When a clinician using the Rorschach focuses on the actual images that a person sees the clinician is emphasizing?

Many people have heard of the famous Rorschach test, also called the Rorschach inkblot test, in which a person is asked to describe what they see in ambiguous inkblot images. This projective test often appears in popular culture and is frequently portrayed as a way of revealing a person’s unconscious thoughts, motives, or desires.

History

One of Hermann Rorschach's favorite games as a child was Klecksography, which involves creating inkblots and making up stories or poems about them. He enjoyed the game so much that his school friends nicknamed him "Klecks," the German word for "inkblot."

His interest in inkblots continued into adulthood. While working in a psychiatric hospital, Rorschach noticed that patients with schizophrenia responded to the blots differently from patients with other diagnoses. He began wondering if inkblots could be used to create profiles for different mental disorders.

So, inspired perhaps by both his favorite childhood game and his studies of Sigmund Freud's dream symbolism, Rorschach developed a systematic approach to using inkblots as an assessment tool.

Rorschach wasn't the first to suggest that a person's interpretation of an ambiguous scene might reveal hidden aspects of that individual's personality. Alfred Binet also experimented with the idea of using inkblots as a way to test creativity and originally planned to include inkblots in his intelligence tests.

Uses

The Rorschach test has grown to be one of the most popularly used psychological tests. It's primarily used in psychotherapy and counseling.

Those who use it regularly do so as a way of obtaining a great deal of qualitative information about a person, including their personality, emotional functioning, and thinking patterns. The therapist and client can then further explore some of these issues during therapy.

Administration

There are 10 official inkblots, each printed on separate white cards. Five inkblots are black and gray; two are black, gray, and red; and three are multicolored without any black. 

During administration, the examiner will sit next to you. This helps them see what you see. The test involves certain steps:

1. Present: The examiner will give you one card at a time and ask you, “What might this be?”
2. Respond: You’re free to interpret the ambiguous image however you want. You can take however long you like to interpret each card and can give as many responses as you want. You can also hold the cards in any position, whether it is upside down or sideways.
3. Record: Your examiner records everything you say, no matter how trivial. They’ll note the time taken for each response, the position the card is being held, your emotional expressions, etc. during the test.
4. Confirm: Once you go through all the inkblots once, your examiner will take you through each inkblot a second time. The goal of this is not to get new information, but to help your examiner see what you see. They’ll ask you to identify where you see what you originally saw and what features make it look like that.

On average, it takes about 1.5 hours to administer and score the test.

Scoring

So what exactly do interpreters of the Rorschach test look for when they are analyzing responses to the inkblots? The actual content of the responses is one thing, but other factors are essential as well.

Content

Content refers to the name or class of objects used in your responses. Some common contents include:

• Whole Human (H): A whole human figure.
• Human Detail (Hd): An incomplete human form (e.g., a leg) or a whole form without a body part (e.g., a person without a head).
• Human Detail (fictional or mythological; Hd): An incomplete fictional or mythological human figure (e.g., wings of an angel).
• Animal Detail (Ad): An incomplete animal form (e.g., cat’s head, claw of a crab).
• Sex (Sx): Anything involving sex organs, activity of a sexual nature, or sexual reproduction (e.g., sexual intercourse, breasts).
• Nature (Na): Anything astronomical or weather-related (e.g., sun, planets, water, rainbow).

Some responses are quite common, while others may be much more unique. Highly atypical responses are notable since they might indicate disturbances in thought patterns.

Location

Identifying the location of your response is another element scored in the Rorschach system. Location refers to how much of the inkblot you 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.
• “S” if the white space in the background was used. 
• “W” if the whole inkblot was used to answer the question.

Determinants

Determinant coding is one of the most complex features of scoring Rorschach. This is where the examiner considers the reasons why you see what you see. What inkblot features helped determine your response and how?

There are six broad categories of inkblot determinants you could be responding to:

• Color
• Form
• Movement
• Pairs and Reflections 
• Shading

For example, if you report seeing a flower in Card 8 because of the red color, your examiner may code that response as Color determinant.

Each category has its own subcategories and there are at least 26 possible determinant codes. More than one determinant can be used in a single response.

Interpretation

Interpreting 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. 

In addition to formal scores, Rorschach interpretation is also based on behaviors expressed during the testing, patterns of scores across responses, unique or consistent themes in the responses, and unique or idiosyncratic perceptions.

A relatively fast response might indicate being at ease with others and comfortable with social relationships. A delayed response, however, might reveal that the individual struggles with social interactions.

Criticisms

Despite its popularity, the Rorschach is a controversial test. Many of the criticisms center on how the test is scored and whether the results have any diagnostic value.

Multiple Scoring Systems

Before 1970, there were as many as five scoring systems that differed so dramatically that they essentially represented five different versions of the test. In 1974, John Exner published a comprehensive new scoring system that combined the strongest elements of the earlier systems.

The Exner scoring system is now the standard approach used in the administration, scoring, and interpretation of the Rorschach test.

Some experts caution, however, that since the Exner scoring system contains errors, clinicians might be prone to over-diagnosing psychotic disorders if they rely heavily on Exner's system.

Lacks Reliability

Another key criticism of the Rorschach is that it lacks reliability. Reliability means you get the same results no matter who is scoring the test. Scoring relies heavily on examiner interpretation. Because of this, two examiners can arrive at two very different conclusions when looking at the same person's responses.

Poor Validity

In addition to early criticism of the inconsistent scoring systems, detractors also find fault with its validity. In other words, does it measure what it claims to measure? In this case, can the Rorschach correctly assess your personality characteristics and emotional functioning?

Unfortunately, the answer is a resounding no. Research shows the Rorschach is most often unable to accurately diagnose most psychological disorders, including depression, anxiety, or personality disorders. However, research shows that it does have value for assessing thought disorders and schizophrenia-related symptoms.

Because all of these issues, in 1999, several psychologists recommended a moratorium on the use of the test for clinical and forensic purposes—at least until further research determined its real validity.

Is the Rorschach Still Used?

Today, some psychologists dismiss the Rorschach as merely a relic of psychology's past, a pseudoscience on par with phrenology. 

However, though the inkblot test may not be a perfect tool, it continues to be used widely, particularly for diagnosing schizophrenia—which was Rorschach's original intent for the test. The test is used in a variety of settings, such as in schools, hospitals, and courtrooms.