Rorschach inkblot test


 * This article is about the psychological exam. For other uses of the term "Rorschach", see Rorschach (disambiguation).

The Rorschach inkblot test (pronounced ) 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.

History
Originally created by Hermann Rorschach in 1921, the scoring system was improved after his death by, among others, Bruno Klopfer. 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 patient 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 patient is examining the inkblots, the psychologist writes down everything the patient says or does, no matter how trivial.

Methods of interpretation differ. 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 mathematical calculations producing a structural summary of the test data. The results of the structural summary are interpreted using existing empirical research data on personality characteristics that have been demonstrated to be associated with different kinds of responses. The calculations of scores are often done electronically.

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.

Controversy
The Rorschach inkblot test is controversial for several reasons.

First, because the basic premise of the test is that objective meaning can be extracted from responses to blots of ink which are supposedly meaningless. It seems that evaluating the results of the test requires the blots of ink to have meaning in the first place&mdash;though meaning of a very subtle kind that has not been directly explicated. Otherwise, the images projected into the patterns would be of little value in assessing personality traits. 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. Additionally, recent research has demonstrated that the blots are not entirely meaningless, and that a patient typically responds to meaningful as well as ambiguous aspects of the blots.

Some critics argue that the 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 whatever categories are involved. With the Exner system of scoring, however, 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 ). In Exner's system, however, 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; however, 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 ).

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 you give twice as many responses overall, you are more likely to give at least some seemingly "pathological" responses. Likewise 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 indeed predict cancer.)

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. Such cases, of course, point toward the failure of some psychologists to follow prescribed procedures, but are not an indictment of the Exner system in general. 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 who allows haste to take precedence over accuracy. It seems that with validity in question to begin with, any psychologist using the test should be extremely careful about following all rules of administration and interpretation to the letter.

Another area of controversy is the test's norms. A great strength of Exner's system was thought to be the availability of normative scores for various populations. However, beginning in the mid-1990s others began to attempt to replicate or update these norms, and found they could not. 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." . However, 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 the 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. With respect to Lilienfeld's finding concerning difficulty in interpersonal relationships, that particular index has been found to be related to divorce and separation whose rates have also increased since the establishment of Exner's original norms.

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) That fact, however, does not render the test without value for diagnostic purposes. 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".

Supporters of the test try to keep the actual cards secret so that the answers are spontaneous. This practice is consistent with the American Psychological Association's ethical standards of preserving test security. The official test is sold only to licensed professionals. These ethics were violated first by William Poundstone in his book Big Secrets (1983), which described the method of administering the test and gave outlines of the ten official images. The images have since been leaked to the Internet. This reduced the value of projective testing for those individuals who have become familiar with the material, potentially impacting their care. The Rorschach Society claims the blots are copyrighted; this has been disputed by others who state that the blots are in the public domain under U.S. copyright law based upon when they were first created and how long Rorschach has been dead (over 80 years).