This study was an investigation of the differences between 97 patients who had prematurely terminated psychotherapy (M = 1 session) and 81 who had participated in individual psychotherapy for at least 6 months and 24 sessions (M = 18 months/72 sessions) on selected Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Rorschach variables. None of the between-group comparisons using the MMPI-2 proved to be significant. However, a multivariate analysis of variance of 9 Rorschach variables in 3 conceptual categories-(a) interpersonal relatedness, (b) psychological resources versus resource demand, and (c) level of psychopathology-proved to be significant alp = .008. The Rorschach scores from the interpersonal-relational category proved to be the most robust in differentiating the 2 groups. The theoretical implications of interpersonal variables are discussed in relation to the termination and continuation of patients in psychotherapy. Although a great deal of research has focused on the process and outcome of psychotherapy, far less has been written about premature termination from psychotherapy. This is surprising in view of the high dropout rates reported in the literature. For example, Garfield (1994) summarized 20 studies, mostly from the 1950s and 1960s; he reported that the median number of psychotherapy interviews for outpatient clinics clustered around six interviews. Garfield indicated that more recent studies are quite consistent with the earlier ones. In an earlier summary (Garfield, 1986), the median number of psychotherapy sessions was between five and eight. Taube, Burns, and Kessler (1984) found similar results in a study of psychologists and psychiatrists in private practice, and Blackwell, Gutmann, and Gutmann (1988) found that the modal number of treatment sessions was a single visit for patients belonging to a health maintenance organization and for patients in a fee-for-service arrangement in a hospital-based outpatient clinic. A report by Howard, Davidson, O'Mahoney, Orlinsky, and Brown (1989) indicated that, in a national survey of the utilization of mental health services, 44% of the patients made fewer than four visits. Howard, Kopta, Krause, and Orlinsky (1986) summarized 15 studies, in which the median number of sessions reported ranged from 4 to 33 sessions, with a median of 12 for the sample. Scogin, Belon, and Malone (1986) also reported that approximately two thirds of psychotherapy patients in the clinic they sampled terminated their treatment prematurely, the majority in less than five sessions, and Phillips (1985) reported a 30% dropout rate after one session and a 50% dropout rate after two sessions. Depending on the criteria used and the patient population stud

In this study, we investigate the reliability, validity, and diagnostic efficiency of the Rorschach Schizophrenia Index (SCZI) in relation to the accurate identification of patients diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) schizophrenia or other psychotic disorder (PD) according to the methodological recommendations offered by Wood, Nezworski, and Stejskal (1996). Seventy-eight patients who were found to meet DSM-IV criteria for a PD or Axis II disorder (PD = 33; borderline personality disorder = 23; Cluster A personality disorders = 9; Cluster C personality disorders = 13) and 50 nonclinical participants were compared on the SCZI. The results of this study indicate that the SCZI is internally consistent and can be reliably scored. In addition, the SCZI was used effectively in differentiating PD patients from patients with an Axis II disorder and from the participants in the nonclinical sample. Also, the SCZI variable was found to be empirically related to the presence of a DSM-IV diagnosis of PD. Finally, this variable could be employed for classification purposes in ways that were clinically meaningful in the diagnosis of a PD. Conceptual and methodological issues are discussed in relation to the assessment of psychosis.

This study investigates the extent to which the Rorschach was able to identify accurately pathological expressions of narcissism according to the methodological recommendations offered by T. Nezworski and J. Wood (1995). Ninety-one patients who were found to meet DSM-IV criteria for an Axis II disorder (Cluster A personality disorders = 10; antisocial = 20, borderline = 25, histrionic = 5, narcissistic [NPD] =15; Cluster C personality disorders = 16) and 50 nonclinical participants were compared on 5 Rorschach variables: reflection, pair, personalization, idealization, and the egocentricity index. The results of this study indicate that selected Rorschach variables can be used effectively to differentiate NPD patients from a nonclinical sample and from Cluster A, Cluster C, and other Cluster B personality disorders. Also, the reflection and idealization variables were found to be empirically related to DSM-IV diagnostic criteria for NPD and a self-report measure of NPD.Finally, these two variables could be used for classification purposes in ways that were clinically meaningful in the diagnosis of NPD.Narcissistic personality disorder (NPD) was included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) in large part because of widespread interest in the theoretical and clinical concept of narcissism by psycho-

In this article we examine the relation between the Rorschach Comprehensive System's Suicide Constellation (S-CON;Exner, 1993;Exner & Wiley, 1977) and lethality of suicide attempts during the course of patients' hospitalization at the Austen Riggs Center (Stockbridge, MA). Patient records were rated as nonsuicidal (n = 37), parasuicidal (n = 37), or near-lethal (n = 30) based on the presence and lethality of self-destructive acts. Diagnostic efficiency statistics utilizing a cutoff score of 7 or more positive indicators successfully predicted which patients would engage in nearlethal suicidal activity relative to parasuicidal patients (overall correct classification rate [OCC] = .79), nonsuicidal inpatients (OCC = .79), and college students (OCC = .89). Although these predictions were influenced by relatively high base rates in the hospital population (14.5%), base rate estimates were calculated for other hypothetical populations revealing different prediction estimates that should be considered when judging the relative efficacy of the S-CON. Logistic regression analysis revealed that an S-CON score of 7 or more was the sole predictor of near-lethal suicide attempts among 9 psychiatric and demographic variables.

The authors explore borderline pathology on a continuum of functioning. Rorschach variables relating to (1) aggression, (2) dependency, (3) object relations, (4) defenses, and (5) boundary disturbance were measured across a nonclinical (NC) and two clinical (borderline patients without self-mutilative behavior = N-BPD, and borderline patients with self-mutilative behaviors = SM-BPD) groups. Results demonstrated good discriminate ability (87%) between clinical and nonclinical protocols. Comparisons between N-BPD and SM-BPD groups revealed overall greater pathological scores for the SM-BPD group, specifically in dependency scores. Convergence with other studies and implications for future clinical and empirical work are discussed.