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A Rorschach Case Study

2017; Hogrefe Verlag; Volume: 38; Issue: 1 Linguagem: Inglês

10.1027/1192-5604/a000089

2151-206X

James H. Kleiger,

Academic and Historical Perspectives in Psychology

Free AccessA Rorschach Case StudyMultiple Psychoanalytic Models of InterpretationJames H. KleigerJames H. Kleiger Private Practice, Bethesda, MD, USA Search for more papers by this authorPublished Online:July 13, 2017https://doi.org/10.1027/1192-5604/a000089PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreRoy Schafer (1954) began his classic work Psychoanalytic Interpretation in Rorschach Testing with the following statement:No matter how helpful a clinical tool may be, a psychological test cannot do its own thinking. What it accomplishes depends upon the thinking that guides its application. This guiding thought is psychological theory, whether explicit and systemized or implicit and unsystematized. (p. xi)Since Schafer spoke these words, the importance of integrating psychological theories of development and psychopathology into test interpretation has been recognized as a well-established axiom of diagnostic testing. However, we are often faced with the question of which guiding theory to use. Do we select the one that inherently appeals to us, that makes most sense and has the greatest explanatory power; or, like Fred Pine (1990), do we seek to evolve a unifying perspective among various models of the mind?At the 2013 Convention of the Society for Personality Assessment (Kleiger et al., 2013) and again at the 2014 International Congress of Rorschach and Projective Methods (Kleiger et al., 2014), distinguished panels of senior psychologists furthered this debate by presenting their interpretations of a single Rorschach protocol from multiple psychoanalytic theoretical lenses.The panelists not only demonstrated how they thought and how they used theory to make data come alive, but like the proverbial blind men describing different parts of the elephant, the contributors represented different theoretical perspectives or schools of thought, anchoring their inferences and formulating treatment implications within the parameters of the particular clinical psychoanalytic model they represented.Each contributor was given the Rorschach and Structural Summary from a patient referred to as Ms. B. and asked to interpret the data from one particular psychoanalytic model of personality. Contributors were asked to organize their presentations around the following questions:1.How does your model aid in a diagnostic understanding of Ms. B.’s internal experience and personality functioning? What unique aspects of her functioning does your model address?2.What features of her Rorschach (formal scores, indices, thematic content, behavior) lend themselves particularly well to your model? In other words, what Rorschach data help you form links with key constructs in your model?3.How does your model guide you in addressing the referral questions and in making inferences about treatment issues based on Ms. B.’s Rorschach (e.g., type of treatment, intensity, potential transference–countertransference themes, need for supportive interventions)?The panelists, now authors, and their psychoanalytic models included:1.Irving Weiner, PhD, psychoanalytic ego psychology;2.Bruce L. Smith, PhD, object relations theory;3.Marshall Silverstein, PhD, self psychology;4.F. Barton Evans, PhD, Sullivanian interpersonal theory; and5.Ety Berant, PhD, attachment theory.Dr. Jed Yalof served as discussant for each paper. His integrated discussion is included in this series of papers.The Case of Ms. BMs. B was an 18-year-old Caucasian woman referred for a psychodiagnostic consultation by her psychotherapist, Dr. X. Early in the spring, Ms. B. ingested a potentially lethal dosage of medication (Ambien and Oxycodone) in an attempt to take her life. Her suicide attempt occurred in the context of close communication with Dr. X., who had spoken to her not long before her overdose. Ms. B. and her therapist had been talking about her depression, but Ms. B. had reportedly reassured Dr. X. that she was safe; she denied plans and intentions to hurt herself. Additionally, she agreed that she would not act on any suicidal feelings without first talking to her therapist or someone else.After her overdose, Ms. B. was discovered by a roommate, who called 911. When Dr. X. eventually spoke with Ms. B. at the hospital, she was reportedly enraged that people were taking away her right to decide if she lived or died. Ms. B. was clear that she had attempted to kill herself. Although she initially refused a voluntary hospitalization, she reluctantly agreed to inpatient treatment after involuntary admission was presented as the only other option. Soon after she was admitted, Ms. B. was said to have calmed considerably. She was no longer voicing any suicidal thoughts or feelings. She was eager to return to classes and her dorm and carry on as if nothing significant had happened.Officials at her college were cautious about having Ms. B. return to school following a suicide attempt without psychiatric clearance. The question about whether she should be allowed to return to school added weight to Dr. X.’s questions about Ms. B.’s mental status, level of suicidality, diagnosis, and treatment recommendations. Thus, Dr. X. formulated the following questions for this psychodiagnostic consultation:1.To what degree does Ms. B. still present a risk for suicide or self-harm? Should she be allowed to return to her dormitory?2.Is there evidence of an emerging bipolar disorder, and to what degree does posttraumatic stress contribute to the diagnostic picture. Finally, is there evidence of a vulnerability to dissociation or psychotic symptoms?3.What are the implications for treatment? What would be the appropriate setting and level of intensity to help Ms. B. address her problems?Ms. B.’s Rorschach responses (Appendix A), coding and sequence of scores (Appendix B), and Structural Summary (Appendix C), based on the Comprehensive System (Exner, 2005), are presented.References Exner, J. E. Jr. (2005). A Rorschach workbook for the Comprehensive System (5th ed.). Asheville, NC: Rorschach Workshops. First citation in articleGoogle Scholar Kleiger, J. H., Weiner, I. B., Silverstein, M. L., Smith, B. L., Evans, F. B. & Yalof, J. A. (2013, March). Multiple psychoanalytic perspectives: A Rorschach case study. Symposium conducted at annual meeting of Society for Personality Assessment, San Diego, CA. First citation in articleGoogle Scholar Kleiger, J. H., Berant, E., Evans, F. B., Ikiz, T., Smith, B. L. & Weiner, I. B. (2014, July). Multiple psychoanalytic perspectives: A Rorschach case study. Symposium conducted at International Congress of Rorschach and Projective Methods, Istanbul, Turkey. First citation in articleGoogle Scholar Pine, F. (1990). Drive, ego, object, & self. New York, NY: Basic Books. First citation in articleGoogle Scholar Schafer, R. (1954). Psychoanalytic interpretation in Rorschach testing. New York, NY: Grune & Stratton. First citation in articleGoogle ScholarAppendix ATable A1 Rorschach ResponsesC-#V^@ResponseInquiryI-1A goblin…(most people see more than one thing)Used whole card, eyes, and fangs or something and horns and pointy ears, a pointy face2Could be…all I see is a goblin (take your time)…an angel without a headWhole thing, body, wings outstretched but it didn’t have a headII-3Cat [immediately responds]I think the way the paint goes outward. Looks like whiskers, and nose pointed up here like a cat and the eyes (How much of the card?) uh [covers ½] like…I guess the white spots and the black width of paints strokes, the black (circle) it’s like a cat’s face [(using top?) no not really4Or…two elephants dancingHead, trunk, ears, black parts5Or the face of a moth(How much?) Now it looks like cat but if red parts were eyes and weird pointy nose, I guess just upper partIII-6Two people playing the drumsThese are people and two drums and these are music notes or something (What suggested a drum?) Looks like tribal drums (tribal drums). Here, seems like motion or maybe one big drum or maybe two individual things next to each other (Musical notes?). Can’t see in real life but kind of looked like that. That’s why I thought playing drums, maybe singing as well7Or …..Someone with a really weird hairdo and a bow on top of their head, wearing sunglasses [puts down, face down and almost reaches for next]Weird futuristic sunglasses, mouth, nose and weird pigtaily thing, braided up in some weird way and bow on topIV-8A dragonHere there are the dragon’s wings and head sort of flying down towards someone, the way it looks to be going9Or a giant without any arms. Looks cut offLooking at everything but thing in middle. Looks like head, and big feet and legs but it doesn’t have any arms10Or ….some sort of animal’s skeleton or skull like a horse or a dog [puts card down]Everything right there, not giant’s legs but everything else. (What about it suggested that?) Water marks indicate eye socket or nose. Water marks indicated teeth and eye sockets (water marks?) the shading. It looks too elongated to be a dog. Here looks like ears are decaying. Looks like skin rotting off (skin rotting off?) doesn’t looks like defined skull still looks like some fur on there (fur, what suggests fur?). These extra lines on here [outlines] are mangy and ears still like a little draped, a little fuzzy V-11BatLooks like wings, whole, looks like wings as it is flapping down and weird ears and legs….[foot shaking]….[puts card face down]VI-13A uh….Great DaneEverything but thing on top. Dark spots looks like its tiny dark eyes, and looks like Great Dane’s face looking right at you. Saggy face and cheeks (saggy?), the lines there and drool here because water marks are lighter and looks like a bone in its mouth like a dog looks at you for praise when it has somethingOr a that giant Jesus on mountain in Rio de JaneiroNever been there, on a big peak right here, big mountain and looks like Jesus like figure holding out arms like a statue is doing. (Mountain?) Looks like, the Jesus in Rio is on a mountain (Jesus) it looks like arms are stretched out14 A Kachina dollSame part. I have a bunch at home on wooden stands. And if I looked at it, the shading makes it look more tribal, like a tribal cloak, which looks like it is kind of spreading out and a mask because it looks like it has whiskers15 Or an animal fur carpetWhole (fur carpet)? Looks like an animal skin like we have at home. We have it in storage because we inherited it from a crazy relative. There’s a stripe in the middle in the shaded area that looks like an animal skin, where you can tell where bits of the animal were. And can also tell where hind legs were chopped off of it. Just the pattern on the bottom part reminds me of a deer skin16…..Or a volcano [puts card down, face down]All of it. This looks like the tunnel where lava is shooting out of the opening and this is a volcano here and the top it looks like an explosion. VII-17Two women talking to each otherLooks like heads, facing each other, and this the bodies, sitting in front of each other. Reminds me of an Indian feather, some weird hairdos 18Or a pile of rocksLooks like, yea, looks like rocks stacked up on each other. I’ve seen pictures of rocks where there are boulders. Don’t know how they do that. How they get there. (What suggested rocks?). The dark color of Rorschach and …how the bottom pieces are big and get smaller so seems like a weird balancing thing19Or a necklaceWhole clunky thing without these. Clasp and big chunky part that is hanging down. Some gaudy necklace that I’d never wear, big fake jewels strung together. Big cheap gold thing20Or like lots of thumbs up [motions] [puts card down, face down]Looks like thumbs up [motions] like, “Hey good for you. Yeah, thumbs up”VIII-21A dressReminds me of one of this mid-1900 dresses, short sleeves and high collar and hugs waist and orange part would just flow out. You can’t see whole dress but would be there22Or uh…two iguanas climbing up a plantGreen part looks like branches and pink things looks like iguanas climbing. Almost looks like orange and pink part looks like a rock that they’re helping to get up on the plant (Rock?) Reminds me of Arizona or El Paso, somewhere in the Southwest when a sunset you see big rocks and they have cool colors. Kind of looks like a plant is springing out of rocks and there is stem there…..[shaking foot puts card down, face down]IX-23A blender exploding [humming softly]Whole thing. Looks like clear part is the blender the glass part and all this stuff, when blenders explode they come out of top. But this looks like it is coming out everywhere, leaking out at bottom24…….Don’t know… something else’s face. Like a wacky or goofy looking Chinese dragon’s faceJust here, where the orange is leaking into the green. Chinese dragons’ faces always like goofy. Sometimes their eyes are crossed and here you see eyes crossed and there’s a nose and a weird mouth. And orange on top is sort of like the horns, maybe the dragon-shaped head25Or a chipmunk with too many acorns in its mouthJust the green part looks like a face of chipmunk with too many acorns. The little white points look like eyes and rest of green is rest of face but it is too big because it stuffed its mouth too fullX-26Bunch of sea creaturesWhole thing. Red parts are lobsters and the blue looks like crabs and little green things. Kind of looks like sea horses and then brown looks like different kinds of crab or weird shrimp. Just so colorful reminds me of different kinds of fish and aquatic life (lobsters?) big and red and looks like tails27Or Eiffel TowerUsed white in middle and this rod on top and it looks like the legs of Eiffel Tower and it’s connected in the middle and goes up and gets smaller 28 Or a man in sunglasses with a goofy mustacheLooks like his face and sunglasses and weird face flushed. Looks like a villain who has been baffled. Weird flushed cheeks and part in middle some goofy mustache (Sunglasses?) blue parts. Big round dots (Flushed cheeks?) some red looks like blushing (What suggests a villain?) I see a narrow face and sunken cheeks and long nose and sinister moustache, reminds me of Jafar from Aladdin or some suspicious European spy; almost comical. (Sunken cheeks?) Just imagine it because face looks triangular so it’s a very narrow face. (Baffled?) Just his look .… As if his evil plan had been foiled but he was determined to make another evil plan. Sort of like cartoonishFavorite card?II Elephants because looks like having funLeast favorite?X Because doesn’t have a super clear image and I had to make somethingTable A1 Rorschach ResponsesView as image HTML Appendix BTable B1 Rorschach coding and sequence of scoresLocation and DQLoc. No.Determinant(s) and Form Quality(2)Content(s)PopZ ScoreSpecial ScoresWSo1Fu(Hd)3.5GHR Wo1Mpo(H)1.0MOR, PHR DdSo99F-AdD+1Mao2A5.5FAB, COP, GHRWo1F-Ad4.5D+1Ma.mao2H, Sc, AyP4.0GHRWS+1FoHd, Cg5.5PHRWo1FMau(A)2.0Wo1Fo(H) P2.0MOR, PHRDd+99Mp.FY-An, Hd4.0MOR, PHRWo1FMaoAP1.0Do1FMp.YF-AdD+8Mpo(H),Ls6.0GHRDo3FY.mpo(H), Cg, AyPER, GHRWo1FYoAd P2.5DR, MOR, PERW+1ma-Ls, Ex2.5D+2Mao2Hd, CgP3.0GHR Wv/+1YF.mpuLs2.5Wo1mp-Cg2.5Ddo21MpuHdPHR Wo1F-Cg4.5W+1FMa.CF.mpo2A, LsP4.5W+1maoHh, Ex5.5Ddo99Fu(Ad)Do1FoAd, FdWo1CFuA5.5DdSo22F-Sc, AyDdS+99Mp.FC-Hd, Cg4.0PHRTable B1 Rorschach coding and sequence of scoresView as image HTML Appendix CFigure C1 Comprehensive System 5th edition structural summarySummarySix experienced clinicians interpreted the Rorschach of Ms. B., an 18-year-old patient who had been referred for psychological testing following a severe suicide attempt. The clinicians each conducted a blind interpretation of Ms. B.’s Rorschach from six different psychoanalytic schools of thought, which included ego psychology, object relations, self psychology, interpersonal theory, the French psychoanalytic school, and attachment theory. In their interpretations of Ms. B.’s Rorschach, the clinicians organized their formulations according to the following set of questions: (1) How does your model aid in a diagnostic understanding of Ms. B.’s internal experience and personality functioning? What unique aspects of her functioning does your model address?; (2) What features of her Rorschach (formal scores, indices, thematic content, behavior) lend themselves particularly well to your psychoanalytic model?; and (3) How does your model guide you in addressing the referral questions and in making inferences about treatment issues based on Ms. B.’s Rorschach (e.g., type of treatment, intensity, potential transference–countertransference themes, need for supportive interventions). A discussant integrates the interpretations of Ms. B.’s Rorschach from multiple psychoanalytic perspectives.RésuméSix cliniciens expérimentés ont interprété le Rorschach de Mme B., une patiente de 18 ans qui avait été renvoyée pour un test psychologique suite à une tentative de suicide. Les cliniciens ont chacun effectué une interprétation aveugle du Rorschach de Mme B. venant de six écoles différentes de pensée psychanalytiques, notamment la psychologie de l’ego, les relations d’objet, la psychologie du soi, la théorie interpersonnelle, l’école psychanalytique française et la théorie de l’attachement. Dans leurs interprétations du Rorschach de Mme B., les cliniciens ont organisé leurs formulations en fonction des questions suivantes: (1) Comment votre modèle aide-t-il à une compréhension diagnostique de l’expérience interne de Mme B et du fonctionnement de sa personnalité? Quels aspects uniques de son fonctionnement correspondent à votre modèle? (2) Quelles caractéristiques du Rorschach (scores formels, indices, contenu thématique, comportement) se prêtent particulièrement bien à votre modèle psychanalytique? Et (3) Comment votre modèle vous pousse à aborder les questions de recommandation et à faire des inférences sur les problèmes de traitement en fonction du Rorschach de Mme B (par exemple, le type de traitement, l’intensité, les thèmes possibles de transfert et contre-transfert, le besoin d’interventions de soutien). Un intervenant intègre les interprétations du Rorschach de Mme B. à partir des multiples perspectives psychanalytiques.ResumenSeis clínicos experimentados interpretaron el Rorschach de la Sra. B., una paciente de 18 años remitida para una administración de tests después de un grave intento de suicidio. Cada clínico realizó una interpretación a ciegas del Rorschach de B. según seis escuelas de pensamiento psicoanalíticas diferentes, que incluían la psicología del yo, la teoría de las relaciones objetales, la psicología del self, la teoría interpersonal, la escuela psicoanalítica francesa y la teoría del apego. En sus interpretaciones del Rorschach de B., los clínicos organizaron sus comentarios de acuerdo con las siguientes preguntas: (1) ¿Cómo ayuda su modelo a la comprensión diagnóstica de la experiencia interna y el funcionamiento de la personalidad de la Sra. B? ¿Qué aspectos singulares de su funcionamiento aborda su modelo? (2) ¿Qué características de su Rorschach (codificación, índices, contenido temático, comportamiento) se adaptan particularmente bien a su modelo psicoanalítico? (3) ¿Cómo le guía su modelo al abordar las preguntas sobre el motivo de consulta y al hacer inferencias sobre cuestiones relacionadas con el tratamiento, basadas ​​en el Rorschach de la Sra. B (por ejemplo, tipo de tratamiento, frecuencia, cuestiones sobre transferencia-contratransferencia, necesidad de intervenciones de apoyo)? Un comentarista integra las interpretaciones del Rorschach de B. desde múltiples perspectivas psicoanalíticas.要 約６人の経験のある臨床家が、重篤な自殺企図により心理検査に紹介されてきた１８歳の女性であるMs.Bのロールシャッハ法の解釈を行った。臨床家たちは６つの異なった精神分析の学派からMs.Bのロールシャッハ法のブラインドアナリシスをそれぞれ行った。６つの学派には、自我心理学、対象関係論、自己心理学、対人関係論、フランス精神分析学派、愛着理論が含まれる。Ms.Bのロールシャッハ解釈において、臨床家たちは以下の疑問に答えるように彼らの解釈をまとめた。（１）あなたのモデルはMs.Bの内的経験やパーソナリティ機能を診断的に理解するのにどのように助けているか？彼女の機能のどのようにユニークな側面にあなたのモデルは対応するのであろうか？（２）彼女のロールシャッハのどの特徴（形態のスコア、指標、主題内容、行動）があなたの精神分析モデルに特に役立っているのか、（３）あなたのモデルはMs.Bの紹介されてきた疑問にどのように対応し、Ms.Bのロールシャッハに基づく治療上の問題ついてどのような推論をするか（すなわち、治療のタイプは、可能性のある転移—逆転移のテーマは、支持的な介入の必要性）。討論者は多様な精神分析の観点からのロールシャッハ解釈を統合している。James H. Kleiger, Private Practice, 6320 Democracy Blvd, Bethesda, MD 20817, USA, james.kleiger@gmail.comFiguresReferencesRelatedDetailsCited byDiscussion of Special Issue Articles “A Rorschach Case Study: Multiple Psychoanalytic Models of Interpretation”Jed Yalof13 July 2017 | Rorschachiana, Vol. 38, No. 1 Special Issue: Multiple Psychoanalytic Models Case StudyVolume 38Issue 1July 2017ISSN: 1192-5604eISSN: 2151-206X ReceivedDecember 19, 2016AcceptedApril 5, 2017Published onlineJuly 13, 2017 InformationRorschachiana (2017), 38, pp. 1-11 https://doi.org/10.1027/1192-5604/a000089.© 2017Hogrefe PublishingPDF download