Introduction
The use of visual images for the objective assessment of a patient’s behavioral patterns and tendencies was one of the invaluable contributions of Hermann Rorschach. The proposed system allowed for conducting brief experiments in practically any setting and its simplicity was added to the confirmed reliability of the tests (Meyer & Eblin, 2012). Subsequently, it developed into a psychological instrument widely used for clinical practice and adopted by the creators of other assessment tools (Bornstein & Masling, 2005).
In order to understand the significance of this approach, which is the combination of Rorschach’s ideas with other methods, it is critical to review the theoretical and practical aspects of the matter. Therefore, this paper aims to consider the history and interpretation of the Rorschach instruments, the foundations of projective assessments, and the correlation between the Comprehensive System and the Rorschach Performance Assessment System.
Foundations of Projective Assessments (Performance Based Assessments)
The wide application of Rorschach’s inkblots was explained by their usefulness for the practical implementation of various types of psychological instruments. The need to incorporate this idea into different tests corresponded to the principles of multimethod assessment. According to them, the gap between patients’ self-reported personal experience and their actual condition can be covered by the introduction of objective measures for better treatment (Mihura & Graceffo, 2014).
Thus, for example, the evaluation of object relations laid in the basis of the Mutuality of Autonomy scale complemented by the portrayal of relationships on the Rorschach proved to add precision to the overall results (Fowler & Erdberg, 2005). In this way, the link between one’s past experience and the current state could be revealed with the adoption of such a complex approach.
One of the developments corresponding to this initiative and beneficial for subsequent research was the clinical instrument known as the Rorschach Oral Dependency Scale. It was designed to examine the phenomenon of activities of the mouth in adolescence and adulthood triggering dependent behaviors such as overeating as an attempt to cope with stress and anxiety (Bornstein & Masling, 2005).
Its importance for further projective assessments was conditional upon the link between the unhealthy behavioral patterns and patients’ reaction to inkblots. In this way, the concepts of orality and dependency were viewed through the lens of Rorschach’s assessment tools combined with the theoretical knowledge of the problem. In turn, this method’s validity was proved by its comparison with some other instruments, including the Thematic Apperception Test (TAT), which demonstrated their correlation (Bornstein & Masling, 2005). As a result, the precision of the test’s predictions and its interdependence with other methods allowed considering it reliable.
Another example of the combination of Rorschach’s ideas and assessment instruments, adding to the founding role of the former in the outcomes is their use for the Ego Impairment Index. This application of inkblots for examining psychological issues and thought disorder was one of the first attempts to combine Comprehensive System of Exner, an extension to Rorschach’s tool, with a practical task (Viglione et al., 2003b).
Such an initiative happened to be beneficial due to the improved use of available cognitive, affective, and human or representational resources for the reception of a clear outcome (Viglione et al., 2003b). As a result, the researchers concluded on the compatibility of the specified methods and their effectiveness in terms of problem-solving and coping activities (Viglione et al., 2003b). Therefore, the foundations of projective assessments implying the intention to evoke patients’ response with the help of ambiguous stimuli on the example of the Rorschach was connected to this approach’s suitability for numerous purposes.
History of the Rorschach
The emergence of the Rorschach Performance Assessment System (R-PAS) was connected to the works of Hermann Rorschach, a Swiss psychiatrist working in a mental hospital, which were subsequently promoted by John Exner and other specialists. Rorschach’s role in the creation of the system was in the development of ten images presenting ambiguous inkblots in 1921, and they allowed objectively evaluating one’s condition (Weiner, 2003).
In this way, he attempted to demonstrate the interrelation between specific symbols and people’s responses to them. The most peculiar specificity of the proposed approach is related to the fact that it did not change over time while other methods were created and consequently abandoned due to their unsuitability to new conditions (Meyer et al., 2011). Therefore, the method of personality assessment developed by Hermann Rorschach can be viewed as a classical approach with a wide range of applications currently used by clinics.
Despite the overall popularity of the Rorschach’s inkblots, it was heavily criticized by many psychologists. They expressed their doubts regarding the test’s validity since the psychometric foundations for their selection were unclear and unfounded (Meyer et al., 2011). This theory received sufficient support only after it was tested by a series of experiments applied to various population groups and potential issues, as mentioned above.
In this way, the accumulation of additional data on the practical outcomes of the Rorschach implementation did not divert the attention of scholars from this approach. On the contrary, they started to conduct their own experiments on the use of inkblots for clinical diagnostics (Smith et al., 2005). As a result, the surveys confirmed the method’s general benefits and highlighted the issues, which should be addressed. They included several variables affecting the outcomes of the examination, including patient engagement, error variance related to the difference in the number of responses, and inconsistency in the score interpretation (Meyer et al., 2011). Nevertheless, the approach gained a wide following and the support of researchers.
Another benefit of Rorschach testing is connected to its simplicity in comparison with other tools for psychological assessment. In contrast to many other clinical training programs and instruments for evaluation, this technique is easier for professionals to learn and use in their everyday practice (Meyer et al., 2011). Moreover, it corresponds to the needs of the present-day specialists regarding the implementation of uniform methods since the Rorschach did not change over time, and it is unlikely to be modified in any way (Meyer et al., 2011). Thus, the benefits for mental clinics and other facilities adopting psychological assessment methods are complemented by international considerations. This conclusion explains the popularity of the Rorschach among practitioners.
CS Versus R-PAS
The two most popular models based on the developments of Hermann Rorschach are the Comprehensive System (CS) created by John Exner and the Rorschach Performance Assessment System (R-PAS). Even though these two approaches have the same theoretical underpinning, which is the use of the Rorschach Inkblot Method (RIM), there are significant differences between them. First, the CS is based on the normative values collected in the United States, whereas the R-PAS is not geographically specific and represents an international base of evidence (Lewey et al., 2019).
Second, the R-PAS variables received validation through their comparison with other systems. The CS has no universal empirical confirmation, partially due to the inclusion of several theories instead of focusing on one principal method (Lewey et al., 2019). In this way, these two models differ in the scope of data, geographic orientation, and practical implementation.
Since the CS and the R-PAS have varying characteristics, as stated above, the results of their interpretation cannot be similar. According to Pianowski et al. (2019), the comparison of the outcomes of the models’ use in practice revealed the prevalence of R-protocols in the R-PAS. In this way, the need for administration was eliminated for the R-PAS in contrast to the CS, which consisted of five protocols (Pianowski et al., 2019).
This conclusion adds to the complex nature of the CS and, therefore, changes scholars’ perspectives on the adoption of these assessment methods for different purposes. Moreover, the examination of the results of the R-PAS demonstrated less perceptual distortions than the CS (Pianowski et al., 2019). In this way, it can be concluded that the use of the R-PAS implies the reception of protocols in an optimal range, which contributes to the appropriate interpretation of data.
From this perspective, the need to reduce variability in responses during the assessments seems to be better addressed by the R-PAS, whereas the scholars claim that the selection of one or another model does not adversely affect the precision. Meyer et al. (2018) argue that the analysis of responses received on the three types of code had stable proportions in relation to the presented cards. As for the administration method, it did not influence the potential projective variable means (Meyer et al., 2018). Therefore, the interpretation of the outcomes of assessment as follows from the CS and the R-PAS practical implementation does not create any challenges regarding the accuracy of results.
Coding and Interpretation of the Rorschach
The Rorschach Inkblot Test is one of the most used assessment tools in present-day clinics and other facilities. As it was mentioned above, the theory behind the use of the Rorschach does not change over time. Meanwhile, some details of the practical implementation might be adjusted to the needs of scholars. For instance, the modifications of variables included such changes as the replacement of the Human Experience Variable (HEV) by the Human Representational Variable (HRV), which reflected specific needs (Viglione et al., 2003a).
In this case, it was necessary to include the required psychometric properties. In turn, the coding process includes the examination of the received responses as related to the tested variables to match them with the main scales (Mihura et al., 2013). For the R-PAS, it covers such aspects as location, space, content, and object (Weiner, 2003). A more detailed examination addresses cognitive and thematic codes providing the data regarding one’s behavior (Weiner, 2003). Subsequently, this information is assessed, and the outcome of testing is formulated.
The following step after administration and coding is the process of interpretation of the results. It implies the use of specific strategies for this purpose aimed at considering the processes, which occur during the conversation with an examinee rather than particular psychological constructs (Mihura et al., 2013). This stage can also be modified as in the case with coding, and the changes can be connected to the technical aspect. More specifically, they are related to the scoring system, according to which the R-PAS interpretations should cover both standard scores and complexity-adjusted scores (Pignolo et al., 2017). Hence, the orientation of specialists is defined by the targeted problems.
The strategies for the R-PAS interpretation vary depending on the need for either empirical and conceptual perspectives or theoretical approaches. Thus, the empirical method implies the use of evidence and the comparison of people’s responses with the data regarding conditions affecting their possible reaction (Weiner & Greene, 2008). For example, the researchers evaluate one’s answers through the lens of specific mental issues.
In the conceptual model, they would focus on various aspects of personality functioning (Weiner & Greene, 2008). These two techniques are believed to be more scientific than such options as the Quija board or the authoritative approaches. The former indicates the guidance by intuition and empathy, which do not have any real value from the perspective of clarity and precision (Weiner & Greene, 2008). The latter, in turn, is oriented on the opinions and conclusions of authorities, and they can be inapplicable to a specific situation and, therefore, deemed unreliable. Therefore, the results of the R-PAS testing will differ depending on the approach preferred by the researchers.
Conclusion
To summarize, the theory developed by Hermann Rorschach, which was laid on the basis of numerous psychological assessment tools, was proved to be beneficial for scientific examination of various conditions of patients. The foundation for the application of the ten inkblots for this purpose was connected to the precision, clarity, and objectivity of this method. The two of the most known systems based on Rorschach’s developments are the Comprehensive System (CS) and the Rorschach Performance Assessment System (R-PAS).
They have the same theoretical underpinning implying the use of the inkblots while being different in implementation and scope. The R-PAS, as an example of one of the most effective Rorschach tools, implies following such steps as administration, coding, and interpretation of data. In other words, the received information is compared with a set of codes, which are subsequently interpreted.
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