Urist1982.pdf

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Validity of the Rorschach Mutuality of Autonomy Scale: A Replication Using Excerpted Responses Jeffrey Urist & Merton Shill Published online: 10 Jun 2010.

To cite this article: Jeffrey Urist & Merton Shill (1982) Validity of the Rorschach Mutuality of Autonomy Scale: A Replication Using Excerpted Responses, Journal of Personality Assessment, 46:5, 450-454, DOI: 10.1207/s15327752jpa4605_1 To link to this article: http://dx.doi.org/10.1207/s15327752jpa4605_1

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Journa! of"ingr~o?2dityAssessment, 1982, 46, 5

Validity of tha RorockrecE; !idutuaJlty a%Autonomy Scale: A Rephioation [i.lslnaEac-ecpted Responses

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JEFFREY UP.IST and MEYFON SI-IIZL Vnivrrbiry of h'iictigan Abstract: This study examines rho tlie of cup-erptedRorschach responses for rating object relatlons. This assezsment of objzcr .e;atlons lotuses on a dimension defiaed as Mutuality of Aumromy. A Rorschach Scaie fcr ?~iutualityof abtono~r~y 1s presented. Its applicaiion to excerpted y Mutuality cf Autonomy Scale to theentire Rorschach data is dess;ijeG. Raters did riot a ~ p i the p r o t o c ~ las had been don? previously (Urist, 1977). Instead, in an attempt to argue that Rorschach ratings in facr reflected ivlutuality of kutanomy and not extraneous factors, ratings were bmed exclusively 03 excerptea responses. Relrability for the excerpiir-g was at a high level of agreement, ;nd the Rorschach Mutua1;ty of A ~ l r o n o Scores ~y based on these excerpts c~rrelated significantly with independent clinic21 ratings of Mutuality of Autonomy.

In a przvious!y reported stxdy (Urist, 1577) an objeci relaiions sca!e, organized around the dimension of Ml~tua!i?yof Autonomy, was developed for the ROTscliach and applied to the protocols of 60 patients. Tbe Rorschach ratings for MLItuality of Autonomy correlated signific a n t ! ~with independent measures of ob. ject relations, specifical:~ therapist ratings and clinical ratizlgs based on an eutobiographical task. The aim of the prese~tpaper is to address a specific methodological question raised by the prwious study. In that stcdy ihe Mutuality of Autcnomy Scale (MAS) had been applied to the subject's estire protec~l.Raters, then, had many types of diagnostic 5ata availabie to them other thzn those specifi; ~ercepts which, it was hypothesizled, reflected the intrapsychie organization of self and object representations. Thought disorder, primitive sexual or aggressive content, peculiar verbalizations, as well as other consciously or unconsciously perceived diagnostic data, were all part of the total data that served as the basis for the Rorschach ratings on the MAS. The question then arises, were the raters in fact rating Mutuality of Actonomy and not same other dimensioi~conveyed thrsugh the Rorschach data? Does the Rorschach specifically reflect, as had been hypothesized, the individual's chatacteristic and enduring modes of experiencing object relationships? What followed from this is ryported below: the attempt

to app!y the MAS to excerpted Rorschach raspowes rather than to entire protocols. Method Szibjects The subjects were 60 adolescent patients, seiected at random from among those referred for psychological testing at Uiiiversity Hospitd Yaurh Services over the past three years. Thirty were outpatients, and 30 inpatients. Of the inpatients, 16 were male and 14- female. The ozlpatierit subjects included 14 males and 14 females. The tctal sample ranged in age between 13 years, 6 months, and 17 years, 2 months. The standard devistion of subjects ages was 1.53 with a mezn age of 15 years, 4 manths. All subjects were judged to be free of any orgapic deficit. The average IQ was 109, ranging from 99 to 127. The Rorschachs were administered by psychology interns of varying degrees of experience. The average R for this sample of protocols was 24.6, ranging from 9 to 43 with a mode of 22. The Ratirig of MutuliEity of Autonomy The Mutuality of Autanomy Scale (MAS), as suggested above, was conceived in terms of a developmental line reflecting the gradual intrapsychic process of individuation and the child's changing conclepti~nof its relative embeddedness in, or psychic separateness from, figures in the external world. The thematic imagery that forms much of

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J. URIST and M. SHILL the basis for the scale was organized around the model of the mother-child dyad. The Scale involves a series of differentiations in thematic content which are thought to represent points of developmental significance in the child's shifting experience of self in relation to the mother, and vice versa. The Scale itself as well as a detailed review of its theoretical underpinnings appear in the original study (Urist, 1977) and therefor appear bellow in summary form only. These points of developmental significance vvhich represent the basis of the Scale biegin at the primitive end with the theme of undifferentiated, symbiotic fusion of body parts. Next would be that point where the child experiences self and mother as each havingphysical priorietorship over their respective bodies, yet where the body of one can be experienced as under the magical control or will of the other. The Scale proceeds through themes of mirroring where, for the very young child relatedness requires that self and other be defined as extensions of one another's need states. Somewhat higher level anaclitic themes involve a greater degree of differentiation between self and other, eventhough object relations at this level can be based heavily on need satisfaction, Higher developmental levels approach more and more the stage of true object constancy {(Fraiberg,1969) where other people are valued as separate individuals i n their own right. At the most advanced extreme of ithis developmental line would be the capiscity for empathy, involving an intense realistic investment in the subjective world of another, while still maintaining the sense of mutual autonomy. A scale for the Rorschach was constructed, d~efiningquantitatively different categories of thematic content that, as a scale, would reflect the stages in the above structural progression in the development d object relations. The Scale was regardled as applicable to all relationships depicted in the content of the subject's Rorschach percepts. Relationships among people, animals, plants, inanimate objects, vague forces, etc.,

45 1

were included. In constructing the Scale, an attempt was made to recognize the way in which aggressive content, as well as libidinal themes, are rnanifested across the full range of Muluality of Autonomy. We avoided building into the scale a prejudicial weighting of libidinal themes over aggressive ones, as though relationships depicted in aggressive terms ips10 facto reflected some deficiency or absence of Mutuality of Autonomy. Themes of intense object-related competition between figures, for example, was regarded as reflecting a relatively high degree of Mutuality of Autonomy. The scale itself cor~sistedof the following 7 points: 1. Reciprocity-Mutuality. 2. Collabol-ation-Cooperation. 3. Simple Interaction. 4. Anaclitic-.Dependent. 5. Reflection-Mirroring. 6. Magical Control-Coercion. 7. Envelopment-Incorporation. For the sake of brevity the scale, which appears in the 1977 article, is not reproduced here. In constructing the: scale, the hope was to achieve more than just a grouping of seven, compartmentalized categories, bud rather, a sense of an internally consistent dimension. In an attempt to emphasize further the Scale's reflecting a continuaus coherent dimension, it was presented to the raters, preceded by a brief definition of Mutuality of Autonomy which was sa follows: Mutuality of Autonomy refers to the degree to which people in relationships are conceived of, by the subject, as psychologically autonomous; as possessing a n enduring, inherent psychic existence. The subject experiences others as possessing a self, while at the same time objectively recognizes his or her own existence as one object among many. Both self and others are simultaneously experienced by the subject as possessing an identity, a will, and the subjective, affective experience of selfhood. The subject conceives of relationships as respecting theseattributes independently of fluctuations in the need state of either one's self or of the ather individual witlhin the relationship.

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452

Validity of the Rorschach Mutuality of Autonomy Scale

Excerpting As mentioned above, the Rorschach scale was intended to be applied to all responses depicting relationships of any kind. Implied relationships were also included; for example, a "squashed bug" would be seen as implying a "squasher" even if it were not elaborated. Out of the 60 protocols, then, any and all responses that reflected in their content an explicit or implied relationship were independently excerpted by a pair of raters. The excerpting led to the following: out of a total of 1477 responses contained in the 60 protocols, the raters disagreed 87 times whether or not to excerpt (i.e., include) a particular response. Raters, in other words, agreed 94% of the time on the excerpting. All 87 disagreements were then resolved through discussion, resulting in a total of 302 excerpted responses for the 60 subjects. The Rorschach MAS was then applied to the excerpted responses. Since typicaliy a given subject would perceive a number of relational themes that often would cover a range of MAS scores, the following scores were calculated for each subject based on applying the MAS to the excerpted responses. 1. highest MAS score 2. lowest MAS score 3. average MAS score 4. high average MAS scorf 5. low average MAS score 6. overall MAS scorec " The high average score involved the mean of highest three scores. The low average score involved the mean of the lowest three scores. The overall score involved the rater's judgement of the most representative score.

Clinical Ratings of Mutuality of Autonomy Independent clinical ratings of object relations were generated by applying a clinical version of the Mutuality of Autonomy Scale (CMAS) to the confidential records of the 60 subjects. These ratings were done by a pair of experienced clinicians. Where, in the judgement of one or both of the clinicians, a given subject's chart failed to provide

sufficient data for a relatively high degree of confidence in their rating, that subject was excluded from the study (the original n was 65; 5 were excluded). The confidential records included at least a developmental history, family history, admission note, clinical progress notes, notes by nursing staff, and regularly updated treatment plans. Only those entries made prior to the testing were made available to the clinical raters. Since 10 of the 60 subjects were either currently in the hospital or had therapists who were still available to provide ratings, it was possible to include therapist's ratings of object relations for these 10 subjects. The therapist's ratings could then be compared to the ratings based on these subjects' records, both scores being based on the same clinical Mutuality of Autonomy Scale (CMAS). The CMAS, then was used to generate therapist rating$ for 10 subjects and was applied to the charts of all subjects. It included the same introduction that preceded the Rorschach MAS and consisted of seven points, paralleling the Rorschach Scale. The reader is referred to the 1977 study for the text of the CMAS.

Results The reliability for all pairs of raters appears in Table 1. Also in Table 1 is the percent agreement between the therapist ratings and the clinical record ratings for the 10 subjects on whom therapist ratings were available. Since Rorschach raters (a) scored each of 302 excerpted responses, and then (b) had to determine an ovrall score for each subject, there are exxentially two reliability scores of the Rorschach ratings. The Rorschach ratings in Table 1 reflect the percent agreement between raters for the overall Rorschach score given to each subject. The percent agreegment between Rorschach raters across all 302 Mutuality of Autonomy ratings (i.e, the scoring for each excerpted re~ponse)was as follows: 52% exact hits, 59% within j/, point and 68% within one point. The highest correlation with the clinical record ratings of object relations was

J. URIST and M. SHILL Table 1 Reliability of Ratings: Percent Agreement Between Raters

Rorschach Mutuality Ratings n = 60 Clinical Records Mutuality Ratings n = 60 Therapist Ratings with Clinical Record Ratings n = 10

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Table 2 Intercorrelations of Rorschach Scores with Clinical Record Scores clinical Records Score

Rorschach Overall Rorschach Average Rorschach Low Average Rorschach High Average Rorschach Highest Rorschach Lowest

.53* .48* .50* .37* .17 .51*

* Significant at .OOI level. generated by the overall Rorschach score. As reflected in Table 2, all Rorschach scores tended to correlate significantly @ = .001) with the clinical record ratings except for the highest Rorschach score. Discussion The significant correlation between the Rorschach Mutuality of Autonomy ratings of the excerpted responses and the clinical ratings of object relations supports the idea that the scale does indeed tap the subject's capacity for object relations. The argument that such a correlation may reflect the influence of an additional or extraneous factor is not supported by these results. The effect of a more general Rorschach health-sickness factor appears significantly less likely in the face of the ability of the more focused use of excerpted responses to generate a significant correlation with an independent measure of object relations. It is, of course, possible that raters may still have been influenced to some degree by other qualities of the excerpted responses themselves, such as form

Percent Witnin One Point

Percent Within K Po~nt

Percent Exact Hits

72 74

60 72

-38 62

90

85

80

level, or by particular aspects of the content unrelated to Mutuality of Autonomy. Nevertheless, the possibility of such extraneous factors has been significantly reduced, given the results of the excerpting. The results raise the question of the validity of the different measures of object relations used i r ~this study. Campbell and Fislce (1959) emphasize that validity can be established onl:y by a combined strategy of (a) assessing the same trait by different methods, and (b) measuring different traits by the same method (multitrair..mulf inet hod matrix). This type of approach offers the possibility of comparing in the future various methods for the aSSeSSnlent of object relations. Being able to contrast the effectiveness of the Rorschach to that of other approaches to assessing object relations would appear to be worthy of further ex.ploration. Specific cornparision between these findings and results of the 1977 study is complicated by the fact that the present study makes use of clinical ratings based on the patients' charts whereas in the earlier study, Rorschach MAS scores were instead correlated with direct ratings by staff of patients' actual behavior as we11 as of other projective data. With the attempt at validation being based on differing external measures, it is difficult to compare the current correlations to those found in the previous study, othr than to note that in both cases the R.orschach MAS scores correlated significantly with the respective clinical measures. In the previous study, obtained correlations between Rorschach MAS and staff ratings were somewaht low~er(r = .47) than the current correlation using ratings based on

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454

Validity of the Rorschach Mutuality of Autonomy Scale

charts (r = .53). On the other hand, the method matrix. Psychologzcal Bulletin, 1959, 56, 81-105. previous study revealed a correlation of .63 between Rorschach MAS and ratings Fraiberg, S. Libidinal object constancy and mental representation. Psychoanalytic Study of the of Mutuality of Autonomy based on an Child, 1969, 24, 9-46. autobiographical task. Kernberg, 0.Borderline conditions and pathoClinical ratings based on patients' logzcal narcissism. New York: Jason Aronson, 1975. charts clearly leave a great deal to be desired as a consistently rich and de- Kohut, H. The analysis of the self: New York: International Universities Press, 1971. pendable source of clinical data across Mahler, M., & Furer, M. On human symbiosis subjects. One can speculate that in vivo and the viczssitudes of individuation: volume I , clinical ratings would represent a more infantile psychosis. New York: International appropriate external validating instruUniversities Press, 1968. ment than the use of patients'charts, and Settlage, C. The psychoanalytic understanding of narcissistic and borderline personality disorders: would, in this case, have allowed for a advances in developmental theory. Journal of better comparison between excerpted the American Psychoanalytzc Association, 1977, and nonexcerpted Rorschach measures. 25, no. 4, 805-834. Nevertheless, the current findings do Urist, J. ThepRorschach test and the assessment of support the claim that obtained correobject relations. Journal of Personality Assessment, 1977, 41, 3-9. lations between Rorschach measures and external clinical measures of Mutuality of Autonomy do reflect valid mea- Jeffrey Urist University Hospital surement of that variable. Psychiatric Hospitals (Box 11) References Campbell, D. T., & Fiske, D. W. Convergent and discriminant validation by the multitrait-multi-

Ann Arbor, MI 48109 Received: January 24, 1981 Revised: June 5, 1981