read and respond essay

w w w . s c i a m . c o m S C I E N T I F I C A M E R I C A N 81

PICTURE?PICTURE? What’s Wrong with This

PSYCHOLOGISTS OF TEN USE THE FAMOUS RORSCHACH INKBLOT TEST AND REL ATED TOOLS TO ASSESS

PERSONALIT Y AND MENTAL ILLNESS. BUT RESEAR CH SAYS THE INSTRUMENTS ARE FREQUENTLY

INEFFECTIVE FOR THOSE PURPOSES

BY SCOTT O. LILIENFELD, JAMES M. WOOD AND HOWARD N. GARB

PHOTOGRAPHS BY JELLE WAGENAAR

But how correct would they be? The answer is important

because psychologists frequently apply such “projective” in-

struments (presenting people with ambiguous images, words

or objects) as components of mental assessments, and because

the outcomes can profoundly affect the lives of the respondents.

The tools often serve, for instance, as aids in diagnosing men-

tal illness, in predicting whether convicts are likely to become

violent after being paroled, in evaluating the mental stability of

parents engaged in custody battles, and in discerning whether

children have been sexually molested.

We recently reviewed a large body of research into how well

projective methods work, concentrating on three of the most

extensively used and best-studied instruments. Overall our find-

ings are unsettling.

Butterflies or Bison? T H E F A M O U S R O R S C H A C H inkblot test—which asks people to describe what they see in a series of 10 inkblots—is by far the

most popular of the projective methods, given to hundreds of

thousands, or perhaps millions, of people every year. The re-

search discussed below refers to the modern, rehabilitated ver-

sion, not to the original construction, introduced in the 1920s

by Swiss psychiatrist Hermann Rorschach.

The initial tool came under severe attack in the 1950s and

1960s, in part because it lacked standardized procedures and

a set of norms (averaged results from the general population).

Standardization is important because seemingly trivial differ-

ences in the way an instrument is administered can affect a

person’s responses to it. Norms provide a reference point for

determining when someone’s responses fall outside an accept-

able range.

In the 1970s John E. Exner, Jr., then at Long Island Uni-

versity, ostensibly corrected those problems in the early Ror-

schach test by introducing what he called the Comprehensive

System. This set of instructions established detailed rules for de-

livering the inkblot exam and for interpreting the responses,

and it provided norms for children and adults.

In spite of the Comprehensive System’s current popularity,

it generally falls short on two crucial criteria that were also

problematic for the original Rorschach: scoring reliability and

validity. A tool possessing scoring reliability yields similar re-

sults regardless of who grades and tabulates the responses. A

valid technique measures what it aims to measure: its results are

consistent with those produced by other trustworthy instru-

ments or are able to predict behavior, or both.

To understand the Rorschach’s scoring reliability defects, it

helps to know something about how reactions to the inkblots

are interpreted. First, a psychologist rates the collected reactions

on more than 100 characteristics, or variables. The evaluator,

for instance, records whether the person looked at whole blots

or just parts, notes whether the detected images were unusual

or typical of most test takers, and indicates which aspects of the

82 S C I E N T I F I C A M E R I C A N M A Y 2 0 0 1

What if you were asked to describe images you saw in an inkblot or to invent a story for an ambiguous illustration— say, of a middle-aged man looking away from a woman who was grabbing his arm? To comply, you would draw on your own emotions, experiences, memories and imagination. You would, in short, project yourself into the images. Once you did that, many practicing psychologists would assert, trained evaluators could mine your musings to reach conclusions about your personality traits, unconscious needs and overall mental health.

w w w . s c i a m . c o m

inky swirls (such as form or color) most

determined what the respondent report-

ed seeing.

Then he or she compiles the findings

into a psychological profile of the indi-

vidual. As part of that interpretive pro-

cess, psychologists might conclude that

focusing on minor details (such as stray

splotches) in the blots, instead of on

whole images, signals obsessiveness in a

patient and that seeing things in the

white spaces within the larger blots, in-

stead of in the inked areas, reveals a neg-

ative, contrary streak.

For the scoring of any variable to be

considered highly reliable, two different

assessors should be very likely to pro-

duce similar ratings when examining

any given person’s responses. Recent in-

vestigations demonstrate, however, that

strong agreement is achieved for only

about half the characteristics examined

by those who score Rorschach respons-

es; evaluators might well come up with

quite different ratings for the remaining

variables.

Equally troubling, analyses of the

Rorschach’s validity indicate that it is

poorly equipped to identify most psychi-

atric conditions—with the notable excep-

tions of schizophrenia and other distur-

bances marked by disordered thoughts,

such as bipolar disorder (manic-depres-

sion). Despite claims by some Rorschach

proponents, the method does not consis-

tently detect depression, anxiety disorders

or psychopathic personality (a condition

characterized by dishonesty, callousness

and lack of guilt).

Moreover, although psychologists

frequently administer the Rorschach to

assess propensities toward violence, im-

pulsiveness and criminal behavior, most

research suggests it is not valid for these

purposes either. Similarly, no compel-

ling evidence supports its use for detect-

ing sexual abuse in children.

Other problems have surfaced as

well. Some evidence suggests that the

Rorschach norms meant to distinguish

mental health from mental illness are

unrepresentative of the U.S. population

and mistakenly make many adults and

children seem maladjusted. For in-

stance, in a 1999 study of 123 adult vol-

unteers at a California blood bank, one

in six had scores supposedly indicative

of schizophrenia.

The inkblot results may be even

more misleading for minorities. Several

investigations have shown that scores

for African-Americans, Native Ameri-

cans, Native Alaskans, Hispanics, and

Central and South Americans differ

markedly from the norms. Together the

collected research raises serious doubts

about the use of the Rorschach inkblots

in the psychotherapy office and in the

courtroom.

Doubts about TAT A N O T H E R P R O J E C T I V E T O O L — the The- matic Apperception Test (TAT)—may

be as problematic as the Rorschach.

This method asks respondents to for-

mulate a story based on ambiguous

scenes in drawings on cards. Among the

31 cards available to psychologists are

ones depicting a boy contemplating a vi-

olin, a distraught woman clutching an

open door, and the man and woman

who were mentioned at the start of this

article. One card, the epitome of ambi-

guity, is totally blank.

The TAT has been called “a clini-

cian’s delight and a statistician’s night-

mare,” in part because its administra-

tion is usually not standardized: differ-

ent clinicians present different numbers

and selections of cards to respondents.

Also, most clinicians interpret people’s

stories intuitively instead of following

a well-tested scoring procedure. Indeed,

a recent survey of nearly 100 North

“It looks like two dinosaurs with huge heads and tiny bodies. They’re moving away from each other but looking back. The black blob in the middle reminds me of a spaceship.”

Once deemed an “x-ray of the mind,” the Rorschach inkblot test remains the most famous— and infamous— projective psychological technique. An examiner hands 10 symmetrical inkblots one at a time in a set order to a viewer, who says what each blot resembles. Five blots contain color; five are black and gray. Respondents can rotate the images. The one above is an inverted version of an Andy Warhol rendering; the actual Ror- schach blots cannot be published.

Responses to the inkblots purportedly reveal aspects of a person’s personality and mental health. Advocates believe, for instance, that references to moving animals—such as the dinosaurs mentioned above—often indicate impulsiveness, whereas allusions to a blot’s “blackness”—as in the spaceship—often indicate depression.

Swiss psychiatrist Hermann Rorschach probably got the idea of showing inkblots from a European parlor game. The test debuted in 1921 and reached high status by 1945. But a critical backlash began taking shape in the 1950s, as researchers found that psychologists often interpreted the same responses differently and that particular responses did not correlate well with specific mental illnesses or personality traits.

Today the Comprehensive System, meant to remedy those weaknesses, is widely used to score and interpret Rorschach responses. But it has been criticized on similar grounds. Moreover, several recent findings indicate that the Comprehensive System incorrectly labels many normal respondents as pathological.

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SCOTT O. LILIENFELD, JAMES M. WOOD and HOWARD N. GARB all conduct research on psychological assessment tools and recently collaborated on an extensive review of re- search into projective instruments that was published by the American Psychological So- ciety (see “More to Explore,” on page 87). Lilienfeld and Wood are associate professors in the departments of psychology at Emory University and the University of Texas at El Paso, respectively. Garb is a clinical psychologist at the Pittsburgh Veterans Administra- tion Health Care System and the University of Pittsburgh and author of the book Study- ing the Clinician: Judgment Research and Psychological Assessment.

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Wasted Ink?

American psychologists practicing in ju-

venile and family courts discovered that

only 3 percent relied on a standardized

TAT scoring system. Unfortunately,

some evidence suggests that clinicians

who interpret the TAT in an intuitive way

are likely to overdiagnose psychological

disturbance.

Many standardized scoring systems

are available for the TAT, but some of

the more popular ones display weak

“test-retest” reliability: they tend to yield

inconsistent scores from one picture-

viewing session to the next. Their validi-

ty is frequently questionable as well;

studies that find positive results are often

contradicted by other investigations. For

example, several scoring systems have

proved unable to differentiate normal in-

dividuals from those who are psychotic

or depressed.

A few standardized scoring systems

for the TAT do appear to do a good job

of discerning certain aspects of person-

ality—notably the need to achieve and a

person’s perceptions of others (a proper-

ty called “object relations”). But many

times individuals who display a high

need to achieve do not score well on mea-

sures of actual achievement, so the abili-

ty of that variable to predict a person’s

behavior may be limited. These scoring

systems currently lack norms and so are

The Thematic Apperception Test (TAT), created by Harvard University psychiatrist Henry A. Murray and his student Christiana Morgan in the 1930s, is among the most commonly used projective measures. Examiners present individuals with a subset (typically five to 12) of 31 cards displaying pictures of ambiguous situations, mostly featuring people. Respondents then construct a story about each picture, describing the events that are occurring, what led up to them, what the characters are thinking and feeling, and what will happen later. Many variations of the TAT are in use, such as the Children’s Apperception Test, featuring animals interacting in ambiguous situations, and the Blacky Test, featuring the adventures of a black dog and its family.

Psychologists have several ways of interpreting responses to the TAT. One promising approach—developed by Boston University psychologist Drew Westen—relies on a specific scoring system to assess people’s perceptions of others (“object relations”). According to that approach, if someone wove a story about an older woman plotting against a younger person in response to the image visible in the photograph at the right, the story would imply that the respondent tends to see malevolence in others—but only if similar themes turned up in stories told about other cards.

Surveys show, however, that most practitioners do not use systematic scoring systems to interpret TAT stories, relying instead on their intuitions. Unfortunately, research indicates that such “impressionistic” interpretations of the TAT are of doubtful validity and may make the TAT a projective exercise for both examiner and examinee.

THEMATIC APPER CEPTION TE ST

Picture Imperfect

not yet ready for application outside of

research settings, but they merit further

investigation.

Faults in the Figures I N C O N T R A S T T O T H E R O R S C H A C H and the TAT, which elicit reactions to existing

images, a third projective approach asks

the people being evaluated to draw the

pictures. A number of these instruments,

such as the frequently applied Draw-a-

Person Test, have examinees depict a hu-

man being; others have them draw hous-

es or trees as well. Clinicians commonly

interpret the sketches by relating specific

“signs”—such as features of the body or

clothing—to facets of personality or to

particular psychological disorders. They

might associate large eyes with paranoia,

long ties with sexual aggression, missing

facial features with depression, and so on.

As is true of the other methods, the re-

search on drawing instruments gives rea-

son for serious concern. In some studies,

raters agree well on scoring, yet in others

the agreement is poor. What is worse, no

strong evidence supports the validity of

the sign approach to interpretation; in

other words, clinicians apparently have

no grounds for linking specific signs to

particular personality traits or psychiatric

diagnoses. Nor is there consistent evi-

dence thats signs purportedly linked to

child sexual abuse (such as tongues or

genitalia) actually reveal a history of mo-

lestation. The only positive result found

repeatedly is that, as a group, people who

draw human figures poorly have some-

what elevated rates of psychological dis-

orders. On the other hand, studies show

that clinicians are likely to attribute men-

tal illness to many normal individuals

who lack artistic ability.

Certain proponents argue that sign

approaches can be valid in the hands of

seasoned experts. Yet one group of re-

searchers reported that experts who ad-

ministered the Draw-a-Person Test were

w w w . s c i a m . c o m S C I E N T I F I C A M E R I C A N 85

Hand Test Subjects say what hands pictured in various positions might be doing. This method is used to assess aggression, anxiety and other personality traits, but it has not been well studied.

Handwriting Analysis (Graphology) Interpreters rely on specific “signs” in a person’s handwriting to assess personality characteristics. Though useless, the method is still used to screen prospective employees.

Lüscher Color Test People rank colored cards in order of preference to reveal personality traits. Most studies find the technique to lack merit.

Play with Anatomically Correct Dolls Research finds that sexually abused children often play with the dolls’ genitalia; however, that behavior is not diagnostic, because many nonabused children do the same thing.

Rosenzweig Picture Frustration Study After one cartoon character makes a provocative remark to another, a viewer decides how the second character should respond. This instrument, featured in the movie A Clockwork Orange, successfully predicts aggression in children.

Sentence Completion Test Test takers finish a sentence, such as, “If only I could . . .” Most versions are poorly studied, but one developed by Jane Loevinger of Washington University is valid for measuring aspects of ego development, such as morality and empathy.

Szondi Test From photographs of patients with various psychiatric disorders, viewers select the ones they like most and least. This technique assumes that the selections reveal something about the choosers’ needs, but research has discredited it.

OTHER PRO JECTI VE TOOL S

What’s the Score?

Even when projective methods assess what they claim to measure, they RARELY ADD MUCH to information

that can be obtained in other, more practical ways.

Psychologists have dozens of projective methods to choose from beyond the Rorschach Test, the TAT and figure drawings. As the sampling below indicates, some stand up well to the scrutiny of research, but many do not.

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less accurate than graduate students at

distinguishing psychological normality

from abnormality.

A few global scoring systems, which

are not based on signs, might be useful.

Instead of assuming a one-to-one corre-

spondence between a feature of a draw-

ing and a personality trait, psychologists

who apply such methods combine many

aspects of the pictures to come up with a

general impression of a person’s adjust-

ment. In a study of 52 children, a global

scoring approach helped to distinguish

normal individuals from those with mood

or anxiety disorders. In another report,

global interpretation correctly differenti-

ated 54 normal children and adolescents

from those who were aggressive or ex-

tremely disobedient. The global approach

may work better than the sign approach

because the act of aggregating informa-

tion can cancel out “noise” from vari-

ables that provide misleading or incom-

plete information.

Our literature review, then, indicates

that, as usually administered, the Ror-

schach, TAT and human figure drawings

are useful only in very limited circum-

stances. The same is true for many other

projective techniques, some of which are

described in the box on the preceding page.

We have also found that even when

the methods assess what they claim to

measure, they tend to lack what psychol-

ogists call “incremental validity”: they

rarely add much to information that can

86 S C I E N T I F I C A M E R I C A N M A Y 2 0 0 1

Psychologists have many projective drawing instruments at their disposal, but the Draw-a- Person Test is among the most popular— especially for assessing children and adolescents. A clinician asks the child to draw someone of the same sex and then someone of the opposite sex in any way that he or she wishes. (A variation involves asking the child to draw a person, house and tree.) Those who employ the test believe that the drawings reveal meaningful information about the child’s personality or mental health.

In a sketch of a man, for example, small feet would supposedly indicate insecurity or instability—a small head, inadequacy. Large hands or teeth would be considered signs of aggression; short arms, a sign of shyness. And feminine features—such as long eyelashes or darkly colored lips—would allegedly suggest sex-role confusion.

Yet research consistently shows that such “signs” bear virtually no relation to personality or mental illness. Scientists have denounced these sign interpretations as “phrenology for the 20th century,” recalling the 19th-century pseudoscience of inferring people’s personalities from the pattern of bumps on their skulls.

Still, the sign approach remains widely used. Some psychologists even claim they can identify sexual abuse from certain key signs. For instance, in the child’s drawing at the right, alleged signs of abuse include a person older than the child, a partially unclothed body, a hand near the genitals, a hand hidden in a pocket, a large nose and a mustache. In reality, the connection between these signs and sexual abuse remains dubious, at best.

HUMAN FIGURE DRAWINGS

Misleading Signs

be obtained in other, more practical ways,

such as by conducting interviews or ad-

ministering objective personality tests.

(Objective tests seek answers to relative-

ly clear-cut questions, such as, “I fre-

quently have thoughts of hurting my-

self—true or false?”) This shortcoming of

projective tools makes the costs in mon-

ey and time hard to justify.

What to Do? S O M E M E N T A L H E A L T H professionals dis- agree with our conclusions. They argue

that projective tools have a long history of

constructive use and, when administered

and interpreted properly, can cut through

the veneer of respondents’ self-reports to

provide a picture of the deepest recesses

of the mind. Critics have also asserted

that we have emphasized negative find-

ings to the exclusion of positive ones.

Yet we remain confident in our con-

clusions. In fact, as negative as our over-

all findings are, they may paint an over-

ly rosy picture of projective techniques be-

cause of the so-called file drawer effect. As

is well known, scientific journals are more

likely to publish reports demonstrating

that some procedure works than reports

finding failure. Consequently, researchers

often quietly file away their negative data,

which may never again see the light of day.

We find it troubling that psychologists

commonly administer projective instru-

ments in situations for which their value

has not been well established by multiple

studies; too many people can suffer if er-

roneous diagnostic judgments influence

therapy plans, custody rulings or criminal

court decisions. Based on our findings, we

strongly urge psychologists to curtail their

use of most projective techniques and,

when they do select such instruments, to

limit themselves to scoring and interpret-

ing the small number of variables that

have been proved trustworthy.

Our results also offer a broader lesson

for practicing clinicians, psychology stu-

dents and the public at large: even sea-

soned professionals can be fooled by their

intuitions and their faith in tools that lack

strong evidence of effectiveness. When a

substantial body of research demonstrates

that old intuitions are wrong, it is time to

adopt new ways of thinking.

w w w . s c i a m . c o m S C I E N T I F I C A M E R I C A N 87

MORE TO E XPLORE The Rorschach: A Comprehensive System, Vol. 1: Basic Foundations. Third edition. John E. Exner. John Wiley & Sons, 1993.

The Comprehensive System for the Rorschach: A Critical Examination. James M. Wood, M. Teresa Nezworski and William J. Stejskal in Psychological Science, Vol. 7, No. 1, pages 3–10; January 1996.

Studying the Clinician: Judgment Research and Psychological Assessment. Howard N. Garb. American Psychological Association, 1998.

Evocative Images: The Thematic Apperception Test and the Art of Projection. Edited by Lon Gieser and Morris I. Stein. American Psychological Association, 1999.

Projective Measures of Personality and Psychopathology: How Well Do They Work? Scott O. Lilienfeld in Skeptical Inquirer, Vol. 23, No. 5, pages 32–39; September/October 1999.

The Scientific Status of Projective Techniques. Scott O. Lilienfeld, James M. Wood and Howard N. Garb in Psychological Science in the Public Interest, Vol. 1, No. 2, pages 27–66; November 2000. Available at www.psychologicalscience.org/newsresearch/publications/journals/pspi1_2.html

In 1995 a survey asked 412 randomly selected clinical psychologists in the Ameri- can Psychological Association how often they used various projective and non- projective assessment tools, including those listed below. Projective instruments present people with ambiguous pictures, words or things; the other measures are less open-ended. The number of clinicians who use projective methods might have declined slightly since 1995, but these techniques remain widely used.

HOW OF TEN THE TOOL S ARE USED

Popularity Poll

P R O J E C T I V E T E C H N I Q U E S

U S E A T L E A S T O C C A S I O N A L L Y

U S E A L W A Y S O R F R E Q U E N T L Y

U S E A T L E A S T O C C A S I O N A L L Y

U S E A L W A Y S O R F R E Q U E N T L Y

Rorschach 43% 82%

Human Figure Drawings 39% 80%

Thematic Apperception Test (TAT) 34% 82%

Sentence Completion Tests 34% 84%

CAT (Children’s version of the TAT) 06% 42%

N O N P R O J E C T I V E T E C H N I Q U E S *

Weshler Adult Intelligence Scale (WAIS) 59% 93%

Minnesota Multiphasic 58% 85% Personality Inventory-2 (MMPI-2)

Weschler Intelligence 42% 69% Scale for Children (WISC)

Beck Depression Inventory 21% 71%

* Those listed are the most commonly used nonprojective tests for assessing adult IQ (WAIS), personality (MMPI-2), childhood IQ (WISC) and depression (Beck Depression Inventory).

SOURCE: “Contemporary Practice of Psychological Assessment by Clinical Psychologists,” by C. E. Watkins et al. in Professional Psychology: Research and Practice, Vol. 26, No. 1, pages 54–60; 1995.