July/August Newsletter

RORSCHACH TRAINING PROGRAMS, INC
JULY/AUGUST NEWSLETTER
VOLUME 9, NUMBER 4

It is a pleasure to have Piero Porcelli,, PhD, as our guest contributor for this issue of the RTP Newsletter. Dr. Porcelli is a full professor of Clinical Psychology at the University of Chieti, Italy. He has authored a number of articles, books, and chapters on psychosomatic medicine and psychological assessment, including clinical research on the assessment and utility of alexithymia and the Rorschach test. He is a member of the editorial boards of international journals such as Psychotherapy and Psychosomatics and Rorschachiana, and served as Editor of the Bulletin of the International Rorschach Society.

THE “FEELING OF MOVEMENT”: THE CHARMING SIDE OF M RESPONSE
Piero Porcelli
I have always been intrigued by the human movement response to the Rorschach. After form, color, and shading, movement is the fourth class of determinants that is, however, particular because what “determines” (hence the name “determinant”) the response is not there in the blot but in the mind of the subject. Blots have indeed relatively unstructured shapes, different colors, and nuanced shades but surely do not move. Technically, the movement response is more a Special Score than a true determinant. What is charming in the M response is not only the fact that the subject imagines a movement that s/he does not see, an event that pertains to the wider class of phenomena of visual illusions, as reversible figures, perceptual art or FM/m responses to the Rorschach. Visual illusions can be explained by activity of the middle temporal complex (MTC) in the visual cortex and by laws of perception, namely it is a phenomenon occurring in the mind of the subject. M response is not limited to that, though. It goes further; it involves the body of the subject.

The story began with Hermann Rorschach, specifically with his famous dream made in the night after he was present at an autopsy for his first time as young medical student and saw a brain that was dissected in transverse slices. He dreamt of his own brain being cut in transverse slices. “One slice after the other was detached from the mass of the hemispheres and fell forward, exactly as had happened at the autopsy. This bodily sensation was very clear, and the image of this dream experience in my memory is even today quite vivid; it has the quality of a lived, experienced perception”, (Searles, 2017, p.78; my italics), he wrote. He was always convinced that this primary feeling of movement, without actual bodily movement, is necessary to consider M as a true determinant of the response, not a mere visual illusion of a form that is secondarily interpreted as moving. As I understand it, M is different from the other 3 classes of determinants because it indicates not only an interaction between the external reality (structural features of the blot) and the subject’s mind (psychological functions involved in the response process), but mainly a dialectical tension between reality, mind and body.

As Schachtel (1959, p.71) said, “the subject knows not merely from the outside, but from the inside, how the human figure seen in the blot moves or holds his posture. It was as if he were for a moment and to some extent inside the figure”. In other words, M includes the mental activity needed for summarizing complex psychological functioning into a verbal response to the “what might it look like?” question as well as the implicit sense of my own body, the body that I feel as myself in my lifelong living experience (the body that I am) as opposed to the objective body that everyone can see from the outside (the body that I have) (Porcelli & Kleiger, 2016).

From this perspective, M responses open the doors for multiple research and integration of separate pathways, beyond the controversies and even the fences the Rorschachers have been able to build through the one-century history of the test. Below, I am briefly mentioning some fields that are potentially involved in explaining the M response or in which M can play a major role in explaining phenomena.

Empirical validity.
Construct validity of M, namely the degree to which an index measures what it claims to be measuring, has been widely investigated in last decades. M responses have been consistently associated with higher psychological processes including field independence, creativity, dream recall, effective interpersonal relations and behaviors, ego strength, intelligence, planning, imagination, treatment outcomes, and empathy, as well as negatively associated with deficits in higher psychological functioning including diagnoses of attention-deficit hyperactive, Alzheimer and Asperger disorders, closed head injury, and alexithymia (Mihura et al., 2013). Construct validity is greatly important because we can be reasonably sure that any hypothesis on M is grounded on the solid basement that the way M has been historically conceived is evidence-based psychology.

Clinical validity.
Even though statistical numbers make us confident in theoretical constructs, they do not tell the whole story. As a clinician, I do not need to know only the strength to which an index is associated to a construct but also why it is, since I need to be aware of the process and the functioning behind the patient’s overt behavior. The effectiveness of the diagnostic process increases to the extent that it achieves some interrelated purposes, including enhanced knowledge (providing clinicians with a meaningful framework that recognizes the underlying clinical condition beyond the presentation of symptoms, and identifying potential or unrecognized problems) and clinical utility (enhancement of decision making to improve the patient’s health status) (Barron, 1998).

The presence of M responses by themselves does not automatically imply healthier psychological functioning. It is not unusual, for example, that M responses, particularly M- responses, are found in some forms of psychopathology as hypervigilant individuals with narcissistic or paranoid features, delusional paranoid schizophrenics, or traumatized subjects with PTSD. These psychopathological syndromes may be considered as different forms of heightened attention to bodily states and dysregulated emotions aiming at early detecting environmental/interpersonal threats and dissociating ideational processes (underlying M) and ineffective adaptation (FQ minus).

If we may consider M as the most proxy variable for mentalization, it is also true that M responses might be an index of pseudo-mentalization in individuals for whom the mental world is decoupled from external reality resulting in endless inconsequential talk of thoughts in psychotherapy. M might be conceived as a dimensional construct rather than a single score, ranging from M with associated negative features (FQ minus, Cognitive Special Scores, PHR) to healthy M (FQo, GHR, COP) to lack of cognitive processing of feelings and bodily states (Pure F that can be thought as equating to “absence of M”, as in alexithymia). Clinical studies on the different forms of M responses are therefore much needed.

Affective neuroscience.
Cumulated data in neuroscience have shown that the CNS is continuously monitoring the external environment (via sensory channels) and the milieu intérieur (via proprioceptive channels, from heartbeats to glycemic levels to intestinal motility, etc.) in real time. Through ascending steps (from spinal cord to brainstem, hypothalamus, and thalamic nuclei), some brain cortical structures (anterior cingulate cortex, prefrontal cortex, hippocampus, amygdala, nucleus accumbens, basal ganglia, and particularly the insula and the somatosensory cortex) actively build body maps. These become the means through which the brain informs itself about the changing states of the body by integrating top-down cognitive-affective information, connecting the current body states with stored images and experiences in memory, and providing direct substrates of feelings (Damasio, 2010). The internal milieu is represented deeper and lower in the brain (hypothalamus and brainstem) for interoception and regulation of the state of the body (homeostasis). The implicit body is not an object of perception unless it is externalized and presented to the classical senses; it is the subject of perception, it is the background state of being conscious (Solms, 2015; Panksepp, 2005). The notion of “embodied cognition” claims that the body that I am is not constrained within the objective body (the body that I have) but is a progression of the mentalizing process – largely unconscious – of one’s somatic states. Several research paradigms are available today for investigating how brain body maps and interoceptive awareness might determine the complex process underlying M responses. A wide landscape is therefore open for future research with the M response.

Brain correlates.
Mentalization includes theory of mind; that is, the ability to perceive and interpret human behavior in terms of intentional mental states to make inferences about mental states in both oneself and others. This is the psychological side of the mind/brain unit, the other one being the fact the human brain is wired to understand the experience of another person by reactivating the brain circuits used to process the same experience in the individual self. Pain manifestations seen in another person activates the affective and even the sensory components of the brain pain-matrix in the observing subject. Similarly, we know today that our ability to understand others partially relies on vicarious activation of the premotor cortex area in the individual brain as if the subject might feel the intentions of others’ behavior within his or her body, not at a conscious level (the body that I have) but at a premotor stage by unconsciously reproducing the intentions of the other within him/herself (the body that I am). Anatomical data demonstrating that the insular lobe is connected with the limbic system make the insula – where emotional and somatic inputs are preconsciously processed – a plausible candidate for relaying action representation information both to limbic areas for emotional processing and to neocortical regions for cognitive awareness. A number of studies using EEG, rTMS, and fMRI have consistently shown that the neural mirroring activity is specific for M responses, does not occur with other kinds of movement (FM/m) and non-movement determinants (e.g., H without M), and occurs in the first 1-2 s, much earlier the subject verbally delivers a conscious M response, thus suggesting the “feeling of movement” is induced at a preconscious level when the subject is likely to be not aware of the process (Porcelli et al., 2013).

Cross-system validity.
The M response is one of the oldest Rorschach scores. Despite the breadth of differences among Rorschach systems over the past century, M has been retained in all coding systems and there is broad consensus among clinicians regarding its conceptual meaning and clinical significance (Weiner, 2003). Investigating the integration of processes underlying M responses might pave the way in reversing the direction of research in psychopathology that traditionally focuses on syndromes first, as in the DSM-based diagnostic criteria. An alternative view of diagnosis, which integrates genetics, neuroimaging, and cognitive science into future diagnostic schemes based on behavioral dimensions and neural systems is represented by the National Institute of Mental Health’s Research Domain Criteria (RDoC).

These criteria have been, however, criticized because they do not consider enough psychological functioning among the units-of-analysis scheme of the five basic domains. The Rorschach has at least one code, the M response, that is provided with empirical evidence and clinical utility, and seems to fit well with cutting-edge fields of scientific knowledge about human beings. In one word, the Rorschach is potentially a powerful instrument for future studies integrating psychology and the so called hard science, even though it is a 100 years-old low-tech, handmade device. The challenge is in our hands.

References
Barron, J. (Ed) (1998). Making Diagnosis Meaningful. Enhancing Evaluation and Treatment of Psychological Disorders. American Psychological Association, Washington.

Damasio, A. (2010). Self comes to mind. Pantheon, New York.

Panksepp, J. (2005). Affective consciousness: Core emotional feelings in animals and humans. Consciousness and Cognition, 14, 30-80.

Porcelli, P., Giromini, L., Parolin, L., Pineda, J. A., & Viglione, D. J. (2013). Mirroring activity in the brain and movement determinant in the Rorschach test. Journal of Personality Assessment, 95, 444-456.

Porcelli, P., & Kleiger, J.H. (2016). The “Feeling of Movement”: Notes on the Rorschach Human Movement Response. Journal of Personality Assessment, 98, 124-134.

Mihura, J. L., Meyer, G. J., Dumitrascu, N., & Bombel, G. (2013). The validity of individual Rorschach variables: Systematic reviews and meta-analyses of the Comprehensive System. Psychological Bulletin, 139, 548–605.

Searles, D. (2017). The Inkblots: Hermann Rorschach, His Iconic Test, and the Power of Seeing. Crown New York.

Schachtel, E. (1959). Experiential foundation of Rorschach’s test. New York, NY: Basic Books.

Solms, M. (2015). The Feeling Brain: Selected Papers on Neuropsychoanalysis. Karnac, London.

Weiner, I. B. (2003). Principles of Rorschach interpretation (2nd ed.). Mahwah, NJ: Erlbaum

XXII RORSCHACH CONGRESS

The 22nd International Rorschach and Projective Techniques Congress was held in Paris from July 17 to July 21. Sponsors for this international meeting included the Comprehensive System International Rorschach Association (CSIRA) and the International Society of the Rorschach & Projective Methods (ISR). The current president of the International Society of the Rorschach & Projective Methods (ISR) Congress is Noriko Nokamura from Japan. She also is the vice-president of CSIRA. The current president of CSIRA is Anne Andronikoff from France.

There were approximately 450 assessment psychologists at the Congress from all over the world—several from the United States. Many research presentations were offered during the week as well as several plenary session presentations, giving testimony to the vitality of projective techniques in the world today—especially the Rorschach.

The Congress ordinarily meets every three years, but the next Congress will be in 2021, probably in Switzerland (proposal yet to be presented) to celebrate the centennial of the publishing of Psychodiagnostics, the initial volume of Hermann Rorschach’s work. Switzerland also is an appropriate location because Rorschach lived and worked in Berne at the time of the publishing of Psychodiagnostics.

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