Which of the following is not a weakness of many projective personality tests?

Percept-Genetic Techniques

Projective techniques, personality scales, and observers’ ratings share the feature of capturing the characteristics of a person at a moment in time. Defense mechanisms, however, unfold over a time span. Sandler and Joffe (1969) pointed to the parallels between perceptual microgenesis and the progressions of conflict, anxiety, and defense observed in psychoanalysis. This parallel is basic to the percept-genetic approach, developed to investigate “events over time” (Smith, 1957, p. 306). Its contribution to research on defense mechanisms is threefold. First, its originators (Kragh & Smith, 1970) have designed methods that permit the observation of defenses in their emergence. Second, they have developed operational definitions and scoring criteria for most of the prominent defense mechanisms. Third, they have accumulated massive amounts of data on these defense mechanisms and the conditions of their occurrence, Percept-genetic contributions are amply represented in this volume; Chapters 5, 7, 8, 13, 17, 19, 24, 25Chapter 5Chapter 7Chapter 8Chapter 13Chapter 17Chapter 19Chapter 24Chapter 25 deal with various aspects of the percept-genetic approach. Chapter 7 gives a methodological overview, that makes it unnecessary to go over the same ground at this point, especially since several additional recent surveys are available (e.g., Draguns, 1991; Olff, Godaert, & Ursin, 1991; Smith 2001). The prototypical percept-genetic instrument is the Defense Mechanism Test (DMT) (Kragh, 1985) which construes major Freudian defense mechanisms as distorted pre-recognition responses to threatening stimuli. Thus, the percept-genetic approach blends two traditions of investigation, the process oriented and the psychodynamic, in reproducing macrotemporal developments in micro-time.

Structure and Ambiguity in Projective Techniques

Projective techniques comprise inkblot methods, story-telling methods, figure drawing methods, and sentence completion methods. In addition to being less structured than objective measures, these four types of projective methods differ from each other in their degree of ambiguity and in whether their ambiguity resides mainly in their stimuli or in their instructions.

Thus in the case of the Rorschach inkblot method, subjects are asked to look at relatively ambiguous stimuli but are given fairly specific instructions to indicate what they see, where they see it, and what makes it look as it does. Story-telling methods such as the TAT involve showing subjects real pictures that are much less ambiguous than inkblots; however, by using general instructions (“Tell me a story”) and open-ended questions (“What will happen next?”), examiners provide only minimal guidance in how subjects should respond. If the Rorschach instructions were “Tell me a story about this inkblot,” the Rorschach would be more ambiguous and more of a projective test than it is. If the TAT instructions were “Tell me what you see here,” the TAT would lose most of its ambiguity and function only barely as a projective test.

Figure drawing techniques use no stimuli at all, save a blank piece of paper, and provide little guidance to subjects, other than some instructions concerning the figures to be drawn (e.g., yourself, a family). Sentence completion methods, in common with story-telling techniques, call for subjects to provide thematic content in response to real and relatively unambiguous test stimuli. Unlike story-telling techniques, however, sentence completion methods do not ordinarily involve querying subjects about their responses or encouraging them to elaborate those that are brief or unrevealing. Thus a stem of “I AM” may be completed with “a happy person,” in which case some subjectivity has been allowed to enter the response, or simply with “here,” in which case only a completely objective response has been given. On balance, figure drawing techniques are the most ambiguous of projective tests and sentence completion methods the least, with inkblot and story-telling techniques in between.

These differences in ambiguity among projective methods were originally noted by Stone and Dellis (1960), who proposed “a levels hypothesis” to take practical account of this variability. According to the levels hypothesis, the degree to which a test is structured is directly related to the level of conscious awareness at which it taps personality processes. The more structured and less ambiguous a test is, the more likely it is to yield information about relatively conscious and superficial levels of personality; conversely, the less structured and more ambiguous a test is, the more likely it is to provide information about deeper levels of personality and characteristics of which subjects themselves may not be consciously aware.

Research reported by Stone and Dellis (1960) and subsequently replicated by Murstein and Wolf (1970) provided empirical support for a relationship between the ambiguity of a test and its likelihood of measuring deeper levels of personality, especially in normally functioning persons. These findings mirrored the basic conception of TAT assessment articulated by Murray (1951), who regarded the virtue of the instrument as residing not in its revelations about what subjects are able and willing to say about themselves, but in what it conveys about personality characteristics: “the patient is unwilling to tell or is unable to tell because he is unconscious of them” (p. 577).

In addition to differing from objective tests and from each other in their degree of structure and ambiguity, individual projective measures typically include both relatively objective and relatively subjective elements. As elaborated by Weiner (1977), the objective elements of projective test data involve structural features of the manner in which responses are formulated, whereas the subjective elements consist of thematic features of the imagery with which responses are embellished.

When projective test data are being interpreted objectively, structural aspects of the subject's responses, such as focusing on wholes and seeing numerous human figures on the Rorschach, are taken as being directly representative of similar behavioral tendencies in the person's life, that is, attending to experience globally and paying close attention to people. When projective test data are being interpreted subjectively, thematic imagery is taken as being indirectly symbolic of a subject's underlying needs, attitudes, conflicts, and concerns. Thus the Rorschach response of “Two girls who are really mad at each other fighting over something they both want” may identify a subject's experiencing peer or sibling rivalry, viewing social interactions as aggressive confrontations in which people are only concerned with what they can get for themselves, or feeling angry or resentful about being in such situations.

On story-telling measures, an example of a structural response feature is giving long stories, which can be objectively scored (by counting the number of words) and which provides a representative indication of inclinations to be verbose. As for subjectively interpreted features, a TAT story in which two people are described as about to separate, leaving one of them sad and lonely for the rest of his or her life, exemplifies thematic imagery that appears to symbolize concerns about suffering the loss of love objects and facing an unhappy future.

On figure drawing measures, which as previously noted are the most ambiguous of projective tests, structural features of the data are limited. Some variables, such as the size of figures drawn, how complete they are, and whether they are clothed, are objective facts that can usually be coded with good agreement. However, interpretation of such objective characteristics of figure drawings, as well as of subjective impressions of drawing qualities, is based mostly on their being symbolic rather than representative of behavior. Interpreting the way figures are drawn or placed is thus primarily thematic. For example, unusual emphasis on a particular part of the body may be interpreted as suggesting concern about functions associated with that part of the body, and a family drawing in which the self is located on one side of the page and the other family members are closely grouped on the other side of the page may be interpreted as symbolizing feelings of isolation or rejection in the family setting.

In sentence completion responses, frequent self-referencing is an example of an objectively scorable, behaviorally representative structural index of tendencies to focus attention on oneself rather than others. Consider the difference between the completions “WHAT PAINS ME is seeing how many unfortunate people there are in the world” and “WHAT PAINS ME is not being able to get the things that I want.” An accumulation of the latter as opposed to the former type of response is objectively representative of self-centeredness. At the same time, the thematic content of both completions suggests in a more subjective way certain underlying concerns, such as worries about the welfare of the human race in the first instances and feelings of being personally deprived in the second.

To bring these introductory observations full circle, the opportunities that projective methods create for subjects to project aspects of themselves into their responses has frequently led to their being associated with psychoanalytic theories of personality, in the context of which the notion of projection was first elaborated. However, there is no necessary relationship between psychoanalytic theory and projective testing, nor is there any reason for clinicians who conceptualize behavior in other ways to view projective methods as incompatible with their frame of reference. The basic principle underlying projective techniques is that something can be learned about people from sampling how they respond in ambiguous situations. This principle is not prisoner to any personality theory, and its utility transcends the theoretical persuasions of individual examiners. Inferences from projective data can be couched equally well in psychodynamic, behavioral, cognitive, and humanistic terms, and the use to which these inferences can be put depends less on theoretical differences in terminology than on the nature of the assessment issues being addressed.

4.16.8 Specific Projective Techniques

Three basic aspects of projective techniques have been recognized (Rabin, 1981). First, the task entails the presentation of an ambiguous set of stimuli and a request to give an open-ended response. The Rorschach and TAT techniques include both of these stimulus and response attributes. Therefore, the focus of interpretation is on the perception of the stimuli presented and the organization of the response. Drawing techniques also demand open-ended responses but usually do not provide a stimulus. Second, the response is shaped by processes that are outside of conscious awareness. An important factor making the response less amenable to conscious manipulation (faking) is that the respondent does not comprehend the meaning of the answers given. Third is the complexity of the interpretive process. Each of these components is briefly addressed below.

1.2 Characteristics of Nonpsychometric Tests

A distinguishing feature, particularly of projective techniques, is the unstructured tasks that are presented to respondents and the ambiguous stimulus items. The principal contrasting feature between psychometric and nonpsychometric tests is the objectivity versus subjectivity of scoring. In the vernacular of psychometricians and measurement specialists, the scoring of nonpsychometric tests involves, in the main, what are referred to as “subjective–intuitive procedures.” However, in spite of these differences, instruments in this category are required by national testing standards to be in compliance with those published by national professional societies. Table I provides examples of both psychometric and nonpsychometric tests.

TABLE I. Examples of Psychometric and Nonpsychometric Tests

Psychometric testsNonpsychometric testsCalifornia Personality Inventory (CPI)Children’s Apperception Test (CAT)Differential Aptitude Tests (DAT)Machover Draw-A-Person Test (D-A-P)Scholastic Assessment Test (SAT)Rorshach Inkblots (RI)aState–Trait Anxiety Inventory (STAI)Rosenzweig Picture Frustration Study (RPFS)Wechsler Intelligence Scale For Children (WISC)Thematic Apperception Test (TAT)

PROJECTIVE ELEMENTS

The use of drawings as a projective technique, in which the child reveals inner feelings about himself and his world, significantly strengthens their usefulness. There is a large body of investigation of children's drawings in the psychological literature. The use of children's drawings in clinical practice builds on this foundation but involves a less formal use of drawings. This technique necessitates a wide range of symbolic interpretations of the drawings, and its effectiveness varies with the skill and experience of the viewer. Certain literature supports this approach to children's drawings. Of particular importance are family drawings, especially kinetic family drawings, or drawings of families doing something. The child is directed to draw a picture “with everyone in your family, all doing something.” Considerable sophistication and objective verification of the family drawings have established this technique in child development. Several components of these drawings call for attention because they reveal a great deal about family dynamics:

Where individual members of the family are placed in the picture

Relative size and position of individuals on the paper

Distortion of an individual or parts of an individual

Omission of a member of the family

Force lines (barriers) between members

Relative amount of detail of a specific member

Studies using grid analysis and computer evaluation add considerable sophistication to the analysis of these components, but that isn't usually needed. Clinically, the child lays out his internal perception of his family through these drawings. Such information can be enormously helpful to the child's clinician in the process of assessing the child's self-image, patterns of communication and relationships with others in the family.

Psychological insights may be especially helpful in interpreting the drawings of children who are younger than 7 or 8 years. These drawings extend the child's language ability and allow access to his subjective reality. The threatening parent of the opposite sex, exaggeration of size, siblings missing, the magnified, nurturing mother or the threatening, menacing father occur with such regularity as children go through important social and emotional stages that these elements are seen readily in drawings (Fig. 5-2). Occasionally, parents can gain insight from such drawings into these special stages of development in ways that may not be apparent from the child's behavior. Drawings can also make parents aware of stressful experiences that have not previously been disclosed by the child. The drawing tells more about deep-seated emotional issues than the child can convey in words or the parent can see in behavior or speech (Figs. 5-3 and 5-4). When the child is able to describe his drawings, his verbal explanations can assist in the interpretation and should be encouraged.

Parents are often interested in interpretation of these drawings. Caution must be used to not overextend their meanings. At times, however, they can shed illumination on situations that would otherwise be obscure. The drawing, like a urinalysis or electrocardiogram, is only one piece of data at one point in time and must not be overinterpreted. However, the appearance of recurring themes in drawings collected over time can contribute to the validity of their meaning. At the very least, they can open up topics for discussion with the child and with the family.

Defense Mechanisms in the Present: A Variety of Clinically Relevant Results

Defense mechanisms based on observer ratings, projective techniques, and self report scales have been associated with psychiatric diagnoses, especially those of borderline disorder, affective disorder, and other DSM-IV diagnostic categories, as indicated in the recent review by Cramer (2000). Denial and other related mechanisms, prominently employed in various physical disorders (e.g., Katz, Weiner, Gallagher, & Hellman, 1970; Oettingen, 1996), have emerged as something of a double edged sword. On the one hand, denial reduces the patients’ anxiety and thereby improves their well-being and their quality of life. On the other hand, denial may also interfere with compliance with treatment and medication orders (Fulde, Junge, & Ahrens, 1995). In psychotherapy, immature defenses were found to decrease after prolonged and intensive psychotherapy (Cramer & Blatt, 1993) Changes in defense use also occurred as obsessive-compulsive and depressive symptoms declined in number (Akkerman, Carr, & Lewin, 1992; Albucher, Abelson, & Nesse, 1998; Hoglend & Perry, 1998). Thus, defense mechanisms are important to consider in the course of assessment, a development implicitly recognized by the incorporation of 31 defense mechanisms into the DSM-IV. In therapy, the findings extant corroborate the impressions and convictions of a great many practitioners; in the course of psychotherapy the client’s defensive structure undergoes a change. Moreover, the limited research findings that have been reported suggest that change is experienced in the direction of greater maturity and appropriateness. Beutel (1988) has proposed additional criteria of defenses that could be incorporated into future process and outcome studies. They include flexibility versus rigidity, intensity and generality, duration, and balance, all of which remain to be converted into standardized ratings and other measures. Vaillant’s (1977, 1993) biographical vignettes of participants in his research as well as of historical figures remain a source for other relevant, and sometimes subtle indicators which can potentially be tested for their applicability in assessment and intervention. Fascinating, but as yet unanswered, questions occur: Is change in defense mechanisms different and more pronounced in psychodynamic therapy as compared with behavioral and cognitive interventions? Do the extent and nature of change vary with the success of therapy? Does targeted change in defense mechanisms through counseling or psychotherapy accomplish its intended results (cf. Clark, 1998)?

3.4 Projective Techniques

According to Pervin (1975), a projective technique “is an instrument that is considered especially sensitive to covert or unconscious aspects of behavior, permits or encourages a wide variety of subject responses, is highly multidimensional, and evokes unusually rich or profuse response data with a minimum of subject awareness concerning the purpose of the test” (p. 33).

The basic assumptions of projective techniques are closely related to the psychodynamic model and psychoanalytic theory: (1) they involve the presentation of stimuli relatively free of structure or cultural meaning, consisting of inkblots, pictures, incomplete verbal sentences or stories, or performance tasks; (2) these materials allow subjects to express idiosyncratic and holistic aspects of their personalities, and allow the assessment of dynamic constructs as well as defense mechanisms against anxiety, and conscious as well as unconscious processes and structures; and (3) subjects are not aware of the purpose of the test and the meaning of their responses to the test. Table V shows four main categories of projective techniques that can be identified depending on the material used and the task involved.

TABLE V. Types and Examples of Projective Techniques Depending on Materials Used and Task

Type of techniqueMaterialTaskExamplesStructuralInkblotsDescribe what it looks likeRorschach Inkblots test (Rorschach, 1929)ThematicPicturesTell a storyThematic apperception test (TAT) (Murray, 1936)ExpressiveWhite paper and pencilDraw a pictureMachover Draw-a-Person test (Machover, 1948)AssociativeWords, incomplete sentences or storiesComplete the sentences or storiesFree association test (Rapaport, 1965)PerformanceConstructional elements (houses, trees, fences, etc.)Build a townTown test (Arthur, 1949)

Although projective methods have been widely used, they have received considerable criticism, and continue to cause controversy. In fact, all the characteristics of projective methods—ill-defined stimuli, idiographic responses, non-standardized procedures, and subjective evaluation—have contributed to a lack of psychometric soundness. In sum, much more research is required for projective methods to be used as scientific tools. Nevertheless, there is an exception, as Weiner (2001) has emphasized: “the Rorschach Inkblot Method has been standardized, normed, made reliable, and validated in ways that exemplify sound scientific principles for developing an assessment instrument” (p. 423).

PERSONALITY ASSESSMENT

Personality assessment has come to rival intelligence testing as a task performed by psychologists. However, while most psychologists would agree that an intelligence test is generally the best way to measure intelligence, no such consensus exists for personality evaluation. In long-term perspective, it would appear that two major philosophies and perhaps three assessment method’s have emerged. The two philosophies can be traced back to Allport’s (1937) distinction between nomothetic versus idiographic methodologies and Meehl’s (1954) distinction between clinical and statistical or actuarial prediction. In essence, some psychologists feel that personality assessments are best accomplished when they are highly individualized, while others have a preference for quantitative procedures based on group norms. The phrase “seer versus sign” has been used to epitomize this dispute. The three methods referred to are the interview, and projective and objective tests. Obviously, the first way psychologists and their predecessors found out about people was to talk to them, giving the interview historical precedence. But following a period when the use of the interview was eschewed by many psychologists, it has made a return. It would appear that the field is in a historical spiral, with various methods leaving and returning at different levels.

The interview began as a relatively unstructured conversation with the patient and perhaps an informant, with varying goals, including obtaining a history, assessing personality structure and dynamics, establishing a diagnosis, and many other matters. Numerous publications have been written about interviewing (e.g., Menninger, 1952), but in general they provided outlines and general guidelines as to what should be accomplished by the interview. However, model interviews were not provided. With or without this guidance, the interview was viewed by many as a subjective, unreliable procedure that could not be sufficiently validated. For example, the unreliability of psychiatric diagnosis based on studies of multiple interviewers had been well established (Zubin, 1967). More recently, however, several structured psychiatric interviews have appeared in which the specific content, if not specific items, has been presented, and for which very adequate reliability has been established. There are by now several such interviews available including the Schedule for Affective Disorders and Schizophrenia (SADS) (Spitzer & Endicott, 1977), the Renard Diagnostic Interview (Helzer, Robins, Croughan, & Weiner, 1981), and the Structured Clinical Interview for DSM-III, DSM-III-R, or DSM-IV (SCID or SCID-R) (Spitzer & Williams, 1983) (now updated for DSM-IV). These interviews have been established in conjunction with objective diagnostic criteria including DSM-III itself, the Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1977), and the Feighner Criteria (Feighner, et al., 1972). These new procedures have apparently ushered in a “comeback” of the interview, and many psychiatrists and psychologists now prefer to use these procedures rather than either the objective- or projective-type psychological test.

Those advocating use of structured interviews point to the fact that in psychiatry, at least, tests must ultimately be validated against judgments made by psychiatrists. These judgments are generally based on interviews and observation, since there really are no biological or other objective markers of most forms of psychopathology. If that is indeed the case, there seems little point in administering elaborate and often lengthy tests when one can just as well use the criterion measure itself, the interview, rather than the test. There is no way that a test can be more valid than an interview if an interview is the validating criterion. Structured interviews have made a major impact on the scientific literature in psychopathology, and it is rare to find a recently written research report in which the diagnoses were not established by one of them. It would appear that we have come full cycle regarding this matter, and until objective markers of various forms of psychopathology are discovered, we will be relying primarily on the structured interviews for our diagnostic assessments.

Interviews such as the SCID or the Diagnostic Interview Schedule (DIS) type are relatively lengthy and comprehensive, but there are now several briefer, more specific interview or interview-like procedures. Within psychiatry, perhaps the most well-known procedure is the Brief Psychiatric Rating Scale (BPRS) (Overall & Gorham, 1962). The BPRS is a brief, structured, repeatable interview that has essentially become the standard instrument for assessment of change in patients, usually as a function of taking some form of psychotropic medication. In the specific area of depression, the Hamilton Depression Scale (Hamilton, 1960) plays a similar role. There are also several widely used interviews for patients with dementia, which generally combine a brief mental-status examination and some form of functional assessment, with particular reference to activities of daily living. The most popular of these scales are the Mini-Mental Status Examination of Folstein, Folstein, and McHugh (1975) and the Dementia Scale of Blessed, Tomlinson, and Roth (1968). Extensive validation studies have been conducted with these instruments, perhaps the most well-known study having to do with the correlation between scores on the Blessed, Tomlinson, and Roth scale used in patients while they are living and the senile plaque count determined on autopsy in patients with dementia. The obtained correlation of .7 quite impressively suggested that the scale was a valid one for detection of dementia. In addition to these interviews and rating scales, numerous methods have been developed by nurses and psychiatric aids for assessment of psychopathology based on direct observation of ward behavior (Raskin, 1982). The most widely used of these rating scales are the Nurses’ Observation Scale for Inpatient Evaluation (NOSIE-30) (Honigfeld & Klett, 1965) and the Ward Behavior Inventory (Burdock, Hardesty, Hakerem, Zubin, & Beck, 1968). These scales assess such behaviors as cooperativeness, appearance, communication, aggressive episodes, and related behaviors, and are based on direct observation rather than reference to medical records or the report of others. Scales of this type supplement the interview with information concerning social competence and capacity to carry out functional activities of daily living.

Again taking a long-term historical view, it is our impression that after many years of neglect by the field, the interview has made a successful return to the arena of psychological assessment; but interviews now used are quite different from the loosely organized, “freewheeling,” conversation-like interviews of the past (Hersen & Van Hassett, 1998). First, their organization tends to be structured, and the interviewer is required to obtain certain items of information. It is generally felt that formulation of specifically-worded questions is counterproductive; rather, the interviewer, who should be an experienced clinician trained in the use of the procedure, should be able to formulate questions that will elicit the required information. Second, the interview procedure must meet psychometric standards of validity and reliability. Finally, while structured interviews tend to be atheoretical in orientation, they are based on contemporary scientific knowledge of psychopathology. Thus, for example, the information needed to establish a differential diagnosis within the general classification of mood disorders is derived from the scientific literature on depression and related mood disorders.

The rise of the interview appears to have occurred in parallel with the decline of projective techniques. Those of us in a chronological category that may be roughly described as middle-age may recall that our graduate training in clinical psychology probably included extensive course work and practicum experience involving the various projective techniques. Most clinical psychologists would probably agree that even though projective techniques are still used to some extent, the atmosphere of ferment and excitement concerning these procedures that existed during the 1940s and 1950s no longer seems to exist. Even though the Rorschach technique and Thematic Apperception Test (TAT) were the major procedures used during that era, a variety of other tests emerged quite rapidly: the projective use of human-figure drawings (Machover, 1949), the Szondi Test (Szondi, 1952), the Make-A-Picture-Story (MAPS) Test (Shneidman, 1952), the Four-Picture Test (VanLennep, 1951), the Sentence Completion Tests (e.g., Rohde, 1957), and the Holtzman Inkblot Test (Holtzman, 1958). The exciting work of Murray and his collaborators reported on in Explorations in Personality (Murray, 1938) had a major impact on the field and stimulated extensive utilization of the TAT. It would probably be fair to say that the sole survivor of this active movement is the Rorschach test. Many clinicians continue to use the Rorschach test, and the work of Exner and his collaborators has lent it increasing scientific respectability (see Chapter 17 in this volume).

There are undoubtedly many reasons for the decline in utilization of projective techniques, but in our view they can be summarized by the following points:

Increasing scientific sophistication created an atmosphere of skepticism concerning these instruments. Their validity and reliability were called into question by numerous studies (e.g., Swensen, 1957, 1968; Zubin, 1967), and a substantial segment of the professional community felt that the claims made for these procedures could not be substantiated.

Developments in alternative procedures, notably the MMPI and other objective tests, convinced many clinicians that the information previously gained from projective tests could be gained more efficiently and less expensively with objective methods. In particular, the voluminous Minnesota Multiphasic Personality Inventory (MMPI) research literature has demonstrated its usefulness in an extremely wide variety of clinical and research settings. When the MMPI and related objective techniques were pitted against projective techniques during the days of the “seer versus sign” controversy, it was generally demonstrated that sign was as good as or better than seer in most of the studies accomplished (Meehl, 1954).

In general, the projective techniques are not atheoretical and, in fact, are generally viewed as being associated with one or another branch of psychoanalytic theory. While psychoanalysis remains a strong and vigorous movement within psychology, there are numerous alternative theoretical systems at large, notably behaviorally and biologically oriented systems. As implied in the section of this chapter covering behavioral assessment, behaviorally oriented psychologists pose theoretical objections to projective techniques and make little use of them in their practices. Similarly, projective techniques tend not to receive high levels of acceptance in biologically-oriented psychiatry departments. In effect, then, utilization of projective techniques declined for scientific, practical, and philosophical reasons. However, the Rorschach test in particular continues to be productively used, primarily by psychodynamically oriented clinicians.

The early history of objective personality tests has been traced by Cronbach (1949, 1960). The beginnings apparently go back to Sir Francis Galton, who devised personality questionnaires during the latter part of the 19th century. We will not repeat that history here, but rather will focus on those procedures that survived into the contemporary era. In our view, there have been three such major survivors: a series of tests developed by Guilford and collaborators (Guilford & Zimmerman, 1949), a similar series developed by Cattell and collaborators (Cattell, Eber, & Tatsuoka, 1970), and the MMPI. In general, but certainly not in all cases, the Guilford and Cattell procedures are used for individuals functioning within the normal range, while the MMPI is more widely used in clinical populations. Thus, for example, Cattell’s 16PF test may be used to screen job applicants, while the MMPI may be more typically used in psychiatric health-care facilities. Furthermore, the Guilford and Cattell tests are based on factor analysis and are trait-oriented, while the MMPI in its standard form does not make use of factor analytically derived scales and is more oriented toward psychiatric classification. Thus, the Guilford and Cattell scales contain measures of such traits as dominance or sociability, while most of the MMPI scales are named after psychiatric classifications such as paranoia or hypochondriasis.

Currently, most psychologists use one or more of these objective tests rather than interviews or projective tests in screening situations. For example, many thousands of patients admitted to psychiatric facilities operated by the Veterans Administration take the MMPI shortly after admission, while applicants for prison-guard jobs in the state of Pennsylvania take the Cattell 16PF. However, the MMPI in particular is commonly used as more than a screening instrument. It is frequently used as a part of an extensive diagnostic evaluation, as a method of evaluating treatment, and in numerous research applications. There is little question that it is the most widely used and extensively studied procedure in the objective personality-test area. Even though the 566 true-or-false items have remained the same since the initial development of the instrument, the test’s applications in clinical interpretation have evolved dramatically over the years. We have gone from perhaps an overly naive dependence on single-scale evaluations and overly literal interpretation of the names of the scales (many of which are archaic psychiatric terms) to a sophisticated configural interpretation of profiles, much of which is based on empirical research (Gilber-stadt & Duker, 1965; Marks, Seeman, & Haller, 1974). Correspondingly, the methods of administering, scoring, and interpreting the MMPI have kept pace with technological and scientific advances in the behavioral sciences. From beginning with sorting cards into piles, hand scoring, and subjective interpretation, the MMPI has gone to computerized administration and scoring, interpretation based, at least to some extent, on empirical findings, and computerized interpretation. As is well known, there are several companies that will provide computerized scoring and interpretations of the MMPI.

Since the appearance of the earlier editions of this handbook, there have been two major developments in the field of objective personality-assessment. First, Millon has produced a new series of tests called the Millon Clinical Multiaxial Inventory (Versions I and II), the Millon Adolescent Personality Inventory, and the Millon Behavioral Health Inventory (Millon, 1982; 1985). Second, the MMPI has been completely revised and restandardized, and is now known as the MMPI-2. Since the appearance of the second edition of this handbook, use of the MMPI-2 has been widely adopted. Chapter 16 in this volume describes these new developments in detail.

Even though we should anticipate continued spiraling of trends in personality assessment, it would appear that we have passed an era of projective techniques and are now living in a time of objective assessment, with an increasing interest in the structured interview. There also appears to be increasing concern with the scientific status of our assessment procedures. In recent years, there has been particular concern about reliability of diagnosis, especially since distressing findings appeared in the literature suggesting that psychiatric diagnoses were being made quite unreliably (Zubin, 1967). The issue of validity in personality assessment remains a difficult one for a number of reasons. First, if by personality assessment we mean prediction or classification of some psychiatric diagnostic category, we have the problem of there being essentially no known objective markers for the major forms of psychopathology. Therefore, we are left essentially with psychiatrists’ judgments. The DSM system has greatly improved this situation by providing objective criteria for the various mental disorders, but the capacity of such instruments as the MMPI or Rorschach test to predict DSM diagnoses has not yet been evaluated and remains a research question for the future. Some scholars, however, even question the usefulness of taking that research course rather than developing increasingly reliable and valid structured interviews (Zubin, 1984). Similarly, there have been many reports of the failure of objective tests to predict such matters as success in an occupation or trustworthiness with regard to handling a weapon. For example, objective tests are no longer used to screen astronauts, since they were not successful in predicting who would be successful or unsuccessful (Cordes, 1983). There does, in fact, appear to be a movement within the general public and the profession toward discontinuation of use of personality-assessment procedures for decision-making in employment situations. We would note as another possibly significant trend, a movement toward direct observation of behavior in the form of behavioral assessment, as in the case of the development of the Autism Diagnostic Observation Schedule (ADOS) (Lord et al., 1989). The Zeitgeist definitely is in opposition to procedures in which the intent is disguised. Burdock and Zubin (1985), for example, argue that, “nothing has as yet replaced behavior for evaluation of mental patients.”

III. Empirical Evidence and the Scientific Status of Projectives

The fate of projective testing is continuously in question because heated disagreements over the scientific status of projective techniques, most notably the Rorschach Inkblot Method, are consistently engaged in scholarly journals. This article cannot address the scope of this debate but provides some evidence of the utility and empirical validity of the projective techniques, using the Rorschach as the prototype. A brief review is undertaken to examine the accuracy of Rorschach in assessing select disorders, in predicting treatment outcome, and in assessing change during and after intensive psychodynamic treatment.

Research has demonstrated the validity of some, but certainly not all Rorschach indexes in accurate diagnosis. When appropriately formulated, the Rorschach has demonstrated high degrees of validity in measuring specific personality constructs such as interpersonal dependency, ego strength, defense mechanisms, and quality of object relations. In terms of differential diagnosis, specific patterns of Rorschach responses have been correlated with independent diagnosis of schizophrenia; major mood disorders; and antisocial, narcissistic, and borderline personality disorders. Perhaps one of the most important uses of the test is in predicting dangerous behavior during treatment. The Rorschach when appropriately scored and formulated can predict with approximately 75% accuracy which patients will make a lethal suicide attempt within 60 days of the administration of the testing. The Rorschach has also demonstrated that scoring indexes can predict similar levels of accurate prediction of patients who will make a near lethal suicide attempt within 60 days of administration of the test.

Traditional applications of projective testing include their use in clinical settings to predict who will most likely benefit from certain forms of psychological treatment. Anecdotal evidence is far more abundant than scientifically sound studies that support the empirical validation of projective testing in predicting treatment outcome. This is in part due to the fact that most researchers in the field conduct exploratory studies rather than replicating others work. As a result research is not cumulative, making it difficult to summarize the general effectiveness of specific measures in predicting specific outcomes. One stunning exception is the myriad studies of Bruno Klopfer's Rorschach Prognostic Rating scale (RPRS). In a sophisticated statistical and conceptual analysis, Meyer and Handler analyzed the results of 20 separate studies assessing the validity of the RPRS in predicting treatment outcome. This meta-analysis (involving 752 participants) revealed that the RPRS was highly predictive of subsequent therapy outcome. To examine its predictive power the authors compared the RPRS to other predictor-criterion pairs from various fields including medicine and education. They found the RPRS was a better predictor of psychotherapy outcome than the SAT and GRE scores are at predicting subsequent grade point average. The RPRS as a predictor of psychotherapy outcome was also superior to electrocardiogram stress tests in predicting subsequent cardiac disease. For an enlightening view of how psychological testing compares to medical diagnostic testing, readers will profit from Meyer and colleagues’ latest work appearing in the American Psychologist.

Steven Applebaum produced two clinically based studies that directly compared inferences based on projective test data to inferences based on traditional interview data. In a small sample of 13 cases, Applebaum found test-based inferences were more accurate than inferences based on interview data. Psychological test-based inferences were most accurate in assessing ego strength, quality of interpersonal relationships, core conflicts, patterns of defense, and transference paradigms. In a second study, 26 additional cases were added to the original 13 to compare interview-based predictions to test-based ones. When psychiatrists and psychological testers disagreed on the predictions, most often testers made correct predictions about the patient's ego strengths, core conflicts, transference paradigms, defense configurations, and the degree of psychological mindedness. The results suggest that projective test data, in the hands of well-trained diagnosticians can be used for making predictions about treatment planning and outcome that is superior to that of clinicans who have clinical data from interviews.

One facet of assessment that has received relatively little attention is the application of projective tests in assessing changes in intrapsychic functioning as an aspect of psychotherapy outcome research. Given that psychoanalytic treatment endeavors to effect structural change, it is remarkable that few researchers have used sensitive measures such as the Rorschach to monitor change. Nonetheless, there are examples of how the Rorschach has been utilized in this manner. Irving Weiner and John Exner, for example, assessed 88 patients prior to starting exploratory dynamic therapy, then retested them on three occasions including at termination. A second group of 88 patients undergoing brief nondynamic psychotherapy were also assessed throughout the course of treatment and at termination. The researchers chose 27 Rorschach variables indicative of patient's ability to manage stress, perceive reality in conventional modes, modulate affective experience, adaptively utilize ideation, be self-reflected, and represent interpersonal relationships.

Results indicated that 24 of the 27 variables were significantly improved for patients in the long-term dynamic therapy, demonstrating progressive improvements at each testing through termination. Short-term patients also made significant improvement but to a lesser extent than patients in psychodynamic treatments. In a similar study Exner and a colleague replicated the first study with 70 patients, 35 in long-term treatment and 35 in brief therapy. The researchers added a fourth testing after termination. They found similar results with one major exception—improvements for patients in long-term treatments were more likely to be sustained, whereas short-term patients did not sustain improvements at follow-up.

In one of the most in-depth and extensive studies of intrapsychic change (involving 90 psychiatric inpatients with serious disturbances. Sidney Blatt and Richard Ford examined the nature of intrapsychic and behavioral change across all patients, while simultaneously assessing differential change in two distinct groups. At 1 year into treatment, the researchers found that the patients as a whole had made significant improvement in externally validated real-world behaviors such as social behavior and symptom expression (assessed from hospital case records). In terms of structural change measured by the Rorschach, they found statistically significant decreases in the degree of thought disorder, with the clearest improvements in the most serious forms of thought disorder frequently found among patients with psychotic disorders. Patients also demonstrated a greater capacity to engage adaptive fantasy and demonstrated a significant improvement in the quality of object representations, both in terms of decrease in their expectations of malevolent interactions and their ability to represent objects as separate and more autonomous.

Blatt and Ford then assessed the possibility that psychodynamic treatment might affect patterns of intrapsychic functioning in different ways depending on the patient's character structure. Blatt and his research group at Yale University had earlier distilled two essential developmental trajectories corresponding to two global character styles, the anaclitic and introjective. The anaclitic character's actions are organized around defending against vulnerabilities to disruptions in need-gratifying interpersonal relationships. Anaclitic patients are highly dependent people who often experience somatic symptoms and seek solace and care from others including physicians and therapists. By contrast, the introjective character is focused primarily on issues of self-definition, autonomous identity, and self-esteem. Introjective characters often eschew dependent longings for fear they will disrupt efforts to secure autonomy and clarity of identity.

When patients were divided along anaclitic and introjective lines, interesting results emerged. For patients primarily concerned with maintaining need-gratifying relationships, changes were noted in moving from experiencing relationships as malevolent, controlling and fused, to more benign and differentiated. This structural change corresponded to the anaclitic patients’ improved social competence and motivation for treatment. For patients with introjective character organizations, the greatest change occurred in decreased thought disorder on the Rorschach, with a corresponding improvement in clinician's assessment of symptoms—most notably, introjective patients demonstrated significant decreases in psychotic symptoms with corresponding improvement in affect modulation. Blatt and Ford's findings support decades of clinical case reports demonstrating that structural change occurs in specific arenas of functioning most related to the patient's psychopathology An equally, if not more important finding is the fact that psychiatric patients with severe disturbances appear to benefit from intensive psychodynamic treatment. Finally, they demonstrate the way in which projective techniques can be sensitive to subtle changes in patients’ intrapsychic processes and can be quantified to study treatment outcome for large groups of patients.

Which one of the following is not a projective test?

Which of the following is not a model for personality testing *?

What is a projective personality test?

What are projective tests used for?