inkblot-test

Rorschach inkblot test

The Rorschach inkblot test (pronounced ʁoɐʃax) is a method of psychological evaluation. Psychologists use this test to try to examine the personality characteristics and emotional functioning of their patients. The Rorschach is currently the second most commonly used test in forensic assessment, after the MMPI, and is the second most widely used test by members of the Society for Personality Assessment. It has been employed in diagnosing underlying thought disorder and differentiating psychotic from nonpsychotic thinking in cases where the patient is reluctant to openly admit to psychotic thinking.

Many skeptics consider the Rorschach inkblot test pseudoscience, as several studies suggested that conclusions reached by test administrators were akin to cold reading. Critics of the test have raised questions about the extraction of objective meaning from responses to inkblots; the objectivity of psychologists administrating the test; inter-rater reliability; the verifiability and general validity of the test; bias of the test's pathology scales towards greater numbers of responses; the limited number of psychological conditions which it accurately diagnoses; the inability to replicate the test's norms; its use in court-ordered evaluations; and the proliferation of the ten inkblot images, potentially invalidating the test for those who have been exposed to them. The Exner Scoring System has addressed many of these criticisms with an extensive body of research.

History

Originally created by Hermann Rorschach in 1921, the scoring system was improved after his death by Bruno Klopfer and others. John E. Exner summarized some of these later developments in the comprehensive Exner system, at the same time trying to make the scoring more statistically rigorous. Some systems are based on the psychoanalytic concept of object relations.

The Exner system is very popular in the United States, while in Europe the textbook by Evald Bohm, which is closer to the original Rorschach system as well as more inspired by psychoanalysis, is often considered to be the standard reference work.

Methods

There are ten official inkblots. Five inkblots are black ink on white paper. Two are black and red ink on white paper. Three are multicolored. After the individual has seen and responded to all the inkblots, the tester then gives them to him again one at a time to study. The test subject is asked to note where he sees what he originally saw and what makes it look like that. The blot can also be rotated. As the subject is examining the inkblots, the psychologist writes down everything the subject says or does, no matter how trivial.

Methods of interpretation differ. Rorschach scoring systems have been described as a system of pegs on which to hang one's knowledge of personality. The most widely used method in the United States is based on the work of John E. Exner.

In the Exner system, responses are scored with reference to their level of vagueness or synthesis of multiple images in the blot, the location of the response, which of a variety of determinants is used to produce the response (i.e., what makes the inkblot look like what it is said to resemble), the form quality of the response (to what extent a response is faithful to how the actual inkblot looks), the contents of the response (what the respondent actually sees in the blot), the degree of mental organizing activity that is involved in producing the response, and any illogical, incongruous, or incoherent aspects of responses.

Using the scores for these categories, the examiner then performs a series of calculations producing a structural summary of the test data. The results of the structural summary are interpreted using existing research data on personality characteristics that have been demonstrated to be associated with different kinds of responses.

A common misconception of the Rorschach test is that its interpretation is based primarily on the contents of the response - what the examinee sees in the inkblot. In fact, the contents of the response are only a comparatively small portion of a broader cluster of variables that are used to interpret the Rorschach data.

Other outdated factors (not included in the Exner system of scoring) include, according to one 1950 source:

Average time per response for which a time of about one minute is suggested as normal with doubling of times considered to be a possible indicator of depression.
The time it takes for the person to react when first faced with a coloured card
Rejection of a card which is suggested should not be considered normal
Turning of the card with failure to turn being labelled a possible sign of depressive psychoses

Because accurate results from the Rorschach depend on an analysis of one's initial impressions of the inkblots, viewing the inkblots before taking the test may lead to invalid results for the test taker. The first card of the Rorschach is presented later in this article.

Controversy

The Rorschach inkblot test is controversial for several reasons.

Test materials

The basic premise of the test is that objective meaning can be extracted from responses to blots of ink which are supposedly meaningless. Supporters of the Rorschach inkblot test believe that the subject's response to an ambiguous and meaningless stimulus can provide insight into their thought processes, but it is not clear how this occurs. Also, recent research shows that the blots are not entirely meaningless, and that a patient typically responds to meaningful as well as ambiguous aspects of the blots.

Tester projection

Some critics argue that the testing psychologist must also project onto the patterns. A possible example sometimes attributed to the psychologist's subjective judgment is that responses are coded (among many other things), for "Form Quality": in essence, whether the subject's response fits with how the blot actually looks. Superficially this might be considered a subjective judgment, depending on how the examiner has internalized the categories involved. But with the Exner system of scoring, much of the subjectivity is eliminated or reduced by use of frequency tables that indicate how often a particular response is given by the population in general. Another example is that the response "bra" was considered a "Sex" response by male psychologists, but a "Clothing" response by females (p. 227 in). But in Exner's system, such a response is always coded as "clothing" unless there is a clear sexual reference in the response.

Third parties could be used to avoid this problem, but the Rorschach's inter-rater reliability has been questioned. That is, in some studies the scores obtained by two independent scorers do not match with great consistency (see pp. 227-234 in). It is commonly claimed that the reliability is over 0.85 for all scales; but this is at best percentage of agreement (a much looser criterion than reliability), and not true for all scales (p. 504 in).

Validity

When interpreted as a projective test, results are thus poorly verifiable. The Exner system of scoring (also known as the "Comprehensive System") is meant to address this, and has all but displaced many earlier (and less consistent) scoring systems. It makes heavy use of what factor (shading, color, outline, etc.) of the inkblot leads to each of the tested person's comments. Disagreements about test validity remain.

Nevertheless, there is substantial research indicating the utility of the measure for a few scores. Several scores correlate well with general intelligence. Interestingly, one such scale is *R*, the total number of responses; this reveals the questionable side-effect that more intelligent people tend to be elevated on many pathology scales, since many scales do not correct for high R: if a subject gives twice as many responses overall, it is more likely that some of these will seem "pathological". Also correlated with intelligence are the scales for Organizational Activity, Complexity, Form Quality, and Human Figure responses (see Table 9.4 in). The same source reports that validity has also been shown for detecting such conditions as schizophrenia and other psychotic disorders; thought disorders; and personality disorders (including borderline personality disorder). There is some evidence that the Deviant Verbalizations scale relates to bipolar disorder. The authors conclude that "Otherwise, the Comprehensive System doesn't appear to bear a consistent relationship to psychological disorders or symptoms, personality characteristics, potential for violence, or such health problems as cancer" (pp. 2249-250 in). (Cancer is mentioned because a small minority of Rorschach enthusiasts have claimed the test can predict cancer.)

Reliability

It is also thought that the test's reliability can depend substantially on details of the testing procedure, such as where the tester and subject are seated; any introductory words; verbal and nonverbal responses to subjects' questions or comments; and how responses are recorded. Exner has published detailed instructions, but Wood et al. cites many court cases where it was found they have not been followed. Similarly, the procedures for coding responses are fairly well specified but extremely time-consuming to inexperienced examiners, and corners may be cut by a psychologist.

Population norms

Another area of controversy are the test's statistical norms. A great strength of Exner's system was thought to be the availability of normative scores for various populations. But, beginning in the mid-1990s others began to try to replicate or update these norms and failed. In particular, discrepancies seemed to focus on indices measuring narcissism, disordered thinking, and discomfort in close relationships. Lillenfeld and colleagues, who are critical of the Rorschach, have stated that this proves that the Rorschach tends to "overpathologise normals". But they may have failed to account for norm changes in the population that may have been drifting in a pathological direction — in other words, that the Rorschach may be accurately reflecting increasing psychopathology in society. As described by Hibbard, personality and social psychologists have written extensively on increasing narcissism in society, and this phenomenon has been shown in other research. The index for difficulty in interpersonal relationships has been found to be related to divorce and separation, whose rates have also increased since Exner's original norms were established.

The accusation of "over-pathologising" has also been rebutted, most recently and definitively, by Mayer et al (2007). They presented an international collaborative study of 4704 Rorschach protocols, obtained in 21 different samples, across 17 different countries, with only 2 % showing significant elevations on the index of perceptual and thinking disorder, 12 % elevated on indices of depression and hyper-vigilance and 13% elevated on persistent stress overload - all in line with expected frequencies among nonpatient populations .

Applications

The test is also especially controversial because it has been commonly used in court-ordered evaluations, as a major factor in assigning custody, granting or denying parole, and so on. This controversy stems, in part, from the limitations of the Rorschach, with no additional data, in making official diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Irving Weiner (co-developer with John Exner of the Comprehensive system) has stated that the Rorschach "is a measure of personality functioning, and it provides information concerning aspects of personality structure and dynamics that make people the kind of people they are. Sometimes such information about personality characteristics is helpful in arriving at a differential diagnosis, if the alternative diagnoses being considered have been well conceptualized with respect to specific or defining personality characteristics".

Secrecy of test items

Supporters of the test try to keep the actual cards secret so that the answers are spontaneous. The ethical principles of the American Psychological Association require psychologists to "maintain the integrity and security of test materials". The official test is sold only to licensed professionals. The inkblots were first made publicly available by William Poundstone in his book Big Secrets (1983), which also described the method of administering the test and gave outlines of the ten official images. The images have since been leaked on to the Internet. This reduced the value of projective testing for those individuals who have become familiar with the material, potentially impacting their care.

While the Rorschach Society has claimed that the blots are copyrighted, they have been in the public domain in Switzerland, the country of origin of Hermann Rorschach, since at least 1973 (50 years after Rorschach's death) according to Swiss copyright law. They are also in the public domain under United States copyright law based on when they were first created and published (before 1923), as well as in countries with a copyright term of up to 70 years post mortem auctoris.