Projective techniques usage worldwide: A review of applied settings

Abstract

Projective techniques have been the target of extensive criticism, from both clinicians and academicians, since the 1940s. However, the last two decades have witnessed a steady stream of rather reviled and condescending commentary directed largely on the lack of psychometric credibility of individual projective methods. The intent of the current study is to determine whether this collective movement, evident in the scholarly literature, against projective techniques has had a deleterious impact on test usage worldwide. To that end, the author identified, through an extensive literature review, published survey research that reported on test usage patterns from 1995-2015. The 28 identified studies served as the data pool to ascertain the extent of use of projective instruments within the context of psychological tests available to mental health practitioners. Around 70% of the sample was from the USA, but other countries (e.g., Africa, UK, Hong Kong, Belgium, and Brazil) were also represented. The analysis showed that at least one projective technique was ranked among the top 5 tests, in terms of usage, in 14 of the 28 studies. Moreover, human-figure-drawings, sentence completion measures, and the TAT were ranked among the top 15 tests in all but three of these studies. These findings confirm continued use (albeit to a lesser degree than 50 years ago) of projective tests among mental health practitioners worldwide, despite the onslaught of perennial criticism in the research literature.

Full text

Projective Techniques Usage Worldwide:
A Review of Applied Settings 1995-2015
Chris Piotrowski
University of West Florida, USA.
Projective techniques have been the target of extensive criticism, from both clinicians
and academicians, since the 1940s. However, the last two decades have witnessed a
steady stream of rather reviled and condescending commentary directed largely on the
lack of psychometric credibility of individual projective methods. The intent of the current
study is to determine whether this collective movement, evident in the scholarly literature,
against projective techniques has had a deleterious impact on test usage worldwide. To
that end, the author identi! ed, through an extensive literature review, published survey
research that reported on test usage patterns from 1995-2015. The 28 identi! ed studies
served as the data pool to ascertain the extent of use of projective instruments within the
context of psychological tests available to mental health practitioners. Around 70% of the
sample was from the USA, but other countries (e.g., Africa, UK, Hong Kong, Belgium,
and Brazil) were also represented. The analysis showed that at least one projective
technique was ranked among the top 5 tests, in terms of usage, in 14 of the 28 studies.
Moreover, human-! gure-drawings, sentence completion measures, and the TAT were
ranked among the top 15 tests in all but three of these studies. These ! ndings con! rm
continued use (albeit to a lesser degree than 50 years ago) of projective tests among
mental health practitioners worldwide, despite the onslaught of perennial criticism in
the research literature.
Keywords: Projective Techniques, Psychological Assessments, TAT, Rorschach,
Mental Health.
© Journal of the Indian Academy of Applied Psychology
2015, Vol. 41, No.3 (Special Issue), 9-19.
C opi ous surv e y data, from the 19 40s
throu gh the 1980 s, attes ts to the clinical
popularity of projective techniques in mental
health settings worldwide, particularly in the
USA (chronologically: Louttit & Browne, 1947;
Frank, 1948; Burton, 1949; Sundberg, 1961;
Hinkle, Nelson, & Miller, 1968; Lubin et al.,
1971; Brown & McGuire, 1976; Wade & Baker,
1977; Piotrowski & Keller, 1978, 1989; Sell
& Torres-Henry, 1979; Fee, Elkins, & Boyd,
1982; Tuma & Pratt, 1982; Lubin, Larsen, &
Matarazzo, 1984; Piotrowski, 1985; Sweeney,
Clarkin, & Fitzgiggon, 1987; Harrison et al.,
1988; Bubenzer, Zimpher, & Mahrle, 1990;
Archer et al., 1991). Thus, over these years,
projective techniques were found to be popular
in adult settings, used frequently in child and
adolescent assessment (Cashel, 2002), relied
upon by school psychologists (Hutton, Dubes,
& Muir, 1992; Miller & Nickerson, 2007), and
applied in forensic settings (Hamel, Gallagher,
& Soares, 2001). Interestingly, the Rorschach
and TAT have been accepted in the assessment
armam entariu m by clin ici ans harb ori ng a
behavioral orientation (see Piotrowski & Keller,
1984).Furthermore, applications of projective
testing to culturally-diverse populations and
ethnic groups have been evident in the research
literature (e.g., Dana, 1998; Lindzey, 1961;
Retief, 1987).
Few survey-based studies on test usage
outside the USA appeared in the 1970s; for
example in Canada (La Pointe, 1974), in South
America (Gonzalez, 1977), and in Germany
(Schober, 1977). In the 1980s, test usage
patterns were noted in a survey of the British
Psych ological Society (Tyler, 1986). Later,
Piotrowski, Keller, & Ogawa (1992) reported on
projective test usage patterns in four countries
during the 1980s, i.e., USA, Japan, Netherlands,
and China (Hong Kong). The analysis showed
Invited Article

10 Chris Piotrowski
that projective tests were quite popular in clinical
assessments across all these geographical
regions. However, it must be noted that during
these decades, the sentiment toward projective
techniques was quite unfavorable across Europe
(see Mahmood, 1988; Poortinga et al., 1982;
Porteous, 1986; Rausch de Traubenberg, 1976).
However, survey data from the early 1990s
found that proj ective measures were quite
popular in Japan (Ogawa & Piotrowski, 1992).
Unfortunately, some published reports on test
use internationally tend to omit discussion of
projective tests (e.g., Cheung, 2004; Evers et
al., 2012; Oakland, 2004; Paterson & Uys, 2005).
Nevertheless, there were perennial concerns
and critiques of projective techniques over the
last 50 years (see Butcher, 2006; Piotrowski,
1984; Reynolds, 1979). It was not until the early
1990s that an onslaught of hardened opposition
to use most projective techniques was evident
from many quarters (Garb 1999; Garb, Wood,
Lilienfeld, & Nezworski, 2002; Hunsley & Bailey,
1999 ; Medoff, 2010; Wood, Nezwo rsk i, &
Stejskal, 1996; Ziskin,1995).In support of these
rather reviled appraisals, extensive reviews of
the literature concluded that validity evidence
for projective techniques has been very limited
(see Lilienfeld, Wood, & Garb, 2000; Mihura,
Meyer, Dumitrascu, & Bombel, 2013; Motta,
Little, & Tobin, 1993; Smith & Dumont, 1995),
including reviews by European researchers
(e .g., Wittko w ski, 1996) . Howe v e r, oth e r
researchers, in reviewing meta-analytic studies,
have reported positive differential diagnostic
outcomes regarding several projective tests
(e .g. ,Kah ill , 1984; Kubisz yn et al. , 200 0;
Piotrowski, 1999 ). In psychometric theory,
the central contention regarding assessment
instruments rests on ‘validity’ metrics that re" ect
psychological and behavioral tendencies (see
Abe ll, Wood, & Liebman, 2001; Bornstein,
1999; Messick, 1995). With regard to projective
tests, the focus of criticism was predominantly
targeted at the lack of validity per se. Based on
this dramatic shift (commencing around 25 years
ago) to expunge projective techniques from both
training emphasis and clinical practice, it would
be of interest to examine extant published data
on clinical use of projective techniques in clinical
and other applied settings since 1990. Moreover,
it would be revealing to investigate recent usage
trends with regard to individual projective tests
worldwide.
In order to appreciate historical trends on
the role of projective testing in applied clinical
settings, the author utilized bibliometric analysis
of the extant literature to: a) identify the extent
of research emphasis on various topics of
investigatory interest, and b) identify data-
based survey studies on usage of projective
techniques. To that end, a systematic search
of the dat abase PsycI NFO (pub lis hed by
th e Americ an Psy chol o gica l As soci ation )
was conducted, as this research repository
is consid ered the lead ing schola rly file of
research in the social and behavioral sciences
worldwide. Table 1 presents areas of topical
focus by researchers regarding projective tests
since 1990. Psychometric credibility, empirical-
quantitative approaches seem to predominate
Table1. Major Investigatory Aspects of Journal
Articles on Projective Techniques (1990-2015)
N
Topical focus
Test validity 548
Personality measures 412
Test reliability 334
Psychometrics 306
Methodology
Empirical analysis 1,771
Quantitative approach 666
Interviews 71
Clinical case study 66
Qualitative design 53
Literature review 47
Longitudinal design 43
Meta-Analysis 16
Age Group
Adult (18+ yrs. of age) 1,553
Adolescents (13-17 yrs. of age) 450
Children (1-12 yrs. of age) 307
Aged (65+ yrs. of age) 268

Projective Techniques Usage Worldwide 11
this area of research, perhaps highlighted by
meta-analysis methods in more recent years.
Moreover, samples that re" ect all age groups
appear to be representative of this body of
research. Table 2 summarizes survey ! ndings on
usage of projective techniques since 1995. This
analysis includes the 28 published studies that
appear in journals, based on clinician/practitioner
samples worldwide. A brief discussion of general
conclusions on projective test use, over the last
two decades, follows below.
Findings
This sec tion discus ses the findings on
projective test usage reported in the 28 survey-
type studies of either practicing psychologists/
mental health practitioners or in mental health
settings worldwide since 1995. Table 2 presents
a summary of the country of origin, samples
surveyed, and degree of test use on speci! c
projective tests. In general, the overall analysis
indicates that projective tests have continued
to be used (to some degree) in the majority of
countries surveyed over the past 20 years. In 50%
of these studies (n=14), at least one projective
technique was ranked within the top ! ve tests
in terms of usage. The Rorschach seems to
be the most popular projective test, evident by
being ranked among the top ! ve tests in 12 of
these 14 studies. This corroborates research-
based ! ndings ( Piotrowski, 1996). Human ! gure
drawings, sentence completion methods, and
the TAT ranked among the top 15 tests in 25 of
the 28 surveys in the current analysis. Validation
research on these instruments show modest
support (e.g., Yama, 1990). In the aggregate, a
general conclusion can be con! dently offered
that projective tests continue to be relied upon
ac ros s div erse psyc holo gic al practi tioner
groups, in various clinical settings, for all age
groups (children, adolescents, adults), across
many countries worldwide, over the last two
decades (1995-2015). These results support the
continued popularity of and interest in projective
assessment, as evidenced in scholarly books
on these select instruments (Aronow, Weiss,
& Reznikoff, 2013; Dana, 2014; Frick, Barry,
& Kamphaus , 201 0; Gr oth -Mar nat, 2009;
Harwood, Beutler, & Groth-Marnat, 2011; Rabin,
1986).
The af! rmation on projective test use, based
on this extensive analysis of the literature seems
to counter several highly-cited studies (e.g.,
Lilienfeld et al., 2000; Wood et al., 2000) and
research compendiums (e.g., Ziskin, 1995)
that contend (the unsupported position) that
projective techniques are moribund in clinical
practice, lack psychometric credibility, and
should be excised from graduate education and
internship training. This perennial degradation of
projective techniques can be aptly summarized
by the comments in Ziskin (1995).
“Of all the criticisms to which projective
techniques have been subject to, perhaps, the
potentially most devastating one is when the
examiner may engage in as much projection and
subjectivity in the interpretation of responses as
did the examinee in generating the responses….
may be primarily biased by clinical impression.”
(p. 824).
What is particularly alarming regarding
such derisive commentary from critics is that
these drawbacks can be readily applied to
objective tests and even behavioral assessment
techniques. Unfortunately, it appears that terms
like ‘Moratorium’ is leveled solely on projective
techniques (Garb, 199 9).Yet, inter es tingly,
opp on en ts of projective tests conveniently
neglect to apply their string ent evalua tive
standards to non-projective instruments.
The current analysis shows that based on
the self-report data from practicing clinicians,
pr o j ectiv e te c h niques co n t inue to be an
appropriate ‘instrument of choice’ in the available
clinical assessment protocol of tests. Although,
the exten t of projective test use has been
tempered over the past 50 years, based on
survey data over the decades (Piotrowski &
Colleagues, 1984, 1985,1992, 1998), it appears
that such techniques continue to provide rich
clinical data for a sizeable segment of mental
health practitioners worldwide (Blatt, 1976;
Keddy & Piotrowski, 1992; Kennedy et al., 1994).
Perhaps, as evidence for the high level of interest
in select projective measures, research teams
continue to explore creative adaptations to the
Rorschach method and Human Figure Drawing
applications. It should be noted that projective

12 Chris Piotrowski
techniques should not be immune from intense
criticism from both clinical and research scholars
- the assessment enterprise can prosper from
thought-provoking challenges. However, cynical
attacks on the future of projective methods
would best be framed on hard data. Irv Weiner
(1983), in his award presentation exclaimed
that despite severe criticisms leveled against
projective techniques (some 50 years ago),
published survey data clearly showed that these
assessment approaches were held in high
regard by practicing clinicians, both in practice
and academic settings. The current ! ndings,
based on objective survey data worldwide,
indicate that although there has been a tepid
decrease in use of projective tests over the
last two decades, Weiner’s contention has not
been invalidated - to the dismay of opponents
of projective techniques.
Conclusion
Critical appraisal is a fundamental, and
welcomed, aspect of scholarship, which clearly
applies to projective methods (Butcher, 2006;
Porto-Noronha, 2002). However, reviews of
the recent literature confirm that projective
techniques have been unfairly targeted by
what can only be characterized as reviled
criticism from a select group of detractors.
Psychometric theory, supported in recent years
by advancements in statistical modeling, posits
that all assessment methods have drawbacks
with regard to validity issues (Messick, 1995;
Meyer et al., 2001). Thought ful, schol arly
rebuttals to attacks on the viability of projective
tests, in recent years, have been scant (see
Weiner, 1996, 1997, for a review). Thus, the
curre nt stud y was des igned to adher e to
providing an objective, data-based approach
in determining whether the perennial weight
of criticism against projective techniques, over
the last two decades, has impacted usage
of this group of assessment instruments in
applied settings worldwide. The ! ndings of the
analysis clearly indicate that a sizeable minority
of mental health practitioners, from over 10
countries, continue to rely on the Rorschach,
Thematic measures, Human-Figure-Drawings,
and Sentence Completion tests as part of the
clinical assessment armamentarium. Such
usage is evident across various patient age
groups (e.g., Kamphaus, Petoskey, & Rowe,
2000; Palmiter, 2004) and in a host of treatment
settings, in addition to court-related evaluations
(Gava & Dell’Aglio, 2013; Lally, 2001; Meloy,
Hansen, & Weiner, 1997; Weiner, Exner, Sciara,
1996). These robust ! ndings suggest that the
clarion-call to abandon projective methods has
largely fallen on deaf ears. Perhaps, this re" ects
the science-practice divide noted so keenly
in the literature (Beutler, Williams, Wake! eld,
& Entwistle, 1995; Hogan & Rengert, 2008;
Piotrowski, 2012). At the same time, the evidence
suggests that practitioners view the merits of
projective testing as a diagnostic tool, as an
indicator or direction for progress in therapy,
and as a compliment to the overall assessment
enterprise (Basu, 2014). Future research should
address the potential impact of evidence-based
psychological assessment guidelines on overall
projective test usage (Jensen-Doss & Hawley,
2011; Youngstrom, 2013). Finally, studies on test
use patterns in countries not represented in the
current analysis would provide a more accurate
appraisal on the current status of projective
testing worldwide (see Bartram & Coyne, 1998;
Boucherat-Hue, 2001; Datu, 2013).
Table 2 Summary and Findings on Use of Projective Techniques across 28 Studies (1995-2015)
Study Country Sample Findings
Chan & Lee (1995) Hong Kong 50 practicing psychologists in
1993
H-T-P ranked 2nd; DAP 7th; SCT
8th; TAT 12th; MAPS Test 16th;
CAT 18th; Rorschach 29th
Kennedy et al.
(1994) USA School psychologists
HFDs ranked 3rd; SCT 4th; H-T-P
5th; KFDs 7th; TAT 9th; CAT 12th;
Rorschach 13th

Projective Techniques Usage Worldwide 13
Watkins et al. (1995) USA 412 clinical psychologists
SCT ranked 4th; TAT 5th;
Rorschach 6th; H-F-Ds 8th; CAT
16th
Borum & Grisso
(1995)
USA 102 forensic psychologists/
psychiatrists
33% of practitioners, in
court-mandated competency
evaluations, use projective tests;
30% rely on the Rorschach;
other PT used infrequently
Lees-Haley et al.
(1996) USA 100 forensic neuropsychology
experts
SCT ranked 10th; Rorschach
23rd; Figure drawings 26th
Ackermann &
Ackermann (1997) USA Practitioners in court-related
settings
Rorschach ranked #2; TAT #4;
SCT 5th
Frauenhoffer et al.
(1998) USA
Surveyed 487 mental health
practitioners (psychologists,
counselors, social workers)
SCT ranked 5th; H-F-Ds 6th;
Rorschach 9th; TAT 12th
Piotrowski et al.
(1998) USA
137 practitioners in National
Register of Health Service
providers in Psychology
Tests considered most important
to practice: Rorschach ranked
3rd; TAT 5th; HFDs 12th. Also,
20% of respondents felt that the
Rorschach & TAT are no longer
used
Muniz et al. (1999)
Spain,
Portugal, &
Latin America
Test use by Practicing
psychologists
Rorschach ranked 3rd; DAP 8th;
TAT 10th
Boccaccini &
Brodsky (1999) USA 80 practicing forensic
psychologists
40% of sample use the
Rorschach-ranked 5th; only 10%
use TAT-ranked 11th
Camara et al. (2000) USA 179 practitioners, mostly clinical
psychologists
Rorschach ranked 4th; TAT 6th;
SCT 15th; CAT 16th
Archer & Newsom
(2000) USA 346 psychologists, working with
adolescents
Rorschach ranked 2nd; SCT 3rd;
TAT 4th; H-T-P 7th; KFDs 11th;
Roberts Apperception Test 19th
Boothby & Clements
(2000) USA Correctional (prison)
psychologists
Rorschach ranked 5th; Projective
drawings 6th
Muniz et al. (2001)
European
(Spain, UK,
Holland,
Slovenia,
Croatia,
Belgium)
3,455 professional psychologists
use psychological tests
Objective psychometric tests
predominate; Rorschach listed
among Top 10 in Spain, Belgium,
& Slovenia; TAT & CAT popular
in Belgium.
Bow et al. (2002) USA
84 psychologists, assessment
practices with parents in child
custody disputes
Rorschach ranked 3rd; TAT 6th;
SCT 8th. Projective drawings
were used most with children.
Lally (2003) USA
64 Diplomate-status forensic
psychologists, test use in court-
related evaluations
Tests considered ‘unacceptable’
by at least 50% of sample:
Projective drawings; Rorschach;
TAT; SCT
Foxcroft et al. (2004) South Africa Practitioners in psychological
assessment
Both objective and projective
tests are acceptable clinical
instruments
Bekhit et al. (2005) England 158 British clinical psychologists
50% of sample use projective
drawings, but only informally in
the assessment process.

14 Chris Piotrowski
de Oliveira et al.
(2005) Brazil 35 professional psychologists
TAT ranked #1; CAT-Human 4th;
Rorschach 5th; CAT-Animal 7th;
HFDs 15th
Hojnoski et al.
(2006) USA 170 school psychologists
reported use of projective tests
About one-third (38%) use
projective assessment; (in rank
order) sentence completion tests,
H-T-P, Kinetic Family Drawing,
DAP, TAT, Rorschach, and CAT
Archer et al. (2006) USA
152 forensic psychologists’ use
of projective techniques in court-
related assessments
About 30% of respondents use
the Rorschach; about 20% use
the TAT, SCT, and projective
drawings.
Herzberg & Mattar
(2008) Brazil
Clinical psychology faculty use
of projective tests in practice,
University of Sao Paulo
Overall, 87% of sample use
projective techniques, a
decrease from a decade earlier;
TAT used most frequently,
whereas the CAT-A usage has
diminished.
Musewicz et al.
(2009) USA
215 psychologists, members
of the APA or Society for
Personality Assessment (SPA)
views on the Rorschach (RIM)
SPA members held more
favorable views toward the
Rorschach; Moreover, the RIM
continues to be used despite
continuing criticism levels against
this test.
Smith et al. (2010) USA
404 members of the
International Neuropsychological
Society or National Academy
of Neuropsychology surveyed
on personality assessment
practices
The TAT and Rorschach were
used (to some degree) by about
32% of the respondents.
Vaskinn et al. (2010) Norway
Members of the Norwegian
Psychological Association
(n=6246) surveyed on use &
opinions on psychological tests
Older psychologists use fewer
tests than younger cohorts;
Psychometric credibility of
individual tests is a major
concern.
Donoso et al. (2010) USA
150 professionals who conduct
vocational rehabilitation
evaluations
Overall, projective techniques
were seldom used; Projective
drawings ranked 13th; Rorschach
15th; TAT 18th
Ackermann & Pritzl
(2011) USA
213 forensic psychologists
surveyed on Tests used
with parents in child custody
evaluations
50% of sample use the
Rorschach, ranked 4th; 40% use
SCT, 5th; 30% use TAT, 8th; 27%
use H-F-Ds, 10th
Peterson et al.
(2014) USA
926 counselors (clinical mental
health, school, occupational)
rated tests of all types regarding
usage
H-T-P ranked 17th, H-F-Ds 21st,
DAP 35th, TAT 40th, KFD 47th,
Rotter ISB 54th, & Rorschach 57th
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Chris Piotrowski, University of West Florida, USA, Email: cpiotrowski@uwf.edu