Contemporary Rorschach Interpretation

By J. Reid Meloy; Marvin W. Acklin et al. | Go to book overview

own rage, is unconsciously managed by projection and projective identification.

The available developmental history is too sketchy to permit more than probablistic statements about etiology. The confirmed early hyperactivity likely resulted in a stressful mother-child relationship. There is evidence in the history of a lack of maternal empathy (or awareness) of Mary's needs, and an unrealistic denial of her growing difficulties. The maternal deficit or unavailability in the presence of an infant's vulnerability and needs can compound the constitutional predisposition and lead to the child's rageful frustration and internalized representation of a bad object. In a long-term prospective study of hyperactive children, Weiss and Hechtman ( 1993) noted developmental risk factors in cognitive learning, troubled object relations, and impaired social skills.


SUMMARY

The Rorschach reveals the complex nature of Mary's psychopathology. Her therapist reported that despite medication efforts, her "rapidly cycling bipolar disorder has been quite resistant to adequate regulation" and referred to this affective disorder as a severe, persistent disability. Her compromised reality testing and unreliable judgment and her very unstable mood disorder made living in the community quite problematic, as evidenced by inappropriate behavior on passes from the hospital. But her problems in living have been greatly compounded by the nature and extent of her internalized object representations and relations, mainly in her great unease and distrust of intimacy and the ongoing, current strength of her preoccupation with preoedipal issues around trust, separation, individuation, and mastery. The comorbidity of the Axis I probable biological mood disorder,2 the ego weaknesses permitting psychotic regression in the presence of intense affect, and the Axis II personality disorder with its object-directed rage, distrust, and pathological, brittle defensive structure, have been delineated by the combined structural and dynamic approach to Rorschach interpretation.


REFERENCES

Acklin, M. W. ( 1992). "Psychodiagnosis of personality structure: Psychotic personality organization I". Journal of Personality Assessment, 58, 454-463.

Acklin, M. W. ( 1993). "Psychodiagnosis of personality structure II. Borderline personality organization". Journal of Personality Assessment, 61, 329-341.

____________________
2
The observed and documented attention deficit hyperactivity disorder may have been prodromal to the developing affective disorder.

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