UNIT 1 INTRODUCTION TO

PROJECTIVE TECHNIQUES AND

NEUROPSYCHOLOGICAL TEST
Structure
1.0 Introduction

1.1 Objectives

1.2 Projective Techniques

1.2.1 Important Projeactive Techniques

1.3 Categories of Projective Techniques

1.4 Basic Assumptions

1.5 Projective Testing

1.5.1 The Rorschach Test
1.5.2 The Thematic Apperception Test (TAT)
1.5.3 Projective Drawings
1.5.4 Sentence Completion Techniques

1.6 Merits of Projective Tests

1.7 Neuropsychological Assessment

1.8 Purposes of Neuropsychological Assessment

1.9 Dimensions and Level of Assessment

1.10 Neuropsychological Testing

1.11 Limitations

1.12 Let Us Sum Up

1.13 Unit End Questions

1.14 Suggested Readings

1.0 INTRODUCTION
In this unit, we willfirst consider what projective testing is. Then we will discuss
the categories and assumptions of projective tests. The main projective tests used
to assess personality are described. Next we will explain some of the core
concepts of the discipline of neuropsychological assessment. In this unit we will
briefly review the major testing approaches used in contemporary neuropsychology
practice.

1.1 OBJECTIVES
After completing this unit, you will be able to: 5
Projective Techniques in • Provide the definition and characteristics of projective techniques;
Psychodiagnostics
• Discuss the categories and basic assumptions of projective techniques;
<,

• Describe the different types of projective tests used;

• Explain what neuropsychological assessment is;

• Discuss the purposes and dimensions of neuropsychological assessment; and

• Discuss the most widely used neuropsychological tests.

1.2 PROJECTIVE TECHNIQUES

Projective Techniques are indirect and unstructured methods of investigation
which have been developed by the psychologists and use projection of respondents
for inferring about underline motives, urges or intentions which cannot be secure
through direct questioning as the respondent either resists to reveal them or is
unable to figure out himself. These techniques are useful in giving respondents
opportunities to express their attitudes without personal embarrassment. These
techniques helps the respondents to project his own attitude and feelings
unconsciously on the subject under study. Thus Projective Techniques play a
important role in motivational researches or in attitude surveys.

Projective technique is any personality test designed to yield information about

someone's personality on the basis of their unrestricted response to ambiguous
objects or situations .. Projective techniques are a set of instruments whose main
objective is to describe and characterise personality. The adjective projective is
a derivative of 'projection', a concept introduced by Freud in the vocabulary of
psychology to describe the design of a defense mechanism leading the subject to
transfer to another person, or thing, his urges, feelings, etc., that he cannot accept
as belonging to him. However, this concept is not commonly used in the field of
projective techniques. Rather, another concept with a less restrictive and specific
meaning is used. This means that, in responding to the stimulus situation, the
subject reveals or externalises aspects of his own personal life, such as motives,
interests, feelings, emotions, conflicts and the like.

To a large extent, the characteristics of the stimuli of the projectives are responsible
for this.externalisation and have an important effect on the nature and content of
the subject's responses. Two such characteristics are the structure and ambiguity
of stimuli. The structure refers to the degree of organisation of the stimulus:
incompleteness, nearly an organised whole or fully divided, close to or far from
being a real representation, etc. The ambiguity concerns the number and variability
of responses each stimulus elicits.

1.2.1 Important Projective Techniques

The following are some of the major projective techniques:

I) Word Association Test.

2) Completion Test.

3) Construction Techniques

4) Expression Techniques
6
1) Word Association Test: An individual is given a clue or hint and asked to Introduction to Projective
respond to the fIrst thing that comes to mind. The association can take the Techniques and
Neuropsychological Test
shape of a picture or a word. There can be lllany interpretations of the same
thing. A list of words is given and you don't know in which word they are
most interested. The interviewer records the responses which reveal the
inner feeling of the respondents. The frequency with which any word is given
a response and the amount of time that elapses before the response is given
. are important for the researcher. For example: Out of 50 respondents 20
people associate the word" Fair" with "Complexion".
2) Completion Test: In this the respondents are asked to complete an
incomplete sentence or story. The completion will reflect their attitude and
state of mind.
3) Construction Test: This is more or less like completion test. They can give
you a picture and you are asked to write a story about it. The initial structure
is limited and not detailed like the completion test. For eg: 2 cartoons are
given and a dialogue is to written.
4) Expression Techniques: In this the people are asked to express the feeling
or attitude of other people.
Disadvantages of Projective Techniques
1) Highly trained interviewers and skilled interpreters are needed.
2) Interpreters bias can be there.
3)' It is a costly method.
4) The respondent selected may not be representative of the entire population.

1.3 CATEGORIES OF PROJECTIVE

TECHNIQUES
For many years, the primary testing tools of clinical psychologists were projective
techniques such as the Rorschach Inkblot Technique. These techniques have in
common the presentation of ambiguous and malleable stimuli to which a large
number of different responses can be made. Presumably, the specific responses
given by a client reflect something about that individual's psychodynamic functioning.
Projective techniques no longer occupy the dominant position they did years ago,
but nevertheless continue to be used in clinical practice and research.
Most projective techniques fall into one of five categories, viz.,
i) Associative techniques: The subject responds to a particular stimulus, such
as an inkblot or a word, by indicating what the stimulus suggests. The
Rorschach Inkblot Technique is a prime example.
ii) Construction techniques: The subject constructs a response, usually in the
form of a story, to a stimulus, usually a picture. The prime example here is
the Thematic Apperception Test(TAT). /

iii) Ordering techniques: This involves placing a set of stimuli in a particular

order. Typically the stimuli are a set of pictures, very much like the panels
of a newspaper comic strip but the panels are presented in random order,
and they need to be placed in order to make a coherent sequence. The
Picture Arrangement subtest of the WAIS is sometimes used as an ordering
technique. 7
Projective Techniques in iv) Completion techniques: Here the subject responds to a "partial" stimulus.
Psychodiagnostics For example, the subject may be given the beginning of a story to complete
or a set of sentence stems (e.g., I am always ... ) to complete. Sentence
completion tests are a prime example here.

v) Expressive techniques: The subject engages in some "creative" activity, such

as drawing, finger painting, acting out certain feelings or situations (as in
psychodrama). The Draw-A-Person test is a good example.

1.4 BASIC ASSUMPTIONS

In general, psychologists believe that behaviour is determined or can be explained
by specific principles. If we observe a person verbally or physically attacking
others, we label the behaviours as aggressive and we seek explanations for the
behaviour, perhaps postulating ''frustration'' or looking for childhood developmental
explanations or antecedent conditions. With projective tests, the assumption is
that specific responses reflect the person's personalityand / or psychodynamic
functioning. This is based, however, on the questionable assumption that the test
protocol presents a sufficiently extensive sampling of the client.

Second, we know that specific behaviours can be strongly influenced by transitory

aspects. A person can do well academically in all courses except one, with
performance in that course influenced by a dislike for the instructor or some
other "chance" factor. Projective tests however, assume that each and every
response is indeed basic and reflective of some major personal themes.

The projective viewpoint further assumes that perception is an active and selective
process, and thus what is perceived is influenced not only by the person's current
needs and motivation, but by that person's unique history and the person's habitual
ways of dealing with the world. The more ambiguous a situation the more the
responses will reflect individual differences in attempting to structure and respond
to that situation. Thus, projective tests are seen as ideal miniature situations,
where presentation can be controlled and resulting responses carefully observed.

Self Assessment Questions

1) Define projective tests.

2) What are the characteristic features of a projective test?

8
 Introduction to Projective
3). What ar the five categories of projective tests? Techniques and
Neuropsychological Test

4) What are the basic assumptions underlying projective tests?

1.5 PROJECTIVE TESTING

Just as there are numerous objective personality and psychological functioning
instruments, there are many projective instruments. Most psychologists use a
small number of preferred projective tests-typically the Rorschach, the Thematic
Apperception Test (TAT), Projective Drawings, and Incomplete Sentences.

1.5.1 The Rorschach Test

The Rorschach Test is the famous inkblot test (Rorschach, 192111942, 1951).
Many people are fascinated by the idea of using inkblots to investigate personality
and psychological functioning, Of course, many people (including psychologists)
are skeptical of projective techniques such as the Rorschach, questioning its
validity as a measure of psychological functioning.

The Rorschach consists of 10 inkblots that are symmetrical; that is, the left side
of each card is essentially a mirror image of the right side. The same 10 inkblots
have been used (in the same order of presentation) since they were first developed
by Herman Rorschach in1921 (Rorschach, 192111942). Half of the cards are
black, white, and gray, and half use color. While there are several different ways
to administer the Rorschach and score, the vast majority of psychologists today
use the method developed by John Exner (Exner, 1974, 1976, 1986, 1993,
2003; Exner & Weiner, 1995). Each card is handed to the patient with the
question, "What might this be?" The psychologist writes down everything the
patient says verbatim. During this free association portion of the test, the
psychologist does not question the patient. After all 10 cards are administered; the
psychologist shows the patient each card a second time and asks questions that
will help in scoring he test. For exaniple, the psychologist might say, "Now I'd
like to show you the cards once again and ask you several questions about each
card so that I can be sure that I see it as you do."

With each card, he or she asks a non leading question such as, "What about the
card made it look like a to you ?"The psychologist looks for
answers that will help him or her score the test in several categories such as
location (i.e., the area of the blot being used), content (i.e., the nature of the
object being described, such as a person, animal, or element of nature), determinants 9
Projective Techniques in (i.e., the parts of the blot that the patient used in the response, such as form,
Psychodiagnostics colour, shading, and movement), and populars (i.e., the responses typically seen
by others). This portion of the test is referred to as the inquiry. Once the test is
completed, scoring involves a highly complex system and analysis. Each response
is carefully scored based on the content, location, determinants, and quality of the
response.

Various aspects of the Rorschach responses are associated with psychological

functioning. For example, the frequent use of shading is generally considered to
be reflective of anxiety and depression. The use of human movement and adequate
nuinber of popular responses are usually associated with adaptive and well-
integrated psychological functioning. Numerous responses that attend to minor
details of the blots often reflect obsessive compulsive traits. Frequent use of the
whitespace around the blot is generally associated with oppositionality and/or
avoidance.

1.5.2 The Thematic Apperception Test (TAT)

The TAT (Murray & Bellack, 1942; Tomkins, 1947) was developed during the
late 1930s by Henry Murray and Christiana Morgan at Harvard University, The
TAT was originally designed to measure personality factors in research settings.
Specifically, it was used to investigate goals, central conflicts, needs, press (i.e.,
factors that facilitate or impede progress towards reaching goals) and achievement
strivings associated with Henry Murray's theory of personology (Murray,1938).
The TAT consists of 31 pictures (one of which is blank), most all of which depict
people rather than objects. Some of the pictures are designed to he administered
to males, some to females, and others to both genders (Figure below). Generally
only a selected number of cards (e.g., 10) are administered to anyone patient.

Fig. 1.1: An example of a TAT card

The psychologist introduces the test by telling the patient that he or she will be
given a series of pictures and requested to tell a story about each. The patient is
instructed to make up a story that reflects what the people in the picture are
thinking, feeling, and doing and also to speculate on what led up to the events
depicted in the picture and what will happen in the future. After each card is
10
presented to the patient, the psychologist writes down everything that is said Introduction to Projective
verbatim. Techniques and
Neuropsychological Test
Although a variety of complex scoring approaches have been developed
(Murray,1943; Shneidman, 1951), most clinicians use their clinical experience and
judgment to analyse the themes that emerge from the patient's stories. Since
clinicians generally do not officially score the TAT,conducting reliability and validity
research is challenging.

Other tests similar to the TAT have been developed for special populations, such
as the Robert's Apperception Test for Children (RATC; McArthur & Roberts,
1982)·for use with elementary school children. The 27 pictures depict children
interacting with parents, teachers, and peers. The Children's Apperception Test
(CAT; Bellak, 1986) was developed for very young children and depicts animals
interacting in various ways.
,

1.5.3 Projective Drawings

Many clinician's ask both children and adults to draw pictures in order to assess
their psychological functioning. Typically, people are asked to draw a house, a
tree, a person, and their family doing something together. For the Draw a Person
test (Machover, 1949), the House Tree Person Technique (Buck, 1948), and the
Kinetic Family Drawing Technique, the patient is instructed to draw each picture
in pencil on a separate blank piece of paper and to avoid the use of stick figures.

On the assumption that a drawing tells us some thing about its creator, clinicians
often ask clients to draw human figures and talk about them. Evaluations of these
drawings are based on the details and shape of the drawing, solidity of the pencil
line, location of the drawing on the paper, size of the figures, features of the
figures, use of background, and comments made by the respondent during the .
drawing task. In the Draw a Person (DAP) Test, the most popular of the
drawing tests, subjects are first told to draw "a person," and then are instructed
to draw another person of the opposite sex.

1.5.4 Sentence Completion Techniques

Another projective technique involves the use of sentence completion. There are
many different versions of this technique (e.g., Forer,1957; P. A. Goldberg, 1965;
Lanyon & Lanyon,1980; Rotter, 1954; Rotter & Rafferty, 1950).The patient is
presented (either orally by the examiner or in writing through a questionnaire) a
series of sentence fragments. These might include items such as, "When he answered
the phone he " or "Most mothers are "
The patient is asked to give the first response that he or she thinks of and
complete the sentence. Again, like projective drawings and the TAT, several
scoring systems have been developed to assist in interpretation.

However, these scoring approaches are generally used only in research settings.
Most clinicians prefer to use their own experience and clinicaljudgment to interpret
the themes that emerge from the completed sentences.

1.6 MERITS OF PROJECTIVE TESTS

Until the1950s, projective tests were the most common technique for assessing
personality. In recent years, however, clinicians and researchers have relied on
them largely to gain "supplementary" insights. One reason for this shift is that 11
Projective Techniques in practitioners who follow the newer models have less use for the tests than
Psychodiagnostics psychodynamic clinicians do. Even more important, the tests have rarely
demonstrated much reliability or validity.

In reliability studies, different clinicians have tended to score the same person's
projective test quite differently. Standardized procedures for administering and
scoring the tests have been developed in order to improve scoring consistency,
but research suggests that the reliability of projective tests remains weak even
when such procedures are used (Wood et al., 2000; Lilienfeld et al., 2000).

Research has also challenged the validity of projective tests. When clinician's try
to describe a client's personality and feelings on the basis of responses to projective
tests, their conclusions often fail to match the self-report of the client, the view of
the psychotherapist, or the picture gathered from an extensive case history. Another
validity problem is that projective tests are sometimes biased against minority
ethnic groups. For example, people are supposed to identify with the characters
in the Thematic Apperception Test (TAT) when they make up stories about them,
yet no members of minority groups are in the TAT pictures. In response to this
problem, some clinicianshave developed other TATlike tests with African American,
Hispanic or Indian figures.

Self Assessment Questions

1) Projective techniques typically involve

a) a set of inkblots
b) an ambiguous set of stimuli
c) true-false statements

d) multiple choice items

2) The Rorschach Inkblot Technique is an example of a(n) technique.
a) associative
b) construction
c) ordering
d) completion
3) In presenting the Rorschach Inkblots to a client, the sequence of
presentation:
a) is always the same
b) is up to the administrator

c) changes with the client's gender

d) does not much matter
4) The TAT consists of
a) two sets of 45 inkblots
b) a series of stories chosen for their emotional impact
c) a series of pictures depicting the adventures of Blacky

d) a set of 31 pictures, most of which are ambiguous

12
 Introduction to Projective
5) The theory behind the TAT focuses on: Techniques and
Neuropsychological Test
a) achievement and failure

b) castration anxiety

c) needs and presses

d) self-esteem and competence

6) What are the merits of projective techniques?

a) When the Draw-A-Man is used as a measure of intelligence, using

modem scoring systemslike Naglieri's, the results indicate:

b) low but generally satisfactory reliability

,
c) higher reliability for each of the drawings than for total score

d) poor inter-rater reliability but acceptable test-retest

e) substantially high reliability with typical coefficients in the,low .90s

1.7 NEUROPSYCHOLOGICAL ASSESSMENT

Organic injury to the brain can have complex and interacting psychological effects,
not only at the level.of intellectual impairment but also at the levels of affective and
behavioural1disturbance. These sequel may be directly or indirectly caused by the
brain injury, and may vary in severity from those which are gross and obvious to
those which are subtle and detectable only on detailed assessment. Nevertheless,
even those which are subtle can have pervasive effects on a patient's social and
occupational functioning, whilst those which are gross may arise from a variety of
causes with different treatment implications. In either case, neuropsychological
assessment can be highly important to clarification of the problem, to prediction
of the functional consequences and to the development of appropriate interventions
or environmental adaptations.

To illustrate this, consider the case of a young man who has sustained a head
injury in an assault. A year after the incident he has made a good physical
recovery, but is very aggressive and has lost his job as a sales manager because
of hostility towards colleagues and a general lack of organisation in his work.
These problems might, on the one hand, arise from organic damage to regions of
the brain involved in the genesis or inhibition of aggression, or, on the other, be
a psychological reaction to some more subtle cognitive deficit such as a generalised
reduction in the efficiency with which information is processed or a mild but
specific impairment of memory. In the former case, a pharmacological treatment
to control the emotional reactions might be most appropriate, whilst in the latter
it would be more relevant to address the underlying cognitive deficit directly and!
or help the patient adjust his lifestyle and outlook to his new limitations.

1.8 PURPOSES OF NEUROPSYCHOLOGICAL

ASSESSMENT
The form taken by any neuropsychological assessment wills depend critically on
the question which is to be answered. Frequent purpose for assessment includes
13
the following:
Projective Techniques in • Description and measurement of organically based cognitive deficits.
Psychodiagnostics
• Differential diagnosis (e.g. to ascertain whether memory problems arise from
organic injury or mood disturbances).

• Prediction of the consequences of neurosurgical excision of brain tissue (e.g.

the cost-benefits likely to accrue from a temporal lobectomy).

• Monitoring improvement or deterioration associated with recovery from, or

exacerbation of, a neurological condition.

• Evaluation of the neuropsychological effects, positive or adverse, of

pharmacological and non-pharmacological treatments (e.g. to determine
whether a psychological intervention has improved attention, or whether an
anticonvulsant might impair learning).

• Guiding rehabilitation strategies.

I

• Predicting or explaining deficits in social, educational, or occupational

functioning.

• Medico-legal evaluations (e.g. contributing to determination of compensation

awards, ascertaining fitness to plead, etc.).

1.9 DIMENSIONS AND LEVEL OF ASSESSMENT

The extensiveness of, and methods employed within, any individual assessment
will be largely determined by the specific referral question, though a wide range
of other factors will also be influential. These will include characteristics of the
patient which affect his or her ability or willingness to carry out certain tests, as
well as resource based considerations, such as the location in which the assessment
is to take place, or the amount of time which is available.

A major element of many neuropsychological assessments is evaluation of the

patient's intellectual functioning, usually tested via formal pen and paper or
computerized test procedures. However, this is neither the only form of assessment
used nor necessarily the most important. If the presenting problem is one of
behavioural or emotional disturbance, assessment may concentrate on the
systematic collection of information either from the patient or from others concerning
factors which may influence its occurrence. Thus, although neuropsychological
assessment is often perceived as a special form of cognitive assessment, it is very
often much broader than this. In practice, a referral to a neuropsychologist will
often result in a multidimensional assessment in which the presenting problem is
analysed from a number of perspectives rather than just one. Sometimes there
may be no formal testing, if the pertinent information can be gleaned from systematic
behavioural observations and interviews.

At a general level, the purpose of neuropsychological assessment may be

categorized into those which are primarily descriptive and those which are
explanatory. The former represents an attempt to identify the type and severity of
any problems, while the latter entails more theoretically driven procedures designed
to illuminate the causes or consequences of an observed deficit. These two aspects
will be differentially important depending on the nature of the initial question. So,
if the purpose of the assessment is to quantify the extent of any memory deficits
(e.g. for the purposes of monitoring change over time, or for medica-legal purposes),
14 then a standardized measurement of different aspects of the patient's memory
 relative to their general intellectual level may suffice. By contrast, if the purpose Introduction to Projective
of the assessment is to determine why the patient has difficulty in remembering Techniques and
Neuropsychological Test
information in daily life and to make therapeutic recommendations, then more
detailed probing of potential causes for the memory problem become relevant.
For instance, it may be that the memory deficit is secondary to poor concentration
or impaired perception, or that it is related to the form in which the information
is presented (e.g. verbally vs. visually). If the assessment clarifies the mechanisms
underlying the patient's problems, then treatment can focus specifically on these.

Descriptive assessments will also vary in terms of their breadth, and this again is
likely to reflect the referral question. In one case the requirement may be to
determine whether a brain injury has resulted in any impairment, whilst in another
-the emphasis maybe particularly on a certain aspect of the patient's functioning.
The basis for focusing on one aspect more than on others may consist in
observations which have already been made (e.g. that the patient appears forgetful)
or on the basis of what is known about the etiology or location of the brain injury
(e.g. that there is' a focal lesion to a part of the brain which is implicated in
memory functions). The prediction of neuropsychological sequelae which are
likely to arise from damage to specified areas of the brain has become an increasingly
sophisticated exercise over the last decade with the emergence of complex
3 information processing models of cognitive function.

1.10 NEUROPSYCHOLOGICAL TESTING

Brain impairment due to head injury, substance abuse, stroke, or other illnesses
and injuries often impact the cognitive ability to use language, think and make
appropriate judgments, adequately perceive and respond to stimuli, and remember
old or new information. Neuropsychological testing assesses brain behaviour skills
such as intellectual, abstract reasoning, memory, visual-perceptual, attention,
concentration, gross and fine motor, and language functioning.

Neuropsychological tests include test batteries as well as individual tests. The

Halstead Reitan Battery (Boll, 1981; Halstead, 1947; Reitan& Davison, 1974)
and the Luria Nebraska Battery (Golden, Hammeke, & Purisch, 1980) are the
most commonly used test batteries with adults. The Halstead Reitan Battery can
be administered to persons aged 15through adulthood and consists of 12 separate
tests along with the administration of the MMPI-2 and the WAIS-III. The battery
takes approximately 6 to 8 hours to administer and provides an overall impairment
index as well as separate scores on each subtest assessing skill such as memory,
sensory-perceptual skills, and the ability to solve new learning problems. Other
versions of the test are available for children between ages Sand 14.

The Luria Nebraska, Battery consists of11 subtests for a total of 269 separate
testing tasks. The subtests assess reading, writing, receptive and expressive speech,
memory, arithmetic, and other skills. The Luria Nebraska battery takes about 2.5
hours to administer.

Another neuropsychological testing approach is represented by the Boston Process

Approach (Delis, Kaplan, & Kramer, 2001;Goodglass, 1986; E. Kaplan et al.,
1991; Milberg, Hebben, & Kaplan, 1986). The Boston process approach uses
a variety of different tests depending upon the nature of the referral question.
Rather than using a standard test battery, the Boston Process Approach uses a
subset of a wide variety of tests in order to answer specific neuropsychological 1~
questions. Performance on one test determines which tests or subtests, if any, will
Projective Techniques in be used next. The testing process could be short or long involving few or many
Psychodiagnostics tests and subtests depending upon what is needed to adequately evaluate strengths
and weaknesses in functioning. For example, if a neuropsychological evaluation of
a head injured patient was to focus on memory skills following a car accident,
several tests would be considered for use. These might include the Benton Visual
Retention Test, the Wechsler Memory Scale-Ill, and the Wisconsin Card Sorting
Test. Each of these tests measure a different facet of memory functioning. Results
provide a clearer picture of short and long term memory as well as visual,
auditory, and sensory memory. If, during testing, language problems were detected,
the receptive and expressive language sections of the Luria Nebraska might be
added to the battery to assess language skills. The language assessment might
help to better understand the relationship between memory and language skills in
this patient.

Some of the commonly used individual neuropsychological tests include the

Wechsler Memory Scale-Ill (Wechsler, 1997), the Benton Visual Retention Test
(Benton, 1991), the WAIS-R as a Neuropsychological Instrument(E. Kaplan et
al., 1991), the WISC-IIl as a Process Instrument (E. Kaplan et al., 1999),the
Kaufman Short Neuropsychological Assessment Procedure (K-SNAP; Kaufman
& Kaufman, 1994), the California Verbal Learning Test (Delis, Kramer, Kaplan,
&Ober,1987, 2000) and the California Verbal Learning Test Children's Version
(Delis, Kramer, Kaplan, & Ober, 1994), and the Wisconsin Card Sorting Test
(Grant & Berg, 1993).
The Delis Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer,
2(01) provides a comprehensive evaluation of executive functioning or high level
thinking and processing as well as cognitive flexibility. It can be administered to
both children and adults from ages 8 through 89. It assesses the integrity of the
frontal lobe area of the brain, and examines potential deficits in abstract and
creative thinking. The D-KEFS consists of9 subtests including the Sorting, Trail
Making, Verbal Fluency, Design Fluency, Color- Word Interference, Tower, 20
Questions, Word Context, and the Proverb tests. These tests measure various
aspects of cognitive functioning that reflect strengths and weaknesses associated
with brain behaviour relationships. Results from these tests are compared with
norms to develop a clearer understandingof the interactionbetween brain functioning
and behaviour, emotions, and thoughts as well as to help locate the site of brain
impairment

Some authors have suggested that physiological tests such as evoked potentials,
electroencephalography (EEG), and reaction time measures may be useful in the
assessment of intelligence and cognitive abilities (Matarazzo,1992; Reed & Jensen,
1991). Evoked potentials assess the brain's ability to process the perception of
a stimulus, and EEG measures electrical activityof the brain. Although psychologists
are currently not licensed to administer or interpret neuro imaging techniques such
as computerized axial tomography (CAT), magnetic resonance imaging (MRI),
and positron emission tomography (PET), these techniques allow examination of
brain structureand function, which is useful in assessingbrain behaviour relationships
such as cognitive abilities. For example, cortical atrophy, shrinkage, or actual loss
of brain tissue has been associated with schizophrenia,Alzheimer's disease, anorexia
nervosa, alcoholism, and mood disorders.
Contemporary neuropsychological testing integrates specialized tests along with
additional sources of information. The tests are often used in conjunction with
16 data obtained from clinical interviews, behavioural observations, and other cognitive,
 personality, and physiological assessment tools. Thus, neuropsychological testing Introduction to Projective' •
is not isolated from other evaluation techniques used by contemporary clinical Techniques and
Neuropsychological Test
psychologists. While neuropsychological assessment is a subspecialty of clinical
psychology, it overlaps with many of the skills and techniques of general clinical
psychologists. In addition to specialised testing, neuropsychologists must have a
high level of understanding of brain structure and functioning.

1.11 LIMITATIONS
Neuropsychological tests in general have a number of limitations. Prigatano and
Redner (1993) identify four major ones:

• Not all changes associated with brain injury are reflected in changed test
performance;

• Test findings do not automatically indicate the reason for the specific
perfonnance;,

• Neuropsychological test batteries are long to administer and therefore

expensive; and

• A patient's performance is influenced not just by brain dysfunction but also

by a variety of other variables such as age and education.

Self Assessment, Questions

1) The Halstead-Reitan battery takes about to administer.

a) 15 'minutes

b) two hours

c) five hours

d) eight hours

2) Most of the subtests used in the Halstead-Reitan

a) were developed specifically for this battery

•
b) were actually borrowed from other procedures

c) are very sound psychometrically

d) are easy to administer and score

3) The Luria-Nebraska Battery consists of subtests.

a) 11

b) 8

c) 10

d) 5
I

iJ 4) The Delis- Kaplan Executive Function System assesses the integrity of the-
)
I" -- area of the brain.

a) Temporallobe

b) Parietal lobe 17
Projective Techniques in c) Frontallobe
Psychodiagnostics
d) Occipital lobe

. 5) Physiological tests such as evoked potentials, electroencephalography

(EEG), and reaction time measures may be useful in the assessment of

a) personality

b) intelligence and cognitive abilities

c) motivation

d) stress

1.12 LET US SUM UP

Projective tests use ambiguous or unstructured testing stimuli. Subjects are asked
.to respond freely to the testing stimuli such as telling stories about pictures,
describing what they see in an inkblot, or saying the first thing that comes to their
mind when hearing a word or sentence fragment. The most common projective
tests used include the Rorschach, the TAT,Incomplete Sentences, and Drawings.

The neuropsychological approach relies on the use of tests in which poor

performance may indicate either focal (localised) or diffuse (widespread) brain
damage. Neuropsychological assessment serves several purposes. First, it can
give a 'neurocognitive' profile of an individual, identifying both strengths and
weaknesses. A second advantage is that repeated testing over time can give an
insight into changes in cognitive functioning that may relate either to recovery after
accident/injury or the progression of a neurological illness. Usually, a series of
tests (called a test battery) will be given. The most widely used batteries are the
Halstead Reitan and The Luria Nebraska test battery.

1.13 UNIT END QUESTIONS

1) What is projective testing and discuss the categories of projective tests?

2) Discuss in brief the major projective tests used in clinical psychology?

3) What is neuropsychological assessment?

4) Discuss the purpose and dimensions of neuropsychological assessment?

5) Briefly describe some of the widely used neuropsychological tests?

6) Why use batteries like the Halstead-Reitan when brain functioning can now
be assessed through a number of medical procedures?

1.14 SUGGESTED READINGS

Groth- Marnat, Gary. (2003). Handbook of Psychological Assessment (4thed.).
New Jersey: John Wiley & Sons, Inc.

Hebban, N., Milberg, W. (2002). Essentials of Neuropsychological Assessment.

New York: John Wiley & Sons, Inc.

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