Coding form dominance in color, shading, and achromatic color responses (Form Dominant, Form Secondary, Formless) has traditionally been an important aspect of Rorschach assessment of ego involvement in the regulation of emotions. The more Form involvement, the more one is accessing cognition to structure and modulate one's experience of emotions. For psychometric and pragmatic reasons, contemporary Rorschach systems have eliminated or curtailed coding form dominance of shading and achromatic color (FDSHAC). Positing that this sacrifices interpretive nuance, we have recently attempted to demonstrate that with supplemental guidelines, FDSHAC can be coded reliably and accurately. We found, however, that the weak link is coding Form Secondary. Thus, using the same data set coded by four experienced Rorschachers, we attempted to mitigate this by evaluating two alternate versions of FDSHAC: One collapses Form Secondary with Form Dominant into a category called "Form Integrated"; the other, Form Secondary with Formless into "Non-Form Dominant." Applying more conservative kappa statistics, which credit only exact matches among raters, the Form Integrated version generally showed stronger interrater reliabilities and scoring accuracies and thus is a promising compromise for assessors wishing to retain some nuance in interpreting ego involvement in the regulation of dysphoria and anxiety. Intraclass correlation coefficients, which credit close-but-inexact coding among raters, revealed little difference. Clinical and research implications as well as limitations are discussed.

Abstract: Coding form dominance in color, shading, and achromatic color responses (Form Dominant, Form Secondary, Formless) has traditionally been an important aspect of Rorschach assessment of ego involvement in the regulation of emotions. The more Form involvement, the more one is accessing cognition to structure and modulate one’s experience of emotions. For psychometric and pragmatic reasons, contemporary Rorschach systems have eliminated or curtailed coding form dominance of shading and achromatic color (FDSHAC). Positing that this sacrifices interpretive nuance, we have recently attempted to demonstrate that with supplemental guidelines, FDSHAC can be coded reliably and accurately. We found, however, that the weak link is coding Form Secondary. Thus, using the same data set coded by four experienced Rorschachers, we attempted to mitigate this by evaluating two alternate versions of FDSHAC: One collapses Form Secondary with Form Dominant into a category called “Form Integrated”; the other, Form Secondary with Formless into “Non-Form Dominant.” Applying more conservative kappa statistics, which credit only exact matches among raters, the Form Integrated version generally showed stronger interrater reliabilities and scoring accuracies and thus is a promising compromise for assessors wishing to retain some nuance in interpreting ego involvement in the regulation of dysphoria and anxiety. Intraclass correlation coefficients, which credit close-but-inexact coding among raters, revealed little difference. Clinical and research implications as well as limitations are discussed.

Although emphasis on psychodynamic thinking has waned in assessment training, the ascendant Rorschach Performance Assessment System (R-PAS; Meyer et al., 2011) has reintegrated psychoanalytic concepts into empirical Rorschach assessment: R-PAS adds scores involving object relations, implicit dependency, aggressive ideation, and ego impairment. R-PAS has, however, excluded the psychodynamic framework for assessing ego involvement in the regulation of anxiety/dysphoria by eliminating the coding of Form Dominance in Shading and Achromatic Color (FDSHAC) that has been part of the Comprehensive System (Exner, 2003). This decision was based in part on concerns about efficiently and reliably coding distinctions among Form Dominant, Form Secondary, and Formless levels of FDSHAC. To establish that such distinctions can be coded reliably, we applied supplemental guidelines (Viglione, 2010) to evaluate reliability among four experienced assessors who coded determinants for 155 Rorschach responses, 115 of which required FDSHAC determination. Applying Gwet's AC2 ' s to ordinal scales, interrater reliabilities were good to excellent. Reliabilities were strongest for Form Dominance in Texture and Achromatic Color, modestly so for Form Dominance in Diffuse Shading, and problematic for Form Dominance of Vista. Among levels of Form involvement across FDSHAC variables, raters had the most difficulty distinguishing Form Secondary. We discuss considerations for clinical coding, psychodynamic configurational analyses for interpretation, and construct validation research.

supervisor. Her book has much to teach those who educate candidates. For example, she writes of one case where “the supervisor’s theories and suggestions for technique”, when used by the candidate with one patient, “seemed to disorganize the patient further” (171). Early in my supervision with Harold Searles, he predicted that the patient would notice changes in how I worked with her as a result of his supervision and would wonder why. Much of the book usefully emphasizes radical changes in our understanding of countertransference, so we now view it as an inevitable and useful source of information about the patient, in contrast with past attitudes which stigmatized countertransference. The author citesmany of the analysts who helped encourage this shift. Searles was controversial because he was ahead of his time in what he wrote about countertransference, starting in the 1950s. He deserves more attention in this book than the passing reference to one of his articles, without any discussion of his immense contributions to the subject matter of Kantrowitz’s book. Better editing would have shortened the book by removing its many repetitions. In the most glaring example, two consecutive paragraphs end with exactly the same, lengthy sentence (174 and 175). More often, as she summarizes what she has written, Kantrowitz restates the same points excessively. Most of the book’s typos are in its final chapter, which is so personal that it must have been painful for her to write and to review. Implicitly, some of her most powerful vignettes involve trauma. But she fails to acknowledge that psychoanalysis has changed in the ways she describes partly because we have now expanded our focus to include both intrapsychic conflict as well as traumatic experiences. Kantrowitz writes that “Some Relational analysts specifically developed their ideas from their work with traumatized patients” (15). I hope that all psychoanalysts are now more skillful in detecting significant trauma in their patients’ lives, and working with it more effectively than we did when some analysts referred to victims of incest as “Oedipal victors”. In summary, Kantrowitz productively deepens our understanding of the vagaries of intersubjective processes between patient and analyst over the course of their work together. As she suggests, more subtle but pivotal aspects of these interactions are easy to miss, even for experienced analysts. Her book should also serve as a warning to all of us to leave the confines of our preferred theory, at times, and read more widely in the current and past psychoanalytic literature, seeking insights that will improve our clinical skills and help us navigate challenging clinical moments.

This section on digital media in child psychoanalysis and psychotherapy is intended to help fill in a gap in the psychoanalytic literature where much more has been written about the cultural and developmental impact of the digital revolution compared to conceptualization and intervention in clinical work with children and adolescents who wish to access digital media within sessions. In this introductory article, I provide a preview of the section's articles by four experienced psychoanalytic child clinicians. Each author-clinician offers multiple case illustrations and commentaries on the formulations that undergird their inventions with child and adolescent patients who sought to bring digital devices and media directly into treatment sessions. The hope is that this section will inspire other child analysts and therapists to write about their experiences on treatment's digital frontier and thus expand our literature on this topic that is of vital importance in contemporary practice.