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CHAPTER

2

REVIEW OF

LITERATURE

Review of Literature

60

• Chapter-2 consist of following areas:

1. Form Appropriate Extended (XA%) and Form

Appropriate Common Areas (WDA%)

2. Conventional Form (X+%) and Unusual Form (Xu%)

3. Distorted Form (X-%)

4. Popular Responses (P)

5. Reliability, Validity and Norms in relation to

Cognitive Mediations

5.A. Reliability

5.B. Validity

5.C. Norms


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Present study is conducted to examine the Cognitive Mediation of

Participants with Mania with Psychotic Symptoms, Severe Depression

with Psychotic Symptoms, Undifferentiated Schizophrenia and Normal

Healthy subjects. There are few studies have done in this concern.

Cognitive Mediations consists of Form Appropriate Extended (XA%),

Form Appropriate Common Areas (WDA%), Conventional Form (X+%),

Unusual Form (Xu%), Distorted Form (X-%) and Popular Response (P).

Following Studies have been done in this variables.

1. Form Appropriate Extended (XA%) and Form Appropriate

Common Areas (WDA%):

XA% is a calculation of responses that are viewed as positive and

work conjunction with WDA%. XA% represents an individual’s

responses to the contours of the inkblot. These responses are viewed as

conventional because the individual only used the shape of the inkblot

to describe what they see.

The calculation for XA% is anticipated to be large and similar to

WDA% but WDA% will usually have a superior percentage. However,

there are situations in which the converse may occur. Interpretations of

the pairing will rely on the calculation of each variable and the extent of

the difference between the pair. Exner (2003) stated that if XA% is

between .78 to .90 and the value for WDA% is equal to or greater than

XA%, this is indicative that mediation is usually appropriate for the

situation, or the subject possesses intact reality testing. When XA% is

less than .70 and WDA% is less than .85, it suggests that a tendency

toward mediational impairment is somewhat pervasive. When the XA%


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is between .70 and .77 and the WDA% is between .75 and .79 it

indicates a moderate level of meditational dysfunction. When the XA%

falls below .70 and the WDA% is between .75 and .79, it indicates a

more substantial level of dysfunction. When the XA% is less than .70

and the WDA% is less than .75, it reflects a significant meditational

impairment. Two elements are important to understanding how

pervasive the impairment mediation may be. The first is the value for

the WDA%. When the WDA% falls between .65 and .74, the dysfunction

is serious and reality testing will be noticeably affected. When the

WDA% is below .65, the dysfunction is severe and reality testing will be

markedly impaired. The second element of concern is the difference

between the XA% and the WDA%. It often provides information about

the extent to which the impairment to reality testing will impact on

everyday functioning. When the difference between the two values is .10

or more, it suggests that the dysfunction will be more noticeable in

circumstances where cues to mediation are less obvious. When the

difference between the two variables is less than .10, it can be assumed

that the impairment is global, that is, the dysfunction tends to occur

regardless of how obvious distal cues may be.

After a thorough research review minimal research was found for

Form Appropriate—Extended (XA%). Due to the paucity of research

available it is believed by the researcher to be important to investigate

this variable further. XA% was introduced in 2003 when Exner elected

to adapt the Cognitive Mediation cluster in order to enhance the

understanding of client mediation. This calculation is achieved by


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dividing the sum of responses that have a Form Quality coding of F+,

Fo, or Fu (“good form fit” responses) by the number of responses (R) in

the protocol (Exner, 2003). F+ consists of answers that would normally

be scored “ordinary” but the response has been improved without

violating the feature of the response. Fo are responses in which the

respondent has communicated form features which are easily

identifiable. These answers are consistently found in 2% of subjects

from the data pool when using W and D areas, or by 50 people in the

pool who responded to Dd areas. Fu are answers that tend to be

uncommon but are seen quickly by an observer. The basic contours

have not been violated and are appropriate. XA% is a calculation of

responses that are viewed as positive and work in conjunction with

WDA%. XA% represents an individual’s responses to the contours of the

inkblot. These responses are viewed as conventional because the

individual only used the shape of the inkblot to describe what they see.

Exner (2001) stated that Form Quality was worth investigating because

individuals under stress or experiencing pathology may or may not

maintain an accurate perception of reality. The calculation for XA% is

anticipated to be large and similar to WDA% but WDA% will usually

have a superior percentage. However, there are situations in which the

converse may occur. Interpretations of the pairing will rely on the

calculation of each variable and the extent of the difference between the

pair.

Le (2002) included XA% and WDA% in her Vietnamese sample

size of 27. She found a significantly low XA% (.65) and a WDA% of .69.


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The current norm set by Exner for XA% is .92 and WDA% is set at .94

(2001). The calculation in assessing these two reality testing variables

would lead one to assume that Le’s highlyeducated sample exhibited

tendencies toward poor reality testing. However, she believed that her

student status, her sample’s empathy for her dissertation plight, or a

cultural factor of wanting to please her may have led to an increase in

the number of overall responses and thus affected her results.

2. Conventional Form (X+%) and Unusual Form (Xu%):

The mean X+% for non patients both children and adults between

.70 to .80. Standard deviations are 0.10, while standard deviations for

various patients groups tend to be higher than non patients. The X+%

means for patients groups are lower than for nonpatients. It is .64

(SD=.14) for a heterogeneous group of 535 outpatients, .53 (SD=.12) for

279 inpatients diagnosed as having serious affective disturbance, and

.40 (SD=.15) for 200 inpatient schizophrenics.

Conventional Form (X+%) represents the proportion of ordinary

responses generated. High responses, greater than .85 reflect behavior

patterns consistent with compliance to social demands. The proportion

of answers that do no violate appropriate use of the blot contours but

do reflect less common ways of translating the stimulus field is scored

as Unusual Form (Xu%). A high responses, greater then .25, implies a

likelihood to be ‘overlly individualistic’ and percentages less than .10

suggest some mediational difficulties (Exner, 2003). X+% that falls

between .70 and .85 in combination with an Xu% less than .10 is

viewed as tendency toward mediational dysfunction (Exner,2003).


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Exner (2001) stated that Conventional Form (X+%) is the

percentage of all the responses that receive a Form Quality coding of F+

or Fo. These are appropriate responses. An X+% mean more than .85

indicates a great degree of conventionality, no matter what the other

variable values indicate. It may also suggest a fixation with social

conformity that forfeits individuality. X+% can also be a useful

measurement of obsessiveness or perfectionistic tendencies (Exner,

2003).

Conversely, X+% with a mean between .55 and .69 and an Xu%

mean of .20 or greater can indicate that the individual tends to make

more decisions that disregard social expectations than the general

public. This unique individual can display antisocial tendencies or they

may be more autonomous in their mediational processes. An X+% less

than .55 introduces the interpretive importance of considering X-%.

When X-% is greater than .20, a greater tendency of abnormal behavior

patterns in mediational dysfunction will probably be observed. Any

orientations toward autonomy and individuality should be avoided in

the interpretation. But, these calculations are not suggestive of poor

reality testing alone just that the subject does not rely on societal

expectations or demands to function. These percentages can contribute

to understanding the subjects’ presenting problem. Exner (2003) has

found X+% to be a reliable variable with high consistency. It is the only

variable within the Rorshach Comprehensive System consistently high

with nonpatient children. However, empirical studies have indicated


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that a low X+% can lead to interpretative errors with vulnerable

populations.

In Dadario’s (2002) study, she investigated five Rorshach

variables that included X+%. The participants were twelve nonverbal

learning disabled individuals (with a mean age = 14.88). Significant

differences were found between the participants and Exner's normative

sample of age-matched children and adolescents. She then compared

her group to Exner's adolescent inpatient schizophrenic sample data

and found no statistically significant differences. Based upon these

results, Dadario felt this could lead to an increase in false positives and

stated that improving conceptualizations and interventions with such a

vulnerable group should be explored further.

Locke (1999) found in her study comparing nineteen ADHD

diagnosed adults published norms that X+% was found to be

statistically significant. Conclusions were drawn that ADHD adults are

different in perception and conventionality and they also run the risk of

receiving a false interpretation because of X+% differences. However,

Smith,et. al (2002) found an increase in X+% in their study of twenty-

two, well-adapted transsexuals who had undergone sexual

reassignment surgery. Pre-surgery means for X+% was .50 and the

post-operative mean was .62. The authors attributed this spike in

Conventional Form to a decrease in X-% and Xu% after the surgical

procedure. Smith revealed in her limitations, however, that her sample

possessed parents who were supportive of their child’s surgical

procedure. It is this perceived support or results of receiving sexual


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reassignment surgery that could partially explain the inconsistency of

X+% for this sample. In identifying severe and pervasive mental

illnesses, Exner considers X+% to be a valuable consideration that

discriminates nonpatients from more seriously disturbed psychiatric

groups (Exner, 1993). The mean X-% for nonpatient children and adults

tends to be .78. While those with more serious illnesses, like

schizophrenia, are apt to display a mean of .40.

The other variable of the Cognitive Mediation cluster to be

explored is Xu%. The calculations are derived by dividing the number of

Form Quality responses coded as unusual by the number of responses

for the record (Exner, 2003). These appropriate responses tend to occur

with low frequency and can be seen quickly seen by the examiner

(Exner, 2001). The Comprehensive System’s non-clinical, normative

adult sample has a mean of .07, non-clinical sixteen year olds tend to

have a mean range of .15, for five year olds this is likely to be around

.21, and the normative schizophrenic sample has a Xu% between .17

and .21. The range of Xu% responses can either indicate a departure

from conventional behavior or a tendency to accommodate to societal

expectancies. So, for interpretive purposes the direction of Xu% in

relation to X+% provides useful information about the subject’s

mediating behavior patterns. An X+% falling between .70 and .85 with a

Xu% between .10 and .20 reflects a behavior style that is in accordance

with societal expectations. An X+% between .55 and .69 combined with

an Xu% of .20 or more reveals a person who is likely to disregard social

rules. Finally, when X+% is less than .55 and Xu% is greater than .20,


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it is likely that mediational dysfunction is occurring and reality testing

is poor. Three studies specifically examining Xu% were found in the

review of the literature.

Gacono, Meloy and Bridges (2000) have reported Rorschach

findings concerning psychopaths, pedophiles, and persons having

committed sexual homicide. The Xu% means range from .23 to .27,

while the X-% means range from .22 to .26. Substantial X-% values,

especially those of .30 or higher, signify an increase in the probability of

inappropriate behavior.

Rouslin (1997) included Xu% in his Rorshach study of a group of

eating disordered women (n=36) and compared them to nonpsychiatric

and clinical samples. He did not find any statistically significant

differences in their responses as hypothesized. However, Pinto (1999)

found a significantly greater amount of Xu% responses in her study of

50 aggressive and non-aggressive adolescent males. Her subjects, aged

thirteen through fifteen, had been identified for disruptive behavior and

were compared with Exner’s normative, non-clinical sample. Her sample

had an average number of unusual responses of 8.67 and the Exner

sample had a mean of 3.47 unusual responses. Half of all the responses

made by Pinto’s sample were identified as unusual or distinctive. These

results suggest that Xu% is capable of detecting aggressive tendencies

amongst adolescent males.

In an effort to explore common characteristics of seven, self-

described psychic channelers, Dawson (1997) found an Xu% mean

ranging from .26 to .50. The X+% mean for her group ranged from .37


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to .67. The results were attributed to her subjects' creativity, abilities to

accomodate to regression, and likelihood to be unconventional.

However, this small, non-clinical sample could also be prone to

diagnostic interpretations indicating antisocial or non-conformist

tendencies, and worse, poor reality testing when considering Xu% and

X+% alone. When Dawson included their Popular mean responses (over

8), the clinical picture revealed that the channelers were able to respond

in a conventional manner.

3. Distorted Form (X-%):

Distorted Form (X-%) represents the percentage of responses that

disregard more appropriate features of blot contours. It tends to

represent a ‘disregard for, or distortion of, reality’ and they occur in

almost every record’. When this percentage is high (.15 to .20) and

associated with a low amount of responses (14 to 16) the administrator

should not be casual about the dysfunction (Exner, 2003).

Distorted Form (X-%) symbolize the percentage of responses that

explain a distortion with reality testing. Weiner (1986) stated people

with numerous minus responses do not accurately perceive the world

as most people do and linked many minus responses to schizophrenia.

Scoring is derived by dividing the sum of Form Quality responses not

commensurate with the blot features (FQx-) by the number of total

responses (Exner, 2003). These are very uncommon responses that

violate the contours of the inkblot. For examiners, these responses can

be very difficult to see, and frequently impossible to locate. Exner’s


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nonpatient sample possessed minus responses, but the occurrence was

relatively infrequent in comparison to those of the schizophrenic

reference sample. Exner’s (2003) nonpatients displayed an X-% mean of

.07 and in the schizophrenic sample (Lambda less than 1.0) the X-%

mean was .36. For the schizophrenic sample with a Lambda higher

than .99 the X-% mean was .38, or over five standard deviations higher

than the nonpatient sample. Exner (2003) stated an X-% between .15

and .20 is usually sufficient to indicate problems in cognitive mediation

and the individual is likely to be exhibiting reality testing impairment.

Typically, an average number of minus responses is expected to be from

one to three. Records with three to four minus responses can yield an

X-% mean from .15 to .20. This appears to be consistent with his 1986

study comparing individuals diagnosed with schizophrenia, schizotypal

or borderline personality disorders. The eventual findings for the three

groups suggested that all had some difficulty in their cognitive

mediational functioning. However, the mean X-% for the borderline

sample was .13, .18 for the schizotypal group, and .31 for the

schizophrenic group. The schizophrenic sample averaged more than six

minus answers in their records.

Archer and Gordon (1988) found a similar response style in their

study amongst 134 adolescent inpatients when comparing those who

had been diagnosed with schizophrenia against those who had been

diagnosed as depressed. Both groups displayed X-% means that would

satify Exner’s indicator of poor cognitive mediation, However, the

schizophrenic group displayed a significant mean of .34.


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Fong-Hartsfield(2000) included in her Rorshach study sexual

offenders who had been diagnosed with schizophrenia and committed

rape with offenders who had been diagnosed with schizophrenia but

had no sexual component in their crime. The schizophrenic rapists

displayed a statistically significant X-% mean of .29 and the

schizophrenics with nonsexual crimes had a mean of .17. These results

are consistent with her hypothesis that schizophrenic rapists have

poorer reality testing than their low violence counterparts.

Exner, et. al (1975) studied 25 individuals prior to elective

surgery and post-surgery, along with individuals who had experienced

considerable physical problems. They found an elevated X-%, when in

combination with an Anatomy or X-ray response. The results of all of

these studies seem to imply that difficulties in perception and mediation

can be detected by X-% and that stressors such as physical health

problems can contribute to this variable being heightened.

Mediational distortion is reflected by X-% , which represents the

proportion of uncommon responses that disregard the appropriate use

of the blot contours. The objects specified are, difficult to see and, in

many instances, impossible to find. In effect, they are violations of

reality. The X-% also has reasonably substantial long term and short

term retest reliability, yielding coefficients ranging from .80 to .90.

Minus responses are not uncommon, but usually occur in low

frequencies.

Exner(2001) studied that about 86% of 600 nonpatients gave at

least one minus answer, and the mean X-% for the group is


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.07(SD=.05). The mean for outpatients is .16(SD=1.0), for inpatient

affective disorder is .19(SD=.10),and for inpatient schizophrenics is

.36(Sd=.13). A substantial proportion of minus answers given by

persons who have significant affective problems include achromatic or

chromatic color or shading determinants (Exner,1993).

Persons with more diffuse cognitive impairment will often give

numerous minus answers that have little homogeneity. Epstein(1998)

has reported that persons with mild or moderate to severe traumatic

brain injury have noticeably low X+%’s and high X-%’s.

Pinto (1999) found that the Rorschach of 50 adolescents with

substantial histories of disruptive behavior contained significantly

higher frequencies of minus and unusual responses.

Bartell and Solanto (1995) have noted higher than expected X-%’s

among children diagnosed with ADHD. Lipgar and Wachler (1991) have

reported that mothers of behaviorally disrupted infants give significantly

fewer from appropriate responses than non patients.

Bannatyne, Gacono and Greene,(1999) studied patterns of

responding on the Rorschach and MMPI-2 for three groups chronic

psychotic forensic patients (undifferentiated schizophrenia,

schizoaffective, and paranoid schizophrenia). They note X+% of less

than .50 in more than half of the records in each group and X-%’s

greater than .20 in two-thirds or more of the protocol in each group.

4. Popular Responses (P):

Rorschach did not mention Popular responses in his monograph,

but did describe them in the posthumously published 1923 paper


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(Rorschach & Oberholzer, 1923). He defined them as answers occurring

at least once in every three records, and suggested that they reflect the

ability to perceive and respond to the commonplace features of the

figures. Baughman (1954) found P to be one of the most stable features

in the test, and least subject to undue sets created by examiners. Short-

term reliabilities range from .84 to .88 and over longer intervals from

.79 to .86.

The Comprehensive system includes 13 Popular responses(P),

derived from a North American, English-speaking sample. Non patient

adults and outpatient average nearly seven, with medians of six and

modes of six and four respectively. Schizophrenics average nearly five

with a mode of six and a median of five, while depressive average

slightly more than five, with a mediation of five but with a mode of

eight. A low frequency of Popular responses in the record of an adult,

four or less, reflects either an inability or unwillingness of the person to

deliver that which may be the most obvious possible answer. The

correlation between Popular responses and X+% is negligible, -.02 for

100 nonpatients adults (Exner, Viglione, & Gillespie, 1984). Low P may

signal serious cognitive problems, but it also may reflect a more unique

person who does not violate reality, but instead tends to deal with it in

a common, but not highly conventional manner. More than 90% gave

the Popular response to card VIII, whereas only about 35% gave the

Popular response to card II.

Rapport et al. (1946) recommends the scoring of P for responses

occurring once in every four or five records. Beck et al. (1961) identify P


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responses as those occurring at least three times as frequently as the

most common answer to a blot, provided that it is given not less than

once by at least 14% of his adult sample. Piotrowski(1957) included

responses given at least once in every four records. Hertz (1970)defines

any answer that occurs once in six protocols as Popular. Popular (P)

responses are answers from the individual that use the most distinct

and obvious elements of the blots. Rorshach did not mention Popular

responses in his body of work, but he did define them as “Vulgar”

responses that occurred at least once in every three records (Rorshach

& Oberholzer, 1923). “Vulgar” is a translation from his European

linguistic influences of Swiss, Russian, and French and interprets as

banal or lacking creativity. He stated that “Vulgar” responses were a

reflection of the respondent’s ability to identify and react to obvious

shapes of blot contours, or see what others see. Eighty years later, this

same theory of the Popular response is upheld by systematizers today

(Exner, 2003).

Schafer (1954) wrote that interpretative knowledge about a

subject’s adaptation, connection with reality, and defenses could be

learned from their Popular responses. In 1993, Exner conducted a

study with 7500 protocols. This sample consisted of 2,500

nonschizophrenic outpatients, 2500 inpatient nonschizophrenics, and

2,500 nonpatient adults. Response frequencies were then generated

through computer tabulations. Those responses that occurred 2,500

times were designated as popular in the comprehensive system. As a

result, 13 Populars emerged (Exner, 1993). Exner (2003) stated that


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most people tend to give six to eight Popular responses. Any more such

responses (10+) can indicate the individual is taking a conventional or

“easy route” in their approach or they are being “obsessive”. Protocols

with four or less Popular responses tended to reflect an “inability or

unwillingness” on the part of the subject to deliver the most obvious

answers. Low responses when taken in consideration of the other

Cognitive Mediation variables and the presenting problem can also

allude to cognitive difficulties, or reveal an exceptional individual who

tends to be unconventional. It appears that stages across the lifespan

can also influence the number of Popular responses. Children at five

years of age tend to provide five responses and this steadily increases.

At ten, they begin to provide an amount equal to nonpatient adults.

However, there have been mixed results in studies examining Popular

responses and senior adults (Reichlin, 1984). It has been assumed that

due to cognitive decline, reluctance to take risks, or unfamiliarity with

test-taking that more aged individual’s Popular response productivity

will decline. But, a study conducted by Geertsma (1962) revealed high

Popular response loadings with normal senior subjects. Additionally,

these results were accomplished with a low number of total responses

(R).

5. Reliability, Validity and Norms in relation to Cognitive

Mediations:

Reliability and Validity of Rorschach Inkblot Test is vary in

different region. Following research finding indicates the valuable

information regarding Reliability and Validity.


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5.A. Reliability

Exner (1986) has pointed out that there is not one Rorschach but at

least five because of the five major systems for interpretation. Reliability

and validity studies performed on one system could not be generalized

to another. Despite these difficulties, estimates of reliability can be

obtained by referring to meta-analytic reviews by Parker, Hansen, and

Hunsley (1988). Parker et al. analyzed 39 papers using 530 different

statistical procedures. Parker and colleagues concluded that, overall,

the Rorschach can be expected to have reliabilities in the low to middle

0.80s. While developing the Exner Comprehensive System, Exner

(1993), gave particular attention to interscorer reliability. No scoring

category was included unless it achieved a minimum 0.85 level among

different scorers. Test-retest reliabilities were more variable. Retesting of

25 variables over a one-year interval for a nonpatient group produced

reliabilities ranging from 0.26 to 0.91. Retesting for children did not

come close to the same degree of stability as for 33 adults, although

Exner reported this was to be expected, given that children undergo

considerable developmental changes (Exner & Weiner, 1995). Short-

term retesting over 7-day and 3-week intervals for 9- year-olds indicated

an acceptable level of stability with levels for 25 variables ranging from

0.70 to 0.90.

5.B. Validity:

The primary focus of early validity studies for the Rorschach was

to differentiate empirically among different populations, based on: a)

past observations of a particular group’s responses to the Rorschach, b)


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the development of norms based on these observations, and c)

comparisons of an individual’s Rorschach responses with these norms.

For example, depressed individuals tend to have very few human

movement responses (Exner & Weiner, 1995; Miller & Hughes, 1995).

General approaches have resulted in a large number of specific scorings

and interpretations, all of which have had various degrees of validation.

According to Groth-Marnat (1997), establishing validity of the

Rorschach has been complicated by the many scoring categories and

quantitative formulas, each of which has varying levels of validity. Some

interpretations have greater validity than others, even within a specific

category. However, the general consensus among several meta-analytic

reviews was that, when rigorous, high-quality studies were analyzed,

validity ranged from 0.40 to 0.50 (Atkinson, 1986; Parker et al., 1988;

Weiner, 1997), making the Rorschach, overall, achieve reliability and

validity levels comparable to the MMPI and MMPI-2 (Meyer, 1996a;

Meyer, 1999; Stricker & Gold, 1999).

The development of Exner’s Comprehensive System was largely

motivated by the deficiencies (and strengths) inherent in each of the

earlier systems. Recently, as a result of there being a greater proportion

of studies that have used the Exner Comprehensive System some

researchers have been less critical of Rorschach validity (Groth-Marnat,

1997; Meyer, 1996b). However, external validity has continued to cause

critical review of the Rorschach (Groth-Marnat, 1997). Groth-Marnat

(1997) noted that the main focus of Rorschach validity studies has been

directed toward determining its ability to discriminate among different


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types of populations; less success has been achieved in making

accurate predictions for areas such as response to therapy, academic

achievement, or spontaneous improvement in a clinical condition.

Under ideal conditions, a test such as the Rorschach should not only

infer characteristics regarding the ways in which individuals organize

their perceptions, but also should convert these inferences into

understanding types of relevant behavior. Multicultural theorists

reported that many measures used to assess students of color did not

capture the relevant facets of behavior or functioning among children of

different cultural groups (Lambert & Rowan, 2003; Haynes et al., 1999).

Lambert and Rowan (2003) stated that measurement developers often

included representative samples of individuals from diverse

background; however, they concluded that the representation was

usually insufficient to explore how these measures functioned within

these different populations.

5.C. Norms:

The Rorschach normative data present two challenges for usefulness.

The first is the size of samples at each age is modest. Only three age

groups (9,11, 16) include more than 130 subjects and two age groups

(5, 6) include less than 100 subjects. Exner, Thomas, and Mason (1985)

also added that the stratification process has potentially created a great

deal of heterogeneity in the data for each group.

Secondly, it has also been noted that all subjects were volunteers,

with parental agreement; in many instances, the actual number of

volunteers with parental agreement was considerably less than the


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actual number of potential subjects available in a school or group. This

was especially a problem in recruiting children from urban

communities. Exner and Weiner (1995) concurred that generally fewer

than 20% of the children in a class volunteered for the study, and that

percentage was considerably reduced by the failure of many in

obtaining parental consent. Therefore, Exner and Weiner (1995)

regarded the data as representing children who, for some reason were

interested in taking the test, and whose parents supported this.

Therefore, this may have left out parents who might be “suspicious” of

testing situations (such as urban parents of color), or children not

particularly interested assessment, possibly skewing the data in some

way. Exner and Weiner (1995) stated that the normative data generated

from the protocols of 1580 children between the ages of 5-16 was

stratified for geographic distribution and partially stratified for

socioeconomic level.

As for reported cross-cultural utility of the norms, Exner and

Weiner (1995) stated that in general, “most results are inconsequential”

(p. 48). Males and females do not differ for any location or determinant

scoring, except that females in age groups 12, 13, and 14 gave

significantly more Y (Y is used for responses based on the light-dark

features or shading features of the blot), responses than males for the

same ages. Exner and Weiner (1995) indicated a higher Y is indicative of

“hopelessness.” Differences were more marked when SES was

considered. For ages 5 to 11, the combined group of middlelower and

lowest lower SES gave significantly fewer M responses (M is used for


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human movement responses) than children of other SES groups

regardless of race, sex, or geography. A lower level of human movement

might be indicative of depression per Exner (2001), Weiner (1997), and

Frank (1993a). Inexplicably there were a few geographic differences, for

example, southwestern and western children 10 to 14 gave more color

answers (C, CF, and FC combined), than children of the same ages from

other areas of the country. In relation to differences in quantity of

responses, Exner and Weiner (1995) suggested that while the test

process is consistent for perceptual-cognitive operations represented in

the structural data, it might also be markedly influenced by cultural

factors. Despite that conclusion Exner & Weiner (1995) thought

establishing normative data for specific cultures, country, or language

would be “unrealistic” (p. 50).

According to Groth-Marnat (1997), combining the results from a

number of studies, the general consensus among well-designed meta-

analytic reviews was that concurrent validity for the Rorschach ranged

from 0.40 to 0.50. This is nearing validity of the Wechsler Intelligence

Scales for Children- 3rd Edition (WISC-III; Wechsler, 1991), that has

concurrent validity for Full Scale IQ scores ranging from 0.65-0.96 with

a median range of 0.83 (Wechsler, 1991). It is also generally comparable

to the concurrent validity reported in the technical manua1 (1997) for

the Wechsler Adult Intelligence Scale-3rd Edition (WAIS-III; Wechsler,

1997)), that was stated to range from 0.60-0.77.

Exner and Weiner (1995) reported another major factor that

might serve to lower validity to be the meaning associated with response


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productivity. Response productivity was found to be closely tied to age,

intellectual level, verbal aptitude, and amount of education (Exner &

Weiner, 1995; Frank, 1994). Norms have been provided for different

ages, but the other three factors (IQ, verbal abilities, and education) can

potentially confound the meanings associated with response

productivity.

Rorschach “scores” are really codes that signify the presence of

certain characteristics within the response (Exner, 1988; Weiner, 1997).

Constellations are of particular importance because they combine

scores into meaningful patterns. Current constellations provide

screening information about schizophrenia, depression, suicide

potential, and interpersonal coping among other manifestations (Exner,

2001). Scores are combined to form seven variable clusters based on

the frequency counts, ratios, percentages, and special indications.

These variable clusters involve personality components or functions

such as affective features, capacity for emotional control and stress

tolerance, ideation, information processing, interpersonal and self-

perceptions, and situationally related stress. In the usual application of

the Rorschach, the most significant emphasis is placed on the final

“global” description of the individual, in which the clinician integrates

the results from different parts of the protocol and takes into account

the interrelations of different scores and reference points.

In the Exner Comprehensive System, the Rorschach is considered

primarily a cognitive perceptual task; responses are believed to measure

the way in which individuals normally react to problem solving


82

situations. Interpretation of the Rorschach using the Exner

Comprehensive System yields a constellation of elements that forms the

structural aspect of the system. Using Exner’s system, certain elevated

or deficient Determinant or Content variables occurring in an

individual’s Rorschach response set are presumed to reflect

characteristic personality traits, especially those signifying pathological

aberrations (Exner, 2001).

Diagnostic interpretation of the Rorschach is based on normative

data originally derived in large part from adult ‘mainstream’ groups.

More recently, the normative data 38 have been updated to include

some children of color (Anastasi, 1998; Groth-Marnat, 1997; Sattler,

1992). The Exner System presents normative data based on 700

nonpatient adults, and 1390 nonpatient children with separate norms

by age, from 5-16 years, as well as groups of adults with psychiatric

problems, adult inpatients with schizophrenia, adults with depression,

and other adult groups. The Exner System normative data included

statistics for 33 different structural variables. Particular profiles can be

used to screen for various psychological disorders such as suicide

potential or “ego-strength”: determinants can be used to represent a

particular way in which an individual perceives stimuli, reflecting some

aspect of cognitive processing.

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