Rorschach Assessment of Adolescents: Theory, Research, and Practice

248 Pages·2016·3.01 MB·English

by  Shira Tibon-Czopp

Advancing Responsible Adolescent Development
Shira Tibon-Czopp
Irving B. Weiner
Rorschach
Assessment of
Adolescents
Theory, Research, and Practice
Advancing Responsible Adolescent Development
Series Editor
Roger J.R. Levesque
Indiana University, Bloomington, IN, USA
More information about this series at h ttp://www.springer.com/series/7284

Shira Tibon-Czopp (cid:129) Irving B. Weiner
Rorschach Assessment
of Adolescents
Theory, Research, and Practice
Shira Tibon-Czopp Irving B. Weiner
Goldsmiths, University of London University of South Florida
London , UK Tampa , FL , USA
ISSN 2195-089X ISSN 2195-0903 (electronic)
Advancing Responsible Adolescent Development
ISBN 978-1-4939-3150-7 ISBN 978-1-4939-3151-4 (eBook)
DOI 10.1007/978-1-4939-3151-4
Library of Congress Control Number: 2015950471
Springer New York Heidelberg Dordrecht London
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Pref ace
T his book is addressed to practitioners and researchers who are interested in adoles-
cent development, personality assessment, and the Rorschach Inkblot Method.
Adolescence is a complex and varied developmental phase, characterized by dra-
matic physical, mental, and psychological changes. Physically, the usual adolescent
growth spurt transforms adolescents from their childhood stature to much of their
adult size and strength, and the pubertal emergence of secondary sex characteristics
alters their shape and appearance. Mentally, adolescents become capable of abstract
thinking and increasingly familiar with the world around them. From a develop-
mental perspective, adolescents come to grips with the tasks of adjusting to their
bodily changes, individuating from their parents, becoming involved in social and
romantic relationships, and beginning to establish a sense of their personal identity
and advance toward adulthood.
Adolescents vary considerably in the pace of these transitions from childhood to
adulthood. Some early adolescents show adult characteristics, while some young
adults are mainly coping with adolescent issues. Moreover, the pace of develop-
mental changes is commonly uneven within as well as between individual adoles-
cents. Some adolescents are mentally sophisticated but socially immature, while
other adolescents of the same age show mature social skills but childishly concrete
reasoning. The wide variability of developmental issues both between and within
adolescents can make it diffi cult to distinguish normal from abnormal development.
This variability also makes it challenging to distinguish between transient reactions
to developmental crises that would be resolved and psychological disorders that are
likely to persist into adulthood.
The diffi culty in distinguishing normal from abnormal development in adoles-
cents has been compounded by an often expressed but erroneous view of adoles-
cence as a stormy period during which young people ordinarily show symptoms of
emotional disturbance. To the contrary, extensive research has documented that dis-
turbance is not an integral feature of normative adolescence and that apparent
symptoms of psychological disorder in young people should not be taken lightly, as
in “She’ll grow out of it” or “He’s just going through a phase.” However, regarding
v
vi Preface
a nd treating transient adjustment problems as evidence of diagnosable psychopa-
thology is as misguided as ignoring or making light of symptom formation in
adolescents.
A s for personality assessment, the distinction between normal range adolescent
functioning and diagnosable or emerging psychopathology can best be accom-
plished by accurate evaluation of a young person’s personality characteristics.
Personality characteristics that differentiate healthy from psychopathological states
can be observed in the four domains of cognitive functioning, affective experience,
interpersonal relatedness, and self-perception. In the domain of cognitive function-
ing, for example, psychologically healthy adolescents are usually able to think logi-
cally and coherently, whereas loose associations and arbitrary or circumstantial
reasoning are likely to indicate psychological disorder. Similarly, normal range ado-
lescents are for the most part able to perceive people and events accurately, whereas
disturbed adolescents often display impaired reality testing.
I n the domain of affective experience, normal range adolescents are reasonably
capable of recognizing and expressing their feelings, whereas severely constricted
emotionality, recurrent depressive moods, and persistent inability to experience
pleasure usually delineate the presence of some disorder. In the domain of interper-
sonal relatedness, adolescents are normally interested in and able to form rewarding
relationships with other people, whereas social disinterest and withdrawal may
refl ect developmental arrest or abnormality. Normal range adolescents are also able
to feel comfortable in close relationship, whereas those with psychological prob-
lems may regard other people with suspicion and distrust, and avoid any intimacy
with them. As for self-perception, psychologically healthy adolescents usually are
progressing toward forming a stable sense of identity and self-worth. Substantial
confusion about the kind of person the adolescent is or would like to become,
extremely lowered self-esteem, and feelings of being inept or unworthy often char-
acterize adolescents with psychological problems.
The Rorschach Inkblot Method is a sensitive and psychometrically sound
assessment instrument that measures personality functioning in the cognitive,
affective, relatedness, and self-perception domains. As such, the Rorschach proves
useful in distinguishing between normal and abnormal development in adolescents
and delineating the type of psychological disorder that might be present. The clini-
cal implications of Rorschach measurements depend on how the obtained fi ndings
accord with normative reference data. Only on the basis of such comparisons can
a valid evaluation be made concerning whether a young person is functioning
within the normal range or is instead likely to be experiencing or susceptible to
psychological disorder. The adolescent norms of the Rorschach Comprehensive
System (CS) have not been changed since the publication of the fi rst edition of
Volume 3 of the Rorschach CS (Exner & Weiner, 1982). Recently collected norma-
tive reference data on international samples of nonpatient adolescents provide con-
temporary cross-cultural data that update the previous norms and are presented in
this volume.
T he book begins with three chapters (Part I) that provide readers with basic infor-
mation on the topics to be discussed in the text. The fi rst of these chapters reviews
Preface vii
the development and foundations of the Rorschach Inkblot Method, with attention
to the continuing evolution of the CS and its utility for assessing adolescents in the
twenty-fi rst century. The second chapter discusses key issues in the assessment of
adolescents, with particular attention to differentiating patterns of psychopathology
from normal developmental variations. The third chapter presents general consider-
ations in utilizing performance-based assessment instruments in the evaluation of
personality functioning in adolescence, including the importance of integrating the
structural, thematic, and behavioral data in Rorschach interpretation and combining
the data with information obtained from self-report inventories.
F ollowing these three introductory chapters, the text continues with three chap-
ters (Part II) that discuss the current status of the Rorschach with respect to theoreti-
cal formulations, research fi ndings, and practice guidelines. Chapter 4 discusses
psychodynamic perspectives on Rorschach interpretation and elaborates the theo-
retical assumptions that responses to the inkblots (a) refl ect how people generally
experience and respond to events and (b) reveal underlying thoughts and feelings
that are likely to infl uence their behavior. Chapter 5 reviews research fi ndings dem-
onstrating that the Rorschach is a reliable, valid, and useful assessment instrument
and presents normative reference data obtained recently from an international sam-
ple of several hundred nonpatient adolescents. Chapter 6 on practice guidelines
addresses the issue of when and with whom the Rorschach works. This chapter
describes the utility of Rorschach assessment whenever decisions are being made in
light of personality characteristics and delineates the cross-cultural applicability of
the Rorschach to people of all ages, except for very young children. The contempo-
rary adolescent reference data provide the basis for presenting the cut-off scores for
45 CS variables and CS-based indices that have implications for normal or abnor-
mal functioning and fi ve stylistic variables that should be considered while inter-
preting the data. This diagnostic approach is illustrated in the text with a case study
of a normally functioning adolescent.
T he next fi ve chapters (Part III) elaborate diagnostic, forensic, and therapeutic
applications of Rorschach assessment. Chapters 7 – 9 discuss how Rorschach fi nd-
ings can facilitate differential diagnosis and treatment planning by providing infor-
mation about personality characteristics and psychopathological manifestations.
With eight varied case illustrations, these chapters show how Rorschach data, when
used properly in relation to age-based norms, can help delineate the presence,
nature, and severity of internalized and externalized symptom patterns. These eight
cases of symptomatic adolescents encompass a broad range of psychopathology,
including cognitive, affective, anxiety, avoidant, obsessive-compulsive, somatiza-
tion, and eating disorders. Each case illustration focuses on variables in the adoles-
cent’s protocol that deviate from normative expectation and thereby provide clues
to the nature of the young person’s disorder. Descriptive information and cutoff
scores for each of the 45 evidence-based variables are discussed in the course of the
case illustrations. Chapter 10 discusses the utility of Rorschach assessment in
resolving psycholegal issues, particularly in cases of criminal misconduct in which
the court is referring to trial competence, criminal responsibility, and correctional
dispositions. Special attention is paid to evaluating whether a behavioral problem
viii Preface
refl ects a transient developmental crisis, is symptomatic of some underlying disor-
der, or indicates the emergence of antisocial behavioral manifestations in adulthood.
Chapter 1 1 shows that Rorschach assessment can be therapeutic in its own right and
discusses the positive therapeutic impact that can derive from a well-conducted
Rorschach examination.
The twelfth and concluding chapter (Part IV) draws on information in the pre-
ceding chapters to formulate an empirically based psychodynamic model for
Rorschach assessment of adolescents that helps to delineate personality characteris-
tics conducive to positive adolescent development. The presented model of
Rorschach Psychoanalytic Science and Practice (RPSP) derives from standardized-
individualized conception of Rorschach assessment in which personality descrip-
tions are based on well-validated CS variables but also capture the individual
uniqueness of adolescents’ subjective experience of their psychological problems.
T his book follows in many respects the second edition of Volume 3 of the
Rorschach Comprehensive System (Exner & Weiner, 1982, 1995), which has been
the major reference source for Rorschach work with young people. The present text
extends the evolution of the CS in several aspects. Beyond reviewing the basic CS
administration and coding guidelines, this CS-based volume presents and applies
several new structural variables, provides updated normative reference data for dis-
tinguishing between healthy and faltering adolescent development, and illustrates
with detailed case studies how Rorschach assessment can help to delineate a wide
range of psychological disorders. Accurate evaluation of adolescents’ personality
functioning and symptom formation is essential for promoting progress toward
responsible and rewarding adulthood.
Tel-Aviv, Israel Shira Tibon- Czopp
Tampa, FL Irving B. Weiner
Acknowledgements
We would like to express our appreciation to several colleagues who assisted us in
the preparation of this book. Liat Appel and Ruth Zeligman of Tel-Aviv University,
Israel, were of great help in reviewing drafts of our text, translating case protocols
into English, and processing statistical data. Also playing an important role in
supporting the project was Gidi Lev of Bar-Ilan University, Israel. Our case illus-
trations include protocols provided by Piero Porcelli at the IRCCS De Bellis
Hospital, Castellana Grotte, Italy; Lily Rothschild-Yakar of University of Haifa,
Israel; Tony Sciara, who is in private practice and at the Rorschach Training
Programs, Asheville, NC; and Norma Semer Lottenberg of the Universidade
Federal do Sao Paolo, Brazil. Additional cases that served to illustrate substantial
issues discussed in the book were provided to us by Efrat Lurie and Michel
Allouche, who are in private practice in Tel-Aviv, Israel. We are most grateful to
all of them for their contribution in making available case illustrations for adoles-
cents of various ages and from different countries.
W e would also like to thank our editor, Roger Levesque, for inviting us to work
on this project and providing us with his many valuable suggestions. We are particu-
larly grateful to the many productive Rorschach theorists, researchers, and practitio-
ners who have been a wellspring of conceptual formulations, research reports, and
clinical experience on which we were able to draw in developing our conclusions
and recommendations. Most importantly, we want to thank our beloved families for
their enthusiastic support of our work.
Shira Tibon - Czopp
Irving B. Weiner
ix