Received: by alpheratz.cpm.aca.mmu.ac.uk id EAA17536 (8.6.9/5.3[ref pg@gmsl.co.uk] for cpm.aca.mmu.ac.uk from fmb-majordomo@mmu.ac.uk); Wed, 21 Feb 2001 04:40:14 GMT Subject: Fwd: What's in an Inkblot? Some Say, Not Much Date: Tue, 20 Feb 2001 23:37:47 -0500 x-sender: wsmith1@camail2.harvard.edu x-mailer: Claris Emailer 2.0v3, Claritas Est Veritas From: "Wade T.Smith" <wade_smith@harvard.edu> To: "SKEPTIC-L" <skeptic@listproc.hcf.jhu.edu>, "Memetics Discussion List" <memetics@mmu.ac.uk> Content-Type: text/plain; charset="iso-8859-1" Content-transfer-encoding: quoted-printable Message-ID: <20010221043747.AAA15584@camailp.harvard.edu@[205.240.180.124]> Sender: fmb-majordomo@mmu.ac.uk Precedence: bulk Reply-To: memetics@mmu.ac.uk
What's in an Inkblot? Some Say, Not Much
By ERICA GOODE
Psychology has produced few more popular icons than the Rorschach inkblot
test.
Devised 80 years ago by a young Swiss psychiatrist, the Rorschach has
entered the language as a synonym for anything ambiguous enough to invite
multiple interpretations. And beyond its pop culture status, it has
retained a central role in personality assessment, administered several
hundred thousand times a year, by conservative estimates, to both
children and adults.
In custody disputes, for example, the test is used to help determine the
emotional fitness of warring parents. Judges and parole boards rely on it
for insight into a prisoner's criminal tendencies or potential for
violence. Clinicians use it in investigating accusations of sexual abuse,
and psychotherapists, as a guide in diagnosing and treating patients.
Yet almost since its creation, the inkblot test has also been
controversial, with early critics calling it "cultish" and later ones
deeming it "scientifically useless."
And in recent years, academic psychology departments have been divided
over the merits of the test, and some have stopped teaching it.
The debate is likely to become even more heated with the publication of
an article provoking discussion and anger among clinicians who routinely
use the Rorschach. In the article, three psychologists conclude that the
inkblot test and two others commonly used ‹ the Thematic Apperception
Test or T.A.T. and the Draw-a-Person test ‹ are seriously flawed and
should not be used in court or the consulting room.
"There has been a substantial gap between the clinical use of these tests
and what the research suggests about their validity," said Dr. Scott O.
Lilienfeld, an associate professor of psychology at Emory University and
the lead author of the article. "The research continues to suggest that
they are not as useful for most purposes as many clinicians believe."
The review, by Dr. Lilienfeld and two colleagues, Dr. James M. Wood of
the University of Texas at El Paso and Dr. Howard Garb of the University
of Pittsburgh, appears in the current issue of the journal Psychological
Science in the Public Interest, a publication of the American
Psychological Society.
The three tests are known as "projective" because they present people
with an ambiguous image or situation and ask them to interpret or make
sense of it. The test taker's responses are assumed to reflect underlying
personality traits and unconscious conflicts, motives and fantasies.
In the T.A.T., test takers are shown a series of evocative pictures
depicting domestic scenes and are asked to tell a story about each one.
The figure-drawing test requires drawing a person on a blank sheet of
paper and then drawing a second person of the opposite sex.
While the Rorschach and the other projective techniques may be valuable
in certain specific situations, the reviewers argue, the tests' ability
to diagnose mental illnesses, assess personality characteristics, predict
behavior or uncover sexual abuse or other trauma is very limited.
The tests, which often take hours to score and interpret, add little
information beyond what can be gleaned from far less time-consuming
assessments, the psychologists say. They recommend that practitioners
refrain from administering the tests for purposes other than research "or
at least limit their interpretations to the very small number of indexes
derived from these techniques that are empirically supported."
Dr. Lilienfeld said that the review was written to raise awareness of the
problems with the tests in the legal field and with "the hope that maybe
we can reach a small number of open-minded people, and in particular
students, who have yet to make up their minds on this issue."
But he added, "I'm confident that many will take issue with our
conclusions."
One of those is Dr. Irving B. Weiner, a clinical professor of psychiatry
and behavioral medicine at the University of South Florida and the
president of the International Rorschach Society, who said the authors of
the journal report took research findings out of context to bolster their
case.
Dr. Lilienfeld and his colleagues do not really understand how clinicians
use the tests, Dr. Weiner said. They "have been used for a long time very
effectively, with very good results and a great deal of scientific
support," he said.
Dr. Gregory J. Meyer, an associate professor of psychology at the
University of Alaska at Anchorage, who has studied the Rorschach, said
admonishing psychologists against using the tests was "not in the spirit
of advancing our science."
He said the journal's decision to run the psychologists' article was like
asking "someone who believes in creationism to review evolutionary theory
and make recommendations about it."
A History of Controversy
Projective tests are no strangers to controversy. The Rorschach, in
particular, has inspired intense passion in defenders and critics over
the decades, leading two scientists to observe in a 1999 paper that the
test had "the dubious distinction of being, simultaneously, the most
cherished and the most reviled of psychological assessment instruments."
Dr. Hermann Rorschach, a Swiss psychiatrist who worked with schizophrenic
patients, is believed to have gotten the idea for the test from a popular
European parlor game called Klexographie, which involves making inkblots
and telling stories about them. As a child, Dr. Rorschach was so good at
the game that he earned the nickname Klecks, or Blot. He died of
peritonitis a year after the test's publication in 1921. He was 37.
The Rorschach's champions have often been almost worshipful in their
belief in its ability to pare back the layers of the psyche, and the test
is generally regarded as offering a richness of information about a
person's psychological world that cannot be gained from interviews or
from "self-report" tests like the Minnesota Multiphasic Personality
Inventory or M.M.P.I.
The test has used the same 10 images since it was developed. Responses to
the inkblots can be scored using more than 100 criteria, including how
common or unusual the responses are, what areas of the blots are focused
on, whether movement is seen in the images, and so on.
In an earlier era, clinicians who demonstrated special skill in
interpreting the test were dubbed Rorschach "wizards," and the technique
sometimes was referred to as "an X- ray of the mind."
Over the years, the test's detractors have also been zealous, making at
times brutal attacks on its scientific validity, especially in the 1950's
and 1960's, when practitioners varied greatly in the ways they
administered and scored the tests.
Some of the criticism abated in the mid-1970's, when Dr. John E. Exner,
then a professor of psychology at Long Island University, developed
systematic rules for giving and scoring the Rorschach and established
norms against which the responses of test takers could be compared.
Dr. Exner's "comprehensive system" is used by a majority of psychologists
who administer the Rorschach. Dr. Exner says that Rorschach Workshops, a
North Carolina research foundation which he directs, trains an average of
300 clinicians a year in the method in the United States and several
hundred more in Europe and Japan. The foundation charges $650 for five
days of intense training in the technique.
With the comprehensive system, the test can yield a complex picture of
people's psychological strengths and weaknesses, the Rorschach's
proponents say, including their intelligence and overall mental
functioning, their ability to relate appropriately to other people, their
sexuality, and their fantasies, fears and preoccupations.
Below the Surface
The test is considered particularly powerful in situations in which
people may not be expected to volunteer negative information about
themselves.
For example, Dr. Carl F. Hoppe, a clinical psychologist who does
psychological evaluations for the Los Angeles Superior Court's family law
division, said he administered the Rorschach about 130 times a year in
"high-conflict" custody disputes.
In a custody evaluation, Dr. Hoppe said, parents are often motivated to
present themselves positively and to deny any sort of difficulties, and
the Rorschach is a way to look beyond the way people present themselves.
"We take some of the familiar away," he said, "and look at patterns of
perceptions in a highly statistical manner."
But even with Dr. Exner's scoring system, the embrace of the Rorschach,
and other projective tests, has been far from universal.
"There is widespread criticism, there's no doubt about it," said Dr.
Wayne H. Holtzman, Hogg professor of psychology at the University of
Texas at Austin, who in 1956 developed his own inkblot test to correct
deficiencies he saw in the Rorschach.
Dr. Lilienfeld and his colleagues argue, for example, that there is
"virtually no evidence" that the Rorschach can accurately diagnose
depression, anxiety, post-traumatic stress disorder or some other
emotional problems, calling into question the test's usefulness in
custody hearings or as a diagnostic tool in psychotherapy.
(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 scant, Dr. Lilienfeld and his colleagues conclude, are the data
supporting the test's use in parole and sentencing hearings to evaluate
whether prisoners are prone to violence or likely to commit future
crimes. Research suggesting a relationship between certain Rorschach
indicators and psychopathic tendencies and violent behavior has been
contradicted by later studies, the authors say.
"It just doesn't work for most things that it's supposed to," Dr. Wood
said.
And the psychologists argue that even when the Rorschach appears to have
greater validity ‹ for example, in assessing intelligence, diagnosing
schizophrenia and predicting a patient's success in psychotherapy ‹ it is
not clear how much additional knowledge is gained from the test.
In some studies, they point out, the ability of clinicians to predict
behavior or diagnose mental disorders actually went down when data from
the Rorschach were added to information derived from other tests.
"The critical question is what, if anything, does this measure buy you
above information that could be more easily collected," Dr. Lilienfeld
said.
Detecting Abnormality
Another problem with the Rorschach, the psychologists say in their
review, is that the test tends to "overpathologize," making even normal
people look maladjusted.
In a study, which they reviewed, of 123 subjects with no psychiatric
history who were given the test, most at a California blood bank, 16
percent scored in the abnormal range on the test's schizophrenia index ‹
far higher than the 1 percent incidence of the illness in the general
population indicated in other surveys. Eighteen percent showed signs of
clinical depression on the test, and 29 percent had indicators of extreme
narcissism.
Empirical backing for the validity of the other two projective measures,
the T.A.T. and the human figure drawing test, was sketchy at best, the
review's authors found, with the drawing test "the weakest" of the three
tests.
Psychologists like Dr. Weiner, the author of "Principles of Rorschach
Interpretation" and another book on the test, strongly disputed the
conclusions drawn in the review.
They said a diagnosis was never made on the basis of the test alone.
"There are plenty of studies that show the Rorschach can help you
identify people who have schizophrenia or whether people are depressed,"
Dr. Weiner said, "but the test doesn't make the diagnosis. No single test
that a clinician uses makes the diagnosis. If you're going to use this
instrument effectively, you're going to take a lot of things into
consideration."
He added: "Tests don't `overpathologize.' That's done by the person who
interprets them."
Dr. Meyer, of the University of Alaska, said that while more research
needed to be done on some of the issues raised by Dr. Lilienfeld and his
colleagues, their views did not fairly reflect what is known about the
validity of the Rorschach and other tests.
In an article to be published in the journal American Psychologist, Dr.
Meyer and other researchers conclude that the validity of psychological
tests, including the Rorschach and the T.A.T., is comparable to that of
medical tests, like ultrasounds and M.R.I.'s. The article is based on a
review of 125 meta-analyses of the validity of psychological and medical
tests.
But even Dr. Exner, the developer of the comprehensive system, agreed
that the test "can be abused unwittingly by the ill-trained person," and
he said he was uncomfortable with the use of the test in "adversarial"
settings, like custody disputes, unless the psychologist was working for
the court, rather than for one parent or the other.
"It takes a long time to learn the Rorschach and you've got to work at
it, it's not simple," said Dr. Exner, who is also the curator of the
Rorschach archives.
The real question for clinicians in using the test, he said, is, "What do
you want to know about the individual?"
"If you're interested only in some diagnostic labeling," Dr. Exner said,
"I don't know that the Rorschach is worth doing, not simply because of
time but because you're flooded with information that you're not going to
use. On the other hand, if you're going to treat someone, I think the
Rorschach is a pretty sturdy instrument.
"The strength of the test," he continued, "is that it helps the really
capable interpreter to develop a picture of an individual."
Copyright 2001 The New York Times Company
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