Wednesday, April 27, 2011

Interpretation of the Rorschach Inkblot Test (Wherein I reveal myself to be a skeptic)

There's even a comic book
character named Rorschach.
Ah, the Rorschach. Were there any of you who hadn't heard of it before coming to this blog? It's really stamped on our collective consciousness, I think.

I talked on Monday about the various things an examiner looks at as the person describes what he sees in the ten Rorschach inkblots. The examiner codes/rates the person's responses and compiles 100-150 scores based on those ratings. The examiner then compares those scores to the norms provided by the Exner system (these are based on the scores of a large sample of individuals who took the Rorschach and were scored using the system). The person's scores--and where they fall compared to the normed scores--are supposed to be an indication of personality functioning.

Examples: If you focus on tiny details of the blots instead of the whole thing? Obsessiveness. Interpreting the white space around the blot? You have a negative/obstinate streak.Seeing a lot of reflections and mirror images in the blots? Narcissism. Seeing food images in more than a few of the inklbots? Dependency.

Get the idea? Proponents of this test suggest it's useful in the detection of all sorts of psychiatric conditions and symptoms.

There are some problems with these claims, though. Just a few of them:
  1. not all the Rorschach categories (in fact, only about 50%) have sufficient interrater reliability. That means that if two people score the Rorschach, they might not come up with the same conclusions. Or they might come up with really different conclusions.
  2. it has a tendency to make normal people seem kinda crazy. There have been at least a few studies that show that when kids and adults who are psychologically healthy take the Rorschach, their responses get scored as pathological much more often than you'd expect. Oh, and African Americans, Native Americans and Native Alaskans, Hispanics, and Central and South Americans also give responses that differ significantly from the norms of Exner's Comprehensive System.
Uh oh.

As it turns out, WE CAN'T REALLY SEE INTO YOUR SOULS, PEOPLE. Er, at least, not like this.

In the last decade, researchers have demonstrated that the Rorschach does NOT reliably detect depression, anxiety, psychopathic personality, tendency toward violence, or sexual abuse in children. Sexual offenders differ from other offenders in some subtle ways--but the research is not rigorous enough for psychologists to say with confidence, "yes, this person is definitely likely to commit a sexual offense." After all--remember that the Rorschach (and the Exner Comprehensive Scoring System specifically) sometimes makes normal, healthy people seem deviant. What it is relatively good at detecting: schizophrenia and other thought disorders. That makes sense, yes? It's quite good at identifying individuals who have overly tangential, disorganized thoughts.

If you really want to delve into the details of the controversy, check out this article. The key to using the Rorschach well is extensive training, careful administration, strict scoring and a focus on the scales that show verified reliability and validity, gathering of a great deal of additional evidence through other methods, and cautious interpretation.

Check it: Search "psychologist" on
Microsoft Clip Art, and many of the
graphics include some
representation of the Rorschach
Several of you asked fantastic questions about use of the Rorschach in psychological practice these days. As recently as a decade ago, the majority of psychologists used this test at least occasionally. It has also been used extensively in court-ordered evaluations, including custody evaluations.

However, this seems to be changing in the last several years. Use of the Rorschach appears to be on the decline (particularly among forensic psychologists who testify in court) as a result of all the research evidence. The psychologists I know who use it do so only in conjunction with a number of objective tests and other techniques (diagnostic interviews, records review, etc.). They are really careful not to base their conclusions about personality and diagnosis on Rorschach information alone.

If you're wondering about me: I got some training in the Rorschach in graduate school, both in administering and scoring it. But FAR from the extensive training one would need to score it with any confidence or validity. As to whether I use any other projective tests in my evaluations of young children ... well, that's a post for another time.

For those of you who were thinking I'd come up with some conclusions about your sanity or psychic functioning, sorry if I've disappointed you. I think the Rorschach is a fascinating instrument, one that has its uses, but that also demonstrates the limits of what psychologists and psychiatrists can do.

Yes, your responses to my improvised inkblot said something about each of you. But that "something" is only the tiniest tip of the ginormous, complicated iceberg of YOU. And that tiny "something" could be affected by a huge number of factors (like how much sleep you'd had the night before, how many Disney movies you'd seen recently, the type of WIP you're currently working on, the way your brain processes information, your value system, your culture, your creativity, your intelligence, your knowledge that your comment would be public, etc., etc., etc.). It would be exceedingly arrogant of me or anyone else, no matter what our training, to draw broad, definitive conclusions based on that tiny bit of mysterious, context-free "something".

Is that what you thought I'd say?

18 comments:

  1. Wow, I would have thought the lack of interrater reliability would have killed the test a long time ago! I guess it's just an example of how hard it is to get rid of something that is part of society's norm.

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  2. But how good is it at detecting OCD (other than focusing on the tiny dots in the image)?

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  3. I'm not really sure were my ink blot response falls. I'm a little bit of everything, maybe? That makes sense!

    ~JD

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  4. First of all, I kind of wish the guy who invented these was named Dr. Ink. "Ink Blots" would be far easier to spell.

    Second, it amazes me how these are evaluated. I would love to see the blots of some famous people and get a (kind of cloudy) window into their soul.

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  5. hee hee hee. that's EXACTLY what i thought you'd say! :)

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  6. IT sounds really subjective depending on who's scoring and what they feel it means so its good that this test is compiles with lots of other ways of identifying mental illness. I still think its neat that so many people can look at the same thing and see something different.

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  7. It's all very interesting, but there is no such thing as exact in matters of the mind.

    Things I'd like to see you blog about:

    Administer an online, abridged MMPI to us readers.

    Talk about the use of MDA and MDMA in therapy in the 70s and 80s.

    IQ tests, age, and The Seven Types of Intelligence.

    I have more, but I can't think of them right now.

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  8. Gives a whole new layer of meaning to getting a second opinion! I'm thinking at least a third and fourth opinion would be useful here. Agree with Dianne S. above. It does make sense that the test is useful for detecting particularly disorganized perceptions, though. Maybe it should be restricted to use for that type of analysis. Interesting, thanks!

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  9. Awww! I though you were going to saythat writers fall into their own "this answer is sooooooo creative, he/she must be a writer" category.

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  10. That's exactly what I thought you'd say :)

    Psychologists... "what does that mean to you?"

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  11. It's so subjective, I'm amazed there's a system to rate it at all, LOL!

    Nice post!

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  12. Oh man, I hope I never have to take it seriously - I'd probably be categorized as insane :D

    Very interesting! I've never known exactly what this test was for - cool read about!

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  13. I'm a ginormous, complicated iceberg! Yay!! (Now, what did Sarah say about narcissism?)

    Thanks for increasing my layman's knowledge of the Rorschach. I'll have to hunt down that comic book character.

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  14. I always wondered why psychologists depended on the Rorschach to help with diagnoses since it really is highly subjective. And it's not just in the viewer's response but also in the doctor's interpretation of answers, which could be literal, metaphorical, or total BS to screw with the doctor's head. Using it alongside other tests makes more sense. Rorschach alone does not an accurate mental picture make :)

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  15. LOL My answer probably told you I had recently watched Shriek. Which is true. :D

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  16. Phew *wipes forehead* I was afraid you might now know how twisted my mind really is. Mwahahaha! Ahem. Very interesting stuff!

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  17. hehe yeah, I had guessed that's the gist of what you'd say. What I found fascinating was all the variations of what people saw in the same blot.

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  18. So you're saying I'm crazy. I knew it! *runs away screaming*

    Hehehe! Yeah, this stuff seems fun and neat when you're just playing around, but I don't think there's much we can do to get into the human mind. I mean, how much do we even know about ourselves? In order to have an even remotely accurate picture, a psychologist or psychiatrist would have to have been present for at least the majority of a person's life. Of course, that's not to say you can't get an idea of something (much as you said the test was useful for determining some conditions), but I can see how all this would be very limited.

    Still, very interesting. :)

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