THE OPERATIONAL MATRIX OF PSYCHIATRIC PRACTICE II. VARIABILITY IN PSYCHIATRIC IMPRESSIONS AND THE PROJECTION HYPOTHESIS
GEORGE N. RAINES M.D., and
JOHN H. ROHRER PH.D.1
1 Psychiatry Department, Georgetown University School of Medicine, Washington, D. C.
The study was designed to test the hypothesis that observed variations between psychiatrists, with respect to diagnostic judgment, reflected a tendency on the part of the psychiatrists to attribute to his client some of the psychiatrist's own personality characteristics, and that this tendency made the psychiatrists more sensitive to certain facets of the personality structure of the psychiatrists and also resulted in a greater perceptual distortion for other facets of the patient's personality structure.
The design utilized involved 5 civilian psychiatrists all of whom had received advanced psychoanalytic training in the same institute. The 4 junior psychiatrists in this group were used as assessment psychiatrists in a special assessment program of 116 enlisted men on duty in a Naval installation. The senior psychiatrist was used to assess the psychodynamic structure of the 4 junior psychiatrists.
The data on the 116 enlisted men comprised diagnostic clinical summaries dictated immediately following an interview that lasted approximately 30 minutes. These data were analyzed through the use of content analysis techniques. Thus, two independent measures of the psychodynamic structure of the junior psychiatrist were available: (a) the senior psychiatrist's impressions written up in the form of a clinical diagnostic summary; and (b) the "projected" reflections of the psychiatrist's psychodynamic structure as revealed in the content analysis of his clinical summaries.
Those content analysis categories that were found to differ between the junior assessing psychiatrists at a statistically significant level were compared with the comparable data to be found in the assessment made by the senior psychiatrist. A high degree of agreement was observed between the two independent measures.
The results of this analysis were interpreted as supporting the projection hypothesis. They also suggest that the hypothesis needs to be expanded to include identification processes, and the psychiatrist's value system and self image. The results are briefly discussed in terms of their implication for psychiatric training, psychiatric theory building relative to psychodynamic principles, and reliable psychiatric diagnosis.
