The Rorschach Test at 100

2021 marks the centenary of the publication of Hermann Rorschach's text, Psychodiagnostics, a 174-page monograph which discussed his studies and included 10 cards which became the foundation of his famous test. Sadly, Rorschach died prematurely the following year of a burst appendix, but the 'Queen of Tests' has lived on, arousing interest and controversy along the way. 

History

Mary Rushton Barkas, a psychiatrist from the Maudsley, introduced the test to this country shortly after Psychodiagnostics was published. She wrote a review of Hermann Rorschach's book in the British Journal of Psychiatryin 1925. From there, the test was disseminated by others. For example, Gordon and Norman reported using the Rorschach to test 'mental defectives' in the British Medical Journal in 1931. 

In the 1930s, the Rorschach test was embraced by Theodora Alcock, child psychotherapist, and by two psychiatrists, Dr James Earl, and Dr Eric Trist at the Tavistock Clinic in London. Two university-based research psychologists studied the test in this early period. In 1932, Oscar Oeser of the Cambridge Psychological Laboratory produced two research papers and in 1933, Phillip Vernon, a recent Cambridge graduate, published four papers on the Rorschach.

According to Hubbard and Hegarty (2016), the wartime context and the evacuation of children from London shaped Bowlby's theory of attachment, but Alcock's first published paper, The Bombed child and the Rorschach test, published in the British Medical Journal in 1941, also played an important role (see box below). Around the same period, Professor Boris Semeonoff, a psychologist working in the Psychology Department at Edinburgh University, became aware of the Rorschach 'Plates' along with the German edition of the Psychodiagnostik, when these were delivered to the University (Semeonoff, 1971). When the Second World War broke out, he served on the British War Office Selection Board. As part of the selection process for the rank of Officer in the military services, candidates were administered psychological tests, including the Rorschach, the Object Relations Technique (ORT), and the Thematic Apperception Test (TAT). Although Professor Semeonoff did not administer the Rorschach himself, he reported, 'I remember being much impressed by the information it was claimed that the Rorschach could give' (Semeonoff, 1971).

From 1948 onwards, Theodora Alcock was active in teaching the Rorschach, along with her colleagues at the Tavistock Clinic and the Tavistock Institute of Human Relations in London, until her retirement in 1968. During the 1950s, teaching in the Rorschach was also available at the Maudsley Hospital to clinical psychology trainees. 

As Head of the Clinical Psychology Training Course at Edinburgh University, Professor Semeonoff promoted the value of the Rorschach and other projective tests for the study of personality. While acting as an external examiner to psychology departments at different universities in the UK, he realised that psychology undergraduates knew very little about projective techniques. He believed this was a consequence of those who taught psychology in universities themselves having very little knowledge of projective tests and therefore not being in a position to provide teaching on this subject. This led him to write his book entitled Projective Techniques, published in 1976.   

Dr Earl established the British Rorschach Forum in 1942, which evolved into the British Society for Projective Psychology, with the aim of maintaining professional standards. This organisation shared knowledge about the Rorschach in the UK and overseas, through meetings, conferences, and the publication of a journal. The British Rorschach Forum hosted the International Congress for the International Rorschach Society in London in 1968 (McCarthy Woods, 2008).

After the Second World War, the Rorschach became the most popular test in clinical practice in the US. In contrast, the test fell into decline in the UK. This coincided with a general decrease in psychometric testing, increased opportunities for psychologists to work as therapists, and the fact that over time there were fewer individuals who could provide training in the Rorschach. As a result, unlike other countries around the world, the Rorschach is not part of the curricula in the clinical psychology training programs in the UK. When Professor Semeonoff was interviewed in 1998, a year before his death, in an article published by Tommy McKay in The Psychologist in 1999, he commented, 'This country has always been different both from the United States and from continental Europe, in that projective techniques have never taken hold here as they have done elsewhere.'

The Rorschach in clinical practice today

Many British psychologists believe that the Rorschach has no psychometric credibility and is obsolete, comparing it to tea-leaf reading. It may come as a surprise, then, to learn that outside of this country, the Rorschach remains widely used across the world. The International Society for the Rorschach has 27 member societies from all corners of the globe, including Argentina, the Czech Republic, Japan, Mexico and Turkey. They view the test as a performance-based measure of personality, offering an array of information that no self-report test provides. 

The Rorschach follows a standardised method of administration and norms are used for the interpretation of results. The administration is done in two phases; in the first, known as the free association stage, the individual is shown the ten Rorschach inkblots one at a time and is asked 'What might this be?' In the second phase, known as the enquiry stage, all the responses are revisited; the evaluator asks the person where they saw what they saw and what it was about the blot that made it look like that to them. All responses are noted down verbatim.

Then the administrator codes the answers, which are analysed using a series of algorithms and interpreted by comparing the results to the normative sample. Although response content is taken into consideration, the test is more like a problem-solving task; individuals are shown an inkblot and they have to use their own internal resources to make sense of it. The coding and interpretation will look at factors like did the individual use the whole blot or just part of it to form their answer? Did they make a coherent whole? Did they focus on the shape, the colour or shading? Did they see something most people see or something unusual? 

The test is based on a normative sample, so participants are expected to see certain things in some of the blots and we have some normative data for this country (Carstairs et al., 2018). For example, one is expected to see human beings on some of the plates; various interpretations can be derived if one does not see any human content. Further interpretations concern what the human figures are doing: are they cooperating or competing?

The results provide information about how people pay attention to the world and how they perceive and think about the objects of their attention. It gives information about how people deal with feelings and about the clarity of their thought processes. The Rorschach assesses the adaptive resources people have available for coping with demands and managing stress as well as how they deal with emotional situations. The test also addresses how people perceive and relate to others and to themselves.

The comprehensive system

Although Hermann Rorschach devised the original test, his premature demise meant that his work was taken on by others who experimented with it, modifying the procedure according to their theoretical orientation. The inkblots remained the same but many approaches were, and still are, in use. This created problems for teaching and disseminating its findings, and a plethora of different systems sprang up.

In the 1970s, John Exner, an American psychologist, created what is known as the Comprehensive System. He brought together different scoring and interpretative systems to create his own standardised method to the Rorschach inkblot test and gave the test rigorous psychometric credentials (Exner, 2003). In the 1980s and 1990s, the Comprehensive System was then taken up by many psychologists around the world and it became widely accepted and researched.

In 2003, James Wood and his colleagues published a book with the provocative title, 'What's wrong with the Rorschach?' (Wood, Nezworski, Lillenfield & Garb, 2003) in which they questioned the validity and reliability of the test. Much of their criticism was flawed (Gacono & Barton Evans, 2008) and it actually served as a catalyst in driving forward attempts to improve the psychometric rigor of the test, including the publication of a White Paper by the Society of Personality Assessment in 2005. This was the outcome of a review by a panel led by Robert Rosenthal, commissioned to provide an independent assessment of the validity of the Rorschach and the MMPI-2. The conclusion was that the magnitude of the validity of both tests was 'about as good as can be expected for personality tests'.

Research since then on the Comprehensive System has shown that it has high correlation coefficients for inter-rater reliability (Meyer, Mihura & Smith, 2005), and good test-retest reliability. Studies on the validity of the Rorschach Comprehensive system have found that it is able to identify affective and coping disturbances in depressed people (Hartmann et al, 2003), and perceptual and thought disturbance (Kleiger, 2017). It is also helpful in the assessment of adolescents (Tibon-Czopp & Weiner, 2016) and in understanding patients who present with post-traumatic stress disorder (Kaser-Boyd & Evans, 2008) and psychopathy (Gacono & Meloy, 2009). It can provide valuable information for treatment planning and predictions about an individual's ability to benefit from psychotherapy (Nygren, 2004). 

However, like any psychometric tool, the Rorschach is not without its shortcomings. The information generated is plotted in what is known as a structural summary, and this is complex and extensive. Furthermore, the Comprehensive System does not use standardised scores, but instead uses an assortment of ratios, indices and constellations; consequently, learning to interpret a structural summary is a challenging task which can be daunting for the beginner. Mastering this requires a significant investment of time and energy from us as psychologists. It requires commitment and dedication and ongoing supervision.

Nowadays, the Exner Comprehensive System vies with another system more recently derived, known as the Rorschach Performance Assessment System (or R-PAS), and there is debate about the relative merits of these two systems. The R-PAS (Meyer et al, 2011) was developed in part because of a wish to simplify the task of interpretation. There is also a French School (also known as the Paris School) which follows a psychoanalytic framework (Verdon & Azoulay, 2020) and in Japan, in addition to the Comprehensive system, there are three other schools: the Kataguchi, Nagoya University and Osaka University schools. In other words, Rorschach experts from around the world continue to develop the test in different ways, demonstrating how fertile Hermann Rorschach's original ideas are!

Clinical applications

Psychometric testing is integral to the psychologist's assessment of the person with whom they are working, and we are familiar with a common language shared amongst the self-report personality tests. Mastery of the language of correlation between scores and variables is critical. For example, when Peter – who was described as disconnected and hypervigilant – came to the clinic to be assessed for a question about paranoia, knowing that the Paranoia scale on the Personality Assessment Inventory (PAI) has a strong correlation with the Minnesota Multiphasic Personality Inventory (MMPI-2) Paranoid personality scale is helpful in a multi-tool assessment that relies on self-report methods. However, translating the information achieved from these test scores into something meaningful that can be used in therapy proves difficult with this information alone. 

The Rorschach, requiring a high level of psychometric competence, departs significantly from the familiar self-report tests in the type of language used. Once the assessor has mastered the language of form, movement, colour, and shading as determinants in how a person like Peter experiences the world, possibilities emerge for inference making and synthesising data with regard to his paranoia or another possible condition. We can see the world as Peter sees it, we understand more deeply how he experiences himself in relation to others. We can then apply a more nuanced language to his feelings and his internal world, and take that understanding into the life of therapy to help him feel better about himself, so he can enhance his relational capacities. 

Responses to the Rorschach tell us something about an individual's attitudes and concerns that the person may not fully recognise in themselves, or would be reluctant or unable to convey more directly (Weiner, 2005). As the Rorschach does not rely on reading or writing, it is useful with people with literacy problems and/or learning disabilities and it helps clients who struggle with the conversational approach of interviews to express themselves more freely than they might otherwise (Peden, 2010). It can quantify implicit psychological processes that are not accessible via questionnaires or interviews that measure self-attributions (Bornstein, 2001). This means that Rorschach data is usefully combined with different data sources such as interviews, or questionnaire data.

In a courtroom setting, a test that does not rely on self-report and that provides psychometrically robust data is very valuable. There is now a body of research on using the Rorschach in parenting evaluations for court, both for child custody and in childcare proceedings (Erard, 2005; Carstairs, 2011). The forensic interpretation of the Rorschach can help in assessing those aspects of psychological functioning that pertain to violence and hostility, risk-taking, antisocial attitudes, and impulsivity among others (de Ruiter & Kaser-Boyd, 2015) which makes it highly applicable in criminal cases. 

A unique test

This year we celebrate an important milestone in the history of psychology with the centenary of the publication of the Rorschach Test. This unique test has a solid empirical foundation. It provides an in-depth and comprehensive psychological description of the individuals we assess, making it invaluable in our compendium of tests across clinical and forensic settings. 

Find more in our archive 

Find more about the British Rorschach Society. The image above is their logo.

The British Rorschach Society will hold their Annual Case Presentation on Wednesday 17th February 2021, 4pm to 6pm, to be held online. One case will be presented from the membership which will provide an opportunity to discuss how the Rorschach data contributes to the formulation and understanding of the examinee's personality functioning in the light of the referral question. Dr Justine McCarthy Woods, Dr Kari Carstairs and Dr Marc Desautels will provide some preliminary thoughts on the case and then the discussion will be open to the audience.

This event is free for all members of the British Rorschach Society. Non-members are very welcome to join us and will be asked to pay £20 per person. 

Any questions and for registration, contact Dr Carstairs on [email protected] or 02083251697.

 

BOX: The bombed child and the Rorschach Test

Theodora Alcock's contribution, 'The bombed child and the Rorschach Test', was published in 1941 in the British Medical Journal. She discussed how children who had experienced bombing in the Second World War would often give responses to a red part of Card II that referred to fires and explosions and that included shading which she related to 'mental "haziness or fog" created by anxiety'. She presented Rorschach data from 19 children aged 3 to 16 and commented on evidence from the test for 'serious endogenous anxiety aroused by traumatic experience'.

Shading relates to responses that incorporate the gradations in the blots from lighter to darker grey and black. In her 1941 contribution, Miss Alcock referred to using the scoring system that Bruno Klopfer had devised. Klopfer was a German psychologist, born in 1900, who left Germany in 1933, spending a year in Switzerland where he studied in Zurich with Carl Jung and where he learned about the Rorschach. He then settled in the USA where he became President of the Society of Projective Techniques in 1947 until his death in 1971. His system was one of the five systems that Exner studied when developing the Comprehensive system, first published in 1974, in which the type of shading that Alcock referred to is scored as Y or diffuse shading. Exner wrote of this variable that it is 'associated with feelings that are prompted by a sense of helplessness or an inability to make a response. When these feelings intensify, they usually manifest as apprehension, anxiety, or sadness and can be very disruptive' (Exner, 2003, pp.266).

Miss Alcock also referred to another contribution that same year from Dr Mons who reported similar findings, also in the British Medical Journal. Dr Mons was the assistant school medical officer and psychologist to hostels for difficult children. He was working with 'previously good and intelligent children' who became 'obstreperous, destructive, mischievous, lazy, truant from school, and, in short, unmanageable' upon having been evacuated. He commented on how these children felt failed by the adults who were supposed to protect them, adding, 'Death has become a personal problem, and parental authority is no longer a safe shield against this direct threat of extinction.'

Based on what he acknowledged was preliminary data from 23 boys exposed to bombing as compared with 32 boys who were not so exposed, he stated, 'the raid-shocked child reveals itself as a clinical entity in the Rorschach test in about 65% of cases'. He added that the Rorschach is not pathognomonic but it gives 'a personality picture', and he commented on how the combination of being exposed to bombing and evacuation led to 'unruly' behaviour.

It is interesting for the modern Rorschach psychologist to see this early experiment in what we would now consider to be cases of post-traumatic stress disorder. The findings from Mons and Alcock are consistent with the work of Armstrong and Loewenstein (1990) who developed the Trauma Content Index (TCI). This index is based on the Exner Comprehensive System scores of Sex, Blood, Anatomy, Morbid, and Aggressive Movement, divided by the total number of responses (TC/R). A TC/R of 0.3 and above was hypothesised to suggest traumatic intrusion. This work was presaged by van der Kolk and Ducey (1989), who studied 13 male Vietnam veterans with the Rorschach and found that their test results contained intrusive traumatic material. A number of studies since 1990 have shown strong empirical support for the TCI.

References

Alcock, A. T. (1941).  The Bombed child and the Rorschach test.  British Medical Journal, Nov. 29, 787.

Armstrong, J.G. & Loewenstein, R. J. (1990). Characteristics of patients with multiple personality and dissociative disorders on psychological testing.  The Journal of Nervous and Mental Disease, 178, 448-454.

Bornstein, R.F. (2001). Clinical utility of the Rorschach Inkblot Method: reframing the debate. Journal of Personality Assessment, 77, 39-47.

Carstairs, K. (2011). Rorschach assessment of parenting capacity:  A case study. Rorschachiana, 32, 91-116.

Carstairs, Kari, Hartley, Sarah, Peden, Andrew, McCarthy Woods, Justine, van Graan, Andre, Andronikof, Anne & Fontan, Patrick.  (2018).  A normative study in England with the Rorschach Comprehensive System.  Rorschachiana, 39, 105-134. https://doi.org/10.1027/1192-5604/a000103

De Ruiter, C., & Kaser-Boyd, N. (2015).  Forensic psychological assessment in practice: Case studies. New York: Routledge

Erard, R. E. (2005).  What the Rorschach can contribute to child custody and parenting time evaluations.  Journal of Child Custody, 2, 119-142.

Exner, J.E. (2003). The Rorschach: A Comprehensive System, Vol. 1: Basic Foundations (4th ed.). New York: Wiley.

Gacono, C. B. & Barton Evans, F. (Eds.) (2008).  The Handbook of Forensic Rorschach Assessment.  Mahwah, New Jersey: Lawrence Erlbaum.

Gacono, C. B., & Meloy, J. R. (2009).  Assessing antisocial and psychopathic personalities.  In J. Butcher (Ed.), The Oxford Handbook of Personality Assessment (pp. 567-581).  London, England: Oxford University Press.

Hartmann, E., Wing, C., Berg, M. & Saether, L. (2003). Depression and vulnerability as assessed by the Rorschach method. Journal of Personality Assessment, 81(3), 242-255. 

Hubbard, Katherine & Hegarty, Peter (2016).  Blots and all: A history of Rorschach ink blot test in Britain.  Journal of the History of the Behavioural Sciences, 52, 146-166.

Kaser-Boyd, N., & Evans, F. B. (2008).  Rorschach assessment of psychological trauma.  In C. B. Gacono, F. B. Evans, N. Kaser-Boyd, and L. A. Gacono (Eds.).  The handbook of forensic Rorschach assessment.  New York: Routledge.

Kleiger, J. (2017). Rorschach assessment of psychotic phenomena: Clinical, conceptual, and empirical developoments. Routledge/Taylor & Francis Group. 

McCarthy Woods, Justine (2008).  The history of the Rorschach in the United Kingdom.  Rorschachiana, 29, 64-80.

McKay, T. (1999).  In the presence of a great psychologist…Boris Semeonoff.  The Psychologist, 12, 406-440.

Meyer, G., Mihura, J. & Smith, B. (2005) The interclinical reliability of Rorschach interpretation in four data sets. Journal of Personality Assessment, 84(3), 296-314. 

Meyer, G., Viglione, D., Mihura, J., Erard, R., & Erdberg, P. (2011).  Rorschach Performance Assessment System: Administration, coding, interpretation, and technical manual.  Toledo, Ohio: Rorschach Performance Assessment System.

Mons, W. E. R. (1941).  Air raids and the child.  British Medical Journal, Nov. 1, 625-626.

Nygren, Marianne (2004).  Differences in Comprehensive System Rorschach variables between groups differing in therapy suitability.  Rorschachiana, 26, 110-146.

Peden, A. (2010).  Why I use the Rorschach test.  Clinical Psychology Forum, 211, 35-37.

Semeonoff, B. (1971).  Rorschach and the development of projective psychology: A personal view.  The British Journal of Projective Psychology and Personality Study, 16, 5-10.

Society for Personality Assessment (2005).  The status of the Rorschach in clinical and forensic practice: An official statement by the Board of Trustees of the Society for Personality Assessment. Journal of Personality Assessment, 85, 219-237.

Tibon-Czopp, S., & Weiner, Irving B. (2016).  Rorschach assessment of adolescents: Theory, research and practice. New York: Springer.

Van der Kolk, Bessel A., & Ducey, Charles P. (1989).  The psychological processing of traumatic experience: Rorschach patterns in PTSD.  Journal of Traumatic Stress, 2, 259-274.

Verdon, B., & Azoulay, C. (2020).  Psychoanalysis and Projective Methods in Personality Assessment.  Oxford: Hogrefe.

Weiner, Irving B. (2005).  Rorschach assessment in Child Custody cases.  Journal of Child Custody, 2, 99-119.

Wood, J., Nezworski, M, Lillenfield, T. & Garb, S. (2003). What's wrong with the Rorschach? Science confronts the controversial inkblot test. Jossey-Bass, San Francisco.