For these reasons, the variability in instructions among the common systems is unfortunate. Obviously, instructions and procedures must be consistent with one's ethical and professional responsibility to respect the patient's autonomy; beyond that the administrative procedures should be minimally intrusive in order to avoid establishing expectancies beyond the most complete possible reporting of the subject's thoughts.
For these reasons, the examination should begin by clarifying its purpose. When the testing is based on a referral, the identity and role of the referring professional should be explicitly clear, as should the nature of the report and the party or parties to whom it will be accessible.
When subjects are being tested
for training purposes within a service setting--a school, clinic, or hospital--it
is important to clarify to what extent a report will become part of the
subject's record, and what access he or she will have to it. It is
also important to provide a means for such
subjects to have answered retrospective questions about themselves
or about the answered.
For example, a graduate student might say,
"Hello Ms. Smith, I'm John Jay, a graduate student in clinical psychology. As part of my training I have to learn to give certain psychological tests, and I appreciate your volunteering your time in this way. Because this is a training exercise, there won't be any report of the results in your school/clinic/hospital records. Before we start, are there any questions you have? If questions occur to you later you can call Dr. Jones at 977-7777."
Because we believe in keeping
the various sources of clinical inferences as separate as possible, we
do not begin testing sessions with a clinical interview. Such interviews
can be very informative, but are best done by someone other than the tester
whenever possible.
"I'm going to show you ten cards, each containing a picture of an inkblot. I'll give them to you one at a time. I'll ask you to look at each card and tell me what it looks like. Spend as much time as you like on each card but be sure to tell me everything that occurs to you."
If the subject fails to give an association and tries to return the first card in less than two minutes, the examiner is to say, "Give yourself plenty of time. Most people see several things on each card."
If the subject gives only one response to the first card and spends less than two minutes searching for additional responses, the examiner is to say:
"Give yourself plenty of time. Most people see more than one thing on each card."
This urging procedure is to be repeated, if necessary, on the second card, but not subsequently.
It is usually best for the tester to minimize any defensiveness or anxiety the patient might feel by taking the responsibility on himself for needing additional information and by carefully avoiding the implication that the patient's performance has been inadequate or faulty. A second principle is to obtain any necessary additional information with a minimum of biasing structure being introduced; avoid suggesting or encouraging the use of specific justifications. At the same time, do be sure to inquire about each element of the percept.
In general, we begin the inquiry as follows:
"Okay. Now that we're done, I'd like to go back over the cards with you to make sure I got your responses straight. Let's see. The first thing you saw on this card was _________________."
The tester then looks up expectantly, providing an opportunity for the patient to talk further about the response. This opportunity will usually elicit sufficient additional information. If the patient does not respond at all, the tester should say, "Tell me more about that."
If sufficient information still is not elicited at this point, the tester should say, "What about the blot brought that to mind?"
If sufficient information still is not available, we conclude that it will be not forthcoming without the introduction of biasing structure.
Be sure to inquire about every salient aspect of the response, indicating in your notes in parentheses what you asked about. For example, Free Association: "A scary bat"; Inquiry: "Why a bat?"..."Why scary?"
The tester should specifically avoid asking the patient to trace the outline of the percept (biasing toward form), and asking about the importance of specific variables (e.g., "Was the color important?").
The second column should be about four inches wide to record the free-association. Record only three or four responses per sheet, leaving space between them. Number each response in succession. Be prepared with 10 or 12 sheets for each administration. For each response, note in which position the card was held when the response was given. Use "carats" with the point of the carat in the same position as the top of the card. For example, would indicate the card was held in the normal position, would indicate it was held upside down, and < and > would indicate it was rotated a quarter turn. All card turning should also be indicated. A circular arrow is usually used for this purpose, e.g., .
The third column should also be about 4" wide to record the inquiry. Put each response directly across from the free-association response to which it corresponds, labeling it with the same number.
It is suggested that ink be used in recording the free-association and inquiry. The response sheets must be written so that others can read them. The subject's name should be written on each sheet. It is helpful to train oneself to write legibly during the administration so that one need not use time recopying.
The scoring system is divided into the following categories:
Location: Blot Area and Frequency (p. ___).
Cognitive Complexity: Perceptual Approach and Organization (p. ___).
Justifications: Blot Attributes alluded to (p. ___).
Imaginal Aspects: Imaginary Attributes (p. ___).
Social Appropriateness: The degree to which the response is characteristically found in grossly disturbed individuals (p. ___).
Conceptual Content: Type of Percept: animal, vegetable, mineral (p. ___).
Interpersonal Expectations: Complexity and Quality of Conscious Human-related Fantasies and Less Conscious General Expectations (p. ___).
Psychosexual Drive and Defense Effectiveness: Psychoanalytically-Derived (p. ___).
Perceptual-Cognitive Characteristic: Thinking Style not scored elsewhere (p. ___).
These nine areas form the
Burstein-Loucks Scoring System. These are the areas important to the assessment
of the psychological functioning of the subject. The various scores which
fall under each of these headings are simply elaborations of these concepts.
An overview of all categories and scores is provided on pages _____.
In giving sample responses, a number of common abbreviations are used: l.l. or ll = looks like; b.f. or bf = butterfly; a.e. or ae = anything else; ? or Q = question asked; I or Inq. = inquiry.
1. Precision Alternatives are second responses to exactly the same area, utilizing exactly the same justification, imaginal aspects, content, psychosexual drive, and motivational valuation with no intervening responses and no card turning. These precision alternatives are designated PA under the Perception-Cognitive Characteristics column of the previous response and not scored otherwise.
2. Responses which are elicited for the first time in the inquiry are called "additional responses." They are scored in brackets and not included in computing ratios and totals on the summary sheet.
3. Occasionally in the inquiry phase, a subject will be unable to remember having given a response or where it was seen. This "lost response" is not counted as a response but is scored LR in the Perceptual-Cognitive Characteristics Category column of the previous response.
4. One exception consists of a free association process in which responses are given by the subject but then later combined into a global, larger response. In this case, the larger, global response is scored rather than the separate scorings of separate response elements.
Scoring Examples: "a tree," "a flower," "a waterfall," "a girl," "Oh, it's a forest scene with a native girl bathing." In this case the overall synthesized response is the one scored.