© Markus Gann | 123rf.com
In 1904, a twenty-year-old medical student at the University of Zurich had a dream. After seeing his first autopsy, he dreamt that his brain was being cut. The dream was so vivid, that after he woke, he could still feel the sharp piercing of the knife. The powerful imagery of the dream captured his imagination and reinforced the medical student’s decision to specialize in psychiatry. That student was Hermann Rorschach, the creator of the inkblot test that bears his name.
The Rorschach inkblot test presents the test taker with a series of ten inkblots and asks them, “What might this be?” What was important to Rorschach was not what they saw, but how they approached the task. “What parts of the image did they focus on or ignore? Did they see the image moving? Did the color on some inkblots help them give better answers, or distract and overwhelm them?” The test taker’s responses are assumed to reflect underlying personality traits as well as unconscious conflicts, motives and fantasies.
The Rorschach is a projective test, where the psychologist writes down everything the participant says or does, no matter how trivial. Administrators of the test typically sit side-by-side in order to ensure they do not influence the test takers answers. There are ten official inkblots, each printed on a white card. Five inkblots are of black ink, two are of black and red ink and three are multicolored. Rorschach said, “The experiment is very simple, so simple that at first it provokes interest and head-shaking everywhere.”
The general goal of the test is to provide data about cognition and personality variables such as motivations, response tendencies, cognitive operations, affectivity, and personal/interpersonal perceptions. The underlying assumption is that an individual will class external stimuli based on person-specific perceptual sets, and including needs, base motives, conflicts, and that this clustering process is representative of the process used in real-life situations.
The general hypothesis underlying projective tests like the Rorschach Inkblot test is that when individuals attempt to understand vague or ambiguous stimuli, their interpretation reflects their needs, feelings, experience, prior conditioning and thought processes. The problem is identifying which needs, feelings, experience prior conditioning or thought processes are reflected in the test. “Projective tests can, by their own claim, draw equally upon the imagined and real, the conscious and unconscious, the recent and old, the important and trivial, the revealing and obvious.” This leaves a significant amount of room for interpretation, making validation of projective tests almost impossible.
Bsed on the belief of a Freudian defense mechanism, projection, they were widely used during the psychoanalytic era of 1940-1960. There are no hard and fast rules in scoring a Rorschach test. Most scoring is qualitative. “All but the most ardent proponents suggest the protocol be analyzed in the context of other tests and clinical information.” Validity and reliability are rendered meaningless by the open-ended, multiple possibilities that are allowed and by the lack of universally-accepted and standardized instructions, administration protocol and scoring procedure. Other evidence suggests there may be cultural biases, as several different cultures produce Rorschach scores different than those from the Exner norms.
The Rorschach Comprehensive System (RCS), also known as the Exner scoring system, is the standard method for interpreting the Rorschach test. Developed in the 1960s, it became the universal standard, “taught in universities, applied by researchers and used by psychologists to this day.” In 1998, Exner was recognized by the American Psychological Association: “Exner has almost single-handedly rescued the Rorschach and brought it back to life.” Today the Rorschach is administered hundreds of thousands of times each year. According to Annie Murphy Paul, 93% of all graduate programs approved by the American Psychological Association taught the test and 90% of clinical practitioners in the field believed psychology students should be trained in Rorschach assessment.
Among mental health professionals, it is the second most popular personality test available; in a recent survey, eight of ten clinical psychologists said they included it in their test batteries at least “occasionally,” and four out of ten reported that they “frequently” or “always” used it.
But, in the words of Annie Murphy Paul, the Rorschach was headed for a “near-death experience.” A psychology professor named James Wood coauthored a highly critical article in Psychological Science, “The Comprehensive System for the Rorschach: A Critical Examination.” The authors alleged, “Basic issues regarding the reliability and validity of the Comprehensive System have not been resolved.” They said the interrater reliability of most scores in the system have never been adequately demonstrated. The important scores and indices in the system were of questionable validity. The research basis of the system consisted mainly of unpublished studies that were often unavailable for examination.
In “The Scientific Status of Projective Techniques,” Lilenfield, Wood and Garb said that despite its widespread use by clinicians, the Rorschach Inkblot Test remained problematic from a psychometric standpoint. They said the scientific status of the RCS appeared to be less then convincing. The RCS norms for many variables appear to misclassify normal individuals as pathological. The possibility of cultural bias has not been excluded. “The substantial majority of Rorschach variables have not demonstrated consistent relations to psychological disorders or personality traits.”
Another article critical published in Psychological Assessment, “The Clinical Utility of the Rorschach: Unfulfilled Promises and an Uncertain Future,” concluded “there is little scientific evidence to support the clinical utility of the Rorschach.” The authors said even if the Rorschach could provide valid information about personality dynamics and treatment outcome, “There is currently no replicated evidence to indicate that this information has any meaningful bearing on services provided to clients and no evidence to substantiate claims of improved treatment outcomes accruing from this information.” They said the Rorschach has the dubious distinction of being, simultaneously, “the most cherished and the most reviled of all psychological assessment tools.”
Given the meager support from thousands of publications to date, the history of disagreements among proponents about the proper use of the Rorschach, and the uncertain acceptance by psychologists of a psychometrically and scientifically sound approach to Rorschach scoring and interpretation, we doubt that there will ever be sufficient evident to suggest that the Rorschach or the Comprehensive System can contribute, in routine clinical practice, to scientifically informed psychological assessment.
As Erica Goode noted in “What’s in an Inkblot,” there has been controversy with the Rorschach almost since its creation. She said early critics called it “cultish.” Later critics, as illustrated above, said it was “scientifically useless.” There is essentially no evidence that the Rorschach can accurately diagnose depression, anxiety, post-traumatic stress disorder or other emotional problems. Yet it has been used in custody disputes to help determine the emotional fitness of parents fighting over child custody and as a diagnostic tool in therapy.
The Rorschach is such a common feature of custody disputes that Fathers’ Right to Custody, a nonprofit organization, includes advice on its Web site on the best ways to respond to the inkblots. Describing one Rorschach card, for example, the site counsels, “This blot is supposed to reveal how you really feel about your mother.” In another case it advises, “Schizophrenics sometimes see moving people in this blot.”
Equally problematic is its use in parole and sentencing hearings to evaluate whether individuals are prone to violence or prone to commit future crimes. Research suggesting a correlation between Rorschach indicators and psychopathic tendencies and violent behavior has been challenged by other studies. “It just doesn’t work for most things it’s supposed to.” In some studies, the ability to predict behavior or diagnose mental disorders went down when data from Rorschach tests were added to information gleaned from other tests. It has become a synonym for “anything ambiguous enough to invite multiple interpretations.”
Dr. Exner, the developer of the RCS scoring system for the Rorschach, acknowledged the test could be unwittingly misused. He also said he was uncomfortable with its use in adversarial settings like custody disputes. “The strength of the test is that it helps the really capable interpreter to develop a picture of an individual.” If you’re only looking to diagnose someone, he didn’t think it was worth doing. On the other hand, if your intention was to treat someone, he thought the Rorschach was a helpful instrument.
Advocates like the author of Principles of Rorschach Interpretation argue that a diagnosis should never be made on the basis of the test alone. If it was going to be used effectively, you would take several factors into consideration. No single test makes the diagnosis. “Tests don’t ‘overpathologize.’ That’s done by the person who interprets them.”
In “The Scientific Status of Projective Tests,” the authors recommended that practitioners stop using the tests for purposes other than research. Alternatively, they suggested the interpretations of the tests be limited “to the very small number of indexes derived from these techniques that are empirically supported.” And that seems to be what further Rorschach research suggested.
In “The validity of individual Rorachach variables,” Mihura et al evaluated the peer-reviewed literature for the 65 main variables in the RCS scoring system. They found 13 variables had excellent support; 17 had good support; 10 had modest support; and 13 had little or no support. The variables with the strongest support were those that assessed cognitive and perceptual processes. Those with the least support tended to be very rare or more recently developed scales. “Our findings are less positive, more nuanced, and more inclusive than those reported in the CS [RCS] test manual.”
In “A second look at the validity of widely used Rorschach indices,” Wood et al agreed there was compelling evidence that 4 categories of cognitive scores in the Rorschach were related to cognitive ability/impairment and thought disorder. They were now comfortable endorsing the use of these scores in some applied and research settings. Unlike Mihura et al, they included unpublished dissertations in their analysis. Wood et al concluded that while the meta-analysis done by Mihura et al reflects the published literature, their neglect of unpublished studies resulted in overestimates of validity for many Rorschach scores. “Therefore, the evidence is presently insufficient to justify using the CS to measure noncognitive characteristics such as emotionality, negative affect, and bodily preoccupations.”
Mihura et al responded to Wood et al in “Standards accuracy, and questions of bias in Rorschach meta-analyses.” They said Wood et al used procedures that contradicted their standards and recommendations for sound Rorschach research and as a result, found lower effect sizes. They also said they found numerous methodological errors, data errors, and omitted studies. Many of their conclusions were said to be based on a narrative review of individual studies and post hoc analyses rather than their meta-analytic findings. “In short, one cannot rely on the findings or conclusions reported in Wood et al.”
So, is the Rorschach Inkblot test worth the time and trouble of administering and taking? Irving Weiner, a clinical professor of psychiatry and behavioral medicine at the University of South Florida, said:
The test can give you objective data, like a blood work. But we all know that some physicians, for whatever reason, are skillful diagnosticians beyond the tests, in seeing the way the patient looks or moves. The Rorschach is a stimulus that generates a lot of information. You may generate hypotheses that aren’t in the hard data yet, but that doesn’t mean this is the same thing as reading tea leaves.
Information presented here was also gleaned from the Online Rorschach Inkblot Test, the “Rorschach test,” and The Cult of Personality Testing by Annie Murphy Paul. You can see representations of the standard ten Rorschach inkblots on Online Rorschach Inkblot Test.