ABSTRACT
Over the last 25 years, diagnosticians have shifted attention and interest away from the assessment of classical neuroses to the study of more primitive types of personality formation. The Rorschach literature has captured this shift in a number of works that have focused almost exclusively on structural aspects of the borderline and narcissistic personality (Acklin, 1993; Kwawer, Lerner, Lerner, & Sugarman, 1980; Lerner & Lerner, 1988), or the psychotic level of personality organization (Acklin, 1992; Holzman, Shenton, & Solovay, 1986; Johnston & Holzman, 1979; Smith, 1983). Certainly the apparent disappearance of neurotic conditions from the Rorschach literature reflects the “retirement” of this term from official diagnostic classification (American Psychiatric Association, 1980). However, the scrapping of the label has also led to a tendency to ignore, or worse, deinvent, the concept of neurosis or neurotic level of functioning. This unfortunate tendency has led diagnosticians to view almost all psychopathology through the lenses of primitive defenses and internalized object relations, deficits in self-cohesion, or weaknesses in the structure of the ego. Such conceptual and diagnostic pigeon-holing may lead clinicians to overlook dynamic conflicts and ego strengths that have implications for making informed treatment decisions about a particular patient. Assessing treatment implications has always been part of psychodiagnostic work; however, in an era of shrinking mental health insurance benefits, it is even more critical to know which patients may be capable of utilizing an aggressive, fast-paced, short-term dynamic psychotherapy or tolerating the intensity of a long-term psychoanalysis.
