INFORMATION TO USERS - AU Digital Research Archive |

INFORMATION TO USERS

This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer.

The quality of this reproduction is dependent upon the quality of the copy

submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment

can adversely affect reproduction.

In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion.

Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book.

Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order.

Bell & Howell Information and Learning 300 North Zeeb Road, Ann Arbor, Ml 48106-1346 USA

800-521-0600

R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

COGNITIVE DECONSTRUCTION IN SEXUALLY COMPULSIVE PRIESTS

by

Carmen Winterschladen

Submitted to the

Faculty of the College of Arts and Sciences

of American University

in Partial Fulfillment of

the Requirements for the Degree

of Master of Arts

in

Psychology

Chair:

Dean^fthe College

7Date

JamraGray. Pn.D.l y ' . C-_ ( ' t J 'k tp c .

David Haaga. Ph.D.

misa Saffiotti. Ph.D.

impson. Ph/O.

1999

American University

Washington. D.C. 20016


UMI Number: 1396143

UMI Microform 1396143 Copyright 1999, by UMI Company. All rights reserved.

This microform edition is protected against unauthorized copying under Title 17, United States Code.

UMI300 North Zeeb Road Ann Arbor, MI 48103


COGNITIVE DECONSTRUCTION IN SEXUALLY COMPULSIVE PRIESTS

by

Carmen Winterschladen

ABSTRACT

The focus of this study is self-destructive compulsive sexual behavior in Roman Catholic clergy

and male religious. It is hypothesized that Baumeister’s theory of cognitive deconstruction, the process by

which people attempt to escape painful self awareness, may offer an explanatory framework for

understanding the cognitive processes of long-term sexually compulsive males who report a history of

compulsive sexual behavior beginning in adolescence. Baumeister outlines four consequences of cognitive

deconstruction: disinhibition, passivity, absence o f emotion, irrational thinking. The Rorschach protocols

of 112 Roman Catholic clergy who were referred for psychiatric evaluation were examined for evidence of

the consequences of cognitive deconstruction. The protocols of 39 priests diagnosed with compulsive

sexuality were compared to the protocols of 37 priests diagnosed with an anxiety disorder and 36 priests

who did not receive a psychiatric diagnosis at the time of evaluation. It was hypothesized that the

compulsive sexuality group would have significantly more extreme scores on the 13 variables chosen to

reflect cognitive deconstruction. The results did not support the hypothesis. The compulsive sex group

was not significantly different from both the anxiety group and the control group on any of the selected

Rorschach variables.

ii


AC K N O W LE D G M EN T S

I would like to thank Dr. James Gray for his service as chair of this thesis committee, and Dr.

David Haaga. Dr. Luisa Saffiotti. and Dr. Gary Thompson for their participation on the thesis committee.

I also wish to thank my colleagues at Saint Luke Institute, especially Michelle Short and Amy

Streiby. for their invaluable help and support, without which this project would never have been

completed.

I am also indebted Joe Thompson, who provided technical support at a critical time. Lastly. I

wish to thank my family and friends for their unw avering moral support and sense of humor.

iii


TABLE OF CONTENTS

ABSTRACT........................................................................................................................................ ii

ACKNOWLEDGMENTS................................................................................................................ iii

LIST OF TABLES.............................................................................................................................v

Chapter

1. INTRODUCTION.......................................................................................................1

Cognitive Deconstruction Theory

Compulsive Sexuality

Cognitive Deconstruction in Compulsive Sexual Behavior

The Research Question

2. METHOD..................................................................................................................23

3. RESULTS..................................................................................................................44

4. DISCUSSION........................................................................................................... 58

The Rorschach as a Measure of Cognitive Deconstruction

Theoretical Network of Cognitive Deconstruction

Failure of the Experimental Design

Instability of the Cognitive Deconstruction State

5. CONCLUSION.........................................................................................................67

REFERENCES.................................................................................................................. 69

iv


LIST OF TABLES

1. Rorschach variables and cognitive deconstruction........................................................................26

2. Correlation coefficients for Rorschach variables....................................................................... 28

3. Mean scores of reference groups.................................................................................................29

4. Disinhibition Rorschach variables..............................................................................................45

5. Coping deficit index variable...................................................................................................... 45

6. Adjusted D variable..................................................................................................................... 46

7. FC:CF+C variable........................................................................................................................47

8. Passivity Rorschach variables..................................................................................................... 47

9. Active to passive ratio variable................................................................................................... 48

10. Movement active to movement passive variable........................................................................ 48

11. Absence of emotion Rorschach variables....................................................................................48

12. Affective ratio variable................................................................................................................ 49

13. Vista variable................................................................................................................................50

14. Egocentricity index variable........................................................................................................50

15. Irrational Thought Rorschach variables......................................................................................50

16. M-variable....................................................................................................................................51

17. Human response variable.............................................................................................................52

18. X-% variable................................................................................................................................52

19. ANOVA X-% variable.................................................................................................................53

20. X+% variable...............................................................................................................................53

21. ANOVA X+% variable................................................................................................................ 54

22. WSUM 6 variable.........................................................................................................................54

23. W:M variable................................................................................................................................ 55

v


24. Zd variable.....................................................................................................................................55

25. MCMI test data............................................................................................................................. 56

26. MMPI-2 test data........................................................................................................................... 57

vi


CHAPTER 1

INTRODUCTION

Cognitive Deconst ruction Theory

In 1990 Baumeister offered a theory of cognitive deconstruction as one explanation of suicidal

behavior. Cognitive deconstruction theory combines cognitive and motivational components and is an

outgrowth of action identification theory (Vallacher & Wegner. 1985,1987). self-discrepancy theory

(Higgins, 1987), objective self-awareness theory ( Duval and Wicklund. 1972), and control theory (Carver

and Scheier, 1982). The central argument of cognitive deconstruction theory is that nonfatal self

destructive or addictive behaviors (such as binge eating) serve to reduce painful awareness of self. He

asserts that suicide may also be an attempt to escape from painful awareness of certain symbolic

interpretations about the self. Cognitive deconstruction has been used to provide an explanatory

framework for understanding the cognitive processes of sex offenders (Ward. Hudson. Marshall. 1995).

This study investigates whether there is evidence that cognitive deconstruction may also relate to the

cognitive processes of self-destructive sexually compulsive patients.

A number of theories propose a relationship between emotional discomfort and inconsistencies or

conflicts in a person’s beliefs, feelings, and actions (Festinger. 1957; Duval and Wicklund, 1972; Carver

& Scheier, 1982, 1990; Higgins, 1987). Several theories have focused on different types of belief

incompatibilities, for example cognitive dissonance (Festinger, 1957), balance theory (Heider, 1958) and

objective self-awareness theory (Duval & Wicklund, 1972). The emotional consequences of belief

incompatibilities are usually described in general terms, such as conflict, stress, or discomfort. This

section will discuss four theories that are relevant to the development of cognitive deconstruction theory

and that address: 1.) different sources of self-inconsistencies or discrepancies (self -discrepancy theory).

2.) the role of self-awareness in one’s motivation to reduce perceived discrepancies (objective self-

awareness

1


2

theory). 3.) the role of emotional discomfort in self- regulation (control theory), and 4.) the hierarchical

organization of identities of actions which lead to different views of an action (action identification

theory). Each theory is an antecedent to cognitive deconstruction theory, and they each contain elements

that are central features of cognitive deconstruction theory'. A discussion of these theories will highlight

how' cognitive deconstruction theory builds on them and differs from them.

I.) Higgins* (1987) self-discrepancy theory distinguishes between two different kinds of

discomfort that people holding incompatible beliefs may experience: dejection-related emotions and

agitation-related emotions. The theory proposes that different clusters of emotional vulnerabilities are

linked to different types of discrepancies that people may possess among their self beliefs. The theory' also

distinguishes three basic domains of the self: a) the actual self, w'hich is one's representation of the

attributes that someone (oneself or another) believes one actually possesses; b) the ideal self which is

one’s representation of the attributes that someone would like one to possess (someone’s hopes,

aspirations, or wishes for one, and c) the ought self which is one's representation of the attributes that

someone believes one should or ought to possess (one’s sense of duty, obligation, or responsibilities).

Higgins goes on to discriminate between two basic standpoints of the self from which one can be judged:

a) one’s own personal standpoint and b) the standpoint of some significant other.

When the discrepancy' is between actual/self or actual/other self state representations (self

concept) and ideal/self or ideal/other standards, the individual will likely suffer more from dejection-

related emotions. When the discrepancy is between self concepts and ought/self or ought/other standards,

individuals are likely to suffer more from agitation-related emotions. The greater the magnitude of the

discrepancy', the more the individual will suffer the kind of discomfort associated with that type of self -

discrepancy.

2.) Duval and Wicklund’s (1972) theory of objective self-awareness addresses the nature of the

conditions that cause consciousness to focus on the self as an object and takes as its central assumption

the notion that the person will evaluate himself as soon as the objective state occurs. This process is

predicated on the existence of a psychological system of standards of correctness possessed by each


3

person. When attention is focused on the self, there will be an automatic comparison of the self with

standards of correctness. Objective self-awareness will lead to a negative self-evaluation whenever the

person is aware of a self-contradiction or discrepancy between an ideal and his actual state. The negative

affect experienced will be greater when a substantial discrepancy is salient for the person. Consequently

he or she will either attempt to avoid the situation provoking objective self awareness or else alter his or

her actual state (moving his or her attention away from the self and onto the environment) in an effort to

reduce the discrepancy. Even without a loss of self-esteem from a prior failure, the objective state is

uncomfortable when endured for extended time periods.

Duval and Wicklund (1972) argue that it is the passive, nonspeaking, nonacting person who is

most susceptible to objective self-awareness. Placing the person into an active situation should increase

subjective self-awareness, which is the opposite conscious state. Activity necessitates the person focusing

attention on events external to himself and subjective self-awareness will result. Self-awareness will be

difficult in that the person is aware of self only insofar as he is the source or the subject of forces acting on

the environment. There is an assumption that objective self awareness creates a negative affect, which

implies that the person will seek out methods of moving out of the state. The individual who is passive

may have difficulty in transferring his attention away from himself, but when he is occupied with a task,

no matter how routine and automatic, he can easily shift his attention from himself to the task. The task

provides a ready escape from the undesirable state of critical self-evaluation (Duval and Wicklund. 1972).

3.) Carver and Scheier's (1982) control theory describes a model of self-regulation provided by a

discrepancy-reducing feedback loop. The function of the feedback loop is to negate, or reduce, sensed

deviations from a comparison value. When a discrepancy is perceiv ed between the present state and the

reference value, a behavior is performed, and the goal of the behavior is to reduce the discrepancy. The

impact of the antecedent behavior creates a change in the present condition, leading to a different

perception of the situation which then, in tum, is compared anew with the reference value. This

arrangement constitutes a closed loop of control, the purpose of which is to minimize deviations from the

standard of comparison. The central function of the feedback system is to maintain the perception of a


4

specific desired condition, i.e.. consistency between the present state and the reference value, not to create

“behavior."'

Carver and Scheier theorize that the standard of comparison comes from a hierarchically

organized system. The highest level of the system is characterized by the abstract integration of

information. Each subordinate level influences the person's behavior, which is aimed at attaining

congruence between the person’s self-image and his or her actual behavior. Actually producing behavior

entails control of more and more concrete behavioral qualities. All of these qualities of behavior represent

lower and lower levels of control in the hierarchy. The approach accounts for the fact that exceedingly

restricted and concrete behavioral acts (i.e. changes in levels of muscle tensions) are used to create

behavioral events that are often so abstract as to seem completely unrelated to those concrete acts.

According to Carver and Scheier (1982) the engagement of the self-regulatory feedback loops

partially depends on the person’s focus of attention The process of directing attention to the self, when a

behavioral standard has been evoked, results in a tendency to compare one's perceptions of one’s present

state or behavior against the standard, leading (when possible) to a reduction of perceptible discrepancies

between the two through self-regulation. There is evidence that self-focus does result in increased

conformity to salient behavioral standards (Hull, 1981; Duval & Wicklund, 1972;. Carver & Scheier,

1990; Snyder 1987). However. Carver and Scheier (1982) suggest that if the person’s expectancy of being

able to reduce the discrepancy is sufficiently unfavorable the person may act on an impulse to withdraw or

disengage from the attempted discrepancy reduction.

4.) The symbolic representation of action is the basis for Vallacher & Wegner's (1985) theory' of

action identification. This theory makes two assumptions: 1.) a person can always offer an identity for his

or her action (identity availability') and 2.) a person’s working knowledge of an action typically consists of

a single prepotent identity, although an action may have several different identities.

According to Vallacher and Wegner (1985), a person’s general knowledge of an action is

determined by the level of the identity of the action within a hierarchical organization. The prepotent

identity can vary between higher and lower levels and so can entail very different understandings of the


action at hand. A person with a high level prepotent identity for an action has an effective understanding

of the action. The person can evaluate whether the course of action is worth pursuing or should be

inhibited because he or she is sensitive to the abstract implications of the behavior. Lower levels of

prepotent identity account for the detail underlying the performance of an action. A person whose

prepotent identity of an action is at too low a level will lose sight of the more comprehensive meaning of

the action, while focusing exclusively on the specific details of the behavior.

Another assumption of the theory states that when an action can be identified at both a higher

and a lower level, there will be a tendency for higher level identity to become prepotent. In other words,

movement towards higher levels of identification is a regular feature of the system.

The process of action identification can influence one’s self-concept which in turn constrains the

identities under which actions are chosen, enacted, and communicated. However, self-understanding in

not an inevitable by-product of action identification. A person who fails to maintain much of what he or

she does at a high level identity may have a weak sense of his or her self-defining qualities. Such a

person can be considered a low-level agent in that this person operates on the world primarily at the level

of detail. The low level agent is likely to think about the self in a relatively impoverished way - as the

author of simple movements. In contrast a high level agent tends to conceptualize most of his or her

actions in more meaningful, high level terms. These terms are not far from the person’s self-conceived

qualities as a person. The high level agent is engaged in action that expresses his conception of self,

whereas the low' level agent is engaged in action that is more divorced from an understanding of self.

Vallacher & Wegner (1985) assessed whether people may differ reliably in their characteristic

level of action identification. They assessed the relationships among level of personal agency (high or low

level agent), self-uncertainty, trait unimportance, and self-evaluation. They found that level of personal

agency signals how well defined a person’s self-concept is. The results of their investigation suggests that

low-level agents are less inclined to think about themselves in terms of broad personality traits than are

their high-level counterparts. It seems that people who are relatively insensitive to the broader meanings

and implications of their everyday actions also fail to have a clearly articulated, trait-like understanding of


6

themselves. They found the low-level agents tended to manifest anxiety and a weak sense o f personal

control. These data paint a portrait of persons who fail to understand their actions, in a manner

conducive to either effective maintenance or coherent self-understanding. High-level identification seems

to be essential not only for effective action, but for an integrated sense of well-being.

Self-discrepancy theory', objective self-awareness theory, control theory', and action identification

theory have features which are incorporated into cognitive deconstruction theory. Self-discrepancy theory

identifies how the discrepancy between self and relevant standards can stem from one's personal

standpoint or from how one believes others perceive him or her. Cognitive deconstraction theory

recognizes that emotional discomfort may stem from a failure to live up to one's own personal standards

or a failure to meet the perceived standards of others. Both dejection-related emotions and agitation-

related emotion may be present as a result of discrepancy between self and reference values. Baumeister's

(1990) theory goes one step further in focusing on the cognitive processes one may use to cope with an

aversive emotional state that is the result of awareness of self discrepancy'.

Duval and Wicklund’s theory of objective self-awareness defines two distinct forms of conscious

attention. In the objective self-awareness state attention is directed tow ard an aspect of the self, in

subjective self-awareness attention is directed toward the external environment. Critical self-evaluation

will lead to negative affect, and the degree of discomfort the person experiences as a result o f self

evaluation is directly related to the size of the perceived discrepancy' between the actual self and the ideal

representation. Alternatively, a contradiction between behavior and beliefs can lead to critical self-

evaluation. Physical activity is one way to shift a person’s attention away from painful objective self-

awareness. As the person becomes engaged in a task, no matter how routine the task may be. awareness

shifts from the objective state to the subjective state. Baumeister’s (1990) theory of cognitive

deconstruction builds on objective self-awareness theory in that it states that a person will actively attempt

to escape negative affect but goes one step further by' outlining how- mental activity provides a means of

escape. Cognitive deconstruction postulates that dismantling meaningful thought and narrowing one’s

focus to a more concrete level can enable the person to flee the negative affect that results from critical self


7

evaluation. Certainly the person may also engage in physical activities or tasks to shift his attention from

objective state to the subjective self-awareness state, but there is an accompanying cognitive activity which

aids in the escape from negative affect.

Vallacher and Wegner’s (1985) theory of action identification suggests that there is a

hierarchical organisation of action identities and that each identity will convey a different understanding

of the action, depending on where the identity falls in the hierarchy. Vallacher and Wegner maintain

that there is a tendency for a person to move from a lower level of identity to a higher level of identity.

Cognitive deconstruction theory also posits a hierarchy of organization. While the theory allows

for shifting between higher or more abstract levels to lower or concrete levels. Baumeister explores the

complex reasons why people do not inevitably move to a higher level of understanding of their actions.

Vallacher and Wegner state that a person may switch from a high-level prepotent identity to a lower level

identity because the higher level identity may not pertain to the ongoing action. Baumeister argues that a

person may switch to a lower level identity (cognitive deconstruction) because the abstract implications of

the action may be a source of negative affect.

In Carver and Scheier’s (1982) control theory, a hierarchically organized system with abstract

thought at the highest level sets the standard for comparison between self and the reference value. They

show how the most concrete actions are used in the service of maintaining a highly abstract self concept.

In contrast Baumeister’s (1990) theory of cognitive deconstruction postulates that one can avoid

recognizing the abstract meaning of concrete actions by purposefully concentrating on the physical

sensations that are present in concrete behavioral acts. The process of deconstructing abstract thought, and

narrowing one’s focus to the concrete, reverses the hierarchical system posited in control theory.

Both theories suggest that if a person expects to fail at reducing discrepancy he or she may

withdraw or disengage rather than attempt discrepancy reduction. According to Baumeister (1990). such a

person would be vulnerable to engaging in cognitive deconstruction.

There are six main steps in cognitive deconstruction theory (Baumeister. 1990).


8

1.) Unrealistically high expectations or unexpected problems or setbacks contribute to a

discrepancy between a desired or expected outcome in a situation and what actually occurred, resulting in

the perception in an individual that he or she is falling below standards. For example, a young man may

enter seminary with unrealistically high expectations about his ministry. He may see his ordination as a

transforming experience which will bestow on him the authority and interpersonal skills necessary to

dramatically improve his effectiveness with people. He may also imagine that ordination will resolve any

inner conflicts that may trouble him, especially in the area of sexuality. After ordination he settles into his

first assignment and finds that his life as an ordained priest does not meet his expectations and he

continues to struggle with the same problems as before ordination.

2.) Internal attributions are made whereby the disappointing outcomes are blamed on the self,

creating negative implications about the self. The self is linked to some undesirable traits which are the

cause of the problems or setbacks, and disappointing events are seen as a reflection of the self. In the

case of the young priest, his setbacks are handled without any reference to external attributions. He may

believe that his problems stem from his innate failure as a person rather than his inexperience as a priest.

He does not recognize that the standards to which he holds himself may be unrealistic.

3.) An aversive state of high self-awareness comes from comparing the self with the relevant

standards and from the self blame for recent disappointments. The newly ordained priest may become

extremely self-conscious when performing his pastoral duties and may focus his attention on his perceived

deficiencies. He may imagine that others are critically evaluating, which adds to his discomfort.

4.) Negative affect arises from the unfavorable comparison of self with unmet standards. The

individual becomes acutely aware of self as inadequate, incompetent or guilty. Attention is focused on

any evidence that he is failing to meet his own or others’ standards. At this stage the new priest will feel

acute pain at his perceived failure and may feel particularly bad or guilty because the grace that he was

suppose to receive at ordination has not transformed his life. He may engage in cognitive distortions such

as overgeneralization (formulating a general rule based on a few' isolated incidents and applying the rule

broadly to other situations) or personalization (attributing external events to self in the absence of any


9

causal connection) (Beck, 1989; Bums, 1981) regarding his perceived failures until he feels overwhelmed

by his view of himself as a complete and utter failure.

5.) The person wishes to escape from this undesirable emotional state by somehow obliterating

awareness of self. In the attempt to escape meaningful thoughts about self, and thereby escape a highly

aversive emotional state, the person engages in mental narrowing. The shift to less meaningful, less

integrative forms of thought and awareness is what is meant by Cognitive Deconstruction. While in the

deconstructed state, the person's time perspective is constricted to a narrow focus. Action is guided by

immediate, proximal goals rather than distal goals. By ceasing to think in meaningful terms about self and

behavior the person can avoid negative conclusions about self, and the emotional pain that accompanies

such conclusions. Deconstructed awareness means that the person is aware of self and action in concrete

ways and rejects abstract levels of meaning or interpretation.

One result of shifting to a deconstructed state is that self-evaluative processes are suspended.

Sustaining deconstructed awareness may be difficult, and so the person desires increasingly strong means

of terminating the aversive thoughts and feelings. In the example of the young priest he may narrow his

focus away from his identity as a priest and instead focus on his physical self. He may become focused on

immediate sexual gratification, or he may use alcohol to numb his feelings or food to distract himself from

thinking of the implications of his perceived failure. This is not the same as when a person may have an

alcoholic drink at the end of the day to unwind. The person is not seeking to unwind; instead he is seeking

an escape from painful self awareness.

6.) The consequences of this deconstructed state include passivity- and impulsivity, suppression

of emotion, irrational thoughts, and a failure to recognize inconsistencies in one's behavior. Accordingly,

the person in a cognitively deconstructed state may be more willing to engage in self-destructive behavior

or behavior which is a source of inner conflict. In the example of the young priest he may chronically

escape negative affect through cognitive deconstruction, engaging in self-destructive activities that focus

his attention on his physical self rather than using feedback to alter his behavior and improve his

functioning.


10

The different self-awareness theories have each emphasized the negative comparison of self

against salient standards. When the self is perceived as falling below standards, the individual's self

esteem plummets and he may view himself in exaggerated negative terms. Two sets of standards are

relevant. The status quo is often important and self-blame may occur if the individual falls short of his

own past level of performance. Other people's expectations are also important, and failure to meet these

may result in private feelings that one cannot live up to what others expect. In both cases painful

awareness of one's shortcomings results in an acute negative state that the person wishes to escape from

as quickly as possible. The person may terminate this aversive state by ceasing to feel emotion, by ceasing

to blame the self, or by ceasing to be aware of self.

The obliteration of self awareness can be accomplished by rejecting higher-level abstract

meaning and interpretation of oneself and shrinking self perception to the most concrete terms. By

directing thought to the movements and sensations of direct bodily experience, one can strip away the

many layers of meaning associated with one's personal identity. Since emotion, attribution, and self-

awareness all involve meaning, a shift to a deconstructed state void of meaningful thought could

effectively terminate all three. By focusing attention on oneself as merely a body, blotting out awareness of

self as an identity with enduring attributes, one can avoid interpreting the meaning of one's actions.

Engaging in actions that are unplanned, irresponsible, and lacking in any long-term context are features

of the type of impulsive and uninhibited behavior that persons in a deconstructed state often exhibit.

Concrete thinking that focuses on immediate goals prevents the individual from recognizing the

implications of his or her behavior.

Ideally, the individual copes with disappointing outcomes by constructing new integrative

meanings for the relevant circumstances in his or her life. If a person is unable to reinterpret his or her

circumstances in a positive fashion he or she may remain stuck in the present, struggling to remain in the

deconstructed state in order to avoid the negative affect that is associated with meaningful thought. The

cognitive shift to a deconstructed state may not be enough to stop unpleasant feelings, and the person may

become receptive to stronger means of escape. To help sustain the deconstructed state the individual may


11

adopt an attitude of passivity, engaging in deconstructed activity' which is without interpretation, such as

compulsive behavior. The person operating in a deconstructed state is passive with respect to important,

meaningful actions and may engage in seemingly random, aimless, impulsive, or mindless activity.

Baumeister (1990) states that there are four relev ant consequences of Cognitive Deconstruction:

disinhibition, passivity, absence o f emotion, and irrational thought. According to Baumeister (1990)

disinhibition, or the removal of inner restrains, makes the individual willing to engage in actions that

violate normal patterns of behavior. The cognitively deconstructed state removes meaningful constructs

or implications about one’s behavior from the person’s awareness. Since inhibitions are to some degree

dependent on meaningful interpretation about one's behavior, this can effectively remove certain inner

restraints which usually serve to inhibit behavior. The person acting in a deconstructed state may engage

in irrational behavior or behavior that is contrary to the person’s normal standards and values. The lack

of self-awareness that is the by-product of cognitive deconstruction may enable a person to engage in

behavior which may be a source of conflict for the person.

In his work on suicide as an escape from the self. Baumeister (1990) states that impulsive

behavior is a reflection of the disinhibition produced by the deconstructed state and is not necessarily a

stable personality trait. Disinhibition as a result of cognitive deconstruction may account for some of the

self-destructive, risky, and compulsive behaviors in which a person may engage. An example of this is

the priest who becomes narrowly focused on his sexual needs and the excitement he may experience from

sexual cruising. He may spend hours in this activity with no regard for the consequences. He may risk

arrest, violence, and disease, as well as public humiliation, in his pursuit of a sexual experience. The

quest for intense sensations may itself be characteristic of many forms of escape from unpleasant affect

which is purportedly the reason one enters a deconstructed state. The attempt to immerse oneself in

immediate, intense sensations in order to escape broader awareness of events, and their implication, could

be a form of sensation-seeking, and appears to be a central feature in other forms of escape from self-

awareness, including alcohol use (Hull. 1981) and sexual masochism (Baumeister. 1988. 1989).


12

According to Baumeister (1990). passivity is a second consequence of dcconstruction. A passive

style may serve as further evidence of the general rejection of meaning, in that adopting a passive

approach enables a person to evade responsibility and to avoid implicating or assessing the self. A

proactive approach involves planning, assessing the capacities of the self, considering the meaningful

implication of one's actions, evaluating if one’s behaviors are consistent with one’s goals and values, and

self-regulating accordingly. Passivity, as a consequence of cognitive deconstruction, facilitates

deconstruction and escape from meaningful implications about the self.

The absence o f emotion is another presumed byproduct of cognitive deconstruction, since the

purpose of the process is to escape from the negative affect associated with meaningful, integrative

interpretations. Lack of affect is sometimes used as a sign of deconstructed, low-level thinking

(Pennebaker, 1989), and so successful escape to low levels of awareness should be characterized by lack of

affect. According to Baumeister (1990), the affect is available, but the person is striving to keep it out of

awareness. Persons using cognitive deconstruction to avoid negative affect keep the painful affect at bay

by avoiding meaningful thought. In the deconstructed state neither positive nor negative affect occur

with any regularity or spontaneity. In avoiding intense emotion the person will be somewhat estranged

from his emotion, but may feel generally bored or vaguely unhappy.

A vulnerability to fantasy or irrational thought is another consequence of cognitive

deconstruction. Most people cannot remain permanently in a deconstructed state, but the person seeking

escape may often be reluctant to face the pain that may accompany thinking realistically about his or her

life in meaningful terms. The suspension of normal, critical thinking can leave a mental vacuum which

makes the individual vulnerable to bizarre thoughts and fantasies. The use of fantasy" may be a

compensatory strategy to help the person avoid realistic thought about his situation.

In summary, to escape from the self is to free oneself of the struggle to maintain a certain image.

According to Baumeister (1991), some people have escapist impulses (watching television or playing or

watching sports) because of stress or boredom. The person may actually be content with himself or

herself and may feel no need to forget the self. Escapist activities may be a response to problems, stress.


13

or oppressive conditions, but this is different than escaping as a response to painful feelings about the self,

where the need to escape is ongoing. The person's feelings of pain about the self drives the impulse to

escape from a meaningful identify, which results in cognitive deconstruction. In this type of escape,

attention is focused intensely on the body and the person becomes absorbed in physical feelings. In other

words, the person can leave behind the burden of his identity and become just a body.

Compulsive Sexuality

The DSM-IV provides the category of Sexual Disorder Not Otherwise Specified for coding a

sexual disturbance that does not meet the criteria for any specific Sexual Disorder and is neither a Sexual

Dysfunction nor a Paraphilia. An example of a sexual disturbance warranting this diagnosis is “Distress

about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by

the individual only as objects to be used” (DSM-IV. 1994. p.538). In this study, the diagnosis of “ Sexual

Disorder NOS: Compulsive Sexuality” (302.9) has been given to individuals who meet the above criteria.

The DSM-IV specifies that sexual behavior, when engaged in excessively, does not warrant a diagnosis of

Obsessive Compulsive Disorder (303.3) as “the person usually derives pleasure from the activity and may

wish to resist only because of its deleterious consequences” (DSM-IV. 1994. p.422).

There is general agreement in the literature that the pattern of sexual behavior that corresponds

to the DSM-IV description exists (Carnes. 1983. 1991; Coleman. 1988. 1992; Earle & Crow, 1990;

Griffin-Shelley, Benjamin. Benjamin. 1995; Goodman. 1993; Kraft-Ebbing. 1886; Laaser. 1991; Money.

1986; Quadland. 1985; Robinson et al., 1993; Robinson etal.. 1994; Taylor. 1996). The two terms that

are commonly used to label the behavior are sexual addiction or sexual compulsivity and many use the

terms interchangeably.

Researchers and clinicians note the development of compulsive sexual behavior is linked to early

childhood trauma and/or abuse and to restrictive attitudes of sexuality and intimacy (Carnes, 1991;

Coleman, 1988; Money. 1986). The sexual experience is used as a coping mechanism for numbing painful

feelings such as inadequacy, isolation, and loneliness. Preoccupation with sexual behavior and fantasies is


14

thought to be rooted in a chaotic and abusive childhood in which retreat into an imaginary' world provided

an escape from physical or emotional abuse or neglect. (Laaser. 1991) This is related to Baumeister’s

argument that some sexual behavior (sexual masochism) can be a form of escape from the self by reducing

the self from identity to body. For the sexually compulsive person, sexual behavior can function both to

produce pleasure and provide an escape from internal discomfort. Through compulsive or addictive sexual

behavior, an individual can create a false sense of security, well-being, and intimacy, thereby distracting

him or herself from the painful realities of life.

Carnes (1983) identifies a number of beliefs and behaviors that typify' the sex addict. At his or

her core the person believes that he or she is basically a bad. unworthy person. This belief is consistent

with the second step in Baumeister’s theory of cognitive deconstruction in which the self is linked to

undesirable traits and the fourth step in which the individual becomes acutely aware of the self as

somehow bad. Earle and Crow (1990) have identified another belief that fuels compulsive sexual

behavior: If I have to depend on my social skills to get close to anyone, it will never happen. It is thought

that compulsive sexual behavior both compensates for and reinforces these beliefs. For some, compulsive

sexual behavior is an attempt to connect intimately with others. (Laaser. 1991)

On the basis of his research and clinical experience. Carnes (1991) outlines a number of signs

that indicate the presence of sexual addiction. These signs include, but are not limited to the following:

1.) A pattern of out-of-control behavior. The amount extent and duration of behavior regularly

exceeds what the person intended. 2.) Severe consequences due to sexual behavior including arrest

personal injury, and serious professional and financial difficulties 3.) Inability to stop despite adverse

consequences. 4.) Persistent pursuit of self-destructive or high-risk behavior. 5.) Sexual obsession and

fantasy as a primary coping strategy. Sexual preoccupation becomes an "analgesic fix." Sex becomes a

primary tool to regulate one’s emotional life. Sexual fantasy, including planning, thinking, and looking

for sexual opportunities may absorb hours of the person's daily activity. This feature also coincides with

cognitive deconstruction in which escape from the self is a strategy for avoiding or regulating painful

emotions associated with the self. 6.) Severe mood changes around sexual activity. Often a feeling of


15

euphoria will accompany the beginning phase of the pursuit of sexual activity, followed by despair and

shame after the encounter. 7.) Sexual obsession becomes the organizing principle of daily life. The person

may neglect important social, occupational, or recreational activities because of sexual behavior.

Clergy and Sexual Compulsivitv

Sexually compulsive clergy share many of the same attributes as sexually compulsive people in

the general population. They tend to have distorted or unrealistic beliefs about themselves, their behavior,

and other people. Their low self esteem is reinforced by their tendency to focus their attention on their

perceived deficiencies. They' have difficulty coping with stress, and they' wish to escape from or suppress

unpleasant emotions. Frequently they have at least one powerful memory of an intense “high"

experienced at a crucial time in their lives. A major feature is their ability' to deny they have a problem.

The celibate priest faces profound professional consequences if his behavior is exposed, and this can lead

to entrenched fear and denial. (Carnes. 1987; Earle & Crow. 1990; Laaser, 1991) This description is

consistent with Baumeister’s assertion that people seek to escape from the self to avoid thinking bad

thoughts about oneself, usually in the wake of some calamity, or to find temporary' relief from the stressful

burden of maintaining an inflated or unrealistic image of self. (Baumeister. 1991)

All sexual addicts have sought ways to rigidly control their behavior. Frequently, the sexually

compulsive priest will turn to religious formulas which never work. Ordination may be seen as way to

control their sexual desires and behaviors. They expect the role of pastor to bestow on them respect

admiration, and authority. They' often believe that ordination will free them from their compulsion to

sexually act out. Sometimes they' embrace a “magical thinking’' style in which they' believe they have a

special relationship with God and will be protected from all consequences, especially if they' cover their

“bad” sexual behavior with “good” works. (Laaser. 1991)

Priests involved in compulsive sexual activity will, like their counterparts in the secular world,

construct elaborate excuses for their behavior and deny they have a problem which warrants professional

treatment. Most of the priests who engage in compulsive sexual activity are homosexual (Berry, 1992;


16

Sipe. 1990. 1994. Taylor, 1996) and are fearful of having theii orientation disclosed. The problem of

denial keeps the sexually compulsive pastor isolated and alone. He leads a double life, appearing in public

in his “priest” role while privately engaging in sexual behaviors which are contradictory to his value

system and jeopardize the life he has built (Schwartz. 1994).

The cycle of sexually compulsive behavior is the same for both priests and the general

population: stress or emotional pain, acting out the impulses, shame and remorse, promise of reform, brief

period of reform, acting out again. (Earle & Crow. 1990: Goodman. 1993) According to Carnes (1983).

shame may be particularly powerful when the authority of the church is inv oked to curtail sexual behavior

in childhood. Sexual pleasure may then be fused with sexual and religious guilt and shame. Self image

and sexual identity' may be further damaged if the child or adolescent discovers he has some homosexual

feelings, and he must carry the M l weight of the church’s moral condemnation of homosexuality.

Carnes and other therapists who have worked with sexually compulsive patients note that clergy

seem particularly vulnerable to sexual addiction. Cames (1987) lists five occupational hazards that are

unique to the clergy and may contribute to their vulnerability in this area.

1.) Traditionally, priests have been idealized as symbols of church life. When the idealization is

personalized, parishioners may develop enhanced expectations of their priests which lead the priest to

withdraw into a secret separate life as a way to escape the burden of such expectations.

2.) The public role of a pastoral leader involves the promotion of moral standards and may

underscore the double life that the sexually compulsive priest leads.

3.) Clergy commonly find themselves in relationships in which others depend on them. The

authority and credibility that comes with the role of priest may serve as a cloak for their behavior, which

again adds to the potential for secrecy and shame.

4.) The spiritual formation of clergy emphasize selfless devotion to the service of others.

Misguided altruism can lead some clergy to emotional impoverishment and over-extension, sometimes

called burnout. As a result clergy may feel angry and resentM, feelings which can fuel rationalization of


17

their addictive behaviors. For example, the priest who tells himself that after a grueling week of endless

pastoral duties he deserves to have the fun and excitement his cruising behavior brings.

5.) Lastly, some clergy may chose religious life as a way to avoid or cure problems. The classic

example is the choice of celibacy as a way to cope with ego-dystonic homosexuality or excessive sexual

behaviors. Choosing celibacy for these reasons only exacerbates the pain of obsession for those prone to

sexual addiction.

Clinicians who have worked with sexually compulsive priests note that their clinical

presentations are often complex, and many may have multiple addictions as well as other

psychopathology. (Carnes, 1987: Irons & Laaser. 1994: Taylor. 1996, Robinson et al,1993) This is

consistent with Carnes' (1989) description of sex addicts in the general population in which he reports

that most sex addicts have more than one, and on average, three paraphilias.

Cognitive Deconstruction in Compulsive Sexual Behavior

The DSM-IV category of Sexual Disorder. Not Otherwise Specified is used for coding a sexual

disturbance that does not meet the criteria for any specific Sexual Disorder. Three examples of sexual

disturbance warranting the diagnosis are given: I.) marked feelings of inadequacy" concerning sexual

performance 2.) persistent marked distress about sexual orientation, and 3.) distress about a pattern of

repeated sexual relationships involving a succession of lovers who are experienced by the individual only

as things to be used (DSM-IV. 1994. p. 538). This last example captures the essential feature of

compulsive sexual behavior.

The person involved in compulsive sexual behavior often uses cognitive distortions to justify the

behavior to himself or herself. The person's affective deficits will also facilitate the problem behavior.

Clinicians working with patients with compulsive sexual behavior note the prevalence of cognitive

distortion, minimization, and denial in their perception of their behavior (Abel, Gore, Holland. Camp.

Becker, Rathner, 1989; Abel. Becker. Cuningham-Rathner.1984; Cames. 1983. 1991; Coleman. 1987;


18

Earle & Crow. 1990: Goodman, 1993; Henderson. Kalichman. 1990: Kalichman. 199l;Laaser. 1991;

Levin. Stava. 1987; Ward. Hudson. Marshall. 1995).

In my clinical experience, the priests who are referred for evaluation because of sexual behavior

problems exhibit the same cognitive and emotional deficits that characterize the descriptions of secular

patients. However, they are different in that most of the priests who are referred for a psychiatric

evaluation because of sexual behavior problems report feeling conflict or distress about their homosexual

feelings and often believe or fear that homosexual feelings are morally wrong and may disqualify a person

from active ministry. Often, this translates into a general feeling of inadequacy' which results in fragile

self esteem and painful self-awareness. (Carnes, 1987) In the clinical interview, the patients describe in

great detail their struggle to control their sexual behavior. Often patients report that perceived criticism

or failure to live up to their own standards, or the standards of others, precipitates their engaging in high

risk sexually compulsive behavior.

Baumeister’s construct of cognitive deconstruclion may offer a theoretical explanation for a

number of the features in the clinical presentation of sexually compulsive patients, including priests.

Frequently, the sexually compulsive priest displays a distorted pattern of thinking about his life

circumstances and about the long-term consequences of his behavior, focusing instead on immediate

sexual gratification. His perception of the compulsive behavior is often distorted: for example, he may

rationalize to himself that frequenting gay bars where he often picks up sexual partners is an appropriate

pastime, especially if he promises himself that “this time” it will be different and he will avoid sexual

contact with anonymous partners. Many sexually compulsive priests report an absence or blunting of

affect prior to or during the compulsive behavior, as well as a more general tendency to distance from

emotions. The compulsive behavior tends to be impulsive and is contrary to the normal standards and

values of priesthood. During times of even minimal stress the person’s inner restraints seem to melt away

and he numbly seeks out anonymous sexual contacts. Previous experiences of being physically hurt,

robbed, arrested, or blackmailed do not deter him from cruising and other forms of high-risk behavior.


19

Many of the sexually compulsive priests who arc referred for psychiatric evaluation have been

engaging in compulsive behavior for years. According to Baumeister (1991) and Ward et al. (1995).

people who begin compulsive sexual behavior, or sexual abusive behavior, in adulthood should display a

cognitive style which reflects repeated switching from concrete or deconstructed levels to higher abstract

levels. While some report that the behavior began fairly late in adulthood, it is not unusual for a client to

report engaging in some form of sexually compulsive behavior since adolescence. In using cognitive

deconstruction as an explanation for the cognitive processes typically seen in sex offenders (denial,

minimization, rationalization, lack of empathy, and suppression of negative emotions during the offense

process) Ward et al. (1995) hypothesize that sex offenders who begin offending in adolescence may

engage in a chronic form of cognitive deconstruction which may be a result of their never having

developed an abstract style of self regulation. They argue that poor developmental experiences contribute

to early onset offending and may lead a vulnerable adolescent to rely on cognitive deconstruction as a

chronic coping mechanism.

Consequently, adolescent sex offenders may, as a result of the deficits which may arise from

inappropriate developmental experiences, attempt to resolve problems and escape negative affect by-

engaging in cognitive processing that remains at the concrete or deconstructed level. The constant stress

of their developmental circumstances may have hindered them from developing an abstract style of

problem-solving and self-regulation, which would allow them to evaluate the long-term consequences of

their behavior. Therefore, the incorporation of cognitive deconstruction as a chronic coping strategy- could

differentiate early onset offenders from those sex offenders whose first offense is in adulthood, or who first

begin engaging in compulsive sex in adulthood.

There is evidence from the clinical presentations of priests who began engaging in sexually

compulsive behavior in adolescence that many of the features and consequences of cognitive

deconstruction have been incorporated into their general cognitive and behavioral style. For example,

many sexually compulsive priests who struggle to gain control of their behavior report that they seem to

be most at risk for acting out when they have experienced a disappointment or when they- feel they are


20

unable to perform adequately, or they are not sufficiently appreciated by colleagues or religious superiors.

Their passive interpersonal style hinders them from initiating appropriate problem-solving strategies,

which may contribute to feelings of worthlessness, self-blame, and in the person magnifying their

perceived faults and inadequacies. Typically, this results in the person impulsively engaging in sexual

cruising behavior or some other behavior that will likely lead to sexual contact. Often the person says that

he was acting in a numbed state in which he thought only of obtaining his goal of immediate sexual

satisfaction. At the time he is unable to engage in the higher level abstract thinking that enables him to

interpret the meaning of his behavior, engage in self-evaluative processes, or assess the long-term

consequences of his actions. Indeed, the interpretive vacuum left by cognitive deconstruction is likely to

lead the person to reconstruct new beliefs that “solve"’ the issue of his sexual deviancv and support his

behavior. For example, he will often justify his cruising behavior by constructing irrational beliefs that

support his behavior, such as his cruising behavior is really just a form of community outreach.

The cognitive processes and behaviors described by the sexually compulsive priest seem to

contain all the consequences of cognitive deconstruction as outlined by Baumeister (1990). The person's

inner constraints fail to inhibit his behavior, resulting in impulsive behavior that is incompatible with the

person’s values as a priest who has taken a vow of celibacy. His passivity helps him avoid responsibility

for his behavior and assessing the appropriateness of his actions. His quest to obtain sexual gratification

helps push negative affect out of his awareness and distracts his mind from broader, more meaningful

concerns. He will often construct irrational beliefs that support his behavior.

The Research Question

This study focused on Roman Catholic priests and religious (members of religious orders who are

not ordained priests) who were referred for psychiatric evaluation because of compulsive sexual behavior,

and who report beginning sexually compulsive behavior before adulthood (age 2 1). The most frequent

reason for referral is a history of cruising for anonymous partners, but the presenting problem can include


21

other forms of nonparaphilic behavior (multiple partners, compulsive fixation on an unattainable

partner, compulsive autoeroticism, compulsive use of pornography).

It was hypothesized that early onset sexually compulsive priests have incorporated cognitive

deconstruction as part of their general behavioral and cognitive style. Their Rorschach protocols were

examined for evidence of the four consequences of cognitive deconstruction (disinihibition, passivity,

absence o f emotion, irrational thinking). The Rorschach variables chosen to reflect the presence of

cognitive deconstruction were: I.) Coping Deficit Index (CDI), 2.) Adjusted D Score. 3.) FC:CF+C

Ratio, 4.) Active to Passive Movement Ratio (a:p ratio). 5.) Human Movement Active to Human

Movement Passive Ratio (Ma:Mp ratio). 6.) Affective Ratio (Afr ratio). 7.) Vista (V). 8.) Egocentricity

Index, 9.) M-. 10.) H: (H) Hd (Hd). 11.) X-%. 12.) X+%, 13.) WSUM6. The definition of each variable,

along with reliability and validity data will be discussed later in the paper.

Two Rorschach variables relating to effort in processing (W:M) and processing efficiency (Zd)

were also examined. These variables are not related to cognitive deconstruction, and it was hypothesized

that there would be no difference among the groups on these variables.

The Rorschach protocols of the early onset sexually compulsive priests were compared with the

Rorschach protocols of two other groups of priests. Priests who were referred for psychological

evaluation because of occupational problems or as part of the candidate assessment process served as a

control group providing data on a nonpsychiatric sample of priests. No Axis I or Axis II diagnosis is a

selection criterion for this group. However, they may have one or more conditions that may be a focus of

clinical attention, such as V62.90 Religious or Spiritual Problem or V62.2 Occupational Problem,

nicotine dependence, or learning disability. It was expected that the Rorschach protocols of this group

would be generally within the normal range and free of any indications of marked psychopathology.

The other comparison group was comprised of priests who were diagnosed at the time of their

evaluation as having an anxiety disorder. The presence of a sexual disorder, eating disorder, or alcohol or

drug dependence would exclude them from this group, as these are other forms of escape from the self

which could indicate the chronic use of cognitive deconstruction as a coping mechanism.


22

Hypothesis

The Rorschach protocols of the early onset sexually compulsive sample (group 1) will be different from

the anxiety sample (group 2) and the nonpsychiatric sample (group 3) in the following ways:

1.) There will be a significantly higher number of subjects in group 1 obtaining a positive CDI: CDI>3.

2.) Significantly more group 1 subjects will obtain an Adjusted D score in the minus range: Adj D<0.

3.) There will be a significantly higher number of group I subjects obtaining a FC.CF+C ratio in which

the CF+C will be greater than the FC by at least 1 point: CF+OFC.

4.) There will be a significantly higher incidence of group 1 subjects obtaining an a:p ratio in which the

value for passive movement exceeds the value for active movement by more than one point: p>a+l.

5.) Significantly more group 1 subjects will obtain a Ma:Mp ratio in which the value for Mp is one point

more than the value for Ma: Mp>Ma.

6.) Significantly more group 1 subjects will have an Affective ratio less than .53: Afr. ratio<53

7.) Significantly more group 1 subjects will have a Vista response: VXD.

8.) Significantly more group 1 subjects will have an egocentricity index (3r+(2)/R) value of .32 or below:

(3r+(2)/R) = or <.32.

9.) Significantly more group 1 subjects will have an M- response: M-X).

10.) Significantly more group 1 subjects will obtain a H: (H) Hd (Hd) ratio in which the stun of pure H

or human responses will be less than 2 and less than the sum of human detail or fictional responses: H<

2 and H<(H) Hd (Hd).

11.) Significantly more group 1 subjects will have a X-% of .20 or greater: X-%= or >.20.

12.) Significantly more group lsubjects will have aX+%less than .60: X+%<60.

13.) Significantly more subjects in group I will have a WSUM6 >9.

14.) There will be no significant difference in the W:M ratio among the 3 groups.

15.) There will be no significant difference in the ZD scores among the 3 groups.


CHAPTER2

METHOD

Subjects

This study examined the archival psychological testing data of 112 Roman Catholic clergy who

participated in a week-long psychological evaluation at a psychiatric hospital for priests and religious.

All the subjects were diagnosed by a psychological evaluation team at a summary meeting that takes

place on the last day of the evaluation process. Diagnoses are made according to the criteria of the

Diagnostic Statistical Manual of Mental Disorders - Third Edition. Revised (DSM-IH-R. 1987) or the

Diagnostic Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV. 1994). The DSM-IH- R

(1987) definition of Sexual Disorder Not Otherwise Specified is unchanged in the DSM-IV (1994). The

diagnosis of Sexual Disorder Not Otherwise Specified is made on the basis of clinical interviews and the

patient’s self report about his sexual behavior. Projective testing is not used to make a diagnosis of

Sexual Disorder Not Otherwise Specified.

The evaluation team includes a chairperson (either a Ph.D. clinical psychologist or psychiatrist)

who is a senior staff clinician. Four different clinicians served as chairperson for the majority of the

subjects in this study. Their level of experience doing psychological assessments of this population using

the Rorschach varies from five to 12 years. The rest of the evaluation team is comprised of clinical staff

who also provide individual and group therapy for both inpatients and outpatients. The staff, which

includes clinical psychologists, clinical social workers, and pastoral counselors, rotate among the

evaluation teams. A neuropsychologist with 12 years of experience works full-time as a member of each

evaluation team and is present for all the summaries. There are no data available on the diagnostic

reliability among the evaluation teams.

The subjects were homogenous for variables such as sex, marital status, socioeconomic status,

faith affiliation, and occupation.

23


24

The subjects were organized into three diagnostic groups: early onset sexual compulsives, anxiety

disorders, and nonpsychiatric control group.

Group 1: Compulsive Sexual Behavior

The 39 subjects in this group did not have an anxiety disorder and all reported early onset (before

age 21) compulsive sexual behavior. At the time of evaluation they' were diagnosed with a Sexual

Disorder according to DSM-IV (1994) criteria. Distress or impairment resulting from a pattern of

repeated sexual relationships involving a succession of lovers who are experienced by the individual only

as things to be used (DSM-IV 1994. p. 538). compulsive cruising for anonymous partners, compulsive

fixation on an unattainable partner, compulsive autoeroticism, compulsive use of pornography.

Group 2: Anxiety Disorders

This group was comprised of 37 subjects diagnosed with any of the following Anxiety Disorders

according to DSM-IV (1994) criteria: Panic Disorder. Specific Phobia. Social Anxiety Disorder.

Obsessive Compulsive Disorder. Acute Stress Disorder. Generalized Anxiety Disorder. Anxiety Disorder

due to a General Medical Condition, Substance-Induced Anxiety Disorder, Anxiety Disorder Not

Otherwise Specified. Subjects in this group did not have a diagnosed sexual disorder.

Group 3: No Psychiatric Diagnosis

The 36 subjects in this group experienced problems serious enough to warrant the same

psychological evaluation process as subjects in the compulsive sexual behavior group and the anxiety

disorder group. However, there may have not been enough information at the time to give them a

diagnosis other than a V code (relational problems, problems related to abuse or neglect or additional

conditions that may be a focus of clinical attention), nicotine dependence, or learning disability.

Measures

The Rorschach Inkblot Test

The Rorschach protocols were administered and scored by staff psychologists using the Exner

Comprehensive System. The tests were administered and scored prior to the evaluation summary; the


25

testing psychologist was. therefore, blind to the patient’s diagnoses. The level of experience in

administering and scoring the Rorschach varied among the psychologists. New psychologists on staff

were trained and supervised by the senior clinical psychologist or the neuropsychologist, each with 12

years' experience in the Rorschach. Most of the Rorschach protocols in this study were administered by

staff psychologists with at least five years of Rorschach testing experience. There are no data available on

the inter-rater reliability among the examiners.

The Rorschach Inkblot Test is one of the most frequently used projective techniques worldwide. It

is thought that in the process of structuring an ambiguous stimulus such as an inkblot the subject will

unveil deep, otherwise inaccessible facets of his or her personality makeup. The emphasis in scoring is

on the perceptual elements of the test and the interpretation of a protocol is based on a structural

summary of the responses, which utilizes ratios, indices and combinations of variables, rather than single

scores. The Rorschach. A Comprehensive System (TRACS) (Exner. 1974) integrates elements from

different scoring systems and provides standardized administration, scoring, and interpretive procedures.

All the protocols in this study were scored using the Comprehensive System.

The Rorschach was chosen over the other available psychological tests (MMPI. MCMI. NEO-PI)

because of the availability of clusters of variables that yield information on how a person may approach

affect and emotional stimuli, interpersonal relationships, cognitive ideation and mediation, and impulse

control. These variables are related to the four consequences of cognitive deconstruction (disinhibition,

passivity, absence o f emotion, irrational thinking). The notion that cognitive deconstruction could be

incorporated into a person’s general personality style and used as a chronic coping strategy (albeit an

ineffective one), suggests that the consequences of cognitive deconstruction would be reflected in some of

the enduring traits that are measured by the Rorschach Inkblot Test variables chosen for this study.

Table 1 outlines the Rorschach variables which are intended to measure the four main

consequences of cognitive deconstruction as outlined by Baumeister (1990).


26

Table 1. Rorschach Variables and Cognitive DeconstructionConsequences of Cognitive Deconstruction Rorschach Variables

DisinhibtionIrrational and impulsive behavior contrary to normal values, standards, and which may be a source of conflict.Quest for intense sensations as a means of escaping broader awareness or meaning.

Coping Deficit Index (CDI) > 3 Adjusted D score < 0 CF+C > FC

PassivitvPassive interpersonal style.Person rejects meaning, evades personal responsibility.Avoids evaluation of self or actions, thereby avoiding self regulation.

Active to Passive Ratio p > a+I Movement active to Movement passive Ratio Mp > Ma

Absence of EmotionAvoid emotion to escape negative affect.Avoid meaningfttl thought in order to avoid painful interpretations about self or actions.Keep affect at a distance, often through the use of fantasy.

Affective Ratio (Afr.) < .53 Vista (V) > 0 Mp > Ma 3r+(2)/R <32

Irrational ThoualitAvoid thinking realistically about self or actions.Vulnerability to bizarre thoughts, fantasies. Fantasy supplants meaningful thought about self or actions and may serve as a compensatory function.

M- > 0 Mp > MaH<2. (H) Hd (Hd) > H X-% > .20. X+% < .60 WSUM6 > 9

Description. Reliability, and Validity- of the Chosen Rorschach Variables

The Rorschach: A Comprehensive System (TRACS) (Exner. 1993) provides information on the

reliability of eleven of the thirteen chosen variables. Table 2 summarizes the correlation coefficients for

nonpatient groups of 50 adults retested after 12 to 14 months and 100 adults retested after 36 to 39

months. Correlation coefficients reached the .80s and .90s for eight of the eleven variables for the first


2 7

year retest and seven of the eleven variables for the three year retest. However, it is important to note that

the retest data are reported as if the variables are all continuous, but. in fact, they are dichotomous. Cutoff

scores, derived from Exner's normative data are used for clinical interpretation and ideally the retest

figure for each variable would be the percentage of the sample maintaining the same classification.

TRACS also provides tables of the test frequencies and scores generated from large

heterogeneous samples of non-patient adults and. for comparative purposes, data from four psy chiatric

reference groups (inpatient schizophrenics, inpatient depressives. outpatients, and outpatient character

disorders). Exner acknowledges that the normative data and the psychiatric reference groups data have

limitations. The non-patient adult sample consists of data generated from the protocols of 700

volunteers, stratified for geographic distribution, and partially stratified for socioeconomic level. These

data have accumulated over a period of more than 20 years and were gathered by a number of different

scorers in different testing situations. Although the examiners are described as "competent-” no data on

interscorer agreement are published with the tables. The psychiatric reference groups include data for the

same variables listed in the normative tables. Each group represents a random selection of between 25%

and 50% of the records available for each group. Because no effort has been made at stratification, the

data for these four groups should not be considered normative. Exner (1993) states that the data in the

psychiatric reference groups tables provide a source of comparison with findings for adult non-patients.

Table 3 summarizes the mean scores of the chosen variables for the nonpatient adult sample and

the four psychiatric reference group published in TRACS (1993). The CDI is the only variable in which

the percentage of the sample obtaining a positive, or clinically important score, is reported.

A major flaw in the validity' data presented here is that for many of the variables there are few, if

any, studies demonstrating that groups independently known to have problems in the areas the variable

purports to measure, such as problems inhibiting or controlling behavior, actually obtain the expected

Rorschach scores.


28

Table 2. Correlation Coefficients for Nonpatient Groups of 50 Adults retested after 12 to 14 Months and 100 Adults Retested After 36 to 39 Months (Exner. 1993)_________________________

Variable Description 1 Year Retest 3 Year Retest

r r

3r+(2)/R Egocentricity Index .89 .87

M Human Movement .84 .87

a Active Movement .83 .86

P Passive Movement .72 .75

FC Form Color Responses .86 .86

CF Color Form Responses .58 .66

C Pure Color .56 .51

CF+C Color Dominant Responses .81 .79

V Vista Responses .87 .81

x+% Extended Good Form .86 .80

Afr Affective Ratio .82 .90

Coping Deficit Index (CDD: The CDI was developed to identify people who appear to have

coping limitations. Individuals who meet four or more of the conditions for a positive score are thought

to have inadequate coping skills which may lead to impulsive behavior, which is a feature of disinhibition.

Exner does not provide retest reliability on the CDI. but data are provided on some of the

variables that make up the index. He publishes reliability coefficients for 50 nonpatient adults tested after

1 year and 3 years for 3 of the 11 variables that are calculated in the CDI score. The three-year

correlation coefficients are .87 for Texture (T). .90 for Affective Ratio (Afr ratio), and .85 for Experience

Actual (EA) (Exner. 1993). However. Exner does not provide information on the percentage of the

sample exceeding the cutoff for these variables (Sum T>1. Afr. <46. EA<6) and the percentage

maintaining the same classification when retested.


29

Table 3. Mean Scores of Reference GroupsVariable Nonpatient

Adult N=700InpatientSchizophrenicN-320

Inpatient Depressive N=315

OutpatientN=440

OutpatientCharacterDisorderN=180

CDI >3 3% 25% 44% 28% 48%

Adj.D. .20 .69 -.57 .38 .19

FC:CF+C 4.09:2.44 1.54:1.66 1.58:2.30 1.23:2.46 .98:1.33

a:p 6.48:2.69 5.51:4.25 4.79:3.66 3.92:3.24 2.82:2.43

Ma:Mp 3.04:1.31 3.38:2.75 1.94:1.67 1.90:1.78 1.39:1.27

Afr ratio .69 .52 .47 .53 .49

Vista .26 .60 1.09 .42 .24

3r+(2)/R .40 .38 .33 .41 .46

M- .03 2.42 .58 .39 .47

X-% .07 .37 .20 .16 .20

X+% .79 .40 .53 .64 .58

WSUM6 3.28 44.69 18.20 9.59 11.31

H: (H) Hd (Hd) 3.40:2.03 3.17:4.25 2.05:3.16 2.10:3.06 1.94:2.62

People who have elevated or positive scores (CDI>3) are likely to have impoverished or

unrewarding social relationships and they may have difficulty contending with the natural demands of a

social world. (Exner. 1993) They may also have histories that are marked by limited interpersonal

effectiveness or success. The coping limitations signified by a positive CDI also raise a more general

question concerning capacity for control. The capacity for control is usually defined in terms of the ability

to form and direct responses: however, even in cases in which that capacity' appears to exist but a marked

kind of social immaturity also exists, there is a potential vulnerability for problems in everyday living.

A positive CDI raises serious questions about the capacity for control and or the tolerance for

stress, even if the values of the Adjusted D Score and EA are within normal limits. Subjects who are

positive on the CDI appear to have more trouble in many coping situations. They tend to feel helpless or


30

out of place when confronted with ev eryday social demands and this sense of helplessness can often give

rise to control problems and ineffective behaviors. Thus, even though the Adjusted D Score may be zero

or greater, positive CDI subjects frequently become disorganized and or ineffective when confronted with

social demands. If the value for the CDI is 4 or 5 it suggests that the personality organization of the

subject is somewhat less mature than might be expected, which can create a vulnerability for problems in

coping with the requirements of everyday living. Subjects with a positive CDI may experience problems

controlling their behavior in times of stress.

Exner (1993) reports that data from 440 outpatients support the postulate that the CDI tends to

identify those who have coping limitations or deficiencies which may result in interpersonal problems.

The outpatients were sorted into two groups, and the target group included all subjects who identified

“interpersonal difficulties” as part of their presenting problem. The CDI was calculated for all 440

subjects and 125 were found to have a positive CDI. It was found that 97 of the subjects who had a

positive CDI were in the group who complained of interpersonal problems (n=204). The other 28

subjects with a positive CDI were in the group with no interpersonal complaints (n=236). The finding

that 48% of the target group had an elevated CDI. compared to 12% of the group with no interpersonal

complaints is statistically significant (p<001). Exner notes that the subjects in the target group did not

necessarily have more interpersonal problems than the subjects in the other group, but apparently subjects

who complained about interpersonal difficulties were more aware of those problems. This may have been

because this group had experienced problems in control.

In a study of the Rorschachs of 98 children and adolescents who had been severely burned.

Holaday and Whittenberg (1994) reported that their sample of bum victims appeared similar to the index

group of helpless individuals with coping deficits, leading them to predict that the CDI would be positive

on many of the protocols. They found significant differences between their sample and Exner’s normative

data (1993, p.302). They found that 49% of the patients met the criteria for a positive score (4) on the

CDI and 68% met 3 or more conditions. They conclude that their study supports Exner’s (1990)

assertion that the CDI is a measure of learned helplessness. It is thought that learned helplessness is


31

related to reactive depression that follows an uncontrollable precipitating event which is viewed by the

individual as the source o f present and future distress (Brehn & Smith. 1986). In this sample the

experience of being severely burned is identified as the trigger for learned helplessness.

In summary, the CDI yields useful information about the adequacy of an individual's coping

skills and how likely he may be to have control problems secondary' to experiencing stressful situations.

According to Exner and Ritzier (personal communication. June 29. 1997). an elevation of the CDI

suggests that in times of stress, the person may have difficulty inhibiting his or her behavior, one of the

consequences of cognitive deconstruction.

Adjusted D: According to Exner (1993). this score offers information regarding the more typical

or usual capacity to formulate and control behaviors. It is the best single index of the ability to maintain

control under demand or stress situations and it provides information regarding the usual capacity for

control, whereas the D score offers information about that capacity as it is at the time of testing. The

score is independent of how adaptive the person's behavior is. Exner (1993) does not provide any

information on retest reliability for this variable.

The Adjusted D score is obtained by using the formula Experience Actual (EA) -Adj es. Exner

(1993) reports that EA (Sum M +WSUMC) is thought to provide information about the extent to which

resources are organized in a manner that makes them accessible. Exner cites the following study as

supporting the theory that EA relates to internal resources. He reports that 30 patients and 30 nonpatients

were retested after an 18 month interval. The mean EA for the nonpatients was 6.25 at the first test and

6.75 at the second test. The patient group was subdivided into two groups on the basis of independent

ratings of improvement provided by both (a) professional and (b) relatives. The mean EA for the

unimproved patient group was 3.50 at pretreatment and 4.25 at the second test. The mean EA for the

patient group rated as improved was 3.75 at pretreatment and 7.25 at the second test.

Subjects with D or Adjusted D scores in the minus range have fewer available resources than are

required in light of the frequency and or intensity of demands made on them. They are overloaded, they

are experiencing more demands for response formulation than they are able to prepare and implement at


32

the moment. The overload predisposes them to inefficient or ineffective functioning. At times, they may

not process information adequately, may not form decisions carefully or thoroughly, or may not

implement decisions fully or effectively. They are vulnerable to impulsiveness in both thinking and

behavior. If only the D score is in the minus range, the overload can be expected to be transient, but if the

Adjusted D score is in the minus range, the condition is more chronic (Exner. 1991.1993).

According to Exner (1993). people who have scores in the minus range may be in an almost

continuous state of overload and function best in routine and predictable environments. New or complex

situations often cause them to become distracted or inefficient and their behaviors may not be adaptive.

The result is that many of their behaviors are inadequate or even inappropriate, and when new demands

occur, their lives usually become disorganized in some ways. People with Adjusted D scores of less than

minus 1 usually have histories that include numerous events marked by faulty judgment, emotional

disruption, and or behavioral ineffectiveness. They are chronically vulnerable to ideational and or

affective impulsiveness and typically function adequately for extended periods only in environments that

are highly structured and routine and over which they have some sense of control (Exner. 1991. 1993).

Whereas a D score in the minus range may be the result of some situational stress, the overload

condition reflected in the minus Adjusted D score can be the result of a perpetuated developmental

failure. This occurs in cases of more immature people whose lives seem to be marked by one chaotic

event after another, or whose general pattern of activity will be marked by an excessive frequency of

ineffective and or maladaptive behaviors. The minus Adjusted D score may not just reflect immaturity, it

can also reflect pathology (Exner. 1991. 1993).

The FC:CF+C Ratio: This ratio provides an index of the extent to which emotional discharges

are modulated (Exner, 1991, 1993; Groth- Mamat, 1990). The data of the ratio are most meaningful

when studied in relation to the D scores. If either or both of the D scores fall into the minus range, the

capacity for control will be much more limited, and the capacities for modulation of affect will be more

vulnerable to interference by even modest but unexpected stressful experiences (Exner. 1991. 1993).


33

Exner (1993) provides correlation coefficients at 1 year and 3 years for each individual variable.

For FC he reports r to be .86 after 1 year and 3 years. For CF he reports r to be .58 after 1 year and .66

after 3 years. For C he reports r to be .56 after 1 year and .51 after 3 years.

According to Exner (1993), less cognitive effort is required to identify colors than forms. Color

responses can involve a more passive process, but when specific form demands are injected into the

translation of color stimuli, it suggests that more cognitive control has been inserted into the process. For

this reason. FC responses point more to affective experiences that have been controlled and or directed by

cognitive elements. On the other hand. CF and C responses suggest instances in which the subject has

been more prone to give way to the affective stimulus, and inject less cognitive modulation into the

translation of the stimulus field.

If a record has a value for CF+C that is equal to or as much as two points greater than the value

for FC. and the value for Pure C is greater than 1. it indicates some potentially serious modulation

problems. People who score this way are often overly intense in their emotional displays and frequently

convey impressions of impulsiveness. This problem could be the product of control difficulties; it could

equally reflect a less mature psychological organization in which the modulation of affect is not regarded

by the subject as being very important.

Exner. Armbruster, and Viglione (1978) report that the directionality of the ratio is stable over

time. In their study of 100 nonpatient adults retested after 3 years it was found that if the value in one

side of the ratio exceeded the other by at least 1 point in the first test, the same directionality existed in the

second test. Weiner and Exner (1991) and Exner and Sanglade (1992) found the stability of the

directionality of the ratio also exists among outpatients up to a least one year of treatment.

There is some evidence that suggests that a higher frequency of CF+C responses may correlate

with impulsive or aggressive behaviors. Sommer and Sommer (1958) assessed the relationship between

assaultive behavior and two types of color responses, aggressive and nonaggressive. They predicted that

subjects giving aggressive color responses would show more assaultive behavior than non aggressive

color subjects. An inspection of subjects' case histories found that, for physical assaultiveness, the


34

aggressive color subjects significantly exceeded the nonaggressive color subjects. They also found that

the aggressive color subjects contained more pure C responses than the nonaggressive color group. The

nonaggressive color group had more FC responses than the aggressive color group.

The FC: CF+C ratio appears to yield information about a subject's ability to modulate affect and

emotional discharges. If color dominates, it suggests that the subject may tend to be overwhelmed by

affective impulses, which would contribute to a tendency to engage in impulsive behavior, one of the

consequences of cognitive deconstruction.

a:p ratio: This relationship concerns flexibility in ideation and attitudes. If the value for passive

movement exceeds the value for active movement by more than one point (p>a+l). it indicates the

subject will tend to assume a more passive role in interpersonal relations. Subjects with this score

usually prefer to avoid responsibility for decision making and are less prone to search out new solutions

to problems or initiate new patterns of behavior.

Exner (1993) reports reliability correlation coefficients for active movement to be .83 after 1 year

and .86 after 3 years. For passive movement he reports r to be .72 after 1 year and .75 after 3 years . High

frequency- of active movement responses does not equate with an unusual frequency- of active behaviors, or

with any special class of behaviors.

Exner devised an index of behavioral passivity using 20 items in the Katz Adjustment Scale

which was completed for 279 outpatients by a significant other of the patient 9 months after treatment

had been initiated. All subjects were volunteers in a long term treatment effects study which required

psychological testing and behavioral evaluations at 9 month intervals for at least 3 years. Examination of

the Rorschach data collected at the 9 month interval revealed that 83 of the 279 patients had a:p ratios in

which p exceeded a by more than 1 point. These subjects had a mean score for the passivity index of 11.6

(SD=4.2). A comparison group of 83 patients was randomly drawn from the other 196 subjects. This

group obtained a mean score on the passivity index of 5.3 (SD=3.3), yielding a significant difference

between the groups (p<.001). (Exner. 1978)


35

Exner (1974) found active movement responses occurred significantly more in the records of

acute schizophrenics, subjects with a history of assaultiveness (regardless of diagnosis), and a group of

individuals with character disorders. He found that passive movement answers occurred more frequently

in the records o f long-term inpatient schizophrenics, depressive individuals, and outpatient neurotics. He

also found that a proportional difference score, comparing the frequencies of active and passive movement

answers differentiated patients from nonpatients.

Blatt et al. (1976) analyzed and compared the Rorschachs of normal adolescents and young

adults with the Rorschachs of a sample of adolescent and young adult psychiatric inpatients and found

that patients gave a greater number of responses that were inert or passive as well as poor form quality.

The Ma:Mp Ratio: This variable concerns some characteristics of thinking. It includes only

human movement responses with total Active entered on the left and total Passive entered on the right.

Exner (1993) lias suggested that when Mp is greater than Ma, it indicates fantasy may be a prominent

feature of the subject’s ideation, which he calls a “Snow White” feature. Subjects with this type of score

are more likely to take flight into passive forms of fantasy as a defensive maneuver, and are less likely to

initiate decisions or behaviors if there is a likely alternative that others will do so.

If the value for Ma is greater than one and the value for Mp is one point more than the value for

Ma. it indicates that the subject has a stylistic tendency to use fantasy excessively. People with this type of

score are prone to defensively substitute fantasy for reality in stressful situations much more often than

most people. This form of avoidance/denial provides some tempo ran' relief from stress by replacing, in

the imagination, an unpleasant situation with one that is easily managed. It also tends to breed

dependency on others because of the implicit assumption that if one avoids facing a problem situation

eventually external forces will bring some resolution. If the value for Mp is two or more points greater

than the value for Ma. it indicates the presence of a marked style in which flight into fantasy has become a

routine tactic for dealing with unpleasant situations. In this case, the person can be said to have a Snow

White syndrome, which is characterized mainly by the avoidance of responsibility or decision-making.


36

The Affective Ratio (Afr): provides information about an individual's responsiveness to

emotional stimulation. If the value of the Afr is less than average but no more than one standard

deviation below the average range, it suggests that the subject is less interested in or less willing to process

emotional stimuli. If the value for Afr is less than average and more than one standard deviation below the

average range, it indicates a marked tendency to avoid emotional stimuli. Such a person may be quite

uncomfortable around emotion and. as a result, often become much more socially constrained or even

isolated.

Exner reports the retest reliability for Afr ratio after 3 years to be .90 for 50 nonpatient adults.

Vista Variable: This variable seems to be related to negative emotional experience that is

generated by self-focusing behavior. The presence of a Vista in a protocol is thought to indicate that the

subject is experiencing discomfort, or even pain, as a result of ruminative self-inspection which is focused

on perceived negative features of the self.

Exner (1993) reports the correlation coefficient for this variable to be .87 after 1 year and .81

after 3 years in nonpatient groups of 50 adults. He does not report correlation coefficients for patient

groups.

Exner (1993) reports that a Vista response may indicate the subject is trying to distance from

painful feelings of inferiority or depression, which may be the source of some anxiety for the subject. The

Vista variable may indicate the person is self critical, attempts to avoid unpleasant stimuli, and may find

introspection painful. Meltzer (1944) studied the Rorschachs of 50 stuttering children and 50 non

stuttering children matched for sex. age, grade, school, and intelligence. He reports that the stuttering

group produced significantly more Vista responses than the nonstuttering group.

Exner and Wylie (1977) found that an elevation in Vista responses is significantly correlated

with effected suicides that occur within 60 days after being tested. Exner (1993). reports that he has cross

validated this finding by examining the Rorschach protocols of 101 subjects who effected their own death

within 60 days of being tested. Fiske and Baughman (1958) and Exner (1993) report that Vista responses


37

also tend to increase in the records of patients who have been in uncovering forms of psychotherapy for at

least 6 months as contrasted with pretreatment records.

Egocentricitv Index (3r+(2)/R): According to Exner (1993). the Egocentricity Index is a crude

measure of self-focusing or self-attending behavior and may possibly provide information about the

subject’s self esteem. If the value is above the average range, greater than .45. it suggests that the person

tends to be much more involved with himself or herself than others. If the value is below' average, less

than .32. it suggests that the person’s estimate of personal worth tends to be quite negative. Exner (1993)

suggests that such individuals regard themselves less favorably when compared with others.

The two determinants which make up this index are pairs (2) and reflections (Fr.rF). Exner

(1993) reports that the hypothesis that reflection and pair answers might be related to overinvolvement

with the self was tested by administering a sentence completion blank to 750 nonpatient adults. Most of

the 30 stems contained the personal pronouns I, me, or my. Responses were scored for whether the answer

focused on the self (S) (example: “I worry about my future’*) or focused on others (O) (example: "I worry

about the homeless”). Eighty subjects. 40 with the highest number of S responses, and 40 with the highest

number of O responses, were administered the Rorschach by 14 examiners. Reflection responses appeared

in the records of 37 of the 40 high S subjects as contrasted with only 2 records of the high O responses.

The blank, entitled the Self Focus Sentence Completion (SFSC) was then standardized on a population of

2500 subjects. The 30 subjects from each extreme were administered the Rorschach. Reflection and pair

responses appeared more than twice as often among the 30 high S subjects as among the records of the

high O group.

Human Movement Response (M): This score is used for responses involving the kinesthetic

activity of a human, or of an animal or fictional character in human-like activity.

Exner (1993) reports the correlation coefficients for a nonpatient group of 50 adults retested after

1 year to be .84. He reports a correlation coefficient of .87 for a nonpatient group of 50 adults retested

after 3 years. He does not report retest correlation coefficients for patient groups.


38

According to Piotrowski (1960) and Exner (1974). subjects who give more cooperative M's are

generally oriented toward more socially effective behaviors. Subjects who give significantly large

numbers of passive M are more prone to avoid decision responsibility and prefer to be more dependent on

others for direction. Exner (1993) reports M is positively correlated with abstract thinking and requires

some delaying operations.

Rorschach suggested that when the form quality of a Movement response is poor (M-), the

likelihood of psychopatholgy appears to be greater (Exner. 1993). Exner and Weiner (1982) have

suggested that M- response is probably related to deficient social skills and poor interpersonal

relationships and included M- as one of the critical criteria for the differentiation of schizophrenia. The

presence of good quality M’s has been regarded as a positive prognostic indicator, especially for seriously

disturbed subjects. Because the frequency of M is usually low. ranging from 3 to 9 for the nonpatient

adult sample, most are expected to include an appropriate use of form. M responses appear to reflect the

deliberate directing of thinking and the more they deviate from the realities of the stimulus field, the more

likely the thinking activity will be marked by deviation. According to Exner (1993), M's may also include

projections that, in some ways, represent some of the inner qualities of the subject. The presence of one

M- response is sufficient to raise concern about peculiarity in ideation. If the frequency is greater than 1.

the likelihood of a marked thinking problem is increased considerably. Two or more M- responses is an

unusual finding, and may indicate the presence of disoriented thinking or psychosis. If most or all of the

M- responses are passive, it increases the probability that characteristics are present from w hich

delusional operations evolve.

Greenwald (1990) reports that, in a sample of students at a large urban university, the M-

variable yielded a significant negative correlation with the Barron Ego Strength Scale. Blatt et al. (1976)

report that a hospitalized sample of adolescents and adults had significantly more minus form quality

human movement responses (M-) than a sample of normal adolescents and young adults.

Interpersonal interest variables: H is the code for a Whole Human response and involves the

percept of a whole human form. (H) is the code for a Whole Human. Fictional or Mythological response


39

and involves the percept of a whole human form that is fictional or mythological, such as clowns, fairies,

giants, witches, fairy tale characters, angels, dwarfs, devils, ghosts, science fiction creatures that arc

humanoid, human-like monsters, and silhouettes of human figures. Hd is the code for Human Detail and

involves the percept of an incomplete human form, such as an arm, leg, fingers, feet the lower part of a

person, a person without a head. etc. (Hd) is the code for Human Detail, Fictional or Mythological and

involves the percept of an incomplete human form that is fictional or mythological such as, the head of the

devil, the arm of a witch, the eyes of an angel, parts of science fiction creatures that are humanoid, a jack-

o-lantem. and all masks.

H: (H) Hd (Hd): This entry provides information about interest in people. The entry includes

both primary and secondary contents. The sum of Pure H responses is entered on the left and the sum of

the other human contents is entered on the right and may provide some information about the extent to

which conceptions of others may be based more on imagination than real experience. Exner does not

provide any information on the retest reliability' of this variable.

The evaluation of human content has several uses. The absolute frequency of all human content

provides some information about interest in people. A breakdown of human contents into those that are

Pure H (versus those that are Hd or parenthesized human figures) seems to indicate whether the subject’s

conceptions of people, including the self, are based on actual experience or are derived more from

imaginary conceptions. The actual substance of human content answers often provides useful projected

information about how people, and the self, are conceptualized. The most critical human content datum

related to self image is the relation between Pure H and other human contents, expressed in the ratio H:

(H)+Hd+(Hd). According to Exner (1993), all nonpatient adults give more Pure H responses than

combination of others, and more Pure H responses than other forms of human content relate to a more

realistic estimate of self image.

When interpreting the H: (H)+Hd+(Hd) ratio with regard to self image, a value on the left side

that is at least equal to. or greater than, the right side is desirable. If the majority of the human contents

include whole figures scored H, it suggests that self image and self value are probably based more on


40

experience than on imagination. In other words, interactions, rather than fantasies, have contributed

significantly to formulations regarding the self. If the majority of human contents are scored Hd or have

parenthesized human contents, it suggests that self image and or self value tend to be based largely on

imaginary rather than on real experience. If the proportion of parenthesized human content is larger than

the number of pure H responses it may indicate a detachment from the real world, and probably signal an

investment in fantasy. Subjects with a score such as this are often less mature and frequently have very

distorted notions of themselves. This more limited self awareness will sometimes serve negatively in

decision making and problem solving activity and creates a potential for difficulties in relating to others.

There is evidence that the appearance of the human response varies directly with cognitive

development and social maturity, is consistent over time for the same subject and occurs frequently in the

records of well-adjusted normal adults. (Barry, Blyth. & Albrecht 1952; Blatt et al. 1976). Blatt and

Ritzier (1974) found that distorted human responses, particularly human-inanimate blends, increase in

frequency across patients as severity of pathology increases. Blatt et al. (1976) found that a sample of

psychiatric inpatients consistently gave a significantly greater number of minus human responses than

did normals.

X- % and X+%: These variables are part of the basic data concerning cognitive mediation and

provide information about the perceptual accuracy and conventionality of the responses as well as the

psychological functioning of the subject. The X-% concerns the proportion of the perceptual distortion

that has occurred in the record and is calculated by dividing the number of Form Quality responses that

are designated minus by R. the total number of responses in the protocol. The X+% concerns the extent to

which the form used in responses is conventional and perceptually accurate. The score is determined by

dividing the sum of all of the Form Quality responses that are designated superior or ordinary by the total

number of responses in the protocol.

Exner does not provide any retest reliability data for the X-%. only for the X+% variable, which

is an indication of the extent to which the form used in responses is conventional and perceptually

accurate. The data published in The Rorschach. A Comprehensive System (TRACS) (Exner. 1993)


41

suggest that the X+% score is stable among nonpatient adults over long periods. The X+% reliability

coefficient for a group of 50 adults retested after one year was .86. The X+% reliability coefficient for a

group of 100 adults retested after three years was .80.

Other researchers have found a relationship between X+%. X-% and cognitive distortion. In a

stuch' of personality characteristics of incarcerated individuals who had committed at least one sexual

homicide, researchers compared their Rorschach scores to the scores of a sample of incarcerated non-

sexually offending violent psychopaths. The X-% scores for both samples were elevated in comparison to

scores published in TRACS for nonpatient adults. (Meloy. Gracono. Kenney. 1994)

Wald et al. (1990) compared the X+% and X-% scores of mothers of incest victims with a control

group of mothers matched for socioeconomic status, age. education, and marital status. The experimental

group mean scores of .55 for X+% and .23 for X-% appear consistent with the researchers' prediction that

mothers of incest victims would exhibit deficits in reality testing as evidenced by their X+% score and

considerable distortion in perceptual accuracy (poor form quality), as evidenced by their X-% score. The

control group scores were in line with the nonpatient scores published by TRACS, the X+% was .76 and

the X-% was .07.

WSUM6: The WSUM6 variable is the weighted sum of six special scores that are used to mark

the presence of an unusual characteristics in thinking in the response. The six scores are used when the

answer contains some form of Unusual Verbalization (UV). which is thought to reflect some form of

cognitive slippage. (Exner, 1993; Adair, Wagner, 1992; Meloy, Gacono. Kenney, 1994: Weiner. 1995)

When some form of cognitive disarray occurs, either momentarily or for longer periods of time, it will

often manifest verbally. Four of the six special scores are designated level 1. for those answers in which a

mild or modest instance of illogical, fluid, peculiar, or circumstantial thinking is present; or level 2, for

answers in which a moderate or severe instance of dissociated, illogical, fluid, or circumstantial thinking

is present. The scores, together with their designated level, are know as The Critical Special Scores and

can be conceptualized as a crude continuum identifying the presence of cognitive mismanagement or


42

dysfunction. The Critical Special Scores are thought to identify' mild cognitive slippage, serious instances

of faulty thinking, and severe cognitive dysfunction (Exner, 1993).

According to Exner (1993), responses which warrant a Critical Special Score are not necessarily

cause for serious concern, provided that they occur with low frequencies. Exner reports that nearly 81%

of the subjects in the adult nonpatient reference group (n=700) gave at least one response which warranted

a Special Score, and the mean of the mean score for the WSUM6 variable for the non-patient group was

3.28. It is suggested in TRACS that when the WSUM6 score exceeds one standard deviation above the

mean (WSUM6 score >9) the data are too compelling to avoid concluding that some disturbance in

thinking exists.

When Meloy et al. (1994) compared the Rorschach protocols of men imprisoned for sexual

homicide with those of a sample of incarcerated, non-sexually offending violent psychopaths they found

the sexual homicide group had a mean WSUM6 score of 23.17 whereas the comparison group had a mean

score of 14.22.

Netter and Viglione (1994) compared the Rorschach scores of a sample of chronic schizophrenic

inpatients to a control group and a malingering (experimental) group. The schizophrenic group obtained a

WSUM6 score within the range expected if the variable is a valid index of thought disorder, the mean

score was 42.73.

Processing Variables

W:M Ratio: This ratio concerns the processing motivation or effort. The W (whole) response is

related to the degree to which a person can interact in an efficient, active manner with his or her

environment (Groth-Mamat. 1990). As noted earlier, the M variable is the number of Human Movement

responses. Elevated frequencies for W signal the investment of more effort than might be necessary for

the task. The frequency' of M responses can be regarded as a crude index of some of the functional

capabilities that are necessary for achievement-oriented activities (Exner, 1993). According to Exner

(1993). if frequency of W answers is substantially greater than the number of M responses it probably


43

indicates that the subject is striving to accomplish more than is reasonable in light of current functional

capacities.

When the frequency of W responses is disproportionately low in relation to the M frequency, it

suggests that the subject is very cautious and possibly over conservative in defining objectives for

achievement (Exner. 1991. 1993).

ZD Variable: This variable relates to processing efficiency and the score for this variable

differentiates between underincorporators, with ZD score less than -3.0. and overincorporators, with ZD

score greater than +3.0. An underincorporative style suggests that the subject scans the stimulus field

hastily and haphazardly and often may neglect critical cues in the environment. An overincorporative

style suggests that the subject invests more effort and energy into scanning activities, which indicates a

cautious, thorough approach to ensure all stimulus cues are included in the input (Exner. 1993).


CHAPTER 3

RESULTS

Data Analysis

Hypotheses were tested using chi-square analyses of the data for each Rorschach variable.

Additionally, one way analysis of variance (ANOVA) techniques were used to analyze the X+% and X-%

variables, the only variables that meet the assumptions for parametric tests.

Results

The study hypothesized that extreme scores on thirteen Rorschach variables reflect the

consequences of Cognitive Deconstruction (disinhibition, passivity, absence o f emotion, and irrational

thinking). It was expected that subjects in the compulsive sex group would obtain significantly more

extreme scores than subjects in the anxiety and control groups, which would offer some support for the

hypothesis that cognitive deconstruction theory may provide a framework for understanding the cognitive

processes of earlv-onset sexually compulsive patients. The results do not support the hypothesis. The

compulsive sex group was not significantly different from both the anxiety and the control groups on any

of the variables, although the compulsive sex subjects had significantly more positive CDI scores than

subjects in the anxiety group. However, there was no significant difference in the number of subjects

obtaining positive CDI scores between the compulsive sex and the control groups. Four other variables

(Ma:Mp, W:M, Vista, M-) yielded significant differences among the groups, but not in the direction

expected.

Tables 4, 8. 11, and 15 summarize the frequency data and chi-square values for the cluster of

variables that measure each of the four consequences of cognitive deconstruction (disinhibition, passivity,

absence o f emotion, irrational thought). Tables 5-7, 9-10, 12-14, 16-18, 20, and 22 list each variable, the

44


45

number of cases in each of the three groups that meet the specific variable criteria, the means and

standard deviations obtained by each group and the chi-square values between each pair of groups.

Tables 19 and 21 show the results of the one-way ANOVAs for the X-% and X+% variables.

There was no difference between mean values for X-% for the compulsive sex group (.2018) and the

anxiety group (.2000) but both were significantly higher than the mean value for the control group

(.1372).

Variables Measuring the Consequences of Cognitive D econstruction

Disinhibition: The three Rorschach variables selected as potential indicators of disinhibition

were CDI (Coping Deficit Index). Adjusted D score and FC: CF+C. Table 4 summarizes the frequency

data and chi-square values for the three disinhibition variables.

Table 4. DisinhibitionVariable Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety && Control & Anxiety Control

CDI>3 10 41% 6 17% 11 34% .311 4.06* 2.216

Adjusted 9 23% 9 24% 8 22% .023 .016 .095D <0Cf+C>FC 22 56% 18 48% 15 41% 1.628 .662 .356

*p < .05

It was predicted that significantly more subjects in group 1 would have a positive CDI (CDI>3).

an Adjusted D score in the minus range (ADJD<0) and a CF+C value that would be greater than FC

(CF+C>FC). The means, standard deviations, the number of cases in each group that meet the specific

variable criteria, and the chi-square values for each of variables between each group are presented in

Tables 5-7.

Table 5. Coping Deficit Index.______________________________________________________CDI Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety & _________ ii=24________ n=34_________n=32________ & Control & Anxiety Controlmean 2.833 2.675 2.906


46

________ Table 5 (Continued)_______________________________________________________________standard 1.340 1.147 1.058deviationCDI>3 10 41% 6 17% 11 34% .311 4.06* 2.216

*p < .05

The CDI. which provides useful information about the adequacy of a person's coping skills, was

not available on some of the older protocols (See Table 4). Scores were available for 24 of the 39 subjects

in the compulsive sex group, for 34 of the 37 subjects in the anxiety group, and for 32 of the 36 subjects in

the control group. The compulsive sex group had significantly more subjects obtaining a positive CDI (11

or 34% of the subjects) than the anxiety group (6% or 17% of the subjects). There was no significant

difference between the compulsive sex and the control groups, or between the anxiety and the control

groups. It was surprising that 34% of the subjects in the control group obtained a positive CDI.

Table 6 outlines data for the Adjusted D variable. The Adjusted D variable provides information

regarding a person’s usual capacity to control behavior. It was predicted that there would be a

significantly higher incidence of ADJD<0 in the compulsive sex group, as scores in the minus range are

thought to suggest a vulnerability to impulsiveness in both thinking and behavior. As seen in Table 5.

there was no significant difference in the frequency of ADJD<0 among the three groups.

_______ Table 6. Adjusted D Variable.________________________________________________________Adjusted D Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety &_____________ n=39 n=37 n=36 & Control & Anxiety Controlmean -2.56E-02

standard 1.842deviationAdjusted 9 23%D<0

Table 7 outlines data for the FC:CF+C variable. It was hypothesized that the compulsive sex

group would have significantly more protocols where CF+C>FC. which would also suggest problems

inhibiting behavior. While 56% of the compulsive sex group had a CF+C score that was greater than FC.

compared to 48% of the anxiety group and 41% of the control group, the difference between the

compulsive sex and the control groups was not significant.

-8.UE-02 -3.47E-17

1.361 1.218

9 24% 8 22% .023 .016 .095


47

_______ Table 7. FC.CF+C Variable.______________________________________________________FCCF+C Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety &_____________n=39_______ n=37________ n=36________ & Control & Anxiety Controlmean 1.71:3.10 2.24:2.83 1.72:2:22

standard 1.70:2.70 2.06:2.04 1.61:2.19deviationCF+C >FC 22 56% 18 48% 15 41% 1.628 .662 .356

Thus, there was no significant difference between the compulsive sex group and the anxiety

group in the frequency of elevated scores on the three Rorschach variables chosen to reflect disinhibition.

It had been expected that subjects in the compulsive sex group would show a higher frequency of extreme

scores on each of the three variables. This actually happened for the CDI - the compulsive sex group had

significantly more positive CDI scores than the anxiety group, but there was no significant difference

between the compulsive sex group and the control group. The results for all three variables suggest that

(1) the anxiety group has significantly fewer subjects with coping deficits than the compulsive sex group,

and (2) subjects in the compulsive sex group do not have any more problems in controlling their behavior

than subjects in the control group.

Passivity : Table 8 summarize the frequency data and chi-square values for the active to passive

ratio and the human movement active to human movement passive ratio, the two variables selected as

potential indictors of passivity.

Table 8. PassivityVariable Compulsive Anxiety Control chi-square chi-square chi-square


p > a+1 9 23% 10 27% 13 36% 1.534 .158 .696

Mp > Ma 10 25% 12 32% 19 52% 5.80** .017 5.045*

**p<02 *p<05

Tables 9 (a:p ratio) and 10 (Ma:Mp ratio) outline the means, standard deviations, frequency data,

and chi-square values for the Rorschach variables selected to measure passivity. It was predicted that the

compulsive sex group would show more evidence of passivity by having (1) a significantly higher number


48

of subjects who had more passive scores than active scores: p >a +1, and (2) a significantly higher number

of passive human movement scores than active human movement scores: Mp>Ma. Surprisingly, the

compulsive sex group had the lowest number of protocols where the passive scores were higher than the

active scores. Contrary to expectations, the control group had significandy more passive human movement

scores than either the compulsive sex group or the control group. The results suggest that significandy

more of the subjects in the control group (52%) may tend to use passive forms of fantasy as a defensive

maneuver.

Table 9. Active to Passive Rado Variable.a:p rado Compulsive

Sex Groupn=39

AnxietyGroupn=37

ControlGroupn=36

chi-square Compulsive & Control

chi-square Compulsive & Anxietv

chi-square Anxiety & Control

mean 6.73:5.12 7.56:6.27 4.66:4.52

standarddeviationp>a+l

4.50:3.46

9 23%

3.44:3.78

10 27%

2.68:2.99

13 36% 1.534 .158 .696

Table 10. Movement Active to Movement Passive RatioMa:Mp ratio Compulsive

Groupn=39

AnxietyGroupn=37

ControlGroupn=36




mean 2.97:1.97 3.35:2.67 1.77:2.19

standarddeviationMp>Ma

2.19:2.24

10 25%

2.01:2.26

12 32%

1.58:1.70

19 52% 5.80** .017 5.045*

**p < .02 *p <.05

Absence o f Emotion: Table 11 summarizes the frequency data and the chi-square values for four

Rorschach variables selected as potential indicators of absence o f emotion.

Table 11. Absence of Emotion.Variable

Afr. < .53

Compulsive Sex Group

24 61%

AnxietyGroup

28 75%

ControlGroup

23 63%

chi-square Compulsive & Control .042

chi-square Compulsive & Anxiety 1.755

chi-square Anxiety & Control 1.208

V>0 14 36% 20 54% 11 30% .238 2.527 4.12*

Mp > Ma 10 25% 12 32% 19 52% 5.80** .017 5.045*


49

Table 11 (Continued)3r+<2)/R<.32

10 25% 16 43% 10 27% .042 3.730 2.873

**p < .02 * P < .05

The Rorschach variables that were chosen as potential indicators of a tendency to avoid emotion

in order to escape negative or painful affect were: Affective ratio (Afr ratio). Vista (V). Ma:Mp ratio, and

Egoccntricity Index (3r+(2)/R). The results of the Ma:Mp ratio are discussed above. Tables 12-14

summarize the means, standard deviations, frequency data, and chi-square values for the Affective ratio.

Vista, and Egocentricity Index variables.

Table 12. Affective Ratio VariableAffectiveRatio

Compulsive Anxiety Sex Group Group n=39 n=37

ControlGroupn=36




mean .50 .44 .50

standard deviation Afr < 53

.15 .20

24 61% 28 75%

.19

23 63% .042 1.755 1.208

An Affective ratio less than .53 suggests a tendency to avoid emotional stimuli. It was

hypothesized that significantly more subjects in the compulsive sex group would achieve such a score. As

seen in Table 9. there was no significant difference in the frequency of low Affective ratio scores among

the groups. The majority of subjects in each group obtained a low Affective ratio score, which suggests

that the tendency to avoid emotional stimuli may be a feature of all three groups.

A Vista response is thought to signal the presence of self-focusing behavior that is painful or

negative. It was hypothesized that compulsive sexual behavior may sometimes be an attempt to escape

painful affect and it was expected that the compulsive sex group would have significantly more subjects

with Vista responses. There was no significant difference in the frequency of Vista responses between the

compulsive sex group and the control group or between the compulsive sex group and the anxiety group.

However, there was a significant difference between the anxiety group and the control group: significantly

more subjects in the anxiety group had a Vista response.


50

Table 13. Vista Variable.__________________________________________________________Vista Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety_____________ n=39_______ n=37_________n=36________& Control & Anxiety & Controlmean .64 1.24 .52

standard 1.15 1.94 1.52deviationV>0 14 36% 20 54% 11 30% .238 2.527 4.12*

*p < .05

An Egocentricity Index of .32 or less is thought to suggest negative self esteem, especially when

the person compares him or herself to others. It was hypothesized that more subjects in the compulsive sex

group would score at .32 or less on this variable. There was no significant difference among the groups.

As seen in Table 11, 43% of the subjects in the anxiety group, 25% of the subjects in the compulsive sex

group, and 27% of the subjects in the control group had Egocentricity Index scores less than .32.

_______ Table 14. Egocentricity Index Variable._______________________________________________(3r+(2)/R) Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety &_____________ n=39________n=37________ n=36________ & Control & Anxiety Controlmean .4169 .3581 .4119

standard .1738 .1512 .1421deviation3r+(2)/R< 10 25% 16 43% 10 27% .042 3.730 2.873.32

Thus, the cluster of variables chosen to reflect absence o f emotion did not yield the expected

results. Contrary' to expectations, subjects in the compulsive sex group did not have a higher frequency of

extreme scores on any of the 4 variables in this cluster.

Irrational Thought: Table 15 summarizes the frequency' data and chi-square values for the six

variables selected a potential indicators o f irrational thought.

_______ Table 15. Irrational Thought________________________________________________________Variable Compulsive Anxiety Control chi-square chi-square chi-square


M- > 0 24 61% 25 67% 15 41% 2.961 .968 4.939*


51

Table 15 (Continued)H<2. (H) Hd (Hd) > H

9 23% 5 13% 10 27% .2185 1.155 2.280

Mp>Ma 10 25% 12 32% 19 52% 5.80** .017 5.045*

X-%>.20 15 38% 18 48% 12 33% .213 .803 1769

X+% <.60 26 66% 25 67% 20 55% .794 .007 1.117

WSUM6 > 9 12 30% 12 32% 9 25% .309 .024 .491

**p < .02 * < .05

The tendency to have bizarre thoughts, avoid thinking realisticaUv about oneself or one’s actions,

or to substitute fantasy for meaningful thought is hypothesized to accompany cognitive deconstruction.

The Rorschach variables chosen to measure these tendencies were: M-. Ma:Mp ratio. H: (H) Hd (Hd). X-

%, X+%. and WSUM6.

An M- response suggests deficient social skills and poor interpersonal relationships, and it was

expected that significantly more of the protocols of the compulsive sex group would have a M- response

(M->0). The results did not support this hypothesis. As shown in Table 16. the compulsive sex group

did not have significantly more M- scores than either the anxiety or the control groups. However, the

anxiety group had significantly more M- scores than the control group.

_______ Table 16. M- Variable._____________________________________________________________M- Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety &_____________n=39________n=37________ n=36________ & Control & Anxiety Controlmean 1.23 1.27 .55

standard 1.61 1.17 .80deviationM->0 24 61% 25 67% 15 41% 2.961 .968 4.939*

_____

It was also hypothesized that protocols in the compulsive sex group would have fewer Whole

Human responses and fewer H responses than the sum of the other human contents, which would suggest

the subject’s concepts of people, including the self, are based more on imaginary conceptions rather than

actual experience. A higher number of pure H responses reportedly suggests interpersonal interest and a

self concept based more on interactions than imagination. Previous research has shown than nonpatient


52

adults give more pure H responses than psychiatric inpatients (Blatt et al. 1976) and it was therefore

expected that the control group would have the lowest frequency of protocols with H<2 and H<(H) Hd

(Hd). Surprisingly, there was no significant difference among the 3 groups on this variable. Twenty-

seven percent of the control group had fewer than 2 pure human, content scores and had more

parenthesized human scores compared to 23 % for the compulsive sex group and 13% for the anxiety

group (See Table 17).

_______ Table 17. Human Response Variable.________________________________________________H: (H), Hd. Compulsive Anxiety Control chi-square chi-square chi-square(Hd) Sex Group Group Group Compulsive Compulsive Anxiety &_____________n=39________n=37________ n=36_________& Control & Anxiety Controlmean 2.92:4.41 3.10:3.86 2.41:2.97

standard 2.37:5.47 1.74:3.00 1.62:2.09deviationH<2. H<(H) 9 23% 5 13% 10 27% .2185 1.155 2.280Hd (Hd)_______________________________________________________________________________

X-% (Table 18) and X+% (Table 20) scores provide information about perceptual accuracy and

cognitive mediation. These scores indicate the likelihood that a subject will translate information in

conventional ways and respond with conventional behaviors. X-% concerns the proportion of perceptual

distortion that occurred in the record. If the value for X-% is less than . 15 it is thought that the frequency

of perceptual distortion is no greater than for most people. A value of .20 or more suggests the subject

may have significant problems in the area of cognitive mediation. It was expected that subjects in the

compulsive sex group would have the highest frequency of X-% scores of .20 or greater. In fact, there was

no significant difference among the three groups. As seen in Table 18, 38% of the compulsive group.

48% of the anxiety group, and 33% of the control group had X-%> scores of .20 or greater.

Table 18. X-% VariableX-% Compulsive Anxiety Control chi-square chi-square chi-square

Sex Group Group Group Compulsive Compulsive Anxiety &n=39 n=37 n=36 & Control & Anxiety Control

mean .2018 .2000 1372

standard .1119 9.493 9.130deviationX-% = or 15 38% 18 48% 12 33% .2L3 .803 1.769>.20


53

Tabic 19 shows the results of the ANOVA for X-%. The control group obtained a mean X-%

score of .13 which was significantly different from the mean X-% scores for the compulsive sex group

(.2018) and the anxiety group (.2000). There was no significant difference between the mean scores for

the compulsive sex and anxiety groups.

_______ Table 19. ANOVA X- % Variable____________________________________________________(I) group (J) group Mean Difference (I-J)compulsive sex group anxiety group 1.795E-03

control group 6.315E-02 *anxiety group compulsive sex group -1.794E-03

control group 6.135E-02 *control group compulsive sex group -6.314E-02*

______________________________ anxiety group__________________ -6.135 E-02*_________________♦The mean difference is significant at the .05 level.

X+% is the extent to which the form used in responses is conventional and perceptually accurate.

It was expected that significantly more protocols in the compulsive sex group would obtain an X-% of less

than .60. According to TRACS (1993) scores below .60 signals a tendency to translate information and

experiences in an unconventional way to the degree that it is probably impairing effective adjustment.

There was no significant difference in the frequency of scores below .60 among the three groups. Sixty-

six percent of the protocols in the compulsive sex group had an X+% score less than .60 compared to 67%

of the protocols in the anxiety group and 55% of the protocols in the control group. The mean X+%

scores for each group was under .60 and the mean score for the control group was .58. far lower than .79.

the mean score for nonpatient adults published in TRACS (1993).

Table 20. X+% VariableX+% Compulsive Anxiety Control chi-square chi-square chi-square


mean .5195 .5316 .5811

standard .1298 .1290 .1093deviationX+% <.60 26 66% 25 67% 20 55% .794 .007 1.117

Table 21 show's the results of the ANOVA for the X+% variable. There was no significant

difference among the group means for this variable.


54

_______ Table 21. ANOVA X+% Variable__________________________________________________(I) group (J) group Mean Difference (I-J)compulsive sex group anxiety group -1.213E-02

control group -6.162E-02anxiety group compulsive sex group 1.213E-02

control group -4.948E-02control group compulsive sex group 6 .162E-02______________________________ anxiety group_________________ 4.949E-02__________________

Table 22 summarizes the data for WSUM6. The score is sensitive to cognitive slippage or

dysfunction and a score over 9 signals the presence of some disturbance in thinking. It was expected that

subjects in the compulsive sex group would have the highest frequency of WSUM6 greater than 9. but

there was no significant difference among the three groups. In the compulsive sex group. 30% of the

subjects had a WSUM6 score greater than 9. compared to 32% in the anxiety group and 25% in the

control group.

Table 22. WSUM6 Variable.WSUM6 Compulsive Anxiety Control chi-square chi-square chi-square


mean 8.64 9.67 5.58

standard 10.49 12.13 6.07deviationWSUM6>9 12 30% 12 32% 9 25% .309 .024 .491

The six variables chosen to measure irrational thinking did not yield the expected results. The

number of subjects who obtained extreme scores in the compulsive sex group was not significantly higher

than the number of subjects obtaining extreme scores in the other two groups. Contrary to expectations,

the control group did not obtain significantly fewer extreme scores than the two psychiatric groups.

The findings for the X+% variable were particularly surprising. It was expected that the X+%

mean score for the control group would be closer to the mean score for nonpatient adults published by

TRACS (1993) than to the mean scores of the psychiatric reference groups. This was not the case. There

was no significant difference in the mean scores among the three groups. The frequency of X+% less than

.60 in each group suggests that the tendency to distort information and experiences may be pervasive in

all the groups to the degree that adjustment may be impaired.


55

Processing Variables

The W:M is also known as the aspirational index. The total number of W or whole responses is

entered on the left and the total number of M or human movement responses is entered on the right. A W

score that is more than 3 times the M score may indicate that the subject is striving to accomplish more

than is reasonable given his or her functional capacities. It was expected that there would be no significant

difference among the three groups on this variable. However. Table 23 shows there was a significant

difference between the anxiety group and the control group. The control group had significantly more

W:M scores where the W score was more than 3 times the M score. This suggests that significantly more

subjects in the control group aspire or strive to achieve more than is reasonable given their level of

resources.

Table 23. W:M VariableW:M Compulsive Anxiety Control Chi-square Chi-square Chi-square


mean 9.94:4.92 11.64:5.75 9.45:4.0

standard 5.67:3.41 4.65:2.58 3.70:2.28deviationW:M > 3:1 10 25% 8 21% 16 44% 2.922 .754 4.309*

* p < .05

The Zd variable relates to processing efficiency and differentiates between an underincorporative

style (Zd<-3) and an overincorporative style (ZD>3). According to Exner (1993). subjects with Zd scores

less than -3 have a tendency to be negligent in processing information, which he terms as

underincorporation. Subjects with Zd scores greater than 3 appear to invest more effort in their

processing activities and are prone to overincorporation. As expected, there was no significant difference

between the three groups on this variable. Table 24 summarizes the data on the Zd variable.

Table 24. Zd variable.Zd score Compulsive Anxiety Control chi-square chi-square chi-square


mean 1.816 -8.53 -6.71standard 5.597 5.735 5.22deviationZd>3 6 15% 7 18% 9 25% .866 .169 2.010


56

_______ Table 24 (Continued)_________________________________________________________Zd< 3 15 38% 13 35% 12 33% .213 .091 .0256

A Comparison of the MMPI-2 and MCMI Profiles

Previous research examined the MMPI-2 and MCMI profiles of the subjects in the compulsive

sex group and the control group samples used in this study. Tables 25 and 26 summarizes the MCMI

mean scores and the MMPI-2 mean scores for each group. This study did not analyze the objective test

data for significan t differences between the two groups. The data is included because it offers additional

information about the psychological features of the target population, sexually compulsive priests, and

how they compare to the control group.

Table 25. MCMI-IIMCMI-II Clinical Scales Compulsive Sex Control Group ______________________ Mean (Std. Dev.) Mean (Std. Dev.)Schizoid 53.35 (23.36) 52.20 (22.73)

Avoidant 51.28 (28.68) 34.50 (29.84)

Dependent 71.25 (23.26) 71.93 (25.82)

Histrionic 56.93 (31.84) 54.33 (24.01)

Narcissistic 52.28 (24.65) 49.05 (24.86)

Antisocial 52.05 (19.45) 37.92 (21.08)

Aggressive/Sadistic 48.90 (23.70) 40.32 (21.50)

Compulsive 61.95 (21.52) 66.75 (16.85)

Passive/Aggressive 51.28 (32.75) 28.85 (29.42)

Self-Defeating 61.08 (29.97) 48.40 (22.49)

Schizotypal 54.10 (14.55) 47.65 (18.19)

Borderline 51.03 (24.28) 29.25 (21.57)

Paranoid 45.90 (20.42) 41.95 (20.20)


57

Table 26. MMPI-2MMPI-2 Clinical Scales

Compulsive Sex Mean (Std. Dev.)

Control Group Mean (Std. Dev.)

Hypochondriasis 57.62 (12.70) 51.22 (8.66)

Depression 62.03 (10.14) 52.43 (10.74)

Hysteria 59.03 (12.13) 52.45 (9.90)

Psychopathic Deviate 64.73 (11.74) 52.92 (9.28)

Masculinity/Femininity 62.95 (11.17) 52.28 (12.29)

Paranoia 60.20 (13.13) 51.90 (11.49)

Psychasthenia 63.55 (14.28) 50.97 (8.75)

Schizophrenia 61.80 (12.91) 50.48 (6.86)

Hypomania 53.58 (9-91) 49.80 (8.92)

Social Introversion 52.25 (10.17) 50.85 (12.67)

Use of Normative Data for Interpretation

TRACS (1993) publishes normative data taken from 700 subjects from eight socioeconomic

levels and three geographic distributions. These data are not appropriate for statistical comparison as few

experimental samples match the size or demographic characteristics of Exner’s normative sample (Ritzier

& Exner. 1995). Also, almost any group that is homogenous for some features should differ from the

published reference groups (Exner, 1993). However, the practice of using published TRACS’ reference

norms as a guideline for noting extreme deviations from expected values is widespread (Dies, 1993).

TRACS identifies 11 key variables to guide an interpretive strategy and the normative data are used to

establish cutoff scores for these variables for interpretive significance (Exner. 1991: Ritzier & Exner.

1995). Although researchers and clinicians routinely identify extreme scores on variables by comparing

the scores of their subjects or patients with TRACS reference data, it must be underscored that this is not

wholly appropriate because of the methodological considerations already mentioned. Ideally, each study

should have as a comparison a matched control group.


CHAPTER4

DISCUSSION

Cognitive deconstruction theory states that a person may try to escape from negative affect caused

by internal attributions of failure by rejecting and avoiding meaningful thought. The person rejects the

broader ideas that are associated with higher level thinking, focusing on concrete movements and sensations

in the present, thereby escaping the emotional discomfort that may accompany painful self-awareness. The

theory has been offered as a possible model for understanding the cognitive processes that may underlie the

initiation, maintenance, and justification of self-destructive sexually compulsive behaviors. Baumeister

(1990) lists four consequences of cognitive deconstruction: disinhibition, passivity, absence o f emotion,

irrational thinking. The features and consequences of cognitive deconstruction theory seemed to be

particularly relevant to the features noted in the clinical presentations of many sexually compulsive priests.

This study was the first attempt to investigate whether the consequences of cognitive

dcconstruction (disinhibition, passivity, absence o f emotion, irrational thinking) could be found in the

Rorschach protocols of a population hypothesized to engage in deconstruction. Extreme scores on thirteen

Rorschach variables were chosen to indicate the presence of the four consequences of cognitive

deconstruction. It was hypothesized that the sample of sexually compulsive priests would yield

significantly more protocols with extreme scores on the chosen variables than two comparison groups: a

group of priests diagnosed with an anxiety disorder and a control group of priests who underwent

psychological evaluation.

While there were some significant differences among the groups, the results did not support the

hypothesis that a sample of priests with sexually compulsive behavior would have significantly more

scores on the Rorschach that signaled the four consequences of cognitive deconstruction (disinhibition,

passivity, absence o f emotion, irrational thinking). There could be a number of explanations for the

results.

58


59

Methodological issues related to alpha and beta error sources need to be taken into account when

interpreting the results. It may be that the statistically significant differences among the groups may not be

a reflection of any real differences, instead, they may be the result of alpha or Type I error. Archer and

Krishnamurthy (1993) point out that when a large number of significance tests are computed within a

single study, an inflation of p values occurs and an increasing number of the obtained differences that

achieve statistical significance may occur due to chance. Alternatively, beta or Type II error reflects the

sensitivity of the statistical test in detecting true differences. The probability of rejecting the null

hypothesis when it is false is referred to as the power for a test: analyses that yield low power elevate the

probability of failing to reject a “false” null hypothesis. The probability of a Type I error and the

probability of a Type II error are inversely related (Agresti & Finlay, 1986). The vulnerability of this study

to Type I error does not alter the overall conclusions, since the significant differences were not in the

direction expected: the compulsive sex group was not significantly different from either the anxiety or the

control groups on any variable.

A major limitation of this study is the lack of available data on Rorschach scorer reliability.

Weiner (1991) offers the following guidelines to establish interrater reliability: at least 20 protocols in a

study should be scored by two or more examiners. There should be at least 80% agreement on variables

central to the particular study. Categories examined should include location, determinants, form level,

and content. Moreover, there are no available data on the reliability of the different evaluation teams in

formulating psychiatric diagnoses.

According to Cronbach and Meehl (1955). when an investigator's prediction and data are

discordant the results can be interpreted in three ways: the test does not measure the construct variable,

the theoretical network which generated the hypothesis is incorrect or the experimental design failed to

test the hypothesis properly.


60

The Rorschach as a Measure of Cognitive Deconst ruction

Data to support the validity of the chosen Rorschach variables as measures of psychological

attributes related to a person’s resources, capacity for control, openness to emotional stimulation,

interpersonal style, self-esteem, and cognitive mediation have been presented earlier in the text. The

Rorschach is interpreted as an indirect measure of various psychological attributes, providing information

about underlying propensities to certain kinds of psychological responses (Meyer. 1996). It was not

purported that these variables are a direct measure of the construct of cognitive deconstruction.

Consideration of what scores in a Rorschach protocol actually mean is a matter of construct validity: do

the test scores actually reflect the presence of the psychological attribute they are intended to measure? In

this study, the Rorschach variables were used to infer the presence of the psychological qualities that are

purported to be the consequences of cognitive deconstruction. For some of the chosen variables there was

a direct connection between the psychological construct and a consequence of cognitive deconstruction.

For example, an a:p ratio of p>a+l indicates passivity and directly relates to passivity as a consequence of

cognitive deconstruction. The interpretation of passive scores on the Rorschach, and passivity as a

consequence of cognitive deconstruction both refer to a passive interpersonal style and a tendency to

avoid personal responsibility.

For other variables, the connection was more indirect. For example, the Vista response, one of

the variables used to assess absence o f emotion, is thought to be related to negative or painful emotional

experience that is generated by self-focusing behavior. However, while the presence of negative emotion is

considered to be a causal factor in the need to avoid emotion in cognitive deconstruction, not everyone

who experiences emotional pain uses avoidance as a means of coping. While a Vista response may signal

the presence of painful affect related to self evaluation, it does not necessarily mean the person is

suppressing the painful affect, or is estranged from his or her emotions.

It was expected that evidence of the consequences of cognitive deconstruction would be present in

the Rorschach protocols of a population that exhibits behavior hypothesized to be used by some people to

escape negative emotions. One explanation for the discordance between the predictions and the results is


that the Rorschach is not a good measure of the consequences of cognitive deconstruction. It may be that

this population of priests does in fact use the process of cognitive deconstruction as a means of escaping

negative emotions, and that they turn to compulsive sexual behavior as a way of m ainta in ing the

deconstructed state. The negative findings may instead be pointing to a weak link between the theory and

the test measurement used.

A more direct measure of the presence of cognitive deconstruction may yield different results.

Any conclusions about the presence of cognitive deconstruction in sexually compulsive priests should be

deferred until more valid measures of the construct are available. Even if this study had yielded positive

results, follow-up studies using a measure that is more directly related to cognitive deconstruction would

be necessary to support the hypothesis that sexually compulsive priests engage in cognitive deconstruction.

Theoretical Network of Cognitive Deconstruction

The second possible interpretation of the results is that the theoretical network which generated

the hypothesis is flawed. According to Cronbach and Meehl (1955). if a construct is too loosely defined, it

will not yield verifiable inferences. Baumeister (1990) developed the theory of cognitive deconstruction as

an explanation o f the processes that may be involved in a person’s flight from negative and painful

implications about the self, and posits that this flight from higher level cognitive activity produces several

consequences. He argues that addictions and similar compulsive behaviors typically involve an escape

from an aversive state as much as a pursuit of pleasure. It may be difficult to use the presence of the

consequences o f cognitive deconstruction to assess the presence of the construct because some of these

attributes may be the nonspecific consequences of psychopathology in general, rather than specific

consequences of cognitive deconstruction. Therefore, the presence of these attributes may be due to a

number of factors other than cognitive deconstruction. Even had group 1 obtained significantly more

protocols with extreme scores on the 13 variables indicating the presence of the consequences of cognitive

deconstruction. the results would not be sufficient to establish the actual presence of construct.


62

Disinhibition, passivity, absence o f emotion, and irrational thinking could be the result of other aspects of

psychopathology.

Future research to validate or support the theory- may need to look for more direct evidence of the

steps leading to cognitive deconstruction (disappointment followed by internal attributions of failure,

leading to negative affect from which the person wishes to escape).

Failure of the Experimental Design

The negative findings may also be due to the failure of the experimental design to test the

hypotheses properly. This study compared the Rorschach protocols of three groups of Roman Catholic

clergy, all referred to a psychiatric hospital for evaluation. It was hypothesized that a significantly higher

number of the protocols of the group diagnosed with compulsive sexuality would have scores that

indicated the presence of the consequences of cognitive deconstruction (disinhibition, passivity, absence o f

emotion, irrational thinking). However, as noted earlier, the variables that were chosen to measure these

attributes also relate to more general problems in functioning, such as inadequate coping skills (CDI).

ability to modulate emotional discharges (FC:CF+C). responsiveness to emotional stimulation (Afr ratio),

and perceptual accuracy (X-% and X+%).

It is possible that all priests referred for evaluation share some common psychological features,

making it more likely for the comparison groups to have similar scores on the variables in question. On

most of the 13 Rorschach variables, there was no difference among the three samples. While the

compulsive sex group did obtain significantly more positive CDI scores than the anxiety group, suggesting

they maybe have inadequate coping skills, there was no difference between the compulsive sex and the

control groups on this variable. The significant differences that were observed among the groups suggest

that: (1) more subjects in the control group may be interpersonally passive compared to the subjects in the

other two groups (Mp>Ma), (2) more subjects in the control group are likely to strive to accomplish more

than is reasonable given their resources (W:M>3:1) compared to subjects in the anxiety group, and (3)

more subjects in the anxiety group may experience painful self-focusing behavior (VX)). interpersonal


63

problems, and poorer social skills (M-) than subjects in the control group. As three of the variables which

yielded significant results relate to aspects of interpersonal functioning (CDL Ma:Mp. M-) it would appear

that all three subject groups have some problems in this area.

An examination of the objective personality tests used in the evaluation process yields additional

information about the psychological features of some of the priests referred for evaluation. It is important

to note that there is no evidence that MCMI results are related to Rorschach results, and the

interrelationship between MMPI results and Rorschach results is weak at best. In 1996. Taylor examined

the Millon Clinical Multiaxial Inventory (MCMI) and the Minnesota Muitiphasic Personality Inventory'

(MMPI) profiles of the compulsive sex and the control samples used in this study. Tables summarizing

these data were presented in the results section (tables 24 and 25). The two samples had very' similar

profiles on the MCMI, which seems to support the notion that many, if not all. priests referred for

evaluation share some common features. Although neither sample obtained elevated group mean scores

(BR>74) on the personality and severe pathology scales, both groups obtained their highest scores on the

Dependent and Compulsive scales. The compulsive sex group had sub-clinical elevations on Dependent,

Compulsive, Self-defeating, and Histrionic scales while the control group had sub-clinical elevations on

Dependent Compulsive, Histrionic, and Schizoid scales. The compulsive sex group scored significantly

higher than the control group on the antisocial, passive-aggressive, and borderline scales.

The MMPI-2 group mean scores for the control group were all within normal limits. However,

the mean scores for the compulsive sex group were moderately elevated on eight of the ten clinical scales.

As noted earlier, the interrelationship between the MMPI and Rorschach is weak. Archer and

Krishnamurthy (1993) examined 37 studies that have reported interrelationships between MMPI and

Rorschach variables in adult populations. They report that 73% of the studies revealed either no

statistically significant relationships or minimal associations between MMPI scales and Rorschach

variables. The authors conclude that the Rorschach and the MMPI may be measuring different aspects of

personality functioning.


64

The results of the MMPI may appear to challenge the notion that the psychological features of the

control group and the compulsive sex group are too similar yield any differences in psychological test

scores. However, there is evidence that some people who look healthy on standard mental health scales,

such as the MMPI. may in fact be maintaining an “illusion of mental health” based on defensive denial of

distress (Shelder, et. al.. 1993). This is a possible explanation for why a control group comprised of

individuals referred for a week-long residential psychological evaluation looks healthy on the MMPI. but

not on the projective testing. Shedler (1993) suggests that people in this group, known as defensive

deniers. need to see themselves as well-adjusted. Shedler (1993) argues that they preserve belief in their

“adjustment” by disavowing much of their emotional life, and consequently, they have little awareness of

their needs, wishes, and feelings. Such people may have scores that fall with in normal limits but. for this

group, the scales appear to measure defensive denial rather than mental health.

Keddy et al. (1990) studied the psychological profiles of a group of Catholic clergy and religious

who were referred for residential treatment for a variety of presenting problems including interpersonal

problems, depression, sexual identity problems, alcoholism, and vocational issues. The Rorschach

protocols of the participants indicated a tendency toward rigidity, losing control in emotionally charged

situations and having unmodulated outbursts of emotion, and an idiosyncratic world view. The data from

Rorschach protocols pointed to a consistent constellation of problems including an overemphasis on

intellectual abilities, difficulty modulating emotional discharges, a tendency' to avoid emotional

complexity, difficulty in engaging in productive introspection, and an idiosyncratic world view. These

findings corresponded to the reasons for referral, such as angry outbursts or sexual acting out.

Kennedy et al. (1977) obtained a randomly selected national sample of 271 priests and. on the

basis of a clinical interview, grouped them into four categories along a continuum of development.

Sixty-five percent were labeled as either maldeveloped or underdeveloped. 29% were considered

developing, and only 6% were seen as maturely developed. The maldeveloped had long histories of

serious psychological problems, including underlying hostile feelings, poor self-esteem, and disruptive

sexual conflicts. The underdeveloped were described as over-identifying with their role as priest and


65

failing to develop a personal sense of themselves. Their lives were shaped by the expectations of others,

they had few experiences of intimacy, and tended to handle their feelings through repression and

inteliectualization. The developing priests were judged to have begun to grow as persons after a delay at

an earlier level. They were characterized by high motivation and vitality. The maturely dev eloped priests

were the reference points for maturity and normality in this population. They achieved a mature level of

personal integration and were characterized as independent and self-sufficient. They tended to be

responsible and aggressive in their work and achieved warm, close relationships with others, including

women.

A major limitation of this study is the lack of a normal (non priest) random sample comparison

group. It is unclear what percentage of a normal group would fall into the different categories, and

without this reference it is uncertain whether the emotional development of the priest population is any

different than the development of the general public.

These two studies suggest that there may be a homogeneity in the psychological makeup and

functioning of Roman Catholic clergy that that transcends diagnostic labels. Their symptoms and

behavioral problems may differ, but at their core many of the priests are likely to share similar attributes.

This may account for the similarity in the Rorschach protocols of the three groups of priests in this study.

It would have been preferable to compare the Rorschach protocols of the target group of sexually

compulsive priests to the protocols of a randomly selected group of priests who were not referred for

psychological evaluation. This would help determine what are typical scores for this population and

thereby establish cutoff scores for clinical interpretation.

Instability of Cognitive Deconstruction State

According to Baumeister (1991) and Ward et al. (1995) people who begin engaging in

compulsive sexual behavior, or sexually abusive behavior, in adulthood should display a cognitive style

which reflects repeated switching from deconstructed levels to higher abstract levels. The natural

tendency of the mind is to drift toward broader meanings; staying at a lower level of awareness may


66

require exertion or distraction. This repeated switching between higher/abstract and lower/concrete levels

is consistent with the notion of a hierarchical system for identifying and executing behavior that is a

feature of action identification theory (Vallacher & Wegner, 1985. 1987). control theory (1982. 1990).

and objective self awareness theory (Duval & Wicklund. 1972).

It may be that early-onset sexually compulsive priests are in a deconstructed state only while they

are acting out sexually, at other times they may shift to a more abstract level of thinking The Rorschach

protocols may reflect the state of the subject at the time of testing, when they may be in a more abstract

level of awareness. Typically, the intervention or catastrophe that precipitates the priest’s referral for

evaluation also forces him to confront his problems in a meaningful way. resulting in a broader and more

abstract level of thinking. The week-long evaluation includes at least two comprehensive clinical

interviews and a spiritual assessment that includes spiritual exercises. Thus, it may be that the evaluation

process shifts the priest to a more abstract level of awareness, therefore providing little evidence of the

more narrow states that characterize cognitive deconstruction.


CHAPTER 5

CONCLUSIONS

This study did not support the hypothesis that early-onset sexually compulsive priests have

incorporated cognitive deconstruction into their general cognitive and behavioral style, as evidenced by a

high number of extreme scores on Rorschach variables that measure the consequences of cognitive

deconstruction. Although there was not evidence that this population was significantly different from the

two comparison groups, the results do not rule out the possibility that sexually compulsive priests may

shift into a cognitively deconstructed state while actually engaging in sexually compulsive behavior.

A number of explanations for the negative results of this study have been discussed. The

construct needs to be more tightly defined so that construct validation does not rely on the presence of

consequences of the construct but targets actual features of cognitive deconstruction. Other factors that

account for the results are the homogeneity of the population used in this study and the measure used to

detea the presence of cognitive deconstruction.

Researchers and clinicians have noted the similarity in the psychological profiles of Roman

Catholic clergy. Some of the most frequent descriptions of priests (non-patient and patient) include:

passive, socially inept, distanced from emotion, displaying poorly modulated emotional discharges, rigid,

intellectually defended, and idiosyncratic in their views. These descriptions are consistent with the

Rorschach protocols obtained by the three groups, and with the results of study of a national, randomly

seleaed. representative sample of priests (Kennedy et al.. 1977). As noted earlier, the Roman Catholic

priesthood seems to attraa persons who share a number of psychological traits.

Among the various psychological test data available for the target population, the Rorschach was

determined to be the most likely to yield information on psychological attributes that were related to the

consequences of cognitive deconstruaion. While the Rorschach variables chosen did relate to the

consequences of cognitive deconstruction, the variables did not relate to the different steps involved in the

67


68

process of cognitive deconstruction. Also, the variables relate to more general pathology, m aking it

difficult to establish a causal link between extreme scores on the chosen variables and cognitive

deconstruction.

Future research using more direct measures of cognitive deconstruction by focusing on the actual

steps involved in the process, rather than the consequences, may yield different results. Also, it is

noteworthy that the control group consisted of priests experiencing a high enough level of dysfunction to

warrant referral for residential psychological evaluation rather than outpatient consultation. A control

group of priests who were higher functioning (and thus not referred for residential psychological

evaluation) may look significantly different on the psychological testing when compared to the

experimental group.


69

REFERENCES

Abel. G.G.. Becker. J.G., Cunningham-Rathner. J. (1984). Complication, consent and cognitions in sex between children and adults. International Journal of Law and Psychiatry. 7. 89-103.

Abel. G.G.. Gore. D.K.. Holland. C.L.. Camp. N. Becker. J.V.. Rathner. J. (1989). The measurement of the cognitive distortions of child molesters. Annals of Sex Research. 137-152.

Archer. R_. Krishnamurthy. R. (1993). A review of MMP1 and Rorschach interrelationships in adult samples. Journal of Personality Assessment. 61(2). 277-293.

Adair, H., Wagner, E. (1992). Stability of unusual verbalizations on the Rorschach for outpatients with schizophrenia. Journal of Clinical Psychology. 48(2). 250-256.

Agresti, A., Finlay. B. (1986). Statistical methods for the social sciences. San Francisco: Dellen Publishing Company.

American Psy chiatric Association (1987). Diagnositic and Statistical Manual of Mental Disorder. Third Edition. Revised. Washington. D.C.: American Psychiatric Association Press.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. Washington. D.C.: American Psychiatric Association Press.

Bam'. J.. Blyth. D.. Albrecht. R. (1952). Relationships between Rorschach scores and adjustment level. Journal of Consulting Psychology. 16. 30-36.

Baumeister. R. (1991). Escaping the self. New York: Basic Books.

Baumeister. R. (1990). Suicide as escape from the self. Psychological Review. 97. (1). 90-113.

Baumeister. R. (1988). Masochism as escape from the self. Journal of Sex Research. 25. 28-58.

Baumeister. R. (1989). Masochism and the self. Hillsdale. NJ.: Earlbaum.

Beck, A. & Weishaar, M. (1989). Cognitive Therapy. In A. Freeman. K. Simon. L. Beutler (Eds.) Comprehensive Handbook of Cognitive Therapy. New York: Plenum Press.

Berry, J. (1992). Lead us not into temptation: Catholic priests and the sexual abuse of children: New York: Doubleday.

Blatt, S., Brenneis, C., Schimek, J.. Glick, M. (1976). Normal development and psychopathological impairment of the concept of the object on the Rorschach. Journal of Abnormal Psy chology. 85. (4), 364-373.

Blatt. S.. Ritzier, B. (1974). Thought disorder and boundary disturbance in psychosis. Journal of Consulting and Clinical Psychology. 42. 370-381.


70

Brehin. S. & Smith, T. (1986). Social psychological approaches to psychological and behavior change. In SL. Garfield & A.E. Bergin (Eds.), Handbook of psychotherapy and behavior change. 69-117. New York: Wiley.

Burns. D. (1981). Feeling good. New York: Penguin Books.

Carnes. P. (1983). Out of the Shadows: Understanding sexual addition. Minneapolis: Compcare.

Carnes, P. (1987). Sexual Addiction: Implications for spiritual formation. Studies in Formative Spirituality. 8 (2). 165-174.

Carnes. P. (1989). Contrary to love. Minneapolis: Compcare.

Carnes. P. (1991). Don’t call it love: Recovering from sexual addiction. New York: Bantam.

Carnes. P. (1996). Addiction or compulsion: politics or illness: Sexual Addiction &Compulsivitv. 3. (2). 127-150.

Carver. C. & Scheier. M. (1982). Control theory: A useful conceptual framework for personality- social, clinical, and health psychology'. Psychological Bulletin. 92. 111-135.

Carver. C. & Scheier. M. (1990). Origins and functions of positive and negative affect: A control-process view. Psychological Review. 97. (1), 19-35.

Choca. J.. Shanley. L.. Van Denburg, E. (1992). Interpretative guide to the Millon Clinical Multiaxial Inventory. Washington DC: American Psychological Association.

Coleman. E. (1988). Sexual Compulsivity: Definition, etiology, and treatment considerations. In E. Coleman (E d.) Chemical Dependency and Intimacy Dvsfuncion. New York: The Haworth Press.

Coleman. E.. (1992). Is your patient suffering from Compulsive Sexual Behavior? Psychiatric Annals. June. 22 (6), 320-325.

Cronbach. L.J. & Meehl. P.E. (1955). Construct validity in psychological tests. Psychological Bulletin. 52. 281-302.

Dies. R. (1995). Subject variables in Rorschach research. In John E. Exner (Ed.), Issues and methods in Rorschach research. 99-121.Mahwah, New Jersey: Lawrence Erlbaum Associates.

Duval. Shelly. & Wicklund, Robert. (1987). A theory of objective self awareness. New York: Academic Press.

Earle. R. & Crow, G. (1990). Sexual Addiction: Understanding and treating the phenomenon. Contemporary Family Therapy. 12 (2). 89-104.

Exner. J.J. (1974). The Rorschach: A comprehensive system. Volume 1. New York: Wiley'.

Exner. J. J. (1991). The Rorschach: A comprehensive svstem. Volume 2: Interpretation (2nd edition). New York: Wiley.

Exner. J. J. (1993). The Rorschach: A comprehensive svstem. Volume 1: Basic foundations (3rd edition). New York: Wiley.


71

Exner. J., Armbruster. G.. Viglione. D. (1978). The temporal stability of some Rorschach features. Journal of Personality Assessment 42. 474-482.

Exner, J. & Murillo. L. (1975).Early prediction of post hospitalization relapse. Journal of Psychiatric Research. 12. 231-237.

Exner. J. & Sanglade. A. (992). Rorschach changes following brief and short term therapy. Journal of Personality Assessment 59. 59-71.

Exner. J. & Weiner. I. (1982). The Rorschach: A comprehensive system, volume 3. assessment of children and adolescents. New York: Wiley.

Exner, J. & Wylie. J. (1977). Some Rorschach data concerning suicide. Journal of Personality Assessment 41. 339-348.

Festinger, L. (1957). A theory of cognitive dissonance. Evanston. II: Row Peterson.

Fisk, D. & Baughman, E. (1958). The relationship between Rorschach scoring categories and the total number of responses. Journal of Abnormal and Social Psychology. 48. 25-30.

Green. R. (1991). The MMPI-2/MMPI an interpretive manual. Needham Heights: Allvn andBacon.

Greenwald, D. (1990). An external construct validity study of Rorschach personality variables. Journal of Personality Assessment 55. (3&4). 768-780.

Griffin-Shelly. E.. Benjamin, L.. Benjamin. R. (1995). Sex addiction and dissociation. Sexual Addiction & Compulsivitv. 2. (4). 295-306.

Groth-Mamet G. (1990). Handbook of psychological assessment. New York: Wiley.

Goodman. A. (1993). Diagnosis and treatment of sexual addiction. Journal of Sex & Marital Therapy. 19 (3). 225-251.

Holaday. M. & Wittenberg, T. (1994). Rorschach responding in children and adolescents who have been severely burned. Journal of Personality Assessment 62. (2). 269-279.

Heider. F. (1958). The psvcholoev of interpersonal relations. New York: Wiley.

Henderson. M.C.. Kalichman, S.C. (1990). Sexually deviant behavior and schizotypv: a theoretical perspective with supportive data. Psychiatric Quarterly. 61. (4). 273-284.

Higgins, E.T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review. 94,319-340.

Hull, J.G. (1981). A self-awareness model of the causes and effects of alcohol consumption. Journal of Abnormal Psychology. 90. (6). 586-600.

Irons, R. & Laaser, M. (1994). The abduction of fidelity: Sexual exploitation by clergy - Experience with inpatient assessment. Sexual Addiction & Compulsivitv. l.(2). 119-129.


72

Irons. R. & Schneider. J. (1994). Sexual addiction: Significant factor in sexual exploitation by health care professionals. Sexual Addiction & Compulsivitv L 3. 198-214.

Kaclichman, S.C. (1991). Psychopathology and personality characteristics of criminal sexual offenders as a function of victim age. Archives of Sexual Behavior. 20. (2). 187-197.

Keddy. P.. Erdberg, P., Sammon, S. (1990). The psychological assessment of Catholic clergy and religious referred for residential treatment. Pastoral Psychology. 38 (3). 147- 159.

Kennedy. E., Heckler. V.. Kobler, F., Walker R. (1977). Clinical assessment of a profession: Roman Catholic clergymen. Journal of Clinical Psychology. 33 (1). 120-128.

Kraft-Ebbing. R. Psvchonathia sexualis (F.J. Rebman translation). New York, Paperback Library. 1965 (first edition. 1886).

Laaser. M. (1991). Sexual addiction by clergy. Pastoral Psychology. 39. 213-235.

Levin. S.M.. Stava. L. (1987). Personality characteristics of sex offenders: a review. Archives of Sexual Behavior. 16. (1). 54-67.

Levine. M. Meltzoff. J. (1956). Cognitive inhibition and Rorschach movement responses. Journal of Consulting Psychology. 20. (2). 119-122.

Meltzer, H. (1944). Personality differences between stuttering and non-stuttering children as indicated by the Rorschach Test. The Journal of Psychology. 17. 49-59.

Meloy, J.R., Gracono, C.B., Kenny. L. (1994). A Rorschach investigation of sexual homicide. Journal of Personality Assessment 62. fl). 58-67.

Meyer. G.J. (1996). Construct validation of scales derived from the Rorschach Method: A review of issues and introduction to the Rorschach Rating Scale. Journal of Personality' Assessment 67 (3). 598- 628.

Money. J. (1986). Love mans: Clinical concepts of sexual/erotic health and pathology. Paraphilia, and gender transportation in childhood, adolescence, and maturity. New York: Irvington Press.

Netter, B„ Viglione, D.(1994) An empirical stud)’ of malingering schizophrenia on the Rorschach. Journal of Personality Assessment 62(1). 45-57.

Pennebaker, J.W. (1989). Stream of consciousness and stress: Levels of thinking. In J.S. Uleman & J.A Bargh (Eds.), The direction of thought: Limits of awareness, intention, and control. 327-350.

PiotrowskL Z. (I960). The movement score. In M. Rickers-Ovsiankina (Ed.) Rorschach Psychology. New' York: Wiley.

Quadland, M. (1985). Compulsive sexual behavior: Definition of a problem and an approach to treatment. Journal of Sex & Marital Therapy. 11 (2). 121-132.

Ritzier, B., Exner. J. (1995). Special issues in subject selection and design. In John J. Exner (Ed.) Issues and methods in Rorschach research. Mahway, New Jersey:Lawrence Erlbaum Associates. 123-143.


73

Robinson . E. Montana. S.. Thompson. G. (1993). A descriptive study of sexually troubled clergy. PaDer Dresented at 13th annual ASTA Conference: Boston. 1993.

Robinson. E.. Greer, J., Estadt B.. Thompson. G. (1994). Shadows of the lantern bearers: a studv of sexually troubled clergy. Ann Arbour. MI: UMI Dissertation Sendees.

Robinson, T. & Valcour, F. (1995). The use of depo-provera in the treatment of child molesters and sexually compulsive males. Sexual addiction & Compulsivitv. 2. (4). 227-234.

Schwartz. M. (1995). Victim to Victimizer. Sexual Addiction & Compulsivitv. 2. (2). 81-88.

Shedler, J., Mayman. M.. Manins. M„ (1993). The illusion of mental health. American Psychologist 48 (11). 1117-1131.

Sipe. A.W. R. (1990). A secret world: Sexuality and the search for celibacy. New York: Brunner/ Mazel. Inc.

Sipe, A.W. R. (1994). The problem of sexual trauma and addiction in the catholic church. Sexual Addiction & Compulsivitv. 1. 2. 130-137.

Sommer, R. & Sommer. D. (1958). Assaultiveness and two types of Rorschach color responses. Journal of Consulting Psychology, 22. 57-62.

Syder, M. (1987). Public appearances private realities. New York: W.H. Freeman Company.

Taylor, G. (1996). An empirical comparison of intermittent and compulsive sexually exploitative clergy. Unpublished Doctoral Dissertation. Loyola College.

Vallacher, R. & Wegner, D. (1985). A theory of action identification. Hillsdale. NJ: Erlbaum.

Vallacher. R. & Wegner, D.(1987). What do people think they’re doing: Action identification and human behavior. Psychological Review. 94. 3-15.

Wald, B., Archer, R.. Winstead, B. (1990). Rorschach characteristics of mothers of incest victims. Journal o f Personalitlv Assessment 55. (3&4), 417-424.

Ward, T., Hudson. S.M., Marshall, W.L. (1995). Cognitive distortions and affective deficits in sex offenders: a cognitive deconstructionist interpretation. Sexual Abuse: A Journal of Research and Treatment 7. (1). 67-83.

Weiner, I. & Exner. J. (1991). Rorschach changes in long-term and short-term psychotherapy. Journal of Personality Assessment 56. 453-465.

Weiner. I. (1995). Methodological considerations in Rorschach research. Psychological Assessment 7(3). 330-337.

Weiner, I. (1991). Editor’s note: interscorer agreement in Rorschach research. Journal of Personality Assessment 56. 1.


INFORMATION TO USERS - AU Digital Research Archive |

Documents

Transcript of INFORMATION TO USERS - AU Digital Research Archive |