投射性精神诊断:墨迹、故事和图画作为临床测量

M. Eby
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摘要

投射性精神诊断指的是使用心理工具,通过这些工具,受试者被要求对一系列模糊的(尽管通常是暗示性的)刺激做出反应,从而将他们个性的各个方面“投射”到这些反应中。这些工具中最著名的包括罗夏墨迹技术(Rorschach Inkblot Technique),在这项技术中,受试者面对10个墨迹,并被问及这些刺激是什么样子的,然后是什么感知特征使它们看起来是那样的。另一种常见的投射技巧是主题统觉测试(Thematic Apperception Test, TAT),这是一种讲故事的练习,在这个练习中,受试者对一系列描述人类互动的模糊但有时高度紧张的黑白图片进行叙述。随着时间的推移,针对儿童(儿童统觉测试)或不同种族人群的类似讲故事工具开发了新的图片。这两种测试都是在心理动力学理论和卡尔·荣格(Carl Jung)的工作的影响下出现的,荣格的单词联想测试是一种心理冲突的投射测量方法。最后,还有一系列的绘图测试,虽然不太常用,但有一个投影的历史,包括人体绘图,弯曲格式塔测试和华特格绘图完成测试。投射工具已经在各种精神病学设置中使用,并被批评为在定量测量或科学有效性方面缺乏充分的基础。罗夏墨迹已经出现了越来越多的基于统计的评分系统,解决了风险和诊断评估中的感知特征、语言和内容。TAT本质上是一种结构化的访谈(因为大多数评分系统不被临床医生使用),但它似乎在收集受试者与其他人关系的信息方面很有用。绘画任务和句子完成测试(来源于单词联想测试)不太常用,尽管在语言能力可能更有限的孩子中更常见。一般来说,投射性测试在定义诊断和风险方面的能力有限(在定义思维障碍和预后方面尤其有用),但它们可能在帮助临床医生更深入地了解被测试者的冲突和资源方面最有用。
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Projective Psychodiagnostics: Inkblots, Stories, and Drawings as Clinical Measures
Projective psychodiagnostics refers to the use of psychological instruments through which the subject is asked to respond to a set of ambiguous (though often suggestive) stimuli, thereby “projecting” aspects of their personality into these responses. The most prominent of these instruments includes the Rorschach Inkblot Technique, in which the subject is confronted with ten inkblots and is asked what these stimuli look like, and then what perceptual features make them look that way. Another common projective technique is the Thematic Apperception Test (TAT), a storytelling exercise in which the subject responds with a narrative to a series of ambiguous but sometimes highly charged black and white pictures depicting human interactions. Over time, new pictures have been developed for similar storytelling instruments targeted to children (the Children’s Apperception Test) or different ethnic populations. Both of these tests emerged under the influence of psychodynamic theories, and of the work of Carl Jung, whose Word Association Test served as a projective measure of psychological conflicts. Finally, there is a series of drawing tests which, while less commonly used, have had a projective history, including human figure drawings, the Bender–Gestalt Test, and the Wartegg Drawing Completion Test. Projective instruments have been used in a variety of psychiatric settings and have been criticized for being insufficiently grounded in either quantitative measures or scientific validity. The Rorschach has emerged with increasingly statistically based scoring systems addressing perceptual features, language, and content in the assessment of risk and diagnosis. The TAT is essentially a structured interview (since most scoring systems are not used by clinicians), but it nonetheless appears to be useful in gleaning information about a subject’s relationships with other people. Drawing tasks and sentence completion tests (derived from word association tests) are less commonly used, though more prevalent with children whose verbal abilities may be more limited. In general, projective tests appear to have some limited ability to define diagnosis and risk (and can be especially helpful in defining thought disorder and prognosis), but they may be most useful in helping clinicians obtain a deeper picture of conflicts and resources within the person tested.
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