The use of the Rorschach method in the investigation of sexual abuse of children

Abstracts

A escolha de métodos apropriados para identificar crianças vítimas de abuso sexual é uma prática necessária no cenário forense. Entre os instrumentos de avaliação psicológica, o Método de Rorschach demonstra especial utilidade para esta finalidade. Visando a ampliar e fundamentar essas ideias, este estudo teve como objetivo verificar a extensão e importância da utilização do Rorschach como instrumento de avaliação psicológica de vítimas de abuso sexual. Para tanto, procedeu-se à busca bibliográfica eletrônica de artigos indexados. Os artigos revisados derivam de estudos desenvolvidos no Brasil, Cuba, Argentina, Chile, Estados Unidos da América e Canadá. Os principais achados atestam a validade do Rorschach em casos de suspeitas de abuso sexual e na investigação das consequências do abuso, e suas possíveis contribuições na área, o que confere ao instrumento propriedades necessárias para responder de forma segura nesse contexto.

avaliação psicológica; teste de Rorschach; abuso sexual; saúde pública

SYSTEMATIC LITERATURE REVIEW

The use of the Rorschach method in the investigation of sexual abuse of children¹

Uso del Rorschach en la investigación del maltrato a los niños

Silvana Alba Scortegagna^I; Anna Elisa de Villemor-Amaral^II

^IUniversidade de Passo Fundo, Passo Fundo-RS, Brasil

^IIUniversidade São Francisco, Itatiba-SP, Brasil

Correspondence to

ABSTRACT

The choice of adequate methods to identify children who were victims of sexual abuse is a necessary practice in the forensic scenery. Among the psychological assessment instruments, the Rorschach test shows special usefulness for this purpose. Aiming at the broadening and foundation of these ideas and seeking to verify the extension and importance of the use of this instrument in psychological evaluation of the victims of sexual abuse. To do so, we preceded to an electronic bibliographic research of indexed papers of studies developed in Brazil, Cuba, Argentina, Chile, United States of America and Canada. The main findings certify the validity of Rorschach in cases where sexual abuse is suspected and in the investigation of its sequels, and its possible contributions to the area, which confers to the instrument the necessary properties to answer in a safe way within this context.

Keywords: psychological assessment, Rorschach test, sexual abuse, public health

RESUMEN

La elección de métodos apropiados para identificar niños víctimas de abuso sexual es una práctica necesaria en el escenario forense. Entre los instrumentos de evaluación psicológica, el método de Rorschach ha demostrado su utilidad especial para esa finalidad. Con el objeto de ampliar y fundamentar esas ideas, se busca verificar la extensión y la importancia de la utilización de este instrumento en la evaluación psicológica de víctimas de abuso sexual. Para esto, se procedió a la búsqueda bibliográfica electrónica de artículos indexados de estudios desarrollados en Brasil Cuba, Argentina, Chile, Estados Unidos de América y Canadá. Los principales resultados certifican la validez de Rorschach en casos de sospechas de abuso sexual y en la investigación de las consecuencias del abuso y sus posibles contribuciones en esta área, lo que confiere al instrumento propiedades necesarias para contestar de forma segura en este ámbito.

Palabras clave: evaluación psicológica, test de Rorschach, abuso sexual, salud pública

Psychological evaluation is frequent in forensic practice to diagnose and recognize emotional indicators in children who are victims of sexual abuse. In that context, the evaluation should provide information based on scientific evidence to guide decision making in different kinds of lawsuits. In cases of guardianship disputes in Family Courts, it can help to define the legal guardian and to check the veracity or not of certain accusations to direct intervention actions that involve victims and their families.

Therefore, observation and the use of interviews and different tests are fundamental to understand the personality traits and emotional dynamics involved in sexual abuse and the main stakeholders. Child victims of sexual abuse are commonly described as reserved, defensive and less willing to talk about their internal pain and survive in dysfunctional and negligent family environments (Blatt, 1975).

One important factor to be considered is that parental roles in the father-mother-child triad reveal that the mother and/or father are not always able to perform their functions, causing a gap in the interdiction process. In that sense, difficulties emerge to distinguish among its members, and it is precisely this lack of distinction, resulting from the impossibility to establish the father function, that should represent the limit and determine the parameters between the I and the other, which promotes the incestuous relation (Bollas, 1992).

Another relevant aspect is mothers' participation in the incest relation between fathers and daughters, which can range from favoring the occurrence of more subtle sexual stimuli to actual sexual contact, representing perverse collusion with the abuser. This form of functioning is evidenced in the Rorschach Comprehensive System (Wald, Archer, & Winstead, 1990) by high distorted response scores (X-%) on a positive Perceptual-Thinking Index (PTI), suggesting a severe thought disorder with deficits on the reality test; increased results on the Depression Index (DEPI), increased responses in the shading-dimension (V), shading-diffuse (Y), revealing a propensity for ruminative self-inspection and emotional ambivalence; also, the shading texture (T) indicators and personality style (EB) indicate distancing in interpersonal relations and inefficient problem-solving resources (Exner, 2003). Therefore, one may consider that mothers of sexual abuse victims process information inefficiently, are negligent and fail to accomplish the necessary maternal function.

In this context, mothers who delegate their tasks to their own daughters are common, making them assume their functions. As this happens, however, the mothers are overwhelmed by feelings of hostility and hatred and by the desire to have their daughters punished and humiliated for improperly taking their place (Forward & Buck, 1989). In these situations, the dynamic ambivalence (love-hatred) between mother and daughter in sexual abuse cases is clearly observed.

This ambivalence is dynamically experienced through projection and introjection mechanisms. Introjection allows children to create a representation of the external world in their mental apparatus, to organize the pulsed chaos and to dialectically address the other's desires - the mother. In sexual abuse situations, the child introjects the mother's incestuous desire and, thus, can accept the place she imposes and also use this situation for revenge, taking hold of what should be the object of the mother's sexual desire - the father. This reveals the importance of considering the existing rivalry between mother and daughter. On the other hand, projection is a resource that permits dealing with the hate that results from frustration and displeasure. In sexual abuse cases, when this does not happen, the hatred can remain in the psyche and mobilize the emergence of the child's self-destructive conducts.

Rather frequently, in their original history, the mothers of childhood sexual abuse victims may also have suffered sexual abuse. Thus, they start to use the denial of their daughters' incest, as the repetition of the incestuous act intertwines with an unconscious relief, to the extent that it preserves them in the position of daughters loved by the father who now seems projected in the husband's figure. In view of the above, one can better understand the mother's difficulty to grant her daughter credibility and support, her position to stay at her partner's side and her use of denial to defend herself against her own painful situation (Bollas, 1992).

Hence, no matter how many efforts the victim is making to reveal the abuse, in incestuous families, the child is intimidated to maintain the abuse as a family secret, which represents the Syndrome of Secrecy (Furniss, 1993). If, on the one hand, maintained silence benefits the perpetuation of incestuous family relations and increases their addiction, on the other, the possibility to intervene in order to make room for a complaint can help the child and her family. It should also be mentioned that the effects of silence enhance the victims' isolation and increase the introjection of the guilt that makes them feel responsible for the misfortune, thus aggravating the traumatic impact and its consequences.

Since Freud (1920/1976), it is known that anything producing great excitement and impeding mental circulation is traumatic. Hence, the abuse the child is a victim of is an objective fact that becomes traumatic and impossible to process mentally, resulting in an intolerable reality for the child, producing excessive excitement, in which the child can find an exit in motor discharge and recurring manifestations of anguish. Through the discharge, these manifestations attempt to metabolize this excess and find ways to symbolize this experience.

The obstacles raised in thought exactly derive from the child's disability to bear the perception of his/her harsh reality and the resulting suffering. Consequently, the ability to think, investigate, symbolize becomes precarious and understanding of and adjustment to the world are impaired. Frequent damage occurs in the development of thought and learning, which are not related to deficient cognitive structures, but to a symptomatic inhibition in the attempt to remove a danger situation that causes anxiety for the ego, which is to get to know one's own story.

That is how the emergence of anxiety symptoms, sleep disorders, post-traumatic stress and inappropriate sexual behavior become habitual. The presence or not of certain symptoms depends on the evolution period though, so that some effects can appear in childhood, while others emerge in another phase (Finkelhor, 1995). To give an example, in school-age children, the predominant symptoms include regressive and aggressive behavior, hyperactivity, sleep disorders and school problems. During adolescence, typical symptoms comprise depression, isolation, substance abuse, somatic complaints, inadequate sexual behavior, self-aggression and suicide attempts.

Thus, it is important to highlight that the symptoms present can derive from the traumatic force that results from the incapacity to attribute form to the mental pain, i.e. to attribute meaning or find representation in the subject's world. The experiences of mistreatment can produce repetitions, as attempts to create a new representation of the non-representable, but which, in view of this impossibility, make room for the act, as the sole alternative for discharge. Acts directed against oneself can indicate the existing inter-relation between experiences of excess and, consequently, between trauma, mental pain and act (Macedo & Werlang, 2007).

Another form for children to manifest their mental suffering is the attempt they make sometimes to transform reality, through refusal or denial. As a form of defense, the term denial consists in the subject's refusal to acknowledge the reality of an intolerable and traumatizing perception (Laplanche & Pontalis, 1992). Thus, the more unbearable the objective reality, the more the sexual abuse victims tend to take distance in the attempt to deny the traumatic event. This hampers not only the identification of abuse experiences, but also the help an intervention can provide for the necessary elaboration.

It is not difficult to understand that the children defensively use the refusal of reality when it is perceived that what supports the trauma or the mental pain, beyond occasional pain or physical marks deriving from the abuse, is the pain of perceiving that their first objects of love act towards their annihilation. In this perspective, the understanding of the abusive dynamics could justify the non-use of self-report measures and the direction towards choices of projective techniques with a view to addressing functional aspects that are not easily accessible, due to the trauma experiences and which the subjects cannot or not able to report (Blatt, 1975).

Furthermore, one can compare what Conte (2008) problematizes when discussing the Testimony Without Damage in psychoanalytic practice versus legal practice and the use of projective tests versus self-report tests in psychological evaluation of sexual victims. The Testimony Without Damage is a practice that aims to reduce the damage of the countless hearings children are submitted to in sexual abuse trials and to help in the production of evidence. In this technique, children and adolescents are heard by judges, district attorneys, lawyers and legal clerks, who can interact during the testimony. Psychologists and social workers basically have an intermediating function, i.e. they retransmit the questions to the victims with a view to obtaining the necessary truth. For the material registration of evidence, the rooms used for this purpose include audio and video equipment and, after these documents have been transcribed, a copy of the recordings is attached to the files.

Returning to that author's considerations, the demand to validate a child's discourse when exposed to a testimony evidences a paradox, as the child needs to reveal and hide. Revealing what is requested with regard to the inquiry means unveiling the objective truth, and hiding what has happened means hiding the subjective experience of pain, shame, embarrassment and passiveness. Thus, not everything may be available at the symbolic level of the word and, when one is not respecting the time of what cannot be revealed, as there is no possibility of mental elaboration, what may happen is revictimization.

When addressing the imperative aspect of an inquiry on a traumatic situation, Conte also declares that, besides provoking the updating of the intense excitement experienced in view of the abuse, it revictimizes the child who is struggling to mentally bear this experience. If the inquiry takes place long after the abuse, this may equally cause problems to the child, as an inscribed but not symbolized trauma can cause symptoms in the body, discharge in acts or splitting of the ego, as observed earlier.

Hence, the therapeutic intervention in these cases is well supported, as calling upon the child to discuss the abuse (s)he was victim of, without offering a destiny for this trauma, equally represents violence. If, from the victim's perspective, one can reach these findings, the following questions remain: What would be the function of a psychologist, listening or inquiring? How can one proceed with psychological evaluation in this context?

Differently from the proposal of the Testimony Without Damage, the psychologist's practice in psychoanalytic listening to child victims' suffering mainly involves the possibility to offer means for a traumatic event like abuse to gain significance, representation, discourse, to allow these children to turn the excess they have experienced into something real for the body, in a symbolic expression, starting the mental elaboration. This process does not only take place through the construction of a historical truth, but an experience-based history.

In view of these considerations, one may suppose that the use of self-report instrument plays a role that is similar to the inquiry proposed in the Testimony Without Damage, when the child is confronted more direct and objectively with his/her pain and suffering. In these circumstances, the importance of using resources like the Rorschach Method seems essential, as it can start the symbolic elaboration through indirect forms of expression, which the child is free to choose. By composing images or constructing forms based on hardly structured stimuli, the child is confronted with his/her experiences, which permits understanding both his/her affective dynamics and cognitive possibilities (Güntert, 2000).

Rorschach mainly plays a valuable role in the description of the complex and dynamic interaction among the psychological, biological and social domains, which is commonly requested in the legal contexts in victimization situations. Although the instrument consistently attends to the rigor of forensic scrutiny, Gacono, Evans and Viglione (2008) highlight the importance for the examiner to select those Rorschach variables that are directly relevant to the questions needed in each situation, which at the same time present research validity standards and constructs for the specific forensic population.

Thus, the authors highlight the need for the examiner to be familiar with the validity of research related to variables in the Rorschach Comprehensive System and, at the same time, but also to know the relevant comparative forensic data and implications for this practice. Among different available studies, Bannatyne, Gacono and Greene (1999) and Gacono and Meloy (1994) stand out for forensic psychiatric patients and antisocial patients and psychopaths, and Gacono, Meloy and Bridges (2000) for sex offenders.

In addition, the Rorschach Method is particularly useful in situations in which the respondent may not want or be incapable of taking part in the examination. These include compulsory evaluations to answer questions in the criminal forensic and custody contexts, which involve adverse relationship components. In these conditions, the manipulation of answers based on self-reports can compromise or even invalidate reliable findings (Bannatyne, Gacono, & Greene, 1999).

It should be reminded that evaluations through methods like the Rorschach, also called self-expression, aim to seek more than one can evidence through self-report, or through symptoms as, to issue nosographic diagnoses, structured interviews, scales and inventories are efficient (Santoantonio & Antunez, 2010; Villemor-Amaral, 2008). In compulsory evaluations, however, the behaviors manifested are often characterized by simulations, which demands the use of instruments that can provide other information than what an individual's volitional controls permit (Villemor-Amaral, 2009). The Rorschach offers these benefits, as its nature allows subjects to freely express their personality traits without feeling threatened by the objectivity of questionnaires or inventories.

Differently from self-report measures, however, the Rorschach demands extensive work and supervised practice to gain efficiency in the administration and verification of basic scores. As a result of the high complexity standards required in forensic evaluation, Rorschach experts need vast experience in coding protocols with a view to safer practice. In addition, good application and coding do not guarantee mastery in the Rorschach, which includes skillful interpretations.

One example to demonstrate the complexity of the above is the study by Weiner, Exner and Sciara (1996). In the analysis of 7,934 court cases judged with the help of Rorschach results, the researchers found that only seven had been contested. Invariably, when the contestations were sustained, not the psychometric properties of the Rorschach, but the psychologist's interpretations were discredited (Viglione & Meyer, 2008). The main problems include that, in court, the interpretations were too broad, used to demonstrate a crime that was committed; too specific, merely to help and formulate the diagnosis without the link with the forensic topic; or completely irrelevant to the legal problem. Thus, the three situations imply problems in the psychologist's educational background, to the detriment of the instrument's qualities.

Although all of these indicators point towards the legitimacy of the Rorschach Method in the forensic context and in sexual victimization situations, when the use of this instrument for this purpose is investigated, a remarkable lack of Brazilian studies is observed in comparison with the number of studies developed in other countries, although these are not very numerous either. One hypothesis can be based on at least two fundamental conditions, one related to the complexity of the issues permeating sexual victimization and compulsory evaluation, and the other to the nature of the instrument.

With a view to broadening and supporting these ideas, this study aimed to verify the extent and importance of the use of the Rorschach as a psychological evaluation tool for sexual abuse victims. Therefore, an electronic bibliographic search was performed of articles indexed in LILACS, Index-Psi Periódicos, Banco de Teses da CAPES, PePSIC, using the keywords Rorschach and childhood sexual abuse, developed in Brazil, Cuba, Argentina, Chile, United States of America and Canada, between 1988 and 2008.

The studies found are scarce, mainly in recent years. They can specifically be grouped into studies that attempt to use the Rorschach to try and determine or confirm traumatic experiences or suspect abuse and those that aim to identify their probable consequences for the mental development of children with a view to planning intervention measures. These objectives differ, but converge in that they offer support to legal decisions on the development of therapeutic interventions for the people involved. Therefore, the main conclusions of these two perspectives need to be examined.

Use of the Rorschach in the Evaluation of Trauma and Suspected Sexual Abuse

The first studies using the Rorschach in trauma victims involved individuals at times of war. Shalit (1965) administered the Rorschach to 20 men doing their military service in the navy while going through a severe sea storm. That study was the first to demonstrate the increased inanimate movement (m), which was consistently proven later in trauma research. In 1984, based on the newly-created Post-Traumatic Stress Disorder (PTSD) diagnosis, Salley and Teiling (1984) studied Vietnam veterans and were the first to document traumatic intrusions based on the Rorschach.

Cerney (1990) reported on two distinct response modes in the Rorschach: those revealing characteristics of flooded patients and of avoidant patients. Hence, due to a possible two-phased response to trauma, the Rorschach protocols are prone to reveal signs of flooding as well as avoidance. The expressions that reveal feelings of constraint show no color determinant, while those revealing flooding show no color modulation.

Further studies were accomplished to check a two-phased trauma response pattern (Brand, Armstrong, & Loewenstein, 2006; Kaser-Boyd, 1993). The findings included emotional instability (CF + C > FC) accompanied by a low affective proportion (<.05). The trauma avoidance feelings were observed in the combination between a high Lambda (L), low number of responses (R) and low affective quotients (Afr) associated with a significant Traumatic Content Index (TC), pure color (C) and color as the secondary form (CF), and Perceptual-Thinking Index (PTI). Also, the presence of protocols was found with signs of "constraint" as well as "flooding", and also protocols with only one of these signs, depending on the phase the individual was in during the evaluation period.

To enhance and deepen this understanding, studies are highlighted that evidence signs of trauma avoidance and studies revealing the presence of feelings of flooding. Signs of avoidance are described in two response patterns of war veterans to the Rorschach, marked by a lack of affective response and a low response rate. The low affective quotient (Afr) and low percentage of blends remit to an emotional paralysis (Kaser-Boyd, 1993), while the low number of responses (R) and a high Lambda (L) are understood as manifestations of cognitive avoidance and, when combined, can produce a low personality style (EB), commonly found in victimization contexts (Levin & Reis, 1996).

In populations with dissociative disorders, an uncommon number of highly introvert subjects is found. On the other hand, in non-dissociative trauma groups, the presence of an extratensive pattern is observed (Armstrong & Loewenstein, 1990). Hence, the dissociation may be related with the presence of some unique determinants that indicate a sign of cognitive and emotional distancing, like a form-based dimensional (FD) response for example (Armstrong, 1991). These findings are consistent with developmental theory, evidencing that the dissociation allows the child to take distance from the burden of emotions and evade into the imaginary world, which is more gratifying than the real world (Armstrong, 1994).

More recently, Brand et al. (2006) investigated 100 patients hospitalized with psychiatric disorders and severe dissociation using the Rorschach and evidenced importance signs of traumatic avoidance. In more than 40% of the sample, R < 14 was obtained, significant when compared to relevant control groups. The authors understood this behavior patterns as an attempt to "limit and escape from painful associations". Additional signs of hesitation were found in the high prevalence of form-based dimensional responses (FD); in the higher frequency of introverted individuals, suggesting the presence of processes of intellectualization and obsessions; in the low affective quotient (Afr), representing emotional paralysis, and in the high human movement responses (M), indicating the use of phantasy for self-protection.

Individuals with recent or especially frightening traumatic experiences commonly give signs of being flooded by the trauma. In Rorschach protocols, they tend to attribute unnecessary details, as if they were capable of defending themselves against images of danger. The traumatic flood can be observed in the relatively unstructured color responses (CF + C > FC) and extratensive EB; in the painful affect expressed in the predominance of shading responses, particularly shading-diffuse (Y) and shading-dimension (V) (Salley & Teiling, 1984); in high negative and adjusted D-scores (AdjD), due to the harmful effects of the flood; in the significant presence of inanimate movement (m) and a positive Hypervigilance Index (HVI), reflecting feelings of despair in view of the burden and hypersensitivity to greater danger (Levin, Lazrove, & van der Kolk, 1999).

It is interesting to highlight that the dissociation, generally present during avoidance periods, can equally appear in the flood phase, in the form of flashbacks. Studies have attempted to identify the flashbacks through content analysis. Since the primordial Rorschach research in war victim populations, researchers have observed the presence of traumatic contents (Leifer, Shapiro, Martone, & Kassem, 1991). Armstrong (1991), for example, developed a Traumatic Content Index (TC) with samples of dissociative disorder patients, which consists in the sum of responses with sex (Sx), blood (Bl), anatomy (An), morbid (MOR) and aggressive movement (AG) contents divided by the total number of responses (TC/R). It was hypothesized that a TC/R of.3 or more suggests traumatic intrusions. Kamphuis, Kugeares and Finn (2000) documented the ability of the TC/R to distinguish between confirmed sexual abuse patients and patients free from this misfortune.

Against the background of this concern, researchers have attempted to distinguish between the Rorschach responses of child and adolescent sexual abuse victims and non-victims. Einbender and Friedrich (1989) evaluated Rorschach data related to cognitive, emotional, social functioning and sexual concern. They found differences between the groups in cognitive and social functioning and sexual preoccupation; also, the victims' reports resulted in a high index of morbid and sexual content and uncommon responses.

Other studies lead to similar conclusions, demonstrating that the victims exhibit responses with more unusual and uncommon contents, like sex and blood. Kendall-Tackett, Williams and Finkelhor (1993) report the high frequency of these contents as the most robust sexual abuse indicator, revealing aspects of anguish and demonstrating signs that the child was a victim of severe damage, was invaded and hurt.

When studying these children's psychological functioning, Leifer et al. (1991) compared the responses of girls with and without a history of abuse. They discovered that victims differed in their high perceptive distortion response (X-%) scores; in the predominant use of shading characteristics; in the positive Depression Index (DEPI); in the high sum of special codes related to strange verbalization characteristics and uncommon, hostile contents; in the decreased number of answers (R); and a difference in the frequency of responses in which objects penetrated others. In summary, the victims demonstrated more disturbed thinking, a higher stress level related to their adaptive skills; they described human relationships more negatively and demonstrated greater concern with sexuality than the comparison group.

As presented, one may suppose that, if abuse is suspected, these indicators can contribute to confirm the fact, highlighting the importance of the Rorschach in this context. Next, we will verify the validity of the Rorschach to map the consequences of abuse and respond to its implications.

Use of the Rorschach in the Evaluation of Consequences of Sexual Abuse

Studies are found in the literature that involve adults who were victims of sexual abuse as a child and demonstrate the indelible consequences of these experiences, reinforcing the need for appropriate interventions. In general, Cerney (1990) and Friedrich, Jaworski, Huxsahl and Bengtson (1997) reported a strong dissociative component in the Rorschach, as verified in the responses with morbid and sexual contents and in the increased index of uncommon responses. Further research support these findings, showing the presence of dissociative responses by sexual abuse victims in the Rorschach, which indicates these individuals' greater vulnerability to disorders involving the soma and the self.

Chagnon (2008) called attention to the characteristics of dissociative protocols with indicators of primary harm to identity construction, including reports of badly distinguished and hardly integrated contents. Difficulties to distinguish precise forms are recurrent, which frequently appear intermingled; besides expressions on the interior of the body, using anatomic and uterine images as a resource, which remits to the weakness of inside-outside or internal-external borders. It is interesting to observe that the images evoked may be witnessing the subject's corporal and mental damage, which corresponds to a sense of not being, like a dismantled self (Meltzer, 1984), or of not being distinguished. Such responses also indicate a profound feeling of weakness and lack of protection.

Kendall-Tackett et al. (1993) and Leifer e al. (1991) aimed to identify characteristics of childhood sexual abuse associated with the development of more severe damage. The results were based on the analyses of psychiatric reports and six Rorschach variables: poor human movement responses; achromatic responses; diffuse shading responses and the smaller percentage of precise responses. The authors concluded that abuse in initial childhood was related with the same Rorschach variables, characterizing disturbed cognition and damaged sense of oneself. The most severe psychological disorders were related with the presence of more than one perpetrator, with the victims' young age and with the frequent abuse episodes.

In this context, the use of the Rorschach in Argentina is observed in the search of elements to diagnose and determine mental damage. In the analysis of sexual abuse victims' protocols, Gravenhorst (2002) found the presence of F% and extended F% as expected, indicating the ego's efforts to be objective and logical. The study supported the findings mentioned with regard to the decreased F+%, extended F+% and Index of Reality (IR), suggesting a severe pathology associated with inoperative functioning of the age and failure to adapt to reality, response form, indicators of defensive rigidity, dissociation and overadaptation.

Other significant elements the author found were damage responses associated with sexuality and skeleton contents; presence of blood contents; direct sexual responses and persecuting, aggressive and violent male figures. Among special phenomena, the following were found: (a) action of tolerance in the presence or past as a sign of having passively supported a violent action; (b) presence of morbid (MOR) responses in the identification of damaged, destructed, broken, dead objects; (c) sadistic oral complex responses associated with sexuality; (d) annulation of Consciousness of Interpretation with negative Self-references in the same response, indicating severe psychological damage, loss of limits and judgment of reality.

As observed, the few international studies and lack of Brazilian studies using the Rorschach to investigate childhood sexual abuse indicate the need for validation and diagnostic studies using this instrument in our context. Therefore, Scortegagna and Villemor-Amaral (2009) evaluated 76 male and female children and adolescents, between 10 and 14 years old, divided in two distinct groups: one group of incestuous abuse victims and the other of non-victims. The authors used a sociodemographic form and the Rorschach Comprehensive System. Besides cognitive development sequelae, significant differences were found between the Rorschach indicators in inanimate movement (m) and blood content (Bl) responses. The anatomic (An), morbid (MOR), sexual (Sx) and imprecise and non-conventional (FQ-) responses demonstrated higher scores in the victim group. It was verified that the presence of distorted self-perception and lower self-esteem among victims derives from the victimization process. These results were considered significant, as they support data obtained in foreign studies and demonstrate the validity of Rorschach use in this context.

Final Considerations

Reflecting on the use of the Rorschach in the investigation of childhood sexual abuse arouses many concerns. First, it should be reminded that most literature emphasizes incest events in disturbed family functioning, so that, whether because of family disorders or the child's weakness, the countless difficulties in breaking with incestuous family dynamics to reveal childhood sexual abuse are considered delicate and complex.

In view of this complexity and the need to better contribute to the clarification of charges or implications of events, resources are sought in appropriate psychological techniques and valid investigation methods. As psychoanalytic listening is based on resources that demonstrate the understanding of traumatic experience and significant protection factors, it can be of great help. These elements are useful to develop psychological evaluation and intervention processes aimed at integrating the traumatic event.

Among psychological investigation methods, the Rorschach stands out as one of the best efficient instruments for this context. Besides its psychometric properties that evidence its consistent validity and reliability, when well administered, it is a valuable tool to enhance forensic practice. In combination with its scores and proportions, it offers the opportunity to observe behavior in response to a new and complex stimulus. It is interesting to observe that, when interpreting random forms, the images the victimized children evoked may be witnessing their bodily and mental damage, as previously observed. Thus, the Rorschach adds an additional dimension to face-to-face interviews, which are essential components of forensic evaluations.

Therefore, great convergence exists among research results involving the application of the Rorschach in children and adults. Despite variations in methodological perspectives among the different authors cited, all admit that sex, blood, morbid contents and indicators of distorted reality perception are elements that emerge in the protocols of recent or more remote sexual abuse victims. This grants the Rorschach the status of an instrument that helps to identify situations of abuse beyond what can be reported and also contributes to establish short and long-term intervention guidelines in care delivery to victims and their families.

Finally, solid research from the last twenty years includes an analysis of the Rorschach's acceptance in court and suggests that the instrument will continue being widely used in clinical and forensic work. Hence, it is obvious that continuing research is needed to specify the applications and limitations for many interpretative postulates and for the development of Brazilian normative tables for the forensic target population.

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1

Artigo derivado da Tese de Doutorado da primeira autora sob a orientação da segunda, defendida no Programa de Pós-graduação em Psicologia da Universidade São Francisco

Publication Dates

• Publication in this collection
  11 Dec 2012
• Date of issue
  Aug 2012

History

• Received
  26 Aug 2010
• Accepted
  06 July 2011
• Reviewed
  04 Dec 2010