Use of Rorschach variables in the assessment of psychotherapy progress

The Rorschach Prognostic Rating Scale (RPRS) is a scale that provides a prognosis for psychotherapy change based on consideration of an individual's ego strength. This study investigated the effectiveness of the Rorschach Prognostic Rating Scale (Klopfer, Kirkner, Wisham, & Baker, 1951) in predicting psychotherapy outcome using a dataset of 90 seriously disturbed patients in long-term intensive psychotherapy. Patients in this study completed the Rorschach upon admission and again 15 months after beginning treatment. At the same time, progress during therapy was assessed using independent ratings of psychological and behavioral characteristics of individual patients collected from clinical case records. Regression analyses indicated that the RPRS may be most useful when used to predict the manifestation of symptoms such as depression, anxiety, hallucinations, and delusions during treatment, but less useful in reflecting the level of disorganized or odd behavior and flattened or labile affect after 15 months. Changes in RPRS scores from Time 1 to Time 2 demonstrated a decrease in Form Level scores and an increase in Animal Movement scores. Results are considered in relation to patient changes in clinical symptoms, in level of stress tolerance, and in access to primary process material during the course of intensive psychotherapy. Patients were also divided into groups based on the level of anaclitic and introjective psychopathology exhibited to allow a comparison of these groups on scores of ego strength. No interaction effects for group type over time in treatment were found. However, those patients exhibiting more introjective psychopathology were found to score slightly higher on Final Prognostic scores, and significantly higher on the Inanimate Movement and Color subscales than did anaclitic patients. The results are discussed in terms of the personality differences of the two groups as measured by the RPRS. Overall, the findings of this study offer further evidence for the predictive validity of the RPRS and provide support for the clinical application of the Rorschach as a useful adjunct in the assessment of an individual's adjustment potential during the course of therapy.