Art Therapy

“One of the basic rules of the universe is that nothing is perfect. Perfection simply doesn’t exist…..Without imperfection, neither you nor I would exist” ― Stephen Hawking


“One of the basic rules of the universe is that nothing is perfect. Perfection simply doesn’t exist…..Without imperfection, neither you nor I would exist” ― Stephen Hawking

Only in Israel

Recently I was surprised to learn that in Israel, in contrast to all other countries around the world, the Rorschach test is still used extensively.  This is a purely projective test, even though those who use it claim it is valid, since there are strict rules for interpretation.  Why am I talking about it, and why should it interest anyone who is not a psychologist, a therapist, or a psychiatrist?  Because I was horrified to learn the scope of how many companies and agencies, including the army, government, and courts of law, rely on results of this test to hire, fire, convict, or reject people.

The original test was first presented by Hermann Rorschach, a swiss psychiatrist in 1921, a year before he died at age 37.  He noticed that the 10 cards of inkblots he created allowed him to distinguish between schizophrenic and “normal” people.  What we have today is a test that true believers claim is an x-ray to the personality.  Like all believers, they attribute to it an almost magical ability to detect mental illness, evaluate personality traits, predict patterns of behavior, and uncover repressed memories and traumas.  My problem with this kind of statement is that it stands on a very flimsy scientific base.  This is purely a projective test whose scoring does not take into consideration variations of culture, belief systems, and education level of tested individuals, nor their familiarity with the test itself.  Then there is the tester, who again checks the answers with their own bias of psychological school of thought, personal cultural biases and interpretation of scoring methods.  Even the most skilled psychologist comes with some inherent biases that often enter the picture unintentionally.

The Rorschach test is supposed to examine a range of functional traits such as cognitive-reality testing, as well as conceptual and thought disorders (e.g. psychopathy), self-perception, interpersonal relations (e.g. ability to express emotions), and existing resources for problem solving and coping with pressure.  Indeed, if it actually is able to do all that, small wonder it is so attractive to agencies that hire people in order to make sure a candidate fits into their organizational environment, and suits the company’s needs.  If it is so good, then why has it fallen out of favor in most of the world?

When I see these claims, I remember a very wonderful individual I will not name, who became a productive member of our community.  She was an orphan, who was brought up on a farm in Australia by her Jewish grandmother, her mother’s mother, after her parents perished in a car accident.  She was doing her residency in  psychiatry at the time we met, and was highly regarded by her colleagues and members of her synagogue.  Unfortunately she became ill, and needed a bone-marrow transplant.  It was then that we were stunned to meet her parents and sister, devout Christians.  I know that she underwent a series of tests, including the Rorschach, before being admitted to do her residency.  I am not sure she even had any medical training, but she was a skilled psychopath who passed all the tests with flying colors.  We in the community, honored her contributions of love and care and her last wish.  I, personally, with another member of our community, traveled with her body to bury her in a cemetery that allowed Jewish burial for non-Jews.  That was over 30 years ago.  Small wonder that the Rorschach test has fallen out of fashion since then.

The scoring of the test is based on the responses of a person to what s/he sees in the color or black-and-white inkblots on a set of 10 cards.  Each card is shown in succession, and the person is asked to name as many objects as s/he can see in each inkblot.  If the tester feels there are too few answers, or none, the whole process is done again.  I posit that here we can see already a problem: it is the decision of the tester whether to repeat the process.  This can unnerve the subject, and make him or her invent things in order to please the tester.  Of course, then comes the question of how common or outlandish the answers are.  True, by now there are so called “standard” answers, but an unusual answer may not stem from a mental-health issue but rather from the particular experience of the subject, which is not shared by the tester.  For example, a person who grew up in Japan and names a bunch of mythical figures unfamiliar to the tester, or a dragon shooting fire, is not disturbed, but connected to his culture.  As common as it is today to take culture bias into account, in this type of test there is no room for such explanation – it is simply scored according to a set formula.  A senior Israeli neuropsychologist (Dr. Assa) who in the past conducted a large number of projective tests, including the Rorschach, is reported as saying “My feeling is that the Rorschach says more about the tester than the subject, because of the scoring method, which contains a dominant subjective element. I am not against administering the Rorschach test within a broader series of tests, but in Israel it’s been made sacrosanct.”

In my own work as an art therapist, I have used the inkblots in a totally different way.  Children and adults love to make seemingly magic creations by folding a piece of paper in half, dropping different colored inks into the seam, then folding and pressing the paper.  When opened, a wonderful mirrored image, similar to the Rorschach images, appears.  I imagine that this indeed was the way Rorschach himself created his set.  He was the son of an art teacher, and had been known to play with this method to the point of acquiring the nickname Klex, or “inkblot,” since he enjoyed klecksography, the name of this form of art.  When I see a client, it is important for me to make sure not to interpret the art, but to find out from the creator what it means.  To work with the material that emerges according to a variety of psychological theories, and not solely from the psychodynamic perspective on which the Rorschach is based.  I agree with Dr. Assa when she says “to enable effective intervention, it’s necessary to look at the patient through a totality of cognitive, social, and medical factors.”  I have worked with head-injury clients, with clients who were mourning, depressed, and suffering trauma from a variety of reasons.  If I had based my treatment on the results of a Rorschach test, I might have needed to concentrate on pathology rather than resilience and abilities, as I do.

Testing is indeed very important in medicine.  This is why any test must undergo rigorous and lengthy procedures before it is allowed for use on humans, to ensure it will perform to the highest possible standard in aiding a diagnosis.  When you test for breast cancer by mammography, for example, the way healthy tissue differs from diseased tissue has been standardized over thousands of samples.  The equipment has been designed, tested, standardized, and refined, until it produces the best possible picture.  Even then there are cases that are not clear and are sent for analysis by better and more sensitive equipment that presents a clearer picture of the tissues.  And even then, the diagnosis does not rely on the picture alone.  A biopsy is taken and the cells are compared to samples of cells in a huge database in order to be certain about the type of cell it is and to determine the best treatment.  True, these tests have life-and-death consequences.  But when the Rorschach test is administered in order to determine a person’s sanity or criminality it is also a serious matter.  Although a group of American analysts and statisticians developed a rigorous scoring method for the Rorschach test, which was introduced in Israel in 2014, the basic problem is still the scoring bias that exists because of the personal interpretation and skill of the test administrator.

“The question is not only whether the Rorschach is valid, but also whether it has added validity that’s worth the investment,” says Dr. Iftah Yovel, head of the clinical psychology track at the Hebrew University.  “In my eyes, the answer is that it’s certainly not. If I administer a depression questionnaire to you, which takes you two minutes to fill out and takes me half a minute to score, there’s no point in my investing as much as five hours in a Rorschach in order to determine whether you’re depressive.”

“It’s not what you look at, but what you see.” – Thoreau.

I am really glad that as an art therapist I am not allowed to diagnose, so I will never be called upon to use the inkblots as a diagnostic tool.  I may create inkblots and enjoy using my imagination to conjure up some creative story from the images I see.  I may offer a client to do the same, and help to unearth some deep-seated memory which we can explore together.  Perhaps we may arrive at a better understanding of some issues the client struggles with, and even to resolve them and grow.  I challenge you to find which images from this article are inkblots from the Rorschach test, and which ones I created.  And for fun, take a piece of paper, fold it in half, open it again and drop some watercolor or ink onto it, fold it over again, and press.  When you open it once more, Voila!  Inkblot.  You too can create your own set.

— 2021-02-11