"The Rorschach Software of Choice"
NOTE: This is a sample report from Version 6 of ROR-SCAN’s Interpretive Scan. The protocol is from Irving B. Weiner’s Principles of Rorschach Interpretation, Chapter 14, p. 379, (Case 9: "Violence potential in a man who had to have his own way"), Lawrence Erlbaum Associates, Mahway, NJ, 1998. Compare this report with Dr. Weiner’s presentation and discussion in the text. The client’s name, "Mr. Ingram", is fictional.
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Name: Mr. Ingram Sex: M Examiner: Ann D. Examiner, Ph.D.
ID: CASE_9W.RW5 Ed: Assoc degree Age: 27 Date Tested: 3/12/99
The following interpretive hypotheses are generated from statistical comparisons of the structural features of the person’s Rorschach test performance with that of groups of people with known personality characteristics. In addition, interactive clinical reasoning is used to deduce some narrative statements. Because all statements are tentative hypotheses based on generalizations, decisions and conclusions about this person can not be made solely from this limited resource. The clinician must cross-validate, refine, and modify these hypotheses by using additional test data and other clinical information. Accurate application of Comprehensive System administration and scoring procedures is essential to the use of this interpretive system.
Test Validity: The person’s test performance and involvement indicate that there is a sufficient sampling of behavior. There is a valid basis for interpretive inference. Some evidence suggests that he may have been resistant or angry about taking the test. If S responses on Cards I and II appear "pathological", some hypotheses about dysfunction may more accurately indicate his noncompliant or hostile set. Intense anger may have led to perceptual distortion or cognitive dysfunction. If distortion is mostly present in S responses and more cooperation can be obtained, consider retesting.
The following hypotheses are listed solely to provide an initial orientation to some of the data in this record. A full analysis of the data is required to confirm or reject their validity. No summary or synopsis is intended.
He has an inflated sense of self-worth. Many psychological operations are used to protect and defend the ego. His style of coping with problems is extratensive. There are indications that he has affective distress relating to depressive features. Problems with interpersonal relationships or cognition are evident. He has problems with processing information. Considerable pessimistic or negative thinking is present. There may be problems involving interpersonal closeness.
Some hypotheses generated from Rorschach data are much more important and pervasive than others, impacting upon the entire personality organization and functioning. The hypotheses which carry the highest priority in this protocol are listed below as Priority A, B, or C. Priority A is listed if certain scores suggest serious psychopathology such as a DSM Axis I clinical syndrome. If the hypothesis is valid, all other features of the patient’s personality should be interpreted in the context of that disruption. Priority B issues are stylistic. An underlying personality or response style influences much of the person’s overall functioning and other features should be considered in that light. Some Priority B issues may relate to Axis II disorders. Priority C issues are influential personality features that contribute to a general understanding of the person, although they may not be of primary concern. If no issues were found for a particular Priority, it is not listed.
Following each listed Priority is a suggested sequence for reading sections of this report. The first listed Priority determines the "entry point" to start a sequential search of data clusters appropriate to the record. The order generally follows Exner’s interpretive strategies for assessing the validity and pervasiveness of the prioritized issues. If higher priority issues do not specify a complete search of all data clusters, then lesser priority issues direct the remaining search strategy until all data clusters have been reviewed.
Priority B: There is a very high suicide potential for this person! Determine his capacity for emotional control and the degree of current situational stress. False positives are found with non-suicidal people in high turmoil such as in custody disputes.
He has an inflated sense of self-worth. Many psychological operations are used to protect and defend the ego. The suggested interpretive search strategy for this record is as follows:
__ Self Perception
__ Interpersonal Perception
The Situational Stress section is not part of this search routine.
His style of coping with problems is extratensive.
__ Affective Functioning
__ Information Processing
__ Cognitive Mediation
__ Ideational Functioning
Self Esteem: He is strongly self-involved and places considerable value on himself to compensate for a basically weak ego that needs constant bolstering. Feelings of entitlement and a wish for automatic recognition and admiration by others are probable and very influential in most dealings with the world. If he can manage to be recognized as very special, development of backup defenses and psychopathology can be prevented. Failure and negative feedback can breed disdain or angry reprisal.
He values himself much more than most. His high opinion of himself is effectively supported by a narcissism or self-absorption which magnifies his virtues as exceedingly special. There is a constellation of variables consistent with narcissistic personality disorder. The ordinarily adequate level of ego strength adds support to this type of characterological disorder. He may feel little need for interaction with others, believing that he, himself, is sufficient or even superior.
His thinking and attitudes frequently are pessimistic due to negative self perceptions. They often derive from problems with early identification or from feeling psychologically or physically harmed in the past. MOR responses can be attempts to exaggerate. MOR or AgPast responses may symbolize aspects of his self-image such as feeling vulnerable, damaged, or inadequate. Repeated, unusual, or dramatic morbid themes, especially with FQ-, provide clues about self-concept if confirmed by other data. These negative views of self sharply conflict with his efforts to see himself more positively. This can be elicited by recent situational blows to the ego.
His sense of self is fixed, rigid, and routinized. This makes him much less able to cope with challenges in daily life which require flexibility.
Introspection: He is being unusually introspective. A re-evaluation of self may be attendant to critical life events, unresolved problems, or impending depression. Uncovering psychotherapy precipitates this degree of introspection prior to resolution of issues. He probably is conflicted by discrepancies between overglorified and negative perceptions of himself. If he feels distress, he may further overcompensate for perceived "weaknesses" with more self-aggrandizement. His introspection is very likely to be painful and distressing and to precipitate guilty rumination and depression. Continued focus on defects and faults may escalate and he may minimize or lose sight of his more positive attributes. He is apt to feel badly about his failures and lack of achievement in light of the limited resources he has available.
His tendency to externalize negative aspects of himself limits how insightful he can be. Because his self-concept is dysphoric, introspection is likely to make him feel gloomy and pessimistic. His rigid values and attitudes limit his potential for understanding himself and, consequently, for changing.
Suspiciousness: The person does not appear to be extremely suspicious. However, he is excessively alert and attentive to his environment, trying hard to process all he takes in. He shows a readiness to perceive hostility and anger. His negative thinking may reflect hostile, resentful or defiant attitudes.
Defensiveness: Some interpersonal behaviors which may appear offensive on the surface may be defended attempts to establish a relationship. To avoid social interaction, he stays interpersonally distant and superficial. To protect himself, he tends to avoid emotional involvement.
His basic defense of overglorifying himself serves to protect him against ego-deflation. He is likely to deny, rationalize, and externalize blame, while elevating himself beyond fault.
Interpersonal Relationships: He is likely to have a history of less effective, adaptive, and conflict-free interpersonal relationships. Others may shun him as being socially inept. The more PHR responses exceed GHR responses, the more likely this is true.
Interactions and views of people are based more on imagination and preconceptions than on actual experiences with individuals. Inspection of projected material in M and H responses with Pair codings may yield information about his relationships. Note particularly any Special Score and FQ- features of the Pair responses. His relationships may be immature and fantasy-laden, perhaps reflected in A and H Content and Pair responses. Rather than engaging people for who they are, his interactions may be more of an attempt to materialize his own wishes, needs, or projections.
He is socially isolated and withdrawn from others. His alienation from a satisfying social network creates the potential for loneliness. Because his coping style requires interpersonal connectedness, the detachment seriously limits his opportunities to work out problems. There is a possibility that lack of contact with others may not matter much to him.
His self-centeredness, self-aggrandizement, and interpersonal shallowness may put people off. Threatening confrontations are strongly resisted but flattery or submission will succeed. His self-absorption breeds distorted views of others. Because others are important in terms of his need for appreciation, superficial relationships are the rule. Negative or confrontive interactions typically are handled by rationalization, blame, or denial. He has difficulty making compromises in interpersonal interactions.
There are features which may lead to social or legal problems stemming from irresponsible behavior, poor judgment, or impaired coping. The constellation of coping deficiencies seen in this record more closely matches that of people with antisocial personality disorder who are found guilty of a criminal offense than of antisocials who do not go to trial and are not convicted. He has some ambivalence or turmoil about interacting with others. Aggressive, antisocial, or asocial tendencies may be present. He is very concerned about maintaining independence, defining personal boundaries, and protecting his personal space. There are underlying oppositional tendencies and he may express anger by being contrary or resistive. Unless there is reason to suspect malingering, explore the possibility of a history of sexual abuse or other forms of trauma by reviewing additional sources of data. He is concerned about aggression, whether as victim or victimizer.
Rather than passively reacting to events, he has a stylistic inclination to actively initiate behavior. In addition, he tends not to listen well to others and to take action even though gathering more preliminary information might be helpful.
He may not expect nor experience comfort or nurturance from interpersonal closeness in ways that others do. He is conservative about intimacy and sharing personal space. With some people, this stems from lost hope of receiving comfort or support from intimate relationships or a lack of or inadequate nurturance or attachment early in his life. Conversely, it may be hard for such people to provide nurturance. People with antisocial personality disorder most often have this absence of interpersonal attachment but many additional criteria are needed to make the diagnosis. He tends to see aggressiveness as an integral part of relationships and may consequently act aggressively. This may be a learned pattern or may be defensive. Modify the preceding by the nature of COP responses with Special Scores. Cooperative interactions can be "spoiled" by the kind of faulty logic or communication measured by the Special Score.
Emotional Constraint: He internalizes his feelings about as much as most people. Because emotional constraint is antagonistic to his extratensive coping style, the tension it produces is especially distressing and may reduce his ability to handle problems. He feels considerable ambivalence and distress about outwardly expressing feelings.
Emotional Control: His control of affect is hampered by either a defensive shutting down of coping resources or a deficit in development.
He has average coping resources for directing and controlling affect and behavior, whether or not he does it in a healthy way. Stress tolerance is usually average, but chronic or intense stress can cause lapses of control and impulsiveness.
The following description of the person’s intensity when experiencing and expressing feelings may indicate temporary rather than long-term, stable characteristics.
If all Pure C responses contain intellectualized or other defensive content, the client may be able to apply those resources to control feelings. However, if some Pure C Content involves more immature or primitive content, those qualities probably characterize the person’s display of strong feelings.
He makes some attempt to inhibit his expression of feelings, suggesting that displaying them may be threatening to him. He may be aware of problems with emotional control or may experience internal pressure due to his suppression of feelings.
He has emotional experiences which he finds very confusing, often feeling both positively and negatively about the same thing and unable to resolve the ambivalence. Past emotional interchanges may have led to negative consequences. Because his typical manner of dealing with feelings is to avoid or withdraw from them, in an emotional environment he is not likely to respond unless strongly provoked.
The client is provoked about the same as most people by drives, wishes, and impulses stemming from internal physiological or psychological needs.
Ego Strength: The following statements should be considered in the context of the very minimal ego resources being applied at this time. Statements about his customary coping capacity may not be reliable, especially if there is evidence of greater potential.
Ordinarily, unburdened by any current stressors, he has about average psychological resources available to cope with ordinary stress, although unusual, unexpected, or prolonged stress may disorganize or overwhelm him as it would most. This does not imply that his ego resources are healthy nor adaptive. However, this may be an overestimate of his ego functioning due to the comparatively few resources available. He is more likely to have ongoing difficulty with ordinary life stresses.
At this time, he is functioning at his typical level of stress tolerance.
Although information about current stress is not part of the suggested search strategy for this record, this section is included for reference.
Whatever situational or temporary stressors may be present, they do not appear to significantly detract from the person’s usual capacity to cope with stress. His awareness of stress from current external situations is about as much as most people’s. There is little evidence that current problems and demands are bothering him emotionally. Thus, feelings of distress, inadequacy, or helplessness may be outside of his awareness. The stress adds somewhat to the psychological complexity of his world, increasing the potential for impulsivity.
He may deny or externalize feelings of stress by use of a narcissistic overcompensation for a prideful ego unwilling to confess such vulnerability.
Due to his tendency to overextend ego resources to attain his goals, potential failure experiences are likely to induce stress and feelings of inadequacy.
Suicide Potential: ===> The Rorschach indicates a very strong suicide risk. The SCON at this level has a very small probability of error in predicting a fatal suicide attempt. Take precautions! In one study of inpatients in a facility with a high base rate (14.5%) of near-lethal suicide attempts, this level of the SCON strongly predicted (81% true positives) a near-lethal suicide attempt within 60 days of testing.
Endogenous Depression: Consider major affect disorder or dysthymic disorder, especially if there is a positive history. This DEPI value may indicate a false positive, recurrent depressive features, somatic or anxiety symptoms, or may detect precursors to depression. There is evidence of very severe impairment or limitation in thinking as applied to problem solving and effectiveness in demanding life situations. Dysphoric ideation is likely. His underlying attitudes, expectations, and views of life and self may be pessimistic, negative, and self-defeating. His coping style suggests depressive symptoms of confused and constrained painful feelings, intellectualization, and devaluation of self-worth.
His strongly dysphoric thinking about himself and the world may be the result of very hurtful or damaging past experiences. His self-concept may include feelings of vulnerability, incompetence, or inadequacy. His negative attitudes stem from early developmental experiences, are persistent, and resist change, making it hard for him to use simple support or consolation.
Reactive Depression: There is insufficient evidence of reactive depression but it can not be ruled out by the Rorschach data alone.
If elimination of all Y responses in the record would reduce DEPI to less than 5, there is a good possibility that the depression is more situational than endogenous. Experiences of failure may precipitate depression due to his problematic self-esteem.
Bipolar characteristics: Because emotional control appears brittle, disruptions of depressed moods by highly emotional or hypomanic displays may occur, representing failures of ideational controls.
Indications of severe cognitive disruption are much more suggestive of bipolar manic disorder than of either bipolar or unipolar depression.
Coping Style: The client is extratensive. His typical problem-solving strategy is to interact emotionally with others to try out various solutions. Preference for this style derives from experiences which have reinforced relying on interactions with people, and expressing or acting on feelings. Many tentative and trial solutions are put forth to learn intuitively how they feel and work. He is prone to external distractions and is likely to be influenced by confrontation, especially with authority figures.
Seriously distorted perceptions of reality interfere with appropriate problem-solving.
If his current test performance is reliable and there is no contradicting history of prior accomplishment, he has fewer coping resources available than most. His social immaturity or inadequacy increases his vulnerability to pathology.
Emotional Receptivity: He is extremely unwilling or unable to respond to or be affected by complex or intense emotion. His strong avoidance of affect is an ongoing trait which may stem from a mistrust of his feelings or a learned fear of not controlling them. If the responses to Cards VIII, IX, and X are exceptionally complex and rich, he may be more emotionally responsive than is implied by the preceding statements. His avoidance of emotionality lowers his potential to adequately resolve interpersonal problems. Backing away from affect as he does probably stems from his fear of losing emotional control. In coping situations, he prefers to be spontaneous, interactive, and demonstrative when affect impinges.
Perceptual Monitoring (Information Processing): The client spends about as much time and energy as most people gathering and integrating information about situations before acting. However, he often becomes very involved with his thoughts or feelings, perhaps as a function of dealing with stress.
The person does not perceive even relatively obvious events in a socially conventional way. He tends to neglect cues about what is socially correct. If the PSV Special Score represents a percept repeated on the same Card, he may have occasional trouble redirecting his attention, perhaps due to preoccupations.
Motivation (Information Processing): He strives harder than most to gather and integrate complex information so that, when presented with problems or decisions, he can be ready to resolve them. If resources are limited or impaired, this can breed frustration. Taking on more demands than he can manage efficiently may serve the purpose of gaining acceptance from others. Consider dynamics of overachievement and fear of failure. Given his currently available resources, he is trying to overachieve to a grandiose degree. Type A personalities, hypomanics, and sociopathic personalities often unrealistically overextend themselves in this way. Energy and time are wasted by compulsive information gathering. In particularly demanding and complex situations he is likely to overextend his achievement efforts and motivation, using more energy and taking on more burden than is necessary. His negative self-focus or anticipation of negative outcomes may limit his effort and persistence with difficult tasks.
The results of his efforts to comprehend and synthesize information he takes in are usually more complex, developed, and mature than most. Sophistication such as this occurs in brighter and better educated people, but is not synonymous with well-being.
Reality Testing and Conventionality (Cognitive Mediation): Mediation is usually appropriate in clear situations, but his reality testing diminishes with ambiguity. He distorts reality to a serious degree. Impaired reality testing of this magnitude often causes ineffective, inappropriate, and deviant everyday behavior which is not in response to reality demands. It can be functionally disabling.
When his reality testing is impaired, it seems to be associated in particular with handling affect, somatic concerns, vulnerability, or a history of medical problems, and experiencing strong feelings. When the client becomes angry or oppositional, he begins to perceive other people or external events in a less accurate fashion. Examine commonalities in emotional overtones and content of S- responses for clues to specific disorganizing problems. When conventional behavior is expected and easy to identify, he tends to be atypical and unconventional, acting more in reference to his own needs or interests than to social expectations. Social acceptability is not an important consideration to him.
Thinking Problems (Ideation): The following hypothesis is based on the Ego Impairment Index (EII), an index under consideration for the Comprehensive System. If calculations or ranges for the EII are changed, this hypothesis may no longer apply: There is evidence of moderate to severe impairment or limitation in thinking as applied to problem solving and effectiveness in demanding life situations. His style of thinking about problems is to gather information, consider how he and others feel about the issue, and to merge intuition with logic. Numerous trial solutions give him important feedback which shape further thinking and decisions. Although he is sufficiently flexible to at times let emotions be subordinated to logic, he usually prefers to consider feelings along with thinking.
The client’s internal needs and the external demands on him impact his thinking to an average degree. Any interference with directed thought is not of clinical concern and may simply help alert him to what needs his attention.
His ideas, beliefs, and values are extremely rigid and fixed. His thinking is narrow and very resistant to change. Consequently, his range of available coping behaviors is restricted. A pessimistic set pervades his thinking and limits his search for possible resolutions to problems. It also may motivate negative self-fulfilling prophesies and a resolute acceptance of faulty logic.
There is no evidence that delusional processes are occurring at this time. There is evidence of serious cognitive problems. His use of faulty logic often leads to errors in judgment and decisions. If he seemed uncertain or unresolved about Special Score responses, disturbed thinking is more ego-alien and may not be a chronic problem. Circumstantial and tangential thinking is seen which may be a result of emotional interferences with thought processes, a characteristic of patients with affect disorders. This also can be a temporary reaction to stress. Poor cognitive control allows his personal agenda to interfere with his staying goal-directed and task-oriented. The projected content of DR Special Scores may disclose the type of intrusive personal material. Schizotypal patients frequently produce DR responses. If the Special Scores contain no bizarre material but just use poor logic not expected at this age, he may simply lack effective social or verbal skills. This can result in poor judgment and inappropriate communications or behaviors. Special Scores using common idiomatic words or thinking suggest less pathology than those with unusual or odd content. Truly bizarre Level 2 answers indicate severe cognitive dysfunction only if confirmed by history. In adults, consider feigned pathology. If the characteristics of any M response are particularly juvenile or primitive, his thinking, at times, probably is less mature than is typical for his age.
Schizophrenia: Note: Although the SCZI is no longer used in the Comprehensive System, hypotheses based on SCZI variables and clusters are included in the following section. Please attend to the stated caveats.
Although disturbed thinking is seen, perceptual distortion is less severe than is typical of schizophrenia. Consider other causes of the cognitive dysfunction such as affect disorder, schizotypal personality disorder, or drug-related conditions.
Structural aspects of the Rorschach may provide some diagnostic clues but they cannot be definitive. Additional sources of information must be used to formulate a diagnosis. This protocol suggests consideration of the following:
non-schizophrenic cognitive dysfunction affect disorder
strong depressive features dysphoric ideation
cognitive dysfunction discomfort with emotion
immaturity narcissistic personality disorder
lack of empathy hostile or antisocial tendencies
The following issues may become therapy concerns or may affect the course of treatment:
subtle or potential depression dysphoric ideation
fragile self-esteem pessimism
suicide risk early emotional trauma
anger avoidance of feelings
disturbed thought processes poor reality testing
affect-driven circumstantiality externalizing
overachievement social isolation
rigid independence antisocial tendencies
unrealistic views of people
If dysthymic symptoms are clinically evident, a trial of anti-depressant medication may prove helpful, although depressive features may not be the major treatment issue. Cognitive techniques are needed to counter depressive and self-destructive thinking and attitudes. Treatment should help him clarify confused feelings, express pain outwardly, minimize intellectualizing about feelings, and prevent degrading of self-worth. Cognitive reframing of the negative self-concept is needed. Improvement may be slow and difficult. Since early experiences have contributed to his negative views, exploration of the past may be painful but helpful in building a more positive self-concept. Support alone is likely to have limited impact. Positive imagery and affirmations may help.
Take precautions for suicide risk!
His avoidance of affect may impede the processing of emotional material in psychotherapy. It may be productive to explore his reluctance or inhibition about reacting to feelings. He has conflict about his feelings and may resist dealing with them in therapy.
Because the client misperceives and distorts when he is angry, therapy will be less effective at such times. Behaviors and decisions should be deferred until his negativity subsides. His distortion of reality indicates that decisions and behaviors may not be based on accurate data. He needs realistic feedback and guidance. If his atypical views of reality contribute to social or interpersonal problems, feedback from the therapist and others may help him establish more consensual grounds for communication and perception. He may not listen well nor try to integrate the therapist’s ideas that stress understanding. In a stressful situation, he is likely to act without thinking about his goals in therapy. Due to his tendency to think in rigid ways, shifting his focus to consider alternate understandings and multiple perspectives will require preparation, planning, and time.
Encouraging self-examination may lead to his dwelling too much on his negative features. A focus on his more positive features and on the world around him is needed. He is likely to painfully dwell on his more negative features, losing sight of his strengths. However, a result of his self-questioning can be to reconstitute an inflated and ungrounded self-esteem. The current lapse may offer an opportunity for mature ego development growth.
Because engaging others with his problems is familiar and comfortable, therapy can be interactive and affect-oriented. The therapist’s authority and group pressure are influential but the person may rush into trying new behaviors before thinking much.
At this time, structure, predictability, support, and assistance are needed when new or difficult problems arise. Additional and more effective coping skills should be developed to combat his sense of helplessness. In psychotherapy, he will find it difficult or "unnecessary" to take responsibility for change, feeling that things should be better without his having to do much. Simply letting him talk about himself will reconstitute possible narcissistic injury, at which time he may feel no need to continue treatment. A commitment to long-term reconstructive therapy is needed to nurture genuine self-worth. Very supportive and constructive confrontation is required for him to learn to live without his props. He probably will want to work hard and accomplish much in psychotherapy. His treatment goals are likely to be unrealistically high. To prevent frustration, he needs help setting and accepting more realistic and achievable goals.
Therapeutic change will be difficult because he is very prone to rationalize, blame, and avoid responsibility, believing that success should come magically without his having to do much. Early termination is likely unless ego is carefully supported. As a protection against negative views of himself, he may deny any need to change, tending to project blame for problems onto others. Psychotherapy may not be accepted unless significant narcissistic injury has occurred, in which case just talking about himself can restore self-confidence. True personality change, if he is convinced he needs it, comes with reconstructive therapy. Resistance to psychotherapy is likely to result from his self-centered involvement and a denial or externalization of his need to change.
Treatment should stress establishment of a strong, supportive social network. His participation may be limited and should be encouraged. In initial therapy sessions, he will have difficulty trusting and making close contact. Persistence is needed to break through his distancing and detachment. If treatment has lasted more than five to seven months, interpersonal closeness and trust should have developed but it does not appear to be established. The therapist-client relationship should be consistent and largely nurturant.
If the person is currently engaged in treatment, termination is ill-advised at this time. Many issues are unresolved and should be addressed. For him to more adequately manage stress, he needs to develop new or more effective coping skills. He needs to experience himself and his environment more thoroughly, openly, accurately, and consistently in order to cope better. To use his ideational resources more effectively, his thinking needs to become more logical, conventional, and applied to reality. Therapy should help him become more able to enjoy and manage his emotional experiences. There are problems with being comfortable and interested in seeking and sustaining close relationships with others. Satisfaction and preoccupation with self remain problematic.
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