As Benjamin Berry, Ph.D. pursued his undergraduate studies in experimental psychology, he became drawn to the field of psychological research and the science of measuring social attitudes to explore implicit pathologies. After studying under current leaders in Rorschach administration, Benjamin continues to apply his research methods to improve his understanding of psychotic processes and psychopathology.
This episode of Menninger Clinic’s Mind Dive Podcast features Dr. Berry, an accomplished psychologist, joining hosts and colleagues, Dr. Kerry Horrell and Dr. Bob Boland, for a conversation on performance-based personality testing and assessing personality pathology in adolescents and adults.
Dr. Berry is an assistant professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He is also an award-winning staff psychologist at The Menninger Clinic where he spearheads the Adolescent Treatment Program.
“So, the Rorschach test really kind of came out of the psychodynamic tradition. Since that time, it has become a lot more flexible, and a lot more […] empirically driven, rather than theoretically driven,” said Dr. Berry. “There was a time when we thought of it as a projective test where the defense mechanism of projection was a key player in how a person constructs responses. We don't necessarily think of it that way today.”
Dr. Berry’s approach to the Rorschach test gives the test subject a cognitive task, making it a structured observational experience, which produces more data for researchers. Similar to other performance-based tests like the one for ADHD, it allows researchers to observe a person’s reactions and compare them to baseline norms. Decades of standardized data allow Dr. Berry to score and compare a person’s results to better understand their individual pathology, making the test a reliable and practical diagnostic tool.
A key example of the Rorschach’s usefulness is its ability to uncover subtle signs of psychosis, especially in early or mild stages of progression. Dr.Berry’s work at Menninger has revolved around using the test as a way of analyzing speech patterns to diagnose personality disorders and lingering effects of psychotic episodes. Despite misconceptions around the Rorschach test, Dr. Berry and the Menninger Clinic effectively use the test as part of their diagnostic toolkit.
Follow The Menninger Clinic on Twitter, Facebook, Instagram and
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
As Benjamin Berry, Ph.D. pursued his undergraduate studies in experimental psychology, he became drawn to the field of psychological research and the science of measuring social attitudes to explore implicit pathologies. After studying under current leaders in Rorschach administration, Benjamin continues to apply his research methods to improve his understanding of psychotic processes and psychopathology.
This episode of Menninger Clinic’s Mind Dive Podcast features Dr. Berry, an accomplished psychologist, joining hosts and colleagues, Dr. Kerry Horrell and Dr. Bob Boland, for a conversation on performance-based personality testing and assessing personality pathology in adolescents and adults.
Dr. Berry is an assistant professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He is also an award-winning staff psychologist at The Menninger Clinic where he spearheads the Adolescent Treatment Program.
“So, the Rorschach test really kind of came out of the psychodynamic tradition. Since that time, it has become a lot more flexible, and a lot more […] empirically driven, rather than theoretically driven,” said Dr. Berry. “There was a time when we thought of it as a projective test where the defense mechanism of projection was a key player in how a person constructs responses. We don't necessarily think of it that way today.”
Dr. Berry’s approach to the Rorschach test gives the test subject a cognitive task, making it a structured observational experience, which produces more data for researchers. Similar to other performance-based tests like the one for ADHD, it allows researchers to observe a person’s reactions and compare them to baseline norms. Decades of standardized data allow Dr. Berry to score and compare a person’s results to better understand their individual pathology, making the test a reliable and practical diagnostic tool.
A key example of the Rorschach’s usefulness is its ability to uncover subtle signs of psychosis, especially in early or mild stages of progression. Dr.Berry’s work at Menninger has revolved around using the test as a way of analyzing speech patterns to diagnose personality disorders and lingering effects of psychotic episodes. Despite misconceptions around the Rorschach test, Dr. Berry and the Menninger Clinic effectively use the test as part of their diagnostic toolkit.
Follow The Menninger Clinic on Twitter, Facebook, Instagram and
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
Welcome to the mind dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland,
Dr. Kerry Horrell:and Dr. Kerry Horrell. twice monthly, we dive into mental health topics that fascinate us as clinical professionals, and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in Welcome back to the mind dive podcast. We are incredibly excited, as I say every time but especially today to have our colleague and one of my dear friends on the show with us Dr. Benjamin Berry. Gosh, saying your name like that also always reminds me of How to Lose a Guy in 10 days Matthew McConaughey's character was Benjamin Berry.
Dr. Benjamin Berry:I'm more attractive than that guy, right?
Dr. Kerry Horrell:100% could not agree more as our listeners can't see. They should know. Yeah, looks just like Matthew McConaughey. But better, younger, better. Matthew McConaughey here with us. Benjamin Berry. I can't call you Benjamin Berry. I'm gonna call you Ben. Dr. Berry, if you will, is a staff psychologist at the Menninger Clinic. He's an Assistant Professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He has special expertise in performance based personality testing, dimensional assessment of personality functioning, and psychoanalytic psychotherapy. His current research activities focus on assessing personality pathology in adolescents and adults with performance based measures which spoiler alert is what we're going to talk about, which includes the ever mysterious Rorschach Inkblot Test. Dr. Berry's research has been published in the Journal of Personality assessment. And he has received an award for work published in that journal, because you're doing cool stuff, Ben.
Dr. Bob Boland:Yeah. Welcome.
Dr. Kerry Horrell:Welcome to the show. Thanks
Dr. Bob Boland:for doing this. Yeah, thanks very much. Yeah. Hi.
Dr. Kerry Horrell:We're generally talking today about the Rorschach Rorschach, which
Dr. Bob Boland:for people who I mean that's, that's the inkblot test. It's the classic one that you see, like in New Yorker cartoons, and
Dr. Kerry Horrell:I was like, there's a cartoon character in Rorschach. Yes, there. Yeah. There's didn't mean that but like The New Yorker
Dr. Bob Boland:ones, like the final like, just like it's kind of like the stereotype of psychology.
Dr. Kerry Horrell:Yeah. But no, there is a cartoon character called the Rorschach. Yeah,
Dr. Benjamin Berry:I think just Rorschach. He's kind of
Dr. Bob Boland:Yeah, that's like, yeah, yeah, no, yeah. But it's there was some talk about this.
Dr. Benjamin Berry:Suffice it to say it is something that is kind of sunk into the culture, right? You see within movies and video games and all kinds of things. Yeah, it's kind of it's got a it's kind of life of its own in a way.
Dr. Bob Boland:All right. So let's, let's start simple, like, what is performance based testing, or performance based personality testing,
Dr. Benjamin Berry:performance based testing really just is psychological testing that involves asking the test taker to do something, rather than asking them to say something. So, you know, for instance, or really common tests in the field is the MMPI. This is a self report test where the person who answers questions about themselves about things that they think they know, think they know, think they know, more, or may legitimately know, yeah, lots of questions. But performance based testing, instead asks them to do something. And it allows kind of like a structured behavioral observation, which can capture all kinds of different information. I don't know
Dr. Kerry Horrell:if you have the answer to this, because I don't think I really have the answer to this. But this is not my specialty. Like people more commonly, we think of this as projective test. And there's been like a shift in the field, at least as long as I've been training, because when I was in my class, learning the Rorschach, I was I would call it a projective test. And my my professor pretty clearly be like, this is a performance based it's not a projective test. Can you say a little bit about like, if people are like, is this a projected? What is Performance Base? Or does the same different?
Dr. Benjamin Berry:Yeah, good question. So the Rorschach really kind of came out of the psychodynamic tradition. And since that time, it has become a lot more flexible, and a lot more, I guess, kind of empirically driven, rather than theoretically driven. So there was a time when we thought of it as a projective test where the defense mechanism, the defense mechanism of projection was really kind of a key player in how a person constructs responses. We don't necessarily think of it that way. Today, the tests can be used. And they
Dr. Bob Boland:mean, like, I just look at these ink blocks, and whatever is like, in me, I sort of project onto the test. Yeah.
Dr. Kerry Horrell:And at the end of this, we're gonna give you the test on
Dr. Bob Boland:not the last time I did it.
Dr. Kerry Horrell:Because you can you can flunk the workshop. Yeah,
Dr. Bob Boland:exactly. Exactly. It's, it's sort of, like a lot of personality for us. Yeah,
Dr. Benjamin Berry:no, but the in part, I think it's also trying to mark that this kind of test is really not all that different from performance based tests in other domains, like cognitive domains. Exactly. Yeah. So you know, if you're assessing for , you will talk to the person you'll ask them questions, but you might also give them a cognitive task to do. And that lets you observe performance coded up compared to norms, something like the Rorschach does a very similar thing in the world of personality and psychopathology. We're gonna get
Dr. Kerry Horrell:to this in a little bit, but that's one of the things that that seems like the change from calling it a projective test, which again, I think many people would still call it or gonna refer to as a projective test. But in like, I
Dr. Bob Boland:won't call it that.
Dr. Kerry Horrell:I know, I still do, quite frankly, a lot of times, but like, that's moved with my guess is like the move to have the Rorschach be not just perceived, but like utilized in a more empirically driven way. It sounds like
Dr. Benjamin Berry:Yeah, and just in the less kind of theory bound way, you know, people, people who people who work kind of across different theoretical modalities in terms of psychotherapy can use the Rorschach in a way that's sort of theory neutral. So yeah, it's it's it is partly a shift in emphasis from, I think, theory to research. It's also shifting emphasis from sort of psychodynamic origins to this kind of broader way of using it. So
Dr. Bob Boland:how did you get interested in this? Yeah, so
Dr. Benjamin Berry:I, my undergrad degree was very experimental psychology focused. Mostly, I was doing research about social attitudes. And I got to do some research on the Implicit Association Test. Oh, cool. Tell
Dr. Bob Boland:us a little bit about that quickly. Yeah, that'd be a whole thing in itself. But
Dr. Kerry Horrell:reference to it. Yeah. I actually don't remember which podcast we've definitely referenced.
Dr. Benjamin Berry:before. Yeah, it's it's an interesting test. So it's, it's a test of social attitudes based on reaction time. So you have people sit down and sort things into categories. So for instance, I think probably the most famous it is the race based it. So you'll have a good category and a bad category. And then you're shown black and white faces, and you sort these things into categories.
Dr. Kerry Horrell:Super quick. Like the big thing is, it's like, you don't have to think about it, you have to like do it really quickly, just how it gets out of the implicit. Yeah,
Dr. Benjamin Berry:right. And, and the reaction time is the mechanism of the test. So it turns out that white participants tend to be faster when they're sorting black faces into a bad category and white faces into a good category,
Dr. Bob Boland:because you have to work harder to sort of go against your own biases, right. But we're not talking about that. You can go online, though, and take the test. Yes.
Dr. Benjamin Berry:Yeah. So that was those some of my first kind of exposure to psychological research. And I was really fascinated by this idea that you could use something as simple as reaction time to try and study something as complex as social attitudes, racism, prejudice. It just got me really interested in measurements in general, and kind of what we're doing in psychology when we're when we're trying to learn things about people. Then when I went to graduate school, I got the really incredible good luck of working with two of the authors of the current Rorschach administration and scoring system. Greg Meyer and Joanie Mahara. I was
Dr. Kerry Horrell:like, you just, you did happen to a school where like, the people doing this, this are the people at the year school? Yeah,
Dr. Benjamin Berry:yeah, this is this is one of the kinds of centers of Rorschach research. Their lab is at the University of Toledo. And I, it really was very lucky because at that time, I knew I was interested in measurement, but didn't know an awful lot about the Rorschach. So I went to graduate school and got this real immersion in the Rorschach, but also, just kind of the conceptual underpinnings of measurements and psychological assessment. Was Phil Erzberg also at University of Toledo? he was not there, but he was closely involved in research that we're doing, because
Dr. Kerry Horrell:I always I always connect him and Greg Meyer together. I think it's cuz I went, I went to a training with Wilson, which it was was, I think maybe one thing we could say about the Rorschach too, which that's gonna be the next thing when you talk about it's like telling us about the word shock. But maybe for people who are either not psychologists or didn't train it if they are like, it's a beast of a task in regard to the scoring of it. And like it is a kind of controversial, I mean that the task itself has got this history and it's got some controversy, but the scoring can be so controversial. I remember going to this because what we can, one thing we'll talk about is there's been shifts in the scoring system, but I was trained on a scoring system, the Exner the comprehensive system, okay. And then when I came to Menninger, we use the our pass the war shock performance assessment system, and I didn't been trained in that so I went to a I went to a two day seminar with Phil Erzberg and Greg Meyer and I'm I'm not kidding we spent I think, like 90 full minutes at one point debating as a whole group whether smashed tomato was aggressive. Like and I just to certain point was like, That's too much. It's too this is we're spending too much time on this but it is such an intensive and there's so much around the scoring of it all. And he's I just alluded to a lot
Dr. Bob Boland:but I switched between lb what someone thought it looked like yeah, and whether
Dr. Kerry Horrell:they would receive this code or the score if that's aggressive. And again, that's just a little a little a peek behind the curtain of like, how How much complexity theory isn't it? But maybe to back up. Do you want to tell us a little bit about the Rorschach? You know, I'm thinking about the our listeners who haven't who've heard of it, but don't know much about it. So can you tell us what it is? You've given us a little bit about what it measures but also, maybe you could tell us a little bit about how it developed? Yeah,
Dr. Bob Boland:it's pretty old test.
Dr. Kerry Horrell:Yeah. Give us a snapshot of what the heck is the Rorschach Inkblot Test? Sure,
Dr. Benjamin Berry:sure. So yeah, the task itself is pretty straightforward. It's 10 inkblot designs, the psychologist chose the test taker the inkblots, and then transcribes what they say and take some other notes about things that they do with the task.
Dr. Kerry Horrell:Can I just chime in for a second? Cuz I don't think I've had a lot of used assets that people don't know it's the same 10 we have a see I haven't
Dr. Bob Boland:changed since I'm in the Hermann Rorschach,
Dr. Kerry Horrell:right? Yeah. 60s himself. Yeah.
Dr. Benjamin Berry:Yeah. That's not a joke. He did. He created them himself. Yeah.
Dr. Kerry Horrell:Like you and I both at the same set of cards. We're not like making them or like changing them this this thing decades
Dr. Bob Boland:ago would have been the same.
Dr. Benjamin Berry:Yeah. Which is part of what makes these particular inkblots useful, right? We have decades and decades of data about what it means when people respond to them in particular ways. It's it's very carefully standardized in that way. But yeah, that's that's the task. We take a transcript of what people say when they're looking at these inkblots. And then as with for instance, we talked about cognitive testing, there's kind of a similar process with the Rorschach where there's a scoring system. I look back through the transcript after I've given a Rorschach and I score it up in a particular way it gets compared to norms and then I have a sense for kind of what this person did across a variety of dimensions relative to what's typical, in terms of the history so there's, there's a really good biography of Hermann Rorschach actually called the inkblots by Damien Searles. Oh, really? Yeah. I'm
Dr. Kerry Horrell:assuming you've read it. I have that. And it's good. Yeah.
Dr. Benjamin Berry:If you're, if you're interested in this sort of deep history, it's a it's a good read.
Dr. Kerry Horrell:For all of you should take that with a real grain of salt because we have a real Rorschach nerd on our hands here. Yeah.
Dr. Benjamin Berry:That's true. But yeah, it was it was published in 1942. By Hermann
Dr. Bob Boland:The test not the book
Dr. Benjamin Berry:The the test, right. And the short story is, it's it's been ever since really, there's been this long and often kind of contentious project, a process of scientific refinement of this test. There's a common misconception. I don't know if you wanted to bring this up carry. The Rorschach is kind of junk science. Yeah. This is a really common reaction that people have that it doesn't stand up to scientific scrutiny, right? People
Dr. Kerry Horrell:in the field have that? Oh, yeah. Still, yeah. Many psychiatrists,
Dr. Benjamin Berry:well, many psychologists, and even more so than the average person. Yeah.
Dr. Bob Boland:In a general sense that people just kind of making it up.
Dr. Kerry Horrell:It's very like that. It's very subjective. Yeah, very subjective. So like, if I know you saw you saw smash tomato, I'd be like, Oh, Bob, right? Yes. That's for sure. It's aggressive. Serious.
Dr. Bob Boland:Yeah, exactly. You're probably a sociopath. Right? Yeah.
Dr. Benjamin Berry:Yeah, my wife kind of made fun of me. At one point, my wife Allison and said, I get this. This is just an icebreaker game that you play with your therapists and you know, they, they show you an inkblot, and they help you start talking about your mother and Exactly.
Dr. Kerry Horrell:That's a really good analysis. Yes
Dr. Benjamin Berry:to you. It's, it's a totally,
Dr. Bob Boland:I think that probably a lot of late people as well, like, you know, have a job because it's the way it's portrayed on TV and stuff.
Dr. Benjamin Berry:So there was, I guess, especially in kind of the late 90s, and the 2000s, that there was a lot of dispute among researchers about whether the test works, what it should be used for the there was a meta analysis in 2013. The first author is Tony Mahara, who was one of my teachers at the University of Toledo. That kind of clarified, a lot of that answered a lot of questions. And a lot of research has happened since then. But what we know now is that the test works, as well as other major tests, things like the MMPI, for instance, during that that kind of contentious research period, there were some popular press papers and books, actually, about the Rorschach that were very critical, which I think is partly why the confusion still lingers, because if you just Google it, you will find a lot of material that says no, no, this is totally made up. That perspective might have had some merit at some point, but it's really just not up to date at this point.
Dr. Bob Boland:Well, what got it back into the fray of science or?
Dr. Benjamin Berry:Yeah, so Kerry mentioned the comprehensive system. Prior to the comprehensive system, there were a lot of different ways of trying to interpret a Rorschach it was, I was gonna say, not standardized, but maybe it's that it was standardized, but in many, many different ways. So you never really knew exactly what you were getting when you had, like
Dr. Kerry Horrell:you. And I could do like, in theory, we weren't around during this time, but like you and I could both give the Rorschach and come up with kind of different results or we look at the same transcript and come up with different things because we might have different ways of scoring it. Yeah.
Dr. Benjamin Berry:And the comprehensive system was this massive effort to kind of organize the empirical research on the test, turned it into something that could be standardized and psychometrically reliable. When the creator of the comprehensive system John Exner died in 2006. There was some drama over who should kind of carry the test forward who should be studying it and updating it that ultimately I led a group of his colleagues to develop R-PAS the Rorschach performance assessment system, which is the one that I learned in Toledo. It's the one that for the most part we use here at Menninger. Should I say a little something about what our past does relative and comprehensive? Yeah, cuz
Dr. Kerry Horrell:I mean, there's still, I don't know this totally. I mean, it wasn't that long ago that I wasn't training, but I was trained on the comprehensive system. And so when I came here, as a trainee, I had to mean it. There's a lot of overlap, and I had to learn the R-PAS system, and there was enough of a distinction. And I think, and hopefully, I'm not giving me your answer. But I think the thing that I noticed the most, and I know you tend to remind me a lot about because Ben is my go to Rorschach question guru, but like, they really got in on like, what is evidence based, and, and sort of, like, really honed in on like, if we're going to make an interpretation? Like, there's good data for this interpretation? That was like one of the main things I took away from it. So I do think it's important to talk about
Dr. Benjamin Berry:Yeah, yeah, that's, that's true. And actually, when you give R-PAS, one of the things that I really love about interpreting R-PAS is that they actually, they have two categories for their variables. They're what they call page one variables, which are good, and they have solid empirical evidence, they sort of make sense logically. And then there are what they call page two variables, which have less research support, they might make a little bit less sense logically, but they have some history. And so they didn't want to get rid of them right away. I know, the intention is that at some point, there will be another edition of R-PAS where either there's been some research to bring those old variables up to par, or they're gonna get rid of
Dr. Bob Boland:it when we see evidence, like what what kind of data we're talking about, they just give it to a bunch of people. And so what they said or what,
Dr. Benjamin Berry:yeah, yeah, so it really it's about psychometric validity. So with, with psychological tests, we always want to know what the test scores correlate with in the person's mind and their behavior in their lives. So for instance, if you have a sample of depressed patients, and you give them all Rorschach, and they all say, some particular type of thing, the correlation between that particular Rorschach score and the depression diagnosis is is what we would call a validity coefficient. So the bulk of the evidence base really is just all of these individual studies that have given raw shocks to different kinds of populations, tried to get a sense for what they might mean. And then it's all been kind of aggregated over time. That was what what the what the 2013 meta analysis was, it was an attempt to take these many, many 1000s of participants Rorschach responses and sort through, what are these things actually correlate with and which of these variables seem to mean something and which don't? That's partly what our past did, it was a matter of kind of pruning different variables. It also uses updated norms, there are there are kind of a whole variety of things. One of the big differences is that in R-PAS, there are some limitations on how many responses a participant is a that's like one of the best parts. Yeah, it's it's it's a lifesaver as a user, but in the comprehensive system, there was a lot more flexibility in terms of how many responses you give, which causes all kinds of measurement problems. So for instance, imagine if, if, on the MMPI, it was up to the test taker to decide how many items they wanted to answer, right, you would have some people give you 25 items, and some people would give you 300 items. And there would be all kinds of variation in the things that you learn just based on how they approach the test. That's, that's a, that's a big measurement problem. And so that was that was one of the big changes with our pass, which,
Dr. Kerry Horrell:again, as a giver of the Rorschach was a lifesaver. Because, you know, each response requires this very careful coding, and it takes a long time. Honestly, I'm not the biggest fan of scoring Rorschachs then over here. Oh, see, you'd love it, but you don't hate it as much as some
Dr. Benjamin Berry:when somebody emails me with with a question about it. It's a really nice distraction from whatever else I'm doing. Yeah,
Dr. Kerry Horrell:it's me. It's me, I'm the one emailing but I like the more they give than the more you have to score on the old comprehensive system. I didn't mean to say the old system in the comprehensive them, they can give you 50 responses and it's like,
Dr. Bob Boland:well, can you give an example I could because it's about page one page two, I will be example of like some response with a lot of validity to it. Yeah,
Dr. Benjamin Berry:that's a good question. So I want to be careful about getting into the specifics of what people can say on the Rorschach and what that might mean
Dr. Bob Boland:or you might call it away and then people won't do it. Yeah, we don't have that big of listenership. I don't think it's gonna ruin the Rorschach for psychology.
Dr. Kerry Horrell:So there is this ethical piece though about like this. Okay, so like, if I told you this is this is not true, this is gonna be hypothetical. But if I told you that seeing, I'm just thinking something random, like a Starbucks mug, in the cards, Starbucks, I'm just I just thought I literally just looked around the room and just tried it meant that you are wanting to become a Broadway singer. This is specific because it's hyperbolic. And I'm just using an example. Like you held that in your mind and even if it was like, years later, that's like in your mind Somewhere in the annals of your mind, and so then you probably wouldn't see
Dr. Bob Boland:surely the secrets around. I mean, can I Google this? You know, we're still not gonna say,
Dr. Benjamin Berry:Yeah, certain things are publicly available that probably we don't love are publicly available. But a lot of other things actually are sort of protected, you know, trade trade data, and we have an
Dr. Kerry Horrell:ethical responsibility that's
Dr. Bob Boland:best kept secret then like, Well,
Dr. Kerry Horrell:can I reframe Bob's question? As the psychologist of the duo?
Dr. Bob Boland:I'm not sure. But let's say that I was
Dr. Kerry Horrell:gonna say like, without peeking behind the curtain too much like without sharing too much. What are some of the things that the Rorschach can measure? Have you alluded to like kind of similar things like the MMPI? Like, what are some of the things that maybe again, like, somebody might end up like, we might be able to learn about them or like, overall things that we can take
Dr. Benjamin Berry:away? Yeah. So it, it covers a fair amount of ground, the things that probably it's best for, and I'll give you kind of this, this is some some jumble of my opinion, and what the research suggests, experience of emotion, emotion regulation, social cognition, kind of subtle indicators of psychosis. And the psychosis is probably what it does best actually, part of the reason for that is that when you give a Rorschach you're taking a sample of speech. So when you go back through later and code it part of what you're looking for is, you know, really in a fine grained way, looking at the kind of coherence and logic of the things that the
Dr. Bob Boland:person says. So you're not just listening to what they say, but how they say it.
Dr. Benjamin Berry:It's relatively very little of the interpretation actually has to do with what people say incidentally. Yeah. Okay. Yeah. And psychosis is a good example where there are oftentimes as we speak, these tiny little lapses in logic or lapses in wording, or we confused one word for another, folks who are actively psychotic will do lots and lots of that folks who are really not, you know, who don't have any kind of psychiatric difficulty going on at all will not do that very often. Part of what's interesting about psychosis, though, is it really is a continuum. So folks who have trauma or folks who have a personality disorder, for instance, kind of fall somewhere between those two poles, you will see some psychotic processes going on. So when you give a Rorschach Well, one of the things that you get that's really nice is this sort of like continuous dimension of psychotic processes and sort of overall psychopathology.
Dr. Bob Boland:So I mean, this, this may well answer the question I would have is like, as a psychiatrist, if I have a patient, when would I refer them to you and say, you know, we really need to get a Rorschach on this person? Yeah, yeah. What kind of questions would be like the kind of questions we might be looking for? Because, like any test, I assume you are more useful if we actually are clear about why we're referring them?
Dr. Benjamin Berry:For sure. Yeah. So I think most commonly, it's used as part of a battery to answer really complex sort of differential diagnostic questions. So here at Menninger, for instance, we very often are trying to tease apart to what extent is this a personality disorder or some kind of lingering effect of a psychotic episode or you know, those those those guys ask the question, yeah, complex diagnostic questions, especially regarding psychosis. So I think when people asked me specifically for a Rorschach, typically, it's because they have someone who they think might be mildly sick. Yeah, sort of maybe in a prodromal phase, or maybe they just came out of an episode. And, you know, the, the team wants to get a sense for how impaired this person's thinking might be by kind of a lingering psychotic process. Those are, those are really important pieces.
Dr. Kerry Horrell:I think one thing that's can be frustrating or tough is that it's important for not only our ethical obligation for test security, that's like in our ethics code that we deploy. Yeah, like
Dr. Bob Boland:what so you do a thing to say like you're sworn to secrecy, but like,
Dr. Kerry Horrell:like, we have an obligation because tests can be invalid if people in the public are aware of them. Do you know what I mean? Like, so there's this responsibility, we have to keep things secure. So that way we can develop and have valid measures. But one of the tricky things, especially with the Rorschach, okay, so like, if you're answering a questionnaire, and the questions are like, do you feel depressed? And you were like, yes. And then I was like, Hey, your test shows? Do you feel depressed? You're like, Yes, correct. That's way oversimplified. But again, hyperbolically. But when you give the Rorschach today's word, and they are I know I am hyperbolic most days, when you give the Rorschach and you have somebody, you know, seeing whatever they're seeing and whatnot and then you say your responses are indicative or your overall testing is indicative of these issues of this sort of process. I feel like such a common thing, especially with the young adults are like, come on, you got that from inkblots, like and in fact, even if I include the Rorschach in a larger battery, even if like there's all those other measures a lot of times one way they'll just like whatever they're like you just looked at some ink blots, whatever, whatever, whatever. They're not usually that aggressive. But again, what do you tend to say to patients, like I wonder how you make sense of it with them of like, how did we Looking at these ink blots and telling you what I saw, get you to things like social cognition and psychosis and mood, like how and emotions, like without giving away, like, the actual like, Well, you saw this and this led to this code like how do you talk to patients about it?
Dr. Benjamin Berry:Yeah, yeah. And I think that's part of the general sort of knee jerk reaction against the Rorschach sometimes is like, Hey, I told you I saw a butterfly, what do you mean, I'm lonely or whatever. So
Dr. Bob Boland:this is one of the ones now.
Dr. Benjamin Berry:I mean, this is partly sort of specific to me and part of the way that I work here at Menninger, but I think oftentimes, when a patient has this kind of GOP rejecting sort of like, no, no, you didn't learn that, from that test. Oftentimes, they're sort of trying to distance themselves from whatever the conversation was. And so I'll do just a little, you know, very quick, sort of psychoeducation, that actually folks who are experiencing this particular difficulty often do this on the test. And here's what I think it means. What do you think, to try and get get them kind of back into the frame of engaging with the material? The really kind of straightforward answer for someone who's who's really demanding answers is just like, look, it's it's correlations, right? We know that this type of response correlates with this type of thing. Here's what we see. This
Dr. Kerry Horrell:is I mean, there's probably reason why I think we wanted to have you on the podcast is because I think you in my life, and as a psychologist have really been a pillar of reflecting on how standardized empirical based this measure is, when I think you did a really nice job with the patients of helping them utilize it therapeutically. And like, again, within a larger battery. And just like I hope people are walking away from this episode hearing like this, yeah, this is a really legitimate tool. And in fact, it can offer I think, especially one thing on my mind is like, especially for patients who may be struggling with sort of like sharing themselves and sharing their mind with us. Like, this is a way that's a little bit less just asking those sort of face valid questions that might get us some more data. Yeah. How
Dr. Bob Boland:commonly is this done these days? Like, are we unique in having it here?
Dr. Benjamin Berry:Or? Yeah, that's a good question. It's definitely on the decline. I wouldn't say partly, I think that's because it does take a fair amount of training in order to use it properly, it takes a fair amount of time to administer and score. So it's never going to be computerized or, you know, I don't know about that. Actually, the the our past team just put out a web app that does voice to text transcription. And I think there's probably going to be some some oil. Yeah, I think actually, a lot could change in that direction. But right now, our past people, yeah, it's, it's, it's a, it's a good change. But it is, it is fairly time intensive right now. And I think that has really made it harder for people to use. It is used pretty commonly here at Menninger. And I think that's partly because we are more likely to have the time. And because our patients are so complex, they come in with so many different kinds of presenting concerns. That really, in order to do a thorough assessment, we need more methods than then we might in another setting. To
Dr. Kerry Horrell:give an example, just really quick. So I took a series of four assessment courses when I was in grad school, the first one covered cognitive tests, like we covered multiple of the big cognitive tests. My second one covered the many complex personality measures like the MMPI. Notice, my third class was just the Rorschach, and then my fourth class with a whole bunch of different neuro psych tests, it's like my normal assessment classes. Were covering many different types of tools, how to give them and how to score them, how to interpret them. We had just one entire semester on class GS for the Rorschach. Like it's just it's more complex than I think many people understand it to be. Wow, yeah,
Dr. Benjamin Berry:I've taught some of those courses. And it is a fairly common reaction that people say, okay, I get it. I've read the research. I know how to do this, but I'm not going to do it. It just takes too much time. That's that's not an unreasonable reaction. But I do think if you're a psychologist who is regularly doing complex assessments, things where psychosis and personality dysfunction are kind of part of the regular presenting question. It can be a really, really powerful tool. Wow.
Dr. Kerry Horrell:I wonder I mean, that was a really nice last word. But do you have any last words for our audience about about the Rorschach what we'd want people to take away from this this episode? I
Dr. Benjamin Berry:don't think so. I think for folks who are interested, yeah, check out that biography. So the name of it. So that's the inkblots by Damien Searles? For psychologists who are suspicious I think don't take my word for it. Go check out that Mahara at all 2013 meta analysis. There's obviously since 2013. There's been a lot of research, but that's a really good place to start. I think that's it for now. Yeah, honestly,
Dr. Kerry Horrell:you should take his word for it though, because Ben is definitely one of the experts, the people really studying this and doing such a good job, and also be so generous in your time and helping those of us who supervise trainees like especially when we get in the nitty gritty, which again, with the Rorschach, you can get there. nitty gritty to be had, and you really help us with that, Ben?
Dr. Bob Boland:I think we're very lucky to have you. So thanks. Both administer and here on the podcast. Yeah. Yeah. So thanks so much for joining us. Yeah.
Dr. Benjamin Berry:Thanks for having me on and carry please keep emailing me Rorschach question. That's
Dr. Kerry Horrell:always always well, you've been listening to the mind die podcast today we've had on Dr. Benjamin berry of the Menninger Clinic and thank you again and I've been one of your co hosts. I'm Dr. Kerry Horrell.
Dr. Bob Boland:I'm Dr. Bob Boland.
Dr. Kerry Horrell:Thanks again. The mind dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.
Dr. Bob Boland:For more episodes like this, visit www dot Menninger clinic.org. To
Dr. Kerry Horrell:submit a topic for discussion, send us an email at podcast@menninger.edu