Toward an Integrative Perspective on the Person Using Rorschach Data to Enhance the Diagnostic Systems

The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) have been criticized frequently in recent years, with most critiques focusing on perceived limitations of diagnostic categories. These criticisms notwithstanding, the most promising approach to refining the diagnostic systems is not to replace the categorical model, but to expand the range of assessment methods that are used by clinicians to render diagnoses. This article presents an evidence-based framework for integrating interview and Rorschach data to enhance diagnostic precision, improve treatment planning, and provide a novel paradigm for studying the dynamics of psychopathology in clinical and community settings. Following a discussion of problems associated with monomethod assessment based on patient self-reports, the advantages of multimethod assessment in psychiatric diagnosis are described. A three-step approach to evidence-based multimethod diagnosis is outlined, emphasizing patients' underlying dynamics, self-attributions, and expressed behaviors. The possibility of updating DSM and ICD symptom criteria to capture these three levels of patient functioning is discussed, strategies for exploring convergences and divergences between interview and Rorschach data are presented, and avenues for expanding the scope of Rorschach practice and research in the 21st century are described.