Using the Rorschach to Define Differences in Schizophrenics and the Implications for Treatment

This article addresses a problem that continues to plague efforts to understand schizophrenia. The question of whether it is a heterogeneous grouping of schizophrenias or whether it is one disorder in different kinds of people continues to permeate research efforts. As discussed by Carpenter et al. (1993), addressing this question is crucial to the direction research on schizophrenia should take. Carpenter et al. consider psycho-pathologically homogeneous subgroups of schizophrenic patients essential to the assessment of brain function and we would add that it is also critical for the evaluation of clinical approaches to schizophrenia. Thus, we ask, in addition to why so much variability exists in many physiologic and anatomic measurements of these patients, why do patients respond differently to psychotherapeutic treatment? We will try to focus on the variability in response to treatment and what might influence it. In particular, we seek to find out whether some of the differences that have been found might be related to differences in the psychological structure of schizophrenic patients especially the way they relate to others, and whether a way can be found to measure these differences in a reliable manner. Perhaps, then, we can have a valid means to find more homogeneous groups of schizophrenic patients.

One of the important findings of the Boston Psychotherapy of Schizophrenia study (Frank and Gunderson, 1990; Stanton et al., 1984) suggests further exploration of the way schizophrenic patients relate. The investigators in that study found that a clinical composite measure called Active Engagement (AE), assessed after 6 months of treatment, significantly