A Commentary on “A Systematic Narrative Review of Evaluating Change in Psychotherapy” (Aschieri & Pascarella, 2021)

Abstract

The Rorschach inkblots are one of the most widely used sets of test stimuli in the history of psychology, and a substantial body of evidence supports the construct validity of a number of variables, particularly from the Comprehensive and Performance Assessment systems (Mihura et al., 2013; for review see Meyer et al., 2016). As Aschieri and Pascarella (this issue) point out, the instrument has significant potential for the examination of treatment change, and is often used for this purpose (Aschieri & Pascarella, 2021). In particular, as a performance-based test, Rorschach scores are relatively independent of biases associated with questionnaires, which likely explains the relatively strong performance of the Rorschach for predicting behavioral outcomes in previous research (Hiller et al., 1999). In this sense, the Rorschach has the potential to communicate whether or not a patient has actually improved, somewhat independent of their desire to communicate that they have improved, as a function of treatment. Initial evidence by Grønnerød ( 2004) supported the use of some Rorschach variables for this purpose, and the results of the follow-up study by Aschieri and Pascarella generally support those conclusions. However, a more general conclusion is that a lot more research, and a lot more rigorous research, is needed to determine whether and how to use the Rorschach to evaluate treatment change. Aschieri and Pascarella raised this issue in the discussion, and noted that many of the studies they reviewed had mixed evidence for overall design quality. In this commentary, we build upon their recommendations by offering several specific

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“…Form Color Balance has a stability coefficient of .71, and Form Quality .84, indicating a meaningful correspondence between temporal stability and susceptibility to change. In summary, Hopwood et al (2021) comment that the initial evidence presented by Grønnerød ( , 2006 and Aschieri and Pascarella (2021) supports the use of some Rorschach variables for psychotherapy evaluation purposes, while more rigorous research is needed to determine whether and how to evaluate treatment change more specifically.…”

Searching for a Common Language to Talk About the Rorschach Within and Outside the International Society of the Rorschach and Projective Methods

“…Finally, perspectives of Rorschach users of the qualities of the test may sound overly positive to the larger professional community. For example, the commentary of Hopwood and colleagues (2021), based on the demanding criteria of psychotherapy research, “toned down” the perhaps overly positive conclusions of Aschieri and Pascarella (2021) with regard to the quality of the Rorschach as a measure of psychotherapy outcome. The unfortunate conclusion is: We, as Rorschach users, are not very capable of talking with each other, and when we open up a dialogue with professionals from other fields, we may find that it is not easy to attune to external standards of research quality.…”

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“…They take as their starting point a meta-analysis by Grønnerød (2004) and provide us with an update. Their discussants, Christopher Hopwood, Mathew Yalch and Xiaochen Luo, respond with a tightly reasoned critique of methodology and recommendations for future research (Hopwood et al, 2021).…”