The clinical utility of the Rorschach: Unfulfilled promises and an uncertain future.

Abstract

The empirical evidence on the Rorschach is reviewed using three definitions of clinical utility: (a) the nature of professional attitudes and extent of clinical usage, (b) the extent of evidence for reliability, validity, diagnostic efficiency, and incremental validity, and (c) the extent of evidence that Rorschach data improve clinical decision-making and/or treatment outcome. Surveys demonstrate that the Rorschach is extensively used; however, these data are insufficient to demonstrate clinical utility as they do not address the rational, scientific, and ethical requirements of professional standards for psychological measures. After reviewing conceptual issues in Rorschach research (especially those in the Comprehensive System) the authors conclude that there is little scientific evidence to support the clinical utility of the Rorschach. Given the absence of data evaluating how the Rorschach is used in routine practice and whether its use is consistent with the manner in which it is used in research, there is currently no scientific basis for justifying the use of Rorschach scales in psychological assessments.

Rorschach Comprehensive Variables and Assessment for Psychodynamic Psychotherapy

“…The incremental validity and clinical utility of the CS has been seriously questioned Hunsley & Bailey, 1999, while other authors have presented support for the incremental validity and utility of the CS (Blais, Hilsenroth, Castlebury, Fowler, & Baity, 2001;Meyer, 2000;Viglione, 1999) An issue that has been central in the critique of the validity of the CS concerns the meta-analytic studies undertaken primarily to obtain information about the general validity of the Rorschach. There are meta-analytic studies (Atkinson, Quarrington, Alp, & Cyr, 1986;Bornstein, 1999;Hiller, Rosenthal, Bornstein, Berry, & Brunell-Neulib, 1999;Parker, Hanson, & Hunsley, 1988), which are regarded as supporting the validity of the Rorschach.…”

“…There are meta-analytic studies (Atkinson, Quarrington, Alp, & Cyr, 1986;Bornstein, 1999;Hiller, Rosenthal, Bornstein, Berry, & Brunell-Neulib, 1999;Parker, Hanson, & Hunsley, 1988), which are regarded as supporting the validity of the Rorschach. However, these studies have been criticised as being methodologically defective, and several researchers have engaged themselves in a controversy concerning the value of the analyses Garb, Florio, & Grove, 1998Hunsley & Bailey, 1999;Lilienfeld et al, 2000;Meyer & Archer, 2001;Parker, Hunsley, & Hanson, 1999;Rosenthal, Hiller, Bornstein, Berry, & Brunell-Neulieb, 2001;Viglione & Hilsenroth, 2001;Weiner, 2001).…”

“…Proponents and critics of the CS have also debated the temporal consistency and the interrater reliability of the CS (Acklin, McDowell, Verschell, & Chan, 2000;Costello, 1999;Ganellen, 2001;Garb et al, 2001;Hibbard, 2003;Hunsley & Bailey, 1999;Lilienfeld et al, 2000;McDowell & Acklin, 1996;Meyer, 1997aMeyer, , 1997bMeyer et al, 2002;Viglione, 1999;Viglione & Hilsenroth, 2001;Weiner, 2001;Wood, Lilienfeld, Nezworski, & Garb, 2001;Wood, Nezworski, & Stejskal, 1996a, 1996bWood, Nezworski, & Stejskal, 1997). In research, the reliability of the CS variables is now mostly calculated by using the intraclass correlation coefficient, ICC, as recommended by among others Acklin et al (2000).…”

Whither the Rorschach? An analysis of the evidence.

“…In the first round of articles in the Special Series, we concluded that there is no evidence that the Rorschach has clinical utility (Hunsley & Bailey, 1999). In the same round, Viglione (1999) also ostensibly addressed the utility of the Rorschach.…”

“…In the previous Special Section, we had an opportunity to present both empirical evidence and logical analysis that we believed were sufficient to demonstrate that the widespread use of the Rorschach in clinical, legal, forensic, and occupational settings is unwarranted on both scientific and ethical grounds (Hunsley & Bailey, 1999). Having reviewed the evidence presented by Killer, Rosenthal, Bornstein, Berry, and Brunell-Neulieb (1999) and Dawes (1999) and the arguments preferred by Strieker and Gold (1999), Viglione (1999), and Weiner (2001), we have found little reason to alter this position.…”