Interview with Dr. Maria Fiorella Gazale
Published at the online journal of the Order of Psychologists of Catalonia, COPC.
1. You as the co-founder of IRPSI (Italian Rorshach Institute and Integrated Multimethod Psychodiagnostics), could you tell me what are the aims of your institute?
Our school aims to teach the use of the main psychodiagnostic tests of personality and cognitive level, for adults and minors, with a good scientific basis, validated by an international literature, with deep respect for the dignity of the person and his or her right to be recognized and understood in a kind, empathetic and scientifically unimpeachable way. The theoretical framework values the relational and collaborative dimensions of the psychodiagnostic context. We do not want to liken the administration of the tests to a kind of x-ray or medical examination, but to a meaningful relationship from which the subject should ultimately derive a feeling of increased self-confidence, a feeling of having been understood and recognized in his merits and weaknesses, and concrete help in overcoming feelings of shame, guilt or helplessness over his own frailties. In the case of child evaluations, we give a lot of space to the empathic and supportive relationship with the parent, from the first meeting to the stages of restitution. Teaching also includes many hours of practicum both on-site and through a mandatory internship in mental health services. We also stimulate students to participate in international congresses, including by collaborating on research and presenting posters or papers.
2. In Spanish and Catalan universities, the assessment exam using projective methods is disappearing; what do you think is the current situation of the use of projective methods, especially in Italy?
The Italian situation, as far as the teaching of psychodiagnostic tests in colleges and universities is concerned, appears to be varied and quite positive. I am thinking of the Bicocca University of Milan, the Catholic University of Milan and Brescia, the University of Turin where psychodiagnostic teaching is numerous and articulated, Padua, Sapienza University of Rome, the University of Catania, and many others. Unfortunately, the hours of training and hands-on practice that university courses devote to psychological assessment remain scarce, however, so the university can give some basic information and arouse an interest in students, but it cannot guarantee a true transmission of the fundamentals of the use of psychodiagnosis and its specific tools. Basic notions of the use of tests within clinical assessment and in typical forensic areas are also conveyed in graduate schools of psychotherapy and postgraduate courses in legal psychology. Several private institutes, such as ours, offer specific master’s degrees on the main psychodiagnostic tests.
3. Why do you consider Rorschach and the other projective methods to be valid and necessary?
The Rorschach test can provide extraordinarily rich and articulate information about the subject’s personality, as can, to a lesser extent, other performance methods with a robust scientific literature such as, for example, the TAT, the Wartegg in Alessandro Crisi’s version, and Phillipson’s ORT. First, a clarification: in the view of Exner, founder of the Comprehensive System, so-called ‘projective’ tests would rather be called ‘performance tests,’ since projection is not exclusive to them: elements of projection are possible in any test, and the specificity of the Rorschach is the fact that it uses highly stimulating and unstructured imagery and places the subject in the need to make a choice between different responses. Exner recalled that a subject to a cognitive test might respond, assuming he or she has to give the answer ‘4,’ by saying “4, like the 4 seasons that remind me of the evolution of time and life”: this would evidently be a projective use within a cognitive test.
I think the importance of imagery testing, particularly the Rorschach test but also TAT and the other similar tests, lies mainly in the ability of visual stimuli to stimulate a part of the brain more directly related to emotional activity and deep memories. Important studies with EEG and fMRI (e.g., Giromini, 2010, Asahi, 2010), have shown that brain activity during Rorschach exposure is particularly active in areas that, such as the amygdala, right temporal area, and orbital prefrontal cortex, have direct emotional resonance or are related to relational and social sensitivity. Moreover, a key aspect of Rorschach administration is precisely the relationship that is established between psychologist and patient.
Having as an intermediate tool in the relationship the Rorschach table, which is strongly emotionally soliciting, but within the structured framework of the test, implies that something similar to the transitional area described by Winnicott is created between the two subjects, which is particularly fruitful and necessary for the growth of the child, in which judgment about the truth and objectivity of an element of perception is suspended, while a shared image is created, allowing the subject to express otherwise unexpressed aspects of himself. In this way the relationship is greatly facilitated and quickly achieves a depth and freedom that would otherwise take a very long time to get to know.
4. You, through your Institute train many psychologists; could you explain the meaning of Multimethod Integrated Psychodiagnostics?
Each test provides a different perspective on personality because it stimulates the patient at a specific level, thus giving partial information. Therefore, psychological assessment must be based on tools that integrate different characteristics that can stimulate the subject at different levels. We know that the subject has states of the mind that may be more or less integrated with each other or dissociated, and that different stimuli may activate them, allowing the diagnostician to recognize them and foster their integration through a respectful, nonjudgmental and integrative restitution of the different aspects that have emerged, in a supportive and empathic relational context.
5. All training goes hand in hand with psychological theory, what is the theory you support?
Psychodiagnostic assessment aims to obtain a functional personality description that takes into account the best possible description of emotional states, behavioral propensities, styles of stimulus processing, reflection and problem solving. According to Exner, the Rorschach Comprehensive System does not require to be interpreted within the framework of a specific personality theory: the description of the person’s specific modes of mental functioning follows a defined procedure, by areas of functioning, and can then be articulated and developed by the clinician’s interpretation, which takes into account all aspects including emotional, affective, relational and biographical aspects of the subject, based on his or her own theory of reference: all these elements are to be integrated and interpreted according to the psychological theory that the expert psychodiagnostic considers most useful.
At one time psychodiagnostic tests, which originated in the context of military selection, and later, in the case of the Rorschach and the TAT, greatly developed in mainstream psychoanalytic circles, aimed essentially at assessing the individuality of the subject, putting systemic and relational aspects in the background. This carried the risk of losing sight of essential aspects underlying psychopathology. Today, this type of psychodiagnosis focused exclusively on individual dynamics is archaeology: the clinician knows that the person is best described on the basis of styles learned in early relationships, attachment style, and Internal Operating Models activated on the basis of early, sometimes traumatic, experiences and the need to adapt to them.
The integration of multiple tools allows us to take much more account of the substantial polyvalence and multifactoriality of the psychic dynamics underlying the subject’s symptoms and disorders. In particular, we use the Family Genogram, which allows us to collect data from the subject’s experience in their relational dynamics with their parents and their parents with the previous generation. We also teach Arnold Bruhm’s ‘Early Memories Procedure’ test that enables the subject to reprocess significant memories from childhood and adulthood and link them to test results, enriching the moment of the final report with personal meaning and emotional impact, which integrates the synchronic dimension of the present and the diachronic dimension of the history of significant relationships.
The theories that, in our school, make, for us teachers, the backdrop for the interpretation of personality are therefore essentially those that value relational dynamics and mentalization skills, both from the relational psychodynamic area and the so-called ‘third generation’ of the cognitive-behavioral school, and also attachment theory and trauma studies in the wake of authors such as Liotti, Van der Hart, and Allan Shore. Central to the assessment is the general framework of collaborative-therapeutic assessment as formulated by Constantine Fisher and Leonard Handler, Mary Tosanger, and Stephen Finn. According to this author, the tests are ‘amplifiers of empathy,’ capable of giving the clinician a very accurate understanding of the patient’s suffering and internal dynamics and enabling both assessment subjects to develop a state of attunement and openness.
6. There are two main fields in the use of projective techniques, clinical and forensic, which one do you think is of most interest in the application of projective tests?
I think it is very useful for the diagnostician to be able to handle both of these areas.
In the clinical setting, the scientific rigor of the test is of course paramount, but more space is given to the empathic and relational dynamic. In contrast, in the forensic context, scientific rigor is absolutely paramount.
In communicating the results of the test in the clinical area we favor the logic of understanding the suffering and the personal elements and dynamics that which the patient will have to process, while in the forensic area the assessment serves a better understanding of the subject so that important decisions can be made relative to his or her life in a truly well-founded and unimpeachable manner. Here the relational aspect is always important, but the task of the diagnostician to offer the judge or lawyer a scientifically unassailable opinion and to be able to justify his or her thoughts in an articulate, documented, and up-to-date manner becomes much more significant.
Really the clinician who works in both fields realizes that they enrich and improve each other. That is why I often tell students that they must know both fields and be able to use either way of working, because competence in the clinical area fosters interpersonal and empathic skills, and competence in the forensic area fosters scientific rigor and precise, rigorous language. Therefore, the answer to your question is that these two forms of psychodiagnostic practice must both be cultivated. In addition, let us not forget that the demand, at least in Italy, for forensic evaluations, both in criminal and civil, is numerous and allows those who work with high quality standards to have good professional satisfaction. The usual areas are those, in criminal law, of the assessment of capacity, for serious offenders, and the assessment of social dangerousness for those not deemed capable; then in civil law the assessments of mental harm, parental capacity, ability to manage economic assets, contract marriage and make a will, or suitability to perform certain professions.
7. How to convince alumni and recently graduated psychologists of the importance of this training?
Young psychologists should be aware that cultivating this skill will enable them to improve in a very real way their ability both to relate to the patient and to plan focused psychotherapy, and to respond to the request for assessments that is always very frequent from numerous other professionals, especially from psychiatrists, but also from professionals as diverse as judges, lawyers, educators, and social workers. 8. And lastly, how do you see the future of projective testing? The future of so-called projective, or imaging performance tests depends in my opinion on the commitment of clinicians and good schools to work at a level of excellence, demonstrating ‘in the field’ and in daily practice the extraordinary potential of these tests.
The specificity of performance testing gives us excellent opportunities, both for ‘what we propose’ and ‘how we propose it.’ The creative and relational aspect of the test, combined with the methodological rigor of all phases, from administration to coding to interpretation and integration with the results of other tests, is something unique and rich in extraordinarily significant relational and heuristic potential. The words of the Rorschach protocol, as well as the themes evoked by the patient, provide us with words and images that, brought back and integrated into the restitution interview, make it an authentic moment of encounter, rich in meaning and understanding, that is particularly meaningful and engaging for us clinicians.
This relational and emotional value does not detract from the scientificity of the results, because what guarantees them is the rigor and accuracy of administration, the scientificity of coding and interpretation, and the reference to accurate and specific international and national normative standards. This is a more important challenge today than in the past, because we are often confronted with a categorical psychiatric diagnosis that often effectively ‘photographs’ the present, but focuses attention on individual compartmentalized aspects and, above all, completely disregards the relationship between patient and clinician. The challenge of the Rorschach is to enable a complex integration of synchronic and diachronic elements at multiple levels, within a framework of scientific rigor, and with unique emotional and relational involvement.
Maria Fiorella Gazale