RORSCHACH TEST

The Rorschach test is a psychological test in which subjects' perceptions of inkblots are recorded and then analyzed
using psychological interpretation, complex algorithms, or both. Some psychologists use this test to examine a person's
personality characteristics and emotional functioning. It has been employed to detect underlying thought disorder,
especially in cases where patients are reluctant to describe their thinking processes openly. The test is named after its
creator, Swiss psychologist Hermann Rorschach. In the 1960s, the Rorschach was the most widely used projective test.
Although the Exner Scoring System (developed since the 1960s) claims to have addressed and often refuted many
criticisms of the original testing system with an extensive body of research, some researchers continue to raise questions.
The areas of dispute include the objectivity of testers, 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.

HISTORY
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, Gobolinks, from the late 19th century. Rorschach's,
however, was the first systematic approach of this kind. The ink blots were hand drawn by Rorschach.

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

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 (after experimenting with several hundred inkblots, he selected a set of ten for
their diagnostic value), but he died the following year. Although he had served as Vice President of the Swiss
Psychoanalytic Society, Rorschach had difficulty in publishing the book and it attracted little attention when it first
appeared.

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

After Rorschach's death, the original test scoring system was improved by Samuel Beck, Bruno Klopfer and others. 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, such as
that described in the textbook by Evald Bohm, which is closer to the original Rorschach system and rooted more deeply
in the original psychoanalysis principles.

Rorschach never intended the inkblots to be used as a general personality test, but developed them as a tool for the
diagnosis of schizophrenia. It was not until 1939 that the test was used as a projective test of personality, a use of which
Rorschach had always been skeptical. Interviewed in 2012 for a BBC Radio 4 documentary, Rita Signer, curator of the
Rorschach Archives in Bern, Switzerland, suggested that far from being random or chance designs, each of the blots
selected by Rorschach for his test had been meticulously designed to be as ambiguous and "conflicted" as possible.

METHOD
The Rorschach test is appropriate for subjects from the age of five to adulthood. The administrator and subject typically
sit next to each other at a table, with the administrator slightly behind the subject. Side-by-side seating of the examiner
and the subject is used to reduce any effects of inadvertent cues from the examiner to the subject. In other words, side-
by-side seating mitigates the possibility that the examiner will accidentally influence the subject's responses. This is to
facilitate a "relaxed but controlled atmosphere".
There are ten official inkblots, each printed on a separate white card, approximately 18 by 24 cm in size. Each of the blots
has near perfect bilateral symmetry. Five inkblots are of black ink, two are of black and red ink and three are multicolored,
on a white background. After the test subject has seen and responded to all of the inkblots (free association phase), the
tester then presents them again one at a time in a set sequence for the subject to study: the subject is asked to note
where he sees what he originally saw and what makes it look like that (inquiry phase). 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 contributes to the assessment. As the subject is
examining the inkblots, the psychologist writes down everything the subject says or does, no matter how trivial. Analysis
of responses is recorded by the test administrator using a tabulation and scoring sheet and, if required, a separate location
chart.

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

Administration of the test to a group of subjects, by means of projected images, has also occasionally been performed,
but mainly for research rather than diagnostic purposes.

Test administration is not to be confused with test interpretation. The interpretation of a Rorschach record is a complex
process. It requires a wealth of knowledge concerning personality dynamics generally as well as considerable experience
with the Rorschach method specifically. Proficiency as a Rorschach administrator can be gained within a few months.
However, even those who are able and qualified to become Rorschach interpreters usually remain in a "learning stage"
for a number of years.

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) as well as
by any comments the subject may make in addition to providing a direct response.

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. "Popularity" and "originality" of responses can also be considered as basic
dimensions in the analysis.

Content
The goal in coding content of the Rorschach is to categorize the objects that the subject describes in response to the
inkblot. There are 27 established codes for identifying the name of the descriptive object. The codes are classified and
include terms such as "human", "nature", "animal", "abstract", "clothing", "fire", and "x-ray", to name a few. Content
described that does not have a code already established should be coded using the code "idiographic contents" with the
shorthand code being "Idio." Items are also coded for statistical popularity (or, conversely, originality).

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.
Location
Identifying the location of the subject's response is another element scored in the Rorschach system. Location refers to
how much of the inkblot was used to answer the question. Administrators score the response "W" if the whole inkblot was
used to answer the question, "D" if a commonly described part of the blot was used, "Dd" if an uncommonly described or
unusual detail was used, or "S" if the white space in the background was used. A score of W is typically associated with
the subject's motivation to interact with his or her surrounding environment. D is interpreted as one having efficient or
adequate functioning. A high frequency of responses coded Dd indicate some maladjustment within the individual.
Responses coded S indicate an oppositional or uncooperative test subject.

Determinants
Systems for Rorschach scoring generally include a concept of "determinants": These are the factors that contribute to
establishing the similarity between the inkblot and the subject's content response about it. They can also 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 as determinants. However currently, another major determinant considered
is shading, which was inadvertently introduced by poor printing quality of the inkblots. Rorschach initially disregarded
shading, since the inkblots originally featured uniform saturation, but later recognized it as a significant factor.

Form is the most common determinant, and is related to intellectual processes. Color responses often provide direct
insight into one's emotional life. Movement and shading have been considered more ambiguously, both in definition and
interpretation. Rorschach considered movement only as the experiencing of actual motion, while others have widened the
scope of this determinant, taking it to mean that the subject sees something "going on".

More than one determinant can contribute to the formation of the subject's perception. Fusion of two determinants is taken
into account, while also assessing which of the two constituted the primary contributor. For example, "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.

VALIDITY
When interpreted as a projective test, results are 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: while the Exner proposed a rigorous scoring system, latitude
remained in the actual interpretation, and the clinician's write-up of the test record is still partly subjective. Reber (1985)
comments ".. there is essentially no evidence whatsoever that the test has even a shred of validity."

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. 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". (Cancer is
mentioned because a small minority of Rorschach enthusiasts have claimed the test can predict cancer.)

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. cites many court
cases where these had not been followed. Similarly, the procedures for coding responses are fairly well specified but
extremely time-consuming leaving them very subject to the author's style and the publisher to the quality of the instructions
(such as was noted with one of Bohm's textbooks in the 1950s) as well as clinic workers (which would include examiners)
being encouraged to cut corners.
United States courts have challenged the Rorschach as well. Jones v Apfel (1997) stated (quoting from Attorney's
Textbook of Medicine) that Rorschach "results do not meet the requirements of standardization, reliability, or validity of
clinical diagnostic tests, and interpretation thus is often controversial". In State ex rel H.H. (1999) where under cross
examination Dr. Bogacki stated under oath "many psychologists do not believe much in the validity or effectiveness of the
Rorschach test" and US v Battle (2001) ruled that the Rorschach "does not have an objective scoring system."

POPULATION NORMS
Another controversial aspect of the test is its statistical norms. Exner's system was thought to possess 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. Lilienfeld and colleagues, who are critical of the Rorschach, have stated that this proves that the Rorschach
tends to "overpathologise normals".Although Rorschach proponents, such as Hibbard, suggest that high rates of
pathology detected by the Rorschach accurately reflect increasing psychopathology in society, the Rorschach also
identifies half of all test-takers as possessing "distorted thinking", a false positive rate unexplained by current research.

The accusation of "over-pathologising" has also been considered 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.

APPLICATIONS
The test is also controversial because of its common use in court-ordered evaluations. 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). Irving B. 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". 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, 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. One study has found that use of the test in courts has increased by three
times in the decade between 1996 and 2005, compared to the previous fifty years. Others however have found that its
usage by forensic psychologists has decreased. Exner and others have claimed that the Rorschach test is capable of
detecting suicidality.

PROTECTION OF TEST ITEMS AND ETHICS

Psychologists object to the publication of psychological test material out of concerns that a patient's test responses will
be influenced ("primed") by previous exposure. The Canadian Psychological Association takes the position that,
"Publishing the questions and answers to any psychological test compromises its usefulness" and calls for "keeping
psychological tests out of the public domain." The same statement quotes their president as saying, "The CPA's concern
is not with the publication of the cards and responses to the Rorschach test per se, for which there is some controversy
in the psychological literature and disagreement among experts, but with the larger issue of the publication and
dissemination of psychological test content".

From a legal standpoint, the Rorschach test images have been in the public domain for many years in most countries,
particularly those with a copyright term of up to 70 years post mortem auctoris. They have been in the public domain in
Hermann Rorschach's native Switzerland since 1992 (70 years after the author's death, or 50 years after the cut-off date
of 1942), according to Swiss copyright law. They are also in the public domain under United States copyright law where
all works published before 1923 are considered to be in the public domain. This means that the Rorschach images may
be used by anyone for any purpose. William Poundstone was, perhaps, first to make them public in his 1983 book Big
Secrets, where he also described the method of administering the test.