A Commentary on “The Rorschach and Trauma” (Kaser-Boyd, 2021)

https://econtent.hogrefe.com/doi/pdf/10.1027/1192-5604/a000143 - Saturday, September 18, 2021 4:29:10 AM - IP Address:54.172.52.212 Special Issue: The Rorschach Test Today: An Update on the Research Commentary A Commentary on “The Rorschach and Trauma” (Kaser-Boyd, 2021) Steven N. Gold College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA Is the Rorschach Test a valid and useful instrument in assessing for traumatization? Variable by variable, Dr. Kaser-Boyd (2021) has done an impressive job of combing through and collating the relevant research literature to provide us with ample empirical findings to answer this question in the affirmative. And yet, there is a poignant irony entailed in the very asking of this question, let alone in painstakingly responding to it by consulting the fairly extensive studies on the topic. Clearly, it is precisely the territory of the quantitative and empirical that detractors of the Rorschach have set up as the guiding standard for measuring the validity and utility of the Rorschach. But the reality is that while Dr. KaserBoyd’s paper substantiates the ability of the Rorschach to identify indicators of traumatization, I would strenuously argue that limiting our attention to this arena fails to capture some of the most advantageous attributes of the Rorschach, especially when our aim is to assess for the impact of traumatic events. Just as is the case for any assessment instrument, there certainly is value, even necessity, in confirming the statistical validity of discrete Rorschach variables and indices in evaluating trauma-related reactivity. It is likely the singular approach seen as legitimate by those critical of the Rorschach. However, it is a tactic that in essential respects misses the forest for the trees. Proceeding in this way is akin to producing a Rorschach record exclusively consisting of isolated D and Dd percepts and totally lacking in “big picture” W responses. Unlike so-called objective measures, the Rorschach test differs from other commonly used psychological instruments designed to assess for the presence or absence of specific symptom patterns or personality traits of the respondent. While diagnostic and characterological information is attainable via the Rorschach, the total Gestalt that emerges, when the unique features of the content of a protocol are integrated with the constellation of locations chosen, response determinants, and other aspects of the record produced, is truly much greater than the sum of its parts. These factors can then coalesce to comprise a portrait of the idiosyncratic lens through which the respondent views the self, others, and their surrounding environment. © 2021 Hogrefe Publishing Rorschachiana (2021), 42(2), 139–142 https://doi.org/10.1027/1192-5604/a000143 https://econtent.hogrefe.com/doi/pdf/10.1027/1192-5604/a000143 - Saturday, September 18, 2021 4:29:10 AM - IP Address:54.172.52.212 140 S. N. Gold In the particular context of assessing for traumatization, the Rorschach helps us to capture the perceptual, cognitive, emotional, imaginal, impulsive, and behavioral inclinations and biases shaped by the individual’s trauma history. This type of information, obviously, is radically more intricate and clinically useful than the comparatively limited data provided by categorial measures. We find ourselves in an age when the standardization represented by structured objective assessment instruments, discrete diagnostic categories, and a priori intervention approaches codified in treatment manuals are frequently touted as the epitome of solid clinical work. In this professional context, the critical role of identifying, appreciating, and being responsive to a survivor’s unique experience of traumatization is too often largely obscured or overlooked altogether. It is difficult to think of an assessment tool that captures this aspect of trauma better than the Rorschach, or that is more useful in augmenting the trauma practitioner’s effectiveness by providing a glimpse into the particular survivor’s experiential realm. This unparalleled feature of the Rorschach is captured by Dr. Kaser-Boyd in the very first line of her paper: As any student of both Rorschach psychology and trauma psychology can affirm, Rorschach inkblot stimuli have the capacity to be triggering. They are not just a tool for detecting the presence of or enumerating types of traumatic reactions; they can actually elicit them. Rather than asking the respondent whether or not they experience various phenomena, or, at best, to what degree they experience them, the Rorschach provides a standardized situation within which the respondent’s perceptual proclivities can be elicited and sampled. In light of this somewhat unique property among assessment tools, the Rorschach is particularly well suited to the evaluation of the impact of trauma on an individual. The triggering potential of the test is a powerful indicator that the information it generates approximates a reproduction of the respondent’s characteristic pattern of trauma-related reactivity. For example, traumatization primes those affected to perceive danger where it may not exist because stimuli associated with the original traumatic event in the mind of the respondent are likely to provoke reactions similar to those experienced at the time of the event. This attribute of trauma survivors endows seemingly harmless and inert ambiguous stimuli – reproductions of random inkblots – with the power to elicit the perceptual, emotional, and physiological qualities associated with the activating properties of posttraumatic stress and the inhibitory and disorienting aspects of trauma-induced dissociation. The benefit of this particular feature of the Rorschach is hinted at in the remainder of the first paragraph of Dr. Kaser-Boyd’s review. Unlike many other instruments, including those specifically designed to measure traumatization, the data provided by the Rorschach extend well beyond the identification of discrete trauma-relevant symptoms that can function as corroborative evidence that the Rorschachiana (2021), 42(2), 139–142 © 2021 Hogrefe Publishing https://econtent.hogrefe.com/doi/pdf/10.1027/1192-5604/a000143 - Saturday, September 18, 2021 4:29:10 AM - IP Address:54.172.52.212 A Commentary on ‘‘The Rorschach and Trauma’’ 141 respondent has been traumatized or be organized to reveal the presence of specific trauma-related diagnoses. Other, so-called objective measures can isolate these various dimensions of traumatization. But the Rorschach, rather than merely rendering the marks of traumatization detectable and tallying them, can furnish a multifaceted image, a fuller understanding, of how encounters with trauma have shaped the scope, limitations, and at times even the content of the patterns of perception, sensation, cognition, emotionality, imagination, and interpersonal style of the traumatized individual. Much more importantly, Rorschach data allow us to peer into the idiosyncratically wrought, trauma-tinged perceptual world as it appears through the distinct eyes of the particular survivor being examined. In doing so, the Rorschach can disclose subjective characteristics of the imprint of trauma on the survivor’s view of self, others, and the world that more rigidly structured tools never could. Given the triggering qualities of the perceptually indistinct, alternately menacingly dark and vividly colored splotches, one key and not at all surprising observation in the literature is that Rorschach inkblot stimuli can be extremely unsettling and even somewhat destabilizing to highly traumatized clients. Although Dr. Kaser-Boyd cites Brand et al. (2006) as specifically identifying those with complex dissociative disorders such as dissociative identity disorder as being at risk for exhibiting this vulnerability, it seems unlikely that this intense reactivity is exclusively exhibited by this limited subset of trauma survivors. While reactions such as these can certainly be disturbingly unwelcome, they do powerfully illustrate the potential for the Rorschach to dramatically elicit the very reactivity that is emblematic of traumatization. However, there is yet another classic hallmark of traumatization in Rorschach protocols noted by Dr. Kaser-Boyd: oscillation between extreme over- and under-reactivity. The research literature repeatedly captures the fluctuation between these two excesses. Some examinees produce records with a paucity of responses, retreat from the more stimulating nuances of the inkblot images via over-reliance on restriction of attention to their form-based characteristics to describe relatively simple, if sometimes distorted percepts. Others veer in the opposite direction, formulating responses that combine several dimensions, such as color, shading, and the attribution of tactile qualities and dimensionality, into a single, if at times complex, image. And in still other instances, respondents amass Rorschach records that vacillate between these polar-opposite styles. In this way the Rorschach can provoke the range of expressiveness – from stark to effusive to an alternation between the two – actually observed among trauma survivors. When the Rorschach data are interpreted, understood, and applied in this way, they take on a much fuller clinical utility than the mere enumeration of symptoms and identification of diagnoses. In conjunction with the empirical findings yielded © 2021 Hogrefe Publishing Rorschachiana (2021), 42(2), 139–142 https://econtent.hogrefe.com/doi/pdf/10.1027/1192-5604/a000143 - Saturday, September 18, 2021 4:29:10 AM - IP Address:54.172.52.212 142 S. N. Gold by aggregate, nomothetic studies of the Rorschach, an idiographic viewpoint enables the therapist to grasp some degree of the lived experience of the trauma survivor. Identification of symptoms and syndromes tends to point us in the direction of determining which interventions may be relevant for optimizing treatment outcome. By contrast, an idiographic appreciation of the individual client’s manner of making sense of the environment, others, and self lends itself to informing the practitioner of what, especially for those with severe and complex traumatization, can be an even more decisive contribution to the success of trauma therapy. I refer here to the provision of the evolution and maintenance of a treatment relationship that fosters a sense of safety, trust, predictability, and, ultimately, a capacity for connection – to one’s surroundings, other people, and even one’s own first-hand experience – that may previously have been entirely foreign and unknown to the trauma survivor, especially in instances of extensive childhood trauma. As the sophistication of our understanding of trauma and its impact matures, and we increasingly come to appreciate the prevalence of dissociative modes of experience among the traumatized, the immense importance of the treatment alliance in promoting and enhancing the capacities for a sense of safety, trust, and connection is coming to be increasingly recognized. By offering a window into the survivor’s experiential world, the Rorschach provides the practitioner with a map for navigating the landscape of the trauma survivor’s intrapersonal and interpersonal world. Employed in this way, the Rorschach can be a matchless source of understanding and irreplaceable guide for understanding, relating to and joining forces with the survivor as a foundation for promoting release from the encumbrances of traumatization. References Brand, B. L., Armstrong, J. G., & Loewenstein, R. J. (2006). Psychological assessment of patients with dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 145–168. https://doi.org/10.1016/j.psc.2005.10.014 Kaser-Boyd, N. (2021). The Rorschach and trauma – An update. Rorschachiana, 42(2), 118–138. https://doi.org/10.1027/1192-5604/a000133 Published online September 15, 2021 Steven N. Gold College of Psychology Nova Southeastern University Fort Lauderdale, FL USA [email protected] Rorschachiana (2021), 42(2), 139–142 © 2021 Hogrefe Publishing