The Projective Assessment Integration System (PAIS):  A Guide for Student Clinicians in Training

When administered, scored, and interpreted correctly, projective assessments remain pivotal in assessing emotional functioning, problem-solving, interpersonal style, and linearity of thought.

Critics of projective testing point to problems with validity, inter-rater reliability, and subjective preconceptions that may limit the generalizability of the results (Lilienfeld et al., 2000). However, there are a plethora of valid and reliable studies identifying object-relational (Westen, 1991), personal problem-solving (Ronan et al., 1993), and dissociative scoring systems (Pica et al., 2001) for the Thematic Apperception Test (TAT), along with standardized scoring systems for the Rorschach using Exner (2003) and the Rorschach Performance Assessment System (R-PAS; Meyer et al., 2011). Karon (1995) commented that a problem with questions about inter-rater reliability rests on the fact that not all clinicians administering and interpreting projective data have the same level of experience and training, which can impact this form of reliability.

The Projective Assessment Integration System (PAIS) is comprised of six triads used to formulate an integrative interpretation of the projective assessment. These triads include the depression triad, cognitive rigidity/defensive triad, obsessive triad, compromised thinking triad, interpersonal triad, and the dissociative triad. The system can be used by trainees and licensed clinicians who may be looking for ways to organize their thoughts and identify similarities and differences across measures and the assessment at large.

Foundation of the System

The concept for the PAIS developed when the author began wondering how Rorschach scoring determinants might translate to or appear in TAT stories and the projective drawings when administered together in a comprehensive assessment. For instance, might shading responses on the Rorschach correspond with depressive TAT stories and/or shaded drawings of houses and trees?

The PAIS centers on sound clinical observation and starts with an analysis of Rorschach responses scored per Exner (2003) and/or more recently, the R-PAS (Meyer et al., 2011). The interpretive process begins with an examination of popular scores, human content/movement, form responses, achromatic responses, texture, shading, and special scores. An analysis of this data is compared to responses on the TAT and projective drawings to identify similarities between them.

Depression Triad

The depression triad begins with an examination of Rorschach responses suggestive of dysphoric affect, primarily associated with shading, texture, achromatic, and morbid responses. This might include a dead animal, a furry coat, or a shadowy monster identified in the performance proper and elaborated upon in the inquiry to identify the appropriate determinant.

If such variables are present, how do they correlate with the TAT? Joo & Park (2021) found that TAT stories of depressive individuals showed a negative emotional tone. This may include responses indicative of sadness, hopelessness, irritability, pessimism, exhaustion, morbid thoughts, and suicidality embedded within the stories.

Corresponding data on the projective drawings might display use of heavy texture or shading by pencil and/or crayon, or a predominant and/or unusual use of black or brown crayon. This might include drawing a black sun. If the examinee is instructed to tell a story about the drawing, it might include depressive themes similar to those found on the TAT.

Corresponding data across all three measures increases evidence for the presence of a dysphoric affect, which can then be analyzed alongside subjective data from the clinical interview, any collateral information obtained, and any significant historical data from chart and/or report reviews. The goal from integrating all the data obtained about the individual is often to arrive at a diagnosis to further inform and improve the treatment plan. Regarding the depression triad, this could potentially inform and suggest the diagnosis of an affective/mood disorder.

Rigidity/Defensive Triad

A rigid or defensive Rorschach might be marked by an over-abundance of pure form responses which has historically and more recently been linked to perceptual rigidity, a guarded test-taking style, and observable defensiveness as noted by Exner (2003) and Mihura, et al. (2015).

Corresponding TAT data, as discussed by Schlesinger (2021), might find an examinee providing short, innocuous descriptions of the cards versus elaborative stories even after the instructions are re-read after administration of the first card; in most cases card one. For example, a card descriptor might read, “that is a boy, that is a violin, he is sitting at the table.”  This might correlate with the Rorschach pure form response, “it’s a bat.” Upon inquiry, the examiner asks, “what made it look like a bat?”. The examinee responds, “just looks like a bat.”

Corresponding projective drawing data might include attempts at stick figures, or simple drawings of human figures and structures that are noticeably stiff and rigid. The examinee may provide little elaboration when queried by the examiner.  

If all three components are met, the examinee might hold a rigid cognitive set, have trouble with ambiguity, struggle with creativity, and/or may become more easily threatened, and/or rely on the use of intellectualization or primitive denial as a way to withhold sharing vulnerabilities.

Obsessive Triad

The Rorschach response set for this triad may be overly detailed with multiple time-consuming responses per card, and/or using very small parts of the card to generate responses as reported by Meyer et al. (2011). The term “obsessive” is used to describe an approach to this ambiguous task that goes beyond what may be encountered with a typical examinee. In this case, the examinee “covers all bases” by scanning the card to make use of every detail without reference to the amount of time he, she, or they are taking to complete the task.

Similarly, TAT responses might be lengthy and overly elaborate making use of very small parts of the card, or including images not present in the card into the stories. The author has found these examinees often asking for reassurance, that is, wondering if they are performing as asked, or if their stories are right.

Corresponding projective drawings include overly detailed, time-consuming drawings coupled with lengthy responses to inquiries and an increased need for reassurance.

Corresponding data across the triad might lead the examiner to consider an anxious, self-conscious, or obsessive thought process. An important caveat about this triad is that it is not meant to diagnose obsessive-compulsive disorder, or obsessive-compulsive personality disorder, but rather a generally obsessive style, or way of coping with anxiety generated during ambiguous situations.

Compromised Thinking Triad

Rorschach indicators for this triad include fewer popular responses in comparison to established normative data (see Exner 2003; Meyer et al. 2011), deviant responses, or verbalizations indicative of strained or peculiar reasoning, such as a bunny with wings flying to another planet.

Corresponding TAT data might show an absence, or limited number of popular responses, such as not seeing the violin in card one, or not describing people on a farm for card two. Peculiar responses would be another indicator. For instance, the author tested one examinee who stated that the man working on the farm is in a blizzard and then is going to do a handstand and walk to his neighbor’s home in a foot of snow.

Projective drawing data indicative of a peculiar or strained thought process might include peculiar representations of people, houses, or trees, and the peculiar use of color, such as drawing orange tree bark or a purple person. Peculiar responses when queried about their drawings are another indicator; for example, “this is a palm tree by a home in Alaska.”

Corresponding data across all three measures may suggest a peculiar, nonconventional, or less than linear way of perceiving the world, but not necessarily a diagnosis of psychosis.

Interpersonal Triad

Rorschach indicators of the interpersonal triad might include a lack of human content or human movement responses. Corresponding TAT data might display a lack of interpersonal interactions in the stories, the main character, perhaps alone in thought and not thinking about others, or statements about characters not liking or not wanting to be around people, or feeling alienated, isolated, or lonely.

Similar themes would likely be noted in the projective drawings, if queried. One might also see a lack of other people being incorporated into the drawings, the characters not interacting with one another, or the main character not thinking about others in the stories.

Corresponding data across all three categories might be suggestive of someone who lacks interpersonal awareness, is avoidant of relationships, does not think relationally, or may struggle with social skills.

Dissociative Triad

Research on the Rorschach with dissociative clients (Leavitt & Labott,1998) has pointed to empirical support for patterns of hidden images, images denied or forgotten during the inquiry, images seen through obscured media (e.g., mist, fog, clouds, smoke, shadowy, ghost-like figures, figures seen from an extreme distance), stimuli reported to be rapidly shifting or being blown apart, and/or human figures being pulled apart.

Relative to the TAT, one might find stories with similar figures or themes of distance or being viewed through some kind of dissociative or obscuring media. Projective drawing data might show similar ghost-like or shadowy figures, figures drawn or described from a distance, through a cloudy, smokey, or foggy mist, or they describe on inquiry shifting figures or figures being pulled apart.

Pica et al. (2001) found dissociative clients to respond to the TAT cards most notably with spontaneous trance states, intra-interview amnesias, and volatile emotional reactions. These behavioral observations are consistent with the denial finding during the Rorschach inquiry noted above; that is, the original response named in the performance proper was forgotten during the inquiry as it may have been given during a dissociative state or forgotten in a dissociative state at a later point in time. Behavioral observations of this sort that cut across the assessment might be suggestive of a dissociative process to be considered alongside the rest of the assessment data.

Report Writing

Before closing, it is worth noting that this system can be used to write an integrated projective section in a formal assessment report. Most often, the results obtained from the projective measures are written under each specific test, which lends itself to a less integrated presentation of the findings. Though beyond the scope of this article, it may be beneficial to give some consideration to completing a comprehensive presentation of the results utilizing a PAIS framework.

For instance, a report might read, “When looking at the data as a whole, the examinee meets four of the six triads suggesting a peculiarity or lack of linearity to his thinking, the potential for a dissociative process, a rather rigid and obsessive way of perceiving the world and/or approaching his environment and showing little interest in others or not being someone who may readily think in relational terms.” This is something that can be placed in a concluding paragraph after presenting the various results from each of the projective tests.

Summary and Conclusion

This article presented the PAIS system that students-in-training, novice clinicians, and more experienced licensed psychologists can use to integrate projective assessment data from the Rorschach, TAT, and projective drawings when administered as part of a psychological assessment battery. The system is ideal for training purposes and can be easily implemented into individual and group supervision. While the goal is to include all three measures in a full assessment, this may not always be possible for many reasons. Even if only two measures are chosen, the system can be used to make for a more confident integration and interpretation of the projective data within the context of the full assessment. Research is currently underway examining archival data to determine how accurately this system can match the diagnosis of completed assessments. The ultimate goal is to standardize the system with the validity and reliability needed to support it empirically and tie together projective assessment data that to this point may be perceived as less than integrated at best.