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Journal of Personality
Assessment
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The Rorschach and

Psychopathy: Toward a More
Accurate Understanding of the
Research Findings
Carl B. Gacono , James L. Loving & Robert H.
Bodholdt
Published online: 10 Jun 2010.

To cite this article: Carl B. Gacono , James L. Loving & Robert H. Bodholdt (2001)
The Rorschach and Psychopathy: Toward a More Accurate Understanding of the
Research Findings, Journal of Personality Assessment, 77:1, 16-38, DOI: 10.1207/
S15327752JPA7701_02

To link to this article: http://dx.doi.org/10.1207/S15327752JPA7701_02

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 JOURNAL OF PERSONALITY ASSESSMENT, 77(1), 16–38
Copyright © 2001, Lawrence Erlbaum Associates, Inc.

The Rorschach and Psychopathy:

Toward a More Accurate Understanding
of the Research Findings
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Carl B. Gacono
Austin, Texas

James L. Loving, Jr.

Philadelphia, Pennsylvania

Robert H. Bodholdt
Bastrop, Texas

In this article we present the reader with an understandable essay on the relation be-
tween the Rorschach and psychopathy. Some degree of sophistication and applied
knowledge of the Hare Psychopathy Checklist–Revised (Hare, 1991) and the Ror-
schach (Rorschach, 1921/1942) are necessary to wade through the literature, weigh
the relative merits of arguments made by proponents and detractors of Rorschach as-
sessment, and meaningfully interpret the findings of relevant studies. Often studies
reviewing the Rorschach’s utility in assessing Antisocial Personality Disorder
(American Psychiatric Association, 1994) and psychopathy exhibit a flawed or super-
ficial understanding of essential theoretical and methodological issues. Argument de-
rived from a suspect or specious premise, such as the notion that the Rorschach was
designed or aspires to correspond with formal diagnosis based on the Diagnostic and
Statistical Manual of Mental Disorders (American Psychiatric Association, 1952,
1994), vitiates conclusions based on such a premise. In this article, we discuss theoret-
ical and methodological issues that can aid the reader or reviewer in achieving a more
accurate understanding of this body of research.

Considering reviews of various debates surrounding the utility of the Rorschach (see
dedicated issues of Psychological Assessment (Meyer, 1999, in press), we are some-
times struck by discrepancies between “camps” that presumably have access to the
 RORSCHACH AND PSYCHOPATHY 17

same data but interpret those data in largely incompatible ways. We suggest that dif-
ferent interpretations of these same data sets inhere at least partly as a function of
some level of undue skepticism: in other words, what one is willing to see. Over 40
years ago the philosopher Feigl (1959/1992) proposed that resolution of such debate
would require a return to the data, with the exclusion of what he termed “metaphysi-
cal doubt”:

We might show the philosopher that he has illegitimately extended ordinary or empir-
ical doubt and thus fallen into metaphysical doubt. Ordinary empirical doubt may oc-
casionally be hard to settle. But if it is transformed into metaphysical doubt, then there
is no conceivable way of settling it by either logical argument or by empirical demon-
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stration. (p. 45)

Some degree of sophistication and applied (rather than textbook or academic)

knowledge of the Hare Psychopathy Checklist–Revised (PCL–R; Hare, 1991) and
Rorschach (Exner, 1993; Rorschach, 1921/1942) are essential to forming relevant
questions for debate (Bornstein, this issue). To wade through the literature, weigh
the relative merits of arguments made by proponents and detractors of Rorschach
assessment, and meaningfully interpret the findings of relevant studies. At a mini-
mum the reader must understand the following concepts in relation to psychopathy
and its assessment:

1. That Antisocial Personality Disorder (ASPD; American Psychiatric Associ-

ation, 1994) and psychopathy are related but distinct constructs, differing from
each other along important historical, theoretical, and definitional lines.
2. That psychopathy may be conceptualized both in dimensional terms (i.e.,
along a continuum of severity) and in categorical terms (i.e., as a taxon or discrete
syndrome), and that applying one of these approaches versus the other to PCL–R
scores affects research findings.
3. That psychopathy may manifest in varying forms across various popula-
tions, for example across gender or throughout development from youth into
adulthood.
4. How “personality testing,” which is only one facet of both psychological as-
sessment and diagnosis, contributes to the assessment of the dimensional aspects
of psychopathy—and how assessment research relates to clinical application of
testing and assessment.
5. That whereas methodological limitations inherent to certain Rorschach or
psychopathy studies may limit our ability to generalize these particular findings to
other settings, they in no way invalidate the compendium of well-designed stud-
ies—as certain rather persistent Rorschach detractors would have us believe.

Often, studies reviewing the Rorschach’s utility in adding to our understanding

of ASPD and psychopathy exhibit a flawed or superficial understanding of one or
 18 GACONO, LOVING, BODHOLDT

more of these issues. This impacts the validity and generalizability of their conclu-
sions. Thus, we endeavor to draw the reader’s attention to a number of potential er-
rors present in certain recent critiques of the Rorschach, with particular attention to
helping the reader achieve informed conclusions regarding the merits of extant
Rorschach psychopathy research.

ASPD, PSYCHOPATHY, AND THE PCL–R

The constructs of Antisocial Personality and psychopathy evolved along separate

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developmental paths. ASPD (American Psychiatric Association, 1994) evolved

from a social deviancy model (Robins, 1966) and from the term sociopathy (Ameri-
can Psychiatric Association, 1952); its criteria is primarily behavioral (one primary
factor).1 Psychopathy, on the other hand, originated from a traditional psychiatric
conceptualization (Cleckley, 1976) that included a combination of traits and be-
haviors (two factors; see Table 1). Psychopathy can be understood as a disorder
comprised of selected behavioral and affective features of all Cluster B syndromes,
including Narcissistic, Histrionic, and Borderline Personality Disorders (see
Gacono, Nieberding, Owen, Rubel, & Bodholdt, 2001).
Considering not only an individual’s antisocial behaviors but also the
characterological, affective, and interpersonal templates that underlie and perpetu-
ate those behaviors facilitates a more thorough understanding of both psychopathic
and nonpsychopathic offenders (e.g., see Gacono & Meloy, 1994; Meloy, 1988;
Meloy & Gacono, 1998). This two-factor conceptualization also results in differing
base rates for psychopathy and ASPD. Although the rates for ASPD in community
samples are estimated at 5.8 % of men and 1.2% of women, 50% to 80% of forensic
populations will typically meet the ASPD diagnosis, with psychopaths comprising
only 15% to 25% of the same forensic population. This overrepresentation of ASPD
makes “identification of ASPD in forensic settings … something like finding ice in
your refrigerator” (Bodholdt, Richards, & Gacono, 2000, p. 59) and detracts from
both the clinical and research usefulness of the diagnosis in these settings.
Several caveats stem from the factor structure differences between ASPD and
psychopathy and their differential base rates. ASPD and psychopathy are not equiv-
alent. When compared to psychopathy, ASPD is extremely heterogeneous. One can
arrive at the ASPD diagnosis by a virtually unlimited number of criteria combina-

1Appearing in the first DSM (American Psychiatric Association, 1952), sociopathy included a vari-

ety of conditions such as sexual deviation, alcoholism, and “dyssocial” and “antisocial” reactions. Al-
though only the antisocial reaction was similar to traditional conceptualizations of psychopathy
(Jenkins, 1960), the replacement of sociopathy with ASPD (Antisocial Personality Disorder; American
Psychiatric Association, 1994) in DSM–II (American Psychiatric Association, 1968) and the subse-
quent increased focus on behavioral criteria would widen the gap between ASPD and psychopathy.
 RORSCHACH AND PSYCHOPATHY 19

TABLE 1
Comparison of Cleckley’s (1976) 16 Characteristics of Psychopathy and
Diagnostic and Statistical Manual of Mental Disorders–IV (DSM–IV;
American Psychiatric Association, 1994) Diagnostic Criteria

Cleckley’s Psychopathy Criteria

1. Superficial charm and good intelligence
2. Absence of delusions and other signs of irrational thinking
3. Absence of “nervousness” or psychoneurotic manifestations
4. Unreliability
5. Untruthfulness and insincerity
6. Lack of remorse or shame
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7. Inadequately motivated antisocial behavior

8. Poor judgement and failure to learn by experience
9. Pathologic egocentricity and incapacity for love
10. General poverty in affective reactions
11. Specific loss of insight
12. Unresponsiveness in general interpersonal relations
13. Fantastic and uninviting behavior with or without drink
14. Suicide rarely carried out
15. Sex life impersonal, trivial, and poorly integrated
16. Failure to follow any life plan
DSM–IV criteria for Antisocial Personality Disorder
1. At least 3 of the following since age 15:
a. Failure to conform to social norms
b. Deceitfulness, lying
c. Impulsivity
d. Irritability and aggressiveness, fights and assaults
e. Reckless disregard for safety of self or others
f. Irresponsibility
g. Lack of remorse
2. Current age at least 18
3. Conduct disorder, onset before 15
4. Occurrence of antisocial behavior not exclusively during the course of schizophrenia or
manic episode

tions,2 so that vastly different individuals are often included together under the um-
brella of this single diagnostic category. Assigning an ASPD label no longer says
anything about whether an individual is psychopathic in the traditional sense.3

2Rogers and Dion (1991) estimated the possible variations in ASPD (Antisocial Personality
Disorder; American Psychiatric Association, 1994) diagnoses for DSM–III (American Psychiatric As-
sociation, 1980) and DSM–III–R (American Psychiatric Association, 1987) combined at roughly 27
trillion. DSM–IV (American Psychiatric Association, 1994) continues to offer a bewildering array of
diagnostic possibilities with 3.2 million variations (Rogers, Salekin, Sewell, & Cruise, 2000).
3Similar to ASPD (Antisocial Personality Disorder; American Psychiatric Association, 1994), the

Conduct Disorder (CD; American Psychiatric Association, 1994) diagnosis relies heavily on behav-
 20 GACONO, LOVING, BODHOLDT

Psychopaths (PCL–R ≥ 30) comprise a smaller, more homogenous group than

individuals diagnosed with ASPD or Conduct Disorder (CD); thus, a psychopathy
designation carries important implications for both research and clinical usage
(prediction and management of behavior). High PCL or PCL–R scores have been
associated with higher frequency and wider variety of offenses committed (Hare,
1991), higher frequency of violent offenses (Hare, 1991; Harris, Rice, & Cormier,
1992), higher re-offense rates (Hare, 1991), poor treatment response (Ogloff,
Wong, & Greenwood, 1990; Rice, Harris, & Cormier, 1992), and more serious and
persistent institutional misbehavior (Gacono, Meloy, Sheppard, Speth, & Roske,
1995; Gacono, Meloy, Speth, & Roske, 1997; Heilbrun et al., 1998). A similar re-
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lation between ASPD and risk has not been demonstrated (Lyon & Ogloff, 2000).
Understanding that ASPD and psychopathy are distinct (but related) constructs
is critical when evaluating the available Rorschach and psychopathy literature.
Unfortunately, some empirical studies and reviews neglect or misunderstand the
distinction between these two groups, and thus arrive at erroneous conclusions that
will be specifically identified later in the article in the discussion of methodologi-
cal issues.

PSYCHOPATHY: TAXON OR DIMENSIONAL

CONSTRUCT?

Psychopathy is used as both a taxon (PCL–R ≥ 30) and a dimensional construct. Di-
mensional uses of the PCL–R are recommended for clinical applications (Bodholdt
et al., 2000; Serin & Brown, 2000; Seto & Lalumiere, 2000). In these contexts, psy-
chopathy is conceptualized as existing along a continuum of severity so that indi-
viduals who obtain higher PCL–R scores exhibit more serious and pervasive
symptoms of psychopathy compared to their lower PCL–R counterparts. Further-
more, a score may best be considered a range of true scores, expanding in both di-
rections by one or more standard errors of measurement depending on the context-
at-large (mitigating vs. aggravating factors such as treatment setting, supervision
and support networks, and coexisting diagnoses including alcohol or other drug de-
pendence) and the imperative to reduce false positives or false negatives—all
within a decision-making paradigm responsive to the specific referral questions for
the individual being assessed (Bodholdt et al., 2000). Clinically, one is more inter-
ested in what ranges of psychopathy are best at predicting behavior than whether a

ioral criteria. It encompasses a heterogeneous group of children and adolescents with community base
rates estimated at 3% to 5% of school-age children (boy to girl ratio = 4:1 to 9:1). Estimates for psy-
chopathy in children and adolescents are thought to be considerably lower (Forth, 1995; Forth, Hart, &
Hare, 1990; Forth & Mailloux, 2000; Frick, Barry, & Bodin, 2000; Frick, O’Brien, Wootton, &
McBurnett, 1994).
 RORSCHACH AND PSYCHOPATHY 21

given individual meets the traditional threshold score for a designation of psychop-
athy (PCL–R ≥ 30).
The work of Quinsey, Harris, Rice, and Cormier (1998) exemplifies a dimen-
sional application of PCL–R scores as the Violence Risk Appraisal Guide and Sex
Offensive Risk Appraisal Guide (actuarial measures designed to assist in risk as-
sessment) use differing cutting scores in a weighted manner for predicting vio-
lence and sexual violence risk. In clinical use, psychopathy level, rather than a
diagnosis of psychopathy, becomes one of several weighted factors in decision
making.4 For example, whereas a score of 24 may be the optimal cutoff for deter-
mining the probability of problematic behavior in one particular setting (e.g., a fo-
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rensic state hospital with adequate staffing and programming), a score of 15 or

even lower should alert staff to the possibility of problematic behavior in, for ex-
ample, a milieu-based day treatment program for more vulnerable seriously men-
tally ill patients (Bodholdt et al., 2000). Expression of psychopathic behavior is
indeed moderated by setting and various aggravating or mitigating factors, and
thus simple reliance on actuarially derived cutoff scores based on a taxon model
makes little sense idiographically.
Taxon designations are appropriate and preferred for comparative research
wherein the researcher is concerned with how psychopaths (PCL–R ≥ 30)
nomothetically differ from nonpsychopaths (PCL–R < 30). However, statistical
approaches that use simple correlational methods to compare categorical variables
to the individual PCL–R score (dimensional application) fail to capture true be-
tween-group differences (e.g., see Heaven, 1988; Ponder, 1998). Identifying
whether psychopathy is referenced as a dimensional versus categorical variable is
essential to evaluating research findings.
A related concern involves the choice of appropriate cutoff scores when study-
ing psychopathy as a taxon. It is only appropriate to compare results across studies
when psychopathy has been defined by a PCL–R score of greater than 30, and thus,
measurement error notwithstanding, establish comparisons between groups com-
prised of fairly homogeneous and distinctive individuals. Some studies that dis-
cuss psychopathy (taxon) actually have few or no psychopaths in their samples.
Prior to assigning any validity to studies that attribute their findings to psychopa-
thy, the reader should examine the mean, standard deviation, frequencies, and
ranges of PCL–R scores to determine whether it appears that indeed psychopaths
are included in the sample. When lowered PCL–R cutoff scores (≤ 30) are used to
establish groups, the best that can be inferred is relative differences among higher
versus lower scorers within that sample (see Peaslee, Fleming, Baumgardner,
Silbaugh, & Thackrey, 1992), as this procedure introduces greater heterogeneity
into the psychopathy subgroup.

4Despite a confusing reference to psychopathy in the DSM–IV (American Psychiatric Association,

1994) narrative describing ASPD, psychopathy is not a diagnosis within the DSM–IV model.
 22 GACONO, LOVING, BODHOLDT

The confusion with dimensional versus taxon uses of the construct are added to
by the new self-report measures of “psychopathy” (Lilienfeld & Andrews, 1996).
These instruments suggest that traits are individually psychopathic, although in re-
ality a psychopathic syndrome is present only when a sufficient number of individ-
ual traits are fully present in aggregate. Mislabeling isolated traits such as self-
centeredness, impulsivity, impaired empathy, irresponsibility, and so forth as in-
herently psychopathic is irresponsible and returns psychology to the pre-1900s
trend of including all personality disorders under the rubric of psychopathy.
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DIAGNOSING AND ASSESSING PSYCHOPATHY

Evaluation of psychopathy is a relatively straightforward process, given special-

ized experience and training (Gacono, 2000b, 2000c; Gacono & Hutton, 1994;
Hare, 1991). To date, the only published reliable and valid method for arriving at a
psychopathic designation is the PCL–R (Hare, 1991).5 Other personality instru-
ments such as the Minnesota Multiphasic Personality Inventory–2 (MMPI–2; see
Hathaway & McKinley, 1967; Butcher, Dahlstrom, Graham, Tellegen, &
Kaemmer, 1989) and Rorschach Inkblot Method (Exner, 1993; Rorschach, 1921/
1942) were not specifically designed to diagnose psychopathy, and not surprisingly
fail to do so, but neither do the PCL–Screening Version (PCL:SV; Hart, Cox, &
Hare, 1995) nor the newer experimental self-report measures of psychopathy
(Lilienfeld & Andrews, 1996).6 Indisputably, the Rorschach and MMPI–2 do pro-
vide the clinician with considerably more information about the person being as-
sessed, including information that might be useful in establishing some form of
diagnosis (Meloy & Gacono, 1995, 2000).
Assessment does not equal (DSM) diagnosis. Some authors (see Wood,
Lilienfeld, Garb, & Nezworski, 2000) have elevated DSM diagnosis to the point
where one might conscientiously wonder if this becomes the matter of the tail (di-
agnosis) wagging the dog (assessment). Knowing that someone has received a di-
agnosis of schizophrenia or obtained a PCL–R score of greater than 30 does indeed
tell us something about the individual, but this pales in comparison with the assess-

5Although Forth, Kosson, and Hare (in press) have developed a youth version of the PCL–R
(PCL:YV), and Frick and others (Frick, Barry, & Bodin, 2000) have developed instruments for assess-
ing psychopathic traits in children, the utility of these other methods remains to be demonstrated.
6Although the PCL:SV (Hart, Cox, & Hare, 1995) may eventually prove to be diagnostically useful,

it is less likely that any competent, ethical clinician would ever use a self-report measure for categoriz-
ing someone as psychopathic. Although the majority of MMPI clinical scales were developed by ex-
tracting items endorsed differentially by psychiatric patients belonging to distinct diagnostic groups,
the correspondence between clinical scale elevations and formal diagnosis was found to be less than
originally promised. Thus, among considerably greater assessment information, the MMPI can be seen
as informing diagnosis, not establishing it (see Hathaway and McKinley, 1967).
 RORSCHACH AND PSYCHOPATHY 23

ment of an individual in his or her totality. Rorschach critics often focus on dis-
crediting one variable or index, such as the Schizophrenia Index, and cite its
inability to diagnose a specific disorder as an indication that the test lacks any va-
lidity. As clinicians, we are ethically obligated to use a battery of instruments and
multiple methods in forming opinions; our work impacts real people. In this re-
gard, personality tests are subjected to within- and between-instrument evaluation.
No single variable, score, or ratio is interpreted in isolation from history, response
style, and other data (Bannatyne, Gacono, & Greene, 1999). This applies to all per-
sonality tests; no competent clinician would use an elevated MMPI–2 Scale 8, in
isolation from other sources of data, to label someone as schizophrenic.
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Most assessment devices, including structured interview schedules, have their

own unique strengths and weaknesses, most typically anchored in the purpose they
were meant to serve. To be interpretively meaningful, all assessment tools must be
shown to possess adequate standards of validity and reliability relative to the man-
ner in which they are employed.7 Certain tests such as the MCMI–III (see Davis,
1999) and certain structured interview schedules (see Rogers, 1995) more or less
explicitly have been designed to overlap with DSM–IV (American Psychiatric As-
sociation, 1994) criteria for diagnosis of various mental disorders, and thus, not
surprisingly, generally excel in this regard as determined by correspondence be-
tween assessment findings and formal DSM–IV diagnosis. In contrast, if the reader
will allow, no version of the DSM has ever been designed to correspond with any
constellation of Rorschach variables, and fares rather poorly when called to do so.
Furthermore, as noted by Bornstein (this issue), various DSM diagnostic criteria
have been (fairly regularly) criticized as flawed, and “most Axis II diagnostic cri-
teria have never been validated against the behavioral indexes they purport to as-
sess” (p. 43). Thus, the nature of the research enterprise continues to be one of
identifying varying degrees of correspondence or lack of correspondence between
various types of Rorschach findings, their relationships—convergent and diver-
gent—to other test findings as well as diagnoses and the meaning of these
relationships.
Although assessment has often been confused with psychological testing, they
are not the same. Assessment has been characterized as a process that

Integrate[s] the results of several carefully selected tests with relevant history infor-
mation and observation … enabl[ing] the sophisticated clinician to form an accurate,
in-depth understanding of the patient; formulate the most appropriate and cost-effec-
tive treatment plan; and later, monitor the course of intervention.” (Meyer et al., 1998,
p. 4)

7The reader is referred to meta-analyses performed by Atkinson (1986); Hiller, Rosenthal,

Bornstein, Berry, and Brunell-Neuleib (1999); and Parker, Hanson, and Hunsley (1988) for an over-
view of issues of reliability and validity of the Rorschach relative to other commonly used tests (see
also Ganellen, 1996).
 24 GACONO, LOVING, BODHOLDT

Alternatively,

Assessment is a process of deduction, selective inquiry, and also inference … rooted

in a knowledge of developmental psychology, personality and individual differences,
and statistics and measurement with knowledge of limits (e.g. in prediction) in cogni-
tive science, ethics, and abnormal psychology including dynamics and defense, with a
keen awareness of various substantive issues. … Assessment forms the cornerstone of
the “forensic mind-set”—one that is data based, utilizing test data, observation, inter-
viewing, and multi-sources of substantiated historical information in forming, test-
ing, and modifying hypotheses. … Assessment is a multifaceted, ongoing, interactive
process, and as such, often blends imperceivably with treatment, staff education, and
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program evaluation and development. One cannot advocate for testing and expect to
achieve assessment. (Gacono, 2000c, pp. 194–195)

Psychological testing is helpful in formulating diagnosis and assessing dimen-

sional aspects of syndromes but is seldom used as the sole measure for making a di-
agnosis; rather, the choice of specific psychological tests stems from referral
questions.
Coding of the PCL–R constitutes a rather global method for assimilating and
quantifying traits and behaviors. Other personality instruments play an important
role in assessing psychopathy by providing a more thorough understanding of a
particular individual, by adding to the convergent or divergent validity of PCL–R
findings, and by elucidating specific areas of the individual’s current functioning.8
The Rorschach, for example, can contribute significantly to the assessment of par-
ticular features, both those conceptually associated with psychopathy and those of
more general relevance (see Gacono, 1998, 2000a; Meloy & Gacono, 1995, 2000).
Because the Rorschach “adds to and refines hypotheses generated by the PCL–R”
(Gacono, 1998, p. 52), it may be used in conjunction with the latter to gain a fuller
understanding of the individual to provide better informed recommendations for
treatment, rehabilitation, and so on (Gacono, 2000a).
Personality testing idiographically refines our understanding of traits such as
narcissism, impulsivity, problems with affect regulation, methods of coping with
emotions, and so forth that are suggested by the PCL–R criteria. In various combi-
nations and proportions (dimensional) these traits and behaviors form clinical syn-

8Psychopathy, as measured by the PCL–R, was initially thought to include two primary factors.
Factor 1 (traits) correlates with Narcissistic and Histrionic Personality Diagnoses and self-report mea-
sures of Machiavellianism and narcissism evidencing negative correlations with Avoidant and
Dependent Personalities, intensity of affect, and anxiety (Hare, 1991). Factor 2 (irresponsible, impul-
sive, thrill-seeking, and antisocial lifestyle) correlates more highly with the DSM–III–R (American
Psychiatric Association, 1987) ASPD diagnosis. Most self-report measures, such as the MMPI–2
(Butcher et al., 1989) and MCMI–III (Millon, 1994), also correlate more strongly with Factor 2 and an
ASPD diagnosis than psychopathy per se.
 RORSCHACH AND PSYCHOPATHY 25

dromes (taxa). Personality testing helps to tease out the similarities and differences
among individuals to an extent not possible with the PCL–R alone.
It would be naive to assume that one Rorschach variable, such as the reflection
response, or scale on a self-report measure should ever be used to diagnose a disor-
der such as psychopathy (Gacono & Meloy, 1994). Concerning reflections,
Gacono and Meloy (1994) appropriately emphasized

When interpreted within the context of the entire protocol, analysis of reflections pro-
vides information concerning the self-focusing process, the nature of the libidinal
drive, internalized object relations, and the defensive use of grandiosity and with-
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drawal … Reflections should never be interpreted in isolation from other structural

data, determinants, content, form quality, or psychodynamic content analysis. (p.
252)

Elevated reflection responses nomothetically add concurrent validity to the in-

creased self-focus, egocentricity, or perhaps narcissism (traits shared by other dis-
orders) in a given sample (see Gacono, Meloy, & Berg, 1992). Consistent with
theory, well-designed studies with similar population parameters find that psycho-
pathic CDs and ASPDs tend to produce more reflection responses than
nonpsychopathic CDs and ASPDs (also see Young, Justice, Erdberg, & Gacono,
2000; psychopaths were three times more likely to produce reflection responses
than nonpsychopaths).
A recent Rorschach article (Gacono, Meloy, & Bridges, 2000) highlights the
appropriate application of theory to research. The authors compared nonsexually
offending psychopaths (N = 32), sexual homicide perpetrators (N = 38), and nonvi-
olent pedophiles (N = 39). Hypotheses were stated based on theoretically derived
assumptions concerning the similarities and differences among the groups, with a
particular interest in the violent–nonviolent and sexual offending–non-sexual-of-
fending continuum. Rorschach data were compared to determine the confluence of
test patterns with psychological theory and real-world behaviors. All groups were
expected to be self-centered or egocentric, and hence elevated reflections were
predicted across groups. Thus, despite the absence of ASPD or psychopathy in the
pedophile group, similar proportions and frequencies for Rorschach reflection re-
sponses were found across groups. The reflection response was not inappropri-
ately touted as an indication for a diagnosis of ASPD or psychopathy, but rather as
an indication of increased self-focus, egocentricity, narcissism, or all of these in
the study groups. To expect the reflection response to differentiate based on diag-
nosis when the groups share a similar trait (associated with the variable) suggests
an absence of understanding of personality theory in general and test interpretation
in particular.
Differences between group and individual data are also relevant. In the same
study (Gacono et al., 2000), participants from approximately half of each group
 26 GACONO, LOVING, BODHOLDT

produced reflections. Would one concretely interpret that the other half of each
group was not egocentric? This would be empirically inaccurate for the psycho-
paths and two thirds of the sexual homicide perpetrators who, to receive a PCL–R
score greater than 30, had to obtain some scores on Factor 1 that correlates strongly
with narcissism. Similar reasoning would be equally naive to apply to the
pedophile group. What the nomothetic data accurately reflect is that self-focus is a
prominent aspect of each of these syndromes and behavioral disorders. The Ror-
schach accurately portrays each of these groups as manifesting more of this trait
than expected in nonpatients or even other patient groups in which pathological
self-focus is not an associated trait. It does not suggest that in the absence of a re-
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flection a particular participant was not egocentric. Traits manifest in different

ways throughout psychological testing. The absence of a specific variable does not
necessarily mean the absence of the trait!
Finally, the usefulness of psychological tests depends on the assessment con-
text. For example, when assessing competency to stand trail, routine cases require
semistructured interview questions to ascertain an individual’s understanding of
their current legal situation, their ability to cooperate with counsel, and so forth;
personality testing may not even be necessary. However, in the case of an identi-
fied psychopath (PCL–R ≥ 30) suspected of malingering schizophrenia, the evalu-
ation of malingering may necessitate administration of the Structured Interview of
Reported Symptoms (Rogers, 1986), observation of ward behavior, and assess-
ment of thought disorder with the Rorschach. The same logic can be applied to
other forensic and clinical issues including the assessment (not diagnosis) of psy-
chopathy (see Meloy & Gacono, 1995, 2000).

METHODOLOGICAL ISSUES

The recent review by Wood et al. (2000) highlighted several of the problems inher-
ent in critiques of Rorschach and psychopathy research. By demonstrating an ap-
parent misunderstanding of certain methodological issues, and by citing several
studies that demonstrate such methodological concerns to support their conclu-
sions, the authors run the risk of confusing or misinforming the reader.9 Our use of
individual studies to highlight methodological problems does not detract from
those studies, particularly in the case of dissertations in which students may be

9Wood and certain colleagues (Wood et al., 1999a, 1999b) have been criticized for similar errors as

well as for other practices that, if true, suggest that they

were not sufficiently careful in their scholarship (e.g., the erroneous citations), were not
aware of some key literature on a topic (e.g., the composite variables), presented a limited
and slanted portrayal of relevant issues and evidence, … and repeatedly dismissed correc-
tive feedback. (Meyer, 2000, p. 77)
 RORSCHACH AND PSYCHOPATHY 27

faced with limitations involving data availability, the knowledge base of their com-
mittee members, and even politics surrounding the dissertation process. We com-
mend rather than criticize their research efforts. However, when these findings are
used to discredit well-designed studies, then they must be subjected to greater
scrutiny.
The most persistent difficulty, both inherent in the Wood et al. (2000) review
and elsewhere, involves studying overly inclusive (sometimes ambiguously de-
fined) samples and then generalizing findings to the discussion of psychopathy. At
the extreme, there are studies that investigate samples defined solely on the basis
of a low baseline or extreme behaviors, such as groups of individuals who have
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committed murder or engaged in other forms of violence (see, e.g., Greco & Cor-
nell, 1992; Kaser-Boyd, 1993). It is not surprising that these studies often produce
mixed or negative results, as participants under study comprise extremely hetero-
geneous groups that may be connected to each other by little more than the perfor-
mance of a single violent act. Similarly, studies are available in the literature that
use less extreme but no less heterogeneous groups for comparison. Pinto (1999),
for example, conducted a Rorschach study of aggressive versus nonaggressive
boys, all of whom had been diagnosed with either CD or oppositional defiant dis-
order (ODD; American Psychiatric Association, 1994). Not surprisingly, she
found no differences across groups with respect to any Rorschach variables stud-
ied, and she did not find any differences across groups in terms of self-reported at-
tachment to parents or to peers.
Similarly, in support of their conclusions, Wood et al. (2000) cited studies
whose results are not directly generalizable to the discussion of psychopathy, or
even ASPD and CD. For instance, Long (1995) and Karfgin (1988/1989) both
studied broadly defined samples of adolescent inpatients with conduct problems
by comparing their Rorschachs with those of other adolescent inpatients without
conduct problems. Not surprisingly, practically no findings were revealed to sup-
port the use of the Rorschach in distinguishing participants with conduct problems
from those without such problems. Another study cited by Wood et al. in this con-
text is that of Archer and Krishnamurthy (1997), who combined adolescents who
had been assigned any of three diagnostic categories (i.e., CD, ODD, adjustment
disorder with disturbance of conduct) into a single conduct-disordered group, then
compared these participants with non-conduct-disordered adolescents. Again, the
authors found no Rorschach differences across groups. To their credit, Wood et al.
acknowledged that “Archer and Krishnamurthy’s approach of combining several
different diagnostic groups into one broadly defined group is potentially problem-
atic. It is possible that the findings might have been different if data had been ex-
amined separately for patients with a narrowly defined diagnosis of Conduct
Disorder” (p. 412). However, their treatment of the Archer and Krishnamurthy
study is potentially misleading. This is because they cite it in conjunction with
Weber, Meloy, and Gacono (1992) when they stated “Only two published studies
 28 GACONO, LOVING, BODHOLDT

with comparison groups have examined the relationship of the Rorschach to CD”
(p. 412). They then proceeded to describe positive findings of the Weber et al.
(1992) study, followed by the negative results of Archer and Krishnamurthy. Al-
though Wood et al. suggested the results of these two studies are contradictory, in
fact they may not be because the former found the Rorschach to be useful when CD
diagnosis was the inclusion criterion, whereas the latter study found nonsupportive
results in a sample defined by more broadly defined criterion.
Other Rorschach or psychopathy investigations have employed an ASPD or
CD diagnosis as the relevant inclusion criterion (see Howard, 1998/1999). At best,
these studies include appropriate comparison groups of similar individuals who
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lack the ASPD (or CD) diagnosis, and when this is true, they sometimes yield re-
sults that are supportive of the Rorschach’s ability to assist in assessment of impor-
tant personality traits (e.g., finding significantly fewer Y, T, and Pure H responses
in the Rorschachs of adolescents with CD versus dysthymia in Weber et al., 1992).
Still, use of ASPD or CD often yields mixed or negative results because as dis-
cussed earlier, these DSM categories are too heterogeneous to expect consistently
positive findings. The use of CD or ASPD as the sole independent measure for
group inclusion in a research design invites similar criticisms to the use of Exner’s
(see Exner, Kinder, & Curtis, 1995) nonpatient Rorschach data as the definitive
comparison data. A study formed on the hypothesis that a group of inmates with
ASPD would differ substantially from other inmates ignores the heterogeneity of
this diagnostic category and its overlap with other DSM Cluster B disorders. Thus,
the most likely outcome is what should have been easily predicted: no significant
differences. Researchers or critics operating under this assumption are likely to be
quite disappointed in the failure of their findings to differentiate among partici-
pants, only to be cited by detractors of Rorschach studies as evidence of some kind
of unexpected finding.10
This is one weakness of the Howard (1998/1999) unpublished dissertation that is
cited by Wood et al. (2000) as evidence of failed replication of findings related to the
paucity of T in ASPDs. A heterogeneous group of ASPD offenders was compared to
other inmates. There was no attempt to control for the presence or absence of charac-
ter pathology in the non-ASPD group. Assuredly, Howard’s (1998/1999) non-
ASPD participant group contained similar traits to the participants with ASPD (par-
ticularly if there are few, if any, psychopaths among those with ASPD) and may have
actually included some participants with ASPD who were not diagnosed as such at

10This does not negate the possibility that ASPD (Antisocial Personality Disorder; American Psy-

chiatric Association, 1994) may contribute to some measurable differences when compared to
noncharacterological participants, such as a comparison of schizophrenics with and without ASPD
(Gacono & Meloy, 1994).
 RORSCHACH AND PSYCHOPATHY 29

the time of testing. The Howard dissertation is an interesting descriptive study, but is
not generalizable and offers little to understanding either ASPD or psychopathy.
It is unrealistic to expect the Rorschach or any other instrument to yield positive
findings with respect to assessing the dimensional features of psychopathy unless
scores from the PCL–R are used as the independent variable to categorically dis-
tinguish psychopaths from nonpsychopaths or to delineate multiple (i.e., three)
levels of severity for comparison. The majority of the studies (Gacono, 1990;
Gacono & Meloy, 1991, 1992, 1994; Gacono, Meloy, & Heaven, 1990; Meloy &
Gacono, 1992) erroneously “set aside” by Wood et al. (2000) for “fail[ing] to use
adequate comparison groups” (p. 411) in actuality used the relevant independent
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measure, presence or absence of psychopathy, and appropriate statistical proce-

dure in their comparisons (see also Young et al., 2000). Gacono and Meloy (1994)
used the Rorschach to psychometrically map the internal world of the psychopath
(Meloy & Gacono, 1998) and to help understand patients with ASPD (elucidating
the subtypes within these groups), not to diagnose ASPD or psychopathy. Any
conclusions offered by Wood et al. must be interpreted in the context of their dis-
missal of the actual study intent and design.
In the Wood et al (2000) review, although they correctly indicated that “two
early studies provided a very limited description of how diagnoses of psychopathy
were established” (p. 415), they cited a study of 47 incarcerated women by
Murphy-Peaslee (1993/1995) as an unsuccessful effort to replicate existing Ror-
schach findings of Gacono, Meloy, and their colleagues (Gacono, 1990; Gacono &
Meloy, 1991, 1992, 1994; Gacono et al., 1992; Gacono et al., 1990; Weber et al.,
1992). However, it should be noted that Murphy-Peaslee implemented a cutoff
score of 27 to define her high psychopathy group. Gacono and Meloy (1994) pre-
viously noted concerns with this practice, as they discussed a related manuscript
by Peaslee et al. (1992):

Peaslee et al.’s (1992) choice of ≥ 27 as a cutoff score for their female primary psy-
chopathy group when comparing across gender is curious. The medium split method
had been used (infrequently) in other studies with all male participants where the psy-
chopathy range was skewed to the low end. This procedure can increase the number of
participants in the high group for better statistical comparison. The lower cutoff does
not affect a comparison of mean PCL-scores between groups (total PCL–R score
comparison) or comparison of subgroups within a larger group (high, moderate, low).
We, however, caution against the use of different cut-off scores when independent
group comparisons are made with dependent variables such as Rorschach variables.
Findings are suspect as the independent measure may not be equal. (p. 102)

Using the appropriate PCL–R cutoff score, however, does not ensure study
generalizability. Although a PCL–R cutoff score greater than 30 is one important
factor in establishing groups, those scores that fall in the moderate ranges may
 30 GACONO, LOVING, BODHOLDT

contain some psychopaths and some nonpsychopaths (due to standard error of

measurement). This is especially problematic when the psychopaths cluster at the
low end of the high range (30 to 33), and the nonpsychopaths cluster at the high
end of the moderate range (26 to 29). When significant Rorschach findings emerge
in this type of sample distribution, “a significant difference … between these simi-
lar groups [becomes] … particularly interesting” (Gacono, 1990, p. 596). The
most accurate research findings are likely to result when comparing more extreme
scoring participants that have an adequate distribution and a normal range of
PCL–R scores (see Loving & Russell, 2000; A. Smith, Gacono, & Kaufman,
1995). Additionally, the impact of degrees of freedom in three group comparisons
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can statistically wash out true between-group differences (see A. Smith, 1994).
Just as there is a problem with generalizing the results of studies that employ
overly inclusive samples or differing PCL–R cutoff scores, there is a similar con-
cern in Rorschach or psychopathy studies that use the PCL–R as an independent
measure of psychopathy with female participants. By referring to a number of such
studies that include female participants, Wood et al (2000) discussed results in a
way that is akin to “mixing apples with oranges.” Psychopathy likely manifests
somewhat differently across genders, so that the salient characteristics (as mea-
sured by personality instruments) found in male psychopaths differ somewhat
from those in female psychopaths (Gacono & Meloy, 1994). Peaslee et al.’s (1992)
work was useful in understanding the confluence of Rorschach findings with the-
ory in women with ASPD, highlighting the similarities between borderline and an-
tisocial women, suggesting differences between male and female psychopaths,
and providing some concurrent validity for the use of the PCL–R with women;
however, lowering the PCL–R cutoff score to designate female psychopathy ne-
cessitates caution when comparing her findings to studies of actual psychopaths
(PCL–R ≥ 30). Despite caution, the reduction in reflection responses found in
Peaslee et al.’s original work might actually reflect theoretically, and recently de-
rived, differences between male and female psychopaths (Cunliffe, Gacono, &
Hibbard, 2000; S. Smith & Gacono, 2000). Why Peaslee (1995) reanalyzed the
original data for inclusion in her dissertation after obtaining significant gender dif-
ferences with the first analysis (Peaslee et al., 1992) is unknown.
Of more serious concern is the evaluation of studies that include male and female
participants in a single comparison group. This is true of the Ponder (1998) disserta-
tion cited in Wood et al. (2000). In an investigation of incarcerated juvenile offend-
ers, Ponder used PCL:YV scores as an independent measure of psychopathy. This is
a strength for the reasons discussed previously, but she combined male and female
juveniles in her sample (n = 43 and n = 7, respectively). Without taking into account
the possible intergender differences in expression of psychopathy, the negative Ror-
schach findings of her study are difficult to interpret. Although they may certainly
speak to poor utility of the Rorschach in this sample, there are other more fundamen-
tal methodological concerns that more likely account for these results.
 RORSCHACH AND PSYCHOPATHY 31

Like those that involve female participants, studies assessing psychopathy in

children and adolescents present conceptual problems that have yet to be clarified
fully through research. Studies that include positive findings (e.g., Loving, 1998; A.
Smith et al., 1995) speak to the applicability of the psychopathy construct in adoles-
cence, the validity of the PCL:YV with certain adolescent populations, and the pos-
sible downward extension of certain Rorschach findings from the adult research to
these younger samples. Although studies that demonstrate negative or equivocal re-
sults may be taken as lack of support for the Rorschach’s validity in assessing psy-
chopathy, they may just as easily reflect that certain characterological or behavioral
aspects of psychopathy have not yet fully crystallized in their adult form by child-
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hood or adolescence, and consequently are not accessed in the same manner through
personality testing. Although Wood et al. (2000) did not entertain the latter hypothe-
sis when discussing mixed results of Rorschach or youth psychopathy studies, this
conclusion would be consistent with the findings of Loving (1998; see also Loving
& Russell, 2000), who found certain core features of psychopathy (i.e., pathological
narcissism and attachment difficulties, as evidenced by elevations in reflections and
absence of texture, respectively) to effectively differentiate across levels of psy-
chopathy in male adolescents.11
Finally, there are other more fundamental methodological shortcomings that
limit the applicability of some studies. One such concern involves inappropriate
use of the PCL and is exemplified by the Ponder (1998) dissertation. To identify
psychopaths, Ponder utilized a modified version of the unpublished PCL:YV,
which involved omitting two items and then prorating total scores. The omission
of these two items is especially relevant in the context of a Rorschach study, as
both the omitted PCL:YV items load onto Factor 1 and are especially salient to the
kinds of features the Rorschach is most apt to assess. Use of this highly unusual
method makes the Ponder findings uninterpretable beyond her sample. Although
there is a tested procedure for modifying the published PCL–R for use with adoles-
cents (see A. Smith et al., 1995), there is none for Ponder’s modification of the un-
published PCL:YV. An additional methodological concern of the same study is the
application of inappropriate statistical procedures to the analysis of certain Ror-
schach data, including the reflection response.
An evaluation of the Rorschach or psychopathy studies and their
generalizability at minimum requires consideration of the following (for addi-
tional cautions, see Exner, 1995):

1. CD and ASPD are comprised of heterogeneous groups of individuals. When-

ever possible, studies that treat psychopathy as a taxon must include psychopathy
11In the same sample (Loving, 1998), certain other Rorschach variables that could be seen as reflec-

tive of noncentral (e.g., m, FD, V, S) features common in psychopaths showed nonsignificant trends in
the expected directions. It is possible that these additional variables are related to personality character-
istics that are not fully developed (and thus not readily detectable through testing) until adulthood.
 32 GACONO, LOVING, BODHOLDT

as an independent measure (evaluated with either the PCL–R, a “recommended”

modified version of the PCL–R for adolescents, or perhaps the PCL:YV) and use
the accepted cutoff scores (PCL–R ≥ 30).
2. Studies need to account for (control or delineate) the limitations imposed by
gender, sexual deviance, concurrent Axis I functional psychosis, age, IQ, testing
setting, legal status, and so forth. These factors can influence the production of cer-
tain Rorschach variables.
3. R (number of responses) must be controlled unless offered as one of the hy-
pothesized group differences (see Gacono et al., 2000). With certain sex offender
groups, for example, increased R is predicted (Bridges, Wilson, & Gacono, 1998;
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Gacono et al., 2000).

4. Response style must be considered when discussing the generalizability of
findings across studies (Bannatyne et al., 1999). R, Lambda, extratensiveness, and
introversiveness can impact the production of certain Rorschach variables (Exner,
1995).

However, all these suggestions must be considered in the context of an in-depth

understanding of how the Rorschach works (Weiner, 2000, in press). For example,
in a high Lambda psychopathic ASPD group (PCL–R ≥ 30) with low mean IQs, it
would be inappropriate to attribute a paucity of reflection responses as failed repli-
cation. High Lambda and low IQ can both constrict the production of certain Ror-
schach variables. On the other hand, an elevation of reflection responses in this
same “constricted” group would strengthen the weight of these findings as it re-
veals the resilience of this characterological marker despite expected suppression.
Similarly, when a comparison group produces significantly less R, but then pro-
ceeds to produce equal numbers of low base-rate variables such as reflections or
texture (see Gacono et al., 2000), the findings provide stronger support for the as-
sociated construct. Other factors such as the presence of schizophrenia can also
impact the manifestation of traits; schizophrenic psychopathic ASPDs are not ex-
pected to produce as many reflection responses as psychopathic ASPDs without
psychosis (Gacono & Meloy, 1994).

CONCLUSIONS

The evaluation of the Rorschach or psychopathy literature requires much greater so-
phistication than understanding the psychometric properties of the individual tests.
When key issues such as the differences between ASPD and psychopathy, the impli-
cations of taxon versus dimensional uses of psychopathy, the fundamental differ-
ences between psychological assessment and diagnosis, and the various confounds
and methodological issues related to psychopathy and Rorschach research are not
 RORSCHACH AND PSYCHOPATHY 33

understood, the reader or reviewer is more vulnerable to being unduly influenced by

the current deluge of Rorschach “bashing,” wherein plausible sounding but falla-
cious arguments about the weaknesses in Rorschach validation research are

designed to convince readers of a conclusion, regardless of its accuracy. … As the

Rorschach evidence base continues to grow and develop, sound and balanced criti-
cism of the literature will help advance scientific knowledge and applied practice.
Conversely, publishing assertions that are known to be wrong or misleading can only
serve political purposes that thwart the goals of science and retard genuine evolution
in the field. (Meyer, 2000, pp. 77, 78)
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Meloy and Gacono (2000) were correct when they stated “The Rorschach is
ideally suited for contributing to the assessment of psychopathy” (p. 236) and “We
have validated the use of the Rorschach as a sensitive instrument to discriminate
between psychopathic and nonpsychopathic (ASPD) subjects ” (p. 237).12 Certain
Rorschach variables, in well-designed studies, appear to have some level of
discriminative strength in differentiating psychopathic ASPDs from
nonpsychopathic ASPDs within the nomothetic paradigm inherent to the necessar-
ily quasi-experimental (i.e., nonrandom assignment to group) designs used in the
studies described. It should be clear to any reader that the Rorschach was never de-
signed to establish a diagnosis of psychopathy, but rather the Rorschach can and
does contribute valuable information to the assessment process.
When reviewing Gacono & Meloy (1994) and other well-designed studies—and
not taking isolated comments out of context—what can be seen is that the Rorschach
has been useful in providing nomothetic data consistent with the differences be-
tween ASPD and psychopathy (psychopaths being more detached and self-focused;
Gacono & Meloy, 1991; Gacono et al., 1992; Gacono et al., 1990; Loving, 1998; A.
Smith et al., 1995; Young et al., 2000). Idiographically, we have provided ample
guidance and suggestions for the integration of Rorschach data in aiding our under-
standing of ASPD and psychopathic individuals (Gacono, 1998; Meloy & Gacono,
1995). Future research may demonstrate that the Rorschach, along with other instru-
ments such as the MMPI–2, will be useful in defining subgroups among PCL–R de-
lineated psychopaths (Gacono, 1997, 1998, 2000c). It should be noted, however,
that although the Rorschach aids in assessing ASPD and psychopathy and perhaps,
someday, delineating subgroups among these groups, it would never be used to ren-
der a diagnosis of ASPD or psychopathy as the DSM and the PCL–R were designed
for and are well-suited to those aspects of assessment.
Resonant with the logic of Feigl (1959/1992), Weiner (in press) wrote

12Note that these statements occur in the context of discussing the relative contributions of other

psychological testing, such as the MMPI–2, and their respective roles in assessing psychopathy.
 34 GACONO, LOVING, BODHOLDT

Scientific debate often proceeds with one side arguing that something is so or some-
thing works, while the other side argues that it is not so or does not work. If the propo-
nents base their arguments on accumulating evidence of its efficacy, and the
opponents base their arguments on being unconvinced by this evidence there comes a
time when being unconvinced exceeds the boundaries of appropriate skepticism.
Those who take issue with the abundant and compelling evidence that Rorschach as-
sessment works very well indeed for certain purposes for which it is intended must
sooner or later present equally abundant and compelling evidence that it does not
work for these purposes, or else put their case to rest. (p. 31)

When key assumptions underlying a “critical review” are based on erroneous pre-
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mises, predetermined biases, or misinformation (see Meyer, 2000), subsequent

conclusions must either be discounted or viewed with skepticism.

ACKNOWLEDGMENTS

This study was, in part, supported by Forensis, Inc. We thank Greg Meyer, Irving
Weiner, and Lynne Bannatyne for their helpful comments and suggestions. The
views expressed in this article are solely those of the authors.

REFERENCES

American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders.
Washington, DC: Author.
American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd
ed.). Washington, DC: Author.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd
ed.). Washington, DC: Author.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd
ed., rev.). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th
ed.). Washington, DC: Author.
Archer, R., & Krishnamurthy, R. (1997). MMPI–A and Rorschach indices related to depression and
conduct disorder: An evaluation of the incremental validity hypothesis. Journal of Personality As-
sessment, 69, 517–533.
Atkinson, L. (1986). The comparative validities of the Rorschach and MMPI: A meta-analysis. Cana-
dian Psychology, 27, 238–247.
Bannatyne, L., Gacono, C. B., & Greene, R. (1999). Differential patterns of responding among three
groups of chronic, psychotic, forensic outpatients. Journal of Clinical Psychology, 55, 1553–1565.
Bodholdt, R., Richards, H., & Gacono, C. B. (2000). Assessing psychopathy in adults: The Psychop-
athy Checklist–Revised and Screening Version. In C. B. Gacono (Ed.)., The clinical and forensic
assessment of psychopathy: A practitioner’s guide (pp. 55–86). Mahwah, NJ: Lawrence Erlbaum
Associates, Inc.
Bridges, M., Wilson, J., & Gacono, C. B. (1998). A Rorschach investigation of defensiveness, self-per-
ception, interpersonal relations, and affective states in incarcerated pedophiles. Journal of Personal-
ity Assessment, 70, 365–385.
Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI–2: Minne-
sota Multiphasic Personality Inventory–2: Manual for administration and scoring. Minneapolis:
University of Minnesota Press.
 RORSCHACH AND PSYCHOPATHY 35

Cleckley, H. (1976). The mask of sanity (6th ed.). St. Louis, MO: Mosby.
Cunliffe, T., Gacono, C. B., & Hibbard, S. (2000, March). Personality characteristics of incarcerated
women. In J. Porcerelli (Chair), Use of the Rorschach and TAT with antisocial personality and psy-
chopathy. Society for Personalty Assessment meeting, Albuquerque, NM.
Davis, R. D. (1999). Millon: Essentials of his science, theory, classification, assessment, and therapy.
Journal of Personality Assessment, 72, 330–352.
Exner, J. E., Jr. (1993). The Rorschach: A comprehensive system: Vol. 1. Basic foundations (3rd ed.).
New York: Wiley.
Exner, J. E., Jr. (Ed.). (1995). Issues and methods in Rorschach research. Mahwah, NJ: Lawrence
Erlbaum Associates, Inc.
Exner, J. E., Jr., Kinder, B., & Curtis, G. (1995). Reviewing basic design features. In J. E. Exner Jr. (Ed.),
Issues and methods in Rorschach research (pp. 145–158). Mahwah, NJ: Lawrence Erlbaum Associ-
Downloaded by [University of Miami] at 10:41 07 January 2015

ates, Inc.
Feigl, H. (1992). Philosophical embarrassments of psychology. In R. Miller (Ed.), The restoration of di-
alogue: Readings in the philosophy of clinical psychology (pp. 34–49). Washington, DC: American
Psychological Association.
Forth, A. (1995). Psychopathy and young offenders: Prevalence, family background, and violence.
Ottawa, Canada: Ministry of the Solicitor General of Canada.
Forth, A., Hart, S., & Hare, R. (1990). Assessment of psychopathy in male young offenders. Psychologi-
cal Assessment: A Journal of Consulting and Clinical Psychology, 2, 342–344.
Forth, A., Kosson, D., & Hare, R. (in press). Hare Psychopathy Checklist: Youth Version. North
Tonawanda, NY: Multi-Health Systems.
Forth, A., & Mailloux, D. (2000). Psychopathy in youth: What do we know? In C. B. Gacono (Ed.), The
clinical and forensic assessment of psychopathy: A practitioner’s guide (pp. 25–54). Mahwah, NJ:
Lawrence Erlbaum Associates, Inc.
Frick, P., Barry, C., & Bodin, D. (2000). Applying the concept of psychopathy to children: Implications
for the assessment of antisocial youth. In C. B. Gacono (Ed.), The clinical and forensic assessment of
psychopathy: A practitioner’s guide (pp. 3–24). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Frick, P., O’Brien, B., Wootton, J., & McBurnett, K. (1994). Psychopathy and conduct problems in chil-
dren. Journal of Abnormal Psychology, 103, 700–707.
Gacono, C. B. (1990). An empirical study of object relations and defensive operations in antisocial per-
sonality disorder. Journal of Personality Assessment, 54, 589–600.
Gacono, C. B. (1997). Borderline personality organization, psychopathy, and sexual homicide: The case
of Brinkley. In R. Meloy, M. Acklin, C. B. Gacono, J. Murray, & C. Peterson (Eds.), Contemporary
Rorschach interpretation (pp. 217–238). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Gacono, C. B. (1998). The use of the Psychopathy Checklist–Revised (PCL–R) and Rorschach in treat-
ment planning with antisocial personality disordered patients. International Journal of Offender
Therapy and Comparative Criminology, 42, 49–64.
Gacono, C. B. (2000a). Appendix C: The use of the Psychopathy Checklist–Revised (PCL–R) and Ror-
schach in treatment planning with antisocial personality disordered patients. In C. B. Gacono (Ed.),
The clinical and forensic assessment of psychopathy: A practitioner’s guide (pp. 409–421).
Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Gacono, C. B. (Ed.). (2000b). The clinical and forensic assessment of psychopathy: A practitioner’s
guide. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Gacono, C. B. (2000c). Suggestions for the implementation and use of the Psychopathy Checklists in fo-
rensic and clinical practice. In C. B. Gacono (Ed.), The clinical and forensic assessment of psychop-
athy: A practitioner’s guide (pp. 175–202). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Gacono, C. B., & Hutton, H. (1994). Suggestions for the clinical and forensic use of the Hare Psy-
chopathy Checklist–Revised (PCL–R). International Journal of Law and Psychiatry, 17,
303–317.
Gacono, C. B, & Meloy, R. (1991). A Rorschach investigation of attachment and anxiety in antisocial
personality disorder. The Journal of Nervous and Mental Disease, 179, 546–552.
 36 GACONO, LOVING, BODHOLDT

Gacono, C. B., & Meloy, R. (1992). The Rorschach and the DSM–III–R antisocial personality: A tribute
to Robert Lindner. Journal of Clinical Psychology, 48, 393–485.
Gacono, C. B., & Meloy, R. (1994). The Rorschach assessment of aggressive and psychopathic person-
alities. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Gacono, C. B., Meloy, R., & Berg, J. (1992). Object relations, defensive operations, and affective states
in narcissistic, borderline, and antisocial personality. Journal of Personality Assessment, 59, 32–49.
Gacono, C. B., Meloy, R., & Bridges, M. (2000). A Rorschach comparison of psychopaths, sexual homi-
cide perpetrators, and nonviolent pedophiles: Where angels fear to tread. Journal of Clinical Psy-
chology, 56, 757–777.
Gacono, C. B., Meloy, R., & Heaven, T. (1990). A Rorschach investigation of narcissism and hysteria in
antisocial personality disorder. Journal of Personality Assessment, 55, 270–279.
Gacono, C. B., Meloy, R., Sheppard, K., Speth, E., & Roske, A. (1995). A clinical investigation of ma-
Downloaded by [University of Miami] at 10:41 07 January 2015

lingering and psychopathy in hospitalized insanity acquittees. Bulletin of the American Academy of
Psychiatry and the Law, 23, 1–11.
Gacono, C. B., Meloy, R., Speth, E., & Roske, A. (1997). Above the law: Escapes from a maximum se-
curity forensic hospital and psychopathy. Bulletin of the American Academy of Psychiatry and the
Law, 25, 547–550.
Gacono, C. B., Nieberding, R., Owen, A., Rubel, J., & Bodholdt, R. (2001). Treating juvenile and adult
offenders with conduct-disorder, antisocial, and psychopathic personalities. In J. B. Ashford, B. D.
Sales, & W. H. Reid (Eds.), Treating adult and juvenile offenders with special needs (pp. 99–129).
Washington, DC: American Psychological Association.
Ganellen, R. (1996). Comparing the diagnostic efficiency of the MMPI, MCMI–II, and Rorschach: A
review. Journal of Personality Assessment, 67, 219–243.
Greco, C., & Cornell, D. (1992). Rorschach object relations of adolescents who committed homicide.
Journal of Personality Assessment, 59, 574–583.
Hare, R. D. (1991). The Hare Psychopathy Checklist–Revised manual. North Tonawanda, NY: Multi-
Health Systems.
Harris, G. T., Rice, M. E., & Cormier, C. A. (1991). Psychopathy and violent recidivism. Law and Hu-
man Behavior, 15, 625–637.
Hart, S., Cox, D., & Hare, R. (1995). The Hare Psychopathy Checklist–Screening Version manual.
North Tonawanda, NY: Multi-Health Systems.
Hathaway, S. R., & McKinley, J. C. (1967). The Minnesota Multiphasic Personality Inventory, manual.
New York: Psychological Corporation.
Heaven, T. (1988). Relationship between Hare’s Psychopathy Checklist and selected Exner Rorschach
variables in an inmate population. Unpublished doctoral dissertation, United States International
University, San Diego, CA.
Heilbrun, K., Hart, S., Hare, R., Gustafson, D., Nunez, C., & White, A. (1998). Inpatient and post-dis-
charge aggression in mentally disordered offenders: The role of psychopathy. Journal of Interper-
sonal Violence, 13, 514–527.
Hiller, J., Rosenthal, R., Bornstein, R., Berry, D., & Brunell-Neuleib, S. (1999). A comparative meta-
analysis of Rorschach and MMPI validity. Psychological Assessment, 11, 278–296.
Howard, W. (1999). The utility of selected Rorschach indices of distress and attachment for differential
diagnosis in a forensic setting (Doctoral dissertation, Georgia State University, 1998). Dissertation
Abstracts International, 59, 5578B.
Jenkins, R. (1960). The psychopathic or antisocial personality. Journal of Nervous and Mental Disease,
131, 318–334.
Karfgin, L. (1989). Conduct disorder and depression in adolescence (Doctoral dissertation, University
of Maryland Baltimore County, 1988). Dissertations Abstracts International, 49, 4575B.
Kaser-Boyd, N. (1993). Rorschachs of women who commit homicide. Journal of Personality Assess-
ment, 60, 458–470.
 RORSCHACH AND PSYCHOPATHY 37

Lilienfeld, S., & Andrews, B. (1996). Development and preliminary validation of a self-report measure
of psychopathic personality traits in noncriminal populations. Journal of Personality Assessment,
66, 488–534.
Long, J. (1995). A comparative study between the Rorschach and MMPI–A in predicting symptoms and
behaviors with inpatient adolescents (Doctoral dissertation, University of Tulsa, 1995). Disserta-
tions Abstracts International, 56, 3452B.
Loving, J. (1998). Selected Rorschach variables of psychopathic male juvenile offenders (Doctoral dis-
sertation, Widener University, 1998). Dissertation Abstracts International, 59, 0878B.
Loving, J., & Russell, W. (2000). Selected Rorschach variables of psychopathic juvenile offenders.
Journal of Personality Assessment, 75, 126–142.
Lyon, D., & Ogloff, J. (2000). Legal and ethical issues in psychopathy assessment. In C. B. Gacono
(Ed.), The clinical and forensic assessment of psychopathy: A practitioner’s guide (pp. 139–174).
Downloaded by [University of Miami] at 10:41 07 January 2015

Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Meloy, R. (1988). The psychopathic mind: Origins, dynamics, and treatment. Northvale, NJ: Aronson.
Meloy, R., & Gacono, C. B. (1992). The aggression response and the Rorschach. Journal of Clinical
Psychology, 48, 104–114.
Meloy, R., & Gacono, C. B. (1995). Assessing the psychopathic personality. In J. Butcher (Ed.), Clinical
foundations of personality assessment (pp. 410–422). New York: Oxford University Press.
Meloy, R., & Gacono, C. B. (1998). The internal world of the psychopath. In T. Millon, E. Simonsen, M.
Birket-Smith, & R. Davis (Eds.), Psychopathy, antisocial, criminal, and violent behavior (pp.
95–109). New York: Guilford.
Meloy, R., & Gacono, C. B. (2000). Assessing psychopathy: Psychological testing and report writing. In
C. B. Gacono (Ed.), The clinical and forensic assessment of psychopathy: A practitioner’s guide (pp.
231–250). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Meyer, G. J. (Ed.). (1999). The utility of the Rorschach for clinical assessment [Special section]. Psy-
chological Assessment, 11, 235–302.
Meyer, G. J. (Ed.). (in press). The utility of the Rorschach for clinical assessment [Special section].
Psychological Assessment.
Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Kubiszyn, T. W., Moreland, K. L., Eisman, E. J., &
Dies, R. R. (1998). Benefits and costs of psychological assessment in healthcare delivery: Report of
the Board of Professional Affairs Psychological Assessment Work Group, Part I. Washington, DC:
American Psychological Association Practice Directorate.
Millon, T. (1994). Millon Clinical Multiaxial Inventory–III (MCMI–III) manual. Minneapolis, MN: Na-
tional Computer Systems.
Millon, T., & Davis, R. (1996). Disorders of personality: DSM–IV and beyond (2nd ed.). New York: Wiley.
Murphy-Peaslee, D. (1995). An investigation of incarcerated female: Rorschach indices and Psychopa-
thy Checklist scores (Doctoral dissertation, California School of Professional Psychology, 1993).
Dissertation Abstracts International, 56, 0531B.
Ogloff, J., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a therapeutic commu-
nity program. Behavioral Sciences and the Law, 8, 81–90.
Parker, K. C. H., Hanson, R. K., & Hunsley, J. (1988). MMPI, Rorschach, and WAIS: A meta-analytic
comparison of reliability, stability, and validity. Psychological Bulletin, 103, 367–373.
Peaslee, D., Fleming, G., Baumgardner, T., Silbaugh, D., & Thackrey, M. (1992). An explication of fe-
male psychopathy: Psychopathy Checklist scores, Rorschach manifestations, and a comparison of
male and female offenders with moderate and severe psychopathy. Unpublished manuscript.
Pinto, A. (1999). A Rorschach study of object representations and attachment in male adolescents with
disruptive behaviors (Doctoral dissertation, Pace University, 1999). Dissertations Abstracts Inter-
national, 59, 5105B.
Ponder, J. (1998). An investigation of psychopathy in a sample of violent juvenile offenders (Doctoral
dissertation, University of Texas at Austin, 1998). Dissertation Abstracts International, 59, 5105B.
 38 GACONO, LOVING, BODHOLDT

Quinsey, V., Harris, G., Rice, M., & Cormier, C. (1998). Violent offenders: Appraising and managing
risk. Washington, DC: American Psychological Association.
Rice, M., Harris, G., & Cormier, C. (1992). Evaluations of a maximum security therapeutic community
for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16, 399–412.
Robbins, L. (1966). Deviant children grown up. Baltimore: Williams & Wilkens.
Rogers, R. (1986). Structured interview of reported symptoms (SIRS). Toronto, Canada: Clarke Institute
of Psychiatry.
Rogers, R. (1995). Diagnostic and structured interviewing: A handbook for psychologists. Odessa, FL:
Psychological Assessment Resources.
Rogers, R., & Dion, K. (1991). Rethinking the DSM–III–R diagnosis of antisocial personality disorder.
Bulletin of the American Academy of Psychiatry and Law, 19, 21–31.
Rogers, R., Salekin, R., Sewell, K., & Cruise, K. (2000). Prototypical analysis of antisocial personality
Downloaded by [University of Miami] at 10:41 07 January 2015

disorder. Criminal Justice and Behavior, 27, 234–255.

Rorschach, H. (1942). Psychodiagnostics. New York: Grune and Stratton. (Original work published 1921)
Serin, R., & Brown, S. (2000). The clinical use of the Hare Psychopathy Checklist–Revised in contem-
porary risk assessment. In C. B. Gacono (Ed.), The clinical and forensic assessment of psychopathy:
A practitioner’s guide (pp. 251–268). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Seto, M., & Lalumiere, M. (2000). Psychopathy and sexual aggression. In C. B. Gacono (Ed.), The clini-
cal and forensic assessment of psychopathy: A practitioner’s guide (pp. 333–350). Mahwah, NJ:
Lawrence Erlbaum Associates, Inc.
Smith, A. (1994). Juvenile psychopathy: Rorschach assessment of narcissistic traits in conduct disor-
dered adolescents. Unpublished doctoral dissertation, California School of Professional
Psychology, Alameda.
Smith, A., Gacono, C. B., & Kaufman, L. (1995). A Rorschach comparison of psychopathic and
nonpsychopathic conduct disordered adolescents. Journal of Clinical Psychology, 53, 289–300.
Smith, S., & Gacono, C. B. (2000, March). A Rorschach investigation of age and gender characteristics
of psychopathy. In J. Porcerelli (Chair), Use of the Rorschach and TAT with antisocial personality
and psychopathy. Society for Personalty Assessment meeting, Albuquerque, NM.
Weber, C., Meloy, R., & Gacono, C. B. (1992). A Rorschach study of attachment and anxiety in inpa-
tient conduct-disordered and dysthymic adolescents. Journal of Personality Assessment, 58, 16–26.
Weiner, I. (2000). Using the Rorschach properly in practice and research. Journal of Clinical Psychol-
ogy, 56, 435–438.
Weiner, I. (in press). Advancing the science of psychological assessment: The Rorschach Inkblot
Method as exemplar. Personality Assessment.
Wood, J., Lilienfeld, S., Garb, H., & Nezworski, T. (2000). The Rorschach test in clinical diagnosis: A crit-
ical review, with a backward look at Garfield (1947). Journal of Clinical Psychology, 56, 395–430.
Wood, J., Nezworski, M., Stejskal, W., Garven, S., & West, S. (1999a). Erratum for “Methodological is-
sues in evaluating Rorschach validity: A comment on Burns and Viglione (1996), Weiner (1996),
and Ganellen (1996).” Assessment, 6, 305.
Wood, J., Nezworski, M., Stejskal, W., Garven, S., & West, S. (1999b). Methodological issues in evalu-
ating Rorschach validity: A comment on Burns and Viglione (1996), Weiner (1996), and Ganellen
(1996). Assessment, 6, 115–129.
Young, M., Justice, J., Erdberg, P., & Gacono, C. B. (2000). The incarcerated psychopath in psychiatric
treatment: Management or treatment? In C. B. Gacono (Ed.), The clinical and forensic assessment of
psychopathy: A practitioner’s guide (pp. 139–174). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Carl B. Gacono
P.O. Box 140633
Austin, TX 78714
E-mail: drcarl14@aol.com

Received November 6, 2000