Projective Assessment of Children and Adolescentsq

M Jain, National Health Mission, Raebareli, India

A Singh and SK Kar, King George’s Medical University, Lucknow, India
IB Weiner and K Kuehnle, University of South Florida, Tampa, FL, United States
Ó 2017 Elsevier Inc. All rights reserved.

Introduction 2
Objectivity and Subjectivity in Personality Assessment Methods 2
Structure and Ambiguity in Projective Techniques 3
Classification of Projective Techniques 4
Value of Projective Assessment 4
Conceptual Basis 5
Empirical Basis 6
Utility of Projective Assessment 6
Applicability of Projective Methods to Children and Adolescents 7
Review of Projective Assessment Methods 8
Rorschach Inkblot Method 8
Administration and Scoring 8
Psychometric Foundations 8
Clinical Utility 9
Holtzman Inkblot Test 9
Administration and Scoring 9
Psychometric Foundations 9
Clinical Utility 9
Somatic Inkblot Test 10
Administration and Scoring 10
Psychometric Foundations 10
Clinical Utility 10
Thematic Apperception Test 10
Administration and Scoring 10
Psychometric Foundations 11
Clinical Utility 11
Children’s Apperception Test 12
Administration and Scoring 12
Psychometric Foundations 12
Clinical Utility 13
Roberts Apperception Test for Children 13
Administration and Scoring 13
Psychometric Foundations 13
Clinical Utility 14
Rosenzweig Picture Frustration Test 14
Administration and Scoring 14
Psychometric Foundations 14
Clinical Utility 14
Tell-Me-A-Story 14
Administration and Scoring 15
Psychometric Foundations 15
Clinical Utility 16
Draw-A-Person 16
Administration and Scoring 16
Psychometric Foundations 17
Clinical Utility 17
House-Tree-Person 18
Administration and Scoring 18
Psychometric Foundations 18

q
Change History: June 2016. M Jain, A Singh and SK Kar updated Abstract, text, the reference section and added Table 1 & 2

Reference Module in Neuroscience and Biobehavioral Psychology http://dx.doi.org/10.1016/B978-0-12-809324-5.05058-6 1

2 Projective Assessment of Children and Adolescents

Clinical Utility 18
Kinetic Family Drawing 19
Administration and Scoring 19
Psychometric Foundations 19
Clinical Utility 20
Sentence Completion Methods 20
Administration and Scoring 20
Psychometric Foundations 20
Clinical Utility 21
The Szondi Test 21
Administration and Scoring 21
Future Directions 21
Summary 23
References 23

Introduction

Projection, as first formulated by Freud (1962) and later elaborated in his presentation of the Schreber case (Freud, 1958), consists
of attributing one’s own characteristics to external objects or events without adequate justification or conscious awareness of doing
so. Frank (1939) suggested that personality tests in which there is relatively little structure induce a subject to “project upon that
plastic field.his private world of personal meanings and feelings” (pp. 395, 402). By linking the concept of projection to the
response process in such measures as the Rorschach Inkblot Method and the Thematic Apperception Test (TAT), Frank gave birth
to the so-called projective hypothesis in personality assessment. His observations about what he called “projection measures” led to
the Rorschach, the TAT, and other assessment methods involving some ambiguity being routinely designated as projective tests.
This article begins with some observations concerning the nature of objectivity and subjectivity in personality assessment
methods and the role of structure and ambiguity in different types of projective techniques. It then turns to the value and utility
of projective assessment and the applicability of projective methods in clinical work with young people. Information is given on
the composition, administration, scoring, psychometric foundations, and clinical utility of 13 projective techniques widely used
in assessing children and adolescents.

Objectivity and Subjectivity in Personality Assessment Methods

As a legacy of Frank’s projective hypothesis, tests designated as projective methods came to be regarded as subjective in nature and
hence quite different from objective methods, such as self-report inventories. This presumed subjectivity of projective methods
fostered a commonplace conviction that these methods are inherently less scientific and less valid than objective methods. In actu-
ality, however, ambiguity is a dimensional rather than a categorical characteristic of tests, and there is little basis for regarding projec-
tive methods as inherently unscientific and invalid or as sharply distinct from objective measures.
Being scientific does not inhere in the nature of a method or instrument, whether subjective or not, but only in whether it can be
studied scientifically. When projective tests are used to generate personality descriptions that can be independently and reliably
assessed for their accuracy, they function as a scientific procedure.
Likewise, the validity of a test inheres not in its nature, but rather in the extent to which it generates significant correlations with
personality characteristics or behaviors it can identify or predict. Abundant research attests that projective methods, when properly
used, can yield valid inferences (Hibbbard et al., 1994, 1995; Parker et al., 1988; Weiner, 1996).
Regarding sharp distinctions between projective and objective measures, the subject’s task on commonly used personality tests
injects considerable objectivity into many projective methods and substantial subjectivity into most objective methods. For
example, responses on the Rorschach, which is the most widely used projective measure, are routinely inquired by asking subjects
“Where did you see it?,” which is a concrete, unambiguous request for a specific item of objective information. When subjects reply
that they used the whole blot for a percept, their response is given a location choice code of W, which is an objective and unam-
biguous procedure on which coders achieve virtually 100% agreement. Numerous other features of how subjects choose to look at
the inkblots can also be objectively coded with good inter-rater reliability, such as the percentage of responses given to the multi-
colored cards (affective ratio), the number of commonly given percepts reported (populars), and the kinds of objects the blots are
said to resemble (people, animals, etc.) (Exner, 1991, pp. 459–460; McDowell and Acklin, 1996; Seaton and Allen, 1996).
Elements of objectivity mark the interpretation as well as the coding of many Rorschach variables. In the case of whole responses,
for example, an unusual preponderance of W in a record correlates with objectively observable tendencies to attend to experience in
a global fashion; a low affective radio identifies an inclination to withdraw from emotionally charged situations; a small number of
 Projective Assessment of Children and Adolescents 3

popular responses correlates with behavioral manifestations of unconventionality; and numerous human percepts is associated
with an active interest in people. In these and many other ways, Rorschach responses identify personality characteristics through
an objective process of coding response features and relating these coded features to their known corollaries in observable behavior.
There are aspects of Rorschach interpretation that may be highly subjective, especially when inferences are drawn from the
thematic imagery subjects produce when they associate to the inkblots along with describing them. Moreover, most other projective
methods have not been as extensively codified as the Rorschach and depend more on qualitative than quantitative analysis. The
present point is merely that the basic nature of projective methods does not preclude their being codified and interpreted to
some extent along objective lines.
Turning now to aspects of subjectivity in objective methods, consider the uncertainty that characterizes many items in the most
widely used objective measure of personality, the adult and adolescent forms of the Minnesota multiphasic personality inventory
(MMPI-2/MMPI-A). Although MMPI-2/MMPI-A instructions to respond true or false are unambiguous and the coding of these
responses is completely objective, Weiner (1993) has previously called attention to the idiography that is embedded in asking
subjects to interpret such items as “I often lose my temper.” Items of this type provide no benchmarks for the frequency of “often”
or for what constitutes loss of temper. In many instances, consequently, responses to self-report items involve subjectivity on the
part of respondents, who must define for themselves what certain terms mean before they can decide how to answer.
Subjectivity influences the interpretation as well as the response process in objective assessment. Granted, the hallmark of objec-
tive tests is an extensive array of quantified scale scores having empirically demonstrated behavioral correlates. Nevertheless, the
interpretation of self-report measures in clinical practice typically goes beyond identifying known corollaries of scale scores to
include consideration of complex patterns of interaction among these scores and between the test profile and aspects of a subject’s
clinical history, interview behavior, and performance on other tests. Some of these complex interactions have been examined empir-
ically, such as various two- and three-point codes on the MMPI-2/MMPI-A, but many have not.
This is not to say that the MMPI-2/MMPI-A and other self-report instruments are basically subjective in nature or that they derive
their utility primarily from clinical judgment. The point is merely that, just as projective instruments are not entirely subjective, self-
report methods are not completely objective, but instead involve some aspects of ambiguity in how subjects respond to them and
how examiners interpret them.
It is for this reason that ambiguity is not a categorical function that characterizes some tests called projective measures, but not
others called objective measures. Instead, ambiguity is a dimensional function that characterizes most tests to some degree, in rela-
tion to how structured they are. Generally speaking, objective tests are more structured than projective tests and therefore less ambig-
uous; projective tests are generally less structured than objective tests and hence more ambiguous; and there is no sharp objective/
subjective dichotomy between relatively structured and relatively unstructured instruments.

Structure and Ambiguity in Projective Techniques

Projective techniques comprise inkblot methods, story-telling methods, figure drawing methods, and sentence completion
methods. In addition to being less structured than objective measures, these four types of projective methods differ from each other
in their degree of ambiguity and in whether their ambiguity resides mainly in their stimuli or in their instructions.
Thus in the case of the Rorschach inkblot method, subjects are asked to look at relatively ambiguous stimuli but are given fairly
specific instructions to indicate what they see, where they see it, and what makes it look as it does. Story-telling methods such as the
TAT involve showing subjects real pictures that are much less ambiguous than inkblots; however, by using general instructions (“Tell
me a story”) and open-ended questions (“What will happen next?”), examiners provide only minimal guidance in how subjects
should respond. If the Rorschach instructions were “Tell me a story about this inkblot,” the Rorschach would be more ambiguous
and more of a projective test than it is. If the TAT instructions were “Tell me what you see here,” the TAT would lose most of its
ambiguity and function only barely as a projective test.
Figure drawing techniques use no stimuli at all, save a blank piece of paper, and provide little guidance to subjects, other than
some instructions concerning the figures to be drawn (e.g., yourself, a family). Sentence completion methods, in common with
story-telling techniques, call for subjects to provide thematic content in response to real and relatively unambiguous test stimuli.
Unlike story-telling techniques, however, sentence completion methods do not ordinarily involve querying subjects about their
responses or encouraging them to elaborate those that are brief or unrevealing. Thus a stem of “I AM” may be completed with
“a happy person,” in which case some subjectivity has been allowed to enter the response, or simply with “here,” in which case
only a completely objective response has been given. On balance, figure drawing techniques are the most ambiguous of projective
tests and sentence completion methods the least, with inkblot and story-telling techniques in between.
These differences in ambiguity among projective methods were originally noted by Stone and Dellis (1960), who proposed “a
levels hypothesis” to take practical account of this variability. According to the levels hypothesis, the degree to which a test is struc-
tured is directly related to the level of conscious awareness at which it taps personality processes. The more structured and less
ambiguous a test is, the more likely it is to yield information about relatively conscious and superficial levels of personality;
conversely, the less structured and more ambiguous a test is, the more likely it is to provide information about deeper levels of
personality and characteristics of which subjects themselves may not be consciously aware.
Research reported by Stone and Dellis (1960) and subsequently replicated by Murstein and Wolf (1970) provided empirical
support for a relationship between the ambiguity of a test and its likelihood of measuring deeper levels of personality, especially
4 Projective Assessment of Children and Adolescents

in normally functioning persons. These findings mirrored the basic conception of TAT assessment articulated by Murray (1951),
who regarded the virtue of the instrument as residing not in its revelations about what subjects are able and willing to say about
themselves, but in what it conveys about personality characteristics: “the patient is unwilling to tell or is unable to tell because
he is unconscious of them” (p. 577).
In addition to differing from objective tests and from each other in their degree of structure and ambiguity, individual projective
measures typically include both relatively objective and relatively subjective elements. As elaborated by Weiner (1977), the objective
elements of projective test data involve structural features of the manner in which responses are formulated, whereas the subjective
elements consist of thematic features of the imagery with which responses are embellished.
When projective test data are being interpreted objectively, structural aspects of the subject’s responses, such as focusing on
wholes and seeing numerous human figures on the Rorschach, are taken as being directly representative of similar behavioral
tendencies in the person’s life, that is, attending to experience globally and paying close attention to people. When projective
test data are being interpreted subjectively, thematic imagery is taken as being indirectly symbolic of a subject’s underlying needs,
attitudes, conflicts, and concerns. Thus the Rorschach response of “Two girls who are really mad at each other fighting over some-
thing they both want” may identify a subject’s experiencing peer or sibling rivalry, viewing social interactions as aggressive confron-
tations in which people are only concerned with what they can get for themselves, or feeling angry or resentful about being in such
situations.
On story-telling measures, an example of a structural response feature is giving long stories, which can be objectively scored (by
counting the number of words) and which provides a representative indication of inclinations to be verbose. As for subjectively
interpreted features, a TAT story in which two people are described as about to separate, leaving one of them sad and lonely for
the rest of his or her life, exemplifies thematic imagery that appears to symbolize concerns about suffering the loss of love objects
and facing an unhappy future.
On figure drawing measures, which as previously noted are the most ambiguous of projective tests, structural features of the data
are limited. Some variables, such as the size of figures drawn, how complete they are, and whether they are clothed, are objective
facts that can usually be coded with good agreement. However, interpretation of such objective characteristics of figure drawings, as
well as of subjective impressions of drawing qualities, is based mostly on their being symbolic rather than representative of
behavior. Interpreting the way figures are drawn or placed is thus primarily thematic. For example, unusual emphasis on a particular
part of the body may be interpreted as suggesting concern about functions associated with that part of the body, and a family
drawing in which the self is located on one side of the page and the other family members are closely grouped on the other
side of the page may be interpreted as symbolizing feelings of isolation or rejection in the family setting.
In sentence completion responses, frequent self-referencing is an example of an objectively scorable, behaviorally representative
structural index of tendencies to focus attention on oneself rather than others. Consider the difference between the completions
“WHAT PAINS ME is seeing how many unfortunate people there are in the world” and “WHAT PAINS ME is not being able to
get the things that I want.” An accumulation of the latter as opposed to the former type of response is objectively representative
of self-centeredness. At the same time, the thematic content of both completions suggests in a more subjective way certain under-
lying concerns, such as worries about the welfare of the human race in the first instances and feelings of being personally deprived in
the second.
To bring these introductory observations full circle, the opportunities that projective methods create for subjects to project
aspects of themselves into their responses has frequently led to their being associated with psychoanalytic theories of personality,
in the context of which the notion of projection was first elaborated. However, there is no necessary relationship between psycho-
analytic theory and projective testing, nor is there any reason for clinicians who conceptualize behavior in other ways to view
projective methods as incompatible with their frame of reference. The basic principle underlying projective techniques is that
something can be learned about people from sampling how they respond in ambiguous situations. This principle is not prisoner
to any personality theory, and its utility transcends the theoretical persuasions of individual examiners. Inferences from projec-
tive data can be couched equally well in psychodynamic, behavioral, cognitive, and humanistic terms, and the use to which these
inferences can be put depends less on theoretical differences in terminology than on the nature of the assessment issues being
addressed.

Classification of Projective Techniques

Various theorists have classified projective tests in different ways. Frank (1939) made initial efforts to classify projective tests. Subse-
quently, the most worthwhile classification based on the type of responses was carried out by Lindzey (1961). Table 1 below,
summarizes classification of projective tests use in children and adolescents.

Value of Projective Assessment

Projective test data provide valuable information about how people are likely to think, feel, and act that is difficult to obtain from
objective assessment procedures. This contribution of projective methods to the personality assessment process has both a concep-
tual and an empirical basis.
 Projective Assessment of Children and Adolescents 5

Table 1 Classification of projective tests use in children and adolescents

Technique used in the

projective test Description Tests

Association techniques Examinee is asked to respond with the associations which Rorschach inkblot test, Holtzman inkblot test, somatic
are evoked in his/ her mind after seeing or listening to inkblot series
stimulus materials.
Construction techniques Examinee is required to construct a story after seeing the Thematic apperception test, Children’s apperception test,
stimulus materials (usually pictures) within a certain Robert’s apperception test for children, tell me a story
specified time.
Completion techniques Examinee is presented with incomplete sentences with the Sentence completion test, Rosenzweig picture frustration
instructions to complete them in any way. test
Expressive techniques Examinee expresses his/ her personality through some Draw a person, house tree person, kinetic family drawing
manipulation tasks, which usually involve interaction
with given materials.
Choice techniques Examinee is presented with some sets of pictures with the Szondi test
instruction to choose the most relevant and appropriate
picture.

Conceptual Basis
Because of their relatively unstructured nature, projective tests measure personality characteristics in subtle and indirect ways. Even
those features of projective test data that can be objectively scored and interpreted involve responses that seldom have obvious
meaning. Subjects in the process of responding usually have little awareness of the interpretive significance that attaches to their
seeing numerous human figures on the Rorschach, giving long stories on the TAT, drawing themselves on the far side of the
page from the rest of their family, or repetitively referring to “I” in their sentence completions; indeed, they may not even be aware
of having responded in these ways.
By contrast, relatively structured objective tests measure personality characteristics in direct ways that often have obvious inter-
pretive significance. Adolescents who answer “true” to such MMPI-A statements as “At times I feel like smashing things” and “I am
easily downed in an argument” will usually have a good idea of what they are indicating about themselves.
The distinction between subtle, indirect measurement of personality characteristics with projective techniques and relatively
direct assessment through questionnaire methods has been formulated by McClelland et al. (1989) in terms of differences between
self-attributed and implicit motives. According to McClelland et al., self-attributed motives are measured by self-report instruments
and are influenced by social incentives in a person’s external environment. Implicit motives, however, are measured by such indirect
techniques as story-telling procedures and are influenced by the internal pleasure derived from various activities in which a person
engages.
Whereas self-attributed motives are comparatively good predictors of immediate specific responses to structured situations,
McClelland et al. continue, implicit motives are comparatively good predictors of long-term trends in behavior across various types
of situations. Research findings described by McClelland et al. confirmed that indirect assessments of underlying motives have
greater validity for predicting long-term trends in behavior than self-report assessments of motives that people directly attribute
to themselves.
Bornstein (1995) has used a meta-analysis of 97 studies of measures of dependency to demonstrate further this difference
between objective and projective assessment. With respect to differential prediction, according to Bornstein, available research indi-
cates that objectively measured dependency correlates better with symptoms and the diagnosis of dependent personality disorder
than does projectively measured dependency, whereas projectively measured dependency correlates better with dependency-related
behaviors.
The conceptual analysis formulated by McClelland et al. and elaborated by Bornstein has direct bearing on the contribution of
projective methods to personality assessment. As previously described, projective assessment taps implicit motives and underlying
personality characteristics that may not be readily apparent and may not be within a subject’s conscious awareness. Because these
covert motives and characteristics exert a powerful influence on long-term behavioral trends, this type of indirect measurement adds
an important dimension to personality evaluations that would not be tapped in its absence.
Finally, with respect to what projective methods contribute to assessment batteries, the relative ambiguity of these methods
makes them less subjective than structured instruments to influence by test-taking attitudes. This is not to say that projective
methods are immune to subjects’ efforts to present themselves in a positive or negative light. The relatively open-ended nature
of projective testing situations and the dialogue they frequently elicit give subjects abundant opportunity to voice attitudes toward
the tests, the examiner, and being examined. However, as long as subjects continue to give responses, neither their attitudes nor their
expression of them is likely to prevent their projective test responses from revealing their personality characteristics. Simply put, the
limited face validity of projective measures makes them more difficult to fake than objective measures, which means that they can
balance a test battery to particularly good effect when self-presentation effects are of concern.
6 Projective Assessment of Children and Adolescents

Empirical Basis
Projective measures vary in the extent to which they have been examined in well-designed research studies, and in many instances
adequate empirical support for these instruments has lagged behind the uses to which clinicians sometimes put them. Nevertheless,
the two most frequently used projective methods, the Rorschach and the TAT, have for the past generation been among the three
most frequently studied personality assessment instruments, exceeded in this respect only by the MMPI/MMPI-2 (Butcher and
Rouse, 1996). For both the Rorschach and the TAT, substantial evidence has accumulated to attest their validity for describing
aspects of personality structure and dynamics and applying these descriptions in differential diagnosis and treatment planning
(Abraham et al., 1994; Alvarado, 1994; Bornstein, 1995; Cramer and Blatt, 1990; Exner and Andronikoff-Sanglade, 1992; Ornduff
and Kelsey, 1996; Ronan et al., 1993; Weiner, 1996; Weiner and Exner, 1991).
Later in this article, specific information is presented concerning the psychometric foundations and demonstrated corollaries of
the projective measures most frequently used with young people. Suffice it to say in summary at this point that these measures prove
valuable in personality assessment because they add information that would otherwise be unavailable and because they withstand
relatively well efforts to exaggerate or conceal.

Utility of Projective Assessment

Whereas the value of projective techniques lies in the previously elaborated reasons why they should be used in personality assess-
ment, their utility relates to decisions concerning when these methods should be included in a test battery. The kinds of information
provided by projective test data indicate that projective measures should be used whenever a thorough personality assessment is
considered relevant to formulating a differential psychodiagnosis or recommending alternative intervention strategies. Because
of their relatively unstructured nature and indirect format, projective measures balance a test battery by tapping personality char-
acteristics at a less conscious level than relatively structured measures. Assessments lacking such balance sample personality func-
tioning from a limited perspective that will usually fail to paint a complete picture of the individual being examined. Batteries
limited solely to projective techniques are similarly imbalanced and ill-advised in comprehensive personality assessments.
The previously mentioned conceptualization of McClelland et al. (1989) bears closely on the importance of a balanced test
battery in clinical assessment. McClelland and his colleagues noted that measures of self-attributed and implicit motives seldom
correlate with each other and should not be expected to do so, because they are measuring different aspects of personality. More-
over, given that directly and indirectly measured motives each predict certain kinds of behavior better than the other, they concluded
that “Separate measures of self-attributed and implicit motives may be combined to yield a better understanding and prediction of
certain types of behavior” (p. 692).
These formulations concerning different types of measures have subsequently been elaborated and confirmed for clinical
purposes with respect to relationships between the Rorschach and the MMPI. Rorschach structural variables and MMPI scales
have been found to show only a few modest correlations in both adult and adolescent samples (Archer and Krishnamurthy,
1993a,b). At the same time, however, apparent contradictions between Rorschach and MMPI findings have been conceptualized
by Weiner (1993, 1995b) not as invalidating either instrument or challenging the incremental utility of administering them in
tandem, but rather as generative data.
Specifically, Weiner argues, apparently discrepant findings between personality assessment instruments of different kinds can be
generative by virtue of complementing each other. Whereas findings on two tests that concur in suggesting the same personality
characteristic are confirmatory and support definite conclusions, he continues, findings that diverge raise important questions to
which they may also suggest helpful answers, especially if one of the tests is a relatively structured and the other a relatively unstruc-
tured instrument.
Consider, for example, a youngster who appears depressed on the Rorschach, with a high depression index (DEPI), but does not
elevate on Scale 2 or the depression content scale of the MMPI-A. This divergent finding could well provide a useful clue to the
adolescent’s having an underlying or emerging depression that is not yet being keenly felt or manifest in well-structured situations.
Alternatively, it could be that the subject is trying to deny or repress depressive affects and cognitions, or is making a conscious deci-
sion not to report manifestations of depression that nevertheless emerge in the absence of supportive structure or are revealed when
the subject is uncertain how to conceal them.
The situation described in this example is familiar to assessment psychologists, who not infrequently work with psychologically
troubled adolescents who can remain reasonably comfortable and controlled in relatively structured situations but become upset
and disorganized in relatively unstructured situations and who may accordingly produce a benign MMPI-A protocol and a disturbed
Rorschach. In such circumstances the objective measure has not erroneously overlooked psychopathology, nor has the projective
measure mistakenly exaggerated it. Instead, the two types of test have combined in complementary fashion to provide valid infor-
mation concerning the subject’s likelihood of behaving in a relatively adaptive or maladaptive fashion, depending on the situational
context in which the behavior appears.
Similarly, subjects in some circumstances may produce a clinically unremarkable Rorschach while showing numerous elevations
on the clinical and content scales of the MMPI-A. Such divergence is best understood not as error variance, but as a possible clue to
the psychological stance of subjects whose degree of disturbance is minimal but who, when asked about themselves in language
they can understand, want to make sure that others fully appreciate whatever problems and concerns they do have. Further
 Projective Assessment of Children and Adolescents 7

illustrations of the clinical utility of divergence as well as convergence between a projective measure, such as the Rorschach and an
objective measure such as the MMPI-2, are provided by Finn (1996) and Ganellen (1996).

Applicability of Projective Methods to Children and Adolescents

Except for an occasional example, this article has thus far made no specific reference to young people. This apparent oversight is
warranted by the fact that the nature of projective methods, the way in which they function, the kinds of information they provide,
and the reasons for using them, are identical for persons of almost all ages. Hence the discussion of projective assessment to this
point is as applicable to children and adolescents as to adults, and requires no modification or qualification as our focus now shifts
specifically to young people.
Indeed, assessors who have learned to interpret projective test data provided by adults do not need to learn any new ways of
working with the data should they begin to examine children and adolescents. By and large, the basic interpretive conclusions
and hypotheses that attach to projective test variables apply regardless of the age of the subject. Whether they are age 8, 18, or
80, subjects who see numerous human figures on the Rorschach are likely to be quite interested in people; those who give long
TAT stories are likely to be verbose; those who refer frequently to themselves in sentence completions are likely to be self-
centered; and those who draw grotesquely distorted human figures probably harbor some disturbing concerns about their own
nature or that of other people.
However, in order to determine the implications of these and other personality characteristics suggested by projective test data,
examiners assessing young people must take into account normative developmental expectations. For example, the data of devel-
opmental psychology indicate that children are more self-centered than adults, and subsequently become increasingly aware of and
concerned about the needs of others as they grow through adolescence and approach maturity. Accordingly, test data that identify
a high degree of self-centeredness may imply maladaptive narcissistic personality traits in an adult, but reflect normal development
and adaptation in a child; conversely, minimal self-centeredness may indicate altruism and good adjustment in an adult but suggest
deviant development and low self-esteem in a child.
Developmental psychology similarly provides some normative expectations for how children are likely to make drawings.
Preschool age children commonly draw with what is called “intellectual realism,” which means that they draw what they know
to be there regardless of whether it would actually be visible. Thus, in X-ray fashion, young children often draw transparencies,
such as people who are visible through walls (Di Leo, 1983). At about age 7 or 8, this intellectual realism gradually gives way to
“visual realism,” in which what is drawn resembles what realistically can be seen. Di Leo (1983, p. 38) observes that this develop-
mental shift mirrors a metamorphosis in thinking from an egocentric to an increasingly objective view of the world. Hence a human
figure drawing by a preschool child showing a belly button through clothing is much less likely to imply maladaptive functioning
that the same drawing done by an adolescent.
As these examples indicate, familiarity with and adequate attention to normative expectation hold the key to valid and useful
applications of projective methods in the assessment of young people. Ideally, projective methods manuals should include norma-
tive reference data that delineate quantitative as well as qualitative expectations for such developmental phenomena as matura-
tional changes in self-centeredness. Regrettably, even though numerous projective test variables have been quantified in various
ways, little progress has been made in generating age-graded norms for them.
The main exception to this dearth of normative developmental data for projective techniques is the Rorschach. Developmental
trends in Rorschach responses from early childhood through adolescence were initially charted many years ago by Ames and her
colleagues (Ames et al., 1974, 1971). The Rorschach comprehensive system has further provided reference data for each of its codified
variables on samples of approximately 100 non-patient young people at each age from 5 to 16 (Exner and Weiner, 1995, chap. 3).
Aside from identifying needs for further research, an analysis of available data can guide clinicians in choosing which projective
methods to include in a battery for assessing a young person’s functioning. The more thorough and reliable the normative devel-
opmental data available for the instrument, the better the choice it will make. Similarly, the better established an instrument’s corre-
lates are in relation to behaviors that are central to the purpose of an assessment, the more reason there is to include it. Thus an
instrument that has been demonstrated to be particularly helpful in identifying youthful depression may be a good choice in
one case, whereas an instrument known to be especially sensitive in revealing family dynamics may be a good choice in another
case.
Similarly, available empirical data and reported clinical experience should be drawn on to determine whether a particular instru-
ment is likely to yield useful information concerning the personality functioning of individuals at certain ages. Thus the children’s
apperception test (CAT) depicting animal figures may be a more effective story-telling measure for a young child than the TAT, but
certainly not for an adolescent (Bellak, 1993, p. 237).
As these observations indicate, projective methods provide sound clinical data only if they are employed in appropriate ways.
First, examiners should have recourse to standardized procedures for administering and scoring any test they use. Lack of such stan-
dard methodology compromises the value of the data obtained, and inattention to standardized methods by examiners who opt
instead for personalized approaches to administration and scoring is clinically disadvantageous and professionally questionable.
Second, clinical interpretations should be derived from test variables with demonstrated reliability and validity. Inadequate
psychometric foundations limit the use to which test data can be put, and examiners who draw conclusions in the absence of sup-
porting empirical evidence, without framing such conclusions as speculative hypotheses, are doing their patients and their methods
8 Projective Assessment of Children and Adolescents

a disservice. Third, the adequacy of projective assessment of young people will be limited in the absence of normative reference data
for test responses of both adjusted and maladjusted children and adolescents and for developmental changes in these responses
over time.
This article continues with reviews of the major inkblot, story telling, figure drawing, and sentence completion methods used in
assessing young people. The composition, administration, and scoring of each of these measures are described; what is known
about their reliability, validity, and normative database is reported; and the clinical purposes they are likely to serve are discussed.
The specific measures reviewed are selected primarily on the basis of their emphasis and frequency of use in clinical and school
settings, as reported in surveys by Archer et al. (1991), Elbert and Holden (1987), Hutton et al. (1992), Kennedy et al. (1994),
Piotrowski and Keller (1989), Stinnett et al. (1994), and Watkins et al. (1995).

Review of Projective Assessment Methods

Rorschach Inkblot Method
The Rorschach inkblot method comprises 10 cards that are inked in shades of black and gray (5 cards); black, gray, and red (2 cards);
and various pastel colors (3 cards). The cards are reproduced in standard fashion, but the inkblot stimuli were originally designed at
random and do not portray any specific objects (Rorschach, 1942). When subjects respond to the Rorschach, they draw on the
shape, shading, and color of the blots to form impressions of what they might be, and in so doing they treat the instrument as
a cognitive-perceptual task (e.g., “It looks like a bat, because it’s got a body here and wings here and it’s black”). In addition, subjects
frequently elaborate their responses beyond the stimulus properties of the blots, and in so doing they treat the instrument as an
associational task (e.g., “This bird is flying around looking for something to eat”).
The cognitive–perceptual aspects of responses constitute structural data in Rorschach assessment and provide representative
indications of the resources and coping style that a person generally brings to bear in problem-solving situations. The associational
aspects of responses constitute thematic data in Rorschach assessment and provide symbolic clues to the underlying needs, atti-
tudes, conflicts, and concerns that are likely to influence a person’s actions and state of mind. The basic nature of the Rorschach
in these respects is discussed further by Exner and Weiner (1995, chap. 1) and Weiner (1986, 1994).

Administration and Scoring

The Rorschach is introduced by telling subjects that the inkblots they are about to see are not anything in particular, but that people
see many different things in them and that their task will be to indicate what the inkblots look like to them. The 10 cards are then
given to subjects one at a time with the instruction “What might this be?” Requests for structure (e.g., “Can I turn the card?”) are
deflected back to the subject (e.g., “It’s up to you”; “Any way you like”). The unguided responses to the 10 cards constitute the free
association phase of the administration, following which there is an inquiry phase in which the examiner reads back each response
and asks subjects where they saw it and what made it look as it did. The purpose of the inquiry is to facilitate coding of the structural
features of the responses, and associations during this phase are not requested or encouraged. Responses are recorded verbatim,
however, and the content of any spontaneous thematic elaborations is carefully noted.
Numerous approaches to codifying Rorschach responses have emerged during the long history of this instrument. The earliest
scoring method was given by S. Beck. Various other methods have also been given by M. Hertz (1969, 1970), B. Klopfer (1962), Z.
Piotrowski (1960, 1969), D. Rapaport (1945). However, for many years the comprehensive system of Exner (1993) has been by
far the most widely used and researched (Piotrowski, 1996). Rorschach responses are coded in the comprehensive system for
various aspects of where percepts are seen (location), why they look as they do (determinants), what they consist of (content),
how commonly they occur (form level and populars), and whether they involve pairs of objects, organization of parts, or special
kinds of elaborations, such as cooperative or aggressive interaction. These codes are than tallied and combined in various ways to
yield a large number of indices, ratios, and percentages that guide the interpretive process, as elaborated in detail by Exner (1991,
chaps. 5–10).

Psychometric Foundations
The psychometric foundations of an assessment instrument comprise the extent to which it can demonstrate adequate interscorer
agreement, reliable measurement, valid correlates, and a representative normative database. The Rorschach inkblot method, as
already indicated in part by examples used earlier in the article, rests on a solid psychometric basis. Interscorer agreement for
the types of variables coded in the comprehensive system typically ranges from 80% to 100%. The reliability of Rorschach data
has been demonstrated in a series of retest studies conducted over intervals ranging from 7 days to 3 years and involving child,
adolescent, and adult subjects. Most of the core variables associated with trait dimensions of personality show stability coefficients
greater than 0.80 in these studies, and some, including the affective ratio and the egocentricity index, consistently hover around 0.90
(Exner, 1991, pp. 459–460; Exner and Weiner, 1995, pp. 21–27; McDowell and Acklin, 1996; Weiner, 1997).
The validity of Rorschach assessment was confirmed in a series of metaanalytic studies that led Parker et al. (1988) to conclude
that the Rorschach meets usual psychometric standards for validity and is comparable to the MMPI in this respect. Specifically,
Parker et al. used the effect sizes reported in 411 studies to derive population estimates of convergent validity of 0.41 for the
Rorschach and 0.46 for the MMPI. Subsequent further confirmations of the validity of this instrument are noted by Weiner
(1996).
 Projective Assessment of Children and Adolescents 9

With respect to its normative database, available information for the comprehensive system includes data on 700 nonpatient
adults demographically representative of the 1980 US census, 1390 nonpatient children and adolescents age 5–16, and large
samples of schizophrenic, depressed, and character disordered patients (Exner, 1993, chap. 12). In addition, longitudinal data re-
ported by Exner et al. (1985) on a group of young people tested every 2 years from age 8 to 16 provide useful reference information
concerning developmental stability and change in Rorschach variables during childhood and adolescence.
As implied by the nature of the normative data, the Rorschach comprehensive system is applicable to young people from age
5. Preschool age children have ordinarily not yet matured sufficiently to deal with the cognitive-perceptual aspects of the
Rorschach situation in ways that lend themselves to the codification that is central to the comprehensive system interpretive
process. An unusually mature four-year-old might on occasion produce a useful record, and immature five- and six-year-olds
may produce records that have limited interpretive significance within the framework of the comprehensive system. Working
within other frameworks, Ames et al. (1974) discuss and provide some normative findings for Rorschach responses of young
children, and Leichtman (1996) has presented a developmental rationale for deriving information from the records of
preschoolers.

Clinical Utility
In common with projective techniques in general, the Rorschach serves clinical purposes primarily as a result of the information it
provides about the structure and dynamics of personality functioning. With respect to personality structure, the Rorschach has
proved especially helpful in identifying and quantifying states of subjectively felt distress that combine elements of anxiety and
depression and in reflecting trait dimensions of how people typically think, process information, handle emotions, manage stress,
feel about themselves, and relate to others. Regarding personality dynamics, the thematic content of Rorschach responses, as previ-
ously noted, is often quite revealing of underlying needs, attitudes, conflicts, and concerns that influence how people are likely to
think, feel, and act at particular points in time and in particular situations.
In addition, Rorschach data can frequently contribute to differential diagnosis in clinical settings. The comprehensive system
provides indices for schizophrenia and depression (DEPI) that can help to identify these conditions in children and adolescents
as well as in adults; for basic deficits in coping capacity that point to developmental arrest in young people; and for numerous
features of conduct and anxiety and/or withdrawal disorders (Exner and Weiner, 1995, chaps 5–8; Weiner, 1986). Rorschach find-
ings have also demonstrated considerable clinical utility in the treatment process by clarifying treatment targets, identifying poten-
tial obstacles to progress in therapy, and providing a basis for evaluating treatment change and outcome (Abraham et al., 1994;
Weiner, 1994).

Holtzman Inkblot Test

The Holtzman Inkblot Test (HIT) was developed by W.H. Holtzman et al. (1961) to overcome the difficulties of Rorschach Inkblot
Test like unlimited number of responses and poorer scorer reliability. It is similar to Rorschach Inkblot Test and has better psycho-
metric properties as well as easy inter-compatibility of examinees.
It consists of two parallel forms (Form A and Form B); each form has 45 cards (Holtzman, 1961). The form A consists of 12 cards
which are black or gray, two are monochromatic, 11 are black with bright color and the remaining 20 are multicolored. Form B
comprises of similar distribution with respect to color, shading and form qualities (Holtzman, 1968). HIT also consists of two prac-
tice cards named “X” and “Y” which is presented before the beginning of each set. The inkblots in HIT are asymmetrical unlike
Rorschach Inkblot Test.

Administration and Scoring

The subjects are supposed to give only one response per card. The responses are recorded along with a brief enquiry consisting
chiefly of two questions: “Where was the percept represented in the blot?” and, “What the percept suggests about the blot?”
Percentile norms are available for all ages above 5 years. The responses are scored on 22 variables which include Rorschach vari-
ables as well as other variables like anxiety, hostility and pathological verbalization.

Psychometric Foundations
Various reliability and validity studies have been conducted for the Holtzman Inkblot test. High reliability has been found for all the
variables in these studies. Holtzman et al. (1961) reported intra-scorer reliability to be uniformly high (0.95 and above) among
most of the highly trained scorers within a median value of 0.99 and inter-scorer reliability for six variables ranging between
0.91 (for form appropriateness) and 0.99 (for location, form definition and movement). Inter scorer reliability was also found
to range from 0.82 to 0.97 for barrier and penetration score (Fisher, 1963) and 0.81 for pathognomic verbalization (Whitaker,
1965). In a validation study by Thorpe and Schwartz (1966), a total of 360 normal subjects were divided into three criterion
age groups with mean ages (in years) of 6.7, 9.7 and 12.7 respectively and it was found that age group differences for 7 HIT variables
were significant beyond 0.001 level of confidence.

Clinical Utility
HIT and Rorschach Inkblot test has many similarities; however in HIT attempts have been made to overcome some of the limita-
tions of the Rorschach Inkblot test. HIT can be used as diagnostic tool in both adults and children. It is able to differentiate between
10 Projective Assessment of Children and Adolescents

normal and the patients with schizophrenia and depression (Moseley, 1963). It has also been reported that HIT discriminates better
between acute and chronic cases than Rorschach (Hanssen, 1967). Moreover, the number of responses is more constant in HIT than
Rorschach. Additionally, HIT has parallel form thus permitting the use of test-retest designs and the study of change within an
individual.

Somatic Inkblot Test

The Somatic Inkblot test (SIS) was originally developed by Wilfred A. Cassell in 1959. It is based on the somatic imagery, body
symbolism, and inner cry. The current version of SIS (SIS II) was developed in 1980. It is in booklet form and consists of Series
A & B with 31 images each (i.e. total 62 images). It begins with a sample image. SIS also consists of video version (with 62 images)
developed in 1984. There is also a black and white version of the test which is used if it is felt that the colored version may poten-
tially be disruptive to the subject.

Administration and Scoring

It can be administered by the subject individually as well as in groups. The subject is asked to relax by taking few deep breaths before
beginning the test. Then the subject also has to complete the health questionnaire which aims to bring to mind any present or past
physical problems. Subsequently, the subject needs to write the responses on the booklet given. After completion of the task, the
subject is asked to select three images which they liked the most and the least. Scoring of the responses is done on 11 indices which
are designed to ensure consistency among scorers. Moreover, four pathological scales are given which includes: Pathological
Anatomy scale, Depression scale, Hostility & Aggression scale and Paranoia scale.

Psychometric Foundations
Studies have been done to find out the reliability and validity of the test. Test-retest reliability has been calculated over a period of
4 weeks and it was found to be ranging from 0.69 to 0.88. The SIS II and SIS Video were divided into two equal halves to calculate
the split half reliability. It was found to be in the range of 0.66–0.89. SIS has been reported to have high content validity in various
studies. Moreover, a high correlation between the subject’s physical disturbance and anatomical response has been found in various
studies (Cassell, 1969; Dubey and Cassell, 1993). It has also been reported that “Atypical” Response of the SIS test are significantly
higher in the psychotics while “Most Typical” Responses are higher in normal subjects illustrating construct validity of the test (Cas-
sell, 1988; Cassell and Dubey, 2003). Additionally, Rathee et al. (1998) demonstrated diagnostic validity of SIS II based on their
study on 200 patients with various mental illnesses from Armed forces.

Clinical Utility
SIS has application in both, making diagnosis and planning interventions. It provides insights into the problems of an individual,
especially past traumatic experience.

Thematic Apperception Test

The most widely known and used story telling technique is the TAT. It was developed by Morgan and Murray (1935) in the belief
that the content of imagined stories would provide clues to the underlying dynamics of a subject’s interpersonal relationships and
self-attitudes. As elaborated by Murray (1943, 1971) and Bellak (1993, chap. 4), TAT data are expected to reveal the hierarchy of
a person’s needs and the nature of his or her dominant emotions and conflicts.
The TAT stimuli comprise 19 black-and-white illustrations of people or scenes and one blank card. The cards are intended for use
with persons age five or older of both genders, and for nine of the cards there are alternate versions for use with adult and child/
adolescent males and with adult and child/adolescent females. Because of the time required to administer the full set of TAT cards,
examiners typically select a subset of 8–12 cards that they anticipate will elicit themes relevant to the assessment issues in a particular
case. The themes usually elicited by the individual cards and the selection of subsets suited for children and adolescents are reviewed
by Bellak (1993, chap. 3), Dana (1985), and Obrzut and Boliek (1986). Regrettably with respect to standardization, however, there
are no specific short forms of the instrument, and how many and which cards are typically chosen vary from one examiner to
another and from one examination to the next.

Administration and Scoring

The TAT cards are given to subjects one at a time with instructions to make up a story for each picture that includes (1) what is
happening at the moment, (2) what the characters are thinking and feeling, (3) what led up to the situation, and (4) what the
outcome will be. The narrated stories are recorded verbatim by the examiner.
Murray (1943) originally proposed a scoring scheme in which each TAT story is rated for the presence and strength of a long list
of needs that are being experienced by the central figure in the story and presses that are being exerted by the environment. This
scoring system proved too elaborate and time consuming for clinical work, and numerous alternative approaches to clinical inter-
pretation were subsequently developed for the instrument. As reviewed by Chandler (1990), Murstein (1963), and Vane (1981),
some of these interpretive approaches, like Murray’s, have consisted of formal quantitative ratings of story characteristics. However,
 Projective Assessment of Children and Adolescents 11

most interpretive approaches have eschewed quantitative scoring in favor of qualitative analyses of story content, and no scoring
system has gained widespread use either clinically or in research studies.
The most commonly employed methods of interpreting the TAT in clinical practice appear to be variations of an “inspection
technique” proposed by Bellak (1993, chap. 4). This technique consists simply of reading through subjects’ stories to identify repet-
itive themes and recurring elements that appear to fall together in meaningful ways. Because this approach lacks any quantification
and rests on the capacity of individual examiners to relate story themes and elements to aspects of personality functioning, Dana
(1985) was moved to observe that “TAT interpretation has become a clinical art form” (p. 90).
Bellak’s influential approach stresses 10 aspects of a story, each of which is taken to have implications for how subjects view and
are likely to deal with interpersonal events and what they anticipate the future to hold for them. These include the main theme of the
story, the identity of the central figure or hero, the main needs of the hero, the way in which the environment is conceived, the
identity and intentions of other figures in the story, the nature of any anxiety or other affect that is being experienced, the nature
of any conflict that is described or suggested, the ways in which conflicts and fears are defended against, the ways in which misbe-
havior is punished, and the level of ego integration.
With respect to research studies, the most productive utilization of the TAT has derived from quantitative scoring systems devel-
oped by McClelland, Atkinson, and their colleagues to measure needs for achievement, affiliation, and power (Atkinson and
Feather, 1966; McClelland et al., 1953). Although scoring for achievement, affiliation, and power motivation has had little clinical
impact, other schemes for coding specific personality characteristics reflected in TAT thematic content have subsequently emerged.
These include scales for level of ego development (Sutton and Swenson, 1983), preferred defense mechanisms (Cramer, 1987),
quality of interpersonal affect (Thomas and Dudek, 1985), problem-solving style (Ronan et al., 1993), and object relations capac-
ities (Westen et al., 1985).
Particularly promising among these is the use of the TAT to assess aspects of object related-ness through the Westen et al. (1985)
measure, known as the social cognition and object relations scale (SCORS). The SCORS provides quantitative indices of the affective
tone subjects ascribe to relationships, their capacity for emotional investment in relationships and social standards, their under-
standing of social causality, and the complexity of their representations of people. By including ratings of subjects along dimensions
of maturity as well as normality/pathology, the SCORS is proving especially relevant to the assessment of young people (Westen
et al., 1991).

Psychometric Foundations
Efforts to demonstrate the reliability and validity of global approaches to interpreting the TAT have been handicapped by the previ-
ously noted proliferation of scoring systems, by clinicians’ preferences for a strictly qualitative and uncoded approach to the data,
and by enormous variation in how the test is administered, including which subset of cards is selected for use. Because of this long-
standing lack of standardization, there has been little opportunity for systematic accumulation of data bearing on the reliability and
validity of the TAT in general, nor has it been possible to develop any substantial normative database.
Accordingly, for both inspection techniques and overall scoring systems developed in the tradition of Murray, the psychometric
literature on the TAT is generally acknowledged to comprise a mix of positive and negative findings that cannot easily be compared
with one another. Hence, despite the widespread use of inspection techniques in clinical practice, neither these nor other global
approaches have been demonstrated to show adequate psychometric properties.
However, research studies with TAT scales developed to measure specific personality characteristics have demonstrated that
the instrument can generate reliable and valid findings when it is used in a standardized manner. The previously mentioned
scales of Cramer (1987) and Westen et al. (1985) are cases in point. Cramer’s scale reliably identifies three major mechanisms
of defenseddenial, projection, and identificationdand has shown valid corollaries in changes observed in patients undergoing
psychotherapy (Cramer and Blatt, 1990). The Westen et al. SCORS has been found to provide reliable identification of develop-
mental variables related to disturbed object relations in children and, as already mentioned, is therefore especially relevant to the
assessment of young people. Validation studies with SCORS have involved psychiatrically disturbed, borderline, physically
abused, and sexually abused young people (Freedenfeld et al., 1995; Ornduff et al., 1994; Westen et al., 1990a,b).

Clinical Utility
The clinical utility of the TAT lies mainly in its potential for elucidating dynamic aspects of personality functioning, particularly with
respect to the feelings and attitudes that subjects hold toward other people, themselves, and possible turns of fortune in their lives
for better or worse. Based on the assumption that children and adolescents identify with the central figures in their TAT stories and
project fantasies and realities regarding their own lives into the events and circumstances they describe, the obtained data can shed
light on a broad range of underlying influences on how young people are likely to think, feel, and act.
As previously noted in commenting on the research of McClelland et al. (1989), the implicit types of motives measured by the
TAT are more likely to correlate with persistent dispositions to behave in certain ways rather than with immediate actions or
symptom formation.
Accordingly, TAT findings will usually not add very much to structural diagnosis of adjustment problems in young people, but
they can be extremely helpful in suggesting possible dynamic origins of adjustment problems. In this regard, the psychometrically
sound SCORS may be a useful scale to include in forensic assessment batteries when issues of custody or adoption are being
addressed. This TAT scale can frequently assist examiners in grasping a young person’s representations of people and his or her
capacities for emotional investment in relationships.
12 Projective Assessment of Children and Adolescents

The thematic content of TAT stories has additional potential to facilitate planning and conducting psychotherapy with young
people, particularly with respect to identifying treatment targets and monitoring progress in therapy. The TAT can also be used
in treatment as a play therapy tool, as in Gardner’s (1971) story telling technique. For example, after a youngster has told TAT
stories, the therapist and child can act out the stories in play, or the therapist can create stories to the same picture stimuli for
comparisons with the child’s stories. Hoffman and Kupperman (1990) describe such an intervention with a 13-year-old boy in
which both therapists wrote stories to the same TAT cards to which the patient had responded. As it turned out, Hoffman’s stories
emphasized the main character’s maladaptive coping mechanisms, whereas Kupperman’s stories emphasized positive and healthy
aspects of the central character’s coping capacities. Over a number of sessions, this boy and his therapist engaged in discussions
concerning whose version of the story was most accurate.

Children’s Apperception Test

Consistent with the purpose of the TAT, Bellak (1993, chap. 13) developed the CAT to facilitate understanding of personality
processes in children, including their “dynamic way of reacting to and handling the problems of growth” (Bellak and Siegel,
1989, p. 102). The CAT pictures were designed to elicit fantasies about aggression, sibling rivalry, fears of being alone at night, atti-
tudes toward parental figures, and eating problems.
The CAT-Animal (CAT-A) form, originally published in 1949 and designed for children 3–10 years old, consists of 10 pictures
depicting animals in human situations. The use of animal figures was based on the assumption that young children identify more
readily with animals than with people and will accordingly tell more meaningful stories about animal than human figures. More-
over, according to Bellak (1993, chap. 13), the use of animal figures makes the CAT-A a culture-free test that is equally applicable to
Caucasian, African-American, and other minority group youngsters as well as to children from different countries, except where
there is little familiarity with some of the inanimate objects depicted, such as bicycles.
There is also a human form of the CAT (the CAT-H) that was developed by Bellak and Hurvich (1966) in response to criticism
of the assumption that children identify more easily with animal than with human figures. Studies reviewed by Bellak and Hur-
vich indicate little difference in stimulus value between the original CAT-A and the CAT-H, in which human figures are
substituted for the animals in the CAT-A scenes. However, the CAT-H does not appear ever to have become much used in clinical
practice.

Administration and Scoring

Children being administered the CAT are told that they are going to take part in a game in which they will tell stories about pictures.
Subjects who appear to regard the CAT as a test are informed that it is not the type of test in which they will be graded for correct or
incorrect answers. Standard procedures call for all 10 CAT pictures to be administered in numerical order, from Card 1 to Card 10.
Children are told to narrate what the animals are doing in the pictured scenes and are asked at appropriate points to say what went
on previously and what will happen next. The examiner encourages and prompts the subject as necessary but avoids being sugges-
tive or asking leading questions. Examiners may also query each story by asking the child to elaborate specific points such as the ages
of characters and why they were given particular names.
In clinical work the CAT is typically interpreted along the lines proposed by Bellak for the TAT, that is, with an inspection tech-
nique used to form qualitative impressions of various dimensions of the subject’s personality functioning (Bellak, 1993, chap. 14).
There is an alternative but rarely used quantitative approach developed by Haworth (1965), called the schedule of adaptive mech-
anisms, in which CAT responses are rated numerically for the degree of adaptability or disturbance they reflect. Haworth also
stressed the importance of recognizing that young children are highly reactive to the immediate circumstances in their lives and
less likely than adolescents or adults to have formed well-established personality traits. She accordingly emphasized careful inter-
pretation of CAT responses in the context of adequate information concerning subjects’ home situation and the nature of any recent
or impending crises in their lives.

Psychometric Foundations
There has regrettably been little accumulation of empirical data bearing on the reliability and validity of the CAT. The widespread
use of Bellak’s qualitative inspection technique in CAT interpretation and a corresponding lack of quantification have precluded
examination of the instrument’s psychometric foundations. Although it has sometimes been suggested that the idiographic
nature of CAT as well as TAT data makes traditional psychometric criteria difficult to apply or even irrelevant, there is nothing
in the nature of the data generated by story telling techniques that prevents their being reliably coded for various types of feelings,
motives, attitudes, and capacities that can in turn be validated against meaningful correlates. The previously noted development
of psycho-metrically sound TAT scales for such specific aspects of personality as achievement motivation and social cognition
proves the point that clinical interpretation of stories can go beyond being an art form and attain respectability as a scientific
procedure as well.
Regarding what research is available concerning the CAT, Bellak (1993, chap. 16) provides a review of studies comparing the
responses typical of children at different ages and examining special features in the stories of maladjusted, schizophrenic, speech
disordered, retarded, brain-damaged, and chronically ill children. Almost all of these studies date from the 1950s, however, and
none provides an adequate basis for developing any formal normative standards or diagnostic guidelines for the instrument.
 Projective Assessment of Children and Adolescents 13

Clinical Utility
As in the case of the TAT, the CAT is useful in clinical assessment primarily as a source of hypotheses concerning subjects’ personality
dynamics, particularly with respect to how they view themselves and other important people in their lives, the nature of their hopes
and fears, and what they expect will happen to them. Although not suitable for adolescents, the CAT is more useful than the TAT in
work with younger children, who are likely to relate more easily to the familiar situations and youthful figures depicted in the CAT
illustrations than to the primarily adult figures and unpopulated scenes shown in the TAT.
Like the TAT, the CAT may also contribute to treatment planning, by suggesting areas of concern on which to focus in the
therapy, and it may itself serve as a play technique. In diagnostic assessments, however, hypotheses generated by this instrument
require support from other data prior to being addressed to questions that necessitate empirical decision making.

Roberts Apperception Test for Children

The Roberts apperception test for children (RATC) is intended for use with young people of ages 6–15 and was designed to improve
on the TAT and CAT by presenting familiar stimuli and employing a standardized scoring system (McArthur and Roberts, 1990).
Instead of illustrations primarily of adults, such as those used in the TAT, or illustrations of animals, as used in the CAT, the
RATC primarily portrays child and adolescent figures engaged in everyday interactions, including scenes of parental affection,
disagreement, school and peer relationships, and observation of nudity. There are 27 RATC cards, 11 of which are alternate
versions for male or female subjects. There is an addition an alternate set of cards portraying African-American individuals in
similar scenes.

Administration and Scoring

The standard 16 cards that compose the RATC are administered individually in numerical order, using male or female versions as
appropriate. Subjects are instructed to make up a story about each picture and to tell what is happening in the picture, what led up to
the scene, how the story ends, and what the people are talking about and feeling. Responses are recorded verbatim.
If subjects tell an incomplete story or omit certain aspects, such as how the characters are feeling, additional inquiry may be used
to help teach them to give scorable responses. This inquiry may be used liberally with the first two cards but not thereafter, which
means that responses on cards 3 through 16 may at times have limited scorable data. The possibility of limited scorable data is the
price to be paid for maintaining careful standardization of the RATC procedure. McArthur and Roberts sanction deviations from the
standard procedures only in specific instances, such as the examination of severely disturbed children. When standard procedures
are not or cannot be followed, they recommend considerable caution in using the scoring procedures.
The scoring system for the RATC consists mainly of coding the content of each story for the presence or absence of 13 profile
scales that have implications for personality characteristics. Eight of these are adaptive scales that relate to thematic indications
of reliance on others, giving support to others, supporting oneself, limit-setting by authority figures, identification of problem situ-
ations, and resolving problems in unrealistic, constructive, or particularly insightful ways. The other five are clinical scales that
pertain to thematic manifestations of anxiety, aggression, depression, experiences of rejection, and inability to resolve problems.
The test manual provides guidelines and examples that promote reliable scoring of each of these scales.
To facilitate interpretation of the data, the raw scores for each of the 13 profile dimensions are summed over the 16 cards and
then plotted on a normatively scaled profile form to yield a visual representation of the data, much in the manner of an MMPI-A
profile. The interpretive yield of the data is further enriched by use of an interpersonal matrix, which consists of a tabular represen-
tation of the frequency of convergence between particular scales and the figures identified (e.g., co-occurrence of themes of reliance
on others with description of interaction with a maternal figure).

Psychometric Foundations
As with the careful coding of specific variables on the TAT, the development of standardized administration and scoring procedures
for the RATC has demonstrated that story telling projective methods can achieve psychometric respectability. McArthur and Roberts
(1990) report inter-rater agreement ranging from 0.80 to 0.93 in the scoring of the various dimensions in their system and split-half
reliabilities ranging from 0.44 to 0.86 on their profile scales, with half of these scales showing reliability coefficients of 0.73 or
higher. The adaptive scales appear to work better in this regard than the clinical scales: only one of the five clinical scales (inability
to resolve problems) shows a split-half reliability greater than 0.55, whereas all but one of the eight adaptive scales (reliance on
others) shows a split-half reliability above 0.60.
Validity studies conducted with 200 non-patient and 200 outpatient youngsters aged 6–15 indicate that subjects generally tell
stories that fit the expectations for the cards for example, that a card intended to depict parental affection typically elicits stories
involving affection. In addition to thus showing content validity, the RATC profiles have been found to distinguish between
well-adjusted and clinic youngsters, to be more resistant to efforts at manipulation than self-report measures, and to correlate
well with a behavior problem checklist completed by subjects’ parents (McArthur and Roberts, 1990; Worchel et al., 1992). Signif-
icantly, however, in the comparisons between well-adjusted and clinic youngsters, significant differences were found on all eight of
the adaptive scales and on two of the five clinical scales, but not on the clinical scales for anxiety, aggression, and depression.
With respect to its normative database, the RATC manual provides the mean and standard deviation for each of the profile scales
for 200 nonpatient youngsters divided by gender and by four age categories (6–7, 8–9, 10–12, and 13–15).
14 Projective Assessment of Children and Adolescents

Clinical Utility
Similar to the TAT, CAT, and other storytelling measures, the RATC contributes to personality assessment of young people primarily
by casting light on their underlying attitudes and concerns. Although the measure includes specifically designated clinical scales that
might be expected to assist in clinical diagnosis as well as dynamic analysis of a youngster’s personality functioning, its clinical scales
as noted appear less reliable than its adaptive scales and less capable of discriminating between patient and nonpatient populations.
The RATC is especially valuable to clinicians as well as researchers by virtue of its careful standardization and adequate psycho-
metric properties. Aside from facilitating the interpretive process and providing the basis for systematic accumulation of data, these
features of the instrument make it particularly attractive to examiners conducting forensic evaluations. Having used the RATC in
their projective assessment of a child or adolescent, rather than the TAT or CAT, psychologists will be better prepared to justify their
procedures and conclusions when giving testimony as an expert witness.
However, examiners may sometimes question whether the information they get from the RATC warrants the amount of time
required to administer it, which in our experience approximates an hour on the average. For some young children, moreover, there
may be difficulties in sustaining their investment in the task. There is no short form of the RATC to use and no shortcut, such as
selecting just a few cards to use or discontinuing a protracted administration before giving all 16 cards. Doing so eliminates the
standardization of the instrument and prevents any meaningful scoring or comparisons with normative data, which means that
the test loses its advantage over a TAT or CAT interpreted by inspection. Our view in this matter is that the RATC warrants the
time required to administer and score it in the standardized manner and, more generally, that psychologists should if at all possible
take whatever time is necessary to use standardized instruments when they are available.
The alternate form of the RATC involving African-American figures may prove useful in assessing African-American young
people. However, there are as yet no data establishing the reliability and validity of this alternate form, nor have any representative
normative data been published for it. Hence the RATC should be used cautiously in multicultural assessments, for which at present
the most promising instrument is Tell-me-a-story.

Rosenzweig Picture Frustration Test

Rosenzweig Picture Frustration test (P–F test) was developed by Rosenzweig in 1942. It is based on the frustration-aggression
hypothesis that is frustration always leads to aggression; however, as individuals have some level of frustration tolerance it may
not always lead to overt aggression.
The test consists of two sets of forms, both for children (for 4–13 years old) and adult (for 14 years and older). Both the forms
consist of 24 cartoon-like pictures each, having two principal characters. The pictures don’t have any facial features or emotions. In
each picture, one of the principal characters is engaged in a frustrating situation which is a common life situation. The pictures
consist of two frustrating situations involving either ego blocking or superego blocking. The test can be administered individually
or in groups. The test has adaptations for French, German, Indian, Italian and Japanese population.

Administration and Scoring

The pictures are shown and the subject is asked to write the first response that comes to his/her mind in that situation. The subject is
supposed to respond in the order pictures are presented to him/ her and no picture has to be left unanswered. It is believed that the
subject mostly identifies with the frustrated person in the picture. Enquiry can be made where the responses are too brief or ambig-
uous. Scoring is done in terms ofdthe direction of aggression and the type of aggression.

Psychometric Foundations
The test-retest reliability study performed on 175 college students at an interval of three to 9 months revealed correlations ranging
from 0.30 to 0.77 for the six scoring categories (Bernard, 1949). Inter scorer reliability has been found to be high. Clarke et al.
(1947) reported approximately 85% agreement between two independent scorers on the P–F test. Lindzey (1954) conducted val-
idity study using Thematic Apperception Test (TAT) as the criterion measure and compared the scores on the two tests. He also
compared the scores of P–F test between groups who were very high and very low in prejudice to minorities. He found that scores
on TAT and P–F test did not correlate on extrapunitiveness and intropunitiveness and no difference was found between high and
low groups.

Clinical Utility
The Rosenzweig Picture Frustration test can be used in both adults as well as adolescents. It can be used as a diagnostic test, espe-
cially with special groups of population like delinquents, stutterers, sex offenders, attempters of suicide, patients, the aged, physi-
cally handicapped, and intellectually disabled. It is also used for personnel selection, job adjustment etc. Additionally, the test has
cross-cultural utilization.

Tell-Me-A-Story
The Tell-me-a-story (TEMAS) was designed as a multicultural story-telling test based on the concept that personality development
occurs within a sociocultural system in which individuals internalize the cultural values of their family and society (Costantino
et al., 1988a). The TEMAS is intended for use with African-American, Hispanic, and Caucasian children and adolescents aged
 Projective Assessment of Children and Adolescents 15

5–18 and comes in two parallel sets, one for minority and the other for nonminority youngsters. The two sets feature either predom-
inantly Hispanic and African-American characters or predominantly nonminority characters all shown in urban environments. Each
set comprises 23 cards, 11 of which have alternate versions for males and females and one of which has alternate versions for chil-
dren and adolescents.
As a distinctive feature of the TEMAS, many of the pictures portray a split scene showing contrasting or conflicting intrapersonal
and interpersonal situations that require some resolution, much in the manner of Kohlberg’s (1976) moral dilemma stories. For
example, one side of a scene may depict apparent delay of gratification, and the other side an inability to delay gratification.
How subjects resolve this conflict in their stories speaks to the adaptiveness of their personality functioning and their stage of moral
development.
The TEMAS provides quantitative scales for measuring the adequacy of subjects’ adaptation with respect to nine aspects of
personality functioning: interpersonal relations, aggression, anxiety/depression, achievement motivation, delay of gratification,
self-concept, sexual identity, moral judgment, and reality testing. There are also quantitative scales for four cognitive functions
related to how individual process information (reaction time, total time, fluency as reflected in the number of words used in a story,
and omissions of relevant visual details) and for four affective functions as indicated by mood states attributed to the main char-
acters in a story (happy, sad, angry, and fearful). These quantitative scales are supplemented by several qualitative indicators used to
describe various other characteristics of the stories.
As stressed by Costantino et al. (1988a), the TEMAS was developed to overcome limitations of traditional thematic apperception
tests and differs from the TAT in several significant ways. These include a focus on interpersonal relationships rather than on intra-
psychic dynamics; the use of personally relevant and culturally sensitive stimuli that emphasize meaning rather than ambiguity; the
representation of both positive and negative poles of emotions, cognitions, and interpersonal functions, as opposed to the heavy
weighting of the TAT stimuli with representations of depression, gloom, anger, and hostility; and the introduction of the joint depic-
tion of contrasting circumstances to elicit expressions of conflict resolution and moral judgment.

Administration and Scoring

Subjects are administered either the minority or nonminority form of the TEMAS, and examiners can choose between a long form,
which comprises all 23 cards and requires approximately 2 h to administer, and a standard short form, which consists of nine cards
and requires 1 h to give. In keeping with generally recommended practice in multicultural assessment (Dana, 1993, chap. 6, 1996),
young people should be tested in their primary language, and those who are bilingual should be tested by a similarly bilingual
examiner. Subjects are instructed to tell a complete story about each picture that indicates what is happening now, what happened
before, and what will happen in the future. These instructions may be repeated as often as necessary and supplemented with struc-
tured inquiries to elicit information concerning who and where the characters are and what they are thinking and feeling.
The TEMAS is scored by rating stories for the presence of the various cognitive and affective functions and on a four-point scale
for the level of adjustment reflected in thematic indications of the personality functions. The resulting scores are then totaled and
translated into normalized T scores that are graphed to provide a readily interpretable visual profile. The TEMAS manual provides
detailed guidelines and case examples to illustrate these scoring procedures.

Psychometric Foundations
As described in the test manual (Costantino et al., 1988a), the TEMAS was carefully developed and standardized over several years
prior to its publication. Unfortunately, except for continued work by the test’s authors, much of it in the form of paper presenta-
tions, there has been little published research concerning the psychometric adequacy of the instrument. On balance, however, the
data provided in the test manual appear to indicate a promising beginning in demonstrating its soundness.
With respect to inter-rater agreement, studies with Hispanic, African-American, and Caucasian subjects have indicated that both
the minority and nonminority versions of TEMAS can be scored reliably, with agreements between trained examiners generally
ranging from 75% to 95% across the various scales. Regarding issues of reliability, on the long form of the TEMAS 11 of the 17
personality, cognitive, and affective scales showed internal consistency (alpha) correlations of 0.74 or higher in the standardization
data, and the median for all 17 was 0.83. Internal consistency was lower on the short form, with a median of 0.68. The internal
consistency data for the short form must be considered preliminary, however, because in this analysis the short form scores
were extracted from the protocols of subjects who had in fact completed the long form, rather than from actual administration
of the short form. In an assessment of its retest reliability, the short form was administered twice to 51 behavior problem children
over an 18 week interval. Very little stability over time was demonstrated in this study. Costantino et al. (1988a) suggest several
plausible explanations for this disappointing result, such as the narrow range of scores among the subjects. Nevertheless, test-
retest reliability remains to be demonstrated for both the short and long forms of the instrument.
Turning to the validity of the TEMAS, ratings by psychologists of the types of personality functions pulled by the stimulus
pictures have indicated good agreement with the intent in designing them, thus attesting that the test measures what it purports
to measure. In terms of its criterion validity, the TEMAS has been found in several studies to discriminate between patient and non-
patient youngsters in Hispanic and African-American as well as Caucasian samples, and to accomplish this distinction in inner city
as well as middle-class settings (Costantino et al., 1989, 1992, 1988b). The TEMAS has not demonstrated any capacity to differen-
tiate specific kinds of disorders, but there is some evidence to suggest that certain story characteristics, including the omission of
main characters or events and failure to notice a conflict in the picture (due to lack of attention), may be sensitive to the presence
of attention deficit hyperactivity disorder (Costantino et al., 1991).
16 Projective Assessment of Children and Adolescents

Initial studies reported in the TEMAS manual indicate further that many of its scales correlate significantly with behavior ratings
by subjects’ mothers and teachers and with behavioral observations of their inclinations toward aggressive or disruptive behavior
and their capacities for self-confidence and delay of gratification. Preliminary data indicate further that TEMAS profiles of young
people prior to their entering therapy can significantly predict aspects of their treatment outcome.
The TEMAS standardization sample comprised 281 male and 361 female youngsters from the New York City area who ranged in
age from 5 to 13 years. This sample of 642 children and adolescents included groups of Caucasian, African-American, Puerto Rican,
and other Hispanic subjects from predominantly lower-and middle-income families. The test manual lists the mean and standard
deviation for each scale by gender and ethnicity for the age groups 5–7, 8–10, and 11–13.

Clinical Utility
The TEMAS brings to clinical assessments the distinct advantages of a well conceptualized and quantitatively standardized story-
telling technique that is also culturally sensitive and normed for minority groups of young people. As in the case of the RATC,
its coded scales and profile graphs facilitate interpretation and provide the type of documentation that typically proves valuable
in forensic cases. Moreover, this measure stands alone as a story-telling test proved applicable in the assessment of African-
American and Hispanic children and adolescents. The TEMAS accordingly merits serious consideration for inclusion in a test battery
for evaluating personality functioning in young people, especially if they come from an urban minority background and if there are
forensic issues in the case.
At this stage in its development, however, the TEMAS has some drawbacks that examiners should keep in mind. First, although it
appears to be useful for assessing level of adjustment and incorporation of societal norms among both minority and nonminority
youth, TEMAS does not provide the breadth of information concerning specific types of concerns and relationships that emerge
from TAT, CAT, and RATC analyses. Second, the normative data available thus far are limited to 5–13-year-old city dwellers and
thus do not provide a psychometric basis for drawing conclusions about adolescents aged 14–18, or suburban and rural dwelling
youngsters. Third, the length of time (2 h) required to administer the 23 card long-form of the test is often impractical in clinical
evaluations. The nine card short-form is an attractive alternative but, as noted, adequate reliability has not yet been demonstrated
for the short-form.

Draw-A-Person
The use of human figure drawings as a projective method of personality assessment is based on the expectation that how subjects
draw people will reveal aspects of how they perceive themselves and feel about others. Clinical use of drawing techniques originated
in work with children, and the first formal drawing test, called the draw-a-man, was developed by Goodenough (1926) and later
refined by Harris (1963) and Naglieri (1988) for use as a nonverbal measure of intellectual development. Machover (1948) intro-
duced the notion of using human figure drawings as a projective device that generates nonverbal, symbolic messages concerning
subjects’ impulses, anxieties, and conflicts, and she proposed numerous possible meanings for structural features of drawings
(e.g., where figures are placed on the page) and the manner in which various parts of the body are drawn (e.g., a disproportionaly
large head).
Koppitz (1968, 1984) subsequently focused attention specifically on draw-a-person (DAP) assessment of young people and
used on Machover’s interpretive hypotheses to formulate 30 specific indicators of emotional disturbance involving the quality of
drawings (e.g., asymmetry, transparencies), special features (e.g., teeth showing, arms clinging to body), and omission of body parts
(e.g., no eyes, no arms). Naglieri and his colleagues (Naglieri et al., 1991; Naglieri and Pfeiffer, 1992) have developed further coding
refinements to produce the draw-a-person: screening procedure of emotional disturbance (DAP:SPED). The DAP:SPED is an actuar-
ialy derived and normatively based system comprising 55 objectively scorable items, such as the measured dimensions and place-
ment of figures. It is intended as a screening test for classifying young people aged 6–17 with respect to their likelihood of having
adjustment difficulties that call for further evaluation.

Administration and Scoring

The DAP is administered by giving subjects a plain 8.5  11 inch piece of paper and asking them to draw a person. When they have
finished the drawing, they are given another piece of paper and asked to draw a person of the opposite sex from the one they have
just drawn. Subjects are further instructed to draw the figure of a whole person rather than a cartoon or stick figure. In keeping with
further suggestions by Machover (1951), subjects are also typically asked and to draw a picture of themselves and to provide some
thematic content concerning the figures they have drawn.
As elaborated by Handler (1985), there are three alternative ways of eliciting such thematic content: by asking subjects to asso-
ciate to their drawings, by asking them to make up a story about the people they have drawn, or by asking them specific questions
about their drawings. Machover (1951) provided 31 specific questions to be used for this purpose with children, such as “What is
their ambition?,”“How happy are they?,”“What do they worry about?,” and “What are their good points?”
As with story-telling techniques, figure drawing methods are most commonly interpreted in clinical practice by an inspection in
which personality characteristics are inferred primarily from subjective impressions of noteworthy or unusual features of the figures
drawn. Items included in the Koppitz and DAP:SPED scales may often enter into these impressionistic assessments. However, these
scales serve only to identify emotional disturbance without contributing in other ways to personality description, such as by
 Projective Assessment of Children and Adolescents 17

indicating how individuals process information, handle emotion, and manage stress. They have consequently not been widely
adopted clinically, and there are no other DAP scoring systems that have attracted much attention in the research literature.

Psychometric Foundations
There is very little psychometric foundation for traditional applications of the DAP, and clinical use of this instrument in assessing
young people frequently goes well beyond any empirical justification in empirical data. The influential inspection approach used by
Machover is neither standardized nor codified, which precludes any systematic evaluation of its reliability or the accumulation of
a normative database. Additionally, although it may be reasonable to expect that unusual emphasis on or omission of some body
part will reflect some particular concern about the nature or functions of that body part, most of Machover’s specific hypotheses
concerning the symbolic significance of figure drawing characteristics lack consistent research support (Kahill, 1984; Roback,
1968; Swensen, 1957, 1968).
The Koppitz system is adequately codified and intended to comprise items that have demonstrably low occurrence in the normal
population. However, there is no normative database for the system, its reliability is yet to be demonstrated, and there is some ques-
tion as to whether it can differentiate between well-adjusted and emotionally disturbed children. In a carefully done study in which
Tharinger and Stark (1990) compared groups of mood disordered, anxiety disordered, mood/anxiety disordered, and well-adjusted
youngsters aged 9.5–14.75 years, the Koppitz signs showed good interscorer agreement but did not differentiate among the subject
groups either in mean total score or in the frequency of any of the 30 individual items.
Such findings warrant concern that the DAP may be a faulty projective technique with questionable propriety for continued clin-
ical use. However, it could be that the DAP is a potentially sound method for which there has not yet been sufficiently sophisticated
development and evaluation to document its capacities. The previously mentioned work of Naglieri et al. (1991) on the DAP:SPED
appears to speak to this point. The DAP:SPED was standardized on a representative national sample of 2355 children and adoles-
cents aged 6–17 years; its objective scoring procedures have generated inter-rater agreements above 90%; its internal consistency
(alpha) reliability estimates are 0.76 among 6–8-year-olds, 0.77 among 9–12-year-olds, and 0.71 among 13–17-year-olds; and
its normalized total score has shown substantial capacity to differentiate nonpatient youngsters from those with identified behav-
ioral or emotional problems (McNeish and Naglieri, 1991; Naglieri and Pfeiffer, 1992).
Also noteworthy is the work of Tharinger and Stark (1990), who paired their failure to validate the Koppitz system with an inves-
tigation of a proposed new system of their own, the DAP integrative system. The integrative DAP is based on a qualitative holistic
scoring approach in which drawings are given an overall adjustment rating on a scale from 1 (absence of psychopathology) to 5
(severe psychopathology). Examiners are instructed to base their impressions on their integrated sense of four characteristics of
a drawing, with the pathological end of the scale involving (1) inhumanness of the drawing suggesting feelings of being incomplete,
grotesque, or monstrous; (2) lack of agency as conveyed by a sense of powerlessness; (3) lack of well-being as reflected in negative
facial expressions; and (4) a hollow, vacant, or stilted sense indicating lack of capacity to interact.
In the same study in which Tharinger and Stark failed to validate the Koppitz system, their integrative system total score signif-
icantly discriminated the mood disordered and anxiety/mood disordered subjects from the well-adjusted youngsters and also corre-
lated significantly with the Coopersmith self-esteem inventory, thus attesting the capacity of the DAP to depict a youngster’s sense of
self. Contemporary literature abounds with sharply divided opinion concerning whether the DAP is a worthless test that should no
longer be used (e.g., Gresham, 1993; Motta et al., 1993) or is instead a potentially valuable clinical tool that has too often been
carelessly used or inadequately researched (e.g., Bardos, 1993; Holtzman, 1993). Results to date with the DAP:SPED and the
DAP integrative system give some reason to believe that improved methodology may yet establish sound psychometric foundations
for carefully specified applications of the DAP.

Clinical Utility
Despite its widespread use in describing subjects’ personality characteristics, there is virtually no empirical evidence that traditional
DAP interpretation has any clinical utility. Smith and Dumont (1995) asked a group of experienced psychologists and graduate
students who had been trained in the use of the DAP to review and comment on a case file. They found that these clinicians
routinely utilized specific symbolic representations in the drawings to draw inferences about the client’s personality characteristics
and diagnostic statusdeven though research does not support any such isomorphic correspondence of specific drawing character-
istics to specific features of personality. Aside from the general ethical issues of using test instruments in unwarranted ways, exam-
iners who are preparing forensic testimony jeopardize their credibility by employing the DAP in this manner.
This does not mean that human figure drawings are without utility in the clinical assessment of children and adolescents. First,
by contrast with the practical difficulties of administering the full RATC and TEMAS, the DAP is an easily administered measure that
requires no test stimuli and usually takes less than 10 min.
Second, as a nonverbal measure the DAP can prove especially useful in the evaluation of frightened, reticent, or otherwise
uncommunicative young people, and it is unaffected by language difficulties or bilingualism. As noted by Cummings (1986), more-
over, many young children may be more capable of expressing their thoughts and feelings in drawings than in words, and drawing
pictures is a more familiar activity to most youngsters than most of the tasks that are set for them in a psychological examination.
Third, unusual characteristics of drawings can suggest avenues for further exploration, even in the absence of definitive conclu-
sions about what these features signify. Examiners need to be circumspect in pursuing such avenues, however, lest they prematurely
conclude that they are exploring in correct directions. The pursuit of speculative hypotheses is just as likely to lead into blind alleys
as down fruitful paths.
18 Projective Assessment of Children and Adolescents

Finally, there is ample indication in the contemporary literature that such approaches as the DAP:SPED and the DAP Integrative
System can help to identify the presence and severity of emotional disturbance in general and can accordingly contribute to treat-
ment recommendations, planning, and monitoring. In the future, codifiable and interpretable thematic content in subjects’ stories
about their drawings, comparable to the data derived from story telling techniques, may further enhance the utility of the DAP.

House-Tree-Person
The House-tree-person (HTP) test was devised by Buck (1948, 1985) as a means of tapping the concerns, interpersonal attitudes,
and self-perceptions of young people more fully than is possible with human figure drawings alone. The HTP is intended for use
with anyone over the age of three and was regarded by Buck as a nonthreatening instrument that can serve well to minimize a child’s
anxiety in testing situations and to assess personality functioning in multicultural and bilingual settings. As postulated by Buck and
subsequently elaborated by.
Hammer (1958, 1985), subjects’ drawings of these three objects are considered to provide symbolic representations of important
aspects of their world.
Specifically, the house, as a dwelling place, is expected to arouse feelings toward the subject’s home life and family relationships
and, particularly for children, attitudes toward their parents and siblings. The tree is seen as encouraging projection of personal feel-
ings about the self that would be more anxiety-provoking to express in drawing a person, because the latter is more obvious in its
representation as a self-portrait. More specifically, the way the trunk of the tree is drawn is considered to portray a subject’s feeling of
basic power and inner strength; the branches are seen as depicting the subject’s ability to derive satisfaction from the environment;
and the overall organization of the drawing is taken as a reflection of the individual’s feeling of intra-personal balance. Finally, the
drawing of the person is expected to reveal aspects of how subjects view themselves, how they would like to be, and what they think
about significant other people in their lives.

Administration and Scoring

Although Buck recommends a four-page booklet with pages measuring 7  8.5 inches, most HTP examiners use four sheets of stan-
dard 8.5  11 in paper on which subjects are asked first to draw “as good a picture of a house as you can,” then a tree, and then
a person of each sex. Subjects are told they can take us long as they wish and draw any kind of house, tree, or person they like.
Completion of the drawings is followed by an interrogation phase in which numerous questions devised by Buck are used to
encourage subjects to define, describe, and associate to their drawings (e.g., “About how old is that tree?,” “What does that house
make you think of?” “Is that person happy?” Buck also recommended a chromatic phase of the HTP in which subjects would do
a second rendering of their drawings in crayon rather than pencil, followed by another interrogation. There are no data to indicate
the frequency with which examiners conduct Buck’s full HTP administration or instead limit the test to the pencil drawings, without
either an inquiry or a chromatic phase.
Following the example of Goodenough, Buck originally proposed an elaborate quantitative system for objective coding of struc-
tural features of the HTP drawings, such as their size and proportions. As best as can be determined from the literature, however,
quantitative coding of the HTP has rarely been employed in clinical practice. Instead, clinicians using this instrument typically rely
on a qualitative inspection technique to identify symbolic implications of drawing characteristics for aspects of personality func-
tioning. As in the case of interpreting the DAP in the tradition of Machover, many of the interpretive hypotheses for the HTP sug-
gested by Buck and by Hammer are quite specific. A door that is tiny in relation to the size of the house is interpreted as indicating
reluctance to make contact with the environment and an inhibited capacity for social relations, for example, and overemphasis on
the roots of the tree where they make contact with the ground is taken as evidence of subjects’ concerns about losing their grip on
reality.

Psychometric Foundations
The entire psychological literature contains only a handful of articles bearing on the psychometric foundations of the HTP. Most of
these are over 25 years old, and none of them provides convincing supportive evidence for the interpretive uses of the instrument
recommended by its leading proponents. Buck’s (1985) 350-page revised manual contains extensive guidelines and case illustra-
tions to facilitate interpretation, but neither reliability nor validity appears in the index. As intriguing as the rationale for the instru-
ment may be to clinicians, especially those who are psychodynamically oriented, there is at present no empirical basis to warrant
inferring personality characteristics from it.

Clinical Utility
Similar to the DAP, the HTP offers the potential advantages in clinical practice of a brief, easily administered, nonverbal, and largely
culture-free assessment instrument, along with perhaps being even less anxiety provoking than the DAP. Emerging refinements with
the DAP suggest that the HTP as well might prove useful in identifying maladjustment in general, monitoring progress and change
in psychotherapy, and even in pointing to possible specific areas of conflict and concern. Moreover, like the DAP inquiry, the HTP
interrogation can produce story-telling content that in turn can be codified and suggest topics for further exploration. As matters
presently stand, however, any such utility remains an unfulfilled potential, and examiners should be circumspect about including
the HTP in their test batteries and basing any firm conclusions on it.
 Projective Assessment of Children and Adolescents 19

Kinetic Family Drawing

Machover (1948) and numerous other clinicians who pioneered in using the DAP to assess young people suggested that useful
information might also be obtained by asking individuals to draw members of their family. This suggestion was formalized by
Burns and Kaufman (1970, 1972) as the kinetic family drawing (KFD) technique, in which subjects are instructed to draw a picture
of everyone in their family, including themselves, doing something. These drawings are then examined for such objective features as
omissions of body parts or of members of the family and interpreted according to the actions, styles, and symbols represented in
them.
Actions in the Burns and Kaufman approach refer to the ways in which the figures drawn are behaving toward each other, which
are thought to provide clues to the intensity and emotional tone of their relationships. Styles concern barriers between family
members that prevent them from interacting at all, which may be expressed by drawing some of them at a far distance from the
others or encasing them in a circle or a box. Symbols comprise a list of specific items, such as beds, flowers, stoves, cats, and the
like, the inclusion of which is considered to reflect various specific unconscious impulses or concerns.
Publication of the KFD was followed by a school adaptation of the technique by Prout and Phillips (1974), known as the
kinetic school drawing (KSD), in which children are asked to draw a school picture of themselves, their teacher, and a friend
or two in which everyone is doing something. The KSD was intended to provide information about peer relationships and about
attitudes and concerns related to school in the same manner as the KFD does for family relationships and feelings about the
home.
Knoff and Prout (1985a,b) subsequently recommended combining the KFD and KSD and administering both measures for
purposes of analysis and comparison. This combined approach, which they call the kinetic drawing system, is expected to identify
adjustment difficulties both at home and in school, to clarify causal or reciprocal relationships between family and school-related
issues, and to indicate which people in subjects’ lives (e.g., father, sister, teacher) are sources of support of tension. In a further exten-
sion of this approach, Burns (1987) has developed a kinetic house-tree-person, in which subjects are instructed to draw on a single
page a picture of a house, a tree, and a person in “some kind of action.”

Administration and Scoring

Similar to procedures followed in other drawing techniques, administration of the KFD consists of giving subjects an 8.5  11 inch
piece of plain paper and asking them to draw a picture of everyone in their family, including themselves, doing something. Begin-
ning with an interpretive approach modeled basically after Machover’s qualitative system, Burns (1982) developed a long list of
actions, style, and symbol characteristics for examiners to consider. As summarized by Knoff and Prout (1985a,b), at least four
objective methods for coding characteristics of kinetic drawings have also been proposed by various investigators, but none of these
has become consistently visible in the literature. A review of the KFD literature by Handler and Habenicht (1994) indicates in
general that cumulative knowledge concerning the adequacy and utility of this instrument has been limited by considerable vari-
ation in whether and how it has been scored in research studies and applied in clinical practice.
Also of note is a thematic elaboration of the KFD proposed by McConaughy and Achenbach (1994) and called the semistruc-
tured interview protocol. In this approach subjects are given the following question to answer after they have completed their family
drawing: (1) what are they doing, (2) what kind of person is (each member), (3) what are three words that describe (each member),
(4) how does (each member) feel in this picture, (5) what is (each member) thinking, (6) who do you get along with best, (7) who
do you get along with least, and (8) what is going to happen next in your picture?

Psychometric Foundations
Handler and Habenicht (1994) were able to reference a substantial number of publications concerning the KFD. However, they
were forced to conclude that, despite its widespread use, this projective method has not yet been adequately developed with respect
to its psychometric properties. Most of the systems previously proposed for coding KFD characteristics can achieve substantial inter-
rater reliability, with percentages of agreement generally ranging well above 0.85 in various studies (Cummings, 1986; Handler and
Habenicht, 1994). However, none of these scoring systems has demonstrated satisfactory retest reliability, even after very brief inter-
vals, and there is little empirical basis for challenging the opinion that “the KFD still remains primarily a clinical instrument with
inadequate norms and questionable validity” (Handler and Habenicht, 1994, p. 441).
With this in mind, Handler and Habenicht have recommended a holistic, integrative approach to KFD interpretation, much in
the manner of the previously noted integrative DAP method used by Tharinger and Stark (1990), rather than the coding and
summation of lists of signs and symbols. In the same study in which Tharinger and Stark demonstrated the superiority of their inte-
grative DAP to the Koppitz scoring system, they also found that a holistic method of evaluating kinetic drawings discriminated
adjusted from maladjusted children more effectively than a traditional scoring guide for KFD interpretation developed by Reynolds
(1978).
In developing his scoring guide, Reynolds urged clinicians and researchers to avoid cookbook approaches that fail to go beyond
positing direct and absolute links between individual drawing characteristics and specific personality features. Instead, scores for
drawing characteristics should be only a first step in interpreting drawings as gestalts that take on meaning only in relation to
a youngster’s personal, family, and cultural context. It can be hoped that eventual attention to this sound advice, perhaps through
the standardization of integrated coding systems, will establish for kinetic drawings the validity that is presently lacking for them to
be used with confidence in clinical evaluations.
20 Projective Assessment of Children and Adolescents

Clinical Utility
Conceived as a means of understanding how children and adolescents conceptualize their family and perceive themselves within
the family context, the KFD is a potentially useful instrument for elaborating the interpersonal dynamics of young people and
orchestrating individual or family therapy for those with adjustment difficulties. By employing the kinetic drawing system, exam-
iners can explore school-based as well as family-related issues for such purposes. Of further potential benefit, subjects from a variety
of ethnic and minority group backgrounds have been found to express dimensions of their family culture in their KFDs (Handler
and Habenicht, 1994), which suggests a role for this instrument in multicultural assessment.
Unfortunately, however, the previously noted psychometric limitations of the KFD makes its clinical use problematic at present,
particularly with respect to basing any firm conclusions on what and how subjects draw. Until such time as adequate research has
clarified what the KFD and other projective drawings methods can and cannot do, clinicians are well advised to regard their figure
drawing findings as suggesting but not confirming any notions about the subject. We would endorse in this regard the conclusion of
Knoff (1990) that “The hypothesis generating use of projective drawings and their ability to be interpreted within various psycho-
logical orientations remains both viable and defensible [but] the validity of hypotheses tied to specific drawing characteristics must
still be determined” (p. 99).

Sentence Completion Methods

Sentence completion methods consist of initial words or phrases, called stems, that subjects are asked to extend either orally or in
writing into complete sentences. Typically used stems vary in length and structure from just one or two words, such as “People.” or
“I wish.,” to detailed specification of people or situations, such as “If only my mother would .” or “When he found he had failed
the examination, he.” As in the case of responses on other projective methods, the manner in which subjects complete sentences is
expected to provide an indirect source of information concerning their underlying feelings, attitudes, and level of adjustment. In
addition to eliciting general information in these respects, the specificity in many sentence completion stems encourages subjects
to reveal their orientation toward particular events and circumstances in their lives.
Sentence completion methods originated in word association tests dating back to the 1890s, and, as reviewed by Haak (1990)
and Lah (1989b), were developed during the 1940s and 1950s into a large number of formal and informal versions, of which the
most noteworthy published scales were the Rohde, the Sacks, the Forer, and the Miale-Holsopple sentence completion tests and the
Rotter incomplete sentences blank (RISB). Of these, the RISB has become the best known and most widely used and includes an
adult, a college, and a high school form (Rotter et al., 1992). Also available are sentence completion forms constructed by Brown
and Unger (1992) for use with adolescents and adults and by Hart (1986) for evaluating school age children. Further comments
focus primarily on the RISB, as the predominant exemplar of the sentence completion method, and on the Hart sentence comple-
tion test (HSCT), because of its specificity for assessing young people.

Administration and Scoring

The RISB is a 40-item test printed on the front and back of a one-page form and comprised mainly of brief stems (eight have just
a single word, 21 have two words, six have three words, and the remaining five have four words). Subjects are given a pencil and
asked to “complete these sentences to express your real feelings.” The test can be administered either individually or in a group
setting; however, Rotter et al. (1992) caution against taking oral rather than written responses, primarily because doing so injects
an interpersonal component into the testing administration that can influence subjects’ responses in various confounding ways.
The RISB and other sentence completion tests are typically interpreted in clinical practice by the inspection methods we have
described previously; that is, examiners read the content of the items and from impressions of what they signify concerning
a subject’s probable personality characteristics. Rotter et al. (1992) also provide a scoring system for rating each item on a seven-
point scale from 0 (most positive adjustment) to 6 (most indication of conflict). These ratings are totaled to yield an overall adjust-
ment score. There is little indication that this or any other codification has received much attention in clinical practice or research
studies, even though some work with college students indicated that the overall RISB score can discriminate those who are receiving
counseling or psychotherapy from their nonpatient peers (Lah, 1989a).
The HSCT is also a 40-item measure in which the item stems were designed specifically to use with children and to sample
family, social, school, and self dimensions of their lives (Hart et al., 1983). HSCT scoring involves rating each item as negative,
neutral, or positive with respect to adjustment and also rating 10 scales composed of various clusters of items concerned with
perceptions of self, family, and school on a five-point negative-to-positive continuum. Criteria are provided for each item to guide
examiners in their ratings and thereby to enhance scoring objectivity and the prospects for achieving inter-rater agreement.

Psychometric Foundations
Although there is a substantial RISB research literature, most of the published studies have used the instrument as a measure of
adjustment but, as pointed out by Lah (1989a), they were not designed to evaluate its properties. Particularly with respect to its
validity, there has been virtually no accumulation of empirical evidence to support any diagnostic or predictive inferences about
personality functioning beyond the modestly demonstrated capacity of the RISB to identify maladjustment. Likewise, little system-
atic progress has been made in assessing the reliability of RISB data and establishing normative standards for them.
This is a regrettable state of affairs because, aside from being a psychodynamically compelling method of enriching personality
assessment, the RISB is an eminently codeable instrument for which excellent interscorer agreement has been demonstrated using
the Rotter et al. approach (Lah, 1989a). Moreover, as discussed in the introductory portions of this article, sentence completion
 Projective Assessment of Children and Adolescents 21

responses have numerous objective, structural, and behavioral components (e.g., time to completion, length of sentences, frequency
of self-vs. other-reference, items omitted) that have rarely been considered in codifying these methods or attempting to establish
a psychometric foundation for them.
The HSCT coding system has also achieved substantial inter-rater agreement and some preliminary success differentiating
between emotionally disturbed and well-adjusted children. However, Hart (1986, p. 269) observed that it remained to further
research to demonstrate adequate reliability and criterion validity for his instrument and to develop sufficiently broad normative
data. The available literature, c.1996, suggests that not much if any, progress has been made in this regard.

Clinical Utility
Sentence completion methods bring to the personality assessment battery an easily administered projective test that can be given to
groups as well as individuals and requires only about 30 min on average for subjects to complete. The scorable 40-item RISB high
school form is suitable for high school and most middle school youngsters, and the 40-item HSCT can be used comfortably with
younger children. Barring a language or reading difficulty, the meaning of the sentence completion stems is clear, and subjects are
not asked to explain, elaborate, or otherwise account for their responses. Hence, incomplete sentence methods are often less threat-
ening or anxiety-provoking than inkblot, story-telling, and figure drawing procedures. However, the previously noted relative lack of
ambiguity in sentence completion stems means that subjects are more aware than on other projective methods of how they are
presenting themselves through their responses.
At this point in time, the RISB and HSCT can be used with justification to form general impressions of a young person’s level of
adjustment and to formulate hypotheses concerning possible conflicts or concerns the young person has and how he or she may feel
about self, other people, and certain situations. Such hypotheses can justifiably be expressed only as speculations, however, not as
conclusions, and they should be considered reasonably correct only to the extent that they are supported by other reliable sources of
information.
Haak (1990) has asserted that sentence completion methods can be used effectively with children to rule out intellectual diffi-
culties, attention deficit disorder, and stress and to rule in depression, anxiety, thought disturbance, and defensiveness, and provides
detailed clinical guidelines for doing so. These suggestions seem sensible in each case, but they are entirely unverified by empirical
data. Hence, like other impressions formed by experienced clinicians, Haak’s diagnostic guidelines provide an agenda for confirma-
tory research, but they should not be elevated from speculations to the status of conclusions until that empirical confirmation
becomes available.

The Szondi Test

The Szondi Test was developed by Leopold Szondi in 1935. The test is based on the drive theory. It believes that needs of a person
constantly undergoes changes.
The test consists of eight pictures representing the eight drive needs and their degree of tension. These drive needs are hermaph-
roditism, the sadist drive need, the epilepsy drive need, the hysteric drive need, the catatonic drive need, the paranoid drive need, the
depressive drive need, and the maniac drive need. The subject is presented with facial photographs of patients with mental illness,
whose personality has been classified with eight of the drive needs.

Administration and Scoring

The subject has to choose two most appealing and two most repulsive photos of each group. Various quantitative, qualitative and
proportional methods have been developed by Szondi and other researchers to score and interpret the test. It is believed that the
subject chooses pictures representing his drive needs. More a picture chosen of a particular drive need, the more it shows about
greater tension present for that particular drive need.
The test is a projective test which assesses personality of the individual but is not used popularly in present time.

Future Directions

Projective methods have been extensively used, taught, and studied for many years, and it seems likely that they will continue in the
future to be regularly included in test batteries for assessing personality functioning in young people. Survey data cited in this article
document that over the last 30 years psychologists have continued with much the same frequency to apply these instruments in
practice and utilize them in research. During this same period the psychometric adequacy and clinical contributions of projective
methods have been regularly and vigorously challenged, and this article indicates that the uses to which some of these instruments
are put often go beyond available justification in empirical data.
How do we account for the persistent use by clinicians of many such as yet unvalidated methods? One could say that there just
happen to be legions of uninformed or unethical clinicians in practice who do not hesitate to employ useless methods if doing so
serves their purpose in some way. However, it seems doubtful that a vast segment of the profession deserves to be tarred with such
a broad brush of evil. Rather, at least the majority of professionals who use projective methods must have good reason on the basis
of their clinical and individual case experience to believe sincerely that these methods provide valid and useful information about
personality functioning in ways that have not yet been translated into supporting research data. One could then say that such clin-
ical confidence in projective methods is based solely on illusory correlation. However, it seems doubtful that a vast segment of
professional personality assessors could be so thoroughly deluded.
22 Projective Assessment of Children and Adolescents

These observations suggest that projective techniques have been and will continue to be used because they yield valuable infor-
mation and generate fruitful hypotheses in clinical assessments. Hopefully, adequate research methods will lead the way toward
improved standardization and codification of projective methods, that will in turn enhance the psychometric foundations on which
they rest. As Kuehnle (1996) has pointed out, inappropriate use of projective instruments for purposes for which they have not been
validated, such as identifying children as having been traumatized or sexually abused, violates ethical standards and risks causing
harm to young people and their families.
More than any of the other projective methods, the Rorschach has had the benefit of rigorous attention to research methodology,
as demonstrated in publications by Exner (1995) and Weiner (1995a) and, as indicated earlier in this article, this method presently
rests on a solid psychometric foundation. What the future of projective methods needs is similar methodological attention to doc-
umenting the reliability of other techniques and their validation for various purposes. To say that sophisticated research methods
are not applicable to projective methods is as unwarranted as asserting that these methods are by nature invalid. To say that projec-
tive test responses cannot be examined scientifically without detracting from their idiographic richness sells projective methods
short and prevents them from realizing their full potential.
Along with these needs for improved research and a narrowed gap between data and practice, the most important future direc-
tion for projective testing of young people lies in developing adequately representative normative data that will facilitate age-specific
and multicultural assessment. There is no lack of projective techniques, but there is a decided lack of reliable information concern-
ing how children and adolescents of different ages, from diverse backgrounds, and with various kinds of personality strengths and
weaknesses, should be expected to respond to them. In addition to the nearly empty coffers of cross-sectional normative data of
these kinds, the cupboard is virtually bare with respect to longitudinal data indicating how young people are likely to change
over time and with maturation in how they respond to projective tests. Collecting and disseminating such data is the number
one agenda item for the future development of projective assessment of children and adults. With time projective tests have
been adapted in various contexts without alteration of their psychometric properties.
Involvement in projective tests also depend on intelligence as well as creativity of the individuals. Intelligence and creativity are
also inter-related. Children use their creativity while undertaking projective tests. Creativity helps in associating concepts and may
be biologically linked with cognition (Velázquez et al., 2015). The association of heritability with creativity is modest as found in
various twin studies (Velázquezet al., 2015). In a recent study by Velázquez et al. (2015), reared apart monozygotic and dizygotic
twins were assigned Draw-a-House (DAH) and Draw-a-Person (DAP) tasks to look for the association of genetic and environ-
mental influence on applied creativity. The result suggest that both genetic as well as environmental factors have impact on applied
creativity of the individuals (Velázquez et al., 2015). Adren et al. (2014), also attempted to explore the genetic link of projective
testdChildren’s Human Figure drawing with intelligence (Arden et al., 2014). Projective tests likedhuman figure drawing during
childhood can also be correlated with intelligence of the individual a decade later (Arden et al., 2014;Table 2).

Table 2 Summary of various projective tests used in children and adolescents

Projective test Developed by Age group Explores about

1. Rorschach inkblot test Herman Rorschach (1942) 5–70 years of age Personality, psychopathology,
coping capacity
2. Holtzman inkblot test W. H. Holtzman et al. (1961) 5 years and above Personality, psychopathology
3. Somatic inkblot test (SIS-I, Wilfred A. Cassell 5–70 years of age Psychopathology and therapeutic
SIS-II) tool
4. Thematic apperception test Morgan and Murray (1935) 5 years or older Personality, needs, conflicts
(TAT)
5. Children’s apperception test Bellak and Bellak (1949) 3–10 years of age Aggressive fantasies, sibling
(CAT) rivalry, phobia, attitudes toward
parental figures, and
problematic eating behavior
6. Robert’s apperception test McArthur and Roberts (1990) 6–15 years of age Personality
for children (RATC)
7. Rosenzweig picture Rosenzweig (1949) Adult form (for 14 years and older), Psychopathology, expression of
frustration test child form (for 4–13 years old) frustration and aggression
8. Tell me a story (TEMAS) Constantino et al. (1988a) 5–18 years of age Adaptation and stage of moral
development
9. Draw a person Goodenough (1926) Children and adolescents Intelligence, personality
10. House tree person (HTP) Buck (1948) 3 years and above Interpersonal attitude, self-
perception, personality
11. Kinetic family drawing Burns and Kaufman (1970, 1972) Children and adolescents Assesses child’s perception about
relationships
12. Sentence completion test Rotter et al. (1992), Hart (1986), Children form 6–18 years of age Attitudes and other significant
Sacks and Levy (1950) areas of an individual’s life.
13. Szondi test Leopold Szondi (1952) Children and adolescents as well as Personality
adults
 Projective Assessment of Children and Adolescents 23

Summary

Projective tests are methods of personality assessment in which some degree of ambiguity in the test stimuli or instructions creates
opportunities for subjects to structure their responses in terms of their individual personality characteristics, and thereby provide
information about the nature of these characteristics. Although projective methods are accordingly more ambiguous and less struc-
tured than so-called objective methods, the differences between these methods are relative rather than absolute. All projective tests
contain objective as well as subjective features and elicit responses that are representative as well as symbolic of behavior, and they
differ from each other in the extent to which they are ambiguous.
Because of their relatively unstructured nature, projective tests measure personality functioning in subtle and indirect ways and
tap underlying psychological characteristics at a less conscious level than relatively structured measures. Projective test data conse-
quently provide valuable information about how people are likely to think, feel, and act that is difficult to obtain from objective
assessment procedures, and they are also less susceptible than objective test data to the influence of test-taking attitudes. Use of
a particular projective test in children and adolescents depends on the purpose of the projective test, therapist’s expertise on the
particular projective technique, time available as well as availability of the tool. The projective tests can explore a range of psycho-
pathologies with variable specificity. Selection of a particular projective test for a particular individual depends on the clinical discre-
tion of the therapist.
Projective methods can be used to good effect with children and adolescents as well as adults. The basic interpretive conclusions
and hypothesis that attach to projective test variables apply regardless of the age of the subject, provided that examiners determine
the implications of their data in the light of normative developmental expectations. Surveys of clinical and school settings indicate
that the projective instruments most frequently administered in evaluating young people are the Rorschach inkblot method, the
thematic apperception test (TAT), the children’s apperception test, the Roberts apperception test for children (RATC), the tell-
me-a-story (TEMAS) test, the draw-a-person, the house-tree-person, the kinetic family drawing, and alternate forms of the sentence
completion test.
For each of these nine projective tests, this article reviews their composition, administration, scoring, psychometric foundations,
and clinical utility. Despite widespread utilization of these nine tests in clinical practice to draw conclusions about the personality
characteristics, level of adjustment, and treatment needs of young people, only the Rorschach presently rests on a solid empirical
foundation. Properly collected and interpreted, Rorschach data provide numerous demonstrably reliable and valid indices that facil-
itate differential diagnosis and treatment planning for children and adolescents with adjustment difficulties.
The RATC and TEMAS have shown through the development of standardized administration and scoring procedures that story-
telling methods have the potential to achieve psychometric respectability. However, further research on the RATC and TEMAS is
needed with regard to multicultural and adolescent norms, respectively. With regard to the TAT, emerging psychometrically sound
schemes for coding specific personality characteristics reflected in thematic content, such as SCORS, appear to provide a basis for
empirical decision making.
The other measures reviewed have in various ways also shown potential to be codified and refined on the basis of empirical data,
and there is reason to be hopeful that advances in research methodology will eventually close a currently regrettable gap between
what is known for sure about these projective methods and what is frequently assumed to be true about them in clinical practice.
Until this gap is narrowed, and especially until such time as more extensive normative and multicultural data become available,
most clinical inferences from projective data should be regarded as hypotheses to be confirmed rather than as facts on which to
base conclusions and recommendations.

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