The first of the ten cards in the Rorschach test, with the occurrence of the most statistically frequent details indicated.[1][2] The images themselves are only one component of the test, whose focus is the analysis of the perception of the images.

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The Rorschach test (German pronunciation: [ʁoɐˈʃax]; also known as the Rorschach inkblot test or simply as an Inkblot test) is a method of psychological evaluation in which subjects' perceptions of inkblots are recorded and then analyzed using, depending on the psychologist, intuitive insight, complex scientifically derived algorithms, or both. Some psychologists use this test to try to examine the personality characteristics and emotional functioning of their patients. It has been employed in diagnosing underlying thought disorder and differentiating psychotic from nonpsychotic thinking in cases where the patient is reluctant to admit openly to psychotic thinking.^[3] The test takes its name from that of its creator, Swiss psychologist Hermann Rorschach.

In a national survey in the U.S., the Rorschach was ranked eighth among psychological tests used in outpatient mental health facilities.^[4] It is the second most widely used test by members of the Society for Personality Assessment, and it is requested in 25% of forensic assessment cases,^[4] usually in a battery of tests frequently also including the MMPI-2 and the MCMI-III.^[5] In surveys, 80% of clinical psychologists engaging in assessment services utilize the Rorschach, and 80% of psychology graduate programs teach it.^[6]

Although the Exner Scoring System (developed since the 1960s) has addressed and often refuted many criticisms of the original testing system with an extensive body of research,^[7] some researchers have raised questions about 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.^[8]

History

Hermann Rorschach created the Rorschach inkblot test in 1921.

Using interpretation of "ambiguous designs" to assess an individual's personality is an idea that goes back to Leonardo da Vinci and Botticelli. Interpretation of inkblots was central to a game from the late 19th century. Rorschach's, however, was the first systematic approach of this kind.^[9]

It has been suggested that Rorschach's use of inkblots may have been inspired by German doctor Justinius Kerne who, in 1857, had published a popular book of poems, each of which was inspired by an accidental inkblot.^[10] French psychologist Alfred Binet had also experimented with inkblots as a creativity test,^[11] and, after the turn of the century, psychological experiments where inkblots were utilized multiplied, with aims such as studying imagination and consciousness.^[12]

After studying 300 mental patients and 100 control subjects, in 1921 Rorschach wrote his book "Psychodiagnostik", which was to form the basis of the inkblot test, but he died the following year. Although Rorschach had served as vice president of the Swiss Psychoanalytic Society, he had trouble in getting the book published, and it attracted little notice when first published.^[13]

In 1927, the newly founded Hans Huber publishing house purchased Rorschach's book "Psychodiagnostik" from the inventory of Ernst Bircher.^[14] Huber has remained the publisher of the test and related book, with Rorschach a registered trademark of Swiss publisher Verlag Hans Huber, Hogrefe AG.^[15] The work has been described as "a densely written piece couched in dry, scientific terminology" ^[16]

After Rorschach's death, the original test scoring system was improved by Samuel Beck, Bruno Klopfer and others.^[17] John E. Exner summarized some of these later developments in the comprehensive 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 remains very popular in the United States, while in Europe other methods sometimes dominate,^[18][19] such as that described in the textbook by Evald Bohm, which is closer to the original Rorschach system and closer to the original psychoanalysis principles.^{[citation needed]}

Method

There are ten official inkblots. Five inkblots are black ink on white paper; two are black and red ink on white paper; and three are multicolored. After the individual has seen and responded to all the inkblots, the tester then presents them 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 subject is usually asked to hold the cards and may rotate them; whether the cards are rotated, and other related factors such as whether permission to rotate them is asked, may expose personality traits and normally contribute to the assessment.^[20] As the subject is examining the inkblots, the psychologist writes down everything the subject says or does, no matter how trivial.

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. ^[21] Methods of interpretation differ. Rorschach scoring systems have been described as a system of pegs on which to hang one's knowledge of personality.^[22] The most widely used method in the United States is based on the work of John E. Exner.

Features or categories

The interpretation of the Rorschach test is not based primarily on the contents of the response, i.e., what the individual sees in the inkblot (the content). 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: for instance, information is provided by the time taken before providing a response for a card can be significant (taking a long time can indicate "shock" on the card),^[23] as well as by any comments the subject may make in addition to providing a direct response^[24]

In particular, information about determinants (the aspects of the inkblots that triggered the response, such as form and color) and location (which details of the inkblots triggered the response) is often considered more important than content, although there is contrasting evidence.^[25][26] Popularity (or originality)^[27] can also be considered another basic category.^[28]

Content

This section requires expansion.

Content is classified in terms of "human", "nature", "animal", "abstract", etc., as well as for statistical popularity (or, conversely, originality).^[29]

More than any other feature in the test, content response can be controlled consciously by the subject, and may be elicited by very disparate factors, which makes it difficult to use content alone to draw any conclusions about the subject's personality; with certain individuals, content responses may potentially be interpreted directly, and some information can at times be obtained by analyzing thematic trends in the whole set of content responses (which is only feasible when several responses are available), but in general content cannot be analyzed outside of the context of the entire test record.^[30]

Location

This section requires expansion.

The basis for the response is usually the whole inkblot, a detail (either a commonly or an uncommonly selected one), or the negative space around or within the inkblot.^[31]

Determinants

Systems for Rorschach scoring generally include a concept of "determinants": these are the factors that contribute to estabilish the similarity between the inkblot and the subject's content response about it, and they can represent certain basic experiential-perceptual attitudes, showing aspects of the way a subject perceives the world. Rorschach's original work used only form, color and movement; currently, another major determinant considered is shading.^[32]

Form is the most common determinant, and is related to intellectual processes; color responses often provide direct insight into emotional life. Shading and movement have been considered more ambiguously, both in definition and interpretation: Rorschach originally disregarded shading (which was originally not even present on the cards, being a result of the print process),^[33] and he considered movement as only actual experiencing of motion, while others have widened the scope of this determinant, taking it to mean that the subject sees something "going on".^[34]

More than one determinant can contribute to the formation of the subject's percept, and fusion of two determinants is taken into account, while also assessing which of the two constituted the primary contributor (e.g. "form-color" implies a more refined control of impulse than "color-form"). It is, indeed, from the relation and balance among determinants that personality can be most readily inferred.^[34]

Exner scoring system

The Exner scoring system, also known as the Rorschach comprehensive system (RCS),^[35] is the standard method for interpreting the Rorschach test. It was developed in the 1960s by Dr. John E. Exner, as a more rigorous system for Rorschach test analysis. It has been heavily validated, and shows high inter-rater reliability.^[7][36] In 1969, Dr. Exner published The Rorschach Systems, a concise description of what would be later called the Exner system. Later, Dr. Exner published a study in multiple volumes called The Rorschach: A Comprehensive system, the most accepted full description of the Exner system.

Creation of the new system was prompted by the realization that at least five related, but ultimately different methods were in common use at the time, with a sizable minority of examiners not employing any recognized method at all, basing instead their judgment on subjective assessment, or arbitrarily mixing characteristics of the various standardized systems.^[37]

The key components of the Exner system are the clusterization of Rorschach variables and a sequential search strategy to determine the order in which to analyze them,^[38] framed in the context of standardized administration, objective, reliable coding and a representative normative database.^[39]

In the 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. It has been reported that popular responses on the first card include bat, badge and coat of arms.^[22]

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.

With the Rorschach plates (the ten inkblots), the area of each blot which is distinguished by the client is noted and coded – typically as "commonly selected" or "uncommonly selected". There were many different methods for coding the areas of the blots. Exner settled upon the area coding system promoted by S. J. Beck (1944 and 1961). This system was in turn based upon Klopfer's (1942) work.

As pertains to response form, a concept of "form quality" was present from the earliest of Rorschach's works, as a subjective judgment of how well the form of the subject's response matched the inkblots (Rorschach would give a higher form score to more "original" yet good form responses), and this concept was followed by other methods, especially in Europe; in contrast, the Exner system solely defines "good form" as a matter of word occurrence frequency, reducing it to a measure of the subject's distance to the population average.^[40]

Controversy

The Rorschach inkblot test is considered controversial by some researchers for several reasons. Some skeptics consider the Rorschach inkblot test pseudoscience,^[8] as several studies suggested that conclusions reached by test administrators since the 1950s were akin to cold reading.^[41]

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.^[7]

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.^[7] Another example is that the response "bra" was considered a "Sex" response by male psychologists, but a "Clothing" response by females.^[42] But in Exner's system, such a response is always coded as "clothing" unless there is a clear sexual reference in the response.^[7]

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.^[43] This conclusion was refuted in studies using large samples reported in 2002.^[44]

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.^[45] 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".^[46] (Cancer is mentioned because a small minority of Rorschach enthusiasts have claimed the test can predict cancer.)^[47]

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.^[42] 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.^[48] Lillenfeld and colleagues, who are critical of the Rorschach, have stated that this proves that the Rorschach tends to "overpathologise normals".^[48] 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,^[49] personality and social psychologists have written extensively on increasing narcissism in society, and this phenomenon has been shown in other research.^[50] 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 by Meyer 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.^[51]

Applications

The test is also controversial because of its common use in court-ordered evaluations.^{[citation needed]} 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).^[52] 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".^[53] In the vast majority of cases, anyway, the Rorschach test wasn't singled out but used as one of several in a battery of tests^[5], and despite the criticism of usage of the Rorschach in the courts, out of 8,000 cases in which forensic psychologists used Rorschach-based testimony, the appropriateness of the instrument was challenged only six times, and the testimony was ruled inadmissible in only one of those cases.^[6] Moreover, use of the test in courts has increased by three times in the decade between 1996 and 2005, compared to the previous fifty years.^[5]

Protection of test items and ethics

Outlines of the ten official inkblots were first made publicly available by William Poundstone in his 1983 book Big Secrets, which also described the method of administering the test.

While the International Society of the Rorschach and Projective Methods (ISR) has claimed that the blots are copyrighted^{[citation needed]}, they have been in the public domain in Hermann Rorschach's native Switzerland, since at least 1992 (70 years after his 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.

The American Psychological Association (APA) rules of ethics, designed to ensure "the welfare and protection of the individuals and groups with whom psychologists work", require that psychologists "make reasonable efforts to maintain the integrity and security of test materials".^[54] A public statement by the British Psychological Society expresses similar concerns and considers the "release of [test] materials to unqualified individuals" to be misuse "which may result in harm to the client".^[55] The APA states that the dissemination of test materials "imposes very concrete harm to the general public" as well, in that "there are a limited number of standardized psychological tests considered appropriate for a given purpose"^[56] (for example, detecting suicidality^[57][58][59]). In the book "Ethics in psychology", it is noted that some believe "reprinting copies of the Rorschach plates ... and listing common responses represents a serious unethical act" for psychologists and is indicative of "questionable professional judgment".^[60]

It has been claimed^[who?] that publication of the inkblots has rendered the test meaningless. It is unknown how easily someone might study the inkblots and fool a psychologist into giving a wrong diagnosis.^[61]

The ten inkblots

The ten inkblots of the Rorschach test printed in Rorschach's Rorschach Test – Psychodiagnostic Plates (Hogrefe, 1927, ISBN: 3-456-82605-2), together with the most frequent responses for either the whole image or the most prominent detail (according to Samuel Beck).^[62] They have been in the public domain in Hermann Rorschach's native Switzerland, since at least 1992 (70 years after his 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).

Plate 1 (bat, butterfly, moth)	Plate 2 (two humans)	Plate 3 (two humans)	Plate 4 (animal skin, massive animal)	Plate 5 (bat, butterfly, moth)
Plate 6 (animal hide, skin, rug)	Plate 7 (human heads, faces)	Plate 8 (pink: animal)	Plate 9 (orange: human)	Plate 10 (blue: crab, lobster, spider)

See also

• Holtzman Inkblot Test – a similar inkblot test designed to correct the limitations of the Rorschach
• Pareidolia
• Picture Arrangement Test
• Projective test
• Thematic Apperception Test

Notes

References

• Rorschach, H. (1998), Psychodiagnostics: A Diagnostic Test Based on Perception, Cambridge, MA, Hogrefe Publishing Corp., 10th Edition, ISBN 978-3-456-83024-7
• Rorschach, H. (1927), Rorschach Test – Psychodiagnostic Plates, Cambridge, MA, Hogrefe Publishing Corp., ISBN 3-456-82605-2.
• Gacano, Carl B.; J. Reid Meloy (1994). The Rorschach Assessment of Aggressive and Psychopathic Personalities. Hillsdale, New Jersey Hove, UK: Lawrence Erlbaum Associates. ISBN 978-0805809800. http://www.questia.com/PM.qst?a=o&d=26031482. 
• Weiner, Irving B. (2003). Principles of Rorschach interpretation. Mahwah, N.J.: L. Erlbaum Associates. ISBN 9780805842326. 
• Exner, John E. (1995). The Rorschach: A Comprehensive System. Vol 1: Basic Foundations. New York: Wiley. ISBN 0-471-55902-4. 
• Groth-Marnat, Gary (2003). Handbook of psychological assessment. John Wiley and Sons. ISBN 9780471419792. 
• Lilienfeld, Jim; Nezworski, M. Teresa (2003). What's Wrong with the Rorschach?. San Francisco, CA: Jossey-Bass, John Wiley & Sones. ISBN 9780787960568. 
• Dana, Richard H. (2000). Handbook of cross-cultural and multicultural personality assessment. Lawrence Erlbaum Associates. ISBN 9780805827897. 

External links

Wikimedia Commons has media related to: Rorschach test

• The International Society of the Rorschach and Projective Methods (ISR)
• Overview of the Rorschach test, published by the Göteborgs Universitet, Sweden