Lerner Experiential approach to the Rorschach

Further thoughts on an experiential psychoanalytic approach to the Rorschach

Paul M. Lerner, EdD, ABPP On the basis of the work of Schachtel and Mayman, the author previously outlined an experiential approach to the Rorschach that differed from both an empirical approach and a more classic psychoanalytic approach originally proposed by Rapaport. Herein, the author further describes that approach by focusing on the person of the assessor as he or she goes about interpreting a protocol. Borrowing from the treatment literature, the author discusses the processes involved, including the need to immerse oneself in the raw data, the internal split between the experiencing self and the observing self, and the role of empathy and reflection. (Bulletin of the Menninger Clinic, 68 [2], 152-163) There is no more daunting, challenging, or exciting a task than Rorschach interpretation. By interpretation, I mean the process of involving oneself in an individuals responses to 10 inkblots, sifting through and organizing the welter of data, transforming the raw material into accurate and meaningful clinical inferences, and integrating these inferences in such a fashion as to be helpful to the individual and his or her family members. Several approaches to interpretation have emerged. Although these approaches share commonalities, they differ in important ways too. For instance, differences may be observed with regard to the weight assigned to different sources of information, the place given the examiner, the role of a personality theory that is independent of the test itself, and the relative importance accorded validity versus depth. One such approach, beginning with the work of David Rapaport and extended by his students, including Schafer (1954) and Mayman (1964), and by Schachtel (1966), has been referred to in various ways, including a psychoanalytic approach to the Rorschach and a theory-driven approach. Although these designations are accurate and

Dr. Lerner is in private practice in Camden, Maine. Correspondence may be sent to Dr. Lerner at PO Box 800, 7-9 Washington Street, Camden, ME 04843. (Copyright 2004 The Menninger Foundation)

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Experiential approach to the Rorschach capture the flavor of this approach, at base it is a clinical approach. Its primary aim is to use the Rorschach as a way of coming to know another, of achieving an understanding of that other person in his or her individuality, complexity, and especially depth. This intent not only informs all aspects of the assessment process, but it also determines the lines of interest one takes in the test itself. Here, one is not primarily concerned with the tests psychometric properties or evidence base. These are seen as measurement issues, not assessment issues. Rather, and as argued by Mayman (1964) and Schachtel (1966), one is concerned with how the test works, how one goes about interpreting or making psychological sense of the data it yields, and the validity of the clinical inferences it generates. Issuing from an abiding commitment to this interpretive tradition, herein I will attempt to describe, apply, and explain aspects of a clinical approach to Rorschach interpretation in which ones emphasis is on mining the test, at various levels, for all that it is worth. As Kinsella (1987) put it in his heart-warming novel, Shoeless Joe, to go the distance (p. 93). Building upon and extending previous writings (Lerner, 1998; Schafer, 1954; Smith, 1976) related to interpretation, in this article I will focus not on the test but on the person of the interpreter. More specifically, I will attempt to understand and conceptualize the work and experience of the assessor as he or she goes about interpreting a protocol from this clinical perspective. Background The clinical inference process consists of a systematic series of steps the assessor takes in transforming the raw material from the Rorschach into an internally consistent, clinically meaningful, informative psychological test report. Elsewhere (Lerner, 1992, 1998), I identified and outlined five distinct steps that constituted the inference process. Because test administration, test scoring, and interpretation are continuous and are part of the same overarching process, I referred to Step 1 as data gathering and emphasized, for interpretive purposes, the importance of careful administration, including adequate inquiry, accurate scoring, and verbatim recording. Recognizing that several highly sophisticated and richly elaborate Rorschach systems (Exner, 1974) have been developed for quantifying the formal scores, I designated Step 2 as qualitative analysis to indicate that it is here that one conducts his or her analyses. For those who approach Rorschach interpretation from a more psychometric perspective, Step 2 is especially critical because it is the tabulated scores and ratios that are the basic data from which inferences are drawn.
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Lerner For the clinically oriented interpreter, Step 3, first order inferences, is the more critical step. Here, one combs through the protocol response by response, phrase by phraseliterally word by wordand whenever a reasonable inference can be drawn, one writes in that inference. The inference is written adjacent to the actual response, score, or phrase so that one can keep track of his or her data source. I referred to Step 4 as transformation to indicate that here one begins to transfer the findings into what ultimately will be the test report. Inferences from the protocol are transposed to work sheets. On the work sheets are headings that correspond to the same headings (e.g., personality structure, thought organization, critical dynamics) that implicitly make up the test report. Inferences are placed under their appropriate headings. These work sheets provide the outline and material from which the testing report is written in Step 5. The report consists essentially of the inferences and the theoretical formulations tying them together. It is written at a level of language that particularizes the report to the individual patient (Smith, 1976). In addition to describing the clinical inference process, I (Lerner, 1998) have previously also identified two different yet complementary and interwoven approaches to the interpretation of Rorschach data. The first, which I labeled a structural approach, emphasizes test responses, the response process, and test rationales. It is based upon and harkens back to Rorschach himself, who believed that his test could elicit conclusions about the individuals characteristic way of experiencing but not about the content of the persons experience. Understandably, this led theorists to focus primarily on the more formal or structural features of a protocolthe scores and their interrelations. As one reviews this approach, whether it is the work of Rapaport or Exner, it becomes apparent that interpretations drawn from the structural features of a Rorschach record usually, although not always, are directed toward structural aspects of personality. There is little question of the important and lasting contributions that have come from this structural approach; however, it does have its limitations. Clearly, there is more to a Rorschach protocol than the scores and determinants, and there is more to a person than can be explained from just a structural perspective. It is on the basis of these limitations that I (Lerner, 1992, 1998) argued for a second and complementary approach to interpretation, one that drew attention to the more subjective aspects of the test record and, by extension, to the individuals subjective experience. What I have in mind, for example, are the meanings that a particular response, the entire test, or being assessed have for an individual as manifest in the content of responses, the full verbalization, or more spontaneous remarks. 154
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Experiential approach to the Rorschach Given that this approach required a more phenomenological orientation, I referred to it as a clinical-experiential approach and suggested that it required the assessors empathy. Further to a clinical-experiential approach To further explore the nature of a clinical-experiential approach, I next focus upon the third step in the inference process-first order inferences, and holding in mind the pivotal role of empathy, I describe other processes involved in this approach. It is my experience that the processes I will be discussing are no different from those involved in the treatment situation; however, in this instance, the relationship is not directly with a patient, but with a test protocol, and one is listening not to the spoken word, but to the written word. Immersion: The experiencing self and the observing self As noted above, in Step 3 of the inference process one scours the test record, systematically reviewing all the raw data with the intent of developing as many reasonable inferences as possible. To do this, and to do this well, one needs to be willing to immerse oneself in the protocol. That is, with a heartfelt sense of interest, wonder, and curiosity, one must be prepared to move into the raw material-to engage it, to feel it, and to preoccupy oneself with it. In essence, to fully experience it. Coincidental with this need to immerse oneself in the data, there is also a need to hold part of oneself back, to maintain that part of oneself a step removed and separate from the immersion. Borrowing from the treatment literature, I think of the part of the self that is immersed in the material as the experiencing self, and the part of the self that remains separate as the observing self. As in the treatment situation, the two selves work simultaneously and there is a constant internal interchange between them. With respect to function, whereas the experiencing self discovers or develops the inference, the observing self refines and extends the inference. For example to Card VII, a 39-year-old woman responded, This started to be a vessel of some kind but then I stopped. It then became two little genies looking at each other. Among other features to be seen in this response, my experiencing self attuned to her exquisite openness, her willingness to share with the examiner her entire thought process, not just the final product. My observing self extended the inference in this way: Underlying the patients candor and openness is a need to be seen, to be known, and to be recognized. Looked at from this perspectivethe split between the experiencing self and the observing selfscoring, a way of organizing the welter of
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Lerner material, is an activity exclusively of the observing self. Therefore, if one does not extend oneself beyond scoring, accepts that for each score or ratio there is a fixed meaning, and relies solely on computer-generated inferences, then ones experiencing self remains idle and inactive. On the other hand, I also appreciate that immersing oneself in a protocol, pushing beyond scoring and making use of ones experiencing self, can stir discomfort. Plunging into a test record often prompts feelings of confusion, bewilderment, and the anxiety of not knowing. Paradoxically, much like the treatment situation, it is the capacity to tolerate these feelings that permits the assessor to achieve a level of understanding that is not possible when one is governed by fixed rules and a predetermined direction. Empathy, reflection, and working models The challenge posed by a clinical-experiential approach is to understand the patients productions on the Rorschach in terms of their deepest meanings. One strives to sense what lies beneath and extends beyond the manifest images, words, and emotional expressions. Although meant to describe the psychoanalytic situation, Greensons (1967) comments are equally applicable to the Rorschach interpretive situation: One must listen to the obvious melody, but also hear the hidden, more latent themes in the left hand, the counterpoint (p. 365). The processes by which one grasps and understands more subtle and complex emotions, conflicts, and experiential themes are empathy and reflection. Within current-day psychoanalytic theory, empathy is viewed in a number of ways. It is considered a necessary quality of a parent and psychotherapist, a core feature of the therapeutic action of treatment, a powerful bond between people, and, most poignantly for our purposes, an information-gathering activity. It was Kohut (1959) who, more than 40 years ago, conceptualized empathy as a mode of observation and data collection. In his paper Introspection, Empathy, and Psychoanalysis, he argued that access to psychological depths could be obtained only through specific types of observation: introspection into ones own subjective state, vicarious introspection, and empathy into that of another. Empathy means to share, to partake and quietly participate in the experiences of another. Although it is considered a preconscious process, it can be consciously instigated or interrupted. It also can succeed or fail. The essential mechanism is a partial and temporary identification with the patient or, in Rorschach assessment, with the patients production. According to Greenson (1967), a powerful motive underlying empathy is the desire to establish contact with a lost love object, the 156
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Experiential approach to the Rorschach un-understood patient. That is, empathy represents an attempt at restitution related to loss. Closely related to empathy is reflection. Empathy leads to feelings, impressions, and pictures; reflection leads to the aha reaction, which means you have hit it, or the oh no reaction, which means you have missed it. Empathy is a function of the experiencing self; reflection is a function of the observing self. Empathy is emotionally more demanding; it consists of an emotional involvement and requires the capacity for controlled regression. It is similar to the creative experience of the writer. Reflection is emotionally less demanding, it involves detachment and perspective, and it is essentially a thinking process. It is out of the ongoing interplay between empathy and reflection, as one is sifting through the protocol, that one begins, ever so patiently and slowly, to construct an inner working model of the patient. Often, but not always, at some point during this sifting, combing process, bits and pieces start to fit together and the model takes shape; it comes to the forefront of ones mind and later material serves to correct, refine, and expand the model. The following example illustrates the interplay between empathy and reflection. In a rapid-fire, staccato manner, an aspiring female junior executive offered the following responses to card VIII: This is a geisha, or it is a hockey mask, or drilling down for gold. Within the empathic mode, next to the word geisha I indicated a willingness to serve and accommodate, next to the words hockey mask I wrote aggressive and self-protective, and adjacent to the phrase drilling down for gold I noted phallicly striving, relentlessly goal-directed, and highly concerned with success and financial reward. I then shifted from the empathic mode to the reflective mode and began integrating these separate inferences together with observations regarding her style of presentation. This led to the following second-order or broader inference: This is a well-defended individual who will serve, accommodate, competedo whatever is necessaryto further her own self-interests. One will find her productive and hardworking; however, her insistence upon high rewards and her lack of appreciation of her impact on others could well be alienating. Holding and primary maternal preoccupation Winnicott (1960) evoked the term holding to account for the mothers provisions during the early stages of her infants development. Typically, the term has been taken to mean her fulfillment of the childs actual physical needs and her providing ego supports to bolster the childs immature ego. More importantly, however, beyond specific functions, the concept refers to the atmosphere or ambiance the mother creates
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Lerner through her empathy and attunement to the child. She creates a world that the infant senses as safe and reliable, and thereby she allows the child to go on being. According to Winnicott, the very earliest stage of holding is what he referred to as primary maternal preoccupation. During and especially toward the end of her pregnancy, the mother reaches a state of heightened sensitivity toward her unborn. This state of preoccupation, which Winnicott affectionately described as a temporary illness, subsides and disappears after the baby is born. Bion (1956) used the metaphor of the container and the contained to extend the concept of holding to include the related process of containment. Underlying this metaphor is the image of an infant emptying its bad contents into the mother, who accepts the unwanted projections, contains them, and alters them in such a way as to permit their reintrojection by the infant. In addition to the other processes I have describedimmersion, empathy, and reflectionby analogy, I believe that holding and preoccupation also are involved in the clinical interpretive enterprise. It is my experience that as one immerses oneself in a protocol one becomes preoccupied with it. As with a patient in treatment, one pushes aside internal and external distractions and tries to be as emotionally available and receptive to the material as possible. In a manner similar to what Winnicott described, with a heightened sensitivity, one feels his or her way into the material. Once emotionally into the protocol, one not only writes down ones inferences, one also holds the inferences and the sources (i.e., earlier percepts, specific verbalizations, unusual scores) in mind. This activity of holding or containing information, I think of as the cognitive holding aspects of interpretation. Most often, this activity finds expressions when a response on a later card resonates and reminds one of an earlier response or an earlier inference. On the basis of several ill-defined, quasi-human forms such as cut-out figures and human-like figures seen on the first several cards, I inferred that a 47-year-old male patient had difficulty fully investing in relationships. I also inferred that his inner representations were not of real people but of vague, nonspecific shadows of people. On Card X, however, he saw two people dancing with the Eiffel Tower behind them. During inquiry, he added, The red shapes and they have gray hats. They are linked together with their hands. I thought of dancing because of the festive colors. His response on Card X reminded me of his earlier human responses and the contrast among them. Whereas his earlier forms were barren and lifeless, this later one was colorful, playful, alive, and vital. I was puzzled by this incongruity. This led me to think about the stimulus 158
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Experiential approach to the Rorschach properties of the cards. Because the lifeless forms appeared on the darkened, achromatic cards and the more vital forms on the enlivening, chromatic cards, I wondered if the difficulty in object relations I had inferred earlier issued not from a structural impairment but rather from the compromising effects of a depressiveness. The inference of a depressiveness quickly reminded me of his response on Card VII of a stone face. Holding all of this information in mind, I developed the following inference: This is an individual who is capable of deeper, more satisfying relationships; however, at this time this capacity is being interfered with by depressive feelings. His depressiveness, which is more long-standing, is, in part, related to his early experience with an emotionally unavailable, stone-faced mother. Again, my point here is that in order to develop more complex and integrated inferences, one must be able to hold in mind a great deal of information. Level of language In discussing the work of Rorschach interpretation from a clinical perspective, I have described the internal split in the assessor between his or her experiencing self and observing self as well as the dual processes of empathy and reflection. Further, I have suggested that whereas empathy is a function of the experiencing self, reflection is more a function of the observing self. Another important distinction between these two modes involves the level of language used in each. In an attempt to clarify the multileveled language of psychoanalysis, Mayman (1963) distinguished three coordinated sets of concepts or language. One set or level is the language used by the clinician in transaction with the patient, an everyday language more akin to poetry than science. Outside the clinical relationship, the clinician uses a middle language of clinical concepts and propositions that help formulate clinical generalizations about an individual. A third, more abstract language consists of hypothetical constructs, a system of impersonal concepts and formulations using more distant, third-person terms that constitute psychoanalytic metapsychology. In applying Maymans language schema to the distinction between the experiencing self/empathy mode and the observing self/reflective mode, it becomes apparent that in the former mode, one tends to use a level of language similar to that used with patients. That is, inferences derived in this mode are stated in descriptive terms, free of psychological and technical jargon, and pitched as close to the patients experience as possible. The inferences themselves are experience-near, and this is reflected in the language they are couched in.
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Lerner By contrast, in the observer self/reflective mode, inferences are conceptualized in a less experience-near way using the middle language level. Although the inferences are conceptualized at this level, one still attempts to state them in everyday language. Inferences in this mode, compared with those in the other mode, tend to be more general, more complex, and more integrative. The role of personality theory To approach Rorschach interpretation in the clinical manner I have described, one does not need to subscribe to a theory of personality that lies outside of the test itself. Nonetheless, having such a personality theory clearly enriches and deepens this process. Speaking more broadly, several writers have attempted to outline the specific functions for Rorschach testing offered by a personality theory, specifically, psychoanalytic theory. Sugarman (1985, 1991), for example, has identified four such functions: (1) organization, (2) integration, (3) clarification, and (4) prediction. He pointed out that a theory of personality assists the Rorschach assessor in understanding and organizing data that are exceedingly complex, in integrating seemingly disparate and unrelated pieces of information, in filling in gaps in the data in an informed way, and in enhancing the prediction of individual behavior as opposed to forecasting more general trends. Having at ones disposal a personality theory that is independent of the test, such as psychoanalytic theory, can enhance both modes of clinical interpretation. In the experiencing self/empathic mode, personality theory alerts the assessor to those aspects of a protocol that are potentially rich sources of inference building. For instance, based on Rapaports (1952) formulations regarding the concept of projection, elaborations and specifications added to a response that are not intrinsic to the blot may be taken as direct expressions of something more private and personal to the assessee. To see, for example, the popular bat on Card V as a huge vampire bat in full flight ready to descend upon a helpless victim provides compelling hints at significant trends in the personality. Along similar lines, a familiarity with psychoanalytic theory, including research scales conceptually based in the theory, can sensitize the assessor to contents with particular meaning. Holt (1970), for example, developed an extensive Rorschach scale for assessing manifestations of primary process and their controls. A section of his scoring manual involves evaluating the content of responses for their possible meaning in terms of the stages of psychosexual development. Responses such as

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Experiential approach to the Rorschach food, mouths, and kissing, for instance, would be classified as oral and considered referable to the oral stage. Thereby, in applying Holts scoring categories to interpretation, when I examine a record and come across contents that correspond to a specific stage, I indicate that stage. For instance, next to imagery such as airplanes or rocket ships, I simply note phallic. Within this experiencing self/empathic mode, I do not elaborate upon or extend the inference further. The functions provided by personality theory in the observing self/reflective mode are quite different. Here, theory, rather than alerting the assessor to particular sources for developing inferences, instead allows the assessor to extend and refine previously derived inferences. One does this by placing the original inference into an appropriate theoretical context. Returning to an earlier example, in the experiencing self/empathy mode, I inferred that a patient presented as exquisitely open. Shifting to the observing self/reflective mode, I then extended the inference by applying to it formulations based in Kohuts (1971) theory of narcissism. This led to the richer and expanded inference that the patients openness was prompted by a strong desire to be known and understood. Holding to Kohuts theory, one could then extend this latter inference in several directions, including the nature of her present and past relationships and implications regarding treatment. Theory in the observing self/reflective mode also permits the assessor to integrate ostensibly separate and unrelated inferences. On Card IV, a very bright but highly anxious 18-year-old high school senior saw a big man that skied into a tree. In the experiencing self/empathic mode, I wrote, an accident ready to happen. On Card VI, this same individual responded, Two doors opening. Mystical doors, like doors to heaven. In the same mode, adjacent to this response I noted, looking to open new doors and begin anew. As this young man had done previously, he then disparaged his performance by commenting, my answers are not very good. Next to this comment, I observed, self-deprecatory. On the basis of psychoanalytic theories of masochism, in the observing self/reflective mode, I tied together these seemingly separate inferences. Specifically, I indicated that it is with optimism the patient looks forward to leaving for college. He views it as a fresh start, an opportunity to begin anew. Despite his hopefulness, his long-standing tendency to undermine his own efforts and to snatch defeat from the jaws of victory, in all likelihood, will reemerge and result in his finding himself in new messes.

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Lerner Summary On the basis of an allegiance to a particular tradition and a genuine concern with the lack of depth I see in too many Rorschach-based reports, herein I have attempted to identify processes involved in a clinical-experiential approach to test interpretation. I have described the need to immerse oneself in the raw material and the internal split that occurs in the assessor between his or her experiencing self and observing self. Whereas the experiencing self makes use of empathy, the observing self makes use of reflection. Working together, these two modes contribute to the construction of an inner working model of the patient. I have also discussed the role and importance of preoccupation and holding. Because the two modes involve different levels of language and make use of theory differently, the inferences that issue from the modes differ with respect to their generality, complexity, and experience-closeness to the patients productions. The recognition that inferences vary based on their mode and level of complexity has implications for evaluating their validity.

References
Bion, W. (1956). Development of schizophrenic thought. In W. Bion (Ed.), Second thoughts (pp. 36-42). New York: Aronson. Exner, J. (1974). The Rorschach: A comprehensive system: Volume 1. Basic foundations. New York: Wiley. Greenson, R. (1967). The technique and practice of psychoanalysis. New York: International Universities Press. Holt, R. (1970). Manual for the scoring of primary process manifestations and their controls in Rorschach responses. New York: Research Center for Mental Health. Kinsella, W. (1987). Shoeless Joe. New York: Ballantine Publishing. Kohut, H. (1959). Introspection, empathy, and psychoanalysis. In P. Ornstein (Ed.), The search for self (Vol. 1, pp. 205-252). Madison, CT: International Universities Press. Kohut, H. (1971). The analysis of the self. New York: International Universities Press. Lerner, P. (1992). Toward an experiential psychoanalytic approach to the Rorschach. Bulletin of the Menninger Clinic, 56, 451-464. Lerner, P. (1998). Psychoanalytic perspectives on the Rorschach. Hillsdale, NJ: Analytic Press. Mayman, M. (1963). Psychoanalytic study of the self-organization with psychological tests. In B. Wigdor (Ed.), Recent advances in the study of behavior change (pp. 97-117). Montreal: McGill University Press. Mayman, M. (1964). Some general propositions implicit in the application of psychological tests. Unpublished manuscript, Menninger Foundation, Topeka, KS. Rapaport, D. (1952). Projective techniques and the theory of thinking. Journal of Projective Techniques, 16, 269-275. Schachtel, E. (1966). Experiential foundations of Rorschachs test. New York: Basic Books.

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Experiential approach to the Rorschach

Schafer, R. (1954). Psychoanalytic interpretation in Rorschach testing. New York: Grune and Stratton. Smith, S. (1976). Psychological testing and the mind of the tester. Bulletin of the Menninger Clinic, 40, 565-572. Sugarman, A. (1985). The nature of clinical assessment. Unpublished manuscript, San Diego, CA. Sugarman, A. (1991). Wheres the beef? Putting personality back into personality assessment. Journal of Personality Assessment, 56, 130-144. Winnicott, D. (1960). The theory of the parent-infant relationship. International Journal of Psycho-Analysis, 41, 385-395.

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