Clinical Diagnosis and Assessment 101
Herman Rorschach (1884–1922). This test includes ten inkblots, one on each of
ten cards. The ambiguity of the shapes permits a patient to imagine freely what
the shapes resemble.
Rorschach tests and projective tests in general have been criticized for two re-lated reasons (Anastasi, 1988; Entwisle, 1972): (1) They do not appear to be valid
(that is, to assess what they are said to measure); and, (2) they are not necessarily
reliable (the assessment of a patient on one day is not necessarily the same as an
assessment made on another day). John Exner (1974) addressed these criticisms by
developing a systematic, comprehensive scoring system for the Rorschach test. This
system has been tested extensively with a variety of populations, and it has been
shown to be reasonably reliable (Sultan et al., 2006). Research shows that Exner’s
system also assesses psychosis reasonably well (Dao & Prevatt, 2006; Garb et al.,
2005; Meyer & Archer, 2001). However, it is not as effective in assessing psycho-
logical disorders in general (Lilienfeld et al., 2000; Wood, Lilienfeld, et al., 2001).
Furthermore, the norms of Exner’s scoring system might lead to misdiagnosing peo-
ple as having a disorder they do not, in fact, have (Wood, Nezworski, et al., 2001).
Thus, although the Rorschach test may provide information regarding aspects of a
patient’s personality and mental functioning, it is not the only tool available to do
so, and it has clear drawbacks.
Another projective test, the Thematic Apperception Test (TAT), uses detailedblack-and-white drawings that often include people. The TAT was developed by
Christiana Morgan and Henry Murray (1935) and is used to discern motivations,
thoughts, and feelings without having to ask a person directly. The patient is asked
to explain the drawings in various ways: The clinician may ask the patient what is
happening in the picture, what has just happened, what will happen next, or what
the people in the picture might be thinking and feeling. Like the Rorschach test, the
TAT elicits responses that presumably refl ect unconscious beliefs, desires, fears, or
issues (Murray, 1943).
Responses on the TAT may be interpreted freely by the clinician or scoredaccording to a scoring system. However, only 3% of clinicians who use the TAT rely
on a scoring system (Pinkerman, Haynes, & Keiser, 1993). Furthermore, the TAT
has been criticized because responses to the drawings can be ambiguous. In par-
ticular, a clinician cannot distinguish between a patient’s thoughts, feelings, or usual
behavior and how the person wants to think, feel, or behave (Lilienfeld, Wood, &
Garb, 2000). This fundamental ambiguity calls into question the rationale for using
the test, which is to understand the patient’s mental processes and contents without
having to ask about them directly.
3.3 • An MMPI-2 Profi le for Validity and Clinical
Scales This is the MMPI-2 profi le of a depressed 47-year-old
man. His highest clinical scores are on the D and Pt scales,
followed by Pd and Si. People with this profi le typically are
signifi cantly depressed, agitated, and anxious. They may
brood about their own defi ciencies and have concentration
problems (Greene, 2000).Figure 3.33 S m f s b p
g3330507090406080100110LFKValidity scale Clinical scaleAverage
scoreScore rangeHs D Hy Pd Mf Pa Pt Sc Ma SiThe Rorschach test is a projective test that consists
of inkblots. Patients are asked what each inkblot—
like the one here—looks like. The Rorschach test
is based on the idea that the test-taker imposes a
structure onto the ambiguous inkblot; the patient’s
responses are thought to reveal something about
himself or herself.Getty ImagesLewis J. Merrim/Photo Researchers
As part of the Thematic Apperception Test,
patients are asked to describe the motivations,
thoughts, and feelings of people portrayed in
various drawings. Some clinicians consider a
patient’s answers to refl ect unconscious beliefs,
feelings, and desires.