II.

Diagnostic Procedures

5. PROJECTIVE TESTING
Judith E. Fox, Ph.D

1. What are projective tests?

Projective tests are individually administered tests generally used to obtain information about emotional functioning. Projective tests are founded on the idea that in ambiguous, unstructured, and open-ended situations aspects of the individuals internal, emotional world are projected onto the environment to influence his or her perception and experience of it. Test responses are understood as samples of the individuals emotional life. Murray was one of the first psychologists to offer a description of how the process of projection works. Murrays ideas about projection were derived largely from Freud: To cope with what is felt to be personally threatening, individuals defensively turn what they experience internally to be dangerous into external dangers. Once the experienced dangers are perceived to be external, they are easier to cope with. Rather than viewing this process of projection necessarily as a defensive maneuver, Murray view it more as peoples tendency to be influenced in the cognitive mediation of perceptual inputs by their needs, interests, and overall psychological organi~ation.~ The label projective methods is applied to various techniques that present the examinee with such psychological activity.

2. What are the most commonly used projective techniques?

Among the many projective tests, the Rorschach, Thematic Apperception Test (TAT), and Draw-A-Person Test are perhaps the most commonly used. Sentence completion tests, in which the patient is asked to complete sentences such as my mother.. . or the best time I ever had was.. . also are common. Although many tests have been developed to uncover inner thoughts and feelings, Lindzey14 long ago suggested a way to classify projective tests on the nature of the projective activity: Associations: The patient is asked to verbalize a response to some stimuli. Examples include the Rorschach test, in which the subject views several ink blots and responds verbally to each, and the word association test, in which the patient is asked to indicate the word that comes to mind in response to another word. Completions:The patient completes an unfinished stimulus. Sentence completion tasks are an example. Constructions:The patient is required to form or develop a production out of a stimulus. The storytelling task of the TAT, for example, requires the patient to construct a story from a picture. Choice or ordering: Patients are asked to place objects in categories or rank order choices or preferences for items. Self-expression: The patient creates something without a stimulus to initiate the response. Drawing tasks or dramatic play are examples. All of these projective methods are based on the assumption that the patients responses and creations reflect some aspect of his or her inner world; thus they are viewed as vehicles that lend articulation to a persons inner experiences.
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3. What are the differences between objective and projective personality tests? When the subject is asked to guess what the examiner is thinking, we call it an objective test; when the examiner tries to guess what the subject is thinking, we call it a projective device.11 The utility of dichotomizing objective and projective tests is controversial. This dichotomy sometimes refers to the way in which a test has been developed, the degree to which the results involve clinician subjectivity, and/or whether or not test questions are open-ended. If often is used to classify tests based on whether they were developed in accordance with fundamental principles of measurement. These principles increase the likelihood that a test is a reliable and valid indicator of the personality variables that it purports to measure. Personality tests such as the Minnesota Multiphasic Personality Inventory (MMPI) may be termed objective when they do not require the clinician to exercise a great deal of individual judgment in ascertaining a subjects test score and personality profile. Even with objective tests, however, subjectivity of the examiner affects interpretation of the test profile. Exner, the developer of a major scoring and interpretation system for the Rorschach, notes that the objective-projective dichotomy is grossly over-simplified: Any stimulus situation that evokes or facilitates the process of projection can be considered a projective method. This is quite independent of whether or not basic rules of measurement have been employed in developing or establishing the test.4 Exner developed a comprehensive system of scoring and interpreting the Rorschach. This, then, is an example of a projective test that has been developed in a fashion similar to the objective test. Regardless of the type of test, contemporary psychologists generally interpret the findings in the context of history, behavior, and interpersonal relationships.
Personality Tests
OBJECTIVE
PROJECTIVE

Structured to elicit a specific class of responses ( e g , true-false inventories) Questions direct; answers self-evident Clinician individual judgement less exercised Developed through lengthy empirical testing and group comparison Individual scores can be graphed and compared with scores obtained from a normative sample

Elicit open-ended responses Questions unstructured; answers obscure Tend to require clinician subjectivity
? ?

4. Describe the Rorschach test. The Rorschach, one of the most widely used projective tests, was developed in 1921 by Hermann Rorschach. It consists of a set of ten ink blots. Each block is sequentially presented to the patient, who is asked to describe what the ink blot suggests. The examiner then asks about the various details of the perceptions to understand the key factors associated with their creation. Of the numerous scoring systems developed for Rorschach data, many involve looking at least three general categories: (1) the location or area of the ink blot on which the response is based; (2) the specific aspects or determinants of the blot used to form the percept (e.g., shape, color, shading), and (3) the content of the percept (e.g., whether it is human or animal). Some systems also attempt to capture the fashion by which the individual organized the response. The degree to which a percept represents an integrated andlor well-formed response often is one indicator of the intactness of the persons thinking. The major premise of the Rorschach is that a person organizes stimuli from the environment based on needs, motives, conflicts, and perceptual processes. Ambiguous stimuli, like ink blots, promote cognitive disorganization and represent the fashion and ease by which the individual draws from internal resources to organize and confront ambiguous situations.

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5. What are the assets and limitations of the Rorschach? Since its initial development, the Rorschach has been a controversial psychological testing instrument. Criticisms of the Rorschach, as is true of most projective tests, focus on the validity and reliability of the test instrument and the conclusions based on test results. Although both reliability and validity have reached acceptable levels on the Rorschach, more objective psychological tests reach superior levels of validity. The most contemporary, data-based system of scoring and interpreting the Rorschach is the Exner Comprehensive System: which provides many scores and formulas of varying reliability and validity. The examiner must be aware of the differences among scores in terms of psychometric properties to interpret test productions adequately. The Rorschach is a complex test. Extensive training in required to evaluate its findings, and some graduate school programs lack such training. Furthermore, the Rorschach may have limited value as an assessment tool for children, in whom its reliability may be adequate for short-term evaluation but limited for longer-term predictions. Lastly, because its administration and interpretation are relatively complex compared with some other psychological tests, it allows an increased possibility for error. On the positive side, highly trained Rorschach clinicians can describe a persons characteristics accurately based on responses to the test.I0The Rorschach also is thought to assist in the evaluation of underlying personality structure because its ambiguity bypasses conscious awareness and defensiveness. It often is used to evaluate an individual who outwardly presents as well-adjusted but inwardly may experience psychopathology. Edel13 has shown, for example, that individuals with borderline personality disorder may perform normally on structured tests, but demonstrate psychopathology on the less structured Rorschach. Lastly, the Rorschach is relatively easy to administer.

6. Describe the Thematic Apperception Test (TAT) and discuss its assets and limitations. The TAT is a projective test developed by Henry Murray in the mid 1930s. It consists of 20 cards that depict a variety of ambiguous scenes. The subject is instructed to make up a story about each card and to include a beginning, middle, and end to the story as well as to describe the thoughts and feelings of the characters. Unlike the Rorschach, the TAT presents more structured test stimuli. It requires a different kind of organization and verbal response. Its interpretation is largely based on Murrays theory of personality, which emphasizes both biologic and socioenvironmental determinants of behavior. Murray believed that the way in which individuals deal with their environment involves both how their environment affects them and how their unique set of needs, attitudes, and values affects their reaction to the environment. The TAT grew from Murrays motivation to assess individuals psychological needs. Generally, the interpretation of TAT responses is based on content analysis of the story. Quantitative analysis of the TAT generally is not attempted, even though some scoring systems have been successfully a~p1ied.l~ Because scoring systems generally are not applied, the reliability and validity of the measure are difficult to ascertain. The effectiveness of the technique often depends more on the clinicians skill than on the quality of the test. On the positive side, the TAT provides material related to various aspects of psychological functioning, including mood, interpersonal themes, problem-solving style, and motivational variables. Patients generally find the test interesting and nonthreatening, and it is easy to administer. Like all projective techniques, the TAT may bypass conscious defenses and facilitate self-revelation.
7. What are projective drawings? How are they used? One common assumption of projective drawing tests of personality is that individuals symbolically create themes, dynamics, and attitudes that project images, feelings, and thoughts vital to understanding the individuals. Projective drawings were most popular during the 1950s and 1960s when psychoanalytic theory was dominant. Goodenoughs Draw-A-Man Test, developed in 1926,7 was the first projective drawing test; it was used to estimate a childs level of intellectual maturity. MachoverI6 extended projective drawings into the area of personality assessment. Such characteristics as size of drawing and

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placement on the page were interpreted as indicators of self-esteem and/or mood. Koppitzl* expanded the developmental and personality aspects of human figure drawings by creating scoring systems reflecting various cognitive and emotional attributes. The House-Tree-Person Test was concurrently by Buck. In 1987 Burns developed the Kinetic House-Tree-Person Test, in which the patient is asked to make the person in the drawing do something. This is probably the most popular form of projective drawings used today. Similarly, the Burns Kinetic Family Drawing, in which the patient draws his family doing something, has been used to assess interpersonal relationships and family dynamics. In interpreting drawings, clinicians tend to depend on clinical intuition, judgment, and experience. In a review of projective drawings, Grath-Marnat8concludes that projective drawings have been used most successfully as a rough measure of intellectual maturation. They are moderately successful in measuring global estimates of adjustment, impulsivity, and anxiety. They are least successful in assessing specific aspects of personality or in making clear diagnoses. 8. How is the efficacy of results produced by projective testing evaluated? Test reliability. Many projective tests have been criticized for results that are not highly stable, consistent, and predictable. Reliability refers to the extent to which an individual will achieve the same score if the test is administered again. Although some variability between scores is expected, a test is thought to be most reliable when variability is at a minimum. In evaluating the reliability of a test, higher reliabilities are obtained when stable variables are measured (e.g., stable personality traits), and lower reliabilities when unstable aspects (e.g., current emotional states) are measured. Some projective tests (e.g., the TAT) lack normative data; the clinician must rely on his or her own experience to interpret the responses. The effectiveness of the technique often depends more on the clinicians skills than on the quality of the test. Patient responses to projective tests also have been found to be affected by such variables as mood, stress, sleep deprivation, and differences in instruction. Such variables may limit a reliable measure of personality traits. Furthermore, when a personality test does not use standardized administration and scoring, its reliability is severely reduced. Test validity. Projective tests also have been criticized for the degree to which they actually measure what they intend to measure. Validity involves the relationship between the test and some external, independently observed event. Thus, a score on impulse control on a particular projective test should correlate highly with some observed criterion of impulse control, i.e., how the patient behaves when experiencing strong emotions. Validity data on projective tests are limited. Test-taking factors. Projective techniques generally are viewed as less susceptible to faking, because they present the subject with an ambiguous situation in which the underlying concepts are covert or unknown. Individuals, therefore, are less able to manipulate their responses to be viewed in a particular light. Projective tests also are nonthreatening to most subjects because they are intrinsically interesting and have no wrong answers. 9. When should patients be referred for projective testing? In general, projective testing is used to address questions about emotional functioning. Examples include the nature and level of depression, anxiety, and/or anger; level and style of impulse control; quality and clarity of thinking (e.g., does the patient experience disordered thinking and/or psychosis); coping styles and capacities; style and capacity for relatedness to others; experience of others; style of solving problems; originality and integrative capacities; emotional responses to stress; emotional reactivity; defensiveness and style of defense; level of personal adjustment or ego functioning; ability to tolerate stress; adequacy of daily functioning; reality testing; level of selfesteem; and experience of family dynamics. Although some psychologists may use projective testing alone to answer some of the above questions, i t is more often used as part of a battery of tests and interpreted in the context of responses to several tests, history, and present described functioning. Projective tests are viewed as often versatile and rich in their findings but not as self-sufficient. Several authors, such as Anastasi,

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have emphasized that projective tests give optimal results when used in a battery of tests and/or as a type of structured clinical interview. Others have noted, however, that test results have not been shown to increase in validity with the addition of other tests.6

10. In what specific situations is projective testing especially valuable? Personality tests often are used to identify the patients verbal responses to structured vs. unstructured situations. Such information may be invaluable to understand how someone who generally appears to function well in a structured interview would handle an ambiguous situation that may be more stressful and disorganizing. Individuals with borderline personality disorder, for example, may perform well on structured tests but evidence disorganized thinking on ambiguous, projective tests. Projective tests may address certain diagnostic questions pertaining to the intactness of thinking and reality testing. Projective testing also may be useful in gaining information about emotional functioning in situations in which the individual is highly defensive andor motivated to appear in particular ways during interview or on more direct, objective tests. Such an approach to test-taking may be part of patients overt personality style or related more to their situation, e.g., feeling a need to present well because of a pending legal situation. In such instances, the ambiguity of projective testing may bypass the patients reluctance to provide personal material.
BIBLIOGRAPHY
1. Anastasi A: Psychological Testing, 6th ed. New York, Macmillan, 1988. 2. Bellak L: The TAT, CAT and SAT in Clinical Use, 4th ed. New York, Grune & Stratton, 1986. 3. Edell WS: Role of structure in disordered thinking in borderline and schizophrenic disorders. J Pers Assess 51:23-41, 1987. 4. Exner JE: Rorschach assessment. In Weiner LB (ed): Clinical Method in Psychology. New York, John Wiley & Sons, 1983. 5. Exner JE: The Rorschach: A Comprehensive System, vol 1,2nd ed. New York, John Wiley & Sons, 1986. 6. Garb HN: The incremental validity of information used in personality assessment. Clin Psychol Rev 4:641-655, 1985. 7. Goodenough F: Measurement of Intelligence by Drawings. New York, World Book, 1926. 8. Grath-Mamat G: Handbook of Psychological Assessment, 2nd ed. New York, John Wiley & Sons, 1990. 9. Handler L: The clinical use of the Draw-A-Person Test (DAP). In Newmark CS (ed): Major Psychological Assessment Instruments. Newton, MA, Selyn & Bacon, 1985. 10. Karon B P Projective tests are valid. Am Psychol 33:764-765, 1978. 11. Kelly GA: The theory and technique of assessment. Annu Rev Psychol 9:325-352, 1958. 12. Koppitz EM: Psychological Evaluation of Human Figure Drawings by Middle School Pupils. New York, Grune & Stratton, 1984. 13. Leiter E: The role of projective testing. In Wetzler S, Katz M (eds): Contemporary Approaches to Psychological Assessment. New York, BrunnerMazel, 1989. 14. Lindzey G: Projective Techniques and Cross-Cultural Research. New York, Appleton-Century-Crofts, 1961. 15. McClelland DC: The Achieving Society. NJ, Van Norstrand, 1961. 16. Machover K: Personality Projection in the Drawings of the Human Figure. Springfield, IL, Charles C Thomas, 1949. 17. Oster GD, Gould P: Using Drawings in Assessment and Therapy. New York, Brunnerhlazel, 1987. 18. Rabin I (ed): Assessment with Projective Techniques. New York, Springer, 1981. 19. Weiner IB: Conceptual and empirical perspectives on the Rorschach assessment of psychopathology. J Pers Assess 50:472-479.