this should not be repeated in a rote or mechanical manner. Individual circumstances or predilections may make other prompts suitable, such as: "Take your time; there's no hurry; look some more to see something else too." "Thanks, but give it some more time. Remember we 're trying to get different responses to each card." "There's no rush; take your time and you'll probably be able to see more than one thing." or "I wonder whether you could see something different there, too."

Only oneprompt per card. After a prompt , the respondent typically gives another answer, or sometimes two or even three. Occasionally , but rarely, the respondent does not give another response after the prompt. He or she may say something like, "/can't see anything else," and hand the card back. If this occurs, the examiner should accept the card without repeating the prompt a second time.

Clarify the prompt if needed. At times, when prompted , the respondent may react by simply elaborating on the initial response. If this occurs, clarify the expectation by saying something like, "Oh, maybe I wasn't clear. I was asking yo u to see a new thing, a different thing,· not to say more about what you already saw."

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Re-engageclients whenneeded. At any point, after a prompt or otherwise,if the respondentstops the active visual inspection of the card and sits passively, not engaged in the task, the examinershould wait for about 20 seconds; if nothing happens, the examiner should offer a prompt if no response or only one response has been given. If two or three responses have already been given, the examiner should ask, "Are you finished?" or suggest, "When you are done, you can hand the card back." The respondent can take the lead from there: she or he may give another response or hand the card back. Tolerateambiguityabout whetherthere is one response or two. Occasionally,the number of responses to a card is not obvious during the RP because the examiner is not sure whether two objects are seen together in one response or as two separate responses. An example on Card III might be "a butteifly ... and two people," with a short pause after the word "butterfly." Because we let the respondent take the lead, this kind of ambiguity is not considered problematicand one would not intervene during the RP to resolve the uncertainty.In deciding whether to prompt, examinersshould use their best judgment about whether the verbalization represents one or more than one response. Applying such judgment to the butterfly and people response above would suggest that there are two responses, so that no prompt is required, even though one remains unsure until the CP. One consequenceof this, however, is that there will be times when what appeared to be two answers during the RP turn out to be only one more complex answer when reviewed in the CP. This may mean that a card is left with just one response and the respondent was never prompted to give a second. Such inconsistenciesin counting responses and prompting are not typically problematic. Pulls. To prevent overly long records, we discourage the respondent from giving more than four responses to a card. Once the person gives four responses, request that she or he return the card. The first time this happens remind the person of the general instructions, which are that we only need two responses to each card; possibly three. The examiner should extend his or her hand and say, "Okay, that's good. Remember; try to give two responses to each card; maybe three." The examiner should repeat a version of this comment on any subsequent cards that generate four responses, even if the card is spontaneouslyreturned after a fourth; e.g., "Thanks, that's fine. Remember, we just need two or maybe three responses.for each." With the second and subsequent pulls, examiners may choose to omit the reference to "three" responses, and only suggest that two responses are sufficient. For example, one could say, "Thanks; two responses would be fine ." If a respondent spontaneouslyreturns the card before the examiner has a chance to act, a reminder that the goal is to get two or three responses per card still should be provided. However, no such reminder is needed on Card X. Please note that the term "pull" to describe this tactic is not to be taken literally. The examiner would not actually grab and pull a card from the person's hands! Rare cases of allowingmore than four responses.In our clinical work and research with the ROptimized administration,respondents have been comfortable and accommodatingwhen asked to return the card. Nevertheless,to preserve rapport with a particularlysensitive respondent, it might be reasonable to allow the person more than four responses. However, these additional responses would typically not be clarified, and they are not coded. Card rejections.Do not allow card rejections,which are instances in which the respondent attempts to return a card without giving a response. Attemptedrejections are rare, occurring most often with Card IX, but they would diminish the usefulness of the results if they were allowed. Research has definitively demonstratedthat all but the youngest children (under three years of age) or the most demented adults can see things on all of the cards. This is a consequence of Hermann Rorschach's artistic embellishmentsto these designs, which lowered their ambiguity and helped ensure they were evocative. If a rejection occurs to Card I or II, sufficient rapport to support an assessmentrelationship may not have been established. If this occurs, stop the testing, talk with the respondent about what

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makes it difficult to give responses, and re-fortify rapport using the general guidelines described earlier. Then start the test over. If rejections persist , yield to the respondent's resistance and discontinue the test. If a respondent attempts to reject a card after Card II , gently but firml y encourage the respondent to take more time and look further. Ultimately yo ur stance should be to insist goodnaturedl y that a response be provided by supporting the respondent's effort to produ ce one. The directive is for examiner s to do their best to be firm and not accept a card rejection, perhaps adding brief encouragements like: "Take your time,"" We're in no hurry," or "You can do it ." If the respondent were to merely describe the color of the blot 3 ("It's red and green") or its shape ("It's jagged") rather than to give a response, one can say~ "Remember, the question ;s what might it be."

Additional Response Phase for brief records . Although it is very unlik ely to occur, if 15 or fewer responses emerge during the RP, the exam iner goes through the cards again in the correc t order and encourages the respondent to give a few more answers. The examiner can introduce the supplemen tary RP with something like: "That was fine. However, we need a few more responses for the test to be helpful. So let's go through the cards again. Take your time when looking at them and see what other things you can come up with ." Hand the respondent the first card and say, "What else might this be?" Say this only once. During this second administration no extra prompts are given and it is not necessary to obtain another response for each card . Although highly unlikely, if one card had generated four responses during the initial RP, follow standard R-Optimized administration guidelines and do not present that card again for an additional response. Similarly, if the respond ent now gives a total of four responses to any card, ask him or her to return it. The additional responses collect ed during this suppl ementary RP are added to those from the initial RP. In other words , if only 15 responses were obtained initially and 5 more emerged during the supplementary RP, then all 20 would be addressed in the CP. The responses should be clarified in the order of the cards, not in the order they were obtained. So if one response was given to Card I in the initial RP and two in the supplementary RP, clarify all three respon ses before going to Card II.

Introduce and Initiate the Clarification Phase Task The Essentials: Managing the Clarification Phase 1. The purpose of Clarification Phase is to resolve coding ambiguities and to ensure that definitive information is available for coding content, location, and determinants. 2. Explain that you will go through the cards again and want to know where each response is seen on the card and what made it look like that. 3. Answer initial questions if needed. 4. Repeat the response verbatim. 5. Provide a reminder or explanation of the task when needed. 6. Clarification questions should address :;pec(fic coding ambiguities. 7. Address key words or phrases. 8. The goal is to code accurately, not to see the response exactly as the respondent does. 9. Clarify whether an ambiguous verbalization is one or two responses. 10. Document respondent's verbalizations and gestures and identtfy the non-obvious and salient response components accurately on the location sheet.

3

Such responses were coded as Color Naming in the CS (Exner,2003), but are not coded in R-PAS.

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Chapter 2

The puq,ose of the Clarification Phase. The CP exists solely to resolve coding ambiguities. No new responses are accepted during this portion of the test ; the respondent is only expected to clarify features as he or she originally perceived them in the RP. Whereas in the RP the respondent always takes the lead , in this phase the examiner must provide at least so me minimal guidance. The examiner introduces the goals of the CP, reads the response verbalization for each response , ascertains what information is needed to resolve coding ambiguity, and then carefully formulates questions to confirm or rule out these coding possibilities. There is no rus h, and brief silent periods are expected while the examiner mentally reviews coding ambiguities and formulates queries. For each response offered in the RP, the examiner will have the possible applicable codes in mind and guide the respondent to provide the necessary information for accurate coding decisions. Clarification Phase: The Basic Instructions The Clarification Phase exists only to obtain data for accurate coding of what was seen during the Respon se Phase. The standard way to introduce the Clarification Phase is as follows: "Now we are going to start the final step . While looldng at the cards I want to review your responses with you to clarify what it is that y ou saw and how you saw it. So we will look at the cards one by one. I will read your responses back to you and I want to know where on the card you were looldng and wha.t about the inkblot made it look like that to you. Does that make sense? "

The process of coding, even if it occurs only in the exami ner's mind, always begins during the RP. While recording each respon se, the examiner attends to where the response is seen (Location) , what it is (Content), how it is organized (Object Qualities), and what makes it look the way it does (Determinants). As each response is given , the examiner makes a mental note (or a written one, if desired) of the most likely coding , while attending carefully to unresolved questions. These questions become the focus of the CP. Much of the relevant coding information emerges during the CP because initially during the RP we do not ask the respondent to describe the elements of the response, only to tell us what it might be.

Coding competence is necessary to clarifycorrectly. A work ing knowledge of the coding rules is fundamental to clarifying correctly. Basic coding information is provided in Chapter 3 and advanced information in Chapter 4. Advanced guidance for the Clarification Phase is presented in Chapter 5, after the coding procedures are presented. Answer the respondent's initial questions . As one does when introducing the test , the examiner should answer questions directly and straightforwardly if respondents are uncertain about what they are to do in the CP. Repeat the response verbatim. After introducing the CP, it is standard procedure to repeat the response verbatim, in its entirety, preferably using roughly the same intonation and timing. The examiner generally does not , however, repeat verbal slips, brief hesitations, repeated phrases, questions , or asides. For longer and more complex responses, it is acceptable to break the response into two, or maybe three, major parts and present them separately. Occasionally, when doing this, it becomes unnecessary to repeat the final part of the verbalization, because the respondent has already provided enough information to code it confidently. Alternatively, with some complex responses, one

Administration

17

might choose to clarify the general percept and then go through the other components separately if they are relevant to coding.

Maintain rapport Maintainin g rapport and the respond ent' s cooperation is critical to effective clarification and to obtainin g valid Rorschach data . Accordingly , one should use discretion in repeatin g the respon dent 's exact RP intonation and w ords . For example, if the respondent struggled to describe the percept and did so awkwardly, verbatim repetition (especially while imitatin g intonation and pacing) can feel like mocking. Accordingly , corrected verba l slips are also typically not repeated in favor of using the words intended by the respondent. In general, the CP places more burden on both the respondent and examine r and often slightly changes the tone of the assessment relationship. Therefore, it is impor tant to be attuned to the respondent and the quality of the rapport. Provide a reminder or explanation of the task when needed In some situations, the responde nt may seem confused by the clarification task or may not pro vide helpful information. The most common indicator of this puzzleme nt occurs early on in Clarification on Card I or Card II. If , for example , after the examiner repeats the response , the responde nt was to say merely "yes" or "that's what I see" or "that's what it is," he or she most likely does not und erstand the clarific ation task (although this might also be resistance). In this situation , it is best to provide a reminder that the goal now is for the examiner to learn where the object is located on the card and what about the inkblot makes the object look the way it does . Less profici ent respondents may lose track of the purpose of clarification at various points throughout the task . In these instances, the examiner should refocus the respondent on the task at hand. When the respond ent understands the CP instructions well , has the cognitive capacity and maturity to stay focused, and is cooperative, he or she will be abl e to provide the requested information to show where the respons e is located and what makes it look the way it does. In these cases where the respond ent is attuned to the Clarification task, the examiner typically does not need to ask specifically for location information. Location most often becomes clear as the client describes the features of each respons e. Other response features may require one or two clarifying question s in order to ensure confident coding. Rarely are more questions needed , and typically only with the most complex of responses. Indeed, a mistake made by beginnin g examiners is to ask too many clarification questions , particularl y about issues that will not influen ce scoring . Asking too few questions also occurs among new examiners, especially when respondents have identified the location of a response but not any determinant s. Thus , mastering the clarification task requires both further instru ction, which is prov ided in Chapter 5, and also administration practice.

Asking Clarification Phase Questions to Finalize Coding Deciding what needs clarification . At the onset of the Clarification Phase for each response, the examine r should review the response mentally to identify: (a) suggested codes that have not been confirm ed and (b) required coding categories that have not been addressed. The respondent's verbalizations and gestures related to these coding ambiguiti es are used to help formulate questions, while other aspects of the response that are not relevant to coding ambiguities are not questioned. Clarification questions address specific coding ambiguities . Clarification questions should address an identifi able coding ambiguity, and they should target one or more specific coding issues. In other words, clarification questions should have the goal of resolving a specific ambiguity , which may be the presence or absenc e of one code (e.g., diffuse sha ding [Y] vs. no use of shading) , differentiating wh ich code is warranted among a number of possibilities (e.g., diffuse shading [Y] vs. texture for a tactile impression [T] vs. achromatic color [C']), or resolving uncertain codes from more than one

18

Chapter 2

coding category (e.g., both Location and Determinant codes). In all cases, questions are asked to clarify the coding of what was seen during the RP, not what might have been seen for the first time once the CP started. At the same time, keep in mind that some of what was seen in the RP may first be reported early in the CP. Most coding ambiguities are communicated by a key word or key phrase, which suggests a code, but does not confirm it. For example , the phrase "back there" contains key words because it could indicate dimensionality. In turn, dimensionality could correspond to the determinant Vista (V) if it is based on shading, or it could correspond to the determinant Form Dimension (FD) if it is based on shape. This uncertainty is a coding ambiguity that should be clarified with a question. The adjective , "hidden," is a key word invoking the same coding ambiguity between Form Dimension (FD, dimensionality based on form) and Vista (V, dimensionality based on shading). As another example, consider "a gun firing," as a response to a red portion of the inkblot stimulus. This response clearly communicates that Inanimate Movement (m) movement is involved , so there is no uncertainty about coding it. However , one is unsure whether the presence of color helped determine why it looked like the gun was firing. Thus, "a gun .firing," attributed to a red area, is another example of a key phrase because of the color coding ambiguity . At times , a single respon se may contain multiple coding ambiguities. For example, if two of these key word examples were combined in a single response as in, "a gun firing back there," one could ask one question that aims to answer both coding ambiguities at once (e.g., "Jam not sure that I see the gun .iring back there as you do" [said with emphasis placed on the bolded words related to the ambiguities], though it is often simplest to ask two separate questions (e.g., "What about it makes it look like it's firing? " and then,'' You said back there; how are you seeing thaf?"). How to formulate clarification questions. A good clarification question focuses on RP material that

addressesthe codingambiguityat hand. As mentionedabove,these ambiguitiesrelate to either (a) a code that is suggested but not confirmed by the object described at a particular blot location or (b) uncertainty about any one or more of the three elements required for coding on each response (i.e., Content = what it is; Location = where it is located; and Determinant = why it looks the way it does). Even though the target of a clarifying question is usually a specific code, one always asks the clarification question in a non-directive way. Open-ended questions are standard, and they must only contain information that has been communicated verbally or nonverbally by the respondent (i.e., the examiner refrains from introducing material by asking about issues that the respondent did not communicate). Also, the examiner should use visual language in the CP whenever possible, because coding should focus on how the respondent sees the response. To elicit relevant visual descriptions , rely on words such as "see" or "looks" in formulating questions. Importantly , because the purpose of the CP is to understand and code the imagery identified during the RP, the examiner ignores communications that contradict the information presented in the RP. A brief list of suggested clarification questions follows in Table 2.1. New examiners are encouraged to use these options when collecting their first few records. Examiners should strive to vary or change the wording of clarifying questions. Repeati ng questions in the same format can cause the respondent to assume an inappropriate response set. For example, repeating the question, "What makes it look like X?" can induce a form-focused problem solving set with an emphasis on justifying individual response fea tures in a stereotyped and unnatural fashion. Clarification questions are not always needed Clarification questions are only intended to resolve coding ambiguity. As long as there is enough information in the Response Phase to code the response, additional questions in the Clarification Phase are not necessary after the standard step of repeating the Response Phase verbalization.

Administration

19

Table 2.1 Sue:e:estedClarification Questions and Probes for Initial Practice Administrations Question/Probe Examples Repeat the key word or phrase. Dark? Behindhim? Minvred? Bloody prints?

And the (key word or phrase)?

And the softness ? And the depth ?

You said it was (key word or phrase)?

You said it was rough ? You said it was pretty ?

Help me see the (key word or phrase) as you do.

Help me see the fur as you do. Help me see the hollow eyes like you do.

What makes it look (key word or phrase) ?

What makes it look bright ? Whal makes il look delicate ? I'm not sure how you see it?

Use only with vaguely stated, confusing , or odd responses with multiple coding ambiguities: Location clarification is rarely needed:

Where did you see it?

Coding accurately versus seeing the response exacdy as the respondent does. As part of introducing the CP, the examiner tells the respondent , "!want to see it the way you did." This instruction appropriately helps orient the respondent to the visual demands of the clarification process . Nevertheless, related to the previous point, accomplishing this in practice is not essential and it is easy to carry this notion too far. Examiners who believe they need to see the percept just as the respondent did can generate excessive questioning, which also produces examiner-to-examiner variability and confusion. The goal of the CP is to code accurately. This goal is reached when the examiner has enough information to be reasonably certain of how to code the response. Clarifying whether it is one or two responses. As noted above, there will be times when it is not clear whether two objects in the RP were seen together as part of one response or as two separate responses. This ambiguity needs to be clarified for proper coding. The preferred method is to let the respondent resolve the ambiguity on his or her own during the CP. To do so, the examiner initially reads the ambiguous language from the RP back to the respondent; i.e., the examiner does the same thing that is typically done with any response by repeating the response verbatim. As one does routinely in repeating RP verbalizations, the examiner should use approximately the same intonation and timing that the respondent used. In most cases the respondent will spontaneou sly make it clear whether the objects were seen together or separately. For instance, consider again the Card III example of "A butterfly ... and two people," with a short pause between identifying the butterfly and the people that leads to ambiguity about whether they are one response or two. Given the circumstances, the examiner may initially assume that these are intended as separate responses . As such, an effective way to clarify while being mindful to address the uncertainty is to follow the respondent's cadence and begin the CP by just mentioning the first object listed, e.g., "Okay, on this response you initially said 'A butterfly ... '" The goal is to see if the person spontan eously includes the second object or not. If the respondent readily includes the second object, then it is safe to assume that all along it was perceived as just one combined respons e. On the other hand , if the respondent only describes the first object

20

Chapter 2

(butterfly) the examiner would assume that these were two separate responses and code accordingly.

In either event, one tries to stay close to the respondent 's verbalization and let him or her clarify the percept as it was seen. Occasionally , after repeating the response , the issue of whether there are one or more responses is not resolved. At this point , examiner s may need to ask directly whether there are one or more responses. For example, one might ask, "Was that one or two answers?" or "Help me with this; were they both part of the same answer? " or "Did you see the butterfly and people together as one answer, or separate ly as two different answers ?" This kind of direct clarifi cation is infr equently needed. Not surprisingly, confusion about what constitutes a respons e occurs more often with examiner s in training who are ju st learning to hear the cadence and intonation of responses and who are findin g out how common it is to get distinct versus combined percepts for particular blot areas. 4 Howeve r, if an examiner questions whether a verbalization refers to one or two responses fairly frequ ently (e.g., once every protocol or two), the examiner probabl y is not giving the respondent enough time to resolve the question on his or her own , or may be having difficulty discerning the subtle cues relevant to the one versus two response decision. Supervision by an experienced examiner may be most helpful at this point. Among experienced examiners, this kind of ambiguity occurs most often when a respondent's thinking is disconnected or confused. Document the Responses and Task Behaviors The Essentials: Documentation

1. Provide enough documentation that a second person could code the record. 2. Document thefollowing at minimum: a. The responses verbatim, b. Coding-relevant gestures, c. Orientation of card, d. Location of response. 3. Either pen and paper or a computer can be used. :/. Use helpful abbreviations (see Table 2.2 Abbreviations/ 5. Ask the respondent to slow down or repeat if necessary. 6. Use these additional documentation conventions: a. Put examiner verbalizations in parentheses, b. Card orientation, prompt and pull, and time delay notations to use, c. Document when the Response Phase was repeated. 7. Code as soon as possible.

Whydocument? One documents or records a Rorschach examination for three reasons: (I) to ensure that the examiner is able to code accurately , (2) to ensure that coding accuracy is later verifiable by a third party , and (3) to recreate the intera ction with sufficient detail so as to understand the respondent better. Taken together, the following procedures will help considerably when someone other than the examiner reviews the record for research, training, supervision, collaboration, or forensic applications.

4

Chapter 4 addressesthe issue of what is in a response and response boundariesin further detail.

Administration

21

Methods of documentation. Examiner s docum ent record s with different styles and formats. For example , some use lined tablets of papers or blank sheets in landscape format and others use computers. When using paper and pen, we recommend that examiners, especially new learners, conform to a standard set of formatting expecta tions described below.

Paper and pen documentation. We recommend using paper in the landscape rather than portrait orientation. At the top of the first page designate the record by indicating at least the name of the respondent and the date of testing. Leave about 40% of the page on the left for the RP text , with the remainder of the right for the CP text. Just above or to the left of each response verbali zation, indicate the card number , the sequentia l running count of the response number , and the card orientation . Use the same response number on the right side of the page to designate the verbalization for that response from the CP. By convention, Roman numerals are used to designate the card numb er and Arabic numerals to designate the response number. Examples are provided below. In each example , the abbreviation "ERR" stands for "examiner repeats response. " For new learners recording responses with pap er and pen, we suggest recording a maximum of two respo nses per page and starting a new sheet of paper with each card . This format helps when scan ning the respondent's verbalizations and it simplifi es learnin g. Leaving plenty of room between responses in the RP transcription is also helpful , so start one response at the top of the page and the other about halfway down the page. One should always bring enou gh paper to handle the longest and most complex record. Thus, a 40 response record would ordinarily require 10 pages if both sides are used or 20 if only one side is used. However , some people g ive quite complex and detailed responses so having several times that much available for contingencies is wise.

Laptopdocu1nentation . Whenusing a laptop,it is ideal to have a preparedtablein a word processor or in a database program like Excel. The table should have up to 40 rows and six columns, with three narrow columns on the left to designate the card numbe r, response number, and card orientation during the response, and then two wider ones for the verbal izations from the Response and Clarification Phases , followed by a narrow column to designate prompts and pulls. A laptop version of the above paper and pencil example is provided below. The blank file for laptop documentation is available for download from the R-PAS webpage (www.r-pas.org).

What to document All critical information related to coding must be included. As a standard , the examiner should provide enough information and spec ificati on about the commu nication and location of the response so that a second person who did not administer the record could code it accurately and confidentl y. This is done by capturing a verbatim transcription of what was said, documenting gestures relevant to coding, and identifying the location of the response and orientation of the card. One also documents behavioral or non-verbal information related to respondent cooperatio n and productivity , which is typically informative in both clinical and non-clinical contexts.

22

Chapter 2

Figure 2.1 Examples of Paper and Pen D ocumentation .

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Coding Practice 275

Table 7.3 C0 d.ID!? Rat·10naIe tior Prac tice Responses #

Codin~ Rationale

1 Even though a moth is very similar to a butterfly, the extrapolation criteria only apply to FQ, not Popular, which must be the exact object. Therefore, no Popular for moth. C' vs. Y? Here the "light and dark coloration" brings in contrasts, hence it suggests shading. Since there is no depth (V) or texture (T) associated with the shading, code Y. 2 No comment. 3 No comment. 4 Bow in hair is Cg. The shape is emphasized over the color so it is coded FC. 5 Sy is establishedwith dancers who are dancing on the same stage. COP, but no MAH, as dancing on the same stage and "swinging around" does not necessarily involve mutuality. 6 For FQ extrapolation use frog (FQo). 7 Although the whole animal word "alligators" is used, because the description "exhausts" the Dl0 area with only the head, code Ad not A. 8 Ad is coded for "wings," _justas A would have been coded had an "eagle" been identified. 9 Just enough form emphasis for FC, after mentioning colors first in CP. Individual flowers have a form demand and the communication about shape and petals rules out Vg. 10 Uterus is not listed for D2, but because Anatomy is listed as FQu code FQu as "women's internal organs" are anatomy and they are not given a specific shape. 11 No comment. 12 At DI Human is FQ- and Hor H-like Head is FQo. For these ghosts a whole figure is implied but they are seen as "blobs" without clear form, so code FQu. 13 ODL for "wishbone" as a good luck object. As noted in the Content Codes table, an unelaborated wishbone is coded NC. 14 FQ- for "mouse" because rodent is listed as FQ-. Since this is a grey area of the blot, "color" is coded as C'. 15 This is an atypical response when it comes to assigning location. Historically, this image of the crab at Dl with a claw at D12 has been coded as Dd, even though this percept occurs frequently enough that it actually meets criteria for a D designation. Nonetheless,like percepts of other single objects that are formed from the combination of D 1 and D 12, it is still coded as Dd. "Claws" have potential for harm and are given as an example in the AGC coding section. 16 The response communicates form and structure (explode and disperse) so Vg is not coded. 17 No comment. 18 If the person had merely said the blot was shaped like a pelvis, SI would not be coded even though it would be part of the image. It is only when the person specifically identifies them as part of the image ("two holes in the center'') that SI is coded. E should have clarified "holes" for dimensionality (FD or V). 19 Praying hands are from a single person so no Sy or 2. 20 Because the respondent says "the white ones" (notjust "the white here"), this suggests they are referring to the birds not just the blot area. 21 FQu because "bear" is not in the FQ table for this location and there are no other entries that are shaped enough like a bear to extrapolate (the closest might be gorilla and human-like, since the bear is standing, which are both FQo). FMp because "standing tall" is almost but not sufficient for FMa. Not M because bears do stand upright. View from below involves FD. 22 FD for "like looking up toward" the "giant" "like I'm below him." Even though giant often refers to a human-like creature, adding the animal features "snout" and "tail" in RP establishes it as (A). Just a "bat" would not be coded AGC, but a "vampire bat" is above the threshold for AGC (and 23 is also listed in our AGC table). 24 Code mp for the wake. Clarification for dimensionality in the wake would have been appropriate.

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Chapter 7

# Codin2 Rationale 25 Kissing gives COP, MAH, and ODL. (H) sounded likely in the RP but in the CP there was no identification of features other than the face so (Hd) is coded . FABl because they are Kewpie dolls kissing, but because they are "puckering up their lips " rather than kissi ng, code Mp rather than Ma. 26 CF for the color emphasis "bright glacier " in the RP and "glacier because of the colors" in the CP. Moun tain lion is coded rather than bear , beca use the mountain lion was established in the RP, with the bear only introduced in the CP. 27 Form specification of the plant preced ed color so it was coded FC rather than CF. However, if the last two sentences of the CP were reversed , it would be coded CF. 28 " . ..sharing a glass of beer" in CP established ODL, MAH, and COP , even if it was changed a bit in CP, given that we code what is clearly established in RP. Human -like figures to D6 are FQu . Ther e is no "glass" listed in the FQ for Dd34 . A bottl e (FQ- ) is somewhat close but not the same shape . Nevertheless, the import ant objects are the humans and the glass is a "positional and logical extension " to the humans, so code FQu rather than FQ-. 29 Bats technically do have parts called 'th umbs' that could make sense in the D1 location , so no INCl. Had there been some suggestion they were human-like thumbs (e.g., "he's saying everything is OK, with his thumbs up "), it would be INCL 30 No comment. 31 No comment. 32 DVI for "smallertail. " 33 Orchestra is a prop , i.e. not seen in response, so no Sy or FD. Because human is not listed at this location but it is easily seen, code FQu. 34 No DRl for 'Tm not very creative ." It is only one step away and the respondent returns to task. This is a standard "insecurity " type reference that occurs often during examin ation as a part of the response process. In the CP, although the respondent refers to a personal experience {biology class), this is not considered a PER because the respond ent says "' if' I remember right from biology class, " which suggests the responde nt is indicating they are tentative or questioning their response. Given the respondent also began this response with an insecurity statement, this also gives us more certainty in not coding this PER. 35 No comment. 36 Illustrates the Dd rule for asymme tr ical objects that make up a D. Merely "on the motorc ycle" is not movement. 37 FABl for bugs holding a peg as a person (not as a bug) wo uld. COP because holding such an object would entail so me coordination or teamwork. Mutuality not emphasized enough for MAH . 38 SI and MOR for holes. 39 SI because of the space is identified as being a part of the face, i.e. the nose. FC for limited emphasis on the red of the lips in the context o.f form elaboration. MOR for smashed up , though there is no suggest ion that this was caused by an external agent so it is not quite enough for MAP. 40 Both SR and SI: SR for figure ground reversal. SI for integration with Fi. 41 Tentativ eness, " .. ..some kind of costume " with "turban ," falls short of Ay. Sy for clothing ("hat") that changes the contours of the humans . " ... having their hands together " lacks mutuality , so no MAH , but the coordinated activity warrants a COP. 42 It appears that the guitars contribut e to calling the people musicians but it is not clear that they are playing the guitars in D2, so the coding for this response does not assume they are playing these guitar s. "Doing some thing together, may be playing somethin g" is both COP and MAH. 43 No comment.

Coding Practice

277

# Codin2 Rationale 44 ODL for dolphin beaks (mouths). FD because obscured by water. FMa for getting ready to jump. Sy for dolphin and water. Although it initially sounded like Ad because the RP mentions "two dolphin heads " without mention of the whole body until the CP, even in the RP they are described as whole animals that are ready to jump, not just heads. So A is coded over Ad. 45 Inanimate movement passive (mp) for the masks "hanging from the ceiling. " 46 Because the girls' ponytails "flying in the air" is due to human activity , it is coded M not m. 47 SR might be considered because the respondent emphasizes the water in its own right. However, SR is coded when the object in white visually pops forward so that the focus of perception is on the contours defining the white object , not the contours of the inked object(s). In this instance , the bay remains backdrop for the land; it is not in the foreground. SI because space is integrated with the ink. Do not code Vg because of the emphasis on the "shape looks like a bay. " C' because the water is "white and not shaded. " V because the shading gives the impression of different levels. DRl might be considered for "when people are looking for a safe place to dock their boats ... " as an off task comment , but the respondent is describing how the shape prompted her to characterize it as a bay . 48 FQu because the head of a short-eared animal is listed. Sadness is attributed to the dog in a way that is consistent with dogs, so no INC and FMp not Mp. Even though the wording sounded like A, the head exhausts the D2 location, so Ad is coded rather than A. 49 Leaves have indefinite form but are touching the giraffe, so they have a positional relationship to the well-articulated giraffe , thus CF. Pink tongue is probably FC, but CF for green leaves supersedes the FC. 50 A rather weak DVI for "perched" as the word is used in an odd way and usually applies to a separate object. 51 (Hd) for mask. No DR for Trekkie comment as it is on-task, but PER because "I'm a Trekkie also, " followed by all of the detailed information displays specialized knowledge. 52 Inverted card has "torches with smoke" as FQu; upright "fire with smoke" is FQo . The response objects are vague (unlike "torches") making orientation less important; code FQo. C ' rather than Y for smoke because the respondent said it was due to color. Not enough definite form for FC. 53 Ma, FABl, COP, and MAH for puppies "doing a little dance with each other." 54 Although the "small detail of what looks like a woven basket " might be inquired for a shading variable (Y, T, or V), this phras e follows an inappropriate question. We do not code anything that emerges after such a question, similar to not coding responses that emerge after the fourth response. 55 "Chewed" is not used to indicate eating, but ODL is a language -based content score so "chewed" is coded. Even though the respondent is expressing personal knowledge by describing how leaves get "mangled ," it is not coded PER because it appears the respondent is sharing common knowledge to help or make a connection with the examiner. 56 This response meets minimum criteria for the PEC type that is illogically restrictive and stated with certitude (i.e., "She must be sleeping because she is lying down."). Two characteristics , however , make this a weak PEC. First, the reaso ning is not very concrete. Second, the reasoning is offered in the CP. However, it is not provoked by an additional clarification question nor is there any tentativeness anywhere in the respon se. 57 This is an example of a response in which dimensionality is mentioned , but it is not threedimensional. Instead, the description of looking "spread out" and "flat " only extends the response in two-dimensional sp ace. 58 V because of the use of shading associated with dimensionality of the valley. Even though the respondent uses the word "color" ("lighter color"), it is used to emphasize the color contrasts of shading.

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# Codin2 Rationale 59 "Neat colors " and "colors are nice " are comments not used in the respons e, so not coded in and of themselves. With multipl e reference to color , a brightly colored blot, and features that could be colored and CF . asking a clarification question about color would be acceptable. A "pink panther " with no spontaneous reference to the cartoon and see n as a panther in the env ironment , so code INC l and AGC. 60 "Tree" is established in RP. so we need to use that to code FQ rather than the "bush ," which comes in the CP. FQu by extrapolation: althou g h Tree is not listed at D11 , foliage is o, plant is u, and shrubs are u, and thus by extrapo lation tree would be coded FQu; fire at D3 is FQo. Code down to FQu for "tree on fire" as both tree and fire are essential features. MAP and MOR for bein g on fire . The damage by another entity or process is implicit here. 61 No form. So C is coded for color and Y for them being melt ed together. 62 Ma and INCl for angry insec ts, inse ct having emotion. Precedent is to code active of "angry" because of tension involved. Angry also is code d as involving aggression , even if unfocused and not consummat ed and coded AGM. INCl and not FAB l because insects are not characterize d as reacting to each other. 63 This response has two possible Cognitive Codes: (1) Bats do not have claws on their wings, so it qualifies for INC 1. (2) "A bat, 'c uz of those little claws" is illogi cally restric tive, so it also qualifies for PEC. PEC is selected because it has a higher WSumCog weight than INCL However , in this case it is a rather weak PEC , and the 5 points may exaggerate the cogn itive slippage in this response. AGC for claws. Bat is not, itself , AGC. 64 C and FQn because there is no reference to form. DRl because of the off-task comment that treats the blot as if it were real. Blood is often associated with damage or injury, but is not coded MOR unless elaborat ed with positive evidence of damag e. In this case, the respond ent's strong emotional reaction to the blood pushes it over the threshold to establish MOR. 65 DRl for " . .. from a very sketchy biological desc ription ." Although both internal anatom y (An) and external body parts (Hd) are visible , it is in the context of a picture (Art) so FAB is not scored. Also, ODL is not score d because womb is not mentioned until the CP. 66 "Trying to help one another, " yields Sy , MAH , and COP. "Red repre senting caution " is ABS. The "symbol of caution" is not described in a way that involves form so it does not contribute to the FQ . Thi s symboli zing function clearly indic ates that reference to red goes beyo nd co lor for location, so Color is coded. The symbol has no form and is not in a clear positional relatio nship to other objects so C is coded rather than CF . 67 "Mirror" was clarifie d in order to code the reflec tion , which was not clearl y sta ted previously. 68 ODL for lips. FD and Sy for coming out from behind something. 69 No comm ent. 70 The first challenge with this response is to determine whether the pliers qualify as separate objects . We interpret "end of its wings are made of pliers " to mean that the pliers are part of the wing , i.e. not separate objects, so no Sy is coded. Thi s is also a difficult FQ co ding decision . The major component of the response is the bat to the W, or alternatively , the W without the D10 pliers, which is obviously FQo. This is not a multipl e object response in that the pliers are not a separate object , howeve r, they must be considered in the FQ, as they are important in the response. Pincers on a crab-FQu in the table, may be the closest shape to the pliers, hence we code FQu. The animate-inanimate comb ination as one entity qualifies this for an INC2. 71 FQ extrapolation : For the W , animal in unnatural form or flattened is FQo . Snail, which is nearly identical in shape to a "slug," is listed as FQ- to D3. However, the latter refers to the whole snail and this percept is only of the head area of the squashed slug. Code FQo as the overarching percept is the flattene d slug. Saying the slug "wo uld feel smooth" justifi es T.

Coding Practice

279

# Codin2 Rationale 72 FQu because "feather duster " is not listed in the FQ table for that location, but it is easy to see and Dd22 is listed as FQo. A difficult V vs. T differential, with V selected because of the visua l emphasis and lack of tactile associatio ns. DRl because the two-step "off task " criterion is met with "Doesn't do a good job. Just pushes the dlust around ." 73 Vg because no definite shape to the clouds as described : Edges are mentioned , so form is included but nothing specific about shape specifical ly distinguishes it as clouds. Shading is used to show density, so code V. "Soft " refers to vis ual, rather than tactile perception so Tis not coded. "Colors" on black, gray, whit e cards typica lly refers to shading. 74 Although 2 humans on Card VII are FQo and , in fact, a Popular , using the D4 portions as part of the body lowers it to FQu. Even though there is some tentativeness , there is no spontaneous permissi ve context (e.g., not identified as conjoined twins), so PEC is coded. Could also be FAB 1, but can only score one Cognitive Code for the same phrase. 75 Art for "fancy, " "ornate. " Although a formed object , emphasis on colors warrants CF. PER for "I have one like it in my kitchen. " 76 CF rather than FC due to emphasis on color and CF rather than C because the seahorses "swimming in the coral" and "you can' t see behind the green " to visualize the body , fixes the coral in space relativ e to the seahor ses . Thus, a specific positional relationship is established. 77 An issue here is whether the crab/lobster legs refer to an animal form or to a food item. In this instance, the legs belong to ''a crab" and reference is made to its body so ODL is not coded. "I can't do anything with ... " is a task-focused comment so DR is not coded . The statement "I don't know if it is just the color" suggests color is the primary determinant over form so CF is coded. 78 No ODL because tea set is only mentioned in the CP. COP and MAH for "havi ng a tea party ," even if "maybe." No specific assertion of dimensionality Qust can't see parts of body), so no FD . H rather than Hd because whole objects are implied even though they are not fully visible. Color is probably just used for location , but ruling it out with a brief clarification question would be useful. 79 This is a classic CON in which areas of the blot are seen as two mutually exclusive percepts. The confusing elaboration treating the inkblot as much more than a stimulus ("You gotta be nice to the picture and give it wings.") is sufficiently independent of the CON to be justif y an additional Cognitive Code, DRl. Code both Hd for face and H for "a person, " even though it is ''sorta like a butterfly with wings." Although a human or human-like figure with wings would be coded FQo, a human face to the Wis listed as FQ- so it is coded FQ-. 80 Even though the "white beard " is identified in a lightly colored area, our guidelines indicate that this qualifies as an SI because the respondent identified it as white (but these lightly colored areas would not qualify for SR). Hat at D4 is FQu and the face and beard are not listed but are seen easily enough to keep FQu code. A "bear d hanging down" is mp. 81 ODL for dining. Even if they are going to fall , the interaction between the people is pleasant and positive, so COP. In addition, "looking at each other" in combination with "going to sit down to dine" implies a mutual experience that is enough to justify MAH, as "to dine" implies both a more formal and intimate experience than "to eat." 82 Ay for Eskimo. In association with "fur," rubbing the card establishes T. Because the darkness contributes to depth, this is coded V. 83 AGC for cougar . DVl for "water pond " and DRl for the autobiographical excursion . No PEC for the mirror image comment because it is not illogically restrictive. Prompt (Pr) is coded. Note this was not the first prompt in the record. If it was the encouragement wou ld be accompanied by a general remind er, such as "We would like two , or maybe three , responses to each card, so please try to give another. "

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# Codin2 Rationale 84 Dark shading and the statement "you can put yo ur finger in them" warrants V. These holes have a classic round or oval shape so Vg wo uld not be coded. The holes are meaningfully related, as you can go in one and come out the other, so Sy. SR is coded in addition to SI because the white holes are popped forward and foreground to the "dark shad ing underneath. " 85 AGC for pincers. IN Cl for 4 (or 3) sets of wings on a bug and also because there is a visual implausibili ty present. The bug has a segmented body that is in the D4 with pincers at the top at Dl but the eyes are at DdS3 0, which is visually inconsistent with the body. The statement "I am not a reliable witness" could so und lik e an odd and irrelevant statement but it appears to be given in an humorou s way to account for the fact that he had seen 4 sets of wings initially but then only saw 3 sets. So it is an on-task playful comment that is not coded. 86 Althou gh dogs do 'kiss' after a fashion it is prototypical M behavior and to justify FM, the respondent would have to elaborate in a way to make the action more consistent with dogs, thus the onus would be on the respondent to establish this unusual scoring for kissing. ODL for kissing. FAB2 - the hearts are associated with con fusing language ("for them," "where hearts would be"), along with implied transparency and the union of both (" 1 heart not 2 ") without any explanation ; all of which ju stifies level 2. COP and MAH for kissing, though the submissive posture leads to coding p rather than a. 87 This response involves questions about response boundaries and whet her it is one or two responses. No choice is made by the respondent so code all elements using the "This-o r-That " guidelines. ODL for picnic. COP and MAH for having a picnic or sitting on a teeter-totter. Mp because no obvious action is occurring either way . 88 PEC for the spon taneous, RP, illogically restrictive, unqu alified, causal attribution "has to be a cave because it's colorful." AGC for tiger. The addition of crysta lline is cons idered part of the response, as it is consistent with the RP and offered quickly at the beginningof the CP. "Light and dark" associated with the crystalline elements establishes Y . "I like caves " in response to a CP question is not a PER because it just conveys an attitude or preference. 89 A "this or that response ," which is not clarified in RP or CP per R-PAS guideline s, and respondent clearly accepts "trapped" as part of the respon se in CP, so MAP. FMa because trying to pull away (and stepping) are both active. Passivity, helples s ODL (Dependency 1) also for trapped. FD for the overlapping parts at the trapped leg. 90 FQ extrapolation : Anatomy to D8 is FQ-. Stomach is not specifica lly listed. Food is not listed to D5 or Dd35 and it is not easily seen. So FQ- overall . For responses with parts that make up a cohesive unit that is not a numbered location , use Dd99 . This is coded mp rather than Mp for the involuntary biological process of digestion. ODL for stomach. The change in color and tone justifies Y. Digestion , like eating, is a natural process of consumpti on. Had there been more emphasis on the food being destroyed or brok en apart MOR could be considered. 91 "Confused" is ODL as it implies a state of helpl essness, but "confusion" does not refer to a being . Although "confusion" may not have a specific shape, the respondent indicates that shape is import ant to the percept, so FQn is not coded . Abstract art is FQo. However, "confusion" is not as commo n or easily seen as abstract art. Still, it is easy enough to see what the respon dent sees (so FQ- not appropriate). Code FQu. "Confusion" is a human subj ective experience, so Mp. "Colors .. .. blending together " is shading, specifically Y. CF, not C, because the blendin g involves "still maintaining their own shapes." ABS because "it represents confus ion because they're blending together." Respondent is suggesting that the colors are symbolic of something else, as in abstract art.

Coding Practice 281

#

92

93

94

95

96

97

Codin2 Rationale The vague flowery-colored, pretty things jus tify CF. FQo is established with W for "Humans or Human-Like Figures (as 09 + 08 ; with D14 Unspecified or a Separate Object), Surrounded by Other Objects." Clubs are mentioned in the RP and CP but they are not emphasized and do not detract from the W object description, which thus provides the best match to the response in its entirety. Soldier/club justify AGC; "hand to hand combat' and CP reference to "movement," establish AGM. No Pair for "breasts" or "ovaries" because they are included in one anatomical presentation and are bilateral, i.e. "come in pairs." For responses with parts that make up a cohesive unit that is not a numbered location, use Dd99. Breasts to the 06 are FQu; vagina to 010 is not listed, and is a gross distortion. Although Anatomy is listed for D 10 as FQu, "vagina" is a more specific shape so we cannot extrapolate. Nothing is close to ovaries for the D2, and ovaries is worse than a good proportion of the FQ- and FQu that are listed, so FQ- is also appropriate. Thus, we have two important objects which are FQ- , so that FQ- is the obvious code. ODL for ovaries or breasts. This response has internal and external anatomy in the same plane without explanation, and thus is a confusing transparency without explanation, so it is coded FAB2. There was no communicationSUQQesting space was being used in any way, so SI is not coded. Lack of any form requirement yields V g and FQn. As is frequent with party or celebration responses, this response takes on an idiosyncratic combination of movement or color. Inanimate movement established by "everything is loose and flying." No reference to people or experience, so it falls short of M. "Together but look free... connected in some areas" is coded Sy. Falls short of ABS because nothing is characterized as symbolizing or representing freedom. FAB2 for the demonic possessed cat skull and INCl for the separately described image of the skull with ears still on it. One could consider a DRl for "It's as if the skull could record the cat's life and it wasn't a good one." However, this appears to be an on-taskexplanationfor the beat up image. AGC for the possessed cat. Ma and AGM for "very angry kitty." MOR because he is unhappy. Although an external force is not identified, the cat became possessed and he is unhappy from it. Hence, MAP is assigned for the imbalanced destructiveness. ODL is coded for "mouth". This response has opposing elements that are never resolved, so code using the "This or That" guidelines. COP is coded for exchanging kisses, as is ODL. However, this is AGM for animals fighting and MAP because they have been bloodied. MAP and MAH are mutually exclusive, so although COP can be coded when MAP (or AGM) is present, MAH cannot. The phrase "exchanging kisses" borders on Mand FABI though in the context of other ambiguities and the fact that it is not mentioned in the CP the response is coded conservatively as FM and no FAB. Although most of the location is used, the respondent has excluded 03 and parts of D7, so the Location is Od. Purse is Cg and given wigs are made of human hair, Hd. Regarding FQ, "wigs" and "purses" are important objects in the response. A good extrapolation for wigs is not possible for the D2 area; "hat" could be considered a similar logical extension for the D2 area in this instance but wigs and hats are not similarly shaped. Wigs blowing in the air are a reasonable fit for D2 and given the logical extension, FQu for wigs. A purse is not listed at Dd31; the closest might "basket" or "pot," which are both FQu. Code FQu for the whole response. "Wigs blowing off" is inanimate movement. Wind is often passive, but here it appears to involve enough force to be coded active. The word "transsexuals" provides permissive context, thus no INCL Perhaps, "it looks like they haven't finished the operation" could lead to a DR, but the examinee returns immediately to the response ("because they have the breasts and they've still got their penises.")

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# Codin2 Rationale 98 ODL for birth. SI for face (at DS3). Human at D6 is FQ-; rats to Dl are FQo. Code down to FQas "human" is an essential, important object. Popular for rats to the Dl even though response as a whole is bizarre and distorted. The movement in "just given birth" is in the past , so no movement coded. FAB2 for woman giving birth to rats. One might consider , INCl for pink rats, a relationship separate from the women giving birth to rats, but newborn rats are "pinkish " in color, so it is not incongruous. One could argue that a clarification question should target "braided " hair for a shading code. 99 The location is exhausted by facial features, so code (Hd) rather than (H). Demonic is concretely associated with the relationship between the smoke and the head, so that only one cognitive code is given for demonic and the smoke relationship: FAB2 for smoke pouring out of his eyes , the sheer magnitude (gushing out) of the smoke , in the context of the contradiction between Jesus and demonic , with the demonic being attributed to the odd reasoning ("because different colored smoke") justifies a Level 2 code. The religious or supernatural context here is not permissive enough to justify no cognitive code. AGC because it is demonic . CF for different colors of smoke. INCl would have been added if it had a "pig nose" instead of "pig-like" nose . There is no mention of any human emotion or activity , just the smoke moving (ma), so no M. The eyes are obscured by the smoke in front of them so FD. ODL still applies to Jesus even when he is seen as demonic because ODL is based on word use. 100 Angry involves Ma and AGM; "steam coming out of his ears " involves an additional inanimate movement active code. The modifier "so angry " fortifies the active coding. Steam coming out of ears is FAB 1. One could make a case for a Level 2 FAB, but steam from the ears is a conventional image that fits with the anger elaboration. The fork in his head is an unusual and implausible image that should also be considered for FAB. It is associated with a logical account

for whythe fork is there, "someonehas stuck himwith a fork," so Level 1 is appropriate.Add INCl for cheeks turning yellow instead of red, as independent of the FABl. MAP for "someone has stuck him with something , a fork. " The person who did this is a prop and is considered only in the implied MAP relationship and not for other codes. MOR for the damage with the fork in the head. ODL for frowning , cheeks, and fork.

Response -Level to Protoco l-Level Conversion

283

CHAPTERS RESPONSE-LEVEL TO PROTOCOL-LEVEL CONVERSION Structure and Basic Terminolog y The codes assigned to each respo nse are organized on the Code Sequence page , which was first described in Chapter 3. An example of this response level data from the scoring program is presented in the figure below.

Figure 8.1 The Code Sequence Page

R-PAS Code Sequence C-10 : EV

P-ID: 43

Age: NA

Gender: Male

Education : NA

ODL RCd # Or LoeLoe# SRSI ContentSyVg2FQ P Determinants CognitiveThematicHR(RP)Opt

I 1 2 3 ll 4 5 Ill 6

7 IV 8 9 10 V 11

w D

V V

4

w D D

2 3

D D D

9 1 4 2

D Od 99 D 10

12 w VI 13 V Dd 14 w VII 15 V D 16 V D VIII 17 < D 18 Dd

33 2 2 1

99

IX 19 > D 1 X 20 D 8 21 D 1 22 V Od 99 23 D 10

A

0

F

H NC Hd

u u

Mp

Vq

H,NC Sy

0

2

0

2

0

Ad

-

c~

0

Ad

u

A

0

Ad A A

u

A,Cg Sy

,u

A,NC Sy

A

Sy

p

F F F p

PH

Ma FMp,C'

0

-

F

u -

FMa F

-

A A

iU

F F

NC

u

ma,FC

© 20 11-2012 R-PAS

Pr

GH

INC2,PEC PER

F F F Ma Ma FMa

u u

A A A

F F F F

0

Bl A

GH

Pr INC1 INC1

PH AGC PH Pr

INC1

AGC AGC

Pr

Pu

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Chapter 8

These response level codes are aggregated at the protoco l level to obtain more reliable summaries of an individua l's perfotmance and psycholog ical characterist ics. At this stage we count codes across all the responses in the protoco l as well as calculate other summary scores, percentages, proportions, and differences from these counts to prepare final scores for interpretation . The page that provides this summary information is called the "Protocol-Level Counts and Calcu lations" page and an example is presented in the figure below. The Counts and Calculat ions page forms the basis for the scores that are actually interpreted on two Summary Score and Profile Pages (called the Page I and Page 2 profiles) . The scores in Figure 8.2 in bold font are the ones that also appear on the Summary Score and Profile pages . This chapter describes how to compute all of the summary scores. Because this chapter refers to the R-PAS online computer program at many points, viewing that while reading this chapter is helpful. Figur·e 8.2 The Protocol-Leve l Counts & Calculations Page R- PAS Proto col Leve l Counts & Calculati ons C· IO: EV

P· IO: 43

Age: NA

Calcatioas

Section

Counts

Responses& Adminis t ration

R

= 23

R89!0

Pr

4

Pu

er

= =

w

=

4

0

= 15

W%

=

17%

Od

=

4

WO

=

Od'¼i

=

17 %

Locatio n

Counts

= =

7

R89 10 35 52% 21% FQu% > 40 28% FQo% < 50 14% FQu% > 45 20% FQo% < 45 6% 8% FQo% < 40 FQu% > 50 FQ-% > 05 67% WD-%>05 64% FQ-% > 10 38% WD-%> 10 33% FQ-% > 15 22% WD-% > 15 15% FQ-% > 20 6% WD-% > 20 8%

FC > (CF+C)+ l FC > (CF+C)+2 FC > (CF+C)+3

Fonn vs. 23% 13% 7%

Color (CF+C) > FC+l (CF+C) > FC+2 (CF+C) > FC+3

27% 17% 10%

R < 18 R >2 8 R > 34 WSumCog > 10 WSumCog > 15 WSumCog> 20 SevCog > 0 SevCog > 1 Popul ar < 4 Popular> 7 Vg% > 10 Vg% > 15 SR> 1 SR> 2 SR>3 C>0 C>l r>0 T=0 T>l PER> 1

Miscellaneous 3% 20% 3% 28% 13% 6% 30% 9% 13% 15% 23% 12% 25% 11% 3% 28% 8% 28% 55% 18% 16%

Variables ODL% > 20 COP = 0 COP >2 MAH=0 MAH> 1 MAH>2 MAP=0 MAP > 1 MAP >2 MAP>MAH MOR>2 AGM=0 AGM>2 AGC>5 PHR >G HR H a+l Mp > Ma IntCont > 5 CritCont% > 40

14% 41% 13% 52% 23% 4% 52% 22% 5% 31% 18% 62% 3% 12% 3% 32% 10% 18% 32% 11% 8%

309

~

310

Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data % % 5th Row Variables Scored notO Mean SD Sk Ku Min %ile 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

R R8910 Pr Pu CT R8910% W D Dd WO W% Dd% SR SI AnyS H (H) Hd (Hd) A (A) Ad (Ad) An Art Ay Bl Cg Ex Fi Sx NC

100.0 100.0 0.0 0.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

21.8 7.3

7.8 3.5

1.8 1.6

3.8 3.7

14.0 2.0

61.4 100.0 99.4 99.1 87.0 100.0 99.4 87.0 59.3 90.3 91.7 88.8 64.3 65.9 41.7 100.0 28.9 85.6 11.5 64.0 59.7 30.9 21.1 73.5 15.3 33.9 28.4 98.7

4.1 33. 1 9.0 9.5 3.3 18.5 43.9 14.l 1.1 2.8 3.2 2.4 1.2 1.4 0.6 7.7 0.4 2.3 0.1 1.3 1.2 0.5 0.3 1.7 0.2 0.5 0.4 6.3

5.4 8.2 4.6 5.8 3.4 6.2 20.9 11.0 1.4 2.2 2.7 1.9 1.2 1.6 0.9 3.0 0.7 2.0 0.4 1.5 1.4 0.8 0.5 1.8 0.5 0.8 0.9 3.9

2.0 0.3 1.3 1.1 2.5 1.5 0.3 1.0 1.8 1.7 1.9 2.2 1.4 1.7 1.6 0.8 2.2 1.7 4.0 1.8 1.6 2.9 2.9 1.8 3.0 1.8 3.0 1.4

5.1 0.0 4.0 1.4 10.1 3.3 -0.5 1.3 3.5 4.5 5.9 14.1 3.3 4.3 2.3 0.9 5.2 4.8 23.2 4.9 4.0 12.3 13.4 5.9 10.0 3.4 12.9 3.3

0.0 11.0 0.0 0.0 0.0 7.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

25th 50th 75th 95th # # %ile %ile %ile %ile Max Mode Scored not 0 14.0 16.0 20.0 25.0 38.0 64.0 14.0 1,396 1,396 3.0 9.0 14.0 28.0 5.0 1,396 1,396 5.0 7.0 0 0 0.0 2.0 6.5 13.0 29.0 0.0 0.0 145 89 20.0 28.0 33.0 38.0 47.0 64.0 33.0 1,396 1,396 3.0 6.0 9.0 11.0 17.0 39.0 9.0 1,396 1,387 2.0 5.0 9.0 12.0 21.0 36.0 7.0 1,396 1,383 0.0 1.0 2.0 4.0 9.0 29.0 1.0 1,396 1,214 12.0 14.0 1,396 1,396 14.0 17.0 21.0 31.0 52.0 12.0 29.0 42.0 58.0 80.0 100.0 50.0 1,396 1,387 20.0 35.0 0.0 1,396 1.214 0.0 6.0 13.0 72.0 0.0 0.0 1.0 2.0 4.7 7.0 0.0 145 86 0.0 1.0 2.0 4.0 7.0 13.0 2.0 145 131 0.0 3.0 4.0 9.0 17.0 2.0 1.0 145 133 0.0 1.0 2.0 3.0 6.0 24.0 1.0 1,396 1,239 0.0 0.0 1.0 2.0 3.0 9.0 0.0 1,396 898 5.0 0.0 1,396 0.0 0.0 1.0 2.0 11.0 920 0.0 0.0 0.0 3.0 5.0 0.0 1,396 1.0 582 3.0 6.0 7.0 9.0 14.0 20.0 6.0 1,396 1,396 0.0 0.0 0.0 1.0 2.0 4.0 0.0 1,396 404 0.0 1.0 2.0 3.0 6.0 15.0 1.0 1,396 1,195 0.0 0.0 0.0 0.0 5.0 0.0 1,396 1.0 161 0.0 0.0 2.0 4.0 0.0 1,396 1.0 11.0 893 0.0 0.0 2.0 4.0 12.0 0.0 1,396 834 1.0 0.0 0.0 2.0 8.0 0.0 1,396 0.0 1.0 432 0.0 0.0 0.0 0.0 1.0 6.0 0.0 1,396 295 0.0 3.0 0.0 1.0 5.0 16.0 1.0 1,396 1,026 0.0 0.0 0.0 0.0 1.0 3.0 0.0 1,396 214 0.0 0.0 0.0 2.0 5.0 0.0 1,396 1.0 473 0.0 0.0 0.0 2.0 8.0 0.0 1,396 1.0 396 8.0 5.0 1,396 1,378 2.0 4.0 6.0 14.0 31.0

311

Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data Row 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

Variables SumH NPH NPH/SumH Sy Vg 2 Sy% Vg% FQo FQu FQFQn WDo WDu

WDWDn MP FQo% FQu% FQ-% WO- % M FM m

FC CF C C' Y T V

% % Scored notO Mean 100.0 97.6 5.6 100.0 3.2 91.0 84.0 97.9 57.7 100.0 98.8 6.3 100.0 59.3 1.4 100.0 99.3 7.0 100.0 98.8 29.8 100.0 59.3 6.2 100.0 100.0 13.5 97.9 7.2 100.0 100.0 87.6 2.4 15.9 100.0 0.3 100.0 100.0 12.8 100.0 97.9 5.6 100.0 78.6 1.8 100.0 15.9 0.3 100.0 29.7 0.4 99.9 100.0 5.3 100.0 100.0 60.0 100.0 97.9 29.2 100.0 87.6 9.8 100.0 78.6 8.3 100.0 3.5 91.6 100.0 3.2 93.4 100.0 67.3 1.4 100.0 75.2 1.9 100.0 72.7 1.6 100.0 25.2 0.4 100.0 70.5 1.7 100.0 62.0 1.3 100.0 39.3 0.6 100.0 32.3 0.5

SD 3.4 2.4 21.8 3.9 1.8 4.0 15.4 7.4 4.2 4.6 2.1 0.8 4.0 3.6 1.6 0.8 0.8 2.0 14.9 12.7 6.7 6.6 2.7 2.2 1.5 1.8 1.6 0.7 1.7 1.6 0.9 0.9

Sk 1.3 1.2 -0.3 1.5 2.3 1.6 0.4 1.5 0.6 1.2 1.8 4.4 0.6 1.3 1.2 4.4 2.3 0.3 0.1 0.0 0.6 0.7 1.5 1.2 1.5 1.4 1.5 2.7 1.5 2.0 1.9 2.8

Ku 3.4 2.2 -0.1 5.3 8.1 5.5 -0.1 2.4 0.5 1.8 5.3 22.0 0.4 2.7 1.7 22.0 5.6 0.4 0.0 -0.3 -0.1 0.1 5.6 2.8 2.5 3.0 3.9 8.8 2.8 6.3 5.2 12.2

Min 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 0.0 0.0 19.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5th 25th 50th 75th 95th # # %ile %ile %ile %ile %ile Max Mode Scored not 0 3.0 1.0 5.0 7.0 12.0 28.0 5.0 1,396 1,363 0.0 2.0 3.0 4.0 8.0 17.0 2.0 1,396 1,27 1 20.0 43.0 60.0 71.0 100.0 100.0 67.0 1,173 1,148 4.0 6.0 13.0 33.0 5.0 1,396 1,379 1.0 8.0 0.0 0.0 5.0 14.0 1.0 2.0 0.0 1,396 828 4.0 14.0 2.0 6.0 9.0 34.0 5.0 1,396 1,386 6.0 18.0 29.0 40.0 57.0 87.0 29.0 1,396 1,379 0.0 0.0 5.0 10.0 21.0 44.0 0.0 1,396 828 7.0 11.0 13.0 16.0 21.0 26.0 14.0 145 145 4.0 6.0 3.0 1.3 9.0 16.7 24.0 145 142 0.0 2.0 3.5 6.0 13.0 145 127 1.0 1.0 0.0 0.0 0.0 5.0 0.0 1.0 0.0 145 23 10.0 12.0 7.0 15.0 20.0 24.0 11.0 145 145 1.0 3.0 5.0 7.0 13.0 19.0 3.0 145 142 0.0 8.0 1.0 1.0 2.5 5.0 1.0 145 114 0.0 0.0 0.0 0.0 5.0 0.0 145 23 1.0 0.0 0.0 0.0 1.0 2.0 4.0 0.0 145 43 2.0 9.0 4.0 5.0 7.0 14.0 6.0 1,396 1,394 38.0 50.0 60.0 70.5 86.0 100.0 61.0 145 145 7.6 19.0 30.0 38.0 50.0 64.0 29.0 145 142 0.0 5.0 9.0 13.5 23.7 29.0 0.0 145 127 0.0 4.0 7.0 13.0 21.0 31.0 0.0 145 114 0.0 2.0 3.0 5.0 8.0 27.0 3.0 1,396 1,279 0.0 2.0 3.0 4.0 7.0 2.0 1,396 1,304 18.0 0.0 0.0 2.0 5.0 9.0 0.0 1,396 940 1.0 0.0 2.0 3.0 5.0 12.0 0.0 1,396 1,050 1.0 0.0 5.0 0.0 1.0 2.0 12.0 1.0 1,396 1,015 0.0 0.0 0.0 1.0 2.0 6.0 0.0 1,396 352 0.0 0.0 1.0 2.0 5.0 12.0 0.0 1,396 984 0.0 0.0 2.0 4.1 14.0 0.0 1,396 1.0 866 0.0 0.0 0.0 2.0 7.0 0.0 1,396 1.0 549 0.0 2.0 0.0 1,396 0.0 0.0 1.0 10.0 451

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Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data % % 5th Row Variables Scored notO Mean SD Sk Ku Min %ile 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

r FD F a p Ma Mp Blend CBlend WSumC SumC (CF+C)/SumC MC M/MC YTVC ' mY F% PPD MC-PPD p/(a+p) Mp/(Ma+Mp) Blend% DVI DV2 DRl DR2 PEC INC! INC2 FABl FAB2 CON

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 66.1 100.0 89.6 100.0 100.0 100.0 100.0 100.0 93.2 60.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

24.0 55.9 99.5 96.5 89.4 77.4 70.1 90.8 39.0 94.6 94.6 89.6 99.4 96.0 90.1 84.4 99.5 99.6 95.1 92.7 87.6 90.8 35.4 1.4 27.7 4.5 13.2 46.2 10.1 31.1 7.7 1.6

0.4 0.9 8.9 4.8 3.3 2.0 1.5 3.8 0.6 3.1 3.9 50.8 6.6 52.5 4.1 2.8 40.4 8.7 -2.0 40.5 42.3 17.5 0.5 0.0 0.5 0.1 0.2 0.7 0.1 0.4 0.1 0.0

0.8 1.2 5.3 3.2 2.7 1.9 1.6 3.0 1.0 2.3 2.7 29.l 4.0 22.7 3.4 2.5 17.5 5.1 4.5 22.5 26.5 12.9 0.9 0.2 1.0 0.3 0.4 1.0 0.4 0.7 0.3 0.1

3.4 1.7 1.2 1.1 1.4 1.3 1.6 1.4 2.1 1.4 1.2 0.0 1.1 -0.2 1.5 1.6 0.3 1.4 -0.4 0.3 0.2 0.8 2.2 9.8 3.2 9.7 3.1 1.8 4.3 1.9 4.8 7.6

16.7 4.1 2.2 2.8 3.0 3.6 3.8 3.6 5.6 3.9 2.7 -0.8 1.9 -0.3 4.0 3.6 -0.3 3. 1 0.8 -0.2 -0.6 0.3 6.3 104.8 13.9 146.3 10.5 4.2 27.4 3.7 31.5 55.9

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -22.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

0.0 0.0 2.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 13.0 0.0 0.0 13.0 2.0 -10.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

25th 50th 75th 95th # # %ile %ile %ile %ile Max Mode Scored not 0 0.0 0.0 0.0 2.0 9.0 0.0 1,396 335 3.0 0.0 1,396 0.0 1.0 1.0 9.0 780 5.0 8.0 11.0 19.0 35.0 6.0 1,396 1,389 3.0 4.0 7.0 10.1 26.0 3.0 1,396 1,347 5.0 8.0 19.0 2.0 1,396 1,248 1.0 3.0 1.0 2.0 3.0 5.0 17.0 1.0 1,396 1,080 0.0 1.0 2.0 5.0 11.0 0.0 1,396 978 2.0 3.0 5.0 9.0 24.0 2.0 1,396 1,268 0.0 0.0 1.0 2.1 7.0 0.0 1,396 545 1.5 2.5 4.5 7.5 20.0 1.5 1,396 1,321 2.0 3.0 5.0 9.0 22.0 3.0 1,396 1,321 33.0 50.0 71.0 100.0 100.0 100.0 923 827 5.0 1,396 1,388 4.0 6.0 8.5 14.1 28.0 38.0 55.0 67.0 89.0 100.0 67.0 1,251 1,201 2.0 3.0 6.0 11.0 26.0 2.0 1,396 1,258 1.0 2.0 4.0 8.0 16.0 1.0 1,396 1,178 28.0 39.0 52.0 71.0 90.0 50.0 1,396 1,389 18.0 37.0 5.0 8.0 11.0 7.0 1,396 1,391 -4.5 -2.0 5.0 -3.0 1,396 1,327 1.0 11.0 25.0 40.0 56.0 80.0 100.0 50.0 1,301 1,206 25.0 40.0 67.0 88.0 100.0 33.0 838 734 7.0 15.0 25.0 42.0 67.0 0.0 1,396 1,268 0.0 0.0 2.0 6.0 0.0 1,396 494 1.0 0.0 2.0 0.0 1,396 0.0 0.0 0.0 20 0.0 0.0 2.0 9.0 0.0 1,396 387 1.0 0.0 0.0 0.0 7.0 0.0 1,396 0.0 63 0.0 0.0 0.0 1.0 3.0 0.0 1,396 184 0.0 0.0 1.0 3.0 7.0 0.0 1,396 645 0.0 0.0 0.0 1.0 5.0 0.0 1,396 141 0.0 0.0 2.0 4.0 0.0 1,396 1.0 434 0.0 0.0 0.0 4.0 0.0 1,396 1.0 108 0.0 1,396 0.0 0.0 0.0 0.0 1.0 23

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Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data Row 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 128 129 130

Variables WSumCog SevCog Lev2Cog ABS PER COP MAH GHR AGM AGC MOR MAP PHR ODL MAHP MAP /MAHP GPHR PHR/GPHR ODL% IntCont CritCont% EII-3 TP-Comp V-Comp SC-Comp Complexity LSO Cmplx Cont Cmplx Det Cmplx FQo CS FQu CS FQ- CS

% % Scored notO Mean 100.0 83.2 7.5 100.0 29.4 0.5 100.0 19.8 0.3 100.0 19.6 0.3 100.0 0.7 41.2 100.0 56.3 1.0 100.0 48.3 0.8 100.0 97.9 4.5 100.0 35.7 0.5 90.3 3.0 100.0 100.0 62.8 1.2 100.0 48.3 0.9 89.7 100.0 2.7 100.0 89.0 2.7 100,0 69,7 1.7 28.3 90.2 48.9 100.0 100.0 7.2 90.8 97.2 36.0 100.0 89.0 11.5 100.0 73.0 2.3 100.0 93.7 20.8 100.0 96.6 -0.1 100.0 94.5 0.6 100.0 99.9 2.9 100.0 100.0 4.7 100.0 100.0 68.0 100.0 100.0 30.4 100.0 100.0 20.2 100.0 100.0 17.4 100.0 100.0 11.0 100.0 99.4 6.3 100.0 96.3 4.3

SD 7.9 0.9 0.7 0.8 1.1 1.2 1.1 2.4 0.9 2.2 1.4 1.2 2.3 2.3 1.7 26.5 3.8 20.4 9.2 2.5 14.2 0.8 0.8 1.5 1.5 28.2 11.6 9.6 8.9 3.9 4.0 3.0

Sk 1.9 3.1 3.9 3.6 2.0 1.5 1.5 0.7 2.1 1.0 1.8 2.7 1.6 1.6 1.3 0.0 1.1 0.4 1.4 1.9 1.0 0.7 0.7 0.6 1.2 1.6 1.8 1.4 1.4 0.8 1.5 1.7

Ku 5.2 13.9 23.8 16.4 4.7 3.1 2.4 0.6 6.7 1.6 4.7 12.6 4.3 4.2

2.1 -0.4 1.5 0.3 2.4 5.2 1.6 0.9 0.3 1.3 3.3 4.0 5.2 3.3 3.2 1.8 2.9 4.6

Min 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 -1.8 -0.9 -1.4 2.2 24.0 11.0 3.0 2.0 1.0 0.0 0.0

5th 25th 50th 75th 95th # # %ile %ile %ile %ile %ile Max Mode Scored not 0 0.0 2.0 5.0 11.0 23.0 63.0 0.0 1,396 1,161 0.0 0.0 0.0 2.0 8.0 0.0 1,396 1.0 411 0.0 0.0 0.0 0.0 2.0 8.0 0.0 1,396 277 0.0 0.0 0.0 0.0 2.0 7.0 0.0 1,396 273 0.0 0.0 3.0 0.0 1.0 7.0 0.0 1,396 575 0.0 0.0 1.0 2.0 3.0 8.0 0.0 1,396 786 0.0 0.0 0.0 3.0 5.0 0.0 145 70 1.0 1.0 3.0 4.0 6.0 9.0 13.0 5.0 145 142 0.0 0.0 0.0 1.0 2.0 8.0 0.0 1,396 498 3.0 4.0 7.0 0.0 1.0 12.0 4.0 145 131 0.0 0.0 2.0 4.0 0.0 1,396 876 1.0 11.0 0.0 0.0 9.0 0.0 1.0 3.0 0.0 145 70 2.0 7.0 0.0 1.0 4.0 14.0 1.0 145 130 0.0 1.0 2.0 4.0 7.0 14.0 2.0 145 129 0.0 3.0 9.0 0.0 0.0 1.0 5.0 145 101 0.0 33.0 50.0 67.0 100.0 100.0 67.0 41 37 3.0 4.0 6.0 9.0 14.7 21.0 3.0 145 145 0.0 22.0 33.0 50.0 68.8 100.0 33.0 141 128 0.0 5.0 10.0 33.0 44.0 0.0 14.0 145 129 0.0 0.0 2.0 3.0 7.0 19.0 0.0 1,396 1,019 0.0 11.0 19.0 28.0 47.0 89.0 0.0 1,396 1,308 -1.2 -0.7 -0.2 0.3 2.8 0.2 145 140 1.5 -0.5 0.0 0.5 2.3 0.6 145 137 1.1 3.1 0.7 2.8 10.3 2.3 1,396 1,394 1.9 3.8 5.6 2.9 3.6 4.5 5.6 7.1 12.0 3.1 145 145 34.0 49.0 62.0 79.0 123.2 231.0 59.0 1,396 1,396 35.0 53.0 101.0 17.0 23.0 28.0 23.0 1,396 1,396 8.0 14.0 18.0 24.0 39.0 72.0 17.0 1,396 1,396 6.0 11.0 16.0 22.0 35.0 69.0 16.0 1,396 1,396 5.0 8.0 13.0 18.0 35.0 10.0 1,396 1,396 11.0 2.0 4.0 5.0 8.0 14.0 28.0 4.0 1,396 1,387 2.0 10.0 1.0 4.0 5.0 23.0 3.0 1,396 1.345

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Table 9.6 Non-Modeled Reference Sample (N = 1396): Descriptive Data % % 5th Row Variables Scored notO Mean SD Sk Ku Min %ile 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157

FQn CS WDo CS WDu CS WD-CS WDn CS M- CS FQo% CS FQu% CS FQ- % CS WD-%CS GHR CS PHR CS GPHR CS PHR/GPHR CS EII-3 CS TP-Comp CS SC-Comp CS W-SI-Sy (H) (Hd) (A) (Ad) H(H)A (A) SumHA H(H)A(A)/SumHA VFD (r*3+Pair)% PPD - MC CFC CFC -FC

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 89.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

21.9 100.0 98.1 91.8 20.8 36.8 100.0 99.4 96.3 91.8 94.6 84.9 98.5 90.7 95.8 96.4 100.0 100.0 83.8 100.0 100.0 100.0 67.9 99.6 95.1 77.2 82.0

0.3 10.4 4.8 3.0 0.3 0.6 51.8 27.7 19.2 16.2 3.5 2.7 6.3 41.9 -0.1 0.6 4.5 15.3 2.3 11.6 16.1 73.4 1.4 37.4 2.0 2.0 0.1

0.8 3.7 3.1 2.3 0.7 1.0 14.3 12.0 10.6 10.4 2.2 2.5 3.7 23.5 0.9 1.0 1.3 6.1 1.9 4.1 5.8 13.8 1.6 15.9 4.5 1.9 2.6

3.5 0.7 1.3 1.3 3.4 3.5 0.0 0.4 0.7 0.8 0.8 1.7 1.4 0.2 0.5 0.7 0.8 1.3 1.2 1.3 1.4 -0.3 1.8 0.5 0.4 1.5 0.1

16.6 1.4 3.1 2.9 15.4 26.4 0.0 0.1 0.9 1.1 1.4 4.8 4.4 -0.3 0.4 0.7 1.2 3.2 2.5 4.0 3.5 -0.3 4.9 0.8 0.8 4.4 2.0

0.0 1.0 0.0 0.0 0.0 0.0 5.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -2.4 -1.4 1.5 4.0 0.0 3.0 5.0 31.0 0.0 0.0 - 11.0 0.0 -11.0

0.0 5.0 1.0 0.0 0.0 0.0 29.0 9.0 4.9 0.0 0.0 0.0 1.0 0.0 -1.5 -0.8 2.7 7.3 0.0 6.0 9.0 50.0 0.0 13.0 -5.0 0.0 -4.0

25th 50th 75th 95th # # %ile %ile %ile %ile Max Mode Scored not 0 0.0 0.0 0.0 2.0 7.0 0.0 1,396 306 8.0 10.0 17.0 10.0 1,396 1,396 13.0 31.0 3.0 4.0 6.0 11.0 23.0 4.0 1,396 1,369 3.0 4.0 7.0 16.0 2.0 1,396 1,282 1.0 0.0 7.0 0.0 1,396 0.0 0.0 2.0 291 3.0 0.0 0.0 1.0 14.0 0.0 1,396 514 42.0 52.0 61.0 76.0 100.0 50.0 1,396 1,396 19.0 27.0 35.0 50.0 71.0 29.0 1,396 1,387 12.0 19.0 26.0 38.1 67.0 13.0 1,396 1,345 22.0 0.0 1,396 1,282 8.0 15.0 35.1 68.0 2.0 3.0 5.0 7.1 16.0 3.0 1,396 1,321 2.0 4.0 8.0 1.0 21.0 1.0 1,396 1,185 4.0 6.0 8.0 13.0 34.0 6.0 1,396 1,375 25.0 40.0 57.0 80.0 100.0 50.0 1,244 1,128 -0.8 -0.1 0.5 1.6 4.0 0.1 1,396 1,337 -0. 1 0.5 1.2 2.5 4.9 0.5 1,396 1,346 3.6 4.3 5.3 6.8 11.9 3.9 1,396 1,396 18.5 11.0 14.0 26.7 41.0 12.0 145 145 2.0 6.0 13.0 1.0 3.0 1.0 1,396 1,170 9.0 11.0 14.0 19.0 40.0 9.0 1,396 1,396 12.0 15.0 19.0 27.0 46.0 15.0 1,396 1,396 64.0 75.0 83.0 94.0 100.0 75.0 1,396 1,396 0.0 2.0 5.0 12.0 1.0 1.0 1,396 948 27.0 47.0 65.0 111.0 33.0 1,396 1,390 36.0 - 1.0 2.0 4.5 10.0 22.5 0.0 1,396 1,327 2.0 3.0 5.0 14.0 1.0 1.0 1,396 1,078 -1.0 0.0 2.0 4.0 14.0 0.0 1,396 1,145

Normative Reference Data

Table 9.7 Non -Modeled Reference Sample (N = 1396): Frequenc:y Data FQ Classification FQo% < 55 38% FQu% > 35 FQo% < 50 24% FQu% > 40 FQo% < 45 14% FQu% > 45 7% FQo% < 40 FQu% > 50 FQ-% > 05 71% WD-%>05 FQ- % > 10 41% WD-%> 10 FQ-% > 15 20% WD-% > 15 FQ-% > 20 9% WD-% > 20

48% 33% 21% 10% 64% 34% 16% 6%

FC > (CF+C)+l FC > (CF+C)+2 FC > (CF+C)+3

Fonn vs. 23% 13% 7%

Color (CF+C) > FC+l (CF+C) > FC+2 (CF+C) > FC+3

26% 16% 8%

R < 18 R > 28 R> 34 WSumCog > 10 WSumCog > 15 WSumCog > 20 SevCog > 0 SevCog > 1 Popular < 4 Popular> 7 Vg% > 10 Vg% > 15 SR> 1 SR> 2 SR> 3 C>0 C>l r>0 T=0 T >l PER> 1

Miscellaneous 34% 16% 7% 26% 14% 7% 29% 10% 17% 13% 24% 11% 26% 12% 7% 25% 7% 24% 61% 14% 17%

Variables ODL% > 20 COP = 0 COP>2 MAH=0 MAH> l MAH>2 MAP=0 MAP> 1 MAP>2 MAP>MAH MOR>2 AGM=0 AGM>2 AGC>5 PHR >G HR H< 2 Pure H = 0 p>a+l Mp>Ma IntCont > 5 CritCont% > 40

14% 44% 11% 52% 23% 6% 52% 23% 6% 32% 15% 64% 4% 12% 2% 37% 11% 17% 31% 11% 10%

315

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Interpretation 317

CHAPTERIO RECOMMENDATIONS FOR INTERPRETATION This chapter provides an organized structure for interpretation. Basic conceptual principles are presented first, followed by practical procedures. Following this are two sections dealing with interpretive implications. The first of these focuses on the response-level coded variables and provides a description of the psychological processes that can contribute to the coded response behavior. The final section provides interpretive inferences for the protocol level variables found on Page 1 and Page 2 of the Summary Scores and Profile pages.

InterpretivePrinciples 1. Performance-Based Personality Test. The Rorschach is a performance-based task of perception

and communication that provides information about personality and information processing. It allows one to observe and measure the "personality in action," as the respondent demonstrates interpretively relevant behaviors while navigating the ten inkblots. From a perceptual-cognitive perspective, the participant is presented with the problem of developing satisfactory interpretations of complex stimuli that provide multiple competing, contradictory, and incomplete response options. From an interpersonal perspective, the participant is asked to perform in a context of novelty and uncertainty while this performance is being observed and evaluated. Thus, at its core, the Rorschach is a behavioral task that provides wide latitude for idiographically unique responses, in which the enacted behaviors are an expression of one's underlying psychological habits, personality features, and processing style. As a behavioral assessment task, the best or most valid interpretations derived from the task are those that link to mental, verbal, and perceptual behaviors in the external environment that parallel those observed in the microcosm of the task. Accordingly, those Rorschach behaviors that most closely resemble their corresponding interpretive constructs (e.g., Form Quality and accuracy of reality testing, severe cognitive scores and thinking disturbance, Morbid responses and feeling damaged or depressed) are among the most valid variables. Said differently, those scores with the smallest inferential leap and that are most "topographically similar" (Foster & Cone, 1995) to their interpretive constructs are most confidently generalizable to everyday life. When interpreting each score, one keeps in mind (a) the specific behaviors that are coded for that score and (b) what logically and conceptually links those behaviors to the inferred personality characteristic. This performance or behavioral foundation has been referred to as the response process or behavioral representational support for interpretation. As with all types of behavior, the words, images, and actions observed during the Rorschach can be interpreted and understood from many theoretical vantage points, including cognitive, behavioral, psychodynamic, and humanistic. 2. The Nature of Rorschach Data. Rorschach behaviors and variables demonstrate how people filter and organize information, what they attend to, how they make sense of and apply meaning to stimuli and situations, how conventionally or idiosyncratically they perceive, and how logically or effectively they think and communicate with another person. Furthermore, they demonstrate how people handle perceptual and conceptual inconsistencies, contradictions, and ambiguity. The codes assigned to responses are designed to organize and quantify relevant information across these behavioral dimensions. Rorschach results are known to have, at best, modest correlations with self-report tests. In contrast to self-reported or introspectively-assessedcharacteristics, Rorschach findings are more strongly

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associated with externally-assessed personality characteristics (e.g., observer ratings, behaviors; Mihura et al., 2011). Therefore, these psychological characteristics tend to be implicit, and may or may not be part of an individual 's conscious awarene ss or verbal self-concept. The test does not provide a self-report of subjective experiences or tell us anything specific about what people consciously feel and think. To know this, we have to ask them directly (e.g., through interview and self-report measures). But as a consequence, the examine r cannot know whether individuals are aware of what they express about themselves through their behavior on the Rorschach. Rather , some individuals may be cognizant of the implications of their task-related behaviors whereas others may be unwilling or unable to communicate what is demonstrated in their overt and covert behavior. As is true in general for implicitly assessed traits, the behavioral expressio ns of these charact eristics are most likely to emerge over time and to be expressed in relatively unfamiliar and unstructured situatio ns in which individuals must rely on themselves for direction . In such situations, external rules, social customs and roles, and interp ersonal expectations are not dominant factors in guiding behavior. At the same time, examiners should understand that not all Rorschach-a ssesse d characteristics will necessarily find obvious behavioral expression. Some people can keep very tight reins on their internal experiences and sponta neous reactions or cultivate a persona that strives to maintain psychological and emotional distance from undesir ed or devalued implicit qualitie s and feared outcomes. In fact, there are well documented cases of people living reasonably normal and productive lives despite disturbed and chaotic -looking Rorschach protocols. In such cases, there are likely compensating skills and environmental interactions that help to sustain their seemingly superior overt adjustment. 3. Empirical Foundation. In addition to the behavioral performance founda tion described above, each interpreted variable has a research -based foundation. Thus , our selection and interpreta tion of

variables is based on a combinationof two typesof empiricalsupport:(1) demonstratednomothetic validity in research, and (2) response process/behavioral representational support derived from the respondent 's in vivo performance. For most variables, basic research support derives from associations with general, overarching criteria. From this broad empirical support, more specific interpretations for the individual variable are generated from the perceptual, conceptual, or linguistic processes embedded in the coded behaviors. Those variables wit h more solid research and behavioral support are listed on Page 1 of the Summary Scores and Profiles output , and those that should be considered more tentatively are listed on Page 2. 4. Person -Focused Interpretive Elements. We recommend combining both a person-focu sed and a test-focused approach when interpreting a protocol. The person-fo cused approach is organized according to the realities of the person being assessed, assessment goals, and the stated and implicit referral questions. This approach allows us to formulate individuall y tailored, helpful, salient , and meaningful interpretation s. It also helps to focus the evaluation and data review process by directing us to examine certain variables while de-emphasizin g others unless they are notable. From this perspective we focus on this person with these particular characteristics in this context and with these questions to ask how the test data help to refine, elaborat e, or reconsider what we think we know and what we still need to figure out. Thus, we emphasize data and inferences relevant to the focal assessment questions and their implications, and we apply data to what we are trying to explain , decide, and understand. Referral questions and implicit goals of the evalua tion are expressed as hypothes es to be tested, which are supported , diminished, elaborated, refuted , or refined by Rorschach data in the context of other data. For instance , when the examiner applies the person-fo cused approa ch to a socially inhibit ed, withdrawn person, the Rorschach data migh t help us to understand whether this is related to problems with limited coping skills, a lack of interest in other people, heightened anxiety, depressio n, or even thought disorder. Whenever possible, hypotheses or questions to be addressed by the Rorschach are explicitly formulated prior to admini stering the instrument. In this way , the test

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findings conform or fail to conform to prior expectations and negative evidence (e.g., scores that fall well within the expected range when deviant levels were anticipated) is weighed along with evidence affirming expectations. Additionally, one attends to strengths as well as problem areas.

5. Test-Focused Interpretive Elements. In this mode , we attend to any and all noteworthy aspects of the test data. Here the interpretation process is organized around notable features of the summary sco res and their comparison to normativ e standards, as well as idiographic response content and relevant behaviors emerging during the testing. Normative comparisons with summary scores answer the question of how much a person diverges from the average person based on the international reference sample . A very high or low standard score (i.e., a large discrepancy from what is typical in the reference sample) indicates that an individual has a large or small amount of the variable in question and that an interpretation can be made contrasting the respondent to the average individual on the characteristic in question. Generally, more emphasis is given to more extreme scores, and the most extreme scores in a protocol are likely important and distinguishing characteristics of the individual. Unusual or personally revealing idiographic content and behavior (as opposed to what is commonly seen by experienced exami ners in relation to particular card locations) can also distinguish the individual being evaluated from normativ e expectations. Given the latitude provided by the task for unique and idiosyncratic responses there are times when this kind of non-coded test behavior provides compelling hypotheses about the respondent that we would pursue further with him or her (e.g., a protocol with six responses containing the phrase "twiste d up" or eight responses of something seen as "drooping" or "eroding "). 6. Synergy among the Interpretive Approaches. Combining the person -focused and test-focused elements are important steps in generating a final interpretation. Although one can think of the two

approachesto interpretationas to someextentcompetingagainstoneanother,theyprovide complementary ways to maximize the interpretive value of an assessment. The test-focus ensures we have a maximal understanding of the person from the available data ; the person - and referral-foci ensure we have understanding of the information that is most needed for the assessment at the present time. Knowing both allows the clinician to provide the most accurate and helpful feedback.

7. General to Specific Progression. As is standard procedure with almost all performance-based and self -report tests , interpretation proceeds from the general to the specific. One should emphasize summary scores that incorporate multiple response features (e.g., the Thought and Perception Composite, Suicide Concern Composite, and Ego Impairment Index , all of which incorporate multiple domains of coded behavior) or scores that typically occur with a fairly high frequency across all responses and thus provide many opportunities to observe the relevant behavior (e.g., W, Sy, FQo%, H, M, WSumCog). As an example, Complexity is the best marker of the "first factor " of the Rorschach , which emerges consistently in factor analytic research. As such, it is the variable that defines the biggest source of variability in the test; through its links to other codes, it is the most important thing that makes one person look different from another person. Because of this, Complexity is considered early in the interpretive process to determine whether we should expect a general pattern of elevations or suppressions across other individual scores. Another feature of this general to specific sequencing is that we first interpret summary scores on the Profile pages alone and in combination before turning to less systematically gathered inferences and observations from task behaviors, which could include additional thematic conten t, patterns discernible in the sequencing and interplay of responses as they were given, and features of the interpersonal interaction between the examiner and the respondent. While being mindful of the ways in which inferences can go astray based on less systematically gathered observations, following this general to specific pattern progresses from the most psychometrically sturdy and reliable to the more

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tentative. When done carefully, and often collaboratively with the client, the process can shape a standard "variable -based inference" to make it more idiographic and person -specific, akin to the technique of using item-content to narrow interpretations of individual scales and subscales in selfreport testing. Fischer (1994; 2000) and Peebles-Kleiger (2002) provide sophisticated examples of these processes. Finally, in addition to the test-focused process of global to specific refinement, a similar process takes place from the person-focused vantage. Hypotheses that might have started out as broadly-stated translations of referral questions become refined, elaborated , supported or challenged as inferences are further specified when tested with emerging Rorschach data. Thus, for example, studying the Rorschach findings concerning an individual who has been referred in order to understand his unruly behavior in the classroom may gradually reveal that his "acting out" has less to do with aggressiveness or impulsivity and more to do with serious difficulties in filtering out what is relevant and important among competing stimuli. The overall process is one in which we interpret the more specific and individualistic data within the broad confines provided by the quantitative support for the summary scores, the frame of reference established by the specific referral questions , and knowledge gained from background , history. and other sources. 8. Relationship between Nomothetic/Statistical and ldiographic/Personal Interpretation. An aim of ours is to improve the psychometric and statistical characteristics of the test so as to support valid informative nomothetic inferences. These interpretations allow one to identify the respondent's similarities and differences relative to known groups based on summary scores of coded behavior. In addition to providing nomothetic group comparisons, the Rorschach provides a wealth of idiographic information that helps one to get to know and understand the individual based on the often very

personalimagesand themestheybringto the task,particularlyfor peoplewho are verballyexpressive and engaged with the task. Although R-PAS development focused on establishing a sturdy psychometric foundation, attending to these idiographic elements in a protocol is a means of incorporating essential information about the individual response process and is thus an essential component of interpretation. 9. Interpretive Domains and Format. In addition to a basic domain addressing Administration Behaviors and Observations, Summary Scores are considered in four conceptually organized interpretive domains: Engagement and Cognitive Processing, Perception and Thinking Problems. Stress and Distress. Self and Other Representation. Variables in each domain are not limited to their assigned cluster. Indeed, many, if not most , variables have implications for multiple domains. They are assigned to the domain for which the variable has the best research and behavioral validity, but these domains do not preclude other ways of organizing interpretive inferences. The Administration Behaviors and Observations domain provides reference data on several basic testtaking behaviors related to R and card turning that set the stage for subsequent interpretation. The Engagement and Cognitive Processing domain addresses the cognitive and problem-solving aspects of the test-taking behavior. It also includes information about coping styles and ways of adapting to the world. Many of its variables are related to the Rorschach 's first factor, and thus the Complexity variable. The Perception and Thinking Problems domain incorporates variables that reflect the perceptual distortions and thought disorder that are hallmarks of psychosis. Highly pathological variants of these scores would be indicators of disturbances in the organization and the content of thought , and elevations raise concerns about the presence of severe mental disorder. Variables in the Stress and Distress section have implications for the affective discomfort and emotional disarray carried by a person. Conceptually, this domain can be trickier to consider than the others because the language that is available to describe these concepts often implies a conscious experience on the part

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of the respondent (e.g., "affec tive discomfort " or "distress " can sound like consciously experienced states). However, the coded behaviors associated with these summary scores , which mostly relate to Determinant , Content , and Thematic Codes, do not imply self-attributed qualities. Finally , the Self and Other Representation sectio n contains variables that involve object relations and interpersonal and self-schema with implications for self-image, self -experience, and interpersonal competency and relationships. Of course, variables that are encountered early in the sequence have implications for concepts and domains addressed later , and vice versa.

10. Strength-Based Interpretation. There is nothing intrinsic to the Rorschach as a performance test that supports negative or pathological interpretations more than positive or healthy ones. However, probably because of assessment psychologists ' historical role working in clinical settings and addressing referral question s about psychopathology and clinical problems , there has been a bias towards negative interpretations of Rorschach scores. Psychological assessment has entered an era in which offering meaningful and helpful feedback of assessment results to clients has become an essential element of good practice. Accordingly , it is important to exert effort to generate strengthbased or positive interpretations as appropriate.

InterpretiveProcedures In this section we articulate practical steps to follow in interpretation. These steps are flexible but provide a procedure for systematically reviewing a record and drawing sound and reasonable inferences from it.

1) Preliminary Information to Develop Hypotheses and Expectations a) Review the nature and context of the evaluation and the assessment goals and questions . b) Consider the implications of demographic factors like age and gender, as well as the client's ethnic, cultural, linguistic, educational, and occupational background , for potential impact on the assessment data. c) Emphasize data relevant to these hypotheses and goals as you encounter them later in the interpretive routine.

2) Formulating Expectations for Major Rorschach Dimensions a) Consider relevant preliminary information from history and other tests, with special attention to response style indicators and intellectual and cognitive sophistication , to formulate expectations for engagement and protocol complexity. b) Estimate the individual's overall level of psychological health and adjustment to help determine whether to focus on adaptive or maladaptive variants of score interpretations.

3) Pre-Interpretation Activities a) When entering the protocol into the scor ing program , correctly specify the referen ce standards to be used for interpretation. By default , the program assumes the protocol was administered using R-Optimized administration and coded for Form Quality using the R-PAS FQ Tables. As such, the program plots results using reference data for an R-Optimized administration

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with FQ coded using the R-PAS tables (N = 640/118 for new codes). However, users can also generate results for a protocol obtained using traditional CS administrationguidelines and scored for FQ using the CS FQ Table. These options are included primarily for users who wish to profile previously collected protocols. At the stage of entering a new protocol (or editing an existing one) one would click the "CS" option for Administration (see below), which then makes use of our Non-R-Optimizedreference data (N = 1396/145 for new codes). One can also click the "CS" option for the FQ Table, which then makes use of our reference data based on that coding (N = either 640 or 1396, depending on the type of Administration). [}

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b) While coding the record: a. Attend to notable idiographic response content, repeated themes, emotional expressions, or interpersonalbehaviors. Typically, these would be instances in which the coding did not capture a salient feature of the individual's protocol. b. Note coding uncertainties,including instances when judgments were close calls and instances when the response itself was confusing, for their possible impact on later protocol level scores and interpretation. These notations can be stored with the coded response when using the Point-and-Clickoption for coding. c) After coding the record, trigger the Results output and scan the Code Sequence table. The goal at this point is to become globally familiar with the coded responses and to ensure the integrity of the online input. In general, review the Code Sequence page looking for any columns with an unusual density of codes (e.g., Sy, Cognitive). Consider printing the Code Sequence table or copying it into a word processor in order to make annotations about coding issues or salient response content. d) Decide what information to plot and to emphasize on the Profile Pages. By default, only the raw score data are presented in regular font and plotted on the Profile Page. The Complexity Adjusted scores are visible in lighter gray font, but they are not plotted. However, as seen in the figure below, this emphasis can be reversed by clicking the Complexity Adjusted option, un-checking the Raw Scores box, and clicking the Change Profile button. Alternatively, both sets of scores can be visualizedjointly by leaving both boxes checked. When this is done, the profile pages continue to show the raw score data (using circle icons) and only shows complexity adjusted results (using square icons) when the Standard Scores differ by eight or more points. We recommend new learners focus primarily on the plot of raw scores. The profile page plots standard score equivalents in the range from 55 to 145 (i.e., the equivalent of 3 standard deviations on a normal curve above and below the mean). However, because many Rorschach scores are not normally distributed, it is not possible for all scores to take on

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values across this full range. By default , the profile has grayed out sections for each score that identify the minimum and maximum values observed in the reference sample 65 • We recommend users keep this option turned on to facilitate accurate inferences. However, the option can be unchecked to simplify the visual display. Profile shows:

@ Raw Scores D ComplexityAdjusted

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Min;lvlax in Norms

[ Change Profile ]

e) Keep in mind the steps used to create the plotted standard scores. The raw scores were converted to percentiles and the percentiles were converted to the standard score equivalents that would be observed on a normal distribution. Thus, these are normalized scores that have been equated onto a common metric for interpretation regardless of each variable ' s initial distribution. As a general matter this means that about 68% of the reference sample has standard scores between 85 and 115 and about 95% of the reference sample has standard scores between 70 and 130. This also means that percentile differences in the average range are slightly de-emphasi zed and percentile differences at the extremes are slightly accentuated. f)

For new learners it is particularly important to understand how each variable on the Profile Pages was obtained. The summary and composite scores cannot be interpreted meaningfully without knowing the elements that contribute to the final score. The Counts and Calculations page, the Appendix page, and the Composite Score Calculation Sheet are helpful in this regard.

4) Interpretive Activities: The 4 S's Our recommended interpretive process first builds a nomothetic backbone to structure and organize key findings and then modifies and adjusts these interpretations based on idiographic , response process considerations. This interpretive procedure can be organized into four basic steps: Scan, Sift, Synthesize, and Summarize. Scan a) Scan the Profile Pages for notably high or low scores designated by the red and black icons with Standard Score equivalents of< 80 or> 120. The scan should take a minute or less. Start with Page 1 and then move to Page 2, taking note of the extreme scores. The goal here is to quickly become globally familiar with all the data to be processed before starting the formal interpretation. These extreme scores may mark crucial features that distinguish this individual from the average person or characterize his or her problems. The scores may be expected or unexpected based on your pre-interpretation activity, but no detailed consideration of the significance of these finding is completed at this stage.

65 It

is possible to obtain normative scores that fall in the shaded area. This occurs when the respond ent has a score that is higher or lower than any score obtained in the normative sample. To alert the user to this situation , on the high end the scoring program assigns the percentile that falls midway between the highest percentile in the norms and the value 99.9 and it assigns the standard score that falls midway betw een the highest standard score in the norms and the value 145. On the low end, the midpoint is computed between the lowest normed values and the percentile value 00.1 and standard score value 55. Obviousl y, these values should not be interpreted literally. They just signify that the respondents score is outside the range found in the normative sample.

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Instead, this fust step helps ensure you are not surprised with notable findings later in the interpretive process. Sift b) Now that you have a general orientation to the data, begin to sift carefuUy through the results , taking note of the standard score for each variable , section by section, on both Page 1 and Page 2, and formulate a preliminary interpretation of its meaning using the interpretive guides that follow in this chapter. Of course, this sifting process is guided by the referral questions and the evaluation goals, so that implications for these objectives are considered for each score. The sifting process is one of weighing interpretive possibilities for each score in turn. It involves synthesizing information, as discussed more below. However , these two activities are differentiated because with sifting , the interpretive procedure focuses on each specific score to refine the interpretive postulates associated with it; with synthesizing, the interpretive procedure focuses on linking different pieces of information across scores. c) Begin with the Administration Behaviors and Observations as a preliminary step before considering the remaining scores. The prompts and pulls intersect in important ways with the overall complexity of a record (e.g., if there are many pulls, the protocol likely would have been lengthier if not more complex). The card turning score can be indicative of a number of personal qualities, though it is included here also as a consideration for interpreting reflection responses.

d) Next,considerthe ComplexityScoreto determinewhetherthe protocolis of low,average, or high complexity. This step is an important prerequisite for all other interpretations . Based on the observed level of complexity, develop expectations for protocol validity in terms of Positive and Negative Predictive Power. Complex records tend to trigger elevations on multiple scores, so the absence of codes or low scores can be more informative (i.e., they have better Negative Predictive Power). Conversely, simplistic records generate suppressions on multiple scores so that the presence of codes or high scores can be most informative (i.e., they have better Positive Predictive Power). If the Complexity Score is notably low(< 85) or high(> 115), make a mental note to evaluate the impact of complexity on particular scores later in the interpretive process through the use of Complexity Adjusted scores. e) In addition to considering the impact of Complexity on other scores , interpret its meaning for this person. Compare the Complexity score to the expected level of productivity , sophistication, and engagement derived from earlier steps. Consider the implications of any salient discrepancies (e.g., What does it mean for this client that her Complexity Standard Score is 85 even though her measured IQ had a Standard Score of 112? What about the Rorschach task interferes with the expression of her general ability?). Interpret the client's overall level of complexity using the protocol level guidelines provided in the Interpretive Tables , paying careful attention to determining the extent to which complexity reflects the intrinsic qualities of the respondent, including anxiety or insecurity, versus motivated reactions to the assessment context (i.e., expressive versus suppressive approaches to the test). Consider examining the three Complexity subcomponents in the Profile Appendix of the results output to determine whether specific elements of responding may be more or less important for the respondent.

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Continue sequentially sifting through the variables in the Engagement and Cognitive Processing domain, followed by the Perceptual and Thinking Problems , Stress and Distress , and Self and Other Representations domains. In general , we recommend organizing interpretations of each variable according to the order they are listed on the Profile Pages , and completing all domains on Page 1 before moving to the domains on Page 2. However, this is not a hard and fast rule and some users may choose to exhaust interpretation by domain, interpreting both the Page 1 and Page 2 variables before moving to the next domain . Advanced users may find it more productive to begin interpretation with the domain that is most centrally tied to the referral question. Following any of these approaches will generate an accumulating interpretiv e narrative for each variable using the tables in the subsequent interpretive sectio ns as inferential guides. Remember, that each domain and the variables within the domain may influence inferences in other domains.

Synthesize g) Because no variable should be interpreted in isolatio n, as you are sifting through interpretive possibilities for each score you will also be synthesizing information, considering each score in relation to other relevant assessment data you have gathered so far, including previously considered information from the scanning and sifting process , history information , observed behavior, referral questions , other test data , and the idiographic features of a response associated with relevant codes. This step is complicated and is the most demanding on the training and skill of the clinician. A common mistake made by beginning clinicians is to use test data to affirm what they think they know based on the person's history. This inclination needs to be resisted. Background information can

helpshapeand tailortest-basedinferences,but the keygoalof an assessmentis to let the test data serve as an independent consultation that also helps shape and refine our understanding of the person 's history and context. h) Burrow into the data. Move from aggregated variables to their component parts. The Counts and Calculations page and the Appendix can be used as supplements to understanding the scores plotted on the Summary Score and Profile Pages. For instance , with a low Complexity score , evaluate whether relatively equal limitations are present across all three subcomponents of the aggregated Complexity score. Two general guidelines here apply: (I) Review of the component parts is most relevant when the aggregated variable is only moderately elevated. That is, if the aggregated variable is extremely elevated, it is likely that all of its component parts are elevated. And if the aggregated variable is very low in elevation, it is likely that all of its components parts are also low. (2) Burrow down one level at a time in the aggregation process. Thus, when considering the Eil-3 , one would review its first-level subcomponents (FQ- , WSumCog, CritCont %, M-, PHR, and GHR, and Ras a control), but not necessarily the second-level elements that comprise those subcompon ents (e.g., not all of the elements that comprise CritCont%). The second-level variables would be reviewed when its parent variables are encountered in the sequential sifting process of working through the full record. Following the Eil-3 example , when its first-level subcomponents (e.g., CritCont%) are encountered in the sift and synthesize process , only then would the second -level components be reviewed (i.e., the MOR, AGM , Bl, etc. , codes that make up CritCont%). As an alternative example to the EII-3 , when interpreting an elevated M- one might go down one level to look at its subcomponents , which would be the actual response content associated with these codes.

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i)

Consider how the variables in each domain on both Page 1 and Page 2, taken together , can be summarized into an overall picture of the respondent's functioning in that particular domain. Keep in mind that Page 1 variables have more empirical support. When Page 2 variables are discrepant with Page 1 variables, be very cautious about interpreting them, particularly when the standard scores are not extreme.

j)

Actively challenge hypothe ses as you go. Beware of confirmation bias and seek out information that may contradict or contextualize yo ur inferences.

k) Consider plotting and interpreting the Complexity Adjusted scores. In general, this should be done when the Complexity Standard Score is< 85 or >115. Complexity Adjusted profiles estimate how the standard scores would look if the respondent had produced a protocol with a typical level of complexity. Complexity Adjusted Standard Scores are not more or less "valid " or correct than those that have not been adjusted. Their point of reference is simply different. Their primary use is in showing which scores are relatively high or low for a particular level of complexity. For example, very complex protocols often have more Cognitive Codes and more Poor Human Representation s (PHR) than less complex protocols. Users can check the box for the Complexity Adjusted view to determin e whether the level of WSumCog or PHR is still higher than expec ted even after the complexity of the protocol has been taken into account. The Complexity Adjusted scores show what the person 's protocol would look like if the person had a typical level of complexity, that is, as if the complexity was increased or decreased to an average or typical level. Note , however , that complexity adjustments do not have a consistent effect on all scores; rather , to the extent that scores are correlated with Complexity they are most notably adjusted.

1) Before interpreting Complexity Adjusted scores be sure to understand the Engagement and Cognitive Processing variables that contribute to Complexity. Thus , one understands what high or low Complexity means for this particular person in part by understanding this person 's scores on R, Form %, Blend , Sy, MC, M, etc. m) When considering the Complexity Adjusted scores, revisit the variables that were significantly affected by complexity and interpret them as "conditional" scores that are particularly salient relative to the person 's level of complexity. Each interpretive inference derived from this step should be accompanied by the qualification , "given his or her level of complexity" (e.g., "EA is quite low (SS = 83), given her level of complexity"; or "WSumCog is actually just at the typical or expected level (SS = 102), given his level of complexity"; or "M is surprisingly high (SS = 115), given her level of complexity"). Interpreting Complexity Adjusted scores is like interpreting strengths and weaknesses on a Wechsler scale. Elevated scores ("strength s") and suppressed scores ("weaknesses") are determined relative to the person's overall level of intelligence. As such, what is considered a relative "strength " for the individual may still be normatively below average, while a relative "weakness " may be normatively above average. Augment your prior formulations with this additional information. n) Incorporate idiographic evidence . ldiographic interpretations are complementary to nomothetic findings and serve to more finely tailor the interpretation to the individual. Typically, idiographic inferences embellish what has been established with a nomothetic foundation rather than provide distinctly new inferences. When idiographic interpretations are not supported by a firm foundation of nomothetic findings in a particular case, the

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examiner may be straying too far afield from defensible interpretation s. And this is the danger of undisciplined idiographic inferences ; rather than refined insight , an examiner can develop fanciful beliefs with little to no grounding in the reality of a person 's life. What follows are a series of recommendations for idiographic interpretive principles that should help the examiner develop disciplined idiographic inferences. i.

Card pull . Become familiar with how the usual response pull for each inkblot is associated with particular kinds of reactions and contents (both those commonly volunteered and most commonly censored). For example, it is important to understand that although different features of the popular D9 figures on Card III are commonly seen as breasts or penis es, it is rare for a respondent to mention both features in a single response. Knowing that the heavy shading on Card IV is often salient to depressed people; that Cards III, IX, and X are the most difficult cards to organize into a W response ; that it is unusual not to see humans or human -like figures on Cards III and VII; or that most people view Cards VIII, IX, and X as having cheerful colors; helps in interpreting responses which either follow or violate expectations. 66 Conversely, idiographic compelling imagery or themes may displace the most frequently seen Popular responses (to I, III, V, VI, VIII, X). Thus , it may be important to review these cards when they involv e "P-failures" (e.g., when a low score on Pis encountered while sifting and synthesizing, one would burrow down to the responses themselves to see what response content interfered with the common Populars).

ii. Response content. As a part of the sifting and synthesizing processes , when refining interpretations of protocol level codes or burrowing into the data, one is likely to

encounterresponseswith personalsignificance.Suchresponsesare oftenidentifiedby Human Movement, distorted Form Quality , Cognitive or Thematic Codes, or Critical Contents (e.g., blood, fire, or sex). So to be thorough, when the sifting and synthesizing is complete, return to the Code Sequence page and response notes to determine whether other response s should be reviewed in detail. Beyond such formal indicators, personalized, poignant, or emotionally compelling imagery, metaphors , and elaboration also signal important interpretive information, especially when such themes are repeated in the protocol. These idiographic qualities of a response may provide relevant information about one's desires, fears, preoccupations , conflicts, and self-perceptions. In situations in which respondents may be motivated to distort or conceal their self-presentations on the Rorschach, it is important to keep in mind that content is much easier to manipulate than other coding categories. iii. Respondent behavior, particularly toward the examiner, can be a rich source of interpretive information. For example , people who construe the test situation as an effort by the examiner to humiliate them, defeat them , or trip them up; people who are constantly looking to the examiner for approval of their responses, additional guidance and instruction, and hints as to possible right answers are demonstrating important personal and interpersonal characteristics. Attitudes and beliefs about one's responses and about one's self are also manifest in test behavior. For example, people who are convinced that their responses will be the most imaginative and sophisticated creations that the examiner has ever heard reveal crucial information about their personality functioning. According[y , one's attitudes towards one's responses may reveal how one feels about one 's productions or contributions to the world. From a 66 For additionaldiscussions

of card pull, see Exner and Erdberg (2005),Peterson (2010),and Weiner (2003).

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performance assessment perspe ctive , these kinds of verbalizations and behavior may constitute a personal and individualistic "demonstration " of some of the characteristics that were established earlier in the interpretation process. Accordingly, in a case of depression, negativ e and dysphori c imagery may be a personaliz ed demonstration of one 's particular experience and expression of that distress. From a person with narcissistic and antisocial problems communication that he is impressed with the creativi ty of his responses but disdainful and critical of the examiner may generalize to similar probl ematic beha viors in the real world. iv. Alignment of idiographic features with standard interpretat ion . Consider how the idiographic respon se features align with the standard interpretation of the code. The foundation for inference s is in the response process underlying the particular coded response features. Thus, prototypi ca l Texture responses (i.e., to soft comforting objects) are more likely to justif y standard inferences about attachment need and contact hunger than highly discrepant, but codable T resp onses such as, "it's a cold, slimy rock- the differences in the colors there makes it look slimy." By the same token, a C' response given in a festive, cheerful context may not carry the same dysphoric implications as when the feeling tone of the response connotes gloom and heaviness. v. Sequenceanalysis. As a more advanced approach to idiographic interpretation , one can attend to response sequences by comparing two or more consecutive responses with respect to both scores and idiographic feature s. Of particular interest is how psychological functioning (e.g., effectiveness of defenses , reality testing , clarity of

thinking,interpersonalthemes,emotionalreactivity) is affectedby particularcontent themes and how the respondent 's functioning deteriorate s or recover s under varying conditions (Peebles-Kleiger, 2002).

Summarize o) At this point the interpretation of the Rorschach protocol should be reasonably complete, and the examiner will be ready to finalize the case conceptualization by summarizing what has been learned about the person from the interpretive process. After considering the Rorschach findings in the context of any other data still to be interpret ed, it is time to formulat e final answers to the referral qu estions. p) Clarify uncertainties and contradictions, and challenge inferences a final time. Revisit coding uncertainties to assess their impa ct on the findings. Identify any contradictions between these test results and information known from other sources; whenever feasible, seek clarification from the respondent about the seeming discrepancy.

q) When summarizing, keep in mind the interpretive principles that opened this chapter. Focus on what has been learned from this particular administration of a complex visualspatial probl em solving task and identify what still needs to be determined. Address strengths, not just limitations. Attend to what is atypical and unique in the proto col, but also what is average and typical. For example, it is clin ically useful to know that an adolescent being evaluated for Asperger's had average PHR/GPHR and MAH scores or that a man being evaluated for psychosis had average TP-Comp and SevCog scores.

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IntegratingRorschachData with Other Tests and Sources of Information Rorschach results are known to have, at best, modest correlations with self-report tests (Archer & Krishnamurthy , 1993; Meyer, 1997b; Meyer, Riethmiller, Brooks, Benoit , & Handler, 2000; Mihura et al., 2011). In contrast to most self-report tests, Rorschach findings most directly apply to implicit traits and motives that may or may not be part of an individual's verba l self-description or self-concept (Bornstein, 2007; Meyer & Archer, 2001). Implicit traits are most likely to emerge over time and to be expressed in relatively unstructured or unfamiliar situations where rules, social customs, or interpersonal expectations do not play a strong role in dictating behavior. Self-report tests and other indicators of explicit traits and motives are more likely to reflect how people habitually think about themselves, how they prefer to see themse lves and to be seen by others, how they are likely to describe themselves in interview situations, and how they are likely to act when making deliberate choices in line with their self-concepts (Bornstein, 2009; McClelland, Koestner , & Weinberger, 1989; Spangler , 1992). Particular strengths of the Rorschach are its ability to permit standardized, in vivo observation of reality testing , problem-solving and coping style , perceptual processing and thinking, and interpersonal behavior; its sensitivity to characteristic representations of self and others and schemas for their interactions; its sampling of salient concerns , meanings and preoccupations (including traumatic repetitions); and its capacity to yield rich , multi-faceted descriptions with considerab le idiographic content. Its weaknesses include its vulnerabilit y to becoming uninformative when respondents refuse to engage with the process or withhold their spontaneous reactions to the test stimuli and the inherent difficulties of determining how and when implicit motives and tendencies will express themselves in overt behavior. The Rorschach and self-report tests are most likely to yield similar results when the test taker is either (a) open and engaged on the Rorschach and candid, insightful, and non-defensive on the self-report test or (b) constricted and cautious on the Rorschach and defensive on the self-report test (Meyer, 1997b; Meyer et al., 2000). It is often not particularly helpful to compare individual scales with similar-sounding names across tests (e.g., V-Comp with MMPI -2 Scale 6 or TP -Comp with MMPI -2 Scale 8 or BIZ) , but so long as the methodological distinctions are kept in mind it can be very useful to compare broad personality descriptions or inferences from each test across similar domains of functioning (e.g., thinking, motivation and affect, self -perception, and interpersonal behavior; see Ganellen, 1996; Blais & Smith , 2008). The Rorschach may also be compared with other free response instruments , such as the TAT (Murray, 1943) or the Early Memories Procedure (Bruhn, 1992). Although such tests can also be considered from a structural and even a form quality standpoint, their primary strength is usually to be found in the thematic content they yield, which can be a rich source of information about characteristic representations of self and others, schemas for interpersonal interaction, leading motives and conflicts, and coping and defensive patterns. Such information may flesh out in a more detailed, nuanced, and dynamic fashion various suggestions gleaned from the "still pictures" of Rorschach content and sequence analysis. Of course , test data of any kind shou ld never be interpreted "blind" in offering descriptions , diagnoses, predictions , or other kinds of opinions with real-world consequences. As suggested earlier in this chapter , it is essential to frame R-PAS and other testing data in the context of the individual's history and present circumstances, behavioral observations, and evidence from third parties or documentary sources (when available), and to tailor communications with respondents and referral sources to the situation and purpose of the evaluation -L e., the referral questions. Generally speaking , R-PAS data

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are likely to make their strongest contributions in understanding how individuals make meaning out of the world around them, including the world of other people.

The Response Process as a Behavioral Foundationfor Interpretation As noted in the first interpretive principle that opened this chapter, the Rorschach is a performance based personality test. Accordingly , understanding the range of behaviors that can contribute to each code and to the task in general is critical to using and interpreting the Rorschach. We define the response process as the factors that lead to or produce the task behaviors captured by a particular code . They are the psychological elements that are present in the process of generating a response with a particular set of coded attributes. The relevant factors or psychological elements are embedded in the respondent 's coded behavior and imagery , which include his or her abilities, organizational efforts , styles of processing , feelings , ideas , motives , and conflicts. These factors include longstanding personality characteristics, current state-like circumstances, and reactions present in the context of being assessed by a particular examiner at a particular time. When choosing variables to include in R-PAS, we considered the plausibility and significance of the hypothesized underlying response process , along with the relevant research evidence. In turn, interpretations for the Page 1 and Page 2 protocol level variables are derived from their response process descriptions and their evidence base in the literature. Thus , response process considerations are a foundation for using the Rorschach as a behaviorally-based performance test of personality and they guide generalization to real life behaviors. It follow s that knowledge of the processes embedded in the behaviors that produce the coded variables is a fundamental ingredient for developing

interpretiveskills.It allowsone to recognize importantproblem-solvingand self-expressivebehaviors demonstrated by respondents and thus to go beyond mere memorization of protocol level interpretative descriptions . Fundamentally, one can only interpret well when one understands the behavioral meaning of the response from a process-based perspective. To help establish such an understanding, this portion of the chapter provides an overview of the behavioral, response process, and problem-solving information associated with the primary responselevel codes. The review is structured to follow each section of the Counts and Calculations page. In the tables below, the variable is listed in the left column and explanatory text on the right. In the left column , following the variable name, is a list of any additional Page 1 or Page 2 protocol level scores to which it contributes. The explanatory material in these tables should not be used mechanistically to generate ready-made interpretations; rather it is designed to facilitate a basic understanding of the task and task behaviors to help the examiner structure idiographically tailored interpretations that are appropriate for the individual case. Overall Response Process and Task Considerations

The response process occurs within the context of the task and the testing situation, so that test behaviors must be understood within those parameters. Relevant context features include the following . First, the instructions and the stimuli provide respondents with broad latitude for approaching the task and organizing responses to it. The inkblots themselves are semi -ambiguous and evocative, providing stimuli that are both suggestive and contradictory , making the task one of selecting images among many competing imperfect possibilities. Because the test instructions give very little direction , they are likely to induce some insecurity in the respondent. Therefore, the test responses and behaviors indicate how a respondent adapts and makes his or her own way in a complex situation with little guidance and direction. Additionally , the Rorschach is administered by another

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person, who is often in a position to make a judgment or decision about the examinee. The specific purpose of the testing can further affect how the task and assessment relationship are viewed (e.g., clinical consultation, forensic evaluation, or personnel selection). Thus, the respondent is in a nondir ective, ambiguous situation with another person (probably a relative stranger), who is a key figure in making some kind of decision that will affect his or her life. This situation requires cooperation and trust in a context of novelty and uncertainty. Schafer (1954) offered some classic description s of how the examiner 's role may be viewe d in assessment, including that of being an autocrat , saint, voye ur, or oracle. To some extent, different respondents can pull for the examiner to enact one role or another and different examiners may have similar predilections to be pulled in one direction or anoth er. To understand the response pro cess and the interpretation of test behaviors , all of these aspects of the Rorschach task should be considered.

Table 10.1 Responses and Administration Behaviors Codes Response Process - Behavioral Representation Foundation After initially being instructed to "try to give two responses ... or maybe three, Prompts to each card," giving only one response is a concrete instance of Pr underproductive behavior that did not meet the situational demands of the environm ent. Broadly, this could be due to limited ability or to limited motivation that in turn may be the result of intrinsic personal qualities or situational factors. These might include cognitive deficits , emotional difficulties (e.g., depression , anxiety), interpersonal dynamics (e.g., oppositionality), the testing situation (e.g., mandatory testing) , or a less than satisfactory assessment alliance. These factors are similar to those associated with a low number of respon ses. Therefore, consider Prompt s when interpreting R and as a test behaviorin and of itself. Pulls After initially being instructed to "give two responses ... or may be three, to each card," giving more than four responses is a concrete instanc e of overproductive Pu behavior that did not meet environmentally set demands. This is particularly true if pulls occur despite reminders about the general instructions . Like other assessment behavior variables, pulls can be due to a variety of sty listic, emotional or cognitive factors, including disinhibition due to hypomania, ADHD , frontal lobe damage, strong achievement strivings, obsessiveness , or interp ersonal dynamics (e.g., pushing boundari es or testing limits). Pulls are also related to high number of responses so also consider Pulls when interpreting R. Card Turns Turning the card is a behavioral manipulation of the environment. It can indicate a variety of qualities , including flexibility, independence, curiosity , CT oppositionality, disinhibition , avoidance of a particular association, or an active < ,V,>,@ or energetic approach to the task . Repeated immediate changes to the card orientation , by reversing it (v) for example, might suggest oppositional qualities. Turning the card sideways increases the probability of seeing a reflection , so Card Turning nee ds to be considered when interpr eting r. Responses Giving a response is being verbally productive and indicates compliance with R task expectations when R is in the range of 20 to 30. Variations in verbal response productivity can be due to several factors. Generally , R is associated with both variability in ability and variation in motivation , due to either intrinsic R is the denominator in or situational factors. As noted with Prompts , Low R can result from cognitive percentage (%) deficits, emotional difficultie s (e.g., depression , anxiety), interpersonal dynamics (e.g., oppositionality), the testing situation (e.g., mandatory testing), scores and

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Table 10.1 Responses and Administration Behaviors Codes Response Process - Behavioral Representation Foundation included in Eil-3 or the examiner not developing a good assessment alliance . A high R can occur & TP -Comp. for the same reasons given in th e Pulls section: disinhibition due to emotional or cognitive reasons (e.g., hypomania, ADHD, frontal lobe damage) , strong achievement strivings , or interpersonal dynamics (e.g., pushing the boundaries, testing the limits). A high R record without Pulls suggests less problematic characteristics than a high R record with Pulls. A high R record without Pulls may be produced by an imaginative , productive , spontaneou s, or intelligent person who enjoys the task. Such a record may also reflect an attempt to impress or to please the examiner. Location & Space Location and Space indicate where and how respondents attend to the perceptual field. In the microcosm of the task , they show how respondents organize and attend to information in their environment. There are two major dimensions of interest: (1) whole versus detail - the extent to which attention is focused on a particular blot detail or the entire stimulus , even if the entire stimu lus is processed in an impressionistic or approximate way , and (2) common versus uncommon - the extent to which attention is focused on the common and obvious versus the atypica l characteristics of the perceptual field.

Table 10.2 Location & Space Codes

Response Process- Behavioral Representation Foundation

Whole

The person used the whole blot or stimulus in producing a response. Generally , Whole responses involve a preference to take on the entire stimulus. If this is done frequently , it typically reflects a sophisticated cognitive effort and ambitiousness. However, for the cohesive or intact cards (e.g., I, IV, and V), the simplest solution is to use the whole blot. In such cases, there is little difference between the response process for this kind of W response and that described for D responses below. Similarly, simple Whole responses to the more complex and challenging segmented cards (e.g., III, IX, and X) are behavioral indicators of a global and imprecise processing style. Such a style is revealed either through vague and impressionistic Whole responses (e.g., "afinger painting or afield of flower s''), or approximate shape Whole responses that lack detail specification (e.g., an unelaborated insect or animal). More sophisticated Whole responses integrate the distinct parts of the blot into a single complex image. Especially when this occurs to the more challenging cards it represents an ambitious , integrative solution and an attempt to deal with all the available information.

w

Included in LSO, W%;WD - %, & V-Comp.

Generalizing this processing approach to everyday life, a person who gives many of these behavioral responses to the task likely will attempt to take into account many details and a great deal of information when making observations in everyday life. As these points attest , Object Qualities (e.g., Sy , Vg) and Complexity Scores (e.g., Blends , multiple contents) are important factors that aid the interpretation of Whole responses . In addition, other scores will indicate whether this kind of information processing leads to conclusions that are realistic and that make

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Table 10.2 Location & Space Codes

Common Detail D Included in LSO andWD - %.

Response Process - Behavioil'al Representation Foundation sense (e.g., the reality testing [FQ] and thought disturbanc e [WSumCog] scores). The person used an obvious , commonly selected part of the blot stimu lus in producing a response . Thus , using a common detail area for a response involves a behavioral example of attending to the most obvious aspects of the visual environment. Moreover, it represents a preference for taking on the easier, more manageable part of the task.

As noted above, there are also cards (I, IV, V) on which a Whole response is the most common and easily managed location for a response , so those W responses have an interpretive meaning that is similar to D responses. Uncommon Detail The person used an area of the blot that is not often selected by others to Dd produce a response. Most often these details are small and/or somewhat arbitrary in the sense that they do not follow obvious visual contours. Thus, the coded behavior indicates the respondent focused on an atypical or small detail Included in LSO and Dd%. in his or her environment as a way to organize information and to make sense of things. Doing this repeated ly may involve attempting to impose one's own way of lookin g at things on the task; making fine, perfectionistic , or idiosyncratic discriminations; having difficulty recognizing the obvious, or defensively avoiding it; being drawn to som e source of emotional preoccupation; or preferring to occuov oneself with the minutiae of life . In the basic Rorschach task , when asked, "What might this be?," the "this" is Space Reversal typically understood to refer to the inkblot itself, not the white background that SR it resides on. Therefore , when respondents use the white background to organize Included in LSO and structure their response rather than the inked area, at some level they are and SC-Comp. resisting or reversing the implicit instruction for the task. The person complies by giving a response , but does so in a different or unexpected way. In particular , an SR response involves a behavioral instance of perceptually reversing the figure and ground, hence the name "Space Reversal. " Reasons that may prompt doing this often include oppositionality, individualism , inventiveness or creativity , an atypical structuring to perception, or even being sensitive to interpersonal pressure so as to resist it. Space Integration It takes cognitive effort to identify the white background as a distinct perceptual SI element and then integrate it with the inkblot proper to produce a "Space Integration " response. Successfully combining figure (inkblot) and ground Included in LSO , (white space) is a more complex achievement than just responding to the inkblot SC-Comp, and V- or a white space on its own. This is the case whether the person uses the inkblot Comp. proper as the main object (SI coded) or the white space as the main object (both SI and SR coded). It is also a distinctive way of adding complexity to a response, as compared to making associations between the subcomponents of the inkblot proper. SI responses therefore involve effort, motivation , complex thinking , and possibly creativity.

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Content Reportin g particular contents require s that the person have such ideas in mind, either in long-term memory or from something recently considered, see n, or experienced. However, it is important to keep in mind that the inkblots are not neutral stimuli; certain cards and locations simply look more like certain things than they do others, which is called "ca rd pull. " Nonetheless, the range and array of contents in a record indicates the type and variety of ideas that come to mind in a situation lending itself to multipl e interpretations. Similarly, seeing particular types of content at an elevated frequency reveals information about the perceiver that goes beyon d card pull. Recent, impactful situation s are often mentally represented in easily accessible ways that can noticeably affect the production of Content Codes. For example, recently witnessing a particularly bloody event could result in an increase in Blood responses and actively studying anatomy in medical school can lead to an increase in Anatomy responses. There are some Thematic Scores that could be cons idered contents (e.g., AGC, MOR, ODL). For these codes, their respons e level interpretation is simil ar to the ideas presented here for Contents. Generally speaking , Contents are the main compon ents of a response that are manipulated when people attempt to appear more psychologicall y disturbed than they are, i.e., when they "fake bad' ' on the test (e.g., versus Location , Object Quality, Determinants , Form Quality). In the context of faking bad, one may often see an increase in the so-called dram atic contents that are included in the Critical Contents score (i.e., An, Bl, Ex, Fi, Sx, AGM, MOR).

Evidencealso indicates thata history of severetrauma with currentlyactivesymptomatology can elevate some of the same Critical Contents (e.g., Armstrong & Loewenstein , 1990). Because the same types of thematically linked content can be responsi ve to general disturbance , malingering, or trauma , it is important to care fully consider the different factors that may elevate the more dramatic, traumatic, or primitive Critical Contents.

Table 10.3 Content Response Process - Behavioral Representation Foundation Codes Human Content In general, the propen sity to see an elevated number of humans in the inkblots is SumH behavior that indicates awareness of, or interest in, other people. Particular types of Human Content responses may indicate how others are viewed , one 's Includ ed in Vown self-identifi cation, or both . There is some research evidence that the Comp. particular qualiti es of Hum an Content responses are influenced by components of object representations , schemas of self and others, or internal attachment models. Whole Human Relative to other Human Conte nt subtypes, regularly seeing whole, realistica lly portrayed humans involves a mor e accurate, integrated, and complete view of Content H people . Doing so is more cognitively sophisticated than a propensity to see human parts (e.g., legs , head) and more realistic and objective than a propensity Includ ed in SumH , to identify fantasized or distort ed characters (e.g., robots , aliens, cartoon NPH, GHR, Vpeople). Also, because whole peo ple are more likely to interact meaningfull y Comp , & SCwith their environment than parts of people , most human content responses Comp. involving meaningful synthesis with a broad er context will involve whole humans [H or (H)] rather than human details [Hd and (Hd)]. Thus, most human content responses involving juxtapo sition to other objects, movement ,

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Table 10.3 Content Codes Response Process - Behavioral Representation Foundation intentionality, distinguishing characteristics, narrative implications, and allusions to the passage of time and relationships will involve Hor (H). In turn, these entail more elaborated and informed schemas for understanding people. Overall, H responses suggest the potential for a cognitively sophisticated and realistic view of oneself and others. Human Detail Seeing just part of a human body involves emphasizing certain elements or Hd characteristics at the expense of a more complete perception of the person. A propensity to identify these kinds of percepts on the task suggests a limited and Included in SumH , less cognitively sophisticated conceptualization of others or perhaps a NPH, PHR, & V- preoccupation with certain qualities. Occasionally, the propensity to identify Comp. particular part-human features can indicate interests or preoccupations (e.g., a propensity to see just eyes may reflect wariness or concerns about what others are looking at; sexual parts may reflect sexual preoccupations) that occur at the expense of a more balanced or integrated view of others.

Whole Human-

Note that most Hd responses are of faces. Faces are such a compelling interpersonal stimulus that humans are born with brain structures that respond specifically to them and throughout life facial information is processed differently than other types of visua l information. Perhaps because of this evolutionary heritage, in combination with suggestive blot features, there is considerable pull on certain cards to identify faces or heads. A (H) response is a representation of an object with fantasized or unrealistic

LikeContent

qualitiesbut that neverthelesshas humanqualities(e.g., sentience, logic,

(H)

emotions) that one can connect with. These (H) representations are not based on ordinary, everyday , and real interactions with others and they do not suggest a Included in SumH, realistic view of oneself and others. Thus, the propensity to identify these kinds NPH, & V-Comp. of objects implies that the person , at least at times , understands him or herself and others in a way that is based on fancifu l, imaginary, or unrealistic elaboration s at the expense of actual , realistic characteristics and possibly more mundane considerations. Human-Like The processes associated with producing (Hd) responses combine the features noted above for Hd and (H). Detail (Hd) Included in SumH, NPH, & V-Comp. Animal Content Animals are a very easy content to see in the inkblots. They are by far the most A, Ad, (A), (Ad) commonly reported objects for people of all ages, though they are more commonly reported by children. Thus, they involve less effort and processing to Included in Videntify than other types of content. Because there are so many potential blot Comp. areas that can be seen as animals, an unusually high proportion of Animal Content can suggest cognitive simplicity or evasiveness and an effort to suppress information about the self. As with Human Contents, animal parts are less sophisticated than whole animals and the parenthesized Animal Contents suggest preference for or reliance on imagination and fantasy. Anatomy Seeing internal body parts at an elevated frequency suggests that a person has bodily, physical , or medical issues on their mind. To the extent that the body An

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Table 10.3 Content Codes Response Process- Behavioral Representation Foundation can symbolize the self, these issues may be more psychological than somatic. As with all Contents, a variety of factors may be involved in their production. Included in CritCont%, PHR, Most commonly, internal body contents may be on someone 's mind because he & Eil-3. or she is concerned with medical illness or body integrity. Psychologically, these responses might suggest vulnerability and concerns with psychic integrity , in that internal body parts are seen as exposed and accessible. In other cases frequent or recent exposure to such images , as with a student taking an anatomy course, may have influenced their production. Indeed, it is not unusual to find frequent An scores among medical personnel. In some cases, An contents may be technically presented by them as a form of defensiveness or one -upmanship (as with PER responses), such that the medical expert assumes these responses are less subject to challenge by the examiner. In general, when anatomy responses are of X-rays and other types of medical scans they may reflect a more controlled , objective, or muted expression of somatic or vulnerable features. Art Art responses vary in their sophistication , although they all prototypically involve some type of distancing from an experience. Some Art responses Included in involve an intellectual process of representing emotional experiences, such as IntCont. symbolic artwork. Others are more decorative, such as jewelry , which can suggest a focus on external appearances. Anthropology Ay responses given at an elevated frequency suggest that historical or cultural Ay matters are on one's mind. These responses often involve a self-conscious

displayof learningor intellectualityand can indicatean intellectualizedviewof Included in IntCont. Blood Bl Included in CritCont% & EII -3. Clothing Cg Included in V-Comp.

the world. Images of blood are a universal sign of injury and hence suggestive of danger , harm, or damage . While typically experienced as fearful or vulnerable imagery, blood also can be associated with sadistic pleasure in injuring others. Images of blood can range from those that are contained and benign (e.g., "a drop of blood") to those that are chaotic and involve trauma, rage , or terror. As with all content, it is of course also possible that the person has experienced or witnessed bloody scenes in real life. Clothing is typically seen on a person and not by itself. When clothing is seen on a person , it suggests some attention to detail or appearances. The nature of the clothing can add important contextual information. For example, reporting decorative and fashionable clothing can suggest that a person is superficially focused on image. Very heavy or protective clothing (e.g., leather or armor) may suggest a defensive concern about vulnerability. Using clothing to provide cloaking or disguise can suggest an interest in or distrust about what is "beneath the surface. " Because Cg responses often involve attention to detail and concerns for hiding or self-protection, Cg also contributes to the Vigilance Composite (V-Comp).

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Table 10.3 Content Response Process - Behavioral Representation Foundation Codes Explosion Envisioning exp losions and eruptions in the inkblots can indicate feelings of exploding (as in "exploding in anger ") or being out of control, as well as fears Ex of the same. Conversely , imagining explosions can also entail a feeling of Included in power, excitement, or danger. The nature of the explosion should play a role in CritCont % understanding the response. For example, the image of a "volcano exploding" & EII-3. carries with it more power and danger than fireworks exploding. Fire Images of fire are associated with heat and danger, which are sometimes used to describe rage or a person 's temper (as in a "fiery nature ") or passion. The nature Fi of the fire should play a role in understanding the response. For example, a Included in forest fire typically embodies danger and destruction, while a candle flame CritCont% typically conveys more control and utility with less danger. & EII-3. Sex Sex responses suggest an attention to sexual matters and possibly sexual Sx concerns or preoccupations. The specific nature of the imagery may suggest different types of concerns, for example, sexual intercourse , gender , or Included in procreation. Because most people are uncomfortable about raising sexua l CritCont% matters with a relative stranger , Sx responses are fairly uncommon. The & EII-3. production of many Sx responses , particularly when described in a raw and graphic fashion, may indicate decompensation into disturbed thinking patterns, preoccupation with sexua l trauma , hostile or sexualized provocativeness towards the examiner, or an effort to display "maturity " and "sophistication. " Not Classified When there are many NC responses with content that does not fit the previous Content categories , it can be informative to determine if there is an idiographic theme to NC these responses or if there are many different types of contents. The latter would suggest a richness of ideas. Moreover , all types of imagery, not just those captured in the Content or Thematic Scores, provide insight into what is on the mind of the respondent. Note: By design, all Content Codes contribute to the Content subcomponentof Complexity.As a result, Content Complexity is not listed in the Codes column. Object Qualities The term "quality" in Object Qualities refers to how the objects perceived on the inkblots are situated and arranged. Of particular importance is the degree of differentiation and integration involved in the way the response is seen. Being able to perceive well -formed objects with specific parts and details and to relate particular objects meaningfully with other objects is a cognitive achievement.

Table 10.4 O~ject Qualities Codes Response Process- Behavioral Representation Foundation Synthesis A Synthesis involves identifying two or more distinct objects and integrating them (e.g., "Two women in high heels, setting a table together"). As such , it Sy involves a developmentally advanced kind of cognitive processing, including a Included in LSO capacity to differentiate two objects in meaningful connection with each other. & V-Comp. In the real world, such sophistication might be manifested by breaking down information and problems into parts and synthesizing them in a more complex organization. It also demonstrates an interest or penchant for combinatory thinking , in which one evaluates how things or ideas relate to one anothe r.

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Table 10.4 Object Qualities Codes Response Process- Behavioral Representation Foundation Vagueness Vague responses involve impressionistic, imprecise , global approximations to Vg the forms and outlines in the blot stimuli , if not an outright avoidance of them. Examples of these vague and unformed responses include an unspecified paint Included in Vg% splotch or a hunk of coal. These task behaviors are analogous to vague , and LSO. impressionistic, unsophisticat ed, and relatively ineffective processing in the real world. Given that these responses lack differentiation and discrimination , they can have an evasive quality , too , in that the respondent is not being specific either to avoid alternative content or to avoid the risk of being wrong. The presence of multiple V g responses may also denote a tendency to give up easily and a failure to resist nascent impulses or ideas until they take on a more mature form.

Pair 2 Included in SCComp .

Together synthesis and vague scoring have response process implications. Intersp ersing vague responses among frequent synthesis responses suggests variability in cognitive operations, such that the individual has the ability to produce complex responses but sometimes reverts to impressionistic and unsophisticated perceptions. Responses with neither a Vg nor a Sy code are given in a rather concrete , straightforward, and easy -to-achieve way. Pairs involve recognizing symmetry by seeing the same object on both sides of the card. Essentially it is a straightforward and relatively obvious way of organizing a response that does not have other important response process implications. It can be related to a concrete, descriptive approach to blot. Pairs

lackevidence-basedcorrelatesso that theyare not interpretedon theirown.

Form Quality and Popular Form Quality (FQ) is designed to measure the accuracy of the forms involved in a response , that is, how well a response fits the blot contours at the particular location on the card. FQ scores are determined by comparing a person 's perceptions of the inkblot (the local environment) to other peoples' perception of the same local environment. This involves: (1) "fit" (i.e., how accurate the respons e is accord ing to independent raters) , and (2) "frequency " (i.e., how often other people give the response at that location) . Thus , FQ is based on a sturdy response process foundation. It should not be surprising that FQ is a well-validated measure of perceptual accuracy and reality testing. Popular responses are also considered in this section because they anchor the high end of the frequency dimension.

Table 10.5 Form 4 )ualitv and Popular Response Process - Behavioral Representation Foundation Codes Ordinary

FQo responses are conventional and accurate perceptions that are easily perceived. Producing these res ponses demonstrates a capacity to interpret the environment in a conventiona l and realistic manner. Good reality testing is Included in FQo%, necessary but not sufficient to produce FQo. GHR, & SCComp. 0

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Codes

Response Process - Behavioral Representation Foundation

Unusual

FQu responses are uncommon perceptions that are nevertheless fairly easily perceived by others. These responses are consistent with adequate reality testing, though perception may also be somewhat unique or unconventional.

u

339

Included in FQu% &GHR. Minus FQ- responses are atypical perceptions that range from those that are difficult for others to see to those that are impossible for others to see. An elevated frequency of these responses on the task is consistent with poor reality testing Included in M- , and the faulty translation or interpretation of environmenta l stimuli. FQ- %, WD - %, PHR, TP-Comp, Because nonpatient samples give about 9% FQ- responses , one or two of them & EII-3. in a protocol are not in themselves a sign of poor reality testing. Instead , they are perhaps a reminder that people often perceive and understand events and experiences from a highly personalized and idiosyncratic perspective. As with FQ- responses, WD- responses are atypical perceptions that range WD Minus WDfrom those that are difficult for others to see to those that are impossible for others to see. The only difference is that these instances of atypica l perception Included in WDoccur to the common ly used blot areas. Behaviorally, an elevated frequency of % & TP-Comp. these responses suggests that even when one is attending to conventional or obvious features in the environment , there is a propensity for information to be interpreted or translated in a distorted and idiosyncratic fashion. None FQn responses are coded when a person reports a percept with no specific form. For objects with no regular contours , it is not meaningful to ask whether the n contours of the object fit the blot and so they are not assigned an o, u, or - code. Included in PHR. By virtue of their formlessness, FQn responses may involve less deliberate control over ideas, feelings , or impulses (e.g., C). They are associated with Vague (Vg) responses. Popular Popular responses are coded when a person sees something that is very p commonly seen at the particular blot location (i.e., something that is obvious to most people). This suggests that the person can take a conventiona l perspective Included in GHR or see the world as others do. A protocol with very few Popular scores may be & SC-Comp. associated with non-conformity or difficulty with seeing the world in ordinary , convent ional ways. An excess of Popular responses, without indicators of individuality and elaboration , may be associated with banality, stereo typy, conformity , insecurity, or efforts to suppress personally revealing material. If all (or nearly all) possible Popular responses are given as responses, it may be important to consider whether the respondent is making a deliberate effort to give responses he or she has read about as being "good" ones.

Determinants Determinants (other than pure Form) generally reflect a sensitivity to various blot features and an ability to account for them and explain those features to another person. From a response process standpoint , Determinants involve the ability to describe nuances and characteristics of one 's environment that the person believes contributes to their understanding of that environment. For that reason, determinants in general are related to other indications of cognitive ability like age, education , and IQ. Theoretically , the range of determinants in a protocol involves flexibility in thinking and sensitivity to nuance.

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Table 10.6 Determinants Codes Movement

Response Process - Behavioral Representation Foundation

Unlike other Determinants , movement is not an actual attribute of the inkblot. Movement is a mental embellishment that requires some All are included in MC capacity to envision or imagine. It is provided to explain blot features , sometimes as a solution for dynamic forms, inconsist encies . and PPD. atop , & SC-Comp. potential relationships. Response process interpretation of the Movement subtypes (M, FM, m) thus involves inferences about the imagery and ideation involved with humans , animals. and inanimate activity. Human Movement M is defined by the respondent envisioning human action or experience. It requires the ability to use one's imagination to envision these M experiences or activities. M is therefore a type of mentalization that Included in MC, M/MC, contributes to the capacity for identification with others and empathy. MC - PPD, Mp/(Ma+ Mp), The cognitive abilities associated with giving an M response include the M-, & TP -Comp. ability to imagine and to envision action or emotion , some capacity to reflect on life experience, and a degree of developmental maturity. Based on the implicit identification of the self with human action and experience, M (relative to FM and m) may involve more awareness, agency , deliberation, and purposefulness , thus seeing the self as the agent or the initiator of the experience. Animal Movement FM, or "feral " movement, is defined by animal imagery and activity. The traditional understanding of the process involved in giving an FM FM respons e is that it reflects ideation stimulated by a need or instinct. This Included in PPD & MC view is based on a contrast of the animal imagery to the human imagery PPD. involved with M. Stereotypically, animal s are seen as driven more by instinct and needs , with less reflection , deliberation , or conscious purpose. However, this interpretation for FM involves a considerable interpretive leap and these inferred qualities are not obvious in the respons e process for the most common FM responses , which involve climbing , walking, flying , standing , and touching . Pending further research , FM is not interpreted on its own. Inanimate movement involves automatic, mechanical, or non -sentient Inanim ate Movement perceived activity . The imagery lacks human or animal volition. Moreover, it is typically characterized by external forces such as gravity m through falling, being pulled or stretched, mechanical forces or other Included in mY, PPD , & automatic or even inexorable forces. Thus, the ideation that presumably MC - PPD accompanies the movement is thought to be experienced as outside one ' s control. Thus, m is believed to reflect states of mental tension or agitation , as well as ideation impinging on, rather than originating from, the perceiver. Active & Passive Active movement is energ etic and/or goal-oriented whereas passiv e Movement movement incorporates less effort, force, and intentionality . As a response process, the active-passive dimension can be understood as a&p contrasting active, motivat ed, goal-directed thinking to passive , Included in p/(a+p) & receptive thinking. Broadly, active versus passive movement suggests Mp/(Ma+Mp) similar contrasts in one's inclinations and interests.

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Table 10.6 Determinants Codes

Color (Chromatic) FC,CF , C Included in WSumC, SumC, (CF+C)/SumC, MC, MC - PPD, M/MC, CBlend, & SC-Comp.

Achromatic Color C'

Included in YTVC', CBlend, PPD, MC - PPD, & SC-Comp.

Shading All types are included in YTVC', PPD, MC-PPD, CBlend, & SC-Comp.

Response Process - Behavioral Representation Foundation

Attending and responding to chromatic color on the blots is believed to be similar to attending and responding to other stimulating, compelling ("colorful") features of the environment. Especially compared to M responses, giving responses based mainly on the color of the blot is believed to involve less ideational activity and to be based more on spontaneous receptivity to experience, including emotional reactivity. The Color codes are the only variables that are also differentiated for the degree to which the form contours of the blot determined how the person responded. Form provides structure and requirements for perceptual fit to an object. As such, the extent to which it is represented in Color responses is thought to suggest cognitive organization and control. Color responses based completely on color and not on form (C) are the most peremptory Color responses. Form-dominated color responses (FC) suggest the least passive reactivity and most cognitive control. Somewhere in between FC and C responses are CF responses, those in which color is very important in determining what the person saw, but the form contours were still a component. Being drawn to dark colors may indicate a "dark" attitude or perspective, or negative affective orientation. This dark attitude may indicate a dampened emotional reactivity or a generally gloomy attitude towards life. On the other hand, especially if the respondent has a range of Determinants and Contents, the presence of C' responses may

indicatethathe or she is opento a rangeof emotionalexperiences, which can be a strength. C' responses that are based on the white color seem less consistent with this interpretation, although white still involves the absence of chromatic color and is a color associated with mourning in some cultures. Focusing on shading indicates a sensitivity to nuance, minor gradations, and inconsistencies in the blot, as well as an effort to make sense of, or account for, these features. To give a shading response, one must first notice these inconsistencies and feel some need to account for them. Thus, at some level shading responses involve being bothered by, or distracted by, subtleties and inconsistencies. By analogy, a person who includes shading features may be more prone to focus on and attempt to account for nuances, inconsistencies, and subtleties in their psychological environment. Additionally, shading by its nature blurs contours and outlines and makes perceptions indistinct. Because of the implied loss of "perceptual hold" (Schachtel, 1966), such blurring can be associated with doubt, insecurity, and anxiety, perhaps even about personal boundaries. From this perspective, shading may be associated with a kind of "anxious sensitivity." Although noticing and reporting shading features suggests a cognitive ability and sensitivity, this tendency could also become a liability if excessive, or if the person is depressed (e.g., it could lead to ruminations) or is in a highly stressed state (in which accounting for every minor nuance could lead to faltering adaptation). This interpretation would also be modified depending on other features of the response, such as whether the

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Table 10.6 Determinants Codes

Response Process - Behavioral Representation Foundation

Diffuse Shading

shading indicates a tactile experience (Texture), depth (Vista) , or is seen in a brightly -colored area (Color -Shading). To the extent one is involved with the grey and black shading features, it might be related to the "dark" or gloomy side of life as described with Achromatic Color above (C'). See the general Shading interpretation section above.

y

Texture

T Also included in V-Comp.

Vista V

Form Dimension FD Included in V-Comp & SC-Comp.

Adding a tactile component to the shading suggests that the person is attuned to touch and to tactile experiences in their environment. The traditional interpretation for Texture links this attunement to tactile experience with interpersona l connections and attachments. However, the most direct inferences from the response process would focus on actual tactile information processing, tactile experience and tactile imagery, possibly extending to tactile comfort. Nonethe less, both tactile comfort and its metaphorical and linguistic extensions (e.g., being snug, warm, or "in touch" with another) are in1portant characteristics of close interpersonal relationships. Multiple T responses may reflect an anxious intensity surrounding the desire to be touched or to be close with others. Vista involves using the nuance and subtleties of the blot's shading to indicate depth. which often involves expanse and distance. Experientially , it involves a stepping back or distancing oneself, as if looking from afar. It is analogous to using nuance and subtleties , or perhaps a feeling of doubt or insecurity , as a basis for taking perspective or distance in evaluating situations in everyday life. Seeing and explaining a Vista response to an examiner requires an appreciab le degree of cognitive sophistication. Although previous interpretive systems have focused on the negative, dysphoric, or critical aspects of the Vista response (e.g. , a negative self-evaluative attitude), providing a Vista response is more concretely a cognitive accomplishment that would be rare for a child or adult with a low IQ. A notable use of dark shading to indicate depth could be analogous to saying that the person is "drawn into the darkness" with this type of thinking, and may be interpreted as such, but providing a Vista is not necessarily problematic or related to the self. Envisioning a form -based dimensional perspective is a cognitive accomplishment, though likely not as sophisticated as producing a Vista response. The cognitive process in an FD response is analogous to taking perspective on a situation. The particular quality of the FD responses (e.g.: (1) seeing depth; (2) seeing something looming above the perceiver ; (3) seeing hollowness) may more clearly indicate the nature of the person ' s experience. There is nothing in the response process to support a narrow interpretation of FD as being related specifica11y to the ability to introspect or evalua te oneself, as it has been understood previously . although it may be a component of that capacity. A more general evaluative perspective or eva luative capacity is suggested by the response process.

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Table 10.6 Determinants Codes

343

Response Process - Behavioral Representation Foundation

Reflection r

Reflections involve attentiveness to symmetry, sameness , and mirroring. If the Reflection response is of a human or sentient object looking at itself in a reflective surface, then the image is one in which the object is self-focused or self-absorbed. This , then, is a representation Included in SC-Comp. that suggests the respondent may be self-focused in everyday life, and perhaps experience others as similarly self-focused. It is not clear whether the common landscape reflections involve an implicit selffocus component, given that the content does not involve a human or human-lik e representation. Form Form responses involve a focus on the shape contours or concrete elements of the blot, and no other determinant features. According ly, F they involve simplification and a fairly straightforward and uninvolved Included in F%. approach to understanding the environment. However , very detailed and accurate specification of form features suggests a sophisticated cognitive process , even if other blot Determinants are not identified. Note: All determinants but F are included in Blend and Blend% and all determinants are included in Determinant Complexity.As a result, these three scores were not separately listed for each row in the Codes column

Cognitive Codes Cognitive Codes address the quality of one 's thinking - in particular , how one puts ideas and visual images together and how one communicates an understanding of the world. Responses are coded for

deviationsin thinkingor problemsin communicatingone's thoughts.CognitiveCodesrepresent some of the more behaviorally obvious and valid Rorschach codes , so their meaning is more selfexplanatory than some of the other codes.

Table 10.7 Cognitive Codes Response Process - Behavioral Representation Foundation Codes Level 1 or 2 Level 1 or 2 is applied to the cogn itive codes for DV, DR, INC, and FAB to Severity indicate whether the thinking deviation is less serious (Level 1) or severe (Level 2). Level 1 responses are example s of a person' s thinking that deviate from precise and concrete communication - they may be playful , creative , immatur e, mistaken, or imprecise - but they are easily understood by others. Level 2 responses suggest a misunde rs tanding of the situation by the way that the person combines or communicates ideas. The more extreme Level 2 responses are bizarre and lose touch with reality. Thus, they are often a behavioral expressio n of a thought disturbanc e. Deviant A person uses either the wrong word or a problematic grammatica l or Verbalization syntactical structure. DVl is a simple cognitive slip, an unsophisticated DV expression , or perhaps a playful word. DV2s are more serious misuses of words or phrases , including confusing neologisms , that impede communication. The interpretation of a DV is fairly straightforward, as DVs represent mild to severe problems with verbal expression. Deviant Response In a Deviant Response, a person veers off task in describing something , in a DR manner that can range from circumstantial yet comprehensible (DRI) to tangential and incomprehen sible (DR2). DRl responses are typica lly instances of otherwise clear communicat ion that simply veers off task a little and can be

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Table 10. 7 Cognitive Codes Response Process - Behavioral Representation Foundation Codes brought back to the original topic . DR2 responses are either bizarre non sequiturs that leave the listener dazed and confused or excursions that depart from the original topic in such a way that it is difficult to return to it and that interferes with communication. The occasional minor DRl could even represent a strength in the sense of identifying so meone who is flexible and free with expression, which may be a good sign for self -expression and therapy. The more severe DR2 , particularly when it recurs several times, may indicate significant derailing of thought and could impede the individuals' ability to effectively communicate with others . Incongruou s An INC response is an image or concept that is put together in an unrealistic Combination way. Like DVl responses , INCl responses involve simple cognitive errors, a INC loosening of inhibitions, or a deliberately playful or creative experimentation. INC2 resp onses are more bizarre combinations of ideas that can be unsettling or difficult to understand . INC2 responses combine features within objects in a primitive , bizarr e, or grossly irrational manner that points not just to a relaxation but a breakdown of conceptual catego ries and the boundari es betwee n fantasy and reality. Fabulized FAB responses combine different ideas, concepts , or thoughts togeth er in a Combination contradictory or illogical way. FABl respon ses are often playful (e.g., they FAB could easily be included in a cartoon) and can be interpersonally engaging or at least easily accepted by others , sometimes indicating creativity or spontaneity, while FAB2 responses are instance s of bizarre, illogical combinations of ideas that do not make sense and can impede communication . Peculiar Logic PEC responses are instances of peculiar, strained , confused, or overly concrete reasoning. Currently , R-PAS does not code Level 1 or 2 PEC respons es, but PEC PEC response s can range from relatively benign concrete and sloppy reasoning to highly disturbed, bizarre , and illogical associations. The latter is more indicative of a thinking disturbance . Contamination CON responses fuse together contradictory and mutually exclusive visual CON images or ideas. Such condensations , especially those that result in a neologism, are most closely linked with primitive or psyc hotic thinking. Occasionally a CON will be condensed into a word that fits the merged ideas (e.g., "batterfly " for a merged bat and butterfly on Card I) that would otherwise qualif y for a DV2 neologism. Note: All Cognitive Codes are included in WSumCog . TP-Comp . PHR. & Ell -3. All but Level 1 are included in SevCog . These scores were not separa tely listed for each row in the Codes column.

Thematic Codes Thematic Codes are an indication that certain ideas or attitudes are on one 's mind. Their interpretation is very similar to Content Codes , but Thematic Codes are usually less concretely tied to the object in the response and more to the theme it implies. Like Contents, there are some Thematic Scor es that respondent s attempt to manipulate when faking bad or when suppressing problemati c information in an effort to appear healthy. Responses given in the context of faking bad often appear in the Critical Contents (An, Bl, Ex, Fi, Sx, AGM, MOR) , but are not limited to them. Conversely, positive components may be purpos ely attributed to responses so as to elevate MAH and COP scores. There is also some evidence that recent , highly stressful situations can noticeably affect the production of

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Thematic Codes; for example, recently witnessing a very destructive, aggressive event could result in seeing more AGC or MOR images in the inkblots.

Table 10.8 Thematic Codes Codes Response Process- Behavioral Representation Foundation Abstract Inkblot designs in and of themselves do not have abstract or symbolic meaning. To Representation report that the inkblots convey a symbolic representation denotes an intellectual or ABS intellectualized cognitive process that the person is also likely to use in everyday life. Included in IntCont. Personal PER responses involve explaining or justifying one 's perceptions based on private, Knowledge personal knowledge or experience. This can be done in either a preemptively defensive or a boastful manner. Defensive explanations of one 's perceptions can Justification PER be delivered with an authoritarian style of self-assured knowledge or in an anxiously defensive way. In either style, the respondent's behavior is one of striving to justify the response as if it was subject to externa l criticism or was not valid and important in and of itself. The boastful type of PER is one that still justifies the response based on personal , private knowledge or experience. However , it differs from the other styles by emphasizing how much knowledge , specialness, or experience the respondent possesses. As such it typically has more of a grandiose or narcissistic quality and may be interpreted accordingly. Aggressive AGM responses occur when the respondent embellishes his or her perception with aggressive activity. As a Movement response, AGM indicates that the person has Movement

ACM Included in CritCont%, PHR, & EII-3 Aggressive Content AGC

Morbid Content MOR Included in CritCont %, SCComp, PHR, & Eil -3.

imagined,and, at somelevel,probablyidentifiedwith, aggressiveactivity,but it does not indicat e the person 's attitude toward it. For example, a respondent's attitude towards the aggression may include pleasure, interest, fear, or detachment. It may be possible to determine this attitude by his or her behavior while giving the response (e.g., reacting with fear or pleasure). Regularly seeing the aggressive , powerful, dangerous, predatory , or threatening images coded by AGC is a behavioral indication that these themes are on the person 's mind. Similar to AGM , it shows that the person envisions aggressive , dangerous , and powerful images , but it does not indicate the person 's attitude toward these images. Moreover, because they are not movement responses , there is less indication of identification with or mentalization of the aggressive activity. These images may be on a respondent's mind because he or she enjoys or identifies with them, fears them as external environmental dangers , or expects them as a natural part of life. It is also possible that these images have been primed by a recent stressfu l experience with someone or something aggressive. Such images are subject to impression management and are easy to produce deliberately. The more obvious ones are also quite easy to suppress. Seeing injured , defective, or damaged images suggest that a person has these ideas on his or her mind , although a MOR code by itself does not indicate the person's attitude toward these ideas. Relevant data support the belief that in most instances the respondent sees him or herself as damaged, flawed , or hurt by life. Howev er, an expressed enjoyment of harm or damage might also indicate that the person is identifying with the aggressor who perpetrated the damage . More rarely , MOR is coded for dysphoric images , which at least suggests that dysphoric ideas are on the respondent's mind or being experienced emotionally. Like many other Thematic

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Table 10.8 Thematic Codes Codes Response Process- Behavioral Representation Foundation

Cooperative Movement COP Included in GHR and EII-3 Mutuality of AutonomyHealth MAH Included in MAP/MAHP. Mutuality of AutonomyPathology MAP Included in MAP/MAHP. Good Human

Codes, MOR is subject to impression management. COP responses involve attributing cooperative, collaborative,synchronized, teamwork, pleasant, benevolent, or helpful qualities to interactions. The propensity to do so suggests a person who has a generally positive template for envisioning relationships,seeing such characteristics as natural components of interactions. MAH responses indicate that a person has envisioned a positive, mutually enhancing relationship in connection with the inkblot image. This suggests attention to, and an ability to envision, such relationships in one's environment, and thus a healthy and productive understanding of relationships.Theoretically, MAH is an expression of healthy and positive object relations, interpersonal schemas, or attachment models. MAP responses indicate that a person has envisioned a controlling, malevolent, and/or destructive relationship. This suggests that a person views these types of relationships as having occurred in the past, anticipates them in the future, or is attuned to such possibilities in the present. Theoretically, MAP is an expression of problematic object relations, interpersonal schemas, and attachment models, though they also may be responsive to state-like psychological crises. A GHR code is automatically assigned to relevant responses by the R-PAS scoring

Representation

programusinga numberof differentcriteria.In general,GHRis codedwhen

GHR

human content or human activity is accompanied by codes indicating an accurate, logical, adaptive, and non-malevolent percept. The structural features of the response suggest an ability to envision the self and relationships with others in an adaptive or positive way. It implies an intact understanding of self and other.

Included in PHR/GPHR& Eil-3. Poor Human Representation PHR Included in PHR/GPHR & Eil-3. Oral Dependent Language ODL Included in ODL%.

The PHR code is automatically assigned if one or more problematic codes accompany responses involving human representationsor human activity. Therefore, PHR indicates that human images, which are analogs to self or interpersonal schemas, have been viewed in a structurally or thematically problematic way that suggests a propensity to misunderstand others, relationships, and/or the self. This could include one or more of the following perceptual features: unrealistic, distorted, illogical, confused, damaged, malevolent, aggressive, vulnerable, or overly personalized.The actual response should be reviewed to understand what might be causing problems. ODL codes the words that suggest or images that convey themes of nurturance, needed support or help, oral activity, food and eating, or birth and fragility. The emphasis with this code is on the implicit linguistic manifestations of these themes, which might be present even when the overt image does not suggest it (e.g., as when ODL is coded for "praying mantis" or ''jel/Jfish"). An elevated frequency of these terms or images identifies respondents who are implicitly motivated by dependent needs, related to an underlying dependent trait or a state.

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Protocol Level Interpretation SummaryScores on the Page 1 Profile We recommend interpreting all scores as dimensional variables on a continuum, rather than as categorical variables with specific cutoffs. In general, for Pa~e 1 variables , interpretation would begin when scores are at or below a standard score of about 90 {2511 percentile) or when they are at or above a standard score of about 110 {75th percentile). As scores diverge further from the mean, the characteristic being assessed becomes more notably different from the typical person and, thus, of potential clinical significance. Administrati on Behaviors and Observatio ns These behaviors are presented first because they represent basic task-relevant behaviors that help to put later interpretations in context. Two of these variables {Prompts and Pulls) are new scores related to R-Optimized administration. Although they need empirical study, interpretive postulates given here are based on logical links tied to the task behaviors. The third variable (Card Turns) in this section has not been systemically recorded in earlier Rorschach systems but does have a limited history of research. Table 10.9 Administrati on Behaviors and Observations Variab les Level Interpretatio n Prompts High A high number of Prompts might be associated with any of the following: limited cognitive ability, rigidity, inflexible perception , depression, lack of trust and engagement, Pr evasiveness , defensiveness, resistance or an uncooperative, oppositional, or passive-aggressive response style. Pulls High A high number of Pulls can be due to achievement strivings, ambitiousness, striving to please, or productivity to soothe insecurity. Problematic over-productivity can also be due to Pu disinhibition , affective ly driven manic or hypomanic qualities, poor psychological boundaries , or problems following or internalizing rules. It may also reflect an interpersonal challenge or test of the examiner. Card Turns General Card turning acts as a moderator variable in the interpretation of Reflections (r) and this is the primary reason why it is listed CT here. Seer section below. +@

Depending on how it is contextually expressed, card turning behavior has been conceptually linked to intellectual curiosity, flexibility , compulsivity , hostility or defiance , anxiety, authoritarianism , and suspiciousness. It can also reflect one 's level of interest in the task or an avoidance of specific unsettling percepts .

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Engagement and Cognitive Processing Domain This domain encompasses a variety of variables that are related to an individual's complexity, productivity and psychological resources , as well as motivation and engagement in the test process. Many of the variables are highly correlated with the "first factor " of the Rorschach as described for the Complexity variab le. Because understanding Complexity sets the stage for interpreting the rest of the protocol , before describing interpretive postulates associated with complexity, we address some basic considerations.

Basic considerationsrelated to protocol complexity. Understanding the level of complexity in a record is one of the most important components of interpretation. It can also be one of the most challenging . This general dimension captures the primary source of variability in all the test scores and is correlated with a wide range of variables on the test. As such it is an excellent marker for "the first factor " on the test (i.e., its primar y dimension), which makes it like g on an IQ test or Welsh 's A on the MMPI-2. Complexity can be challenging to interpret in part because it is associated with both personal traits and also situational response sty le features. As with validity scales from self-report measures like the MMPI-2 , it is sometimes difficult to decide whether the complex ity score derives from (a) the cognitive and coping sophistication that is intrinsic to the person versus (b) their situationa lly reactive test-taking or response style expressions. Some of the personal characteristics associated with complexity are intelligence, creativity, curiosity, attention to detail, openness to experience, productivity and psychological resources. Bright, engaged individuals more frequently produce complex records , whereas cognitively limited individuals (e.g., with neuropsychological deficits or negative symptoms of schizophrenia) typically produce simplistic records. Low Complexity also may be due to characterological constriction , depressive withdrawal, anxiety leading to cognitive constriction or rigidity , or traumatic numbing. Simplicity may also indicate discomfort with the ambiguity and insecurity that accompa nies formulating responses to the Rorschach stimuli. As an index of situationally reactive test-taking, Complexity can vary according to respondents ' level of interest , motivation , and engagement in the task. Thus, low Complexity can be due to a guarded , withholding approach to the test, so as to present oneself in a positive light by suppressing persona IJy relevant and potentially compromising material. High Complexity scores may embody a dramatic or rambling effort to simulate severe psychological disturbance , or possibly an effort to "show off " one's skills. Because of these competing influences, when interpreting Complexity, it is important to know the context of the assessment (e.g., clinical , forensic , or personnel evaluation) and the history of the person's functioning (e.g .. high or low functioning). Such background information sets the frame for interpreting the rest of the protocol. The examiner shou ld not expect to be able to determine from the test results alone the degree to which complexity is due to the person 's intrinsic qualities or to their situationally determined response to the assessment context. To address this question , the examiner should evaluate the history of functioning and also consider whether or not there is an incentive or secondary gain to distort the results. In the table that follows , interpretive postulates related to Complexity are differentiat ed by whether situationa l manipulation of the test scores seems likely.

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Because many other scores (particularly those in the Engagement and Cognitive Processing domain) are substantially correlated with Complexity, the R-PAS scoring program can statistically adjust for the level of complexity in the profile. These complexity adjusted scores estimate what the person's score would be if he or she had a median level of complexity. Typically, these adjusted scores would be considered when the Complexity Standard Score is less than 85 or greater than 115. Table 10.10 En2:a1ement and CO!nitive Processm2: Domam Variables Level Interpretation Complexity General An overall index of complexity of processing in that it measures differentiation, integration, and productivity at the response Derived from the level. Associated with age, education, intelligence, and sophistication of adaptation. Responding to the test with a high Complexity score Location , Space , means that the person has brought a considerable amount of and Object psychological activity and effort to bear in coping with the Qualities; and the demands of the test. Doing so in real life should be associated density of with more success and flexibility in coping, and a preference for Determinants and more cognitive activity and energy when responding to Contents challenges High In the absence of an attempt to exaggerate , complexity scores may reflect either a psychological strength or the presence of disturbance. A person 's history of adaptive functioning , other assessment information , and observations , as well as the context of the assessment , should be consistent with the direction of the interpretation. As a psychological strength, a high Complexity score would suggest sophisticated processing, productivity, superior psychological resour ces, and engagement in the world. In healthy individuals, complexity is related to sophisticated and flexible ways of coping and thinking. Although generally associated with strengths , sometimes high Complexity may involve problematic characteristics. Complexity can be associated with losing ideational control or focus as a result of anxiety, agitation, mania, trauma, emergent psychosis , or from self-defeating rumination or internal preoccupations. From a more concrete perspective, it is not necessarily adaptive to make every problem complex or to involve differentiated and effortful processing when a simple, straightforward , and familiar solution would suffic e. In more disturbed individuals , a high Complexity score could be related to confusion , poor psychological boundaries, and being overwhelmed with upsetting and poorly controlled ideas and emotions. In such cases, there should be other evidence of serious dysfunction in the person's history, particularly when obtained from other sources.

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Table 10.10 Ene:aiement and Coi nitive Proces.sme Domam Variables Level Interpretation (Continued) (Continued) If accompanied by a high number of Pulls, high Complexity and Complexity High high R may indicate problems with lack of inhibition or impulse contro l. High Complexity with a low number of Pulls suggests organized resources for complex processing and adaptive high functioning along with achievement strivings. High A high Complexity score can be an expression of exaggeration Dramatized or malingering in the form of offering many complex, dramatic, 'disturbed' violent or gross responses. This may be evident if there are response style excessive elaborations with narratives notable for their shockvalue but delivered without evidence of disorganized speech , if there is intermittent refusal to cooperate, or if a high Dramatic Contents score is obtained in the absence of any known trauma. As noted above, one needs to take into consideration the circumstances of the evaluation, the potential of secondary gain, and other information to infer that Complexity is elevated from exaggeration. This appears to be a rare occurrence; in most clinical settings , Complexity elevations are due to the combination of genuine cognitive resources and pathology. Low A low Complexity score may be due to a cognitive or coping deficit or to an emotional factor such as an anxiety-driven conflict, depressive withdrawal, or traumatic numbin g.

If low Complexityindicatesa cognitivedeficit then one would anticipate the person to have a history of limited autonomous functioning outside of a structured environm ent. In this case, low complexity indicat es a propensity for simplistic processing , inadequate psychological resources, and limited ability to engage in the world. The person likely will have trouble describing feelings , thoughts, and reactions. Low Complexity can be secondary to several emotionally-driven processes. For example, it can result from an intrinsic , anxietydriven defensive maneuver to hide aspects of the self, not only from the examiner but also from the person himself or herself . Thus, there is a fearful inhibition to spontaneously engage with the task. Low complexity can also be due to withdrawal and lack of engagement with the environment secondary to depression , or from cognitive constriction and rigidity secondary to anxiety. Manifestations from both of these processes may be observable in the respondent ' s test-taking behavior (e.g., body language) and thematic content (e.g., MOR, or fearful or insecure elaborations ). Reactions to trauma often have a biphasic presentation of being overwhelmed and flooded versus avoidant and constricted. Just as traumatic floodin g can lead to high Complexity scores, on the other end of the spectrum traumatic numbing can lead to low

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Table 10.10 Eru!:alement and Co!!n1bveProcessme Domam Variables Level Interpretation Complexity scores. A positive trauma history, trauma related content in responses . and behaviorally fearful responses to the stimuli, would naturally make this interpretation more viable. Very low Complexity scores (standard score< 80) generally necessitate more tentative interpretations across other scores, as there is less personally relevant Rorschach data to ai:rnregate. LowFrom a situationally reactive perspective , a low Complexity Defensive or score suggests defensively limited engagement with the task insecure through giving overly simplistic or stereotyped responses. For response style instance , a low Complexity score for an articulate and bright person with advanced education would be consistent with this interpretation. In this context low scores reveal an attempt to suppress rather than express, so that the Rorschach protocol shows more how a person hides things, rather than revealing her or his persona11ty.Interpretively, there may be little that can be obtained from a protocol like this unless unexpected instances of pathological disturbance slip through.

If this style of responding reflects personal insecurity rather than fear of how the assessment results may be used, one could infer the individual may act in a reserved, insecure, and personally

non-revealing mannerin othersettings.As a result, he or she Low-Poor assessment alliance

Number of responses

R

General

may cope poorly in relatively unstructured emotional or interpersonal situations. Occasionally , the assessment alliance between the respondent and examiner is insufficient, leading to low Complexity scores secondary to limited engagement from mistrust or disinterest in the assessment. If a low Complexity score seems surprising in the context of the respondent's cognitive abilities and the other contingencies of the assessment, the examiner should evaluate whether it might be due to an insufficient assessment alliance (e.g., Did the examiner establish rapport and engage the respondent in the task by explaining the reason for the assessment? Was the examinee forthcoming with information and provide personally relevant examples in the interview?). Like Complexity, the respondent 's history and the testing situation should help guide understanding of R. For example, a person tested as part of a criminal investigation may be less forthcoming and open in giving responses , yet possesses the personal characteristics of a person capable of producing a high R. The reasons for variations in R are multifaceted and sensitive to many influences, so its interpretation needs to be considered in light of other variables, particularly Complexity markers (F%, Synthesis, location use). When considering R, one should also consider the extent to which Prompts and Pulls were used, and that almost all count variables correlate with R to some extent.

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·r Processm e Domam T able 1010 . Ene:ai emen t and COJn11ve Interpretati on Variables Level (Continued) High High R is a sign of ideational flexihiJity, particu1arly if R Complexity is average or above. If Complexity is low , high R may indicate a somewhat shallow and superficia l responsiveness (as in the proverb "a shallow brook is noisy ") . In general, high R can be an indication that the respondent (a) is compliant or dutifu l, (b) is verbally and perceptually intelligent and fluent, (c) is obsessive or vigilant, (d) is energetic or manic , (e) enjoys being the focus of attention, or (f) believes producing more is a sign of achievement (e.g., "more is better "). In the absence of motivated defensiv eness or a poor assessment Low alliance , a low R suggests inflexibility in seeing things from multiple perspectives, especial ly when prompts are given and even more so when these result in no additional responses. Emotionally -driven reasons for low R are similar to those for low Complexity, so refer to that section for interpretive information . Form% General The interpretation of F%, the proportion of pure form responses F% in a record, is similar to the Complexity interpretation but reversed (i.e., high F% is analogous to low Comp1exity). F% is F/R the compone nt of Complexity that is related to noticing , reacting to, and articu]ating subtleties in the inkb ]ot environment, and this is generalized to similar processes attending to one's inner life and external world. The person does not notice or focus on subtle features in his or High her internal or external world. By the same token, the person may understand herself, others, and her sunoundings in a simple and unreflective way. The person may approach the world in a manner that is disengaged, distant , and uninvolved. This simplification or lack of involvement can be an adaptation to stressful comp lexity or uncertainties , but a lack of awareness implies a general liability. It can be helpful to look at specific pure form responses to make

Low

sure that most of them are as simple and unelaborated as the generic interpretation implies. Sometimes, pure F responses involve considerab le attention to detail or may be accompanied by revealing self -expression. The person is able to notice and articulate nuances and subtle aspects of his or her interna l and external world. As a result, he is able to engage meaningfully with the complex and subtle aspects of his experiences and relationships. This can also be a liability in the sense that it may be difficult for such a person to focus on important features of the environment while ignoring irrelevancies and to take a detached , objective stance when appropriate . Noticing nuances and subtleties does not mean that perceptions are accurate; to assess this, review the form quality indices. Less healthy people may be easily upset or influenced

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Table 10.10 Eru!:alement and Co!!n1bveProcessme Domam Variables Level Interpretation by noticing nuances and subtleties because of their lack of insulation against troubling circumstances. As F% nears zero, it is likely to suggest a pathological, or at least highly unusual, openness to experience and environmental inputs that may deplete psychological resources. This variable is interpretively like F%, but it is related even Blend General more to the ability to identify and articulate multiple features of the environment. Blends may be more closely related to flexibility in thinking in that the different determinants included within blends involve different modes of structuring perception. High A tendency to process new information with a degree of richness and flexibility by simultaneously attending to multiple features of the situation. Very high Blend scores with multiple determinants can indicate excessive complexity that leads to confusion and unpredictability and that may interfere with the person being easily understood by others or even by oneself. Low Simplistic processing marked by neglecting or ignoring opportunitie s to attend to richne ss and complexity in the environm ent. Synthesis General A measure of complex and sophisticated processing and coping , reflecting integrative cognitive activit y or relational thinking. In contrast to other complexity variables , this variable deals Sy

specificallywith the synthesisand integrationof different

High

Low to Average

Human Movement and Weighted Color

General

concepts and ideas. Cognitive processing and thinking incorporates synthetic and complex components. The respondent has sophisticated and differentiated psychological and cognitive operations . In taking in information , the individual tends to conceptualize how one component is related to another. Review Vague% to determine if there are also instances of less sophisticated, vague and impressionistic thinking , which would suggest more variability in one 's approach to processing and conceptualizing. Cognitive processing focuses on common, easy to achieve, and straightforward components. Overall, thinking is simple and straightforward versus combinatory, relational , and synthetic. Review Vague % to evaluate whether vague and impressionistic thinking replaces synthetic integration. A measure of psychological activity and processing most often interpreted as an index of psychological resources and adaptive capacity. It is bas ed on the ability and propensit y to populate , animate, and color one 's experiential world.

MC M+WSumC

Similar interpretations are offered for MC and for MC - PPD , so both should be considered together.

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Table 10.10 Ene:aiement and Coi nitive Proces.sme Domam Variables Level Interpretation (Continued) High The ability to mentally engage in the world with vitality, MC reflective thought, emotion, and psychological activity. Depending on other variables and factors, a high MC is generally associated with better adaptation.

Low

MC - PPD

General

(M+WSumC)(FM+m+Y+T+V+ C')

High

Low

However, this is not always the case. For example, the existence of psychological activity does not necessarily mean that activity is being put to productive use. Consequently, a high MC should be challenged by noting if Movement and Color responses are accompanied by vague or formless percepts (Pure C, M with FQn), distorted form quality (FQ-), or thinking disturbance (CognitiveCodes). Suggests limited psychologicalresources, an absence of enlivening thought and emotion, and a chronic problem with being able to cope. However, these inferences can be misleading if MC is suppressed due to guardedness or other situational factors (e.g., current depressive episode). The index of Human Movement and Weighted Color (MC) to Potentially Pro,blematic Determinants (PPD) is a measure of likely coping effectiveness. It is obtained by contrasting codes that suggest resources associated with ideational elaboration (movement)and lively responsivenessto the world (chromatic color) (MC) to codesthatsuggest potentiallytaxinganxiousness (noticing the nuances and subtleties of shading that indicate a sort of an uncomfortable vigilance), disruptive ideation (inanimateor animal movement, which are more primitive types of movement), and dysphoria (darkening their experience with achromatic color and shading) (PPD). The interpretation of this index should consider the quality of the variables that go into MC and PPD. MC may not indicate healthy resources if it is accompanied by FQ- , Cognitive Codes, and Pure C. For PPD, the ability to identify shading in achromatic color, and dimensionality within shading, can be a resource rather than a liability when accompanied by other indicators of psychological health both within and outside of the Rorschach protocol (see response-level interpretation above). Suggests the person has the internal capacity to cope sturdily and effectively with the day-to-day events of life. The person can bring his or her own internal resources to different settings so that they are not easily influenced by situational events. This can make them more stable, predictable, reliable, and resilient in handling stressful or upsetting situations. It may also make them somewhat less vulnerable than most people to setbacks and stressors, or disruptions in relationships with others. Suggests a limited internal capacity to cope effectively with the day-to-day events of life. Situational stressors influence individuals with low MC - PPD scores more than others, leading

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Table 10.10 Eru!:alement and Co!!n1bveProcessme Domam Variables Level Interpretation to disruptions in their concentration or thinking or impulsive behavior and emotional upsets, all of which makes them more unstable and unpredi ctable. They may function better in a consistently predictable or struct ured enviro nment.

Human Movement

General

M

High

In highly complex or long records, MC - PPD tends to be lower, so that one shou ld consult complexity adjusted scores in these cases. Also, low scores may be associated with psychological sensitivity and a tendency to be troubled or concerned with inconsistencies in the world. Thus, in healthy individuals it can be related to internally contained anxieties and stress in the context of a deep and meaningful engagement in life. Such troubles would compromise functioning in psychiatrically disturbed individuals. M sugges ts the ability to use one 's imagination to elaborate human experie nce or activities. The overall healthiness of M is affected by other characteristics , with optimal M respon ses including MAH, good form quality, and the absence of problematic Thematic and Cognitive Codes. High M is an indicator of ideation, interpersonal cognition , and related constrll!ctssuch as imagination, intelligence , reasoning, and thinking before acting. This type of mentalization

contributes to empathy. M may involve more awareness, agency, M Proportion M/MC

General

deliberation , and purposefulness, thus seeing the self as the agent or the initi ator of the experience. The Human Movement Proportion assesses the degree to which decisions and actio ns are impacted by thoughtful deliberation (M) versus react ivity, vitality, and emotional expressiveness (WSumC).

M/(M+WSumC) Some research suggests that the relative strength of M is the more important component of these variables. In addition , before making inferen ces about strong emotional reactivity or impulsivity, there are many other factors that should be assesse d as contributors - such as a high level of stress, thought disturbance, or substance use . The Color Dominance Proportion should also be consulted regarding the strength of one 's reactions and emo tional expressions. Proportion scores are less reliable than their component scores, so that generally four human movement and/or color responses should be present before interpreting the M proportion . However , tentativ e interpretations may be considered for fewer responses if M is zero and WSumC is two or three, or vice versa.

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Table 10.10 Ene:aiement and Coi nitive Proces.sme Domam Variables Level Interpretation (Continued) High Associated with a coping style 67 characteri zed by deliberation M/MC and thoughtful strategy. Decision s and actions are generally delayed until multiple options have been considered. Decisions are infrequ ently impacted by immediat e and strong reactions , emotionality , or interplay with external stimuli. Emotional reactions tend to involve ideational components and internal representations, rather than being solely based on spontaneous reactions to events or interaction s with the world. There may be some preference for "living in one's head " and some resistance to "living in the moment" when the latter involves being absorbed in external phenomena. Midrange Decisions and actions are guided by both ideational activity and logic and by affective reactions and feelings.

Low

CFC Proportion (CF+C)/SumC

General

When raw scores for both M and WSumC are low (0 to 2) and separated by just one point (e.g., 0 vs. 1, 1 vs. 2), the proportion should not be interpreted. In these situations, emphasize interpretation s of the low M +WSumC (low MC). Copes by spontaneously reacting to and interacting with the world. A trial-and -error or give -and-take approach is more prominent in guidin g action. Gut reaction s, inspirations , and emotions, rather than thinking things through and playing events out on a mental stage , influence how one views events, oneself , and the world. The Color Dominanc e Proportion captures the dominance of color over form in determining the percept and is a crude measure of a relative absence, or relaxation, of cognitive control and modulation in one's reactions to the environm ent, especially when there is emotional provocation. Th e nature of the color responses can affect the interpretation . For example, a predominance of blood and fire color responses on Cards II and III or explosions on Card IX and X would be interpreted differentl y than more positive or enjoyable colorful responses, typically on Cards VIII and X. Proportion scores are less reliable than their component scores . In addition , four applicabl e respons es generally should be present before interpreting this variable. Howeve r, tentative interpretations may be considered for fewer responses if CFC is zero and FC is two or three , or vice versa.

67

Historically , high M proportion scores were referred to as an "introversive" sty le, while very low scores were called an "extratensive " style, and people were classified using fixed cut-off criteria as having or not having the style (Exner, 2003). In R-PAS (as in Rorschach 's [1921] original work) these styles are considered dimensionally, with more extreme scores suggest ing more of the characteristic.

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Table 10.10 Eru!:alement and Co!!n1bveProcessme Domam Variables Level Interpretation (Continued) High Reactions to emotionaJly -toned stimuli in one's external or (CF+C)/SumC internal environm ent tend to be direct, spontaneous, immediate, and absorbing. These reactions are accompanied by relatively little cognitive control, mental filtering, intellectual processing , or restraint. In healthy individuals , and in responses with pleasant content, high scores suggest receptivity to pleasant or positive emotio ns that allow one to enj oy life.

Low

At the extreme end, emotional reactions may be overly intense, and dramatic responses to emotional situations. The research literature sugges ts this interpretation may be true more for the modulation of negative emotions rather than for general emotional control. Reactions to emotionally-toned environmental stimuli tend to be modulated and! muted by mental processing and cognitive control. This can reflect emotional development and maturity. Howeve r, at the extreme end, individuals may excessively rely on logic or affective constric tion in response to emotional situations and strong environmental stimu li. Individuals like this might not be able to "let go" and enjoy life very easily.

Perception and Thinking Domain The variables in this domain largely refer to problems in thinking , ju dgment , or perception . Some variables involve conventionality and seeing the world as others do. Altogether, they are related to severity of psychopatho logy with the most extreme form being represented by schizophrenic spectrum and psychotic disorders. The most maladaptive combination of variables would involve low complexity/engagemen t and significant probl ems in the Perception and Thinking Domain.

Table 10.11 Perception and Thinkine Domam Variables Level Interpretation Ego Impairment General The Ego Impairment Index is a broad band measure of thinking Index-3 disturbance and severity of psychopathology. Its components include reality testing (FQ), thought disturbance (Cognitive Eil-3 Codes) , crud e and disturbing thought content (Critical Content scores), and measures of interpersonal misunderstanding and Derived from FQ- , disturbance (M-, GHR and PHR). M-, WSumCog , Critical Contents , The Eil -3 is s imilar to the TP -Comp but it also includes crude PHR, GHR, and R and disturbing thought content and imagery related to self- and other-representations. Therefore, if the Eil-3 is high and the TP -Comp is average or low, the EII-3 elevatio n may be due to crude and disturbing thought content or impaired objectrepresentations. If so, one should consider inferences about general personali ty dysfunctio n or the contribution of trauma rather than psychotic-type disturbances.

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Table 10.11 Perception and Thinkine: Domam Variables Level Interpretation

Thought & Perception Composite

General

TP-Comp

Derived from FQ-% , WD-% , M- , WSumCog, FAB2, and R Extremely High= Raw Score> ~ 3.0

High= Raw Score>~ 2.0

Low to Average= Raw Score< 1.0

Weighted Sum of the Six Cognitive Codes WSumCog

1xDVl +2xDV2+ 2xlNC1+4xlNC2+ 3xDR1+6xDR2+ 4xFAB1+7xFAB2 +5xPEC+7xCON

General

Psychological health with clear and sophisticated cognitive processing would be best demonstrated by the combination of low EII-3 and high Complexity scores. This composite assesses reality testing (via form quality variables) and thought disorganization {viaCognitive Codes). Mild elevations occur fairly often with mild to moderately severe disorders without clear psychosis. It is possible that only one of the two components will cause an elevation, but both are more likely implicated with very high IP -Comp scores. This variable is based on its earlier versions in the Comprehensive System (the Perceptual-Thinking Index [PTI] and Schizophrenia Index [SCZI]) and the EII-3. TP-Comp has some of the best empirical foundations in R-PAS. Provides clear evidence of a severe disturbance with notable thinking and reality testing problems as is typically found in schizophrenic spectrum disorders, schizoaffective disorders, bipolar manic disorder with psychotic features, and druginduced psychotic disorders. This finding is unlikely to be associated with malingering or trauma, though this is possible. Suggests problems thinking clearly and seeing things accurately. Can indicate vulnerability to psychotic, quasipsychotic, or borderline states. May be associated with malingering or trauma. Indicates the ability to think clearly and to see things accurately. As with the Eil-3, psychological health with clear and sophisticated thinking is best demonstrated by a low TPComp score and a high Complexity score. A measure of disturbed and disordered thought. Mild elevations can be associated with immature and ineffective thinking and reasoning rather than disturbed or disorganized thought, especially when Level 1 and qualitatively less disturbed or playfully-given responses dominate. There are two groups of Cognitive Codes that may characterize a person's responses those that are visual (i.e., INC, FAB, CON) or those that are linguistic (e.g., DV, DR, PEC). CON can involve both elements when the respondent merges or condenses images and words (e.g., the images of a bat and a butterfly become merged and verbalized as a "batterfly"). Reviewing the nature of the component Cognitive Codes that contribute to WSumCog can help one understand whether the elevation is due to frequent but mild thinking problems (e.g., Level 1 Cognitive Codes), less frequent but severe thinking problems (Severe Cognitive Codes), or both. See the Response Level Interpretation section for interpretation of the individual components of WSumCog. In general, the overall composite is more reliable than the individual variables.

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Table 10.11 Perception and Thinkine Domam Variables Level Interpretation

Severe Cognitive Codes SevCog

General

DV2+DR2+ INC2+FAB2+ PEC+CON

FQ Percentages

General

FQ-%, WD-%, and FQo%

FQ-%

General

FQ- /R

High

WD-% WD- /WD

General

Sometimes inaccurate "false positive" elevations result from examiners who (a) overcode PEC and DR or (b) repeatedly assign PEC for logically restrictive and concrete verbalizations. More rarely, overcoding FAB2 relative to FABl may contribute to an inaccurate elevation. CON is exceedingly rare and must be coded conservatively. Although less encompassing than WSumCog, this variable captures the more severe disruptions in thought processes that are typically most indicative of psychotic -level lapses in conceptualization, reasoning , communication, or thought organization. The rare cases in which WSumCog is high and this scale is low may indicate idiosyncratic cognitive issues like ineffective problem solving or immature thinking patterns, which likely are not associated with schizophrenic or psychotic spectrum disorders. As with WSumCog, one should ensure that elevated SevCog Codes do not rely so lely on repeated speech patterns , mistaken scoring (over-coding DR2 , PEC or CON), or mild and concrete PECs. Finally, one should also consider whether playfulness with the examiner or the task, deliberate efforts to be shocking or provocative, or a penchant for narrative dramatization might be healthier processes contributing to an elevation. In general , these measures assess conventionality of perception and reality testing. Keep in mind that there is considerable redundancy among the FQ percentages. Research supports the general interpretation of each of these measures, but the distinctions among them are less clear. FQ-% is a measure of distortion or misinterpretation , often leading to poor judgments or unconventional behavior. Internal imagery and concerns may overwhelm the person's ability to process and interpret external reality and the person may describe things in a mistaken , distorted, personalized way that others will not understand. Because about 10% of nonpatient responses are coded FQ-, the presence of one or two FQresponses in a record should not be taken as a sign of pathology. It is important to recognize, too, that even for high functioning people it is not all that rare to see idiosyncratic interpretations of situations or faulty attributions to events. High FQ-% is strongly associated with reality disturbance and psychopathology. There is good support in the research literature for this interpretation. WD-% is similar to FQ-%, but it more specifically indicates whether distortion or misinterpretation occurs even in perceptual situations that are more commonly selected , conventionally used , and tied to familiarly identified objects. As such , distortions in this context may be considered more

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Table 10.11 Perception and Thinkine:Domam Variables Level Interpretation (Continued) atypical and problematic. WD-% and FQ-% are probably the WD-% best combination of scores to use to assess perceptual judgment and reality testing. It can be important to compare them and determine whether a person's perceptions of events and circumstances lapse and are distorted more specifically in uncommon versus common situations. High High WD- % is strongly associated with reality disturbance and psychopathology. FQo% General A measure of conventional judgment and seeing the world the way most other people do. FQo/R High High FQo% is generally associated with psychological health and good reality testing. Low If FQo% is low, it is important to determine whether this is due to reality testing problems (high FQ-% & WD-%). If not, the person may have a more unconventional and individualistic approach to life than a pathological reality-testing problem. Popular General A measure of highly conventional and widely-accepted interpretations of the environment and sensitivity to obvious P external cues. Excessively high or low scores can potentially be problematic (see these sections below). Although highly conventional perceptions can and do vary by culture, this score shows very similar average values across cultures.

High

Low

There are only 13 Popular contents, and the maximum is reached rather quickly. As such, Pis more closely associated with R in short or average length protocols than in long records. Excessively high scores in the absence of complexity may be associated with banality , being overly conventional, and having stereotyped views of the world. However , a moderately high level of Popular can be an important strength in disturbed individuals, showing the ability to, at least at times, see the world in conventional ways. Popular responses can occur infrequently for many reasons. The reasons might include reality testing problems, idiosyncrasy , or wanting to be different. Examine responses that supplant the more common Popular responses {i.e., Cards III, V, and VIII, and then I, IV, VI, and VII) to observe what is so compelling as to suppress a conventional response to the obvious stimuli there.

Stress and Distress Domain The variables in this domain have some relationship to stress and distress in various forms. Many have implications for other concepts and phenomena beyond the Stress and Distress Domain.

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Table 10.12 Stress and Distress Domain Variables Level Interpretati on Inanimate General Both of these scores have shown some relationship to moderate Movement and to severe stressors. The traditional interpretation of these scores Diffuse Shading is that Y indicates a helpless feeling in the face of the stressors whereas m is related to an anxious kind of ideation that is m,Y outside of one 's control or possibly impinging on oneself from external forces. There is little evidence that m or Y is reliably related to self-reported distress. They can reflect an expectable or natural response to stressors , even if they also signal an internal struggJe and less than optimal functioning. Morbid Content General Associated with morbid, pessimistic, and damaged ideational themes. The respondent may see himself as damaged , flawed, MOR or somehow harmed by life and external events. If an elevation is due to the less commonly given dysphoric MOR responses , it would suggest a dysphoric and negative view of the world and the presence of implicit distress. Although uncommon , a person who expresses enjoyment of the morbidity seen in the inkblot is likely identifying with the aggressor who perpetrated the damage rather than the victim of the aggression. In the latter case , MOR may be associated with aggressive tendencies or acceptance of aggression. Indeed , most MOR elevations involve some recognition or expectation of aggression and damage.

Suicide Concern Composite

General

SC-Comp Derived from V, FD, CBlend, Symmetry (r with Pairs), MOR, LSO Complexity, SR, SI, MC - PPD, CF+C Prop, FQo%, P, and

H

Extremely High = Raw Score abouts High = Raw Score about 7

MOR is more likely to differentiate patients from nonpatients than it is to identify depression selectively within a patient sample. A general measure of suicide risk and self-d estructive behavior . Psycho logically , it may be related to desperation. Evidence suggests that it is not related to self-mutilation or suicidal gestures that lack lethal intent This score represents a more worrisome implicit risk for suicide that again may not be recognized in overt behavior and selfreport but shou ld be explored with the patient. Based on implicitly assessed psychological factors, SC-Comp suggests the person is at possible risk for suicide. This risk may not be fully evident in self-report or self- characterizations and should be explored. Although people who commit suicide or engage in near-lethal suicidal behavior elevate this index, the base rate for suicide in most populations is low, which leads to many false positive results.

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Self and Other Representation Domain These variables encompass a mix of different types of coded behavior, including basic perceptual operations related to figure and ground , linguistically-grounded themes , perceptually-grounded themes, and direct representations of people and other animate objects. They are considered together because they all relate to ways of understanding the self, others, and relationships as a foundation of interpersona l relatedness . Of course , the variables considered in other domains have implications for this domain, just as the Self and Other Domain has implications for overall psychopathology because interpersonal relatedness is a central component of human adaptation. Table 10.13 Self and Other Representation Domain Variables

Level

Interpretation

Oral Dependent Language

General

A measure with strong validity support for assessing implicit dependent attitudes and behaviors. High scores are indicative of strong implicit dependency needs that may have important implications for interpersonal functioning. Interpersona l style and behavior will be characterized by dependence on others for nurturance, guidance, support, direction , and psychological sustenance and concomitant difficulties with self-assertion and sensitivity to loss and rejection. As an implicit behavioral measure of oppositionality and independence strivings, interpretive inferences flow from the psycho logical process of perceptually reversing figure and ground. By determining what the background looks like rather than what the ink looks like, the person reverses the task demands and essentially does the opposite of what was requested. Reversals may be prompted by creativity , individuality, oppositionality, or healthy self-assertive strivings. The existing research is most supportive of SR as an indication of oppositionality or doing the opposite of what is requested.

High ODL%

Space Reversal

General

SR

MAP Proportion

General

There is little support for interpreting SR as a measure of anger, so this inference should be avoided. Mutuality of Autonomy scores are a general measure of one's level of object relations functioning.

MAP/MAHP At times there are no MAP or MAH scores in a protocol and research has not yet addressed appropriate inferences to draw from that absence , though it suggests representations are neither particularly healthy or destructive. Proportion scores are less reliable than their component scores. In addition , four MAcoded responses generally shou ld be present before interpreting this variable. However , tentative interpretations may be considered for fewer MA-responses if MAP is zero and MAH is two or three, or vice versa.

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Table 10.13 Self and Other Representation Domain Variab les

Level

Interpre tation

High

High scores reflect both psychopathology and poor object relations , including distorted schemas of self and other relationships. People with high scores have difficulty interacting with others in mature and mutually enhancing, supportive, and autonomous ways. There is a tendency to attribute negative, destructive, self-centered, or malevolent characteristics to interpersonal relationships and interactions. Very high scores are most common in individual s with borderline personality characteristics. Low scores indicate the capacity to envision and possibly to enact relationships in mature and mutually enhancing, supportive ways that also respect the independence and separatene ss of the participants. The Human Representation codes are a general measure of how one understands people and relationships, including the self, and thus the codes speak to interpersonal competency and capacity for relatedness.

Low

PHR Proportion

General

PHR/GP HR Derived from Human Representation Content (including SumH , M , COP,or AGM) with FQ , P, An, and Cognitive Codes.

In contrast to the Mutuality of Autonomy variables, which directly code thematic elements of relational interactions , PHR and GHR do not focus so much on the thematic nature of interactions but rather incorporate structural components of the response that speak to the intactness of the representations of the self, other, and relationships. In that light, PHR and GHR may have more to do with normative social representations and skill with interpersonal interaction s, whereas MAP and MAH have more to do with the personal experience of relationships and capacity for intimacy.

High

Responses classified primarily due to later steps in the HR algorithm might not be optimaJly accurate. The proportion is generally unreliable with fewer than four raw scores, although PHR to GHR differences of Oto 2 or 3 or vice versa might be interpreted tentatively . High scores suggest a problematic or less adaptive understanding of self and others. Due to the multifaceted nature of the scale, high scores can indicate any or all of the following problematic ways in which self and others are perceived: distorted, illogical/confused , damaged, malevo lent, aggressive, personalized , partial , unrealistic , or vulnerable. It can be helpful to determine if there is a particular theme that leads to the PHR codes (e.g., aggressive and personalized vs. distorted and illogical).

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Table 10.13 Self and Other Representation Domain Variables

Level

Interpretation

(Continued) PHR/GPHR

Low

M-

General

Low scores suggest interpersonal competence and skills in managing and understanding interactions and relationships. They do not necessarily mean that the respondent maintains close and meanin gful relationships, or really cares about others or is sensitive to them, although such outcome s are more likely with low scores. Some individuals with low scores may use their sophisticated social awareness to influence or manipulate others. A rough measure of atypical or distorted understanding of peopl e that suggests disturbed interpersonal relations. Representations may be impaired by preoccupation s or beliefs that interfere with the realistic appraisal and understanding of other people's thoughts and intentions.

M with FQ-

In the past M- has been interpreted on its own as a measure of psychosis, but the research does not support such an interpretation.

Aggressive Content AGC

General

As a low base rat e score, it is important to monitor close scoring decision s, so as to consider their impact on interpretation. This is particularly true with long, complex records, where M- = 1 or even M- =2 might represent false positive results. This score reflects aggressi ve concerns, preoccupations, and identifications. However , as with other Thematic Codes, AGC responses can be subject to impression manageme nt. Most people are able to recognize their AGC percepts and can suppress them in an effort to deny aggressive interests and present themselves as non-aggressive and as posing no threat. Thus, low scores are not readily interpretable without taking response style issues into consideration. Indeed, like many other scores, the purpose and context of the evaluation needs to be considered whe n interpreting AGC. AGC should always be interpreted in the context of the individual's history of aggressive and competitive behavio r and overall personality organization . This context will help estimate the potential for identi fying with the aggressor , acting out the aggression, and the extent to which the level of aggression is sublimated or subserves mastery strivings and socially acceptable competitiveness. In addition, other test indicators of health and sophistication, and the content and organization of the aggressive responses themselves , should be considered .

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Table 10.13 Self and Other Representation Domain Variab les

Vigilance Composite

Level

Interpre tation

High

High scores typically reflect identification with power , aggressiveness , and dangerousness. Aggressive behaviors or callousness may not be involved, in that one's aggressive intere sts or preoccupations may be expressed in more socially acceptable ways through competitiveness and mastery strivings, leisure pursuits (e.g., gun collecting, video games), or occupational choices.

General

V-Comp Derived from LSO Complexity codes, SR, SI, T , SumH, Parenthesized Content, Whole to Partial Content , and Cg. High= Raw Score> 4.5

Extremely High= Raw Score> 5.5

H

General

High

Low

High scores may also reflect a fear of aggressive dangers in the environment or a vacillation between the two alternati ve identifications. As a measure of vigilance, V-Comp is understood as assess ing guardedn ess, eff ortful and focused cognition, sensitivity to cues of danger , and interp ersonal wariness and distancing . V-Comp elevations can be associated with vigilant ly scanning the environm ent for threats, but elevations are not specific to paranoid conditions because the index captures more of a cognitive style than an expectation of malevolence from others and fearfulness. For users familiar with the previous version of this scale (HVI) , note that HVI required an absence of Texture scores, which is not required in the V-Comp. Further research may illuminat e the meaning of low scores. Indicates a focused , effortful, detail oriented, guarded and vigilant cognitive style of processing information. This could be associated with interper sonal distancing and wariness. A more extreme, inflexible , and vigilant cognitive style with notable interpersonal distancing and wariness. Could be associated with an organized paranoid personality. In a context of poor reality testing (FQ- and especially M-) and disturbed thinking (elevated Cognitive Codes), paranoid projections may be likely. The ability to mentalize who le, intact human s. The quality of these responses should be considered (e.g., by noting whether they are accompanied by GHR or PHR, MAH or MAP), along with the relatively small number of inkblot locations where it is feasible to identify accurately perceived whole human figures. High scores are associated with the ability to mentalize whole, intact humans and are believed to suggest a potential for a more complete and comprehensiv e understand ing of self and others, so as to suggest a capacity for healthy interpersona l relations. Difficulty mentali zing whole humans can suggest a problem in understanding other people as complex whole individual s versus in terms of their particu lar social roles or their meaning as objects of desire , fear, or revulsion.

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Table 10.13 Self and Other Representation Domain Variables

Level

Interpretation

Cooperative Movement

General

Relative to MAH, a broader range of positive and benevolent interpersonal representations qualify for COP coding, making these scores more common. They thus provide a helpful reminder to look for personal and interpersonal strengths . COP responses can be subject to impression management and may reflect an interest in presenting oneself as cooperative or as responsive to positive social cues . Suggests a propensity to view interactions as supportive, helpful, rewarding , and collaborative. May not be interested in relationships or may not generally view relationships as supportive and cooperative. Alternatively , these representations may not be expressed because of other more pressing and compelling images and concerns. MAH codes are not common. In general, the MAH score reflects a developmental achievement and so it is considered on its own in addition to the MAP Proportion score in order to recognize healthy and adaptive representations. An elevated MAH score suggests the potential for mature and healthy interpersonal relationships, including a likely capacity for depth and intimacy. These scores, like COP, can be influenced by positive impression management.

COP

High Low

Mutuality of Autonomy Health

General

MAH

High

SummaryScores on the Page 2 Profile Interpret Summary Scores on the Page 2 Profile more tentatively than Page 1 variables. In general, more extreme deviations from the expected value may be required to lend interpretive meaning to the Page 2 variables. For instance, for Page 2 variables one could consider scores to be interpretable and potentially clinically relevant when they are at or below a standard score of about 85 (15th percentile) or when they are at or above a standard score of about 115 (85th percentile). As with Page 1 variables, the more scores diverge from the mean the more the characteristic being assessed becomes notably different from the typical person and of potential clinical significance.

Ta ble 1014 . En2a2ement an dC oimttve p rocessm2 Domam Variables Level Interpretation W% General Typically involves holistic, global processing. Providing W responses to the spatially segmented inkblots (II, III, VIII, IX, X) , particularly when accompanied by a Synthesis score, W/R indicates a complex cognitive endeavor and suggests a tendency to take on the whole situation, to challenge oneself, and to exhaust available information. The accuracy and logic of this more sophisticated effort, however, would be determined at least in part by the thinking disturbance (Cognitive Codes) and perceptual accuracy (FQ) in the response.

Interpretation 367

Table 10.14 Em?ae:ementand Cm nitive Processme: Domam Variables Level Interpretation

Dd%

General

Dd/R

A whole location for intact blots (I, IV, V) or accompanied by Vagueness (V g) are simple, unsophisticated solutions. Similarly, providing a global but simplistic and ill-fitting single object response to the segmented or broken blots (II, 111,VII, VIII, IX , X) reflects an "approximate" or imprecise mode of processing, which is commonly seen in younger children. Therefore, it is important to consider the quality of the W , including Sy and the presence of Blends or multiple contents, when interpreting this score. Because it is increasingly difficult to give W responses as R increases, it is very unusual to have a high W% along with a high R. A tendency to focus on uncommon,small, or idiosyncratic details. The person may impose an idiosyncraticway of looking at the world instead of more typical ways of taking in information.This can involve making finer discriminations, being picky about details, and focusing on clues and small pieces of information, at the expense of getting the larger picture. A preponderance of small Dd locations is associated with attending to small details, which may reflect obsessiveness or vigilance, while carving out atypical, larger Dd locations is

behaviorthat suggestsan odd,individual,or uniqueway of construing the environment.

Space Integration

General

SI Intellectualized Content

General

IntCont

2xABS+Art+Ay

High

Vagueness% Ve:%

General

Although a high score may be associated with detail and precise thinking, it can also indicate a more pathological obsessive or paranoid cognitive style. Indicative of complex and flexible thinking. A person who frequently integrates space with the ink is demonstrating a complex effortful cognitive operation of attending to, differentiating, and synthesizing features of the environment. An abstract or symbolic intellectualized style of information processing. It is useful to review the content to ensure it has an intellectualized quality. For example, decorative Art contents may be more reflective of a concern with appearances. Unsophisticated Art contents such as a child's finger-painting or vague and impressionisticrepresentations can be more histrionic or regressive. An individual prone to respond in a highly intellectualized, pseudo-intellectual, or pedantic manner. The person may prefer to talk about feelings than to experience them directly. Intellectualization is often used as a defense against emotional or social unpleasantness or distress. Vague, impressionistic, unsophisticated processing that can be due to a cognitive deficit, a cognitive style, impulsivity, and/or evasive defensiveness. As defensive avoidance, it can reflect a

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Table 10.14 En2a2ement and Co1nitive Processm2 Domam Variables Level Interpretation hys terical or histrionic cognitive style or it can simply be a Vg/R general solution to avoid reporting specific information and details. When an elevated Vg% score occurs along with an elevated Synthesis or Complexity score, it suggests there is some variability or inconsistency in sophistication of thought across situations and time.

Dimensional variables

General

Vand FD

Vista

General

V

As a low base rat e score, it is important to monitor close scoring decisions, so as to consider their potential impact on interpretation. The response processes these two scores attempt to capture involve taking perspective or distance. Seeing and being able to describe how an object in a two-dimensional plane appears to be in a three-dimensional perspective requires cognitive sophistication, which is why both variables appear in this domain . Perspective -taking might be interpreted more negatively in cases of extreme distancing as in dissociation or in depression or paranoia where views of oneself or others have a negative affective colorin g. Generating a Vista score involves taking perspective or distance, looking beneath the surface of things, or looking through things , all of which involve an analytic or evaluativ e perspective , and making fine distinction s. Given its strong association with cognitive measures of ability (e.g., IQ), the traditional interpretation of Vista as solely indicative of a depressoge nic and negative self-evaluation appear s to be too narrow. Nonetheless, because it has implications for depressive process, this variable is also considered below in the Stress and Distr ess domain. Ind eed, in the context of depression, it may be associated with negative self-evaluation, and critical evaluation of the world at large , and it may contribute to ruminations.

Form Dimension FD

General

As a low base rate score, it is important to monitor close scoring decisions , so as to consider their potential impact on interpretation. FD involves perspective taking similar to Vista , althou gh it does not necessarily involve the same kinds of fine discriminations or a process of seeing through or behind things. Extreme defensive distancing (e.g., being very far from or high above) can indicate dissociation in cases of trauma. A percept seen as looming out towards the respondent can occur in paranoid states. FD respons es may also be associated with an

Interpretation

369

Table 10.14 Em?ae:ementand Cm nitive Processme: Domam Variables Level Interpretation empty/hollow experience (e.g., using white space as eyes but seeing them as hollow).

R8910%

General

(R to Cards VIII, IX, and X) IR

FD traditionally has been interpreted as a measure of introspection, but no strong research supports this interpretation. It is possible that the nature of the dimensional perception could help differentiate whether it suggests the ability to see oneself , others, or circumstances in perspective. From the perspective of aligning inferences with response process or coded behavior, the inference that one can take perspective on his or her personal circumstances would seem more likely if the coded percept involved seeing across distance or over an expanse rather than looking up from the ground at a towering figure. The response process suggests that R8910% taps a general responsiveness to compelling or vibrant stimuli, which may include emotional situations with other people. However , there is a lack of research that targets this interpretation of the scale. This scale might be improved by taking into consideration the complexity of responses to the color cards. For example, R8910% may be elevated due to simplistic form-based Pair

responsesthat commonlyoccuron CardX, whichwould instead suggest superficial and concrete processing.

Weighted Sum of Color WSumC .SxFC+lxCF+ l.SxC

General

In addition, some individuals display what appears to be a heightened responsivity to the comp elling colorful stimuli of the last three cards, not by giving more responses , but by generating a single, highly complex and detailed response to each card. The response process suggests this variable is related to an interest in and awareness of stimulating , compelling features of the environment, which may include one 's emotional reactions to them. It can be viewed as a gross measure of reactivity, vitality , and liveliness , and perhaps a willingness to process and respond to emotion. As a component of MC, it is also globally associated with adaptation and psychological strength. It is very unusual not to have some color codes in a protocol. Such a finding may be associated with very limited reactivity , avoidance, idiosyncrasy , or problems in taking the test. By itself WSumC does not provide information about a person's affective experience. Direct expressions of positive and negative emotions in test behaviors and verbalizations about the task or process can off er useful behavioral evidence of the respondent's emotional experiences.

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Table 10.14 En2a2ement and Co1nitive Processm2 Domam Variables Level Interpretation C General Color without any form, or Pure Color, suggests openness to immediate impressions and a relatively unfiltered or unmodulated experience . This may have implications for internal experiences (e.g., emotional reactivity ; being flooded by affect or captured by ideas) and reactions to the environment (e.g., spontaneity; hasty and changeable responding). If a C response is accompanied by content that is positive and conventional, or occurs in a decidedly healthy and controlled individual, it can be associated with a willingness to yield to positive experiences.

Mp Proportion

General

Mp/(Mp+Ma)

As a low base rate score, it is important to monitor close scoring decisions , so as to consider their potential impact on interpretation. The response process suggests this variable indicates a propensity for passive (versus active) fantasy and ideation , especially involving people. Protocols with few movement scores are subject to misinterpretation because of instability in the proportion. In this case, it is important to monitor close active versus passive scoring decisions , so as to consider their impact on

interpretation.Also, proportionscoresare less reliablethan

High

their component scores. Four applicable responses generally should be present before interpreting this variable. However , tentative interpretation s may be considered for fewer responses if Mp is zero and Ma is two or three, or vice versa. There is a propensity for reflective imagination , passive fantasy , or rumination. Withdrawal into escapist fantasy or ruminativ e ideation may supplant active engagement with the environment in the form of purposeful problem -solving and personal initiative.

Table 10.15 Perception and Thinking Domain Variables

Level

Interpretation

FQu%

General

The response process suggests FQu % is associated with unconventional and individuali stic ways of interpreting the world. Other people may be able to understand how the person interprets situation s, but the interpretations are more personalized, idiosyncratic, or individuali zed.

FQu/R

FQu% is interpretivel y the least reliable form quality score, which is why it is on Page 2. One needs to see a greater deviation from the mean than for other FQ scores.

Interpretation

371

Table 10.16 Stress and Distress Domain Variables

Level

Interpretation

Potentially Problematic Determinants

General

This variable is generally related to cognitive ability (i.e., the capacity to animate percepts and attend to and describe a range of blot features) that, under certain conditions, can become a liability. That is, PPD can be indicative of experiences outside one 's contro l in terms of stimu lating, irritating, upsetting or pressing needs , feeling s, or perturbations. Interpret with MC to determine the degree of psychologi cal resour ces in compar ison to this measure of psychological demands .

PPD FM+m+ Y+T+V +C '

Sum of Shading and Achromatic Color

General

YTVC' Y+T+V+C '

Color Blended with Shading and Achromatic Color

General

CBlend FC , CF, or C with Y , T, V, orC '

Achromatic Color

General

C' High

This variab le can be high with long and complex records for healthy individuals who use complex processing . In these cases it is likely asso ciated with the richness of internal experience, heighten ed reac tivity to the world, and depth and sensiti vity. A rough measure of being drawn to inconsistencies , uncertaintie s, and nuances in the environment. In healthy individuals, elevated scores may be associated with an adaptive sensitivity to these nuances and subtleties in one's internal or emotional life or within one's interpersonal exper iences. In less heal thy individuals , these experiences interfere with coping and adaptation , so that one is likely to experience considerable implicit distress related to anxiousness, irritation , sadness, dysphoria , loneliness, or helplessness. These responses suggest emotional or environmenta l sensitivity. Affectively, they can be related to a propensity for emotionally spontaneous reactions (Color) to be compromised by concerns with inconsistencies , indefiniteness , and nuances (Shading) or darkness and deadening (Achromatic Color). This score thus suggests one is pron e to vulnerabl e mixed affective experiences - specifically , negative feelings that spoil positive reactions and enjoyment. For example , a person may avoid spontaneou s go od feelings because they also evoke this uncomfortable, vu lnerab le, distressing state. These inferen ces are most reasonable when bright colors are tarnished by shading (when shading or achromatic coloring occurs in a chromatic color area), in contrast to instances when the color and shading occur in different areas of the blot. As a low base rate score, it is important to monitor close scoring decisions , so as to consider their potential impact on int erpretation . Can indicate being drawn to dreary, negative , distressing stimuli , parti cularly when it involves elaborations of black and gray features. This score is not reliably related to the self-report or diagnosis of depression . Elevations may be associated with efforts to dampen or deaden emotional reactivity. These inferences should be checked against response imagery to ensure the content is consistent

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Table 10.16 Stress and Distress Domain Variables

Vista

Level

General

V

Critical Contents CritCont% (MOR+AGM +An+ Bl+Ex+Fi +Sx) IR

General

Interpretation with that interpretation (e.g., "a black pit" or "black like night") rather than indicative of a more neutral or positive valence (i.e., most white objects or dark-colored objects with a more positive connotation; e.g. , "a black tuxedo"). As indicated in the cognitive processing section, Vista involves perspective-taking or an evaluative attitude. It may be associated with some discomfort or dissatisfaction when directed against the self or others , but it is not problematic or pathological in and of itself. Therefore , in healthy individuals it can suggest a more sophisticated self, other, or interpersonal evaluative capacity, even it entails tolerating some discomfort. Within the context of depression or psychopathology, this faultfinding and criticism of the self or others can become excessive and disturbing, or be related to rumination so as to sustain distress. As a low base rate score , it is important to monitor close scoring decisions , so as to consider their potential impact on interpretation. In genera l, content codes reflect what one thinks about and meanings attributed to the world. The Critical Contents draw on a range of codes that reflect response imagery that is often censored or inhibited in general social interactions. The Critical Contents variable was developed as a measure of ego lapse or failure to censor problematic imagery for the Ego Impairment Index . However , its codes are virtually identical to the codes included on the Dramatic Content malingering index and on the Trauma Content Index (TCI), which is associated with trauma, abuse , and dissociative propensities. As noted in the left column , CritCont% is comprised of Morbid, Aggressive Movement , Anatomy , Blood, Explosions, Fire , and Sex. The TCI includes all of these elements except Explosions and Fire. Dramatic Contents include all of these elements except Anatomy. Because these three variables have such a high degree of structural overlap (with correlations in the range of .85 to .95), they cannot be reliably differentiated from each other when working with individual clients. However, they have widely diverging interpretations so it is important to consider all three interpretive prospects when CritCont% is elevated; i.e., do the scores indicate traumatic experiences consistent with the TCI, primitive thinking consistent with Critical Contents, or malingering consistent with Dramatic Contents. When evaluating CritCont% elevations, it is important to examine the array of constituent scores and the responses

Interpretation

373

Table 10.16 Stress and Distress Domain Variables

Level

High

Interpretation themselves to evaluate whether the content is widespread among multiple codes or narrowly expressed in one or two (e.g., An and Bl; AGM and Ex) and the extent to which it is more likely to be problematic or benign (e.g., MOR as "dead and decayed flesh" vs. "a broken cookie"). Indeed , it is possib le to find positive or healthy CritCont% elevations in protocols in which these scores are logically integrated with complex , accurate, and socially acceptable response imagery. In these situations , the Critica l Content imagery is muted or contained rather than crude or blatant. Individuals like this may express needs , urges, or fantasies in ways that are socia lly acceptable and allow them to achieve personal gratification. As noted above, there are three important interpretations to consider with CritCont% elevations: (I) The possibility of a history of trauma and a propensity for dissociation. However , trauma-related representations are often idiosyncratic or disguised and related to the traumatizing event in a personalized , idiographic manner that may not be detected by these codes. (2) The presence of crude or primitive cognitions can suggest a failure of censorship (as in borderline and psychotic states). The degree to which these contents are extreme, blatant, or bizarre versus modulated, subtle, and integrated is probably also related to psychological disturbance. (3) Finally, an elevation may be associated with exaggeration and malingering when it takes the form of expressing crude , dramatic , or disturbing imagery on the test in an effort to be shocking.

Table 10.17 Se If an d 0 ther Represen tat·10n Domam Variables

Level

Interpretatio n

All Human Content

General

In genera l, human content scores are thought to correlate with interpersonal interest and awareness. High scores suggest the person is interested in people and attentive to them. However , with some individuals this interest and awareness may also be associated with more paranoid guardedness and watchfu lness. To determine the latter, consider other indicators (e.g., elevated Vigilance Composite, elevated Scale 6 or RC6 on the MMPI -2, PAR -Hon the PAI). Low scores suggest limited interest in people or compelling and preoccupying concerns that compete with thoughts about people. It is very unusual to have no human content in a record and its absence suggests interpersonal problems, conflict , or avoidance.

High SumH H+(H)+Hd+( Hd)

Low

374 Chapter 10

Table 10.17 Self and Other Representation Domam Variables

Level

Interpretation

Non-Pure H Proportion

High

Suggests a tendency to view self and others in unrealistic or fanciful ways, or to mentally play out interpersonalscenarios in such ways. This is in contrast to a mature, straightforward, and informed understanding of the actual qualities of self and others. It can also indicate a tendency to identify with fantasy characters from popular culture or with the person's own preferred fantasy life. The mental imagery may be upsetting and threatening or playful and interesting. A review of these contents should help further understand the particular nature of the way that humans are seen or imagined.

NPH/SumH

[(H)+Hd+(Hd)]I [H+(H)+Hd+(Hd)]

Reflections

General

r

High

Proportion scores are less reliable than their component scores. In addition, four responses with human content coding generally should be present before interpreting this variable. However, tentative interpretationsmay be considered for fewer responses if NPH is zero and H is two or three, or vice versa. Indicates that the person may experience her/him self as reflected in the world in a self-centeredway. Cognitively, it suggests that the individual uses the self as a frame of reference when processing information. Reflection scores suggest that the person may need mirroring

supportor may experienceherselfor himselfas reflectedin the world in a self-centered way. Elevations suggest narcissisticlike or pleasurably self-involved traits. This is rarely unconflicted, however, as it is most typical that the person simultaneously requires considerableexternal support, admiration, and approval to maintain an exaggerated self-esteem that counters underlying fears of inadequacy and deficiency.

Passive Proportion General p/(p+a)

This interpretation is indicated to the extent that a human or animal is viewing itself in a reflective surface and not when the response is simply a landscape reflection. Frequently turning the card produces many more landscape reflection scores, which can trigger false positive inferences. So inferences should carefully consider the type of reflection response given and whether Card Tums are above average. A gross measure of a passive vs. active inclinations or attitudes. Protocols with few movement scores are subject to misinterpretation because of instability in the proportion. In this case, it is important to monitor close active versus passive scoring decisions, so as to consider their potential impact on interpretation. Also, proportion scores are less reliable than their component scores. In addition, four movement responses generally should be present before interpreting this variable.

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375

Ta ble 10 .17 Se If an d 0 ther Represen tat·10n Domam Variables

Level

High

Aggressive Movement

General

AGM

High

Texture

General

T

Interpretation However, tentative interpretations may be considered for fewer responses if p is zero and a is two or three, or vice versa . Passive inclination or attitude that may involve relying on others or a tendency to surrender to chance, luck, or fate, and thus less effective coping. From a behavioral perspective , AGM involves an aggressive intent or motive. However , it is a rather narrowly defined score that misses other kinds of aggressive content, henc e the inclusion of AGC in R-PAS. (When interpreting this variable, be aware that aggressive responses are easily manipulated, i.e., they can be embellished or inhibited.) May indicate an awarenes s of, and perhaps an interest in or preoccupation with, aggress ive intents or actions in the world. As a movement response, it presupposes some ability to mentalize aggressive impulses, implying some capacity for delay in acting on them. Ther e is no reliab le evidence that AGM is related to physica l aggression directed at either self or others . This is a coarse measure of sensitivity to tactile impressions that is thought to translate to interest in interpersonal closeness or contact. As a low base rate score, it is important to monitor close scoring decisions, so as to consider their potential impact on interpretation. The nature of the tactile response object may be important to interpretation (e.g., soft vs. rough) but research is inconclusive on this issue and rough tactile responses are relatively rare.

Low Average to High Average

Historica lly, the absence of Twas considered to reflect problematic interpersonal relationships, characterized by emotional distance or a dismissive attachment style. However , perhaps because it is common for non-patients to have no T in their records, the research is less supportive of its absence as a sign of difficulty and more supportiv e of a high level of T indicating a preoccupation with or strong need for interpersonal closeness or contact. Raw T values of O and 1 are in the normal range and thus generally fall below the threshold for discrepancy-based interpretation. However , they fall at opposite ends of the average range, separated by 16 SS points, so that differences between them may be considered . Particularly when a person identifi es other kinds of shading features, the absence of a texture code may be associated with a more distant or formal sty le of interper sonal relatedness , though this would not be

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Table 10.17 SeIf and 0th er Represen t at·10n Domam Variables

Level

Interpretation considered problematic in itself. Relatively speaking, the presence of one texture code may suggest comfort and interest in closeness and a secure attachment style.

Personal Knowledge Justification

High= A high score suggests a strong desire for interpersonal Raw Score> closeness, contact , or support, and an anxious or preoccupied 1 attachment style. It may be associated with a feeling of loneliness or pain and distress because interpersonal needs are unmet. High Suggests a tendency to justify one's views and positions based on private, personal knowledge or authority.

PER

Anatomy An

High

The interpretation of this score depends on the nature and quality of how the personal information is conveyed. It may suggest defensiveness if it is conveyed in an authoritarian or self-justified manner. or it may be an attempt to engage the examiner if it is conveyed as a sharing of experiences. Any defensive or self-assertive tendency would rest on an expectation of being challenged by others and underlying doubts about one 's productions. Suggests that a person has bodily , physical, or medical concerns on their mind. At a more conceptual level, this may represent a vulnerability or fragility in terms of body image and psyche. Medical professionals, technicians, and students may report more of these images simply due to their frequent exposure to them, but can also occur that they are using this specialized knowledge to "one-up" the examiner or to evade the risk of being challenged or wrong when giving responses.

Case Illustration 377

CHAPTERII CLINICALCASE ILLUSTRATION This chapter demonstrates how to apply the interpretive principles and psychometric information found in previous chapters to understand a client. It assists readers in learning how to conduct an empirically-based yet idiographically rich interpretation. In general practice one would make more use of other assessment instruments and integrate more non-Rorschach information. However our purpose here is to illustrate basic R-PAS interpretation, so our focus remains rather narrowly on that goal.

Backgroundand Assessment Goals RM68 is a single man in his mid-20s who comes from a Mormon family and is a graduate student studying business. He presented for an assessment to "re-administer the MMPI test." He reports that as a senior in high school he was administered the MMPI-A by a therapist and was diagnosed with "paranoid schizophrenia."69 He terminated treatment shortly after this diagnosis and said he disagreed with it. Later, he saw a therapist multiple times a week for a couple of months to 'cure' himself of homosexual thoughts and urges. He said that the therapist had him listen to 'scary tapes,' which he associated with mind control and which troubled him. He also felt he was not listened to and left therapy. Over the next couple of years, he briefly sought therapy twice, but stated it was not helpful. His presenting problems, as he described them, were: I have a hard time thinking clearly. J 'mfilled with se/fdoubt I don't want to be around people anymore and I have a hard time trusting people I have dreams about people doing bad things I have a hard time communicating, and I didn't used to be that way I have a hard time distinguishing between reality and non-reality

RM stated that his initial anxiety began when he was 12 years old and his parents divorced. He said he used to make friends easily and "felt unstoppable," but now he spends almost all of his time alone in his room and rarely interacts with others, including with the family members at home. He described some paranoia and secrecy in the family. For example, he is troubled about some significant family secrets and he keeps his own secrets from his family. His 'big secret' is that he is attracted to men. He does not want to act on these desires, nor does he want to develop a relationship with a female, so he has had no intimate relationships. He reported that he is afraid that he will inadvertently let others know he is gay and is terrified of this. For instance, he is afraid that he will just uncontrollably blurt out 'T m gay!" or that he will give away his thoughts and feelings by expressions on his face that he is unaware of. In addition, once when he "might have been looking at [gay] porn" on his computer, a friend instant messaged him, "What are you doing?" He imagined that somehow this person knew what he was doing or could see what he was doing on his computer and panicked. He also wonders about things like whether or not the government could actually ever read people's thoughts, and if they could read his. All of these thoughts cause him to panic and fear he may be psychotic. Although his 68

The patient's initials and some aspects of his background have been altered to protect his anonymity. He has graciously granted permission for us to publish his case material. 69 His MMPI-A complete d in high school was obtained an d it showed a clear 6-8 code type, with distinct elevations on Scales 6 ("Paranoia ") and 8 ("Schizophrenia").

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family is strongly Mormon, RM himself has disaffiliated from the church. He says his family has accepted this decision, and he denies that religious beliefs play a role in his efforts to "cure " his homosexuality. Somewhat surprising ly, given his other concerns, RM said his worst fear was that the assessor would tell him that he had Narcissistic Personality Disorder, which he thought might be indicated because he is so self-absorbed and preoccupied with his fears and anxieties. RM developed the following assessment questions with the assessor as part of a collaborative assessment process (Finn, 2007; Fischer, 1994).

What is n1ydiagnosis? Why can't I get my work done? Why can't I concentrate? What is at the root of my self-doubt?

1.

2. 3. 4.

The assessor 's diagnostic and conceptual focus was to understand the interplay between RM's obsessive-compulsive tendencies and his reports of thinking disturbance and their relationship to his fear of 'being found out' that he is gay. In addition , the assessor was attentive to the cultural factors that are part of RM ' s context and actively considered the role they may play in his presenting problems. Other assessment findings. We focus at the outset on the interpretation of RM 's Rorschach findings at the expense of integration with other assessment instruments , two of which are considered briefly at the end of this chapter. Here we simply note his WAIS -IV Full Scale IQ was 118, which is at the upper end of the Above Average range, with little variation across the four subdomains. His IQ, as

well as his statusas a graduatestudent,led us to expectsomecomplexity,sophistication,and possibly some intellectualizing in his Rorschach protocol. Assessment questions for the Rorschach. Important areas of focus for the Rorschach were providing a performance -based assessment of thinking disturbance and reality testing, and to get a better picture of RM' s mental representations of himself and others. The Rorschach has strengths in all of these areas and thus the obtained results can be expected to be highly relevant for understanding RM ' s personality and his presenting problems. What follows are RM' s responses and his location sheet.

Table 111 . RM's RorschachR esponses Card R Or

I

1

Response

I'd say uh, some sort of butterfly or moth, or a bat maybe. I think it looks like um ... the movie the Silence of the Lambs , there is this creature that they find that looks like this , so a moth. (E: Remember, we'd like two, or maybe three, responses to each card, so please try to give another.)

Clarification

(Examiner Repeats Response [ERR].) Yeah, so these are the wings of it & in the movie there are almost these eye shapes {DdS26), so these would be the eye shapes & right there & there, these would be the wings & these are the antennae.

ROpt

Pr

Case Illustration

Response

Clarification

Does it have to be right side up? (E: It's up to you) (v /\ v) This looks like a ship of some sort. Like a flying saucer, some sort of ship with these as the landing things. Now that sounds like a crazy response! (laughs)

ERR. These would be the crazy landing things. Um, this would be the entire object. Like something you would see in a movie, so it's a very large extraterrestrial thing. Yup. So this is the whole ship & this is the landing apparatus or the feet of the ship .

3

Um, this looks like a ... I was trying to think and .. . I guess that the first thing that comes to me is it looks like an entrance (Dd24) & this is some sort of courtyard (DSS). Maybe two ... I don't know ... landscape work on either side (D6) & some sort of castle (D4) or something at the end.

ERR. So the gradation in color from dark to lighter gives the effect of it ascending upward. That applies more to the mountain but since I said courtyard you wouldn 't necessarily have mountains so it has to be some sort of landscape.

4

These kind of remind me of two ERR. So again the gradation; it goes upward on mountain ranges ("snout " of D1 either side. The same thing, the same effect of bear) & a valley in the middle (D4 height. So this would be the valley floor (DSS) since it's completely flat since it doesn't have any + part below it). coloring that gives a geographica l look (touches card) & that 's the castle right there, at the meeting ... it kind of connects the two.

Card R Or 2

II

5

III

V

V

(v) This looks like some sort of mask. These are the eyes (red in center of D1) & this is the mask part.

ERR. So these red splotches right here are the eyes (Dd99 red) & this is where your nose would go through (DSS), & this is the outline; the edges of the mask. & these are kind of hanging down (D2), additions to the regular mask, & so is this (D3).

6

These looks like two um ... like ERR. Mhmm , so these right here. This whole two statues (D9). Like someth ing figure & some of the other side. They are both looking inwards, like looking at each other. lYOuwould see ... there was this movie, The NeverEnding Story , where at the entrance there were two huge statues. Like sphinxes maybe.

7

Ok, & uh, then it looks like two ... I guess two statues, like two something .. . maybe two creatures (D9) pushing an alien down. This looks like his head (D7).

ERR. So these are the same two creatures, but I guess in this case they wouldn't be statues . They are battling the alien & this is the alien head right here. It is sort of the prototypical alien with large eyes & it sort of looks like ERR. E.T. too with the wrinkles; these lines look kind of like wrinkles. (E: WMLL wrinkles?) They just , the lin es, they kind of... they just do! (laughs)

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ROpt

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Card R Or

Response

Clarification

ROpt

8

V

ERR . So these kind of look like the soles of his feet almost from below the ground or (02), so that's why I was thinking from below. & very near the ground looking up at these would be his legs & this would be his body or some monster (D7). Here are his his torso, & his arms & his head. [Could query arms, feet , head ... I don ' t know about soles of his feet.] what that would be (points to O 1). V

(v) It looks like some sort of ERR . So these would be the wings right here & flying creature (W). Not really then it tapers downward . These would be like like a bat or moth, I don ' t know . It tendrils. This would be the head & antennae. (E: looks like it has legs but the legs You said the appenda ges look curled? WMLL would be curled up {D4). If these curled?) Yeah , it sort of curls back (traces form of were the wings (D2), these objects D4) . would have to be some sort of appendages that are curled. It looks like a moth. Yeah. I can't ERR . So I was talking about how these ridges & really say it looks like a butterfly. grooves go up & down (traces outline of wing with It looks too gangly . .. not really finger), & then they kind of taper off & it gets gangly but not streamlined enough narrower , making wing shapes. & this wou ld be the head & antennae , & I guess this would be either a to be a butterfly . pair of legs of sorts or a second pair of antennae. (E: legs or antennae?) They look more like legs.

V 11

12

ERR . So this is the head right here (07) & this would be the arms (D5), & the eyes in the head ; very large eyes. & I'm ju st seeing this now but the bowtie , this sort of looks like a jacket , this dark part (Dd34) , so it lends more credibility to the bowtie , like he 's wearing a jacket & a bowtie . So yeah, otherwise this is the body . That's it. I didn 't make anything out of these red splotches (D2).

It looks like I' m looking up

IV 9

10

(v) This kind of looks like some sort of creature (DI) . The head , the arms, & body, & here is a bowtie (D3), but on the middle of his chest (DdS24) so it wouldn't work. Like it wouldn't really be a bowtie .

V

(v /\ v) I guess it still looks like a moth but instead of the wings pointing downwards they are pointing upwards. (crack knuckles) I don ' t know why but this is making me nervous .

ERR. Yeah , & I don 't know why. I never noticed a difference whether a butterfly's wings point up or downwards; same with a moth , but. .. but I'm guessing that there is a difference so that's just what I made of it. That one was one & the other one was the other [i.e., one is a butterfly & one is a moth]. The same goes for these (point to D9); these actually look more like antennae than the others when it was flipped upside-down .

Case Illustration

Card R Or

VI 13

Response

Alright, I'm seeing this as some ERR. The same thing as the other one where it is a sort of valley, like a very narrow mountain & the gradation of color going upward . opening in the valley , like a Um, & then these marks in here looks like um, the stream (D 12). I 'm thinking some peaks of the mountain (light shading outside D 12), sort of strange version of Christ ... the mountain range. They give it a geographica l the statue, like in Rio de Janeiro look & then it kind of meets toward here; this is the (D3). It's called Christ Redeemer. mountain, or pedestal , or maybe the mountain is & I see facial features , like eyes & made into a pedestal (Dd31 areas). Maybe that's a nose. I don ' t know if his arms the case. Then this was the statue standing on the are outstretched like that but it's mountain (D1); the head, the two arms, & these are definitely a statue. His arms , his the two swooshes coming out, like two brush head ... then there 's two lines strokes. coming out of the base of the head like whiskers or something, & I don' t know what to make out of these two below the arms , these two swishes I guess you could call them.

14 @ (v" v ") I'm also seeing some sort of ghostly figure , like the head starts around the nose (of statue) then like forms into a head in the chest area (of the statue) (middle area of D2). (")

15

VII 16

Clarification

ERR. So with that I was meaning the nose (of statue) right here, then the head (of ghost) sort of crowns right here. (E: Just a head?) Yeah.just a head. (E: WMLL ghostly?) Good question! Qaughs) There it is, I do see slightly darker inside, sort of hazy. I don ' t know, it's not easily distinguishable from the rest of the torso of the statue so it blends in.

And these right here, I kind of see ERR. Yup. So all of this is where it's a little bit ridges. Like they are sort of like darker. [Could clarify for V.] wearing away , like the peak of the mountain (inside D4) Two busts (D2) kind of resting on, ERR. So these are the pedestals right here, & this is teetering on these two uh ... rock the base of the bust , barely touching. So it's, yeah, stands (D4), looking at each other barely on there . This is the base & here is the neck, with the head jutted out like an old like an old lady that has osteoporosis. & this is the head, the nose, the mouth, lips, chin, & this is her lady 's head. hair. Or hat, cause this looks like some sort of hat style or something.

381

ROpt

382

Chapter 11

Card R Or

Response

Clarification

ROpt

(v) These look like ... It looks like a bay of some sort. It 's kind of like the coast & the land (W) & the bay (DS7). What else ... yeah, it very much looks like a bay. These are the shadows near the coast; as it goes furthe r up it seems like it's less shadowy & it forms the mountain. It looks like the sun is coming from the west eastward & lighting up this side & leaving the other side darker. & it is the same on the other side (of the card).

ERR. So I kind of imagined like the other ones, cause it's darker & gets lighter as it goes upward so it kind of gives that effect of height. & this is the coast & it goes all the way around, then this is the other side of the bay, mirroring. So they are mirror images of each other. So yeah , these sort of look like mountains. I guess since it's more open , not a valley , I saw it as more of a bay . This would naturally be the open ing to the bay.

VIII 18

This looks like two bears (Dl) standing on, I don't know what that is. Some sort of rock formation {D6). They are hanging off & sort of pulling this, I don ' t know what that is. The one leg I guess, or the claw , is clutching this light green part & the other claw is clutching or grasping this dark green part.

ERR. So this looks like a bear & these looks like four legs. So this looks like the head of the bear & it's kind of standing on one leg here & so this leg in the front is touching the green part so I figure since it's leaning back it is grasping this to keep from falling off. Then its other leg is touching this part as well so for the same reason it must be clutching that, hold ing on.

19

Um, since it's green I was thinking a tree, but actually it looks like a cedar tree {D8). Like what you would see on the flag of Lebanon. So that would be the top of the cedar tree, the light green {D4), & these two darker green objects would be the flags {D5).

ERR. So I was thinking that because of the color & the shape. The Lebanese flag is the same color & shape & this looks like the skeleton of a tree. You have all the kind of minor branches & the trunk right here is kind of exposed a little bit. So it kind of makes it look like a, sort of a tree that has been cut down; it has lost a lot of its mass.

(v) I guess I'm seeing like sunglasses (D5). This dark green. & maybe some sort of helmet, a helmet that wraps around the head

ERR. So this would be the glasses & there is kind of a11opening sort of. Sort of like any glasses it has a cutout for the nose to rest on; kind of the formation of a pair of glasses . And this would be the mask that connects to the glasses here, & I'm thinking it 's helmet-like because if this was the meeting point with the glasses it wou ld be sort of. .. sort of going back , to the back of the head. (Indicates depth.) [Could clarify for sunglasses.]

17

20

V

V

(W).

Case Illustration

Card R Or

Response

Clarification

IX 21

These looks like two wizards (D3) ERR . I immediately thought wizard because it with very , like, um, very, almost looks like the outline of a person but since it has very long claws . Or maybe they ' re this cone, a cone on its head, I thought wizard. So holding weapon s kind of. I'm thinking that these lines that come outward Weapons that are pointed at each seem to be protruding from the rest of the body other. These looks like guns. They mass in the direction of the other wizard. Then the are ju st hanging there pointed , guns are, this would be the handle of the gun & this pointed at each wizard's neck. So would be the part. .. I don' t know what it's they are ju st hanging there, it's not called .. . the part where you load it. Well , not load like the wizards are holding them it. .. so this looks like the shape of a gun but it 's & pointin g at each other's neck. pointed inward, not outward; inwards toward the They are just hanging . I see like a neck. So I saw this green, this sort of greenish very shadowy figure (Dd99) in color. This looks like shoulders, this is the head. & between them (wizards) ju st sort down here it's sort of like arms at his sides, leaving of standing there. Larger than both openings (i.e., making space at DdS23). That (wizards). He is sort of would be his waist. (E: WMLL shadowy?) Because interceding between them & his the color is so dim. Not dim because that's light. arms kind of on his waist , or It's ju st very lightly ... it's not very saturate d. maybe down by his sides.

22

Then this is some sort of. I guess ERR. So I'm thinking some sort of god or goddess like a figure within ... a face or creature in mytho logy that would reside within. (DdS29) within some sort of This is the face, the nose, & the mouth. The white object, like a bush (Dl). Like contrasting with the green, the indentations & stuff somet hing that maybe lives within create the illusion of the face. I'm thinking there a bush. are two; one in this direction, one in the other direction. [Could clarify within for dimensionality .]

X 23

24

That looks like an Eiffel Tower ERR . So these would be the legs of the lion, the (D14) almost , behind two body , & the head. In the distan ce behind them is sphinxes ... two lions (D8) I guess , this tower. So I was thinking more before I saw facing each other. these as lions I saw this who le thing as the Eiffel Tower , but since these are lions this would be ju st some regular tower. Some generic tower. Like I guess I'm seeing the same ERR . Sort of the same thing. The dark & it gets thing. Like an opening & these are lighter as you go upward. It gives the same effect two land masses, the pink (D9). & of ascending & descending. & then this is the the blue is like some sort of bridge & these are the two sides & this is an opening, water , & this is the bridge. It is a bridge strange bridge (D6) connecting the two land masses together. because it is connected to the pink.

383

ROpt

384

Chapter 11

Figure 11.1 RM 's Location Sheet

8~

a.II

but DZ.s

I= WS

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Case Illustration 385

Pre-InterpretationActivities With the record documented and location sheet completed, the protocol is ready to be coded. We encourage readers to code the record both as scoring practice and as a way to become familiar with the source material for interpretation. In the scoring program we would retain the default settings for ROptimized administration and for coding with the R-PAS FQ tables. As we coded, we saw three places where the clarification could have benefitted from an additional question (see responses 9, 15, and 20). In each case the uncertain codes related to Diffuse Shading, Vista, or Achromatic Color. As we proceeded with the interpretation we were mindful that one or more of these scores may be underestimated. All of these responses were already assigned determinants other than Form, so the coding uncertainties would not affect Form%. However, Complexity, Blends, and PPD may have been a bit higher with additional clarification. Although various benchmark or threshold questions emerged when coding the record, we note two instances of uncertainty concerning Cognitive Codes. These occurred on responses 17 and 23. On #17 the coasts surrounding the bay are mirror images of each other. This implies the physical impossibility that the sun is lighting both the outer leftmost edge and the outer rightmost edge. However, RM never stated that this implausibility was actually present; he only described how the light affected the left side of the image. Because there was uncertainty about how he viewed the lighting we considered, but did not assign, a Cognitive Code. Response 23 was also on the edge, though in this instance we assigned a Cognitive Code. In the response phase RM reported an Eiffel Tower with sphinxes or lions in front of it. Subsequently, during the CP phase he emended the response and clarified that it was no longer an image of the Eiffel Tower once he saw the lions. Although his CP assertion that it was a generictower promptedus not to code Ay for this percept, we continuedto code the initial FAB 1, recognizing that it was a weak instance of FAB 1. Once the response coding was completed, we generated the results output and briefly examined the Code Sequence page and the Counts and Calculations page, both of which are reproduced below. Several features that stand out on the Code Sequence page include the relative density of Sy codes, as well as the number of SI codes and the number of responses with multiple Content codes. The relative absence of Cognitive Codes is also noteworthy. Because the primary focus of interpretation takes place with information portrayed on the Profile Pages, the primary purpose of the Counts and Calculations page is to serve as a summary reference page for all the computations. However, it is also the only place where determinant blends are concisely listed, so those should always be reviewed. His five Blends include three with dimensional codes and three with human activity. One of the blends is complex and comprised of three elements.

386

Chapter 11

Figure 11.2 RM's Code Sequence Page

R-PAS Code Sequence C-10 : Case RM

P- 10 : 7

Cd # OrLoe Loe# I 1 2 II 3 4

V

w w

Dd 24,5,6,4 SI Dd 99,4,5 SI SI 5 V w 111 6 D 9 7 D 9,7 8 V D 1,3,24 SI IV 9 D 7 10 V w V 11 w 12 V w VI 13 w 15 VII 16 17 V VIII18 19 20 V IX 21 22 X 23 24

Dd

99

Gender : Male

Education : 17 +

ODL RSRSI Content Sy\lg2FQP Determinants Cognitive Thematic HR (RP)Opt SI

14@ Dd 99

Age : ~25

A NC NC NC (Hd},NC (H),Art (H},(Hd} (Hd),Cg (H) (A) A A (H},Ay,NC

(Hd)

0

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Sy Sy Sy Sy Sy Sy

LI

2

LI -

20 2o 0 0

LI 0 0

Sy

2

LI

-

p

F F V V mp Mp Ma F FD FMa,FD F F Mp,V y y

NC Vg LI w (Hd},Art,Cg Sy 2 o p Mp,mp w SI NC 0 Y,V w A,NC Sy 2 0 p FMa Ay,NC Sy 2 0 D 8 FC w Cg Sy LI FD (H},(Hd},Cg,NC Dd 3,26,99 Sy 2 LI p Mp,mp,Y Dd 1,29 SRSI (Hd),Ay,NC Sy 2 CF D 14,8 A,NC Sy 2 FD Dd 9,6,99 SI NC Sy 2 LI V ©20 11 R-PAS

PER

Pr

PH GH COP,AGM,MAP PH GH AGC GH

INC1

PHODL

PH MOR MOR

DV1

AGC MOR.MAP

FAB1

AGC

FAB1

AGC

PHODL ODL

PH PH

R-PAS Protoco l Level Counts & Calc ulatio ns P-ID: 7

C-1 D: Case RM Section

Counts

Respon:sesl!t

R

Administration

Pr

= 24 = 1

CT

=

Location

Counts

R8910

Pu

Calculations

= =

7

= 11

D

Dd

=

WD

7

R8910 0/o

=

29 0/o

0

I

7

w

Ag e : "'25

= = 17

6

WO/o

Del%

= 46 % = 290/o

Edu ca t io n: 17+

Gender: Male

:Section

Counts

Dete .rmina nts

M

:Blends :

Calculations

Counts

s

FC

FM

= =

2

CF

FMa, FD

m

=

3

C

Mp,V Mp,mp

C'

=

0

y

Y,V

T

= =

0

V

0

FD

Mp ,mp,Y

r

F Space

SR

=

1

AnyS

=

8

51

=

= =

WSumC

1

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= =

,O

(CF+C}/SumC =

4

MC

=

= = =

5

M/ MC

= 77 0/o

4

YTVC '

=

5

mY

= = 21 °/o = 14 = -75

8

PPD MC - PPD

Conte .nt

= = = =

0

An

=

0

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= 12

a

3

p

5

Art

2

NPH

Ma

Mp

Ay

3

NPH/ 5umH

= 100 1l/o

= =

1

0

s

CBlen d

7

Bl

5

Cg

1

DV2

{A)

= =

= = = =

=

=

1

Ex

=

1

INC2

= {4} =

Ad

=

0

Fi

=

0

DR2

(6)

(Ad)

=

0

Sx

= 0 = 13 I

2

FA62

{7) =

0

CON

(7)

H (H)

Hd { Hd)

A

NC

12

4

DVl

( 1)

0

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0

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{3)

Cog nruve Codes

FAB 1 (4) PEC

T hematic Codes

Sy ntl'le-Sis

Sy

V aguenes s

Vg

Pair

2

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Sy%

=

Vg O/o

=

62% 4 0/o

=

11

FQoO/o

9

WDu

4

FQuO/o

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4

WD·

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= 46 % = 38 0.fo

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FQn

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0

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M-

=

0

p

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=

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= = =

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=

0

PER

COP

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MAH

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1 3

ODL

= = =

GHR

=

3

M OR

woo

FQo

2

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9

= =

7

p/(a + p)

'I

Hp / ( H a + Mp}=

=

0

Blen.d%

=

0

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= 11

0

SevCog

=

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= =

2

=

70 0.fo 80 0.fo

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Form Quality a nd Popular

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0

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=

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= 36 = 25

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© 2010-2013 R-PAS

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388

Chapter 11

Interpretationof the Profde SummaryPages70 1. In Scanning the two default Profile Pages (see Figures 11.4 and 11.5 at the end of the chapter), we find black icons (Standard Score equivalents> 130 or< 70) flagging his Vigilance Composite (YComp = 138) on Page 1 and his five Vista codes (V = 140) on Page 2. On Page 1, we also find red icons (SS = 121 to 130 or 70 to 79) flagging elevations on Synthesis (Sy= 128), the Suicide Concern Composite (SC-Comp = 122), and the Poor Human Representations Proportion (PHR Prp = 126), as well as the absence of whole Human content (H = 75). On Page 2, there are red icons designating elevations on Space Integration (SI= 130), Form Dimension determinants (FD= 129), sum of all Human contents (SumH = 126), and the Non-Pure Human Content Proportion (NPH Prp = 125). Of importance to our assessment questions regarding psychosis, variables assessing thought disorder and perceptual distortion are not among his extreme scores. From this quick scan we see that RM puts considerable energy into synthesizing and organizing his observations, that he shows strong indications of hypervigilance , and that he has a notable inclination for perspective -taking and perhaps a tendency towards insecurity and self-critical attitudes. He also has deficits viewing himself and others in mature and realistic ways and has a combination of characteristics that normatively increase our concern about his risk for serious self-harm. The latter will be particularly important to contextualize when sifting and synthesizing. For now, the quick scan has alerted us to areas of difficulty that will a11owus to tailor inferences as we begin to thoroughly and systematically consider his profiled scores and sift through their meaning for him. 2. We begin the Sifting and Synthesizing process on Page 1 with the Administration Behaviors and Observations. One Prompt (Pr = 105) in a record is not unusual , particularly when it occurs on the first card. It may just be that he had not yet quite fully assimilated the instructions to give

"two...maybethreeresponses" to eachcard.Zero pullsis unremarkable . Afterbeingpromptedon the first card, RM asked if turning was permitted and ended up turning the card seven times (CT = 110). "Burrowing down " one level into the data by examining the turns on the Code Sequence page (in the ' Or' column), we note that the card turns were always upside down and never on the first response. Although frequently turning cards upside down can mark an oppositional attitude, that is more often the case when it happens on the first response to a card. For RM , it appears more likely that his CT elevation reflects a systematic approach to looking for more responses. Given that our scan of the protocol revealed elevations on Sy and V-Comp, his card turning likely reflects an effort to be thorough and vigilant so as to ensure he does not miss anything of potential importance. Of note, given that RM was regularly turning the cards, he had an opportunity to view the cards in the landscape position so that the absence of a Reflection (r) response is more reliable (reflections are most likely to be given in the landscape orientation). 3. Next, we evaluate Engagement and Cognitive Processing , starting with Complexity. As noted in Chapter 10, it is important to know the context of the assessment when interpreting Complexity. In RM's case, we have a person who is self-referred, and we know of no reasons for him to malinger. Therefore, we would expect at least moderate openness and honesty from such a person because it would be in his best interest. Because we are also not aware of any external reasons for RM to malinger, we would not expect over-dramatizing to be the cause of high Complexity scores. We know from RM's WAIS-IV testing that he has above-average intelligence. He was also 70

The numbering used here does not correspond to the numbering of Interpretive Principles or Procedures in Chapter 10. Rather, it simply reflects our syste matic, step-by-step progression through the profile pages. The numbering can also be helpful didactically, as it makes it easy to identify specific points in the narrative.

Case Illustration 389

engaged and open with the assessor and appeared motivated to learn more about himself. All of these factors are associated with higher Complexity,such that his observed Standard Score of 120 is not inconsistent with what we would expect. In general the Complexityscore speaks to resources and assets for coping and functioning. However, that is not always the case and complexity can be associatedwith rumination, over-thinking,and excessive complication.From our scan of the protocol we know that SC-Comp, Sy, V, and FD are a11elevated and thus we need to keep in mind how his complexity might be a liability, at least at the present time. From a situational perspective, his high Complexityscore indicates that RM was engaged in the task and spontaneouslyput forth considerableeffort. As such, we anticipate the test will be very sensitive to any serious problems and that when the results suggest he does not have a particular problem (e.g., psychosis), they are likely to be trustworthy (i.e., to have high Negative Predictive Power). Conversely, in a complex record, people sometimes are unusually open or self-revealing,such that they may sometimes look somewhat worse-off thanthey really are. Finally, when Complexity scores are more than a standard deviation above or below the mean, as is the case for RM, at some point we will want to review the ComplexityAdjusted scores for his protocol by checking the box for "Complexity Adjusted" and clicking . However, before adjusting for Complexityand removing its effects from his data, we want to first ensure we have a reasonably full understandingof what Complexitymeans for him. In particular, we want to understand the extent to which complexity may be a liability for him rather thanjust a resource. 4. To understand Complexity for RM it is helpful to review the other Engagement and Cognitive Processing variables on Page 1, almost all of which are tied to Complexity.We find that RM gave an average number of responses (R = 102). Because of this we know that his Complexityis related more to the density of what is included in each response rather than to frequent responding per se. Next,we see that RM has relativelyfew simplisticpure Formresponses(F% = 83). Although not extreme, with a score this low it is reasonable to think RM may have some difficulty simplifying his experience or distancing himself from perceivedsubtleties and nuances. He has a near average number of determinant blends (Blend = 106), which suggests he may not be taxed by competingdimensionsof information,though we recall this score may be underestimatedin his record as a result of some ClarificationPhase ambiguities. As noted from our scan earlier, RM has 15 Synthesis responses,which is an extraordinarilyhigh number (Sy= 128). Synthesizingis one of the defining features of his protocol, and we can see he is extremely concerned with making sense of his environment by determininghow everything relates to everything else. This synthetic activity is a key contributorto his complexity. Given the V-Comp, V, and SC-Comp scores noted during the initial scan, we would anticipate there is an anxious, driven, taxing quality associated with this need to figure out how everything is connected. 5. Continuing through the Engagement and Cognitive Processingdomain, we see that his sum of Human Movement and Weighted Color responses is average (MC = 99), suggesting a typical level of psychologicalresources for managing the demands of life. However, the next score reveals that this typical level of capacity to enliven and color his percepts is not sufficient for him. There is a marked imbalance between his MC resources and the liabilitiessuggested by his Potentially Problematic Determinants (MC - PPD = 84). Compared to most people, then, RM has adequate coping resources, but for someone who is shouldering the extraordinarilyintensive processingburden he is faced with, he is woefully underpowered.His current level of mental and emotional complexity is overwhelminghis capacities and burning him out. RM cannot bring sufficient resources to bear to think clearly and sustain a sense of well-being. He is prone to become overwhelmedand to feel he is losing his grip. These findings help us to understand further the answers to three of his questions: why he can't get his work done; why he has difficulty concentrating;and what are the "roots" of his self-doubt.

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6. Rounding out this domain, we see that RM is at the upper end of the average range for Human Movement responses (M = 109), suggesting a reasonably good capacity to think things through and to use ideas and his imagination to solve problems. Burrowing down into the data one level, we review the other coded characteristics associated with the M scores and note happily that none of his Ms has severely distorted form quality (FQ-). When considering the relative proportion of M responses over the combination of M and WSumC , we see that RM is on the introversive end of the spectrum and relies more on his thinking and imagination than on his feelings and reactivity to the environment in making his way through life (M/M C = 118). Although his Color Dominance Proportion would be considered average, we do not interpr et it because it is based on just two relevant scored response s. This relative absence of color responses suggests he is reserved and rather non-reacti ve to strong stimuli in the world, and thus may not be fully engaged and experie ncing the fulfillment and satisfaction tha t others enjoy. Based on our initial scan of the protocol, we could also note how his extreme prop ensity for persp ective taking (Vista combined with FD) adds to this style a component of being removed or distant from the give-and-take of the world. Altogether, these latter findings stro ngly support our earlier speculation that RM lives too much "in his head " and suggest that helping him become more responsive to the environment and to real experiences with other people would be a reasonabl e treatment target. 7. With the review of the Page 1 Engagement and Cognitive Processing section complete, we are now in a better position to reconsider his Complexity score . Clearly Complexity reflects assets related to task engagement, perceptual sensitivity, articulateness , and synthetic capacities. However , as noted before, cognitive complexity can be a liability if the person does not have the emotional or interpersonal resources to use it adaptively. When one considers RM's self-reported

anxietyand preoccupations, as well as his difficulty thinking,communicating, and distinguishing between reality and non-reality, these Complexity findings suggest that he has trouble simplifyin g and stepping back from experiences in an autonomous and centered way , such that he is not able to filter out the "small stuff " to focus on what is important. Also, his preoccupation with finding all the connections (real or imagined) between the disparat e elements of his experience can interfere with his thinkin g and communicating clearly . His high Complexity also would be associated with the elevated vigilance noted during the initial Scanning and it likely drives mminati ve preoccupations that leave him caught up in disturbing ideas and passively imagining outcomes to his dilemmas. If he can be helped to reduce his overall complexity in treatment, that should be accompanied by a better capacity to filter (e.g., higher F%) and to prioritize his concerns and let less important matters fade into the background so that he can function more efficiently and not be so over-burdened. 8. Now that we have a reasonable understanding of his Complexity, we can adjust for it. The scoring program permits two options. We can either switch the profile display so that it shows just the Complexity Adjusted scores or we can view both the raw and Complexity Adjusted scores together. To ensure the latter option does not produce an overly cluttered display, both icons are profiled only if they differ by the equivalent of at least 8 standard score points . Because it is conceptually helpful to see both the original score and its Complexity Adjusted counterpart, for this chapter we will select the second option. The Complexity Adjusted version of Page 1 is presented as Figure 13.6 toward the end of the chapter. A review of that figure reveals that nine of the Page 1 variables changed enough to plot both sets of results. This is typical, though the numb er of variables with plotted adjustments increases as Complexity becomes more deviant. In general, Complexity Adjustments are not notable with percentage or proportion scores.

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9. Reviewing the Engagement and Cognitive Processing Section with Complexity Adjusted scores we see a similar pattern for four variables. What appeared to be average or slightly above average scores tum out to be scores that are low average or very low, given his level of complexity. This is true for R (CAdj = 83), Blend (CAdj = 85), M (CAdj = 89), and most notably MC (CAdj = 72). These adjusted scores indicate that, given how complex his record is, it is surprising he only has 24 responses, 5 Blends, 5 Ms, and a total score of 6.5 for MC. These scores are not as high as we would have predicted from his Complexity. The adjustment for MC reveals a finding very similar to that indicated by his MC - PPD difference score: Rather than being average, given his overall level of Complexity, his resources for effectively managing the tension, conflicts, and turmoil he is currently experiencing are quite inadequate . We can see he is at just the 3rd percentile of the MC distribution after adjusting for Complexity. Burrowing down one level to consider the elements that contribute to MC, we see that his psychological resources are low for his level of complexity mostly because he has such minim al interest in or awareness of stimulating environmental features (CAdj WSumC = 70) rather than problems in mentalizing or using his imagination (CAdj M = 89). 10. There are two other scores in this domain with plotted adjustments. With respect to F%, we can infer that relatively low scores for this simplicity variable are expected in highly complex records like his. Because of this, what previously looked like a low average simplicity score (83) can now be seen as typical (95), given his level of complexity. Thus , we would say that his attentiveness to nuances and subtleties is about the same as other people who operate at his level of complexity. However , RM still puts more effort into finding connections between different ideas and concepts (CAdj Sy= 113) than other adults who possess the same high level of complexity as he does. Thus, his level of synthesizing remains a notable behavioral characteristic of his even after accounting for the overall complexity of his record . 11. Beginning the Perception and Thinking Problems domain , remember that a key diagnostic question is whether RM is psychotic. The first two variables are markers of psychosis: the Ego Impairment Index-3 (EII-3) and the Thought & Perception Composite (TP-Comp), and the next four scores (Weighted Sum of Cognitive Codes, Sum of Severe Cognitive Codes, FQ- %, and WD-%) are critical subcomponents of the TP-Comp and Eil-3. Beginning with the Eil-3, we find that it is very high (118). This finding offers reliable evidence of serious psychopathology , quite possibly involving a thinking disturbance or perceptual distortion , although this variable can be elevated for reasons other than psycho sis. Notice that Complexity Adjustment modifie s it only marginally (115). We conclude that RM is having fairly severe problems in functioning adaptively, which so far may or may not be the result of a psychotic process. To decide this question, we need to continue on with other variables in this domain, though we also recall from our initial scan that indices of disorder ed thought and distorted perception were not flagged. Turning to TP-Comp , we find only a moderately elevated score (111, Raw TP-Comp = 1.2), which is not at the level we would expect to see in a psychosis. Our interpretive guidelines for this score suggest that RM has some difficulties in thinking clearly or seeing things accurately, but not to the point where he seriously loses touch with reality. It appears, then, that the more highly elevated Eil-3 is due to subcompon ents other than the Form Quality and Cognitive Scores that it shares with the TP-Comp. The other subcomponents are PHR/GPHR and Critical Contents. Burrowing down one level, we find that Critical Contents is not high (CritCont% = 98), suggesting that his adaptive problems are less likely tied to trauma-relevant imagery or intrusi ve primitive process imagery. However , the PHR/GPHR component of the Eil-3 is very high (126), which suggests that RM has impairment in understanding himself and his relationships with other people. Therefore, when we review PHR/GPHR in the sifting and synthesizing process, we will want to

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further burrow down into its components, including an idiographic content review of his human representations. 12. So far our review of the Perceptual and Thinking Problems domain has uncovered significant problems in adaptive functioning , which are in large part related to his difficulties understanding people, including himself. The next several scores help us to identify the specific nature of any perception and thinking problems. His Weighted Sum of Cognitive Codes , a general measure of disturbed and distorted thought, is only a little above average (WSumCog = 110). Fortunately, he has no Severe Cognitive Codes (SevCog = 94; raw score= 0), which strongly militates against the probability of psychosis, particularly given the Negative Predictive Power expected in a complex protocol like this one. Considering these two scores (WSumCog and SevCog) together, it appears that he has some immature or idiosyncratic thinking problems (Level 1), but these do not rise to the level of a clinical thought disorder. When burrowing down one level to examine the components of WSumCog, the Appendix (see Figure 13.8 on the final page in this chapter) reveals three of the four scores are due to implausible relationships (INCl and 2 FABls), which may be an important consideration for RM, given his intense focus on looking for connections between different ideas (Sy= 128). In general, Cognitive Codes are better for identifying confusion and positive symptoms of thought disorder , rather than negative manifestations of psychosis, such as poverty in the content of thought and simple perseverations. However , the complexity of RM' s record eliminates the already remote possibility that he would be presenting with negative symptoms of psychosis. 13. When to move from the codes to consider the idiographic content data? Some interpreters prefer to complete a more nomothetically -oriented review of summary scores and response codes before considering an idiographic analysis of response content or the sequencing of response features. One rationale for this approach is that the nomothetic interpretations tied to codes and summary scores are psychometrically sturdier and provide the foundation for later individualizing and elaboration through idiographic material. Also, some find it more efficient to consider one and then the other ; codes and then content. Considering the words and behaviors linked to the content as a whole also allows one to interpret it in the same order that it occurred , in its natural form, which may allow for a more accurate translation. Other interpreters prefer to move from codes to content during the sifting and synthesizing process related to relevant scores. As such, one would burrow down to consider response content as a way to test and to elaborate on hypotheses as they emerge in the interpretive process. Doing so also provides a way to check whether the actual test behaviors align with the standard interpretations of the coded quantitativ e variables. We do not strongly advocate one approach over the other , as they can relate to practical, contextual issues for a case, and both have their advantages and disadvantages. Nevertheless, here we have followed the second method of interspersing idiographic content analysis within the nomothetic analysis of codes and summary scores. 14. Such an idiographic review of the Cognitive Codes can help us determine whether particular emotionally-charged ideas or conflicts are contributing to thinking problems. Also, one of RM 's assessment questions was to understand his concentration difficulties and the assessor's main assessment question was to "understand the interplay betwe en RM's obsessive-compulsive tendencies and his reports of thinking disturbance and their relationship to his fear of 'being found out' that he is gay." The scorable components of RM 's Cognitive Codes were: Card VI R13 "Christ the Redeemer" with "these two [lines coming out] below the arms, these two swishes I guess you could call them" (INCl) . On Card VIII R19 "the skeleton of a tree ... that has been cut down" (DVI). On Card IX R21, "Wizards ... weapons that are pointed at each other ...guns .. .just hanging there pointed , pointed at each other's neck" (FABl). On Card X R23, "an E[ffel Tower

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... behind two lions" (FABl , though a weak one). On the first one (R13), alth ough we do not want to place too much confidence in a symbolic content interpr etation for one response, the incongruous combination is between "Christ the Red eemer ," a religious symbol, and the "lines" that he refers to as 'swishes,' which is slang for an effem inate man. On the next response (R19), the deviant verbalization (skeleton) is Morbid . On the last two responses (R21, R23), the fabulized contents are aggressive (guns, lions). Therefore , there is some evidence that emotionally-charged ideas - related to religion and sex ual identi ty, morbidity , and aggression - may contribute to his mild-l evel thinking problems. We are aware of his sexual conflicts regarding his attraction to men and that he reports dreams about people doing "bad things ." But we might want to follow up on potential religious conflicts regarding his sex uality , even though he is disaffiliated from the church, as well as aggressive or morbid thoughts that might be tied to mild lapses in thinking. It is also possible that obsessive thoughts or urges associate d with these contents are resu lting in RM 's making some implausible connections, as all four responses are also coded Sy. 15. Regardin g RM ' s reality testing, his minus Form Quality is high (FQ-% = 114), telling us that even though he is not psychotic , he often misinte rprets or distorts what is going on, and this can lead to significan t problems with his judgm ent and overall adjustment. Choosing to burrow down at this time into the idiographic nature of his FQ - responses , we note that three of his four responses have qualities of being hidden or difficult to see (RS = "mask ;" Rl 4 = a "ghostly figure" that is virtually embedded within the Christ figur e; R22 = a "god or goddess" that "lives within a bush," for which the blot components "create the illusion of the face"). Thematicall y, these responses fit with RM's preoccupation with secrecy , suspiciou s hype rvigila nce that involves looking for hidden clues, and his reported difficulty in "distingui shing between reality and nonreality. " Fortunately , malevolence is not emphasized in any of these FQ- responses. His minus Form Quality in conventional locations (WD-% = 110) indicates that in ordinary,obvious situations , his reality testing is not quite as bad. In fact, for his level of complexity , it is pretty typical (CAdj WD -% = 103). Finally, the last two items in this domain - ordinary Form Quality responses (FQo%) and Populars - are scores that represent more conve ntional thinking. The findings that RM 's FQo% is low(= 85) and that he has only four Popular responses (P = 88) suggest that his typical way of viewing the world is uncon ventional. Because of concerns about his interp ersonal relationship s, we look down one level to the responses and examine Cards III and VII to determine whether he saw human figures that qualify as Populars . On three responses, he does see figures that are human -like but only one earns him a Popular , and even that one is rather idiosyncratic (Card VII: busts of old ladies with osteoporosis). It is also relevant to consider which percep ts are seen in place of the two most common Populars : those on Cards I and V. In both instances he considered a Popular percept but rejected it. On Card I, he considered both a butterfly and a bat but rejected them in favor of the moth image from Silence of the Lambs. On Card V, he conside red the butterfly but rejected it in favor of a moth because the percept was too gangly . These are near-Popular responses, where complexity from either added precision or added personal associations interfer ed with identificat ion of the more conventional perceptions. 16. Continuing down Page 1 to the Stress and Distress Domain , all of the scores in this domain are elevated (Inanimate Movement [m = 113], Diffuse Shading [Y = 120], Morbid [MOR = 117], and Suicide Concern Composite [SC-Comp = 122]), so that it is highly likely that he is affectively troubled and can ying salient tension , agitation, and distress. After Complexity Adjustment , all scores but Inanimate Movement remain elevated.71 Particularly when these

71

The slight decline in all of these scores with Complexity Adjustment also highlights how these markers of internal agitation and distress are nomothetic contri butors to protocol complexity. That is, part of what makes a

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findings are taken together, although we cannot be sure of his actual subjective experience based on just the coded behaviors that generated these scores, he appears to be carrying considerable anxiety, tension, helplessness, agitation, and dysphoria, perhaps to the point of despair. It is very likely that such emotional pain and coping difficulties interfere with both his cognition and emotional stability. Although there may be acute stressors contributing to his presentation (with 7 m and Y codes), on the positive side, his current level of distress will probably help motivate him to remain and work in therapy. RM's scores suggest he has a damaged or defective self-image and a pessimistic attitude towards his life (MOR). Checking his verbatim responses, we find that all of his Morbid responses (15, 16, and 19) are images of deterioration ("ridges ... wearing away ;" "old lady that has osteoporosis ;" "a tree that has been cut down; it has lost a lot of its mass "). It seems likely that he views himself as being vulnerable as life goes on, or more concretely, as deteriorating. If he is not currently describing feelings of depression, he is at risk for depressive experiences. It may be important to discuss with RM whether he has a concern that negative or difficult life experiences have eroded his confidence and perhaps even his physical functioning or his body. These finding are clearly relevant to RM's question about the roots of his self-doubt. 17. Finally, RM has a combination of implicitly assessed characteristics that place him at increased nomothetic risk for suicidal behavior (SC-Comp= 122; raw score= 7.0). As such, his potential for self-harm needs to be carefully evaluated and contextualized. Clinically, the biggest challenge contending with elevated SC-Comp scores come in addressing the false positive rate. Most research completed with the S-CON, the CS precursor to the SC-Comp, took place with inpatient or research-specific samples where the base rate of suicidal behavior was quite high relative to what it is in an outpatient mental health setting like the one where RM is being evaluated. In settings and with populations where the base rate for serious self-harm is lower than in the original research, the Positive Predictive Power of the variable attenuates, leading to an increase in false positive rates. Other mitigating factors for RM include the fact that he is seeking help now, that his religious background discourages suicide, and that he has no known history of suicidal or self-harm behavior. Nonetheless, given the indicators seen here speaking to his affective turmoil, overwhelmed coping resources, unconventional perception, and lack of full human representations, it will be important to ask him directly about active suicidal thoughts, plans, and means, and to take appropriate action based on the information that emerges. 18. Previous review suggests that some Self and Other Representation Domain scores are problematic. The first variable, Oral Dependent Language (ODL% = 105), is in the average range, suggesting he has a normal degree of implicit dependency needs. He has only one Space Reversal , which is expected (SR= 102) and does not suggest oppositionality. RM has two Mutuality of Autonomy Pathology codes (MAP = 116, from the Appendix) and no Mutuality of Autonomy Health codes (MAH = 90). It is risky to interpret this ratio when there are only two MAHP responses in total (MAP/MAHP = NIA), but with both being negative representations, there is no evidence to suggest he has a satisfying and mutually enhancing understanding of relationships. He has ten responses that qualify for Human Representation codes , which is an adequate base for inferences. However, 70% of them are Poor (PHR/GPHR= 126). As noted earlier, this suggests he does not understand others very well, which was a significant contributor to his psychological disturbance and compromised functioning (Eil-3). It is almost certainly difficult for him to understand what it takes to have a mature, mutually satisfying relationship with another person.

record complex is elevations on thes e scales. Thus , it is also con-ect to recognize that part of RM 's elevated Complexity is due to elevated levels of implicit distress , tension , agitation , and turmoil.

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19. We als o can revie w PHR and GHR responses to understand the idiographic nature of his human representations . Looking at the Code Sequence, there are 10 PHR and GHR response s (on 5-9, 13-14 , 16, and 21-22). The reader should review these responses before continuing with this section . One obvious chara cteristic of RM' s hum an repr esen tations is that none of them are realistic , whole humans . They are all imaginary, fantasized , or quasi -humans or human -like creatures. Six of these responses have fantasy humans that are rather nonde script (RS - mask; R7 - two creatur es, an alien; RS - creature ; R9 - mon ster; R14 - ghostly figure; R21 - shadowy figure) suggesting an identity or understanding or others that is not well-develop ed, or perhaps vaguely threat ening in a way that could fortify his suspiciousness of others. Only two of these six responses are enlivened with movement, the first of which is the "two creatures pushing an alien down ... They are battling the alien." It is easy to imagine that this image represe nts a metaphorical internal battle for him, with the alien representing an alien part of him that he is trying fight off and push down. Of course we know from his presenting complaint s that he enga ges in this kind of struggl e with his alien -feeling sexuality. Th e second of these responses with moveme nt (R21) is complex so it is described later. Other Human Co ntent includ es Card VII, RI 6, which depicts two busts of an old lady with osteoporosis that are teetering on their stan ds, a response discussed earlier regar ding his sense of self as deteriorating and vulnerable. All of RM' s other human contents across four response s have specia l pow ers or knowledge (R6 - sphinxes from "The NeverE nding Story; " R13 - Christ the Redeemer in Rio de Janeiro; R21 - wizards with guns hanging there, point ed at their necks; R22 - a god or goddess from mythology that lives in a bush). According to the movie storyline of "The NeverEnding Story," the sphinxes ' eyes stay closed until someo ne who "does not feel his own worth" tries to pass. When they do open their eyes they can see "straight into your heart." Those failing the test are killed by the sphinxe s. Similarly , Christ can also see into one's heart and evaluate one's worth and moral purity. These representation s are consistent with RM 's struggl e wit h his sex uality. From this perspective, it is perhaps meaningful that the sphinxe s from response 13 morph into the creatures on respons e 14 who are battlin g to push down the alien. However , these representations go beyond sexuality and suggest a deeper questionin g of his wor th and purit y. We are thus concerned about RM 's possible rejection of himself along with his sexuality. Given that there is no clear way for him to escape his conflicts, we would again attend to his elevated Suicide Concern Composite. Notabl y, on Card IX, R2 1 RM reports two wizards who are initially holdin g guns point ed at each other 's neck , but later he overtly denies the active aggression and says that the guns are ju st passive ly hanging , though now they are pointed inward at each wizard's own neck. He adds a larger "shadowy figure" who is "sort o_finterceding between them," thou gh the passive homicidal -suicidal image ry is never resolved. This imagery suggests that in therapy it will be important to exp lore the depth to which RM rejects himself. Also as part of the assessment, the image ry again supports the need for a formal suicide risk assessment. 20. Continuing the Self and Other Representation domain, RM has no minus Form Quality Human Movement responses (M- = 95), which sugges ts that even though he has difficulty understandin g other people , he does not often imbue them with bizarre or severe ly distorted qualitie s. Aggressive Content (AGC = 108) is unremarkable , suggesting that he is not preoccup ied with aggressive themes. As previo usly not ed, his Vigilance Composite is extraordinarily high {V-Comp = 138), eve n when adjusted for Complexity (= 131). At this extreme leve l, one may infer that he is rarel y able to relax , let his guard down , or feel comfortably engaged with anot her person. He likely feels the need to keep a safe distance from others and remain alert to all potential threats. This V-Co mp elevation can be considered the keynote to this domain of functionin g and a signat ure feature of his record. As such , it could also fruitfull y become the prim ary target in treatme nt. The absence of elevated AGC and the deteriorationthemed MOR responses may suggest that the anxiety d1iving his vigilance is not so much that he

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will be treated aggressively,but that his confidence is slowly and irreversibly eroding and through interacting with others his true inner worthlessness (per his belief) will be revealed. On the positive side, despite the magnitude of his V-Comp elevation, we see that in this complex record he produced an adequate number of M responses and none of them showed a severely distorted understandingof other people (M- responses).This is heartening. Taken together with the absence of severe thinking problems, we could infer that although RM is extremely fearful and has many unrealistic notions about other people, he probably does not have systematizeddelusions. Given the cognitive and affective characteristicsdiscussed earlier in the interpretiveprocess, it is likely that RM sustains an effortful and focused level of vigilant concentration,is overly serious, does not allow himself to enjoy what others findjoyful, and does not express his feelings in a spontaneousway. Given all these things, others may not experiencehim as approachableor inviting. 21. The last three scores in the Self and Other Representationsdomain can provide signs of healthy potential. Unfortunately,the absence of any pure Human Contents (H = 75, raw H = O)is atypical, placing him at the 5th percentile in our reference sample. Thus, he has a limited capacity to view people as integrated, complex persons in a realistic way, with both strengths and weaknesses.The presence of one Cooperative Movement Response (COP = 102) might be a positive sign, suggesting the capacity to envision at least some degree of pleasant, collaborative relationshipswith others. Yet examining this response more closely, we see it also earned an AGM and an MAP code, which disqualifiedit for the healthiest object relations score, Mutuality of Autonomy Health (MAH = 90). The absence of MAH responses is consistent with his overall difficulty in establishing and maintaining meaningful intimacy. RM had another response that bordered on receiving a COP code - the shadowy figure that was "sort of interceding" between the wizardswhohadguns pointedat theirnecks (CardIX, R2l); any positiverelationshiphere,too, was spoiled by an aggressivethreat. 22. We continue the Sifting and Synthesizing Process and now turn to Page 2 to review the variables covering the same set of domains (except for AdministrativeBehaviors and Observations).Because Page 2 variables have a weaker evidence base, we use these findings primarily to extend, refine, and enrich our interpretationsfrom the Page 1 review rather than as a basis for moving off in new directions. 23. Beginning with Engagement and Cognitive Processing on Page 2, we review RM's use of locations. His use of Whole locations is unremarkable (W = 105), but nearly a third of his responses involve Unusual Detail locations (Dd% = 116). His peculiar and idiosyncraticways of looking at the world, noted earlier, are evidently influenced in large part by what he chooses to pay attention to. Rather than paying attention to the obvious features of the environment that interest most people, he carves his own boundaries, imposing his own way of looking at things. Not surprisingly,given an average number of W locationsand a high proportion of Dd locations, we would anticipate a low frequency of responses with Common Detail locations. which can be confirmed by checking the Profile Appendix (D = 86). By checking the specific locations, we see that he is both attentive to small details (e.g., II, Dd24; IX, Dd26) and prone to focus on perceptual features that most people ignore (the Dd 99 areas). Given his hypervigilance, this perceptual propensityprobably reflects his constant search for clues and signs of possible threats. Having noted earlier that his WD-% is a bit lower than his FQ-%, we can infer that teaching him to pay better attention to what is more obvious and conventional may help him to interpret the world more accurately and less suspiciously. Space Integration is very high (SI = 130), even given his overall level of complexity.This strong propensity to link white space with ink is consistent both with the vigilancejust noted and with his equally pronounced Synthesisscore (Sy = 128).

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24. Continuing in the Engagement and Cognitive Processing domain , as might be expecte d given what we have already learned about RM 's cognitiv e operations and processing, Intellectualized Content is elevated (IntCont = 116), suggesting that he keeps many of his experiences at arm 's length by treating them as intellectual concerns. This is consistent with the general sense discussed earlier that he "thinks too much " and his lack of engagement in life. We are not surprised that his Vagueness is average (Vg% = 99), becau se it is rare for him to let down his guard and think in an impressionistic manner. Of note, as seen during the Scanning process, RM produces a remarka bly large number of Vista responses (V = 140), and quite a few Form Dimension responses as well (FD = 129), giving him a total of 9 responses coded for dimensionality . In more reasonable quantities, FDs and even Vs signal a desirable capacity for perspective-taking that can be helpful in arriving at therapeutic insights , but at this extreme level and in the context of other codes (e.g., MOR , MC - PPD , Y, m, SC-Comp) they sugges t a paralyzing, self-consciousness and ruminative self-evaluation. When consi dered alongside his V-Comp , this intense level of perspective-taking or seeing things at a distance suggests and equally relentless surveillance of others. 25. His relative responding to the last three fully -colored cards is at the low end of the average range (R8910 % = 92). His score on the variable is probably a little misleading , however, because when one steps down a level to inspect the Code Sequence, it is clear that all of his respons es to the last three cards are complex and more complex than the protocol as a whole (e.g., all 7 responses have multiple component features , am earn a Sy code , all have determinant s other than simple form , and almost receive multiple content codes). This suggests that when RM is in emotio nally-evocative situation s he becomes even more complex in his processing efforts. The next variable , the Weighted Sum of Color responses (WSumC = 88; Complexity Adjusted= 70), suggests that he is emotionally restricted and lacks a well-developed awareness of his own affectivereactions.Alternatively,it may be too risky and destabilizingto colorhis experiences with enlivening reactions to the environment. His absen ce of pure Color responses is expected (C = 95). The final score in this domain , the Passive Human Movement Proportion , is very high (Mp/(Ma+Mp) = 122) and suggests a propensity for passive fantasy and ideation that is consistent with the previous interpr etation that he ruminat es excessively. This finding unders cores that he has difficulty turning his excessive cognitive activity to useful advantage by formulating constructive and practical plans to deal with his problems. Further, the fact that these passive movement scores involve human repres entation s suggests that he may comfort himself with passive and wishful fantasies involving others. 26. Under the Perception and Thinking Problems Domain , we see that his unusual Form Quality is slightly elevated (FQu% = 110). This score suggests some individualisti c or unconventional ways of seeing the world and it is consistent with his low Popular score and his excessive use of Dd locations. 27. Looking at the Stress and Distress Domain , the variables are ordered so that the first of the five Determinant variables, Potentially Problematic Determinants (PPD), is the most inclusive. For RM, PPD and the next distress variable, Sum of Shading and Achromatic Color (YTVC ') , are both elevated (114 and 118). However, to a notabl e degree , these elevatio ns are part and parcel of what drives his overall complexity, as revealed by their drop when they are Complexity Adjusted (to 100 and 109, respectively). Never theless, given the level of distress, acute stress, self conscious ness, and dissatisfaction, the remaining YTVC' elevation suggests that were he less involved in the nuances and inconsistencies in his world, he would be less troubled and more able to focus his considerable problem-solving capacity in an more adaptive way. The absence of Blends consisting of Color with Shading or Achromatic Color is typical (CBlend = 91; raw score = O). However, whe n returning to his extremely high frequency of Vista and interpreting it

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in terms of Stress and Distress , it suggests an intense negative evaluation of himself (V = 140). Such an interpretation draws support from prior considerations of his deterioration -themed MOR responses , his elevated MAP/MAHP , PHR/GPHR, FD, and Suicide Concern Composite. Finally, as noted earlier when we burrowed down to the EII-3 components, his Critical Contents (CritCont% = 98) are not elevated. If they were, we would pursue the possibility of trauma or preoccupations with p1imitive ideas as contributing to his distress. We would also step down a level to determine exactly which codes were contributing to any observed elevation. 28. With respect to the Self and Other Representation Domain, his Sum of All Human Contents is very high (SumH = 126), but they are all partial and/or imaginary human repre sentations, as indicated by the Non-Pure Human Proportion (NPH/SumH = 127, which is at the maximum value possible). Burrowing down to the individual Contents in the Appendix, we see that all 12 of his Human Content responses are imaginary. This is extremely rare [(H) = 133; (Hd) = 143)]. Although SumH typically reflects an interest in other people , with no pure H responses and so many representations of fantasized or imaginary humans , it may be that this interest is not in actual people he knows from experience but in imagined characters imbued with either hopeful or fearful qualities. When adjusting for Complexity, the imbalance in his representations becomes even more pronounced. Among hypervigilant patients, a high interest in others is typically in the service of warily watching them to see what they might do-what threats they may pose. 29. The absence of a reflection is unremarkable (r = 95); most of our reference sample offered no reflections. Given that RM often turned the cards to give his response s (CT = 110), he had the opportunity to see the more common landscape reflection images, so we can place more confidence in the Negative Predictive Power of this null finding. This finding also speaks against

RM's big worrythathe has a NarcissisticPersonalityDisorder.The proportionof Passive Movement responses is high (p/(a+p) = 118), suggesting he adopts a passive approach to life. He has plenty of movement responses, which lends to the reliability of his score on this variable. RM has one Aggressive Movement response, which places him at the upper end of the average range (AGM = 110), and suggests that his awareness of aggressive intent or combativeness is slightly above average. Regarding Texture responses, viewed as a measure of interest in interpersonal closeness or contact (including tactile contact), he has a typical raw score of zero (T = 91). At this stage, considering this variable further does not allow us to say more than was already asserted above when considering his vigilance and limited understanding of relationships and other people . 30. RM has only one Personal Knowledge Justification respons e (PER= 109), though it is a barely codable one (since it refers to a popular movie), that seems to serve more to draw the examiner into his fantasy life than to one-up the examiner. The absence of Anatomy responses is uncommon (An = 85) , but less interpretatively significant than an elevated score would be.

AdditionalIdiographicInterpretationwith Response Process and Content 1. Additional salient responses . During the foregoing interpretation sequence, we have reviewed idiographic response content components of RM ' s protocol in the context of examining his minus Form Quality, Cognitive Scores, and the Thematic Scores - including GHR and PHR to assess his representations of self and others. Now we review the rest of the responses for notable idiographic information, and we consider potential inference s that emerge from the sequence of responses and their elements. As noted earlier, some prefer to postpone any interpretation of the idiographic content information to this point , so that it comes after all of the nomothetic coded data are considered. However, for us because we have already reviewed many of responses and

Case Illustration

399

verbalizations in the context of previous steps, we comb through the responses not already considered for those that stand out in terms of their idiographic content. 2. One that stands out idiographically and has not already been considered in detail is the first response to the test. The first response starts out as the conventional butterfly or moth or bat , but then becom es the moth from the Oscar-winning action-horror movie, "The Silence of the Lamb s." This moth is depicted on movie posters as a "Death 's Head" moth, coveri ng the lips of the film's female protagonist. The title of the movie seems to resonat e with both RM 's fear of people discovering his "big secret" and fears of becomin g a victim. Although more speculative, the gruesome killings in the service of sexual cross-ge nder transformation that are depicted in the movie may amplify the connotations of terror , shame , and helpl essness. One also could wonder if RM fears his unacceptable sexuality is as abhorrent and dangerous as that of the protagonist in this film. 3. Another idiographically meaningful percept is Response 20 to Card VIII , which depicts dark green sunglasses that accompany a helmet and mask. Like the other imag e of a mask (RS), this image suggests both secrecy and wary vigilance. However, unlike the earlier mask this one does not just disguise ; it also clearly protects and insulates the wearer. In this percept, the facial expressions of the wearer are inscrutable and would never leak out. Perhaps RM may also wonder what kinds of secrets are hidd en by the protective expressions of others. 4. A final noteworthy response that was not considered before is Response 18 to Card VIII , which features the Popular bears. Rath er than actively climbing , as they are usually depict ed, they are standing on one leg, leanin g back , and graspin g and clutching "to keep from falling off." Like the teetering busts of the old women, this response seems to illustrate RM' s sense of precariousness and lack of a feeling of mastery. 5. Sequence analysis. At times it also can be help ful to examine the Code Sequence and verbatim proto col for resp onse sequences of particular interest. In this case, there do not seem to be any particularly salient instances of deterioration , impro vement , or failure and recovery. The most notabl e pattern was already mentioned in the context of the R8910 % score and that concerns the added complexity that emerges on these brightly colored cards. It is interesting to note that he perseverates in offerin g three moth responses in a row (RIO - R12). It is difficult to say with any confidenc e what this means , but it is possible that the emotional impact of the earlier "Silence of the Lambs " response was still difficult to diffuse.

400

Chapter 11

Summaryof Major Findings A brief summary of the principal findings follows and is organized into the four main R-PAS domains: Engagement and Cognitive Processing. Perception and Thinking Problems. Stress and Distress, and Self and Other Representation. Engagement and Cognitive Processing RM has above average intelligence and an impressive capacity to process the complex and ambiguous elements of his experience. Despite this, he is so driven to consider every possible detail and connection concerning what he imagines and observes and all of their inter-relationships that he becomes lost and overwhelmed in his ruminations and obsessive analyses. He has little sense of mastery of this mental activity and is usually unable to organize it in the service of active, practical problem-solving. He finds it difficult to filter out important from unimportant matters or to consider any events or interactions in a detached or neutral manner, even when such efficient treatment is preferable. He is so internally focused and intellectualized that he tends to be insensitive to much of what is obvious and pressing to most people in the world around him. Thus , he is usually not able to use his natural emotional reactions and trial-and-error testing of his ideas as a corrective to his darklythemed imaginings. Driving this relentless mental activity are internal demands for constant critical self-scrutiny and simultaneous vigilance against potential threats from a judgmental and potentially hostile environment that end up making him feel worse about himself. He evinces a well-developed capacity for perspective-taking and self-reflection, but he is not currently able to make effective use of it because of the intensity of his painful self-consciousness. Two positive prognostic features of his processing are that he shows cognitive flexibility and openness to experience and that he does not

appearproneto holddistortedperceptionsof otherpeopleconcerningtheirintentionsand motives.It seems clear that if he could be helped in therapy to reduce his ruminations and "cool down" his constant critical self -analyses and fear of being critically evaluated by others, that this would take tremendous pressure off of him and give him a sense of much-needed breathing space. Learning to be more emotionally accepting of his sexual orientation would probably be the single most helpful step toward achieving these goals. Perception and Thinking Problems Sophisticated in terms of their complexity, RM' s thinking processes are nonetheless immature in that they are overly subjective and too extensively colored by withdrawal into fantasy. Although he has some peculiar ideas and idiosyncratic ways of looking at the world , there is no evidence of thought disorder at the psychotic level. Nevertheless, he does often misperceive and misinterpret what is going on. This is consistent with his subjective impression that he has "a hard time distinguishing reality from non-reality." His distorted perceptions are exacerbated by his tendency to become preoccupied with less obvious and more arbitrary aspects of the environment rather than the usual, commonsense details that concern most people , and thus he is subject to confusion in the midst of his overly complex thinking. To the extent that he can be helped to focus more on the obvious and to reduce the complexity of his cognitive processing, it is likely that his reality testing would improve substantially. Stress and Distress RM's focused and effortful concentration , tension, and worry are rarely relieved by relaxation, enjoyment, and gratification, for he is not engaged in life in satisfying and fulfilling ways. Thus, there is a dearth of positive emotion and spontaneity. In addition, there is evidence of considerable distress, anxiety, tension , and dysphoria, all accompanied by a sense losing control over his life. Feelings of

Case Illustration

401

helplessness, paralysis , deep insecurity , a precarious sense of slipping or losing ground, and particularly an intense preoccupation with feelings of worthlessness and self-criticism are driving him close to the edge where life may not feel worth living anymore . Many of these feelings are probably organized around his rejection of his sexuality , the significance of which is greatly magnified by religious and cultural factors , and from which he sees no avenue of escape. It is important to explore whether he has recently contemplated suicide or other self-destructive behavior .

Self and Other Representation Based on his representations and imagery, RM feels alienated from both himself and other people. He experiences himself as vulnerable , ineffective, and even powerless much of the time. It is likely that when he tries to assert himself or be forceful, he will typicaUy end up feeling drained, defeated, and impotent. Intensely concerned about being shamed or humiliated by others, he often feels morbidly self-conscious and imagines himself as transparent and insubstantial in other people 's eyes. Much of the time , he tries to conceal his thoughts and feelings so that his secrets will not be revealed . It is likely that his shame around homosexuali ty is associated in his mind with a lack of masculinity and selfefficacy , as well as religiously -tinged beliefs about immorality. Although he is interested in other people and wishes for harmonious interactions with them , he does not understand other people very well as whole , separate beings with their own needs and concerns. Others pose a danger and he has the sense that they have damaged him in the past. He is preoccupied with feeling safe and thus vigilantly keeps his distance from others and life at large.

Integration with Other Test Findings

Givenour recommendationto conductmulti-methodassessments,we brieflyreportthe resultsof two other tests: a cognitive performance test (the Wechsler Adult InteUigence Scale, 4 th Edition ; WAIS -IV) and a self -report inventory (the Minnesota Multiphasic Personality Inventory , 2nd Edition; MMPI-2). As previously noted , his WAIS -IV Full Scale IQ is 118, placing him in the high average range of general intellectual ability. RM has a strength in Vocabulary (15) and no notable weaknesses. Given that one of his assessment questions was about concentration problems , it is notable that his Working Memory Index revealed no problems (SS = 117). While intelligence is an asset for his overall adaptive functioning and suitability for insight -oriented therapy , the R-PAS findings demonstrate that too many of his cognitive resources are diverted at this time into obsessive ruminations , anxious fantasies , and hypervigilant scanning for potential threats. RM 's MMPl-2 was valid for interpretation (T-scores: VRIN = 69, F = 76, L = 43, F = 47) and consisted of a "floati ng profile " with a well-defined 7-2-8 code type, with T-Scores of 105, 95, and 93, for Scales 7, 2, and 8, respectively (his next highest I-score was 76 on Scale 3; all using standard Kcorrected scores). Taken individually , these three extremely elevated scales are consistent with the obsessionality , self-consciousness, alienation, misery , and hopelessne ss that were noted while interpreting the R-PAS results. Recall previou sly that his MMPI-A was a codetype 6-8 and that he was diagnosed by one mental health professional with paranoid schizophrenia, a diagnosis with which RM disagreed. For his current MMPI -2, his T-scores for Scales 6 and 8 were 68 and 93, respectively ; although, of note, the Restructured Clinical Scales revealed low scores on the parall el versions of these scales (RC6 = 41, RCS = 56). The additional findings that his Scale 7 elevation is about 10 points above Scale 8 and that he was in the average range on the Bizarre Mentation Scale (T = 51) and endorsed no psychotic symptomatology items (BIZl; raw score= O; T= 44) and few persecutory ideas (Pal= 52) militate against a diagnosis of psychosis, which is consistent with the R-PAS findings.

402

Chapter 11

Configural interpretation of the 7-2-8 code type would emphasize excessive introspection, overideation, morbid rumination, anxiety, poor concentration, feelings of inadequacy and inferiority , and possibly isolation of affect. It should also be noted that, consistent with the elevated R-PAS Suicide Concern Composite, RM's MMPI-2 Suicidal Ideation subscale was high (DEP4; T = 89) and he endorsed the item: "Most of the time I wish I were dead. " It is of note that there is substantial overlap between his MMPl-2 and R-PAS findings , although there will not always be such clear correspondence for any one person between differing methods of assessment. 72 Answers to RM' s Questions about Himself 1.

What is my diagnosis? You are suffering from a severe anxiety disorder with significant obsessive features and also from chronic depression. At the heart of your anxiety and depression is the self-doubt that you have described , along with associated feelings of intense shame and despair about being able to alter your circumstances. You spend a lot of time fantasizing about what might go wrong and this interferes with your feeling fully alive and connected to the world around you. It also sometimes leads you to have peculiar and unrealistic ideas about yourself and other people , but there is no evidence that you have any kind of psychotic disorder. There is good reason to believe that if you could learn to like yourself better and stop putting so much effort into protecting yourself, life would become much less of a strain for you.

2.

Why can't I get my work done? Your WAIS -IV test results show that when you are solving complex, impersonal problems in an atmosphere of relative safety, you have more than enough reasoning capacity, working memory storage, verbal fluency , perceptual organization , and efficiency to perform well on academic work. The MMPI -2 and R-PAS testing, on the other hand, demonstrate that your relentless worrying about your perceived faults and deficiencies and how other people might react to them is a tremendous drain on your energy and problem-solving resources. When anxiety associated with your self-doubts and fears of how others may see you begin to intrude on your efforts , you start to feel helpless, ineffective , and lacking in energy and motivation. In addition, the dilemma of your current circumstances simply preoccupies you. It is so compelling and pervasive that you have little mental resources to allocate to issues or concerns that are less life-relevant , including rather dry academic tasks. One treatment goal may be to begin to cultivate a greater capacity for neutral , disinterested problem-solving.

72

Rorschach and MMPI -2 results are most likely to confirm each other in this way when , as in the present case, the respondent is simultaneously open and candid on the MMPl-2 and productive and engaged on the Rorschach (Meyer, 1999; Meyer et al. , 2000). In many other cases , MMPI -2 and Rorschach results show minimal agreement or even opposing results (Archer & Krishnamurthy , 1993; Meyer, 1999) because of differen ces in response sets in approaching the two instruments (Meyer, 1999; Meyer et al., 2000) , divergences between verbally formulated self-understanding and unrecognized or disowned implicit motives (Bornstein , 2002; Finn, 1996, 2010; Shedler , Mayman, & Manis, 1993), and differential sensitivities of the instruments (Ganellen, 1996). Divergent results between the two types of tests must be reconciled in the interpretive process so that the particular strengths of each kind of testing are used to best advantage (Ganellen, 1996; Weiner, 1999).

Case Illustration 403

3.

U1Jycan't I concentrate?

Effective concentrationrequires setting priorities and deciding what to ignore or set aside. You find it very difficult to filter out what is essential from what is of secondary importance because you tend to invest everything with personal meaning and try to see where every element fits within the larger system. On top of this, your chronic wariness and anxiety create a kind of background noise that interfereswith the clarity of your thinking. Learning mindfulness - living in the here and now and fully devoting your efforts to one task at a time - will improve your concentration. 4.

What is at the root of my self-doubt?

Although you are an intelligent, thoughtful, perceptive person, you experienceyourself as damaged, ineffective, and helpless much of the time. These feelings are aggravated by the tremendousenergy you put into worrying about other people looking at you critically and becoming aware of secrets you consider shameful and bad, primarily having to do with your attraction to men. Your constant vigilance against being embarrassedand humiliatedand your intense self-consciousnessoften overwhelmyou to the point where it sometimes feels as though life is not worth living. You can greatly benefit from help with understandingyourself and other people in more balanced, realistic ways. However, it is necessary for intellectual understandingto be accompaniedby emotional acceptance of who you are.

404

Chapter 11

Figur e 11.4 RM's Page 1 Profil e Plotti ng Raw Scor es R-PAS Summary Scores and Profil es - Page 1 C-10: Case RM

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Case Illustration 405

Figure 11.5 RM's Page 2 Profile Plotting Raw Scores R-PAS Summary Scores and Profil es - Page 2 P-10:7

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R-Optimized Administration

409

CHAPTER12 R-OPTIMIZEDADMINISTRATION Problemswith the Distributionof R in the CS The rationale for the R-PAS R-Optimized administration procedures is based on the long-recognized problem that the number of responses (R) significantly influences distributions of other Rorschach variables and confounds their interpretation (Cronbach, 1949; Exner , 1992, 1995; Fiske & Baughman , 1953; Holtzman , 1958; Kinder, 1992; Lipgar, 1992; Meyer, 1992a; Wood, Nezworski, & Stejskal, 1996). When the CS was introduced, R was not controlled because nonpatient reference data showed what Exner believed to be a manageable variation in R (M = 21.75, SD= 5.1; Exner , 1974; 1978). Subsequently, Exner decided to omit protocols with less than 14 responses due to inadequate testretest reliability (Exner, 1988). After taking this step of setting 14 R as the minimum and collecting additional data, the CS adult normative sample showed very modest variability, with a standard deviation of just 4.23 (M = 22.67, N = 600; Exner, 2003). Nevertheless, in addition to the fact that many researchers continue to see the need to address variability in R (e.g., Kinder, 1992; Meyer, 1992a; Sultan & Meyer, 2009; Wood, Nezworski, & Stejskal, I 996), there is concern that the CS normative data may underestimate the variability of R found in other nonpatient samples. Compared to the 2003 CS normative sample of 600 participants , Exner and Erdberg's (2005) contemporary nonpatient sample produced a slightly more dispersed distributio n for R, with SD= 5.68 (M = 23.36; N= 450). Other nonpati ent samples have consistently produced even greater variability , often with a considerably greater proportion of brief records. Viglione and Hilsenroth (2001) summarized data from six normative approximation samples and reported a weighted mean SD for R of 7.3 (M = 21.9). Additionally, among 4,704 adults from 21 samples in 17 countries, Meyer, Erdberg, and Shaffer (2007) reported an even greater SD of 7.90 (M = 22.31). Considerable variability is evident among patient records also. For the CS inpatient samples reported by Exner (1986), the standard deviation for R was 8.66 (N=320) for inpatient schizophrenics and 8.52 (N=3 l 5) for inpatient depressives. Exner reported less variability for R with outpatients and a character disorder sample (SDs=5.18, 4.29) than with the inpatients , but they also had a lower number of responses (R=20.41, 18.44) than his inpatient groups (R=23.44, 22.70). Using the samples reported in Meyer et al. (2000), the SD for R was 8.5 for a sample of outpatients (N=350) and 10.05 for a mixed sample of inpatients, outpatients, and medical patients (N=362). Our CS "applied " sample , a diverse group of 1052 clients and research subjects from clinical and forensic settings collected by numerous examiners, revealed similarly high variability in R with a mean of 22.95 and a standard deviation of 9.10. Overall, the research evidence clearly reveals that the variability in R greatly exceeds historical CS expectations. A much greater proportion of short records (14- 17 responses) and of long records (28 or more responses) are produced, with a smaller proportion of records in the optimal range of about 18 to 27 responses. Wide variability in R isa concern for interpreting Rorschach protocols. Data from 1,342 records (Viglione & Meyer, 2008) demonstrates that many Rorschach CS variables are highly correlated with R (r > .40). Some of the CS variables on this list (and their closest R-PAS counterparts) are D, Dd, DQ+ (Sy), Sum Shading (YTVC') , SumH, EA (MC), and PHR. A study by Sultan and Meyer (2009) also demonstrated that the stability of Rorschach scores was negatively affected by both higher mean R (22% of the CS variables) and greater variability of R (30% of the CS variables). Obviously, when

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scores vary in association with R, rather than as a result of the personality and processing features specific to these scores, validity and interpretation suffer. Some early research finding s suggested that variability in R may be associate d with examin er characteristics or expectations (Lord, 1950). Such a conclusion is consistent with data observed in the Journal of Personali ty Assessment supplement on In ternationa l Reference Samples for the Rorschac h Comprehensive System (Shaffer, Erdberg, & Meyer, 2007b). All contributors to this volum e were asked to explore whether the examin ers who collected their reference data showed significant variability in R. Although some samples were unable to explore this issue (e.g., data collected by just a single examin er) and some samples did not find differences, the extent of variability across examiners can be illustrated by using the two adult samples of reference data from the U.S. (Exner, 2007; Shaffer , Erdberg, & Haroian , 2007). The Exner (2007) sample contained statistically significant examiner differences. Across 24 examiners, the average R per examiner ranged from lows of 20.2 and 20.52 for two examiners who collected 31 and 26 protocol s, respectively, to highs of 26.9 and 27.7 for two examiner s who collected 6 protocol s each. In the Shaffer, Erdberg, and Haroian sample, across 25 examiners the total discrepanc y was greater, with two examiners on the low R side producing means of 16.6 (10 protocols) and 16.9 (12 protocols) and two examiners on the high side producing means of 25.1 and 26.1 (14 protocols each). These multiple data sources suggest that R sometimes functions as a nuisance variable and a confound that reduces interpretive accuracy . Short Rorschach records with 16 or fewer responses probably represent insuffici ent and unreliable behavioral samples that may underesti mate probl ems, miss salient personality characteristics, and necessitate tentative interpretations. Although long Rorschach records may survey personality and processing more thoroughl y, they may also over-estimate problems , waste examiner and respondent time, and result in records with lower stability (Sultan & Meyer, 2009) . At both ends of the continuum, one must ask whether the degree of elevation on a given score is associated with the overall level of productivity versus personal characteristics implied by that particular score. Additionally, excessive variability in R in conjunction with the large proportion of CS records in the 14-17 response range creates skewed distribution s for many other variabl es that then interfere with the quantitative analysis of data. Even though variability in R can in itself yield meaningful behaviorally-ba sed information about productivity , activity , resources, energy level, and cooperation, using standard CS administration guidelines it is not fully clear to what extent that variability is attributable to the respondent vs. the examiner. Given other data it is clear that the reliability and validity of the Rorschach would be increased by maintainin g the range of R within optimal limits. For all these reasons , we decided to limit the variability in R by implementing a new approach to administration. Ultimately, this led to the R-Optimized (R-Opt) admini stration with our instruction for "two , or maybe three responses '' per card and the "prompt for two , pull after four , with reminder " procedure during the test itself.

Research Leading to R-Optimized Administration First Alternate Administration Study An alternate admini stration method by Dean, Viglione , Perry, and Meyer (2007) was the first approximation of what ultimately became the R-Optimiz ed administration procedure . In this method , examiners prompted for a second response a maximum of three times , except to cards V and IX, and

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used the current R-PAS method for pulls (asking for the card back after four responses). The participants were 61 adults in long -term residential treatment at either a state psychiatric facility or a state prison , about half of whom had been diagnosed with psychotic disorders. Forensic samples with chronic psychiatric needs like this have coping deficits and thus often have difficulty engaging with the task and so produce low R protocols (Viglione, 1999). Participants in this study were randomly assigned to the alternate or standard CS administratiion. As anticipated, with standard CS administration, examiners had to frequently re-administer the task, with this occurring 23% of the time. With the alternate method there were no instances when fewer than 14 respons es were obtained , so no re-administrations were necessary. Notably, the associations between Rorschach predictors and a thought disorder criterion were stronger with the alternat e administration procedure than with standard CS administration, with correlations of .44 versus .36, respectively. Overall, this initial research demonstrated that altered administration procedures ensured a more optimal range for R while sustaining or increasing the validity of Rorschach measures of thought disorder and psychosis and avoiding the complications associated with re-administration. This study also demonstrated that adjusting for Complexity improved validity when protocols were shorter or longer than expected (i.e., < 18 or> 28).

Second Alternate Administration Study Heartened by the Dean et al. validity and re -administration findings, we undertook a second study (Viglione, Converse et al., 2011) to optimize the range of R. Unlike Dean et al., however, the alternate procedure implemented in the second study used a "prompt for two, pull after four " tactic for all ten cards. Examiners were graduate students enrolled in personality assessment courses focusing on performance -based assessment. These graduate students had administered at least two previous records (M = 3.8) to participants they had recruited for course assignments. 73 Examiners were randomly assigned to administer either the CS (n = 54) or the alternate (n = 62) method , and then told to switch between the two administration methods thereafter. Teaching assistants reviewed and corrected their coding. This "prompt for two, pull after four " administration method successfully eliminated brief records and increased the proportion of records in the optimal range of R from 18 to 27. Only 3% of the alternate administration records had 17 responses and there were no records with fewer than 17. This trivial number contrasted with 37% of the CS-administered records having 17 or fewer responses , with a minimum of 14 and a median of 18 for the entire sample. Like the Dean et al. study, here again in an examination context that tends to produce brief records , the prompting for two responses largely eliminated short, less useful records . The CS administration with this sample produced a mean R of 19.59 and SD of 4.58, whereas the "prompt for two, pull after four " administration produced a mean R of 23.56 and SD of 5.93. The low SD with the CS was attained by having a large proportion of short records that are not interpretively useful, not by having a small amount of variability around a higher number of responses. Turning to the high end of the R distribution , the "prompt for two , pull after four " administration guideline unexpectedly produced an excessive proportion (21.0%) of protocols in the high range (R 2: 28), compared to the CS records (4%). Thus , our second alternate method produced more optimal length records but also had the disadvantage producing too many long records. Our impression was that some participants tried to figure out what was wanted or expected based on the pattern of prompts and pulls and that a subset of them concluded we must really want four responses per card, given that it was only then that we thanked them and asked for the card back. 73

This exam ination context, with students practicin g class assignments with volunteers they recruit , commonly produces brief records. Three such studies each showed a median R of 18 (Evans, MacDermott, Viglione, & Meyer , 2010; Shaffer, Erdberg , & Haroian , 2007; Viglione, Converse et al., 2011).

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Third Alternate Administration Study Introducing R-Optimized Administration

To address the problem of long records and the seeming ambiguity associated with the prompts and pulls, our third alternate administration experiment (Evans, MacDermott, Viglione, & Meyer, 2010) added the current R-Opt instruction to "give two, or maybe three responses to each card" when introducing the test, while retaining the "prompt for two, pull after four" tactic. However, with the new guidance provided at the start of the task, we redefined the pull to also have it be accompanied by a reminder of the instructions to give two or maybe three responses. The design and procedure were otherwise exactly the same as that described in the second alternate administration study. As expected, adding the current R-Opt instruction to "give 2, or maybe 3 responses... " produced significantly more records (86.4% v. 54.6%) in the optimal range (i.e., 18 to 27) and reduced the high R records (R .2:28) from 21% to 9 .1%. Once again, the CS method produced many short records in the problematic range (39.1% < 18), though this rarely occurred with the R-Opt method records (4.5%). Also as expected, the number of prompts per respondent was reduced from 2.1 to 0.93. In this study, we also evaluated the effect of type of administration on individual variables. At this point in the development of R-PAS, we examined 55 CS variables that were retained in one form or the other in R-PAS. Only 3 variables (besides R) differed significantly across administration methods, a proportion that is no greater than that expected by chance. Fourth Alternate Administration Study Using R-Optimized with a Patient Group

Moore (2011) was the first to use the R-Opt administration guidelines in a clinical research study. In her study, 72 older individuals with schizophrenia were tested. R ranged from 1374 to 30 for all but one respondent who gave 40 responses. The mean R for this sample is 23.14 with a SD of 5.64, with 72.2%in the 18-27 range. When the one outlier with 40 responses was removed, the M dropped to 22.66 and the SD to 4.93. Thus, a clinical research sample that would be expected to produce low but variable R using CS administration instead produced a sufficient number of responses and limited variability.

Conclusionfor R-OptimizedAdministration This series of studies evaluating various methods of optimizing R shows that the final R-Optimized administration procedure reduces the occurrence of both short and long records, so as to bring more records into the optimal interpretive range of 18 to 27 responses. This research supports adopting ROptimized administration in R-PAS and suggests that interpretive validity and utility will be increased. Re-administration has seldom been necessary with the alternate and final R-Optimized procedures, and there is no longer any threat of excessively long records with more than 40 responses, a prospect that should comfort examiners. Results also are consistent with the conclusion that R-Optimized administration may reduce examiner variability, a major goal of R-PAS, by offering simple but explicit instructions for encouraging sufficient productivity. In addition, by providing verbal and behavioral guidelines for respondents, and by quantifying the prompts and pulls that indicate when those parameters are not met, R-Optimized administration much more clearly identifies meaningful variability in respondents and their propensity to give many or few responses.

74 A few of these

respondents with schizophreniawere quite confused and resistant to prompts.

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CHAPTER13 DEVELOPINGTHE FORM QUALITYTABLES This chapter is co-authored 75 with Helena Lunazzi\ Anna Elisa de Villemor-Amaralb, Ricardo Primib, Latife Yazigf, Regina Sonia Gattas Fernandes do Nascimentod, Norma Lottenberg Semer\ Yoriko Takahashi'\ Fatima Mirallesr, Ramona Dumitrascu g, and Nicolae Dumitrascu g.

Overview One feature that makes Rorschach -based assessment unique among assessment measures is that it is a task of visual perception and representation under uncertain and imprecise conditions. People completing the task have wide latitude to describe many, many different kinds of things. However, the inkblots are not amorphous or entirely ambiguous; they have considerable built-in structure (Exner, 2000; Guinzbourg de Braude, 2008). This structure is characterized by features that look like objects or parts of objects in the real world , i.e., critical bits (Exner, 1996),juxtaposed against other obscure or opposing features, so that the inkblot forms are also incomplete and internally contradictory. As described briefly in Chapter 6, the R-PAS Form Quality tables are designed to capture the quality of the forms perceived in the inkblots and thereby to differentiate responses that are common, conventional, and accurate representations of blot structure from those that are atypical and idiosyncratic representations that distort or misrepresent the contours and features of the inkblots. To make these distinctions our foundation research for the FQ tables focused on the two elements that contribute to perceptual accuracy: Fit and Frequency. Fit refers to how well the perceived object matches the inkblot features at the location where it is perceived. Frequency refers to how often the perceived object is spontaneously mentioned at a particular location by people completing the task. To facilitate their straightforward use in clinical practice, these dimensions were combined to classify objects into three Form Quality categories: ordinary (FQo), unusual (FQu), or minus (FQ- ). In this chapter we describe the steps that were followed to achieve this.

Fit Our research on perceptual fit began in 2001 with the creation of a database of response objects identif1ed by various Rorschach systematizers (Meyer, Patton, & Henley, 2003). Our goal at the time was to compile a thorough list of objects reported to the inkblots along with an integrated database of designated FQ codes for these objects. Response objects were obtained from the Form Quality tables compiled by Beck (1961), Exner (1974, 1986, 2003), and Hertz (1970). We also included objects described by Thomas (1964), Small (1956), and Beizmann (1970). The last two sources included response objects and recommended Form Quality codes from experts in Europe and the U.S., including responses that had been coded by Rorschach, Bohm, Klopfer, Loosli-Usteri, Binder, Bleuler, Oberholzer , Rickers-Ovsiankina, and others. These responses were compiled and organized by location area. Location areas delineated by different sources were first converted into a common set of designated areas. Fit was determined from what we called Form Accuracy (FA) Ratings. These ratings were obtained by giving judges the inkblot, showing them the designated location, and asking them how well a series of 75

aUniversidad Nacional de La Plata, Argentina; bUniversidade Sao Francisco, Brazil; cuniversidade Federal de Sao Paulo - Escola Paulista de Medicina, Brazil; dPontificia Universidade Cat6lica de Sao Paulo, Brazil; eosaka Shoin Women's University, Japan; runiversidad Pontificia Comillas, Madrid, Spain; gUniversity of Toledo, OH.

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specific objects fit that location area. Judges were asked "Can you see the response quickly and easily at the designated location?" and for their answer they rated all objects on the following 5-point scale: 1 =No .I can't see it at all. Clearly, it's a distortion. 2 = Not really. I don't really see that. Overall, it does not match the blot area. 3 = A little. If I work at it, I can sort of see that. 4 =Yes . I can see that. It matches the blot pretty well . 5 =Defin itely.I think it looks exact ly or almost exactly like that. FA judges could also skip a response or designate it with a 99 to indicate they were not familiar with the object or did not understand the term. An examp le of the record form is given in Figure 13.1.

Figure 13.1 Example of Form Accuracy Rating Form with Designated Location Area Depicted

'r / ;},

Rate Each Object on the 1 to 5 Scale (or 99)

..J......

2

04 ~

w

.

1 =No. I can't see it at all. Clearly, it's a distortion . =Not really. I don't rea'lly see that. Overall, it does not match the blot area. 3 =A little . If I work at it, I can sort of see that. 4 =Yes. I can see that. It matches the blot pretty well. 5 =Definitely. I think it looks exactly or almost exactly like that. 99

=Not familiar

with obj ect or don't understand

Row Card Location Ang le Object 203 1 04 Buddha V 204 1 04 V cup, glass 205 1 04 V cup, stone , on a gravestone 206 1 04 V goblet with foot 207 1 04 V shrub 208 1 04 V Sphinx 209 Anatomy , specified (e.g., liver, heart) 1 04 210 1 04 Anatomy , unspecified 211 1 04 branch 212 clown with outstretched hands , a ghostl y figure 1 04 213 1 04 coral piece 214 04 dog, rear view 1 215 figure, half human and half demon , threateningly holds its 1 04 hands up 216 1 04 grave stone 217 1 04 hour-cilass 218 1 04 human, body with two torsos and one pair of limbs

Rating Comment

FA data collection took place in two rounds . In the first round, we obtained FA (fit) ratings on a unified set of 9,230 Rorschach respons e objects that had been reported in either Beck (1961) or Exner (1974, 1986, 2003). The second round obtained a smal l number of FA ratings on additions to or elaborations of objects used by Exner and Beck (e.g .. rather than relying on the ambiguous category of "animal, " we asked judges to separately rate "animal, unspecified type" versus specified alternatives). However , this round of FA data collection was primarily focused on objects that were culled from the other sources (i.e., Beizmann , 1970; Hertz, 1970; Small , 1956; & Thomas, 1964). As this project began, the 10,224 objects in Hertz's extensive FQ tables had already been reviewed for content overlap with the objects in Exner and Beck tables. A total of 6,823 of the objects in Hertz ' s FQ tables were deemed to be an exact match to objects in Exner 's and Beck 's FQ tables by two judges , with disagreements resolved by a third. The FQ codes Hertz assigned for these objects were integrated with the FQ codes assigned by Exner and Beck in our database , and then these objects were not considered further for form accuracy ratings. However, for the remaining Hertz objects (3,401) and for the objects

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obtained from Beizmann and Small (2,029) and from Thomas (233), we evaluated their distinctiveness relative to objects that were already rated for fit. In order to be rated for fit on the second round of data collection, two judges had to agree that the object was "sufficiently distinct " from what had already been rated to justify including it as a new object in the FA data collection packet. The goal here was to be efficient and to avoid collecting FA ratings on synonyms or near-synonyms (e.g., for D1 of Card VIII, we did not want to collect ratings on "canine " if we already had ratings on "dog , unspecified" or for D1 of Card IX, we did not want to collect ratings on "shrubs" if we already had ratings on "bushes") or response elaborations that would not have any real bearing on fit (e.g., for Dl on Card II, we did not want to collect ratings on "picture of a bear " if we already had ratings on "bear"). Operationally , the "sufficiently distinct" criterion was defined as ajudgment that the object under consideration as a new listing in the table might be rated one point higher or lower than the most similar object already listed in the table. If two judges working independently agreed that the new object was not sufficiently distinct, it was not rated for fit ; if they agreed that the new object was sufficiently distinct , it was rated for fit; if they disagreed on whether the object was sufficiently distinct , a third judge made a final decision. In the end, an additional 3,801 objects were considered suitable to be rated for the second round of FA data collection. Data collection for these FA ratings took place using forms in English or with translations to other languages. In the list that follows, we identify when a non-English translation was used and also identify when judges were not native English speakers. First round FA ratings were obtained in Brazil (in Brazilian Portuguese, no native English speakers), Finland (no native English speakers), Italy (no native English speakers), Israel (no native English speakers) , Japan (in Japanese; no native English speakers), Portugal (in Portuguese, no native English speakers), and in various sites in the U.S. , including San Diego, Toledo , Houston, and Santa Barbara. Second round FA ratings were obtained in

Japan (inJapanese,no nativeEnglishspeakers),Romania(nonativeEnglishspeakers),Taiwan(using Traditional Chinese characters, no native English speakers), Turkey (no native English speakers), and various sites in the U.S., primarily in Toledo and San Diego. In addition , we recruited two samples of recent immigrants, one from Taiwan living in San Diego (with ratings using Traditional Chinese characters, no native English speakers) and the other from mainland China living in Toledo (with ratings using Traditional Chinese characters, no natii.veEnglish speakers). Each judge was asked to rate about 250 objects for their fit with the designated Rorschach location area (see Figure 13.1), a task which typically would] take about an hour. In total we obtained 130,287 Fit ratings from 569 judges (see Appendix F for a list of judges). About 58% of the FA judges had some experience using the Rorschach; the other 42% had no previous exposure to the inkblots. About 52% of the FA judges were not native English speakers. Although demographic information was not available for all judges , about 69% were female and they had an average age of 28 (SD = 9.2, range 18 to 60). FA judges included undergraduate and graduate students , as well as professionals in the field. In addition, a convenience sampling approach generated FA ratings from adults who were not university-affiliated and not psychologists in Japan , Romania , Taiwan , and Turkey. All of the final Rorschach response objects in the FQ tables were rated for fit between 5 and 15 times, with an average of 9.9 times. FA judges varied considerably in their style of using of the FA rating scale, with some judges adopting a conservative position of relatively low ratings , some a liberal position of relatively high ratings , some a restricted range in the middle of the scale, and some a polari zed range relying on the ends of the scale. Consequently, raw scores were ipsatized by converting each rater's raw scores to z-scores and thereby giving each rater M = 0.00 and SD= 1.0. Across all objects these z scores were then re-expressed on the original 1 to 5 point scale of measur ement. This was done by multiplying the z-scores by the ratio of the raw to z-score SDs (I.232/0.998 = 1.234) and then adding in the difference in mean values for the raw scores and z-scores

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(2.671 - 0.00 = 2.671); i.e., the estimated raw score from the z-rating = z-rating x 1.234 + 2.671. The resulting value was then rounded to two decimal places and also truncated so that all values were in the original range between 1 and 5. Each judge's ratings were randomly allocated to the pt through 15th rating position, such that some might fall in the 1s1 set of ratings, some in the 61h set, some in the 91h set, etc., with anotherjudge having his or her ratings fall in a different pattern across different sets of rating. Because rater effects were thus not consistent, we anticipatedjust modest correlations among the ratings. This is what we observed, with an average pairwise correlation of .20 among the 1st through 151h sets of ratings (weighted by the number of objectsjud ged in each correlation). However, as expected, the average correlation among all the z-score based ratings was slightly higher at .25. The z-score based ratings were averaged across judges to obtain a final Form Accuracy score for each response object. Because averaging across multiplejudges allows random errors of measurement to cancel out, on average the effective reliability of the final ratings was .77, using the standard formula for coefficient alpha and treating each judge as an item on the composite scale (with pairwise reliability of .25 and an average of 9.9 judges). Although this degree of effective reliability is reasonable, it can still lead to inconsistent mean ratings for similar objects. Consequently, we went through the table of FA ratings entry-by-entry and consolidated ratings for similarly shaped objects when this was justified either by their nearsynonymous shape or by their near identical ratings. During this process as much as possible we also identified and resolved any irregularities in the ratings. For example, to the D1 area of Card III, we had the following objects sorted by their initial mean FA ratings: Initial Mean 7 Original FQ Table Objects FA Rating Birds (2, D7 as Separate O~ject) 2.5 Ostriches(2) 2.5 Birds (2) 2.7 Chickens 2.7 3.0 Donald Duck (2) Birds (Cocks or Roosters [May Be Fighting}, D ucks, Large Birds by Nest) 3.2 Birds (Large, Resembling Humans) 3.5 From these we created two consolidated categories, one that combined the Donald Duck percept with the birds resembling humans and one that combined the others: Final 2 Final ConsolidatedFQ Table Objects FA Rating Birds (2, D7 as Separate Object; e.g., Roosters, Chickens, Ostriche,s) 3.0 Birds (Large, Described as Human-L ike) 3.2 As this consolidation and smoothing progressed, we were working on the frequency data (to be discussed next) and also coding protocols using FA ratings or an early version of the FQ tables. We discovered a small number of relatively frequently identified objects that were not previously rated. These objects were rated for fit and added to the database, raising the total number of objects from 13,031 to 13,050. After consolidation, the number of object categories is smaller but still large, encompassing 11,324 entries. To make use of the FA ratings in the FQ tables, we considered various cut-points that would allow us to translate the average ratings into three FA classification categories corresponding to the traditional FQ categories of -, u, and o. For instance, we considered logical cut-points based on the descriptive anchors in the FA rating scale, in which ratings less than 2.0 ("Not really. I don't really see that. .. ") were considered FA-, ratings greater than or equal to 4.0 ("Yes. I can see that. It matches the blot

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pretty well") were considered FAo, and ratings in between were considered FAu. We also considered a historical precedent model, in which we identified the cut -points on the FA rating scale that when applied to the same objects reproduced the frequency of-, u, and o responses listed in the CS Form Quality tables. In initial research the latter approach was slightly more valid (Horn, Meyer , Viglione, & Ozbey, 2008; Meyer & Viglione, 2008; Ozbey, Meyer , Viglione, Dean , & Horn, 2008; Ptucha , Saltman, Filizetti, Viglione, & Meyer, 2008). Following that model, in our final set of objects we classified those with a mean rating of 2.4 or less to be minus by FA criteria. On the other end , objects with a mean rating of 3.5 or more were considered ordinary by FA criteria. Objects with average accuracy ratings between 2.5 and 3.4 were considered to be unusual by FA criteria.

Frequency Frequency data were derived from five sets of adult FQ tables that were created in Argentina (N = 506; 56% female; ages 18-65+; Lunazzi, Urrutia , Garcia de Ia Fuente, Elias, Fernandez, De La Fuente, Bianco, & Sarachu, 2011) , Brazil (N = 600; 54% female; ages 17-64; Villemor-Amaral , Yazigi, Nascimento, Primi, & Semer, 2007), Italy (N = 792; adults balanac ed for gender; Parisi, Pes. & Cicioni, 2005), Japan (N = 400; 50% female; ages 20-69; Takahashi , Takahashi, & Nishio, 2009), and Spain (N = 470 ; 50% female; ages 17-65+; Miralles Sangro, 1996, 1997). These FQ tables were derived from normativ e samples of nonpati ents, except for the Spanish tables , which were derived from outpatients. Data were collected using CS administration procedures (Exner, 2003} in Argentina, Brazil, Japan , and Spain. The Italian sample was collected using procedures for the Rome school , which also has separate response and clarification phases , and produces about the same number of responses (M = 24.7) as in R-PAS (M = 24.2). For Italy , the specific object frequencies were obtained

directly fromthe Parisi et aL publication.For Argentina,Brazil,Japan, and Spain,the specificobject frequencies were compiled for use in developing the R-PAS tables and are not otherwise published. We compiled specific frequency data for all Rorschach respon se objects that were reported by at least 1.5% of the people in each sample , except for the Italian tables, which published its results based on objects identified by at least 2.0% of their respondents. Of interest, object frequencies in Rorschach data roughly follow the shape of a Zipf distribution . which is also known as a Pareto distribution, zeta distribution , rank -size distribution , or a power -law distribution. All these distributions quantify phenomena where "large " events (e.g., a world war) are rare, but "small" events (e.g., a military skirmish} are quite common. "Large " and "small" can also refer to occurrences or frequencies, such that high frequency or high occurrence events are rare but low frequency or low occurrence events are common. The Zipf distribution is named after the lingui st Zipf (1932), who discovered the lawful relation between the frequency of a word's use in language and its rank, such that the 2nd most common word ("of') occurs half as often as the most common word ("the"); the 3rd most common word ("and") occurs 1/3 as often as the most common; the 4111most common word ("a") occurs 1/4 as often as the first , and so on. Plotting such a distribution, with size or frequency on the vertical axis and rank on the horizontal axis, results in a distinctive non -normal distribution that has a tall, near-vertical arm on the left to characterize the rare events that are large or occur at a high frequency and a long, near-horizontal tail on the right that characterizes the very common events that are small or occur at a low rate. This type of distribution characterizes many natural phenomena, including earthquake magnitudes, city size , the distribution of wealth, frequency of visits to web sites, the circumference of the trunk and branches of a tree, and citations to scie ntific papers (Adamic, & Huberman , 2002; Bejan , Lorente, & Lee, 2008 ; Clauset, Shalizi , & Newman . 2009; Zipf , 1949). Thus , very large magnitude earthquakes are quite rare, while very small tremors are quite common , such that the size of earthquakes recorded in any given time period decreases at a stable rate following a power function. Similarly. there are a relativ ely small number of mega-cities but a vast number of small towns.

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Chapter 13

Figure 13.2 displays a distribution of Rorschach response object frequencies (on the vertical axis) as a function of their rank (on the horizontal axis), using data from Brazil as an examp le. The Brazilian FQ tables are based on responses from 600 participants. From the highest point on the near-vertical left arm of the graph it can be seen that the most frequent object, with Rank = 1, occurs about 375 times . Although it is difficult to discern the frequency of the next most frequent object (i.e., with Rank = 2), it is clear that there is a sharp drop in frequency as tlhe rank increases. In fact, the 30 th most common object (i.e., Rank = 30) was reported 50 times (i.e., it has a frequency of 50) and just 262 objects (Rank = 262) have a frequency of 9 or more. A frequency of 9 is designated on the graph by the horizontal line and it marks the cut-off of the objects that were reported by 1.5% of the sample or more (i.e., 9 people reporting the same object constitute 1.5% of the 600 participants). Turning to the nearhorizontal tail that extends to the right of the graph, although it is a bit difficult to discern , objects reported by two people occupy the Ranks from 1,110 to 1,920 ; the remainder of the tail is defined by objects that were reported by just one person , encompassing the Ranks from 1,921 to 6,459 , which exhausts the objects in the FQ database . This is a prototypic looking Zipf distribution, much like what one would see from the distribution of earthquake magnitudes, city sizes, etc.

Figure 13.2 Frequency by Rank Distribution of Objects from the Brazilian FQ Tables

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Viewing a List of Your Protocols

At the home page (ControlPanel), users can click the link "View protocols" to see a list of all protocols that were entered. If the user is a setting owner, the list will show all protocols including those that sub-users entered. The screen looks similar to the one shown in Figure G.7. The example screen is cut at the bottom, but scrollbars allow users to scroll up and down the list. The list shows all protocols , along with brief information about them. For every protocol, there are icons next to its P-ID showing what type of protocol it is. For example, protocol 7 has an orange and a blue icon, which indicates that it is an app roved teaching and an approved research - advanced protocol. Users can hover the cursor over the icons to trigger a small popup description. Administrationinformation is displayed for every protocol, such as who entered it and when. Depending on the kind of data that was saved, other informationmay appear, like C-ID, client·s age, client's gender, etc.

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