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Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujcontent.uj.ac.za/vital/access/manager/Index?site_name=Research%20Output (Accessed: Date).

Reviewing psychological projective techniques in the South African context

Marichen Klaver

MINOR DISSERTATION

Submitted in partial fulfilment of the

requirements for the degree

MAGISTER EDUCATIONIS

EDUCATIONAL PSYCHOLOGY

in the

FACULTY OF EDUCATION

THE UNIVERSITY OF JOHANNESBURG

SUPERVISOR: Dr. H. Dunbar-Krige

October 2017

ACKNOWLEDGEMENTS

I would like to thank my wonderful family for all their support throughout my studying career. Thank you for always believing in me and for all your constant love and support.

To Leighton Cooper, thank you for all your encouragement and support. I appreciate your believing in me, even when I doubted myself.

I would like to thank my supervisor, Dr Helen Dunbar-Krige for all her support and advice over the two years of my Master’s degree, I appreciate it.

iii

ABSTRACT

Due to the historical segregation of educational opportunities, the development of psychological assessment in South Africa took place in a racially segregated society, promoted by unequal allocation of resources based on racial class. Therefore, the development of psychological assessment made use of western models, where the development of similar but separate measures for the different language and racial groups in South Africa were implemented. As a result, current South African standardised, projective techniques are mostly based on western norms and exclude most of the South African population, potentially resulting in inaccurate, invalid test results. Psychological assessment in South Africa faces many challenges at present. Within the diverse nation of South Africa, when conducting psychological assessments, including projective techniques, one must be aware of an individual’s background, abilities, language and cultural background in order to gain a valid and holistic view of the individual.

This study intended to review psychological projective techniques within the South African context. This qualitative literature review study intends to review psychological projective techniques within the South African context. The aims of this research study were: (1) to determine and report on what projective techniques are available within the South African context, (2) to explore the challenges of projective techniques in the assessment process and (3) to provide recommendations for the use of projective technique in South Africa. There were limited current research and studies available on projective techniques in the South African context.

The two main themes that emerged from the literature include the limited research on projective techniques in the South African context and the non-appropriateness of projective techniques on the diverse South African populations. From the investigation conducted on past and current literature and research on projective techniques, very few projective techniques will be suitable for the South African population. Recommendations were made based on information gathered, that one should keep in mind in order to ensure the appropriateness and validity of projective techniques.

TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS ii AFFIDAVIT iii ABSTRACT iv LIST OF TABLES vii LIST OF FIGURES ix ABBREVIATIONS AND ACRONYMS x

CHAPTER 1: BACKGROUND AND METHODOLOGY 1.1. INTRODUCTION 1 1.2. BACKGROUND OF RESEARCH STUDY 1 1.3. CONTEXT OF RESEARCH STUDY 4 1.4. AIMS OF THE STUDY 5 1.5. RESEARCH DESIGN AND METHODOLOGY 6 1.6. ETHICAL ADHERENCE 7 1.7. BRONFENBRENNER’S SOCIO-ECOLOGICAL MODEL 7 1.8. EDUCATIONAL AND PSYCHOLOGICAL ASSESSMENTS 9 1.8.1. Purpose of assessment 10 1.8.2. Sattler’s Four pillars of assessment 11 1.8.3. Sattler’s 11 steps in the assessment process 13 1.9. CLARIFICATION OF CONCEPTS 15 1.9.1. Psychological assessment 15 1.9.2. Psychological tests 16 1.9.3. Projective Techniques 16 1.11. CONCLUSION 16

CHAPTER 2: TYPES OF PROJECTIVE TECHNIQUES 2.1. INTRODUCTION 18 2.2. PROJECTIVE TECHNIQUES 18 2.2.1 Projective hypothesis 21 2.2.2 Development of Projective Techniques 20 2.2.3 Classification of psychological tests 21 2.3 TYPES OF PROJECTIVE TECHNIQUES 22 2.3.1. Association techniques 23 2.3.1.1. Rorschach Ink Blot Test 24

2.3.1.2. Word association test 25 2.3.1.3. The Hand Test 26 2.3.2. Construction techniques 27 2.3.2.1. Thematic Apperception Test & Children’s Apperception Test 28 2.3.2.2. Roberts-2 31 2.3.2.3. Bene-Anthony Family Relations Test Children’s Version 32 2.3.2.4. Children's Self-Report and Projective Inventory 34 2.3.2.5. The Koppitz-2 35 2.3.2.6. Drawing / story creation methods and art based techniques 36 A. Draw-A-Person Projective Test 37 B. House-Tree-Person Test & Kinetic House-Tree-Person Test 39 C. Kinetic Family Drawing & Kinetic School Drawing 41 D. Diagnostic Drawing Series 43 E. Face Stimulus Assessment 44 F. Disadvantages of projective drawing tests 46 2.3.3. Completion techniques 47 2.3.3.1. Sentence Completion techniques 47 2.3.3.2. Rosenzweig Picture Frustration Study 48 2.3.4. Arrangement/ selection techniques 49 2.3.4.1. Szondi Test 49 2.3.4.2. Lüscher Color Test 50 2.3.5. Expression techniques 50 2.3.5.1. Expressive projective techniques through external objects 50 2.3.5.2. Handwriting Analysis 51 2.4. CONCLUSION 52

CHAPTER 3: FACTORS THAT INFLUENCE THE USE OF PROJECTIVE TECHNIQUES 3.1. INTRODUCTION 54 3.2. PROJECTIVE TESTING IN SOUTH AFRICA 54 3.2.1. Research within the South African context 55 3.2.2. Benefits and disadvantages of using projective techniques 56 3.2.3. Projective Techniques in Practice 57 3.3. FACTORS INFLUENCING ASSESSMENT RESULTS 61 3.3.1. Biological context 61 3.3.2. Social Context 61 3.3.2.1. Language 62 3.3.2.2. Culture 62

3.3.2.3. Bronfenbrenner’s bio-ecological model 64 3.3.3. Methodological factors 64 3.3.3.1. Test administration and testing environment 66 3.3.3.2. Training 67 3.3.3.3. Status of the test-taker and influence of the assessment practitioner 67 3.3.3.4. Bias 68 3.3.3.5. Interpreting patterns in test scores 70

3.4. INTEGRATED APPROACH TO PROJECTIVE TECHNIQUES 71 3.4.1. Initial Assessment and Consultation Procedure 72 3.4.2. Case conceptualisation 73 3.5. CONCLUSION 75

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS 4.1. INTRODUCTION 76 4.2. EMERGING THEMES 77 4.2.1 Limited research of projective techniques in South African context 77 4.2.2. Non-appropriateness of projective techniques in South African context 79 4.2.2.1. Test development and adaptation 81 4.2.2.2. Language and culture 83 4.3. RECOMMENDATIONS 85 4.4. CONCLUSION 89 REFERENCE LIST 90 ADDENDUM 1: EDITOR LETTER ADDENDUM 2: TURN IT IN REPORT

vii

LIST OF TABLES

Table 1.1. Summary of literature used in this study 11

Table 1.2. Four Pillars of the Assessment Process 12

Table 2.1. Types of projective techniques 23

Table 2.2. The use of the TAT and CAT in South Africa by registration category 31

Table 3.1. Total Mention Score (TMS), Percentage of School Psychologists Using Specific Projective Techniques, and Utility Ratings for Specific Techniques 58

Table 3.2. Tests that are regularly used by practitioners (total sample) 59

Table 3.3. Additional tests that practitioners have identified that they frequently use in their work. 60

Table 3.4. Cross-cultural test use by practitioners. 64

Table 3.5. Types of Bias 68

Table 3.6. Sources of bias in cross-cultural assessment 69

viii

LIST OF FIGURES

Figure 1.1. Literature Review Process 7

Figure 1.2. Assessment process 11

Figure 1.3. Sattler’s 11 steps assessment process 15

Figure 2.1. The Rorschach inkblots examples 24

Figure 2.2. The hand Test manual and picture cards 27

Figure 2.3. The TAT Picture cards 29

Figure 2.4. Children's Apperception Test (CAT) 30

Figure 2.5. Roberts Apperception Test for Children: 2 (Roberts-2) 32

Figure 2.6. Family Relations Test: Children’s Version 33

Figure 2.7. Children's Self-Report and Projective Inventory 34

Figure 2.8. DAP drawing test case examples 38

Figure 2.9. House-Tree-Person (H-T-P) Projective Drawing Technique 40

Figure 2.10. HTP drawing examples 40

Figure 2.11. KFD drawing examples 42

Figure 2.12. KFD drawing test case examples 42

Figure 2.13. Kinetic Drawing System for Family and School 43

Figure 2.14. Diagnostic Drawing Series Examples 44

Figure 2.15. FSA stimulus pictures 45

Figure 2.16. FSA stimulus pictures example 46

Figure 2.17. Picture Frustration Study (PFS) picture cards 49

Figure 2.18. An example of large writing with good and low form standard 52

Figure 3.1. Preparation prior to the assessment process 66

Figure 3.2. Summary of the IAC 73

Figure 3.3. Example genogram 74

Figure 4.1. Emerging Themes 77

Figure 4.2. Guidelines to administering projective techniques 88

ABBREVIATIONS AND ACRONYMS

BDT The Bridge Drawing Test

BIS Brink Incomplete sentences

DA Dynamic Assessment

DAF Draw-a-Face test

DAS Draw-a-Story Assessment

DAP Draw-a-Person Test

DAP:SPED The Draw-A-Person: Screening Procedure for Emotional Disturbance

DDS Diagnostic Drawing Series

CAT Children’s Apperception Test

CDDS The Child Diagnostic Drawing Series

CSRPI Children's Self-Report and Projective Inventory

FAT Free Association Test

FDCT Franck Drawing Completion Test

FEATS The Formal Elements Art Therapy Scale

FRTC Family Relations Test: Children’s Version

FSA Face Stimulus Assessment

HPCSA Health Professions Council of South Africa

HSRC Human Science Research Council

HTP House-Tree-Person Test

IAC Initial Assessment Consultation

KFD Kinetic Family Drawing

KHTP Kinetic House-Tree-Person Test

KSD Kinetic School Drawing

LSEN Special Needs Education

MDT Mirror Drawing Test

PFS Picture Frustration Study

PPAT The Person Picking an Apple from a Tree

RATC Roberts Apperception Test for Children

RISB Rotter Incomplete Sentence Test

Roberts-2 Roberts Apperception Test for Children: 2

SCT Sentence Completion Tests

SSCT Sacks Sentence Completion Test

TAT Thematic Apperception Test

TRACS The Rorschach: A Comprehensive System

WISC-IV Wechsler Intelligence Scales for Children, Fourth Edition

WIAS-III Wechsler Intelligence Scales for Adults, Third Edition

WUSCT Washington University Sentence Completion Test

CHAPTER 1 BACKGROUND AND METHODOLOGY

1.1. INTRODUCTION

This research study will focus on exploring and reviewing psychological projective testing within the South African context. Projective testing is described as projective techniques used to assess personality dynamics (Sattler, 2014). These tests are used during the assessment process where individual’s responds to ambiguous stimuli in order to reveal the underlying dynamics of personality, thoughts and/or emotions (Sattler, 2014). By conducting a literature-based study, the researcher will gain a more in depth understanding of these assessment tools and explore the histories, founders, opinions and reviews of others and the uses within the South African context. The purpose is to increase one’s knowledge of projective techniques through documented literature and compare the information.

This chapter will focus on the background and the context of the research study, the purpose of educational and psychological assessments, as well as the aims of the literature study will be discussed. Furthermore, the non-empirical research methodology will be discussed. Lastly, the theories within this study will be explored and clarifications of topics will be provided.

1.2. BACKGROUND OF RESEARCH STUDY

Psychological assessment can be traced back as early as 1915, where researchers worked primarily in the area of intellectual assessment, that were developed and normed on white children (Dunston,1923; Fick, 1929; Loades & Rich, 1917; Macrone, 1928). This manifested the start of an era of inequality for psychological assessment within South Africa (Laher & Cockcroft, 2014). The segregation of races continued throughout the 1920s and 1930s (Abrahams, 2001; Seedat & Mackenzie, 2008).

The former education system during the apartheid era (1948-1994) encouraged segregation, separating educational opportunities into the four racial groups, namely: Whites, Indians, Blacks and Coloureds (Swart, 2004). As such, the development of psychological assessment in South Africa took place in a racially segregated society, promoted by unequal allocation of resources based on racial class. The development

1 of psychological assessment from the 1960’s until 1984 made use of western models, where the development of similar but separate measures for the different language and racial groups in South Africa were implemented (Abrahams, Foxcroft, & Roodt, 2013; Laher & Cockcroft, 2014). These test developments excluded individuals from being assessed based on their racial and cultural background and during the Apartheid era in South Africa, psychological assessment and special education were only available to white learners.

With the change into a democratic government from 1994, this new foundation included the Bill of Rights, which stated that all South Africans had the right to Basic Education (Stofile & Green, 2007). This new availability of basic education resulted in the fact that the assessment processes had to change to include assessment for all children from different race, culture and languages. The Health Professions Council of South Africa (HPCSA) Form 208 (2005) states that fair testing practices require the test taker to be able to administer a test in the language that the test taker is sufficiently competent in. With the changes in the educational system and the inclusion of all children, changes had to be made in psychological assessments that gave way to test development, adaption, translation as well as tests in multiple languages. The multicultural and multilingual society of South Africa must therefore adapt their test measures in order for all test takers to have a valid and reliable test result (De Kock, Kanjee, & Foxcroft, 2013). All test takers should be given the opportunity to complete an assessment or activity in a fair manner regardless of their culture, language or socio-economic background. The goal is for all individuals to be assessed and to complete a test in their own mother language, but in the South African context, this ideal is not always possible, since South Africa has 11 official languages.

The diversity in terms of culture and language creates a problem when adapting and translating psychological tests and as a result, the value and reliability of the test may become invalid. Test translation involves translating a test from one language to other languages (De Kock, Kanjee, & Foxcroft, 2013), which may create the difficulty of losing the meaning of test questions and instructions. Test adaptation on the other hand, involves the process of changing the content of the test measure to become more applicable for examinees (De Kock, Kanjee, & Foxcroft, 2013). De Kock et al. (2013) discusses important reasons for adapting test measures which considers the (a) fairness of the assessment that arises when a test taker is able to complete a test

2 in their own language which may also eliminate any bias associated with the test taking, (b) the cost and time saved when translating a test instead of designing a new test measure and (c) the opportunity to compare the newly developed measures to existing norms and information available.

Ethnic and cultural diversity is a big part of South African history and should be taken into account when psychological assessment is conducted. Culture can be defined according to (Gladding, 2007, p. 311) as “the customary beliefs, social forms, and material traits of a racial, religious, or social group.” South Africa has a wide range of cultural diversity and the children that will be evaluated will have different ethnic and cultural backgrounds that should be taken into consideration when tests are performed and findings are interpreted. Different ways of life, language, culture, family and social interactions and economic status must be kept in mind when assessment takes place as these factors influence the test results. According to Sattler (2001), a psychologist must take aspects of ethnicity into account when working with individuals and their families. An ethics code requires that “psychologist take into account the purpose of the assessment as well as the various test factors, test taking ability, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences, that might affect psychologists’ judgements or reduce the accuracy of their interpretations” (Gumbiner, 2002, p. 91). In the South African context, the White Paper 6 policy document was implemented and discussed strategies on how to achieve an inclusive education and training system (Department of Education, 2001). As such, it is an essential aspect to take all the different aspects of the diverse South African context into account when adapting and translating an existing assessment measure, ensuring that the results are fair, accurate, valid and reliable. It can be seen that the process involved in adapting an assessment is a longitudinal process that includes multiple researchand adaptions. This is not always plausible within the South African context, as adapting and translating existing psychological tests are time consuming and costly and as a result, there are limited tests available that are standardised and takes an individual’s culture, language and background into consideration. This study focuses on projective techniques within the South African context.

1.3. CONTEXT OF RESEARCH STUDY

As a student Educational Psychologist at Sparrow School (a LSEN or Special Needs Education school), the researcher noticed the challenge of working with individuals and parents from a diverse cultural and socioeconomic background.

Individuals come from disadvantaged areas, single households, foster care and experience cognitive, psychological, emotional, as well as language and learning barriers. The majority of these individuals’ home language is not English and they struggle with the language of learning and teaching in English. This is evident in classroom observations, tests and examinations as well as educational psychological assessments conducted.

As an educational psychologist, it is essential that one is aware of one’s own as well as the individuals’ cultural background and racial heritage and how this might have an influence on the counselling or assessment process. (Nelson-Jones, 2014). According to Sattler (2001) a psychologist must take aspects of ethnicity into account when working with individuals and their families. Therefore, when conducting psychological assessments, especially projective tests, one has to be aware of an individual’s background, abilities, language and cultural background in order to gain a valid and holistic view of the individual and consider all these aspects when scoring and interpreting both informal and standardised tests. Emotional assessments are usually also conducted during the assessment process or as part of the therapeutic process. These emotional assessments may be in the form of formal or informal projective testing.

When conducting full educational and psychological assessments at Sparrow Schools, it was realised that most of the tests, projective tests included, used during the assessment process are not culturally and linguistically relevant to most individuals. Thus, some of the assessment results tend to show individuals in a negative light based on their performance on standardised tests. This is not always the case, and at times individuals’ cultural background, home environment and social, economic situation can have an influence on their knowledge and performance, making certain test results invalid.

Since current South African standardised psychological assessments, including projective testing is mostly based on western norms it excludes most of the South African population, which can result in inaccurate, invalid test results. Therefore, the focus should be on developing new psychological assessment material, which includes the diverse South African population. However, the development of new test material comes with its own challenges as the development is a very complex and costly process that is very time consuming (Foxcroft, Paterson, Le Roux and Herbst, 2004; Foxcroft, 2013). The test developer in South Africa has to consider the official languages (English, Afrikaans, Zulu, Tswana, Northern and Southern Sotho, Xhosa, Venda, Swazi and Tsonga), and take into consideration that each language group represents a different cultural and ethnic background (Moletsane, 2004). It can be seen by the diversity of the South African context that translating existing psychological tests or developing new psychological tests in different languages does not create culturally fair and accurate tests (Moletsane, 2004).

Current standardised psychological tests, such as projective tests within the South African context, exclude the majority of the population, yet to some, it is still considered a useful tool in providing baseline information in order to guide training, support and psychological interventions (Abrahams, Foxcroft & Roodt, 2013). Despite the shortcomings in standardised projective testing, these tests can be seen as valid, reliable and cost-effective, if they are used in an ethical and fair way by a trained practitioner in combination with multiple processes and methods of gaining information (Abrahams, Foxcroft & Roodt, 2013).

As discussed above, there are multiple aspects to take into consideration when conducting psychological assessment as a psychologist within the South African context. As such, test translation, development and adaptation is not always a plausible solution to ensure fair, valid and reliable assessment results.

This leads to the research question for this particular study: What projective techniques are available and suitable within the South African context?

1.4. AIMS OF THE STUDY

The aim of this study was to review the availability and suitability of projective techniques within the South African context.

The objectives were:

• To determine and report on what projective techniques are available within the South African context. • To explore the challenges of projective techniques in the assessment process. • To provide recommendations for the use of projective technique in South Africa.

1.5. RESEARCH DESIGN AND METHODOLOGY

This qualitative literature review study endeavoured to gain a better understanding and conduct an in-depth search (Henning, Van Rensburg, & Smit, 2013; Greig, Taylor, & MacKay, 2007) of projective techniques available within the South African context. This process involved collecting, comprehending, analysing, synthesizing and evaluating the literature to build general themes and make interpretations based on the meaning of the literature (Creswell, 2014; Levy & Ellis, 2006).

Within a qualitative research study, it is essential that the researcher engage in the self-reflective process (Nagata, Suzuki, & Kohn-Wood, 2012) to ensure that no personal bias or viewpoints will have an influence on the analysing and evaluating of research within the literature study.

This is a non-empirical study with a literature review as a research design. The aim of the study is to provide an overview of projective techniques in South Africa through analysing trends and debates from existing data (Mouton, 2001). Secondary data analysis will be used.

A literature review can be seen as a process of identifying, locating, summarising, analysing, evaluating as well as the synthesis of information on a specific topic from multiple selected published or unpublished documents obtained from various sources (Gay, Mills, & Airasian, 2006; Onwuegbuzie, Leech, & Collins, 2012; Onwuegbuzie, Collins, Leech, Dellinger & Jiao, 2010). The literature review should be transparent throughout, provide adequate evidence to support results and conclusions and should be comprehensive (Onwuegbuzie, Leech, & Collins, 2012). The purpose of the literature review is to discover and gain new perspectives, understanding the subject and identifying the relationship between ideas and practices (Randolph, 2009).

Onwuegbuzie, Collins, Leech, Dellinger and Jiao (2010) states that there are two methods of analysing literature, namely within-study literature (analysing content from specific work) and between-study literature (comparing and contrasting information from multiple literature sources). For this literature study, both within-study and between-study analysis will be used. Multiple resources will be used during the literature review, which will allow the researcher to enhance the quality of the synthesis (Onwuegbuzie, Leech, & Collins, 2012). Furthermore, the researcher will ensure the trustworthiness and credibility of all sources used to increase the legitimation of the study.

According to Levy and Ellis (2006), there is a three-step process when conducting a literature review. In this research study, the process of “collect, know, comprehend, apply, analyse, synthesize, and evaluate” will be applied (Levy & Ellis, 2006).

2. Processing

1. Know the literature 2. Comprehend the literature 1. Input 3. Apply 3. Output 4. Analyse

5. Synthesize 6. Evaluate

Figure 1.1. Literature Review Process (Levy & Ellis, 2006)

Secondary data analysis will be used to analyse the literature collected for the purpose of this study. Analysis data involves breaking up the data into patterns, trends, relationships and manageable themes (Mouton, 2001). The systemic research method of Secondary data analysis involves the use of existing data, collected for the purposes of the research question (Andrews, Higgins, Andrews & Lalor, 2012; Hinds, Vogel and Clarke-Steffen 1997; Johnston, 2014; Smith, Ayanian, Covinsky, Landon, McCarthy, Wee & Steinman, 2011; Szabo and Strang 1997). The research method therefore, consists of how the researcher collects, analyses, and interprets the data in the study

(Creswell, 2009; 2014). In collecting and analysing data for this research study the following evaluative steps will be followed to ensure integration and quality of data collected (Stewart & Kamins, 1993). These steps include: (1) defining the purpose of this study; (2) who was responsible for collecting the information; (3) determining what information was collected; (4) and when the information was collected; (5) determining how the information was obtained; and (6) how consistent is the information obtained from one source with information available from other sources (Johnston, 2014; Stewart & Kamins, 1993).

This review is focused on books and articles between the period (1930-2017). Only books, articles and research studies with the focus on psychological assessments, projective tests/techniques were used.

Table 1.1. is a summary of the resources found and used during this research study. It was however, quite difficult to gather information using just the keywords above and therefore additional keywords and phrases were used to gather all the information used in this research study.

Table 1.1: Summary of literature used for this study

Number of Keywords Number of Resource Keywords resources resources used used Journal “projective tests” 54 “projective tests” 11 “projective techniques” “projective techniques” Articles “projective “projective Tertiary assessments” 5 assessments” 11 “assessment” “assessment” studies “psychological “psychological Books assessments” 51 assessments” 9 AND/OR “South Africa”

1.6. ETHICAL ADHERENCE, LIMITATIONS AND TRUSTWORTHINESS

Research ethics is defined as a set of principles which lead and support researchers in conducting and achieving ethical research (Johnson & Christensen, 2012). Non- empirical literature reviews are limited to existing research however it can provide a good understanding of the relevant data, previous studies and debates around the research topic (Mouton, 2001).

The limitations of using secondary data restricts the researcher’s ability to control data collection errors and constrains the analysis of original objectives of research (Johnston, 2014; Mouton, 2001). Since the researcher did not collect the data, there are limited control over what is contained in the data set and the researcher is unaware of the primary data’s data collection process and how well it was carried out which is a significant disadvantage of using secondary data (Johnston, 2014). Furthermore, the additional sources of errors and limitations includes the selectivity of sources, misunderstanding of sources, interpretations of one own viewpoints and poor integration of literature (Mouton, 2001) which can have an influence on the trustworthiness of the research study.

Therefore, during this research study, the researcher will ensure trustworthiness of the data collection and analysis process through ensuring that all literature resources and data are relevant, dependable, trustworthy, valid and reliable, plausible, objective, neutral and have credibility (Onwuegbuzie, Leech, & Collins, 2012). Additionally, multiple resources will be used during the literature review, which will allow the researcher to enhance the quality of the synthesis (Onwuegbuzie, Leech, & Collins, 2012). Furthermore, the researcher will ensure the trustworthiness and credibility of all sources used to increase the legitimation of the study. Another way in which the trustworthiness of this research study will be ensured is through the researcher’s ability to maintain a high level of objectivity and sensitivity when collecting, interpreting, analysing and triangulating the data (Johnston, 2014).

1.7. BRONFENBRENNER’S SOCIO-ECOLOGICAL MODEL

When conducting this research study the theory of Bronfenbrenner will be used when reviewing projective testing within the assessment process.

There is a strong interplay between an individual’s characteristics and their environment, which has an influence on their behaviour (Bronfenbrenner, 2005; Stoutjesdijk, 2013). Family functioning can therefore have an impact on an individual’s social-emotional development and can influence their behaviour and emotions (Scholte & van der Ploeg, 2013; Stoutjesdijk, 2013). Therefore, it is essential to take an individual’s background and family structures into account as it may have a positive or negative effect on a their development and behaviour.

Bronfenbrenner’s bio-ecological model of development forms part of the social ecological model, which examines the relations between the developments of the individual within their social context. The bio-ecological model describes the influences that might occur directly or indirectly and that have a result on the individual’s life and development. Bronfenbrenner developed the five models of child development. These include the microsystem, consisting of the their direct environment; the mesosystem is a set of microsystems that interact on a continuous basis (Swick & Williams, 2006). Thirdly the exosystem, which does not directly influence them, but may influence people in the child’s direct relationship, the macrosystem involves cultural beliefs, societal values and political trend. The last system is the chronosystem, examining the interactions between all the systems and its effects on individual development over time (Donald, Lazarus, & Lolwana, 2010). This model is more suited in the South African context as a result of the wide range of cultural and social diversity. It is important to consider all aspects of a child’s development to determine the extent of disability and interventions that can be implemented. Different aspects of psychological assessment like parents, teachers, classrooms, etc. are systems on their own. All these systems affect each other and may ultimately influence the whole ecological system (Donald, Lazarus, & Lolwana, 2010). Therefore, it is clear how this model can be incorporated into the psychological assessment process in conjunction with Sattler’s 11 steps of assessment in order to gain a more holistic view of an individual and through that gain information from all aspects in order to ensure a fair and valid testing environment.

1.8. EDUCATIONAL AND PSYCHOLOGICAL ASSESSMENTS

Psychological assessment measures can be categorised into multiple areas or domains, namely the cognitive and neuropsychological abilities, language abilities and academic skills, emotional and personality, non-verbal abilities as well as visual perception, motor and sensory functioning, memory and concept formation, planning and reasoning (Roodt, Stroud, Foxcroft, & Elkonin, 2013; Nagy, 2011; ter Laak, Gokhale, & Desai, 2013).

Psychometric assessment involves multiple standardised tests listed in the HPCSA Form 208 (2005) to which each test results are compared to a norm group. According

10 to Stofile and Green (2007, p. 54) barriers to learning that may arise in psychometric assessment in the South African context include

socioeconomic barriers; discriminatory negative attitudes and stereotyping; inflexible curricula; inappropriate language of teaching and learning; inappropriate communication; inaccessible and unsafe built environment; inappropriate and inadequate provision of support services; lack of enabling and protective legislation and policy; lack of parental recognition and involvement; disability; and lack of human resource development strategies.

1.8.1. Purpose of assessment

The assessment process can be seen as a multidimensional process where information about a client is gathered in such a way that it provides a greater understanding of a client’s functioning in order to make the relevant and appropriate decision on the best intervention strategies (Roodt & Foxcroft, 2013). According to Sattler (2014) when conducting assessments a multimethod approach should be implemented where the use of multiple assessment methods such as interviewing relevant parties, examining records/other information, observations, informal and formal assessment techniques assessing the individual’s different areas of skills are used. Assessment therefore focuses on collecting information, gaining an understanding of information gathered, integrating all relevant information in order to make a judgement and to intervene and facilitate the solution (ter Laak, Gokhale, & Desai, 2013). The combination of assessment measures should be tailored to each individual or group (Roodt & Foxcroft, 2013). An assessment process must be conducted using:

multiple measures (different types of tests, observations, interviews)

multiple domains multiple occasions (attention, cognitive, (patterns should be language, academic, identified over a period non-verbal, personality of time) and emotional)

multiple sources (other multiple settings (home, professionals, teachers, school, consulting room, parents, gaurdians, work, with peers, employers, extended parents or one on one) family, ect)

Figure 1.2. Assessment process (Adapted from Roodt and Foxcroft (2013, p. 7)).

The purpose of projective techniques within the assessment process is to assess the dynamics of an individual’s personality, which may include their thoughts and emotions (Sattler, 2014). Projective testing tests focus on the unconscious inner aspects of personality through providing an unstructured, vague and ambiguous stimulus (Gregory, 2015). The focus of projective methods in the assessment process is used to assess aspects of personality based on the performance of a structured, unstructured or incomplete stimulus (Cohen, Swerdlik & Sturman, 2013). Projective tests are used indirectly where the examinee is not asked to directly disclose information, but alternatively they are required to talk about the stimuli presented (Cohen, Swerdlik & Sturman, 2013).

1.8.2. Sattler’s Four Pillars of Assessment

The four pillars of assessment refer to a number of test measures used to assess a learner. These pillars are seen as a tool and guideline when assessing an individual and should be used to avoid any personal bias against an individual being tested, avoiding any irrelevant sources that might have a negative effect on the examinee’s performance (Sattler, 2001; Sattler, 2014). These four pillars include the norm- reference tests/formal assessment measures, interviews, observation and informal assessment procedures (Table 1.2).

Table 1.2. Four Pillars of the Assessment Process

Norm-referenced tests refer to standardised tests on a specific defined group called the norm group. These tests are scaled so that each score achieved by the examinee

can be compared within the norm group giving an indication to where the examinee’s ability lies. These norm-referenced tests are used in order for the examiner to be able to compare the test results of the examinee to those of his/her peer group (Miller, tests / formal formal / tests

Lovler & McIntire, 2013). This is in order to determine the level of their functionality and to determine the examinee’s cognitive, emotional, motor, academic or behavioural weaknesses and strengths and to use these results as a baseline for referenced -

future measures assessment test measurements to record the development of the examinee (Sattler, 2001,

Norm Sattler, 2014). The administration, scoring and interpretation of projective tests are more often than not standardised (Sattler, 2014).

Interviews are used throughout the assessment process to gather and gain information about an individual (Sattler, 2001; Sattler, 2014). Interviews can be either structured, with the goal of diagnosis, semi-structured interviews where lists of questions are provided. In this process, room for flexibility on questions are allowed

as needed and the unstructured interviews are usually open-ended questions with the idea that the less you intrude the more the individual will tell you (Orton, 1997; Miller, Lovler & McIntire, 2013; Sattler, 2001; Sattler, 2014). According to Orton (1997) one Interviews should conduct different interviews throughout the assessment process, including interviews with parents, guardian or extended family, the child, teachers and other professionals or parties that might provide insight and relevant background information.

Observations are done during the assessment process as well as multiple different settings, including the classroom, playground as well as a child’s home (Sattler,

2001). Observations are made by the psychologist, teacher and parents in a team effort to get a better understanding of the individual’s behaviour, learning styles, attention period, frame of mind and emotion, interaction with peers, teachers and

Observation parents (Orton, 1997). During projective testing, observations are made of the individual’s responses, verbal and nonverbal behaviour, and any alternative observations that can provide information about the individual.

Informal assessment procedure may involve written language samples such as essays, test papers, etc. school records, personal documents, informal test and criterion-referenced tests (Sattler, 2001). All informal tests are used during the assessment procedures to conduct a detailed and accurate profile of the individual’s ability within a number of different settings and assessment results. Gaining informal

information on personality or behaviour can be done through gathering descriptive and open-ended information (Sattler, 2014). Orton (1997) suggests that play activities can be used as part of informal assessment techniques to create a stress free environment for children to get comfortable with the counsellor and to be able to

Informal tests Informal express what is bothering them. These activities include stories and poems, art, puppets, games and free play. Groth-Marnat (1997; 1990; 2003) suggests that through expressive projective techniques such as role-play, drama or children’s play one is able to interpret and gain meaningful understanding of an individual. Projective testing may include inkblots, words, pictures, drawings, etc. (Cohen, Swerdlik & Sturman, 2013).

1.8.3. Sattler’s 11 steps in the assessment process

Sattler (2014) provides assessment guidelines that can be used for the assessment process. These guidelines should be followed in order to conduct effective and reliable test results. Sattler’s 11 steps to the assessment process is the basis of the assessment process. These 11 steps must be done in every case and every step should be completed. The 11 steps (as illustrated in Figure 1.3) include: (1) the review of the referral information, (2) deciding whether to accept the referral and if it is within your scope of practice according to the Health Professions Council of South Africa (HPCSA, 2011).

The next step is (3) obtaining relevant background information from the individual, teachers, parents, guardians or extended family as well as other records containing other relevant information. It is important to always get consent from the parents of the learners before any assessment, counselling or interventions are implemented, as well as learner assent. According to Bond (2010) informed consent is someone’s agreement to treatment understanding the methods and procedures that will be used, the risks and benefits and being informed of applicable alternatives. Furthermore, one

14 should (4) consider any other relevant information from others that might be needed in order to gain a comprehensive set of information which will assist in determining what assistance the individual might need (Sattler, 2014). This will enable the practitioner to refer the individual to the appropriate health professional or implement the required interventions in order for the individual to benefit from the psychological service. Interviews, one of Sattler’s pillars of assessment mentioned above, are used to gather all relevant information and will be used before and during the assessment process to gather and gain information about the individual from parents, teacher and other relevant professionals (Sattler, 2001; Sattler 2014). Interviews can be either structured, semi-structured or unstructured (Orton, 1997; Miller, Lovler & McIntire, 2013; Sattler, 2001; Sattler, 2014). As part of Sattler’s pillars of assessment (5) observing the individual in several settings and gathering information on the individual’s behaviour, appearance and any other relevant aspects form part of the assessment process (Sattler, 2014). Observations are made by the professional, teacher, parents and other relevant parties in a team effort to get a better understanding of the individual’s behaviour, learning styles, attention period, frame of mind and emotion, interaction with peers, teachers and parents, etc (Orton, 1997).

Subsequently, (6) one selects and administer suitable assessments based on the information gathered and the reason for assessment. The assessment measures used, can be both informal and formal standardised tests. All tests used during the assessment process ensure that a detailed and accurate profile of the test taker’s ability within a number of different domains are attained (Sattler, 2001). During projective testing inkblots, words, pictures, drawings, etc. can be utilised as a projective stimulus (Cohen, Swerdlik & Sturman, 2013) in order to gain more insight. Projective testing is seen as an indirect assessment, which focuses on the test taker’s responses minimising the possibility that the test taker might fake the test (Cohen, Swerdlik & Sturman, 2013). Furthermore, projective tests are less language based, as some tests require minimal language skills.

After administering the assessment measures the assessment results are (7) interpreted using information from the tests, the background information, the observations and interviews conducted throughout the process. The next step in Sattler’s assessment process involves (8) developing intervention strategies and recommendations bases on the results, as well as (9) writing a report containing the

15 findings, interpretations and recommendations (Sattler, 2001; Sattler, 2014). The report should be finalised as soon as possible after the assessments have been conducted and the report writing should be clear, concise and comprehensive (Angus, 2006). Once the assessment report is finalised, (10) feedback should be provided with parents, the examinee and other concerned individuals to discuss the assessment results (Sattler, 2001; Sattler, 2014). Lastly, a (11) follow up meeting should be scheduled to discuss recommendations made and to re-evaluate and monitor the changes that might take place with regards to the individual’s development and progress made with implemented interventions and recommendations (Sattler, 2001;

5. develop 9. write 1. reason for interventions/ assessment referral recommendations report

6. interpretation of 2. accept/refer out 10. feedback tests

3. gaining 7. selecting/ background administering 11. follow up information tests

4. information from relevant 8. observations others

Sattler, 2014).

Figure 1.3. Sattler’s 11 step assessment process (Adapted from Sattler (2001; 2014)).

1.9. CLARIFICATION OF CONCEPTS

1.9.1. Psychological assessment

Psychological assessment as stated in (Roodt & Foxcroft, 2013, p. 4) refers to the “process orientated activity aimed at gathering a wide array of information by using psychological assessment measures (tests) and information from many other sources (eg. Interviews, a person’s history, collateral sources)”. Assessment can be seen as the way in which one expand ones knowledge and insight in the understanding of an individual through integrating information from multiple sources in order for you to make appropriate educated decisions and interventions (Sattler, 2001; ter Laak, Gokhale, & Desai, 2013). Wicks-Nelson and Israel (2000, p. 91) refers to assessment as “an ongoing process”.

1.9.2. Psychological tests

Psychological test can thus be seen as one source of information within the assessment process (ter Laak, Gokhale, & Desai, 2013).

1.9.3. Projective techniques

Projective techniques are used in order to assess personality dynamics that include thoughts and emotions (Sattler, 2014). Hogan (2015) states that: projective techniques can be used within clinical, counselling and school psychology for the assessment of individual cases, or it can be used in the field of research. Furthermore, projective techniques can be used within the psychological setting as an icebreaker forming part of the conversation or interview process and are generally used in order to assess personality variables (Hogan, 2015).

1.10. CONCLUSION

This chapter focused on the background and research methods of this research study. Due to the historical segregation of educational opportunities, the development of psychological assessment in South Africa took place in a racially segregated society promoted by unequal allocation of resources based on racial class. Therefore, the development and use of psychological assessment from the 1960’s until 1984, made use of western models. Consequently, current South African standardised psychological assessments, including projective testing are mostly based on western

17 norms and exclude most of the South African population, which can result in inaccurate, invalid test results. Available techniques of gathering additional information should be explored.

Chapter two will discuss projective techniques and the different types of techniques available. Projective techniques in the South African context as well as different factors that can influence assessment results will be explored in chapter three. Lastly, chapter four will discuss the themes that emerged throughout this literature study and provide recommendations going forward.

CHAPTER TWO

TYPES OF PROJECTIVE TECHNIQUES

2.1 INTRODUCTION

In South Africa, projective techniques are used in clinical settings and for research to gather information, asses functioning, understanding behaviour, form diagnosis and plan appropriate treatments. Given the history and diverse South African population, conducting assessment, including projective techniques can pose multiple challenges.

The most commonly used projective techniques in South Africa used in a variety of settings such as psychiatric hospitals, community clinics and in private practice include: the Children’s Apperception Test (CAT), the Draw-a-Person Test (DAP), the Rorschach, the Thematic Apperception Test (TAT), Rotter Incomplete Sentence Test (RISB), the Kinetic Family Drawing (KFD), and the House-Tree-Person Test (HTP) (Bain, Amod & Gericke, 2013).

This chapter will firstly review projective techniques and their development. Furthermore, this chapter will aim to gain a more in depth understanding of projective techniques by exploring their histories, founders, opinions and reviews of others as well as the uses and studies within the South African context. Both International and South African research will be reviewed, with the focus on research done in the last 5 years, if available.

2.2 PROJECTIVE TECHNIQUES

Projective techniques are any technique, assessment, method or set of procedures where individuals have to respond verbally or motorically to an ambiguous, unrestricted, unstructured stimulus (Bain, Amod & Gericke, 2013; Betts, 2003; Coon & Mitterer, 2015; Hogan, 2015; Miller & Nickerson, 2006). A vague, unclear stimulus such as an inkblot, or stimulus that requires an individual to generate a response such as a drawing following open ended instructions is presented to an individual (Hogan, 2015; Lilienfeld, Wood & Garb, 2000).

It is suggested that the term ‘projective techniques’ is best suited to describe projective testing measures as these techniques do not meet the traditional criteria for

19 psychological tests (Lilienfeld, Wood & Garb, 2000). Most projective techniques do not include standardised stimuli and instructions, systematic scoring procedures, or standardised norms in order to compare responses (Lilienfeld, Wood & Garb, 2000) and therefore cannot be named projective tests. For the purpose of this literature study, all projective assessment measures will be referred to as projective techniques.

The underlining theoretical understanding of projective testing measures is that individuals tend to project their feelings, behaviours, motivations, personality and unconscious thoughts onto other people or objects therefore revealing their unconscious thoughts (Bain, Amod & Gericke, 2013; Barlow & Durand, 2009; Brooke, 2004; Catterall & Ibbotson, 2000; Miller & Nickerson, 2006).

Responses within projective techniques are therefore not seen in the traditional assessment sense as these techniques do not require a ‘right’ or ‘wrong’ response, but rather assess responses of the reflection of the unconscious drives, feelings and/or wishes (Coon & Mitterer, 2015). The advantages of projective techniques within the assessment process is the ability to evade an individual’s conscious defences and allow the psychologist to gain psychological information the individual might not be consciously aware of (Coon & Mitterer, 2015; Lilienfeld, Wood & Garb, 2000). Projective techniques are more adaptable and can be utilised in a variety of settings, including a psychological setting, within the assessment process and/or within research strategies (Catterall & Ibbotson, 2000).

Projective techniques can be utilised in isolation or alternatively they can be used in combination with other quantitative and qualitative techniques (Catterall & Ibbotson, 2000). In South Africa, projective tests are used for the screening of socio-emotional difficulties, to validate diagnosis, to gain information regarding personality and to identify themes (Bain, Amod & Gericke, 2013). To gain a more holistic and reliable perception of an individual the guidelines provided by Sattler (2014) should be followed when engaging in projective testing. This involves a multidimensional process where all relevant information is gathered to gain a complete picture of a person’s functioning in order to make the relevant and appropriate decision on the best intervention strategies (Roodt & Foxcroft, 2013).

Projective techniques are not solely restricted for use within the assessment process and can be used within all aspects of the therapeutic process and research. In the

20 therapeutic setting, projective techniques can be used in various ways and responses can provide further information, ideas or perspectives and create opportunity for further discussions (Catterall & Ibbotson, 2000).

2.2.1 PROJECTIVE HYPOTHESIS

The projective hypothesis can be considered as the underlying foundation of projective techniques (Hogan, 2015; Lilienfeld, Wood & Garb, 2000; Miller & Nickerson, 2006). This hypothesis assumes that an ambiguous response to a stimulus is determined by an individual’s personality dynamics which may include their “desires, fantasies, inclinations, fears, motives”, etc. (Hogan, 2015, p. 512). An individual will therefore consciously and/or unconsciously project aspects of their personality through unstructured stimulus (Kroon, 1999; LaRoque & Obrzut, 2006; Miller & Nickerson, 2006; Obrzut & Boliek, 1986). Therefore, an individual’s world is viewed and interpreted through their own experiences (Miller & Nickerson, 2006).

The projective hypothesis should be fused within the assessment process in order to gain a more holistic understanding of the results when using projective techniques (Reynolds & Kamphaus, 2003).

2.2.2 DEVELOPMENT OF PROJECTIVE TECHNIQUES

From 1890 to 1905 was considered a period of experiments with regards to mental measurements and known as the laboratory period (Sattler, 1982). During this time the work of Wundt, Galton, and Cattell involved conducting experimentations and exploring associations between ideas with human subjects (Kroon, 1999). Projective measures are historically based on the theories and perceptions installed within the framework of nonstandard characteristics and originated from psychodynamic theory (Carter, Daniels, & Zickar, 2013; Miller & Nickerson, 2006).

Sigmund Freud initiated the concept of projection, based on psychoanalysis, stating the ego uses a defence mechanism where individuals unconsciously project their negative personality characteristics and impulses onto others (Bain, Amod & Gericke, 2013; Freud, 1958; Lilienfeld, Wood & Garb, 2000; Miguel & Pessotto, 2016). Other methods Freud used in psychoanalysis to gain access to an individual’s unconscious include methods such as free association and hypnosis (Kroon, 1999).

Grounded in the principle of projection it was predicted that when introduced to an unstructured, unclear stimulus, the personality may have a predisposition to assign meaning to it (Frank, 1939). Projective testing measures were thus first developed by psychoanalytic workers in which ambiguous stimuli such as pictures of objects or people are used to gain more information about an individual’s unconscious thoughts and personality (Barlow & Durand, 2009). Projective techniques further originated from the work of Herman Rorschach and his discovery that individuals unconsciously and automatically project their fears, desires, feelings, conflicts and attitudes onto unstructured stimuli (Rorschach, 1924a, Rorschach, 1924b). Early records of projective techniques can be found in the work of Galton and Freud in the late 19th century (Bain, Amod & Gericke, 2013).

In the early twentieth century, projective techniques were developed within the field of clinical psychology and served the purpose of encouraging individuals to express their inner private feelings and thoughts that would otherwise be too embarrassing or threatening to express (Catterall & Ibbotson, 2000). Projective measures developed during this time (Rorschach Inkblot Test, Thematic Apperception Test, Draw-A-Person Test and House-Tree-Person Test) influenced the development of art therapy as a diagnostic tool (Junge, 2016). Projective tests became more predominant during the 1940’s and 1950’s as clinicians changed their approach, moving away from the nomothetic approach to a more qualitative idiographic approach (Bain, Amod & Gericke, 2013). The use of these projective tools reduced later in the 1950s through the 1980s, as the result of an emphasis on situational elements of behaviour, the decreased belief in the psychoanalytic theory, poor reviews on the validity of these tools as well as the cost-effectiveness of these tools (Bain, Amod & Gericke, 2013; Betts, 2005; Groth-Marnat, 1990; 2003).

Projective tests have been criticized since the beginning, due to the lack of adequate reliability and validity (Miller & Nickerson, 2006).

2.2.3 Classification of projective techniques

Projective techniques differ from structured standardised tests in both the stimulus and response sections as it is more ambiguous, and responses and instructions can be interpreted in various ways (Lilienfeld, Wood & Garb, 2000). A test is considered to be standardised when the procedure of administering the test is constant between 22 examiners and settings (Gregory, 2015). Projective techniques however, are limited in standardisation and this aspect of projective techniques has been criticised over the years as they have multiple possible responses, which make them difficult to evaluate and standardise (Trull, 2005).

When conducting any psychological assessments, it is critical to distinguish between standardised and non-standardised tests. According to Miller, Lovler and McIntire (2013) a psychological test can be classified as standardised when a test has been administered to a larger group known as the standardisation sample in order to obtain data that is ultimately used as a frame of reference when interpreting an individual’s score. The aim of the data collected is to develop norms that is utilised as a frame of reference on the average performance of the standardisation sample (Miller, Lovler & McIntire, 2013). Standardised tests furthermore have set directions for the administration as well as scoring (Miller, Lovler & McIntire, 2013). In contrast to standardised tests, non-standardised tests are more informally utilised for single administration purposes (Miller, Lovler & McIntire, 2013).

Projective techniques can be both standardised and non-standardised however; they are mostly classified as unstructured (Miller, Lovler & McIntire, 2013).

2.3 TYPES OF PROJECTIVE TECHNIQUES

Projective techniques can consist of inkblots (e.g., Rorschach), stories telling from pictures (e.g., Thematic Apperception Test), and creating drawings (e.g. Draw a Person, House-Tree-Person) (Miguel & Pessotto, 2016).

Research shows there are multiple views and categories that projective techniques are categorised into. According to Lilienfeld, Wood and Garb (2000), Carter, Daniels and Zickar (2013) and Linzey (1959) projective techniques can be subdivided into the following five categories; association techniques, construction techniques, completion techniques, arrangement/selective techniques or expression techniques.

Table 2.1: Types of projective techniques

Category Projective techniques

Association Rorschach Ink Blot Test Word association test The Hand Test Construction Thematic Apperception Test (TAT) & Children’s Apperception Test (CAT) Roberts-2 Bene-Anthony Family Relations Test Children’s Version (FRTC) Children's Self-Report and Projective Inventory (CSRPI) The Koppitz-2 Drawing / story creation methods and art based techniques: • Draw-A-Person Projective Test (DAP) • House-Tree-Person Test (HTP) and Kinetic House-Tree-Person Test (KHTP) • Kinetic Family Drawing (KFD) & Kinetic School Drawing (KSD) • Diagnostic Drawing Series (DDS) • Face Stimulus Assessment (FSA) Completion Sentence Completion techniques Rosenzweig Picture Frustration Study Arrangement/ Selection Szondi Test Lüscher Colour Test

Expressive Expressive projective techniques through external objects Handwriting Analysis

2.3.1 Association techniques

Association techniques require individuals to respond spontaneously verbally to a stimulus presented (Carter, Daniels & Zickar, 2013; Catterall & Ibbotson, 2000). The stimuli may be presented in various forms such as words and/or picture stimulus and include word association techniques as well as the inkblot techniques (Carter, Daniels & Zickar, 2013; Catterall & Ibbotson, 2000; Lilienfeld, Wood & Garb, 2000).

Literature on association techniques suggests that these techniques are based on Freud’s free association techniques and aims to capture the immediate and unfiltered responses of an individual (Carter, Daniels & Zickar, 2013). The most used popular techniques in this category include the Rorschach Inkblot Test and Word Association Tests.

2.3.1.1. The Rorschach Inkblot Test

The Rorschach Inkblot Test was developed by Herman Rorschach a Swiss psychologist in the 1920’s (Coon & Mitterer, 2015; Groth-Marnat, 2003; Walsh & Betz, 2001). This Inkblot Test consists of 10 standardised symmetrical inkblots (5 in black and white and 5 in colour) that vary in shading and colour, form and complexity (Figure 2.1) (Carter, Daniels & Zickar, 2013; Coon & Mitterer, 2015). This test requires an individual to express what they see in each inkblot with spontaneous associations and interpretations (Kroon, 1999; Lilienfeld, Wood & Garb, 2000). The Rorschach Inkblot Test assumes that individuals reflect their misperceptions and the way they contextualise their own world through their responses (Cattell, 1951; Exner; 1989) and when telling a story, the individual has already projected themselves into that circumstance, exposing personality and mentality (Qu & Shen, 2014).

Figure 2.1. The Rorschach inkblots examples (Coon & Mitterer, 2015).

The Rorschach Inkblot Test originated from Gestalt and Psychoanalysis perspectives (Qu & Shen, 2014). This series of inkblots was initially developed to study the perceptual processes of individuals (Barlow & Durand, 2009). The aim was to examine characteristic responses within different types of populations in order to develop norms to differentiate between several clinical and normal populations to diagnose psychological disorders (Barlow & Durand, 2009; Groth-Marnat, 2003). These population groups included individuals with intellectual disabilities, schizophrenics,

25 scholars, artists, individuals considered normal and other specific subgroups (Groth- Marnat, 2003). Later, two standard Rorschach handbooks followed: The Beck scoring system (Beck, Beck, Levitt, & Molish, 1944) and the Klopfer method (Klopfer, Ainsworth, Klopfer, & Holt, 1954). Alternative systems developed include the Hertz system, Piotrowski system and the Rapaport system (Qu & Shen, 2014).

In 1968, John Exner published a book, The Rorschach: A Comprehensive System (TRACS), which provides a scientific foundation for the Rorschach Inkblot Test with detailed rules in terms of administration, scoring as well as a set of norms for both children and adults (Exner, 1968; Lilienfeld, Wood & Garb, 2000). Exner's scoring system is grounded in a psychometric approach and has been researched and updated through extensive data collection (Exner, 1982, 1986, 1991) ensuring a more reliable and standardised method for the Rorschach scoring (Ritzler, 1995). TRACS lead to in the most commonly used scoring system by clinicians (Garb, Wood, Lilienfeld, Scott, Lilienfeld & Nezworskid, 2005; Lilienfeld, Wood & Garb, 2000; Qu & Shen, 2014).

Today, clinicians still make use of other non-Comprehensive System approaches to the Rorschach Inkblot test despite criticism and concerns regarding the inadequate norms, poor reliability, and validity (Lilienfeld, Wood & Garb, 2000). In addition, this test is time and effort consuming, which may influence the assessment efficiency (Qu & Shen, 2014).

In South Africa, professionals use the Rorschach in the clinical and forensic setting. Although there has been much debate and research conducted on the validity and reliability of this projective technique, it is found that the Rorschach’s culture free stimuli are a good technique to explore cross-cultural differences (Brink, 2013). Efforts have been made, in South Africa, to develop appropriate norms and guidelines for the Rorschach, however there are no developed norms and guidelines for the Rorschach on South African populations currently (Brink, 2013).

2.3.1.2. Word Association techniques

According to Catterall & Ibbotson (2000), the word association techniques are mainly used in order to identify an individual’s vocabulary. These projective techniques consist of lists of stimulus words presented orally or in writing to an individual, one at a time,

26 where individuals are instructed to respond with the first word that comes to mind and responses are scored through content analysis (Gardner, 1961; Nielsen & Ingwersen, 1999; Oynama, 2010).

Galton and Wundt first experimented with word associations (Daston, 1968) and Swiss psychoanalyst Carl Gustave Jung developed a word association list in 1910 (Jung, 1910). Jung identified word association's effectiveness when investigating psychological complexes such as thoughts, feelings, memories and perceptions in the personal unconscious (Daston, 1968; Spiteri, 2005). His word association method can be seen as the oldest projective technique by some (Peck & McGuire, 1959). The Kent- Rosanoff Word List, was developed in a normative study and was intended for diagnostic use with psychiatric patients (Kroon, 1999). Moreover, Galton developed the Word Association Test to assess associations made by individuals, verbal memories, thought processes, emotional states, and personalities (Nielsen & Ingwersen, 1999; Oynama, 2010) and is used to investigate cognitive structures (Bahar & Hansell, 2000). The Free Association Test (FAT) is mostly used to expose association mechanisms (Oynama, 2010).

Although there are numerous versions of word association techniques developed, throughout the year’s word association techniques, however, have been succeeded by other techniques such as sentence completion techniques and are not much used (Daston, 1968; Kroon, 1999). Limited research on the use and development of word association techniques within South Africa has been found. A study conducted by Goliath (2014) on entrepreneur students and small business owners used word association techniques in order to reveal both affective and cognitive associations with the concept entrepreneurship. No research was found on word association techniques in the South African context.

2.3.1.3. The Hand Test

The Hand Test is another projective technique within this category. This test was developed by Edwin E. Wagner (1962) as a projective technique used to identify the actional predispositions of individuals. During this test the individual is asked to guess what each hand might be doing after being shown multiple pictures of moving hands (Lilienfeld, Wood & Garb, 2000). There have been multiple clinical studies done to determine the usefulness of this assessment within a clinical setting (Clemence, 27

Hilsenroth, Sivic, Rasch & Waehler, 1998; Clemence, Hilsenroth, Sivic & Rasch, 1999).

Figure 2.2. The hand Test manual and picture cards (The hand test [online image])

A recent study done by Vladislav, Marc, Agavriloaei, Mӑrӑcineanu and Ştefan (2012) aimed to determine if the Hand Test could distinguish between ‘normal’ individuals and individuals with a clinical history of epilepsy, externalising disorders and/or internalizing disorders. The results indicated that Hand Test is a useful projective tool to use for individuals with a clinical history of epilepsy, externalising disorders and/or internalizing disorders (Vladislav, et al., 2012). It should be noted that the Hand Test in isolation is not developed to produce a complete indication of the individual’s personality (Wagner, 1983) and should be used as one tool within a multi-method assessment process in order to obtain a holistic view of an individual (Vladislav, et al., 2012).

The hand test is not listed on the HPCSA (2005) form 208’s classified psychological tests that is suitable to use in South Africa and should therefore not be used within the South African context.

2.3.2 CONSTRUCTION TECHNIQUES

Projective techniques within this category include drawing or storytelling techniques and require an individual to construct a picture and/or story where the purpose is to encourage the expression of imagination and creativity (Catterall & Ibbotson, 2000). Individuals are presented with a picture where they are instructed to explain what is

28 happening or alternatively they can be instructed to draw their own picture/s (Catterall & Ibbotson, 2000).

Since the Thematic Apperception Test (TAT) a number of other projective story techniques have followed including the Children's Apperception Test (CAT) (Bellak & Abrams, 1997); the Roberts Apperception Test for Children (RATC) (McArthur & Roberts, 1982); the Blacky Pictures Test (Blum, 1950); the Make-A-Picture Story Test (MAPS) (Shneidman, 1949); the School Apperception Method (SAM) (Soloman & Starr, 1968); the Michigan Pictures Test Revised (MPTR) (Hutt, 1980); the Gerontological Apperception Test (GAT) (Wolk & Wolk, 1971); the Tell-Me-A-Story (TEMAS) (Constantino, Malgady & Vazquez, 1981); and the Southern Mississippi TAT (SM-TAT) (Ritzler, Sharkey, &- Chudy. 1980).

Although there are many projective techniques within this category, for the purpose of this study, the following techniques will be discussed: The Thematic Apperception Technique (Murray, 1943), Children’s Apperception Test, Roberts-Second Edition (Roberts & Gruber, 2005), Bene-Anthony Family Relations Test: Children’s Version (FRTC) (Bene & Anthony, 1957), Children's Self-Report and Projective Inventory (CSRPI) (Ziffer & Shapiro, 1992), The Koppitz-2 (Koppitz, 1963), the Kinetic Family Drawing (KFD), the Draw-a-Person test (DAP) as well as alternative drawing techniques. These techniques are implemented as a tool to gain relevant information from individuals who might be too young to communicate or face challenges in verbal communication (Bannon, Tirella & Miller, 2015; Lilienfeld, Wood & Garb, 2000) and provide information about how an individual construct their world (Fisher, Doyon, Saldaña & Allen, 2007). The reliance of an individual’s verbal abilities in construction techniques, especially storytelling techniques may affect the results of these tests and should be used with caution and never in isolation (Fisher, Doyon, Saldaña & Allen, 2007). Further limitations of these techniques include questionable validity and reliability leading to unreliable administration, scoring and interpretation (Kamphaus & Frick, 2005).

2.3.2.1. Thematic Apperception Test (TAT) & Children’s Apperception Test (CAT)

The Thematic Apperception Test was developed and published in 1938 by Henry Murray and Christiana Morgan to assess an individual’s reactions to ambiguous

29 interpersonal stimuli and gain idiographic information (Aronow, Weiss & Reznikoff, 2001; Groth-Marnat, 2003; Lilienfeld, Wood & Garb, 2000; Morgan & Murray, 1935).

This test consists of 31 cards (Figure 2.3) illustrating ambiguous situations of a social nature in which one or more individuals are engaging in interactions portraying everyday life situations (Gericke, Bain & Amod, 2013; Gregory, 2015; Lilienfeld, Wood & Garb, 2000).

Figure 2.3. The TAT Picture cards (The TAT Picture cards [online image], 2014).

This test aims at revealing dominant drives, emotions, views, thoughts, conflicts of personality and how an individual view the self as well as their world (Aronow, Weiss & Reznikoff, 2001; Murray, 1943). The underlying perception of this projective technique is that an individual may reveal their underlying personality needs such as need for achievement, etc. through the content of stories (Gregory, 2015).

In a study conducted on the validity and reliability of psychological tests it was found that the validity of the TAT is influenced by the instructions given as any variation may affect the results (Gericke, Bain & Amod, 2013). It is therefore essential that the TAT is administered as is in the manual to ensure valid assessment results. This technique differs from traditional projective drawing or inkblot type techniques as the TAT cards consists of a more structures stimuli and require more complex verbal responses (Groth-Marnat, 2003).

In South Africa, according to Foxcroft, Paterson, Le Roux and Herbst (2004), the TAT is a commonly used projective techniques used by clinical psychologists. In 1953, an African TAT was developed, however it has not been used in clinical settings or further researched (Lee, 1953a; Lee, 1953b) despite the need for culturally applicable pictures, scoring variables, interpretation procedures and normative data (Dana, 1999). It is believed that pictures of African individuals need to be shown to individuals of African origin to obtain more meaningful data or attain validity in the South African context (Hofer & Chasiotis, 2004; Murstein, 1965).

The TAT has produced related tests to assess different age groups, including tests like the Children’s Apperception Test, the Roberts Apperception Test for children, the Adolescent Apperception Cards as well as the Senior Apperception Test (Lilienfeld, Wood & Garb, 2000). Like the TAT the Children’s Apperception Test (CAT) is used to assess children (aged 3 - 10 years) and consist of ten picture cards (Figure 2.4) that is administered in sequential order (Gericke, Bain & Amod, 2013). The CAT consists of three systems, including a human and two animal (Gericke, Bain & Amod, 2013).

Figure 2.4 Children's Apperception Test (CAT) (The Children's Apperception Test [online image])

The TAT and CAT are widely used in South Africa by professionals. In the table below, the popularity of these projective techniques in the different professional registrations.

Table 2.2 The use of the TAT and CAT in South Africa by registration category. Clinical Educational Research Counselling Psychology Psychology Psychology Psychology

1. TAT (Murray) 4. CAT 5. TAT (Murray) 8. TAT (Murray)

6. CAT 8. TAT (Murray)

10. CAT-H

(Foxcroft, Paterson, Le Roux & Herbst, 2004)

As a result of the diversity in South Africa and the lack of standardisation for South African population groups Hofer and Chasiotis (2004), recommended the following when conducting apperception tests:

Use thematic content analysis to produce themes, avoiding possible cultural biases through defied scoring categories. One should furthermore maintain awareness of the cultural background of individuals and how the stimulus pull of a picture card may differ across cultural groups (Hofer & Chasiotis, 2004). Gericke, Bain and Amod (2013) therefore suggest one should be familiar with the personal history, reason for referral, social and cultural environment of an individual to provide contextual framework. Furthermore, each story should be evaluated and considered with regards to the larger context through integrating all information to produce a meaningful interpretation.

Although the TAT and CAT are widely used in the South African context, it is recommended that further research is conducted regarding the cross-cultural application of these apperception tests (Gericke, Bain & Amod, 2013).

2.3.2.2. Roberts Apperception Test for Children: 2 (Roberts-2)

The Roberts Apperception Test for Children: 2 (Roberts-2) was developed by Western Psychological Services as a narrative measure to assess the social growth and tendency to experience emotional, social or/and adjustment difficulties within social situations and is used to assess social cognitive understanding (Roberts, 2005; Roberts & Gruber, 2005). It can be administered to individuals ranging from age 6 to 18 years (Roberts & Gruber, 2005). This assessment measure consists of three sets (White, Black and Hispanic/Latino) of 16 stimulus cards (Figure 2.5) where individuals

32 are instructed to construct a story based on the thoughts and feelings of the characters (Roberts & Gruber, 2005). The earlier version of the Roberts-2, the Roberts Apperception Test for Children (RATC) (McArthur & Roberts, 1982) had 16 cards displaying realistic drawings of children in everyday situations (Kroon, 1999). The RATC have been significantly revised to improve standardisation and strengthen the psychometric properties of this assessment measure (Roberts & Gruber, 2005).

Figure 2.5. Roberts Apperception Test for Children: 2 (Roberts-2) (Roberts Apperception Test for Children: 2 [online image])

According to Roberts & Gruber (2005), the Roberts-2 is based on the assumption that an individual’s expressive language skills can provide an indication of their social cognitive skills (Piaget & Inhelder, 1971). The Roberts-2 is therefore grounded in the theoretical foundations of developmental psychology and is compatible with cognitive, behavioural, humanistic and psychodynamic theoretical orientations (Roberts, 2005; Roberts & Gruber, 2005). The Roberts-2 is considered to have adequate reliability as it consists of clear scoring procedures (Roberts & Gruber, 2005).

Although the Roberts-2 is used, limited research within the South African context have been found.

2.3.2.3. Bene-Anthony Family Relations Test: Children’s Version (FRTC)

The Bene-Anthony Family Relations Test: Children’s Version (FRTC) was developed to assess an individual’s perception of their social-emotional family relations (Beelmann & Schmidt-Denter, 1999; Parkin, 2001). This semi-projective diagnostic

33 method was developed by Eva Bene and James Anthony, as an objective and reliable assessment technique that measures an individual’s feelings towards different family members (Beelmann & Schmidt-Denter, 1999; Bene & Anthony, 1957; Meyer, 1963).

This projective technique consists of 21 ambiguous paper figures (Figure 2.6) that are attached to slit boxes where 20 figures represent people of different builds, ages, and sex ranging from grandparents to a baby (Bene & Anthony, 1957; Bene & Anthony, 1965; Geddis, Turner & Eardley, 1977; Meyer, 1963). The 21st figure represents a male figure showing it back called “Mr. Nobody” which gives an individual the opportunity to reject or disown feelings (Bene & Anthony, 1957; Meyer, 1963). An individual is instructed to choose figures to represent the individuals they reside with where after they read a series of cards and allocate a statement to the figure it best applies to (Meyer, 1963). This test allows one to determine the themes of positive and negative feelings the individual may have towards the concerned individuals or themselves (Meyer, 1963).

Figure 2.6. Family Relations Test: Children’s Version (Family Relations Test: Children’s Version [online image]).

Although this projective technique is found useful within practice, a survey conducted by professionals indicated that 86% of professionals rephrase at least one of the items on the test and that the majority of professionals modify this test in some form (Parkin, 2001). A study conducted by Beelmann and Schmidt-Denter (1999) revealed that the FRTC is a reliable diagnostic measure when assessing kindergarten children. Another study done on South African intern psychologists to determine if the FRTC deepened their insight into their client’s family dynamics revealed that the FRTC significantly contributed to the understanding of the family dynamics of their clients (Brand, 1996). This indicates that the FRTC is an effective assessment technique for evaluating family

34 systems (Brand, 1996). There have been several studies conducted regarding the validity and reliability of the FRTC (Meyer, 1963; Frost, 1969; Kauffman, 1970) and the FRTC is considered of great value when utilised in combination with other sources of information (Geddis, Turner & Eardley, 1977).

Although there is limited research, recent studies and studies conducted in the South African context regarding the FRTC this projective technique can be seen as beneficial within the diverse South African context. As the FRTC is a non-verbal technique where talking is not essential (Geddis, Turner & Eardley, 1977) one can argue that it can be useful on the multilingual South African population.

2.3.2.4. Children's Self-Report and Projective Inventory (CSRPI)

The Children's Self-Report and Projective Inventory (CSRPI) was developed in 1992 by Ziffer and Shapiro (1992) to assess the social and emotional functioning of children aged 5 to 12 years, using a multi-method inventory of projective and self-report techniques (Cross & Gust, 1996; Kroon, 1999). This projective technique was developed to assess the inner world of feelings, thoughts and to recognise behavioural, emotional and interpersonal concerns (Carson, Chowdhury, Perry & Pati, 1999). The CSRPI consists of eight assessment measures (Figure 2.7) including: The Colour How You Feel, Colour How Others Makes You Feel, Draw a child in the Rain, Kinetic Family Drawing, two self-report measure (Critical Items and Perceived Competence), sentence completion and projective story card (Cross & Gust, 1996).

Figure 2.7. Children's Self-Report and Projective Inventory (Children's Self-Report and Projective Inventory [online image])

These components can be used in isolation to explore specific concerns or as a whole to gain a comprehensive picture of a child’s emotional functioning (Ziffer & Shapiro, 1992). It can be used as part of psychological assessment and/or as part of individual or family therapy (Ziffer & Shapiro, 1992).

Some disadvantages of the CSRPI are that there are no normative data and there is limited research found (Kroon, 1999). There were no recent research and literature available and no literature within the South African context was found.

2.3.2.5. The Koppitz-2

The Koppitz Bender Gestalt Test for Young Children (Koppitz, 1963, 1975) was developed by Koppitz from observations of misrepresentations drawings of individuals using the original nine Bender design cards. This scoring system was revised and redeveloped and the Koppitz-2 was developed (Reynolds, 2007). The Koppitz-2 consists of 16 design cards from the Bender Gestalt II aimed at assessing visual motor integration skills (Brannigan & Decker, 2003).

According to Bender and Koppitz emotional disturbances can develop secondary to difficulties in visual perception as a result of negative experiences or frustrations that

36 arise from those impaired cognitive skills (Reynolds, 2007). The Koppitz-2 scoring system for emotional indicators, the Supplemental Emotional Indicators (EIs), uses the Bender Gestalt drawings as a projective measure to distinguish emotional disturbances in individuals (Reynolds, 2007). The Koppitz-2 scoring system should therefore only be used as one part in gaining comprehensive information on an individual’s cognitive and behavioural abilities (Reynolds, 2007).

2.3.2.6. Drawing / story creation methods and art based techniques

Art based assessments assume that an individual will project their characteristics into a task reducing the probability of providing “fake” or generated desired answers enabling one to gain information in order to create a treatment plan (Brooke, 2004; Malchiodi, 2012). Art based assessments include standardised tests with specific directives as well as projective tests that are more open-ended (Martin & Horovitz, 2014). Drawing and story creation methods are most commonly used in the assessment process.

According to Hammer (1997), drawings can be utilised to provide information on individual’s defensive structures and primary thought processes. Drawings are a projective technique as an unstructured, ambiguous situation is created where individuals can make meaning through drawing their own life experiences (Amod, Gericke & Bain, 2013). Projective drawings are utilised as a method where individuals can explore and express their personal experiences, personality, perceptions and attributes without verbal communications (Brooke, 2004; Malchiodi, 1998). Drawings are found to be a useful tool within research, assessment and the therapeutic process as they ensure that a more reachable task is appropriate to use across a wide range of ages and for most individuals, and it serves as a non-threatening way of communicating emotions and experiences (Bannon, Tirella & Miller, 2015). Drawings, as a projective technique, can be conducted in a diversity of informal and formal ways and children’s drawings (in particular) have been implemented in various settings as a resource for non-verbal communication. Lally (2001) identified three methods used to interpret drawings. (1) An overall qualitative impression of a drawing can be made about the individual’s personality and level of pathology. This method relies on the professional’s experience and has no formal scoring guidelines. (2) A second method for interpreting drawings, links single signs within a drawing with specific personality

37 aspects or diagnosis (Carmody & Crossman, 2011; Lally, 2001). (3) The frequency of pathology indicators within a drawing is used in this method (Lally, 2001). These drawings can additionally be utilised as an icebreaker technique to establish rapport building, provide a sample of an individual’s reaction and behaviour to a semi- structured task, explore an individual’s personality and perceptions of relationships between family, peers, school and significant others (Knoff and Prout, 1985, cited in Brooke, 2004).

There are various projective drawing techniques such as the Mirror Drawing Test (MDT), The Bridge Drawing Test (BDT), The Child Diagnostic Drawing Series (CDDS), The Person Picking an Apple from a Tree (PPAT), The Formal Elements Art Therapy Scale (FEATS) and The Draw-a-story assessment (DAS), etc. that will not be discussed in this research study. For this research study the following drawing techniques will be reviewed: Draw-A-Person Projective Test (DAP), House-Tree- Person Test (HTP) and Kinetic House-Tree-Person Test (KHTP), Kinetic Family Drawing (KFD) and Kinetic School Drawing (KSD), Diagnostic Drawing Series (DDS) and Face Stimulus Assessment (FSA).

A. Draw-A-Person Projective Test (DAP) The Draw-A-Person (DAP) is a projective technique rooted in psychoanalytic thought and based on the assumptions that an individual directed to ‘draw a person’ would project their impulses, anxieties, conflicts, and characteristics in the human figure (figure 2.6) (Lilienfeld, Wood & Garb, 2000; Machover, 1949; Malchiodi, 1998). The DAP is used with children and adolescents with developmental, learning and behavioural difficulties within various settings, including assessments and/or in therapy (Burgess & Hartman, 1993; Camara, Nathan, & Puente, 2000; Carmody & Crossman, 2011). It provides information on aspects of the self, mental development, maturity, attitudes, personality traits, emotional state and disturbances and experiences of an individual (Carreras, Uriel, & Liporace, 2013; Crusco, 2013). Over the years, there have been various Human Figure Drawing tests developed, including those developed by Machover (1949), Koppitz (1968) and Naglieri (1988). Machover (1949) developed specific symbolic meanings to details such as buttons, pockets, etc. as well as structural qualities such as shading, size, lines, etc.

Figure 2.8 DAP drawing test case examples [online book image] (Amod, Gericke & Bain, 2013).

Developmental scoring systems for children’s drawings were developed based on Koppitz’s research on children’s drawings (Malchiodi, 1998). Koppitz developed separate scales to determine the emotional indicators and developmental levels and a scale to evaluate the mental maturity of an individual based on their figure drawings (Koppitz, 1968). Research done by Naglieri and colleagues resulted in the development of objective scoring systems of the DAP which provide cognitive and emotional disturbance scores from drawings (Naglieri, 1988; Naglieri, McNeish, & Bardos, 1991). The Draw-A-Person: Screening Procedure for Emotional Disturbance (DAP: SPED) is a quick screening tool and require little verbal skills which is especially beneficial when working with younger individuals or individuals with lower verbal abilities (Matto, 2002; Matto, Naglieri, & Clausen, 2005; Naglieri, McNeish, & Bardos, 1991). Reviews conducted on the DAP: SPED showed that reliable and accurate information about emotional and behavioural function can be obtained if the test is correctly used (Matto, Naglieri & Clausen, 2005; Trevisan, 1996).

Although there have been various scoring systems developed for the DAP the insufficient training of professionals is still of concern (Smith & Dumont, 1995) and the controversy over the use of the DAP test in general still exist (Carmody & Crossman, 2011). Lilienfeld, Wood and Garb (2000) indicated that there are no reliable scoring systems for DAP and responses in projective testing like the DAP has been found to

39 be ‘fakable’ (Rogers, 2008). One can therefore question the reliability and validity of drawing as a projective measure and the use and analysis of drawings should be used with great caution (Archer, Buffington-Vollum, Stredny & Handel, 2006; Carmody & Crossman, 2011).

Even though there are evident disadvantages with regards to the clinical use of the DAP, the DAP has clear advantages in the therapeutic setting for rapport building, allowing individuals to express themselves in a non-verbal, unthreatening way (Carmody & Crossman, 2011; Maganto & Garaigordobil, 2011; Riethmiller & Handler, 1997). Human drawings are comparatively culture free and is therefore useful for individuals who are difficult to assess such as individuals who struggle verbally and academically as well as individuals with hyperactivity (Abell, Wood, & Liebman, 2001; Aiken, 2000; Williams, Fall, Eaves & Woods-Groves, 2006).

In South African, despite the limitations and concerns related to the DAP; this projective drawing technique is still widely used by professionals (Amod, Gericke & Bain, 2013). Despite projective drawing techniques’ widespread use in South African, these techniques are not listed as psychological assessments according to the Health Professions Council of South Africa (Amod, Gericke & Bain, 2013) and it is recommended that extensive research be conducted about the validity and reliability as well as the appropriateness of this test on the diverse South African population.

B. House-Tree-Person Test (HTP) and Kinetic House-Tree-Person Test (KHTP) Buck developed the House-Tree-Person Test (HTP) in 1948 as a supplementary to intelligence tests during that time (Malchiodi, 1998; Buck, 1948, 1987). This technique requires an individual to make and explain drawings of a house, tree and person (Figure 2.9. & Figure 2.10.) (Buck, 1948). The aim of the HTP was to gain information regarding an individual’s personality development as well as their conscious and unconscious relations (Brooke, 2004; Horovitz, 2014; Malchiodi, 1998). The HTP furthermore, produce information regarding an individual’s efficiency, flexibility, maturity and sensitivity (Buck, 1987). According to Buck (1948) the objects of a person, tree and house were selected as it relates to all ages especially very young children. The drawing of the house was intended to reveal information regarding an individual’s home experience and individuals living within the house while the drawing of the tree

40 focused on revealing information regarding an individual’s psychological development as well as feelings about the environment (Malchiodi, 1998). The HTP therefore reveals an individual’s internal interpretation of their environment, themselves as well as things considered as important to them (Buck, 1966; Hammer, 1980).

Various studies have been conducted on the HTP (Kline & Svaste-Xuto, 1981; Lewis & Goldstein, 1981; Marzolf & Kirchner, 1972; Ramirez, 1983). Among these studies sex differences were identified (Kline & Svaste-Xuto, 1981; Marzolf & Kirchner, 1972) and the importance of taking this into account when analysing and interpreting drawings were suggested. No cultural differences were identified and results showed that when objectively scored, the HTP is suitable for cross-cultural use (Kline & Svaste- Xuto, 1981). The HTP was found to be useful in-group settings as it assists in overcoming resistance patterns within a group by reducing the defensiveness of the group and promoting group discussions (Ramirez, 1983).

Figure 2.9. House-Tree-Person (H-T-P) Projective Drawing Technique (House-Tree- Person (H-T-P) Projective Drawing Technique [online image]).

Figure 2.10. HTP drawing examples [online image] (Shin, 2003).

Limitations of the House-Tree-Person Test (HTP) and Draw-A-Person Test (DAP) resulted in the development of kinetic assessments (Brooke, 2004). Non-kinetic projective techniques were criticised because they restrict the illustration of important family dynamics that provides information about family roles, influences, perceptions and interactions (Brooke, 2004; Knoff & Prout, 1985b).

The Kinetic House-Tree-Person Test (KHTP) was developed in 1987 by Robert Burns and unlike the HTP the KHTP combines all three images (house, tree, person) on one page and includes physical activities of family members (Brooke, 2004). The aim of the KHTP is to gain an understanding of human development, dynamics within multiple clinical situations, creates a visual metaphor, and tells a story about the self (Brooke, 2004; Burns, 1987). The KHTP is a qualitative measure that incorporates Maslow’s Hierarchy of Needs theory to produce a developmental model for the test (Burns, 1987; Maslow, 1954).

C. Kinetic Family Drawing (KFD) & Kinetic School Drawing (KSD)

The Kinetic Family Drawing is a projective technique used to gain an understanding of an individual’s perception of the relationships between themselves and their family (Bannon, Tirella & Miller, 2015; Brooke, 2004). Family drawings can similarly be used to reflect the emotional dynamics and boundaries within a family system, measure attachment and adjustment as well as relationships (Bannon, Tirella & Miller 2015; Leon, Wallace, & Rudy, 2007).

This technique requires individuals to illustrate family members engaging in an activity together and should be ideally be supplemented with other standardised measures (Figure 2.11. & Figure 2.12.) (Dunn, O’Connor, & Levy, 2002; Bannon, Tirella & Miller, 2015). According to Brooke (2004) limited information about theoretical background and the test development, as well as difficulty about interpretation form part of the undesirable features of the KFD. Bannon, Tirella and Miller (2015) nonetheless states

42 that the KFD is among the most used projective drawing techniques, which demonstrates a good inter-rater reliability.

Figure 2.11. KFD drawing examples [online image], (Shin, 2003).

Figure 2.12. KFD drawing test case examples [online book image], (Amod, Gericke & Bain, 2013).

As a result of an absence of an objective scoring system within the KFD manual (Brooke, 2004) multiple scoring systems were developed (Elin and Nucho, 1979, cited in Brooke, 2004; Mostkoff and Lazarus, 1983, cited in Brooke, 2004). In South Africa, the kinetic Drawing System developed by Knoff and Prout (1985) is still widely used today in clinical and research settings.

Like the Kinetic Family Drawing, the Kinetic School Drawing (KSD) (Figure 2.13.) instructs an individual to draw a school picture including themselves, their teacher, a friend or two each doing something (Brooke, 2004). Based on studies done by Sarbaugh (1982) and Prout and Celmer (1984) qualitative interpretations of the KSD were developed.

The KSD interpretation examines the actions between the figures, the characteristics of figures, positions, distance, and barriers present, the style and symbols (Brooke, 2004).

Figure 2.13. Kinetic Drawing System for Family and School (Kinetic Drawing System for Family and School [online image]).

The KSD is a projective technique that relies on the qualitative interpretation of drawings and as a result Knoff and Prout (1985) advised examiners to be cautious when interpreting individuals from special populations as limited guidelines are provided.

D. Diagnostic Drawing Series The Diagnostic Drawing Series (DDS) was developed by Barry Cohen and Barbara Lesowitz in 1982 to be used in a clinical setting and aimed to assess individual’s responses to both structured and unstructured drawing tasks (Brooke, 2004). The DDS assesses adolescents and adults in order to gain information on their cognitive capacity, behavioural positions, strengths and defences (Brooke, 2004).

Figure 2.14. Diagnostic Drawing Series Examples (Diagnostic Drawing Series Examples [online image]).

The DDS consists of three drawing tasks (Figure 2.14); (1) a free drawing that aims at revealing an individual’s defensive functioning, (2) a directive tree drawing that aims to reveal information about an individual’s vegetative/psychic state and their life energy and (3) a directive drawing where an individual is instructed to make a picture of how they are feeling using shapes, colours and lines (Brooke, 2004; Burns, 1987; Cohen, 1985). This drawing aims at gaining information regarding an individual’s emotional state (Brooke, 2004).

A disadvantage of the DDS is the fact that the handbook and rating guide did not provide sufficient information to a professional in order to make a diagnosis and therefore the clinicians had to rely on their own skills (Brooke, 2004). This may have an effect on the reliability of this projective test. This projective technique is not used in South Africa and limited current research is available.

E. Face Stimulus Assessment (FSA)

Betts (2003) developed the Face Stimulus Assessment (FSA) on the principles that individuals with autism, communication difficulties, a lack of motivation would benefit from stimulus drawings of a face. This projective measure was developed for the nonverbal individuals who presented with cognitive impairments, had difficulty following directions (for example, individuals who are unresponsive to ‘Draw-a-person’ instructions), individuals who were not motivated to draw without a visual stimulus (Betts, 2003). The aim of the Face Stimulus Assessment is to gain a more in-depth understanding of an individual’s cognitive functioning, creative capabilities as well as their developmental levels (Betts, 2003; Brooke, 2004; Mattson & Betts, 2016). This assessment provides an individual with the opportunity to project their own concepts

45 and ideas and psychological information onto the picture in an unrestricted manner (Brooke, 2004; Mattson & Betts, 2016). The FSA is a standardised projective drawing assessment and can be administered to individuals from multicultural backgrounds with multiple disabilities, communication disorders and autism (Betts, 2014; Betts, 2013). Individuals are presented with three stimulus pictures (Figure 2.15. & Figure 2.16.) consisting of an initial face stimulus, an outline of a face, followed by a blank page (Betts, 2003).

Initially Betts (2001) provided guidelines by an informal rating procedure based on her clinical experience. Further studies on the FSA were conducted by Robb (2002) who administered this assessment as a pre-and post-assessment with a group of Russian children from orphanages. The overall findings indicated that the use of art therapy assisted in addressing matters that contribute to anxiety within children (Robb, 2002). No suggestions for future research were recommended (Brooke, 2004; Robb, 2002).

Limited normative research and guidelines for interpretation were available influencing the reliability and validity of this assessment (Brooke, 2004). In the attempt to achieve some standardisation a manual for the FSA was developed based on studies done by Hamilton (2008). Currently the FSA has a second edition rating manual (Betts, 2014; Betts, 2013).

Figure 2.15. FSA stimulus pictures (Betts, 2003).

The Draw-a-Face test (DAF) and the Franck Drawing Completion Test (FDCT) were earlier versions of face oriented assessment instruments (Burns & Zweig, 1980; Franck, 1976).

Figure 2.16. FSA stimulus pictures example (Betts, 2003)

The DAF consists of a manual that contains multiple scenes representing groups of children engaged in various games, tasks, and events (Brooke, 2004; Burns & Zweig, 1980). The children in these scenes’ faces are blank and individuals are instructed to draw in the faces of the children in each picture that is most like the individuals (Brooke, 2004). The Franck Drawing Completion Test provides individuals with a booklet of stimulus drawings the individual can use (Franck, 1976; Mattson & Betts, 2016).

F. Disadvantages of projective Drawing Tests

Despite concerns regarding the validity and reliability of projective drawing techniques, these techniques are still utilised for diagnosis and treatment (Brooke, 2004; Malchiodi, 1998). Studies have shown that there are limited literature, reviews and reestablishment of norms for projective drawings available (Malchiodi, 1998).

According to Golomb (1990) there is limited consideration of developmental aspects of the drawings, which allows a therapist to distinguish and understand which characteristics within a drawing is normal and which may be significant or important. A therapist therefore needs to place more emphasis on the developmental aspects in order to gain a more accurate interpretation of significant characteristics.

It is argued that projective drawing techniques do not take an individual’s multidimensional aspects into account (Malchiodi, 1998; Malchiodi, 2012). Furthermore, most projective drawing tests are developed and normed based on the Western cultures resulting in a lack of sensitivity to different cultures, class, gender, etc. (Malchiodi, 1998; Malchiodi, 2012).

The sociocultural influence that may have an effect on an individual’s motivation and attributes in projective drawings needs to be taken into consideration at all times. These include an individual’s race, ethnicity, religion and socioeconomic status and are factors that need to be explored as it may have an influence on the drawings (Malchiodi, 1998; Malchiodi, 2012).

2.3.3 COMPLETION TECHNIQUES

This more structured technique requires individuals to complete an incomplete stimulus such as the beginning of a sentence or to complete thought and speech bubbles in a cartoon drawing (Catterall & Ibbotson, 2000). Techniques within this category include sentence completion methods and the Rosenzweig Picture Frustration Study (Lilienfeld, Wood & Garb, 2000).

2.3.3.1. Sentence Completion techniques (SCT)

The projective use of Sentence Completion Tests (SCT) is a popular method used to assess personality and functioning (Hojnoski, Morrison, Brown & Matthews, 2006; Rogers, Bishop & Lane, 2003). The sentence completion tests require individuals to complete various incomplete sentences (Lilienfeld, Wood & Garb, 2000) and are generally quick to administer (Fisher, Doyon, Saldaña & Allen, 2007). The open ended, semi-structured, indirect nature of this test allows an individual to construct a wider range of responses compared to other projective measures (Holaday, Smith & Sherry, 2000). Instead of posing direct questions the indirectness of this test measure allows for the expression of attitudes and feelings (Holaday, Smith & Sherry, 2000; Rogers, Bishop & Lane, 2003). The sentence completion tests are based on psychodynamic foundations and can be used as a quick screening tool in the assessment process to determine personality and emotional functioning (Rogers, Bishop & Lane, 2003).

Several variations and forms of the sentence completion techniques have been developed over the years (Gregory, 2015) each focusing on different areas of psychological functioning and serving different purposes (Rabin & Zltogorski, 1981). These may include the Brink Incomplete sentences (BIS), Rotter’s Incomplete Sentence Blank (RISB) (Rotter & Rafferty, 1950), Washington University Sentence Completion Test (WUSCT) (Loevinger, 1998) and The Sacks Sentence Completion Test (SSCT) (Carew, 2009). Although this technique is categorised as a projective

48 technique, it is argued that a highly-structured stimulus and limited written response cannot reveal an individual’s inner world and that the projective hypothesis does therefore not apply (Kroon, 1999). Semeonof (1976) suggests that sentence completion techniques show similarities to open-ended self-report questionnaire.

A survey conducted by Holaday, Smith and Sherry (2000) revealed that psychologists often administer SCTs in a non-systematic manner, avoiding formal scoring and interpreting test results based on their theoretical orientation. When using assessment measures that have not been supported by research, the validity is questionable and these measures should not be used for formal psychological evaluation, but rather used informally as an aid for examining in psychotherapy (Rogers, Bishop & Lane, 2003). Due to the large number of SCT’s available psychologists may not be aware of the best measure based on purpose, administration, interpretation, and validity (Rogers, Bishop & Lane, 2003) and might rarely use individualised tests for a specific presenting problem (Holaday, Smith & Sherry, 2000). It would therefore be recommended that sentence completion tests be individualised to fit a specific problem in order to gain a holistic view of an individual and their presenting problem. For example, using the Sentence Completion Test for Depression to assess depressive thinking in an individual, as there is evidence of reliability and validity in assessing depressive thinking (Barton, Morley, Bloxham, Kitson, & Platts, 2005).

Although the use of sentence completion techniques is used within the South African context there were limited recent research available and no known research found in the South African context. Therefore one can question the validity and the cross- cultural appropriateness of this technique in South Africa.

2.3.3.2. Rosenzweig Picture Frustration Study

The Picture Frustration Study (PFS) was developed by Rosenzweig in 1978 (Rosenzweig, 1978) and is based on the psychodynamic theories (Hornsveld, Nijman, Hollin & Kraaimaat, 2007). The Rosenzweig Picture Frustration Study technique evaluates an individual’s verbal response to various situations through the demonstration of cartoons in various frustrating situations (Carter, Daniels & Zickar, 2013; Lilienfeld, Wood & Garb, 2000)

This test consists of 24 cartoon-like pictures (Clarke, Rosenzweig & Fleming, 1947; Rosenzweig, 1978) that illustrates a figure in a frustrating situation (Kroon, 1999). Individuals are instructed to study the situations and write the figure’s verbal reaction in the blank box the first appropriate reply that enters their mind (Hornsveld, Nijman, Hollin & Kraaimaat, 2007). An example of a frustrating situation presented may be ‘being accidentally splashed with water by a passing car’ (Figure 2.17.) (Lilienfeld, Wood & Garb, 2000, p. 30). While there have been, some studies done on the PFS (Ferreira & Capitão, 2013), the use of the PFS is not used within the South African context and limited current research is available. This technique however is similar to the sentence completion method where an individual is provided with a highly-structured stimulus and it requires limited written response (Kroon, 1999).

Figure 2.17. Picture Frustration Study (PFS) picture cards (Picture Frustration Study (PFS) picture cards [online image]).

2.3.4 Arrangement/selection techniques

These techniques may also include choice or ordering techniques and require an individual to select, arrange or group pictures, words or statements (Catterall & Ibbotson, 2000). These techniques may include the Szondi Test and Lüscher Colour Test. As these projective techniques are not used within the South African context, it will be briefly reviewed.

2.3.4.1. Szondi Test

The Szondi Test consists of picture cards representing individuals with different psychiatric pathologies (Kroon, 1999). When administering the Szondi Test individuals are asked to state which patients they most and least prefer from a selection of photographs of patients with different psychiatric disorders (Lilienfeld, Wood & Garb, 2000). Arguably, choice tasks can hardly be considered as projective methods, since it is doubtful whether consciously made choices and value judgments reveal the deeper layers of an individual’s personality dynamics (Anderson & Anderson, 1951).

Furthermore, there are very limited recent research on the Szondi Test and one can question the validity and reliability of this test in light of the DSM 5.

2.3.4.2. Lüscher Colour Test

Lüscher Colour Test requires individuals to rank different coloured cards, according to preference (Lilienfeld, Wood & Garb, 2000). This test however, has been criticised based on its reliability and a study conducted examining the validity of the Lüscher Colour Test that Colour preference does not relate to self-descriptions (Picco & Dzindolet, 1994). This test is not often used in South Africa and limited research is available.

2.3.5 EXPRESSIVE TECHNIQUES

Expressive techniques are used in such a way that individuals can express themselves through external objects. These projective methods often involve play materials used to reflect an individual’s inner world (Kroon, 1999). Individuals can role-play themselves or other individuals through the use of puppets, dolls or alternative external objects (Lilienfeld, Wood & Garb, 2000; Catterall & Ibbotson, 2000). Expressive projective techniques may include projective doll play, puppetry as well as handwriting analysis (Lilienfeld, Wood & Garb, 2000; Catterall & Ibbotson, 2000). Other techniques include the Structured Doll Play Test (Lynn & Lynn, 1959), Bühler’s World Test (Bühler & Kelley, 1941; Bühler, Lumry, & Carrol, 1951); the Sceno-test (Von Staabs, 1951) from Germany; and the Test du Village (Arthus, 1949) from France. In South African these tests are rarely used and will not be reviewed in this study.

2.3.5.1 Expressive projective techniques through external objects

Expressive projective techniques can include various play therapy techniques such as doll play, puppet play, game playing, sand play and storytelling (Orton, 1997). Through play an individual is able to express their inner thoughts and feelings and through play therapy a professional can use play as a technique to assess an individual in a safe environment (Orton, 1997). Play therapy can be used to build rapport, as communication and as an assessment tool (Orton, 1997). Orton (1997) suggests an integrative approach where various techniques can be utilised such as puppet and doll play, storytelling techniques, sand play and other creative art techniques.

Expressive art therapy can also be used to enhance the personal growth within individuals and groups (Corey, 2014). Through this therapy an individual is given the opportunity to express their feelings and to gain insight through movement, visual art, journal writing, sound and music and include drawing, movement, painting, sculpting, music, writing, and improvisation (Corey, 2014).

Doll play techniques have been found to be a useful technique used with younger children as it elicits projective responses from individuals ( , 1968). The hypotheses of projective doll play assume that individuals will recreate situations and project themselves through the doll figures and is an effective technique with individuals who are deaf, have language and speech difficulties as well as special needs individuals (Haworth, 1968). Doll play assessment is a semi-projective technique that allows an individual to play and act out situations and stories using dolls (Westphal, 2007). This technique gives an individual more freedom in their responses and is an advantage (Westphal, 2007). A disadvantage to doll play, however can occur when an individual feels uneasy, their response could be biased to represent an outcome that they feel is more acceptable (Westphal, 2007).

There are various expressive projective techniques used in play therapy in South Africa. These techniques are found useful within different age, language and cultural groups.

2.3.5.2. Handwriting Analysis

Handwriting analysis is another projective technique within the expression category where individuals are asked to provide a spontaneous sample of their handwriting (Lilienfeld, Wood & Garb, 2000). Handwriting analysis studies graphology to

52 understand human behaviour and is believed to access the deeper layers and complexities of personality structure dynamics (Cronje & Roets, 2013).

The theory behind this technique looks at the direct link between the brain and the psycho-motor movements of writing and examines how underlying psychodynamics may play a role in the formation of letters (Figure 2.18.) (Cronje & Roets, 2013). This projective technique is a valuable and reliable tool for personality assessment (Broschk, 2003) however a holistic approach is recommended to ensure a reliable method of handwriting analysis in projective assessment (Cronje, 2009; Cronje & Roets, 2013).

In a study conducted by Cronje and Roets (2013), graphology was found to be a useful and practical technique in psychological assessment and diagnosis as it is easy to administer, culture fair and does not require expensive test material. There have been various studies conducted on handwriting analysis within South Africa (Aschendorf, 2013; Broschk, 2003; Cronje, 2009; Cronje & Roets, 2013).

Figure 2.18. An example of large writing with good and low form standard (Cronje & Roets, 2013).

Limited training of this technique is available within the Masters courses offered at various Universities and as such this technique is not be used by professionals in the assessment process.

2.4. CONCLUSION

This chapter focused on various projective techniques available both internationally and in South Africa. These techniques are used both within a clinical setting and/or in

53 research. As discussed above most available projective techniques are old and outdated with limited recent published research regarding their validity, reliability and cross-cultural appropriateness. In South Africa, it is consequently vital as a professional to be mindful of limitations and drawbacks when projective techniques are used on the diverse South African population.

It is therefore vital to be aware of the factors that may have an influence on projective assessment results. In chapter 3, projective techniques in the South African context as well as the techniques that are used in practice will be discussed. Furthermore, factors that may influence assessment results will be explored.

CHAPTER 3 FACTORS THAT CAN INFLUENCE THE USE OF PROJECTIVE THECHNIQUES AND THE ASSESSMENT PROCESS 3.1. INTRODUCTION

There are various projective techniques available both internationally and nationally. In South Africa professionals work with a diverse range of individuals who come from different backgrounds, culture, language, religious belief and experiences (Leach, Stevens, Lindsay, Ferrero & Korkut, 2012). With this said there are limited projective techniques, that are suitable to use on the diverse population of South Africa. As such professionals are limited in the availability of projective techniques for the use in the assessment process. This chapter will discuss projective techniques in the South African context as well as explore factors that can influence assessment results and that should be considered when conducting and interpreting projective techniques.

3.2 PROJECTIVE TESTING IN SOUTH AFRICA

In South Africa psychological assessment was only recognised after World War I and assessments were greatly influenced by the Western worldview (Gregory, 2015).

The South African Ethical Code of Professional Conduct requires psychologists to protect the individual’s human rights in all professional conduct (Allan, 2013) and they therefore have responsibilities and ethical obligations set by the Health Professions Council of South Africa as well as the South African Constitution’s Bill of Rights Chapter 2.

Professionals may encounter ethical dilemmas due to differences in worldviews, conflicts between cultural beliefs and should therefore avoid discriminating unfairly against individuals based on religion, sexuality, ethnicity disability, language, culture, belief or religion or any other basis proscribed by law (HPCSA Form 223 (2006) and Allan and Love (2010). All decision making in the assessment process should be guided by the well-being of the individual and ethical rules of conduct (Leach, Stevens, Lindsay, Ferrero & Korkut, 2012).

There have been numerous debates and research done on the validity and reliability of projective techniques in both clinical and forensic settings (Erickson, Lilienfeld & Vitacco, 2007).

3.2.1 Research within the South African Context

The limited research and certainty concerning the validity and culturally applicability of tests used in South Africa have been pointed out by the South African Professional Board for Psychology, which encouraged research on cultural bias in an attempt to make needed adaptations (HPCSA, 2005; Matthews & Bouwer, 2009).

Research on University level has produced multiple small-scale South African relevant studies. However, in order for psychological to be ethical and culturally sound they need thorough, large-scale development, adaptation as well as test revision (Foxcroft, Paterson, le Roux & Herbst, 2004).

There have been multiple University level studies conducted on revising and translating the Junior South African Individual Scales (JSAIS) into isiZulu and Sesotho (Blake, 2012; Bouwer, 2014; Mareana, 2014; Mawila, 2013; Mdluli, 2011; Naicker, 2013; Teixeira, 2012; Tsakani, 2013). Other studies on cognitive assessments within the South African context include multiple research studies conducted with regards to the Raven’s Progressive Matrices (Caffarra, Vezzadini, Zonato, Copelli & Venneri, 2003; Crawford-Nutt, 1976; Freeman, 1984; Israel, 2006; Nottcutt, 1949-50; Owen, 1992; Rushton & Skuy, 2000; Rushton, Skuy & Bons, 2004; Rushton, Skuy & Fridjhon, 2002). In addition, studies on the adaptations of cognitive assessments such as the Wechsler Intelligence Scales for Children, Fourth Edition (WISC-IV) and the Wechsler Intelligence Scales for Adults, Third Edition (WAIS-III) within the South African context (Foxcroft & Aston, 2006; Nell, 1994; Shuttleworth-Edwards, Gaylard & Radloff, 2013; Shuttleworth-Edwards, van der Merwe, van Tonder & Radloff, 2013).

A study conducted by Paterson and Uys (2005) aimed at investigating the purposes of psychological test usage, the equity and cross-cultural applicability of tests and competence of test users in South Africa. The need to development tests that are relevant at industry and practical level was identified in the study (Paterson & Uys, 2005).

Research conducted by Matthews & Bouwer (2009) on the TAT and South African adolescents lead to the development of the dynamic assessment (DA); a revised

56 method of probing and questioning to access richer stories and gain deeper projections. A further study conducted by Matthews & Bouwer (2013) on the cultural barriers in projective assessments. This study’s findings concluded that knowledge of cultural and linguistic influences should be incorporated in order to gain an understanding of a client (Matthews & Bouwer, 2013). A further need for the training in cultural influences on the projective procedure, as well as the use of cultural interviewing which should enhance within the assessment process (Matthews & Bouwer, 2013).

A study conducted by Moletsane and Eloff (2006) where the Rorschach was administered on black South African learners resulted in the adjustment of procedures when administering the Rorschach Comprehensive System (TRACS). Other research includes the use of projective techniques such as the KFD. Ebersöhn, Eloff, Finestone, van Dullemen, Sikkema and Durham (2012) conducted a study on the use of the KFD to measure resilience in children of HIV-positive mothers. Studies done with drawing tests with South African populations showed that HFD’s and KFD’s are beneficial techniques in order to gather further understanding into family dynamics and children’s attachment patterns and emotional functioning (Douglas, 2010; Makunga & Shange, 2009).

A study done by Nomthandazo (2014) researched the challenges faced by psychologists in using current psychological assessment tool on bilingual individuals. This study concluded that there is a shortage of culturally as well as contextually appropriate assessment tools in South African context (Nomthandazo, 2014). Furthermore, findings suggest that assessment tools lack applicability on the language and context of individuals and may result in assessment results not being a true reflection. Although there are studies available on projective techniques more research on the validity, reliability and the use of these techniques in practice should be conducted.

3.2.2. Benefits and Disadvantages of Using Projective Techniques

Projective techniques are used for research, assessment, and in psychotherapy to build rapport and assess perceptions, feelings and attitudes (Bain, Amod & Gericke, 2013). It is a useful tool in assessing children’s and adolescent’s perceptions (Bain,

Amod & Gericke, 2013). Projective techniques such as storytelling and drawings are effective methods of assessment used instead of direct questioning techniques (Bain, Amod & Gericke, 2013; Catterall & Ibbotson, 2000). In research, projective techniques are useful and can be utilised in extensive varieties of research strategies and applications (Catterall & Ibbotson, 2000). Projective techniques can be useful within the clinical setting and in research; however one should be aware of some limitations and disadvantages of these techniques.

The administration, scoring and interpretation of projective techniques are time intensive (Bain, Amod & Gericke, 2013). It is argued that responses in projective techniques can reflect cultural and social awareness instead of the projection of unconscious thoughts and feelings (Catterall & Ibbotson, 2000). This aspect should be considered and professionals should be aware of this when conducting and interpreting projective techniques. Projective tests have criticized since the beginning due to the lack of adequate reliability, validity, predictive and inadequate norms (Klopfer & Taulbee, 1976; Lilienfeld, Wood, & Garb, 2000; Miller & Nickerson, 2006; Motta, Little & Tobin, 1993; Salvia & Ysseldyke, 2001). The use of projective techniques has been restricted due to an emphasis on evidence based assessment and legal aspects associated with using results from questionable assessment tools (Knoff, 2003; Mash & Hunsley, 2005; Merrell, Ervin & Gimpel, 2006; Miller & Nickerson, 2006).

The validity and reliability as well as the cross-cultural appropriateness of using projective techniques in South Africa should be kept in mind when administering and interpreting these techniques.

3.2.3 Projective techniques in practice

In a study conducted by Hojnoski, Morrison, Brown and Matthews (2006) professionals reported that they used projective techniques on an average of 10.6% in social- emotional assessments. Furthermore, 53% of professionals in a survey done by Shapiro and Heick (2004) indicated that they have used projective techniques in 4 or more of their last 10 cases. In a more recent study conducted by Oakland, Douglas and Kane (2016) revealed that there has been a decrease in the use of the Rorschach Inkblot Test and the Thematic Apperception Test over the last 24 years.

Although the use of projective techniques has decreased over the years, these studies suggest that in general, professionals still use some type of projective techniques in practice (Hojnoski, Morrison, Brown & Matthews, 2006; Piotrowski, 2015; Shapiro & Heick, 2004). A study conducted by Hojnoski, Morrison, Brown and Matthews (2006) revealed that the sentence completion projective technique, followed by the Bender- Gestalt, the HTP and KFD are the most used projective techniques in practice followed by the DAP, TAT and Rorschach (Table 3.1). While this is a study conducted over 10 years ago it is an indication that these projective techniques are still used in practice. A more recent study indicated that the Rorschach is considered the most popular projective technique, where the Human Figure drawings, sentence completion methods, and the TAT ranked among the top 15 tests (Piotrowski, 2015).

Table 3.1. Total Mention Score (TMS), Percentage of School Psychologists Using Specific Projective Techniques, and Utility Ratings for Specific Techniques

(Hojnoski, Morrison, Brown & Matthews, 2006)

Within the South African context Foxcroft, Paterson, Le Roux and Herbst (2004) conducted a study on the use of psychological assessment in practice. This study involved registration practitioners such as clinical, counselling, educational, industrial, research psychologists and psychometrist. The 20 most commonly used psychological assessments in practice is illustrated in Table 3.2 (Foxcroft, Paterson, Le Roux & Herbst., 2004). This list contains some projective techniques including the TAT, CAT, Rorschach cards, CAT-H and the CAT-S. This is evident that amongst the top 20 psychological tests used in practice projective techniques are used despite their limitations and concerns. Practitioners in this study indicated that they have limited information regarding the validity and reliability (< 40%) of the above mentioned

59 projective techniques tests (Table 3.2) (Foxcroft, Paterson, Le Roux & Herbst, 2004). Furthermore, practitioners indicated that these projective techniques need revising.

In Table 3.3 additional tests that practitioners frequently use in their work is illustrated. The Kinetic Family Drawing, Rotter Incomplete Sentences, and the Bene Anthony Family Relations Test are projective techniques that practitioners frequently use (Foxcroft, Paterson, Le Roux & Herbst., 2004). Projective techniques used in practice has raised some concerns, as they have not proven to be suitable to use with culturally or ethnically diverse populations (Lilienfeld et al., 2000).

Table 3.2. Tests that are regularly used by practitioners (total sample)

(Foxcroft, Paterson, Le Roux & Herbst., 2004)

In conclusion this study shows that even though some projective techniques that are more frequently used in South African practice there are still concerns among professionals that these techniques need to be revised and that there is limited information with regards to its validity and reliability.

Table 3.3. Additional tests that practitioners have identified that they frequently use in their work.

(Foxcroft, Paterson, Le Roux & Herbst., 2004)

According to the HPCSA Form 208 (2005) most projective techniques available and mentioned in chapter two and in Table 3.2 and Table 3.3 are not part of the HPCSA list of classified tests to use. Further concerns are that the tests listed above have not been developed or adapted within a multicultural context (Foxcroft, Paterson, Le Roux & Herbst., 2004). However, despite these limitations and concerns projective techniques are still used in South African practice. In a most recent survey conducted by the HPCSA (2017), the results show that 86.4% of educational psychologist, 80.9% of psychometrist, 69.4% of clinical psychologist and 61.3% of counselling psychologist’s main activity in practice is assessment and diagnosis. Of these professionals it was found that 72.5% of practitioners’ secondary activities to assessment and diagnosis involve emotional assessment (HPCSA, 2017). It is therefore evident that despite the criticism of projective techniques most practitioners in the different fields of psychology still largely used these techniques in the assessment process and part of the emotional assessment.

Hojnoski, Morrison, Brown and Matthews (2006) states that the use of assessments with poor psychometric properties can lead to unethical practice and can potentially put an individual at risk for misidentification, and this should be considered when an assessment measure is being selected. As a professional in practice in South Africa one should therefore be aware and consider different factors when selecting, administrating, and interpreting projective techniques.

3.3 FACTORS INFLUENCING ASSESSMENT RESULTS

Assessment measures assume that characteristics influence behaviour within multiple contexts and are therefore used to make assumptions of an individual’s behaviours (Grieve & Foxcroft, 2013). To gain a better understanding of an individual’s abilities and functioning one should take multiple factors into account that may have a direct or indirect influence on the individual. Case history is an essential step in the assessment process and should be relied on throughout the process to guide and provide information on the individual’s life events that can lead to psychological difficulties (Edwards & Young, 2013). The assessment process should therefore be conceptualised and results should be interpreted within context, including physical setting, language, culture and socioeconomic status environment (Bain, Amod & Gericke, 2013).

3.3.1 BIOLOGICAL CONTEXT

Chronological age is one of the factors that can have an effect on an individual’s test performance (Grieve & Foxcroft, 2013). Most psychological assessments are based on age groups and are developed to determine the skills, interests and characteristics based on age group norms.

3.3.2 SOCIAL CONTEXT

In South Africa, the social context of an individual can have an influence on them in various ways. Diversity in language, culture, socioeconomic status, etc. the opportunity to complete an assessment or activity in a fair manner, regardless of an individual’s culture, language or socioeconomic background tends to be near impossible.

Given South Africa’s diverse population and the apartheid history most psychological assessments were brought to Africa during the colonial era and cannot be seen as

62 indigenous to South Africa putting forward concerns regarding the validity and reliability of decisions made based on these international techniques (Bain, Amod & Gericke, 2013; Foxcroft, 2002; Moletsane, 2004). International assessments used on the South African population are problematic as the norm groups are not suitable for individual’s and assessment outcomes may be questionable (Bain, Amod & Gericke, 2013).

As guided by the Ethical Code of Professional Conduct of the Professional Board for Psychology in South Africa professionals should make an effort to ensure that both language and culturally appropriate services are provided to individuals. It is therefore essential as professional in the psychological field to be aware of the different cultural and ethnic groups to provide competent services (American Psychological Association, 2002). In the South African context, however it is not always possible due to the 11 official languages and multiple cultural backgrounds. One should therefore be aware of one’s own limitations and know when to refer to other professionals who can provide services you cannot.

3.3.2.1. Language Language is seen as the way an individual learns to organise experiences and thoughts and is at the centre of the many interdependent cognitive, affective and social factors that shape learning (Department of Basic Education, 2010). The language of an individual forms part of their background and identity (Zikalala, 2014). According to Lindon (2006), everyone has a sense of individual and family identity that arises from their own ethnic or cultural group or national background. Language is therefore seen as an important part of an individual (Zikalala, 2014) and should therefore be viewed as an important aspect of learning and developing.

In the South African context, the use of psychological assessment in particular projective techniques in an individual’s home language is limited. The goal is for all individuals to be assessed and to complete a test in their own mother language, but in the South African context this ideal is not always possible since South Africa has 11 official languages.

3.3.2.2. Culture Emotions, social interactions and behaviour differ across cultures and therefore it is essential that throughout the assessment process one should evaluate individual’s

63 responses based on appropriate cultural norms (Mesquita and Walker, 2003). Given South Africa’s history, psychological assessments were developed based on racial groups resulting in few assessment measures that are appropriate for all South Africans and throughout the years’ professionals have used assessment measures that are normed on US or European samples (Bain, Amod & Gericke, 2013). Based on this, projective techniques cannot be viewed as culturally fair (Foxcroft, Paterson, Le Roux & Herbst, 2004) and caution should be used when interpreting results (Bain, Amod & Gericke, 2013) to ensure that all cultural aspects of an individual is considered. According to the HPCSA cultural factors may have an influence on a psychologist’s judgement or reduce the accuracy of interpretations (HPCSA, 2004). One should therefore gain a sense of balance between understanding cultural norms and understanding to what extent these norms may influence the individual (Fisher, Doyon, Saldaña & Allen, 2007). Culturally competent assessments should ensure that all factors, including cultural factors and/or lack of educational opportunities are considered and do not influence an individual’s school performance (Fisher, Doyon, Saldaña & Allen, 2007). Although there are still continuing debates regarding the validity and cultural appropriateness of assessment measures professionals continue to find projective techniques useful (Bain, Amod & Gericke, 2013; Foxcroft, Paterson, Le Roux & Herbst, 2004).

Socioeconomic status on the other hand can also have an influence on the assessment results and should be considered when conducting, interpreting and reporting on assessments. In a study it was concluded that responses on the TAT was affected based on individual’s socioeconomic standing (Ehrenreich, 1990) and therefore highlights the importance of taking culture and socioeconomic status into account when conducting projective techniques. In South Africa, the increase of Westernisation and urbanisation leads to individuals adopting beliefs and norms of various cultures resulting in difficulty interpreting results (Bain, Amod & Gericke, 2013).

Given the multicultural diversity of the South African, professionals face challenges relating to performing assessments on individuals from different cultural backgrounds (Foxcroft, Paterson, Le Roux & Herbst, 2004). A study conducted by Foxcroft, Paterson, Le Roux and Herbst (2004) revealed that 65.8% of participants felt that assessment tests used in practice is only sometimes appropriate for cross-cultural use while 11% felt that none of the tests used in practice is appropriate for cross-cultural

64 use (Table 3.4). Furthermore, the study revealed that half of the participants felt that they need more training in the use, adaption and interpretation of cross-cultural tests and 58% of participants indicated that more culturally appropriate tests are needed (Foxcroft, Paterson, Le Roux & Herbst, 2004).

Table 3.4. Cross-cultural test use by practitioners.

(Foxcroft, Paterson, Le Roux & Herbst, 2004).

Although professionals in South Africa use outdated test and tests that is not appropriate for use on cross-cultural diverse individuals, they still feel that more training and culturally appropriate tests is needed in practice. There is a great demand for adapting and developing test measures for the multicultural and multilingual South Africa population to ensure all test takers to have valid and reliable test result (De Kock, Kanjee, & Foxcroft, 2013).

3.3.2.3. Bronfenbrenner’s bio-ecological model

Bronfenbrenner’s bio-ecological model of development forms part of the social ecological model examining the relationships between the developments of the individual within their social context (Donald, Lazarus & Lolwana, 2010) The bio- ecological model consists of different systems that interact throughout a child’s development (Donald, Lazarus & Lolwana, 2010). These systems should be included in the assessment process. To gain a holistic view of an individual it is essential to consider all systems that can influence an individual, especially within the multicultural diverse population of South Africa.

3.3.3. METHODOLOGICAL FACTORS

Various biological and/or social factors can influence assessment results, however the assessment process plays an important part and can be influenced by several factors. Sattler (2014) provides assessment guidelines that can be used in the assessment

65 process to ensure effective and reliable test results. Throughout the assessment process, attention should be paid to the administration of tests, the examiners influence, interpretation of results, test bias and case conceptualisation.

3.3.3.1. Test administration and testing environment

As a professional before conducting any assessment with an individual it is essential that a strong client-counsellor rapport be established for possible anxiety and stress to be reduced and to ensure that the performance will result in valid results (Griessel, Jansen & Stoud, 2013; Gumbiner, 2002). The environment in which the testing takes place plays a vital role in the assessment process. As a professional, one must have patience, warmth, empathy, understanding and respect and the willingness to work under conditions that might be less favourable (Ferreira, 2004; Sattler, 2001). Furthermore, the testing environment should make the individual feel safe and comfortable and where the parents or guardians feel welcome (Orton, 1997).

Sattler (2014) looks at process where an examiner must have self-awareness to ensure that the attitude towards an individual does not affect the testing and to avoid any possible form of bias against an individual. To ensure good assessment practices Griessel, Jansen and Stoud (2013) recommend that a professional prepare for all assessment sessions (Figure 3.1). The following steps are recommended:

9. Obtain informed consent

8. Plan orientation 1. Select measure for procedures test battery

7. Plan how to 2. Check assessment address linguistic material and factors PREPARATION Duties prior to assessment equipment administration session

6. Plan the sequence of assessment meausres 3. Become familiar with and the length of assessment measures assessment sessions and instructions

5. Check personal circumstances of 4. Check assessment test-taker conditions

Figure 3.1. Preparation prior to the assessment process (Adapted from Griessel, Jansen & Stoud (2013, pp. 134)).

Most Psychological assessments have standardised assessment procedures and should be adhered to, to ensure valid assessment results. In a diverse South African context, however minor adjustments and flexibility of assessment procedures is necessary (Grieve & Foxcroft, 2013). Care needs to be taken when adjustments are made to an assessment process and should be done in accordance to an individual’s needs and should be justified (Grieve & Foxcroft, 2013). As stated by the HPCSA Form 223:

A psychologist who performs interventions or administers, scores, interprets or uses assessment methods shall make every effort to identify situations in which particular assessment methods or norms may not be applicable or may require adjustment in administration, scoring and interpretation because of factors such as age, belief, birth, colour, conscience, culture, disability, disease, ethnic or social origin, gender, language, marital status, pregnancy, race, religion, sexual orientation or socioeconomic status (HPCSA, 2006, p. 31).

Changes to standardised assessments, however, should be noted in writing and taken into consideration during interpretations (Grieve & Foxcroft, 2013). Fair assessment procedures should however be ensured through the appropriate, ethical and fair use of assessment measures, taking the needs and rights of the test taker into account and considering the social and cultural context and how this may affect the assessment results and interpretations (Foxcroft, Roodt & Abrahams, 2013).

3.3.3.2. Training

The lack of validity in projective techniques may result from inadequate training at college and university level, resulting in the improper or superficial use of these techniques (Miller & Nickerson, 2006). According to Van de Vijver & Tanzer (2004) training in the administration and interpretation of tests is essential to reduce the risk of method bias. Training therefore plays a vital role in the assessment process.

In South Africa, most Universities that offer Master’s courses in different psychological fields that train practitioners in the theoretical foundations, administration, scoring and interpretation, clinical uses and the diagnostic indicators of projective techniques (Bain, Amod & Gericke, 2013). However, in a survey conducted by Foxcroft, Paterson, Le Roux & Herbst (2004), professionals using projective techniques within South Africa have voiced concerns about the level of training received in projective techniques.

This raised concerns regarding training opportunities and development of skills that are available in South Africa.

3.3.3.3. Status of the test-taker and influence of the assessment practitioner The influence of the assessment practitioner plays just as important role as the testing environment and administration of an assessment. One should be aware of the influence that a professional may have on an individual during the testing process. To ensure a more ethical and methodologically sound approach to projective techniques one should be aware of and acknowledge this influence (Bain, Amod & Gericke, 2013). This includes being aware of how a difference in culture and language can influence the understanding of instructions or influence the ability for an individual to express himself clearly. Establishing rapport before conducting projective techniques may reduce this tester effect (Bain, Amod & Gericke, 2013).

Building rapport ensures a warm, comfortable atmosphere brings about cooperation and motivates the examinee (Gregory, 2015). Anxiety, passive-aggressive non- cooperation or open hostility reactions may be the result if rapport is not established (Gregory, 2015). Furthermore, a failure to establish rapport may lead to misrepresentation of test finding, underestimated measures of ability and misjudgement of personality.

3.3.3.4. Bias

In South Africa, psychological assessment cannot be parted from the country's political, economic, and social history (Meiring, 2007) nevertheless the South African law, requires professionals to be proactively involved to ensure that assessments are fair and unbiased (Van de Vijver & Rothmann, 2004).

Bias occurs when there is a difference between the scores of indicators of a theory with those in the underlying ability (De Kock, Kanjee & Foxcroft, 2013; Meiring, 2007). According to Meiring (2007) internal bias refers to the presence of those factors that play a different role within different cultures and three types of internal bias is identified (Table 3.5 and Table 3.6) (1) construct bias, (2) method bias and (3) item bias.

Table 3.5. Types of Bias

(Meiring, 2007)

Method bias occurs through various methodological factors and includes sample bias, instrument bias, and administration bias (Meiring, 2007). During the administration of projective techniques, administration bias may occur where language differences can cause communication difficulties during the testing process (Van de Vijver & Tanzer, 2004).

Table 3.6. Sources of bias in cross-cultural assessment.

(Van de Vijver & Rothmann, 2004, pp. 3)

Tester effect is another form of administration bias and can occur when an individual’s behaviour is influenced through being in the company of someone from a different culture (Bain, Amod & Gericke, 2013). Within the South African context and history of Apartheid and racial tension this aspect should be carefully considered and one should be aware of the implications of this during the testing process and influence this may have on the test results (Bain, Amod & Gericke, 2013; Foxcroft, Roodt & Abrahams, 2001).

Additionally, bias can occur in cross-cultural testing situations where the examiner may not understand aspects of an individual’s culture resulting in ethnocentric interpretations (Bain, Amod & Gericke, 2013). Table 3.6 provides some sources of bias that occurs in cross-cultural assessment. As a professional one, should therefore be aware of bias within the assessment process.

3.3.3.5. Interpreting patterns in test scores

Projective techniques can be analysed and interpreted in various ways through objective approaches, content analysis and/or subjective interpretive approaches (Bain, Amod & Gericke, 2013). Subjective interpretations of projective techniques are problematic in terms of their validity and reliability as results may differ each time it is administered to the same individual or depending on who interprets the results (Bain, Amod & Gericke, 2013). Objective approaches are therefore a more reliable method as it uses set scoring systems and is recommended to achieve adequate reliability and validity.

Although there are various concerns regarding the validity of projective techniques, professionals continue to rely on these techniques in the clinical setting. However, one should be sensitive to developmental trends, cultural and other factors that may have an influence on the results and performance of an individual. Therefore, two methods of analysing and interpreting projective techniques; content analysis approach (Mostyn, 1985) and the interpretive approach (Durgee, 1988) are used to examine the content to identify themes/categories (Catterall & Ibbotson, 2000). All aspects of an individual should be considered when assessment results are interpreted. It is important to gain a holistic view of an individual and the process of case conceptualisation plays an essential role to ensure this.

3.4 INTEGRATED APPROACH TO PROJECTIVE TECHNIQUES

Gathering information from various sources of assessments, both informal and formal across different settings from multiple informants (parents, teachers, learners), ensures reliable, valid, and comprehensive assessment results (McConaughy & Ritter, 2002; Miller & Nickerson, 2006). Assessment methods such as interviews,

71 observations and informal report measures are more acceptable and useful tools when assessing emotional and behavioural difficulties (Cheramie, Griffin, & Morgan, 2000; Eckert, Hintze, & Shapiro, 1997).

Foxcroft (2002; 2011) suggests adopting an emic approach to testing where the thoughts and behaviour of an individual are observed by means of a set criteria relevant to a set culture. Given the current debates and the questionability of the use of projective techniques in the South African context, it is essential for professionals to approach the use of projective techniques in such a way that it is still ethically respectful and produce methodologically sound results (Bain, Amod & Gericke, 2013; Sattler, 2001; Sattler, 2014). This can be done by being aware of the limitations that projective techniques pose with cross-cultural use and gaining a thorough understanding of an individual’s social and cultural context (Bain, Amod & Gericke, 2013). The risk of construct and method bias can be reduced in assessment through gaining knowledge of the culture and language of an individual (Van de Vijver & Tanzer, 2004). Community and family genograms are also a useful tool to gather information with regards to cultural and other aspects that may have an influence on an individual and family (Ivey, Ivey & Simek-Morgan,1997).

It would therefore be recommended that projective techniques be used as a way to build rapport and develop a hypothesis without drawing conclusions about an individual’s social and emotional functioning (Fisher, Doyon, Saldaña & Allen, 2007; Garb, Wood, Lillienfeld, & Nezworksi, 2002; Miller & Nickerson, 2006). These techniques should be used to gain a better understanding of an individual instead of assessing for diagnostic purposes (Lerner, 2000). Furthermore, projective techniques should not be used in isolation, but should be used as part of the assessment process to understand an individual in their context through their history and responses to other assessments (Bain, Amod & Gericke, 2013).

3.4.1. Initial Assessment and Consultation (IAC) Procedure

In South Africa, more conventional assessment techniques focus on the individual’s pathology and deficits (Warburton, 2008). The IAC approach embodies a shift from a pathology orientation towards a more interactional, holistic problem-solving approach

72 within the assessment process (Dangor, 1983). The IAC approach incorporates an ecosystemic theory, where the participation of the family and significant others is essential in both the assessment process and the intervention plan (Warburton, 2008). Therefore, the IAC approach offers a more empowering, interactive option than traditional assessment (Amod, 2003; Warburton, 2008). Furthermore, the IAC framework uses various assessment techniques including dynamic assessment, assessment through instruction and assessment through counselling (Warburton, 2008).

Multiple research studies have been conducted on the IAC model and have concluded that this model is appropriate and useful assessment approach across cultural groups (Adelman & Taylor, 1979; Amod, 2003; Amod, Lynn & Fridjhon, 2000; Amod, Skuy, Sonderup & Fridjhon, 2000; Dangor, 1983; Manala, 2001; Skuy, Westaway & Hickson, 1986; Sonderup, 1998; Warburton, 2008). These studies include research done within the South African context and it has been established that this model is useful especially within the diverse South Africa context.

Figure 3.2. A Summary of the Initial Assessment and Consultation (IAC) Procedure (Warburton, 2008).

3.4.2. Case Conceptualisation

During the assessment process, it is essential to gather some background and family information to get a better understanding of the individual’s dynamics. There are two effective ways of gathering background information, firstly one can construct a genogram (Figure 3.2) which illustrates an individual’s family dynamics.

A genogram is a pictorial diagram of a family using data gathered during a semi structured interview to assess for various elements of family functioning, such as conflict, cut off, enmeshment, and other family relationship patterns (Platt & Skowron, 2013, pp. 35).

Figure 3.3. Example genogram (Waters, Watson & Wetzel, 1994).

Today, the genogram interview is used within the clinical setting, although it has some downsides such as limited standardisation and a limited theoretical foundation (Platt & Skowron, 2013). However, it is a useful tool in the assessment process to gather and gain a more holistic view.

A second method is case conceptualisation, which is the process of gathering holistic information relating to an individual from various sources, including interviews, medical and school reports as well as assessment results to develop an effective intervention plan (Henderson & Andrés, 2014). An individual’s cultural origin, identity, language, socioeconomic status, environmental needs, and all aspects that have an influence on the individual should be considered when conceptualising a case (Henderson & Andrés, 2014). Furthermore, as a professional one should keep one’s scope of practice, code of conduct in mind during this process.

3.5 CONCLUSION

In South Africa, the use of projective techniques in practice and research is still used widely, despite the criticism related to these techniques and their appropriateness in the diverse population of South Africa. There are various factors that can influence the results of assessments and as a professional working within a diverse South African context, one should be aware of these factors. Therefore, it can be suggested that all aspects of an individual should be taken into account when administering, interpreting and conceptualising assessment results.

Based on the literature reviewed in chapter one, two and three recommendations can be made when administering and interpreting projective techniques. These recommendations will be discussed in the next chapter.

CHAPTER 4 CONCLUSION AND RECOMMENDATIONS

4.1. INTRODUCTION

The focus of this study was to review projective techniques within the South African context. The aims of this research study were to (1) determine what projective techniques are available within the South African context, (2) report on availability of projective testing within the South African context, (3) report on factors that may influence projective techniques and their results, (4) provide recommendations for the use of projective technique in South Africa.

Chapter one focused on the background and context of the study as well as Sattler’s assessment process and guidelines. In chapter two types of projective techniques were discussed. Chapter three discussed projective technique in the South African context along with the factors that influence assessment results.

This chapter focuses on interpreting the main themes, which emerged from the literature relating to projective techniques in the South Africa context. The main findings of each of these themes will be briefly discussed and the literature reviewed in chapter two and chapter three as well as additional literature will be discussed in relation to the themes. Lastly, the limitations of the research will be discussed as well as recommendations based on the findings for educational psychologists, and for future research.

4.2. EMERGING THEMES

During the literature review the main themes that emerged from the literature in terms of projective techniques within the South African context include:

Projective techniques in South Africa

Limited research of Non appropriateness projective techniques of projective in South African techniques in South context African context

Language and Culture

Test development and adaptations

Figure 4.1. Emerging Themes

4.2.1 Limited research of projective techniques in South African context

Throughout this research study it was evident that there is limited current research available on projective techniques both internationally and within the South African context. In chapter two types of projective techniques were discussed and based on the literature that was available it is apparent that most research on projective techniques are more than twenty years old and based on the original test development. There was very limited research on projective techniques and its suitability on different population groups and most of the projective techniques discussed in chapter two had no recent research available. It was evident from the literature available that most projective techniques are outdated and no new development or research has been conducted. With this in mind, one can argue the appropriateness of these projective techniques on a diverse population such as South Africa.

Although there are some studies that have been conducted on projective techniques in the South African context, these have been on small scale and additional research needs to still be conducted. Furthermore, to my knowledge there are no current mass studies and research on projective techniques in the South African context. This poses a problem as practitioners in South Africa still make use of projective techniques in the assessment and therapeutic process. As discussed in chapter three Foxcroft, Paterson, Le Roux and Herbst (2004) conducted a study on psychological assessments in South Africa. In this study is was evident that projective techniques such as the TAT, CAT, Rorschach cards, Kinetic Family Drawing, Rotter Incomplete Sentences, and the Bene Anthony Family Relations Test are still used in practice. However, as discussed in previous chapters these techniques are outdated and limited research have been conducted concerning the use of projective techniques in South Africa.

Research on psychological assessment including projective techniques that are available have been published in textbooks, international as well as South African conferences and journals. There have been a few research studies and University Dissertations that focuses on projective techniques however these were minor research studies. Therefore, the need for further research on projective techniques in South Africa is crucial.

Although there has been research conducted on psychological assessments in South Africa, local South African research have gained momentum since 2004 (Laher and Cockcroft, 2014). There are multiple studies available on cognitive assessments in the South African context such as studies done on the Junior South African Individual Scales (Blake, 2012; Bouwer, 2014; Mareana, 2014; Mawila, 2013; Mdluli, 2011; Naicker, 2013; Teixeira, 2012; Tsakani, 2013), the Raven’s Progressive Matrices (Caffarra, Vezzadini, Zonato, Copelli & Venneri, 2003; Crawford-Nutt, 1976; Freeman, 1984; Israel, 2006; Notcutt, 1949-50; Owen, 1992; Rushton & Skuy, 2000; Rushton, Skuy & Bons, 2004; Rushton, Skuy & Fridjhon, 2002) as well as the Fourth Edition (WISC-IV) and the Wechsler Intelligence Scales for Adults, Third Edition (WAIS-III) (Foxcroft & Aston, 2006; Nell, 1994; Shuttleworth-Edwards, Gaylard & Radloff, 2013; Shuttleworth-Edwards, van der Merwe, van Tonder & Radloff, 2013).

However, obtaining relevant and current research on projective techniques in South Africa was a challenge throughout this research study. As discussed in chapter three some studies were available with regards to projective techniques. A study conducted by Moletsane and Eloff (2006) resulted in the adjustment of procedures when administering the Rorschach Comprehensive System (TRACS). Other studies made use of the KFD and the HFD to measure resilience in children of HIV-positive mothers, family dynamics and children’s attachment patterns (Ebersöhn, Eloff, Finestone, van Dullemen, Sikkema and Durham; 2012; Douglas, 2010; Makunga & Shange, 2009).

Studies done by Matthews and Bouwer (2009; 2013) researched the TAT projective technique with South African adolescents that lead to the development of the dynamic assessment (DA) as well as explored cultural barriers in projective assessments.

Nomthandazo (2014) researched the challenges faced by psychologists in using current psychological assessment tool on bilingual individuals. Although this research study was not directly focused on projective techniques it provided beneficial information with regards to recommendations and limitations of assessment tools in the South African context.

Based on the literature available and discussions done within this research study it is evident that there is limited research available on projective techniques within the South African context. It is therefore essential that more research be conducted on projective techniques and the suitability of these techniques on the diverse population groups.

4.2.2. Non-appropriateness of projective techniques in South African context

As a student educational psychologist working at a special needs school it has become evident that most psychological assessments that are available are not suited for learners from all diversities. Having done multiple assessment and therapy cases during my practicum it is apparent that each case should be conducted in a unique way. In my school, there are learners from different cultural backgrounds, social economic backgrounds, language, etc. Through my Master’s course, practical experience and research, it is clear that most assessment tools are old and outdated and not appropriate to use on all populations.

In chapter two and chapter three the different types of projective techniques were discussed as well as projective technique in the South African context. It was evident in the literature that projective techniques are outdated and use norms that are not applicable to most populations today. However, through research it is clear that although the use of projective techniques has decreased over the years, projective techniques are still used in practice (Hojnoski, Morrison, Brown & Matthews, 2006; Shapiro & Heick, 2004). As discussed in chapter two, South African registered professionals including clinical, counselling, educational, industrial and research psychologists and psychometrist still use psychological assessments including some projective techniques in practice despite having limited information on the validity and reliability of the tests and the fact that these tests have not been developed or adapted within multicultural contexts (Foxcroft, Paterson, Le Roux & Herbst., 2004).

Projective techniques have been criticised since the beginning due to the lack of adequate reliability, validity, predictive and inadequate norms (Klopfer & Taulbee, 1976; Lilienfeld, Wood, & Garb, 2000; Miller & Nickerson, 2006; Motta, Little & Tobin, 1993; Salvia & Ysseldyke, 2001). However, despite their limitations and disadvantages they can be useful within the clinical setting and in research. Since current standardised psychological assessments including projective testing that are used in South Africa, are mostly based on western norm it unfortunately excludes most of the South African population, which can result in inaccurate and invalid test results. Furthermore, projective techniques used within the South African context excludes majority of the population. Despite all these disadvantages and concerns around the use of projective techniques in a South African context, these techniques are still considered a useful tool in providing baseline information in order to guide training, support and psychological interventions (Abrahams, Foxcroft, & Roodt, 2013).

As noted throughout this study it is evident that there should be a focus on developing new projective assessment material which includes and is more suited for the diverse South African population. However, as discussed in chapter one the development of new test material and the adaptation of existing tests comes with its own challenges as the development of tests is a very complex and costly process that is very time consuming (Foxcroft, Paterson, Le Roux and Herbst, 2004; Foxcroft, 2013).

4.2.2.1. Test development and adaptations

The limited availability of projective techniques in South Africa limits professionals from gathering information during the therapeutic or assessment process. As discussed in chapter three projective techniques are still used in South Africa despite the limited research, inappropriate norms and validity of these tests. This was confirmed by Nomthandazo (2014) as she discusses the scarcity and outdated use of psychological assessment tools in South Africa. Ideally, the development and adaption of projective techniques to suite the South African population is needed in order to ensure the reliability and validity of assessment results.

South Africa is a multicultural and multilingual society, and thus there is need for the adaption and development of assessment measures (Reiff, 1997). However, the multicultural South Africa is considered challenging for psychometric test development due to factors, discussed in chapter 3, such as language, culture, socio-economic status, test environment, bias, etc. can have an influence on test performances (Amod, 2003, Foxcroft, Paterson, Le Roux & Herbst, 2004; Foxcroft, Roodt & Abrahams, 2013; Reiff 1997; Swanepoel & Krüger, 2011; Warburton, 2008). It is therefore necessary for development in projective techniques within the South African context. The application of traditional assessment including projective techniques on individuals from diverse backgrounds may be unfair to certain groups of the population (Seabi, 2007; Warburton, 2008).

According to Foxcroft, Paterson, le Roux and Herbst (2004), in order for psychological assessment procedures within South Africa to be ethical and culturally sound they need thorough, large-scale development, adaptation as well as test revision. Although there have been significant attempts made within the last 15 to 20 years to develop more appropriate assessment methods in order to limit the disadvantaging and excluding of portions of the South African population, this is however a complex and challenging process (Laher & Cockcroft, 2013). Due to the international test market and the restructuring of the Human Science Research Council (HSRC) there have been limited local test developments in South Africa, limiting fair and reliable standardisation of psychological and projective tests that are appropriate for local populations (Laher & Cockcroft, 2014). These standardised tests would not only

82 provide valid and reliable assessment results but would be able useful on populations where Western methods do not apply.

Although there has been some development regarding psychological assessment in the South African, these assessments are still doubted in terms of their suitability on the population (Laher & Cockcroft, 2014). There have been numerous attempts to develop more suitable methods of assessments that exclude and disadvantage parts of the South African population (Laher & Cockcroft, 2014).

Some development and adaptations in South Africa include cognitive assessments such as the Wechsler Intelligence Scales for Children, Fourth Edition (WISC-IV) and the Wechsler Intelligence Scales for Adults, Third Edition (WAIS-III) (Foxcroft & Aston, 2006; Nell, 1994; Shuttleworth-Edwards, Gaylard & Radloff, 2013; Shuttleworth- Edwards, van der Merwe, van Tonder & Radloff, 2013). Other adaptations include the clinical self-report measures of depression, alcohol use and post-traumatic stress disorder, for a Xhosa speaking population (Smit, Van den Berg, Bekker, Seedat & Stein, 2006) as well as some development of Academic assessments. However, with regards to projective techniques there have been limited development and adaptations within the South African context.

The limited research and certainty regarding the validity and culturally inappropriate tests used in South Africa have been recognised by the South African Professional Board for Psychology and over the year’s research on cultural bias has been encouraged in order to make needed adaptations (HPCSA, 2005; Matthews & Bouwer, 2009). However, test development and adaptions poses its own difficulties as discussed in chapter one. The process of research, adaptions and development on psychological assessment including projective test to ensure that the assessment tools are appropriate on the South African population can be a time consuming and costly process.

From the investigation conducted on past and current literature and research on projective techniques very few projective techniques will be suitable for the South African population. Therefore, the following recommendations should be kept in mind in order to ensure the appropriateness of these assessment techniques within the assessment process. Factors such as language and culture, gender and age, race, socio-economic status and educational background, environmental factors should be 83 considered when evaluating and development of cross-cultural psychological assessments (Paterson & Uys, 2005).

4.2.2.2. Language and culture

South Africa with its multilingual, multicultural population poses much difficulty for professionals in the field of psychology especially in the assessment process. Although there are some assessment tools available in different languages that can be applicable on some South African population groups however, there was limited information, research and appropriate norms available when conducting this research study. This poses difficulty in terms of availability of projective techniques within the South African context.

In a study conducted by Paterson and Uys (2005) on psychological tests in the South African workplace participants had two views on the language of assessment within the workplace. Firstly, it was felt that individuals should respond to psychological assessments in English as this is the main global language used in business and a barrier in English may have a negative impact on an individual’s performance at work and therefore they should be able to converse fluently in English (Paterson & Uys, 2005).

On the other hand, participants argued that individuals may perform badly due to not being fluent in the assessment language and this is however not a true reflection of their abilities (Paterson & Uys, 2005). Furthermore, the assessment tool is unable to provide accurate information and individuals should not stop individuals from benefiting from psychological assessments.

These views are challenging in the South African context and with the diversity in languages in South Africa one can argue that language does have an influence on assessment results. As stated by Paterson and Uys (2005) language can be pose challenges in terms of the language an assessment is constructed in, the level of difficulty of the assessment language as well as the language competency of an individual taking the assessment. These aspects should be taken into account when an individual is being assessed. Therefore, it is essential to ensure that the assessment result is a true reflection of an individual’s ability and not a reflection of

84 their competency in the assessment’s language (Foxcroft, 2004). One can ask the question of how language can be transformed in psychological testing to ensure the appropriateness within the South African context.

In South Africa, the influence of language on assessments plays a significant role and one should bear in mind that the translation of an assessment tool is not the answer when it comes to the use of these assessments across different cultures. Test translation may create the difficulty of losing the meaning of test questions and instructions (De Kock, Kanjee, & Foxcroft, 2013).

A solution to language difficulties in psychological assessment can lead to the utilisation of non-verbal assessment measures (Paterson & Uys, 2005). According to Highhouse (2002) there are negative attitudes towards standard psychometric assessments, which have increased the use of projective techniques. Although projective technique can provide opportunities for more objective response within the multilingual South Africa projective techniques can pose as problematic as individual’s response at times must be translated affecting the accuracy and validity of the responses.

In personality and projective techniques, the cultural context of an individual can affect their performance and results as concepts have different meanings and are experienced differently across cultures (Paterson & Uys, 2005). Hence one should keep in mind how item bias and validity of these measures differ across cultures. Current projective techniques are culture-bound and interpretations of responses differ across cultures.

As argued by Catterall and Ibbotson (2000) responses in projective techniques can reflect cultural and social awareness instead of the projection of unconscious thoughts and feelings therefore in a diverse South African context one should question whether responses in projective techniques are a true reflection of an individual’s thoughts and feeling. Although the flaws in standardised psychological projective testing, tests can be seen as culturally appropriate when they are used in an ethical and fair way by a trained practitioner in combination with multiple processes and methods of gaining information which will ensure more valid, reliable and cost effective results (Abrahams, Foxcroft, & Roodt, 2013).

4.3 RECOMMENDATIONS

It is evident from this research study, that there are multiple disadvantages to the use of projective techniques on the South African population. These disadvantages include old outdated projective assessment tools, limited research, inappropriate norms, language and cultural challenges, etc. Based on the emerging themes and the literature that was reviewed in chapter one, two and three the following recommendations can be made.

Firstly, the limited research that is available on projective techniques can be seen as challenging as it limits one’s knowledge and decrease the appropriateness of these techniques. It is therefore recommended that more research with regards to projective techniques and its cross-cultural appropriateness within South Africa be conducted. Further investigations on individual informal and standardised projective techniques as well as their appropriateness on the South African population are recommended. Although there have been multiple small and large-scale research and investigations done, there are still not sufficient research available within the South African context. Within the Universities research, dissertations and articles are produced every year however this is done on small scale and does not address the current difficulties. The process of research and investigations are time consuming and costly which also affects the type of research being produced at this stage.

Furthermore, current projective techniques should be developed and adapted in order to provide valid and reliable test results. Factors such as language and culture, gender and age, race, socio-economic status and educational background, environmental factors should be considered when evaluating and developing cross-cultural psychological assessments (Paterson & Uys, 2005). Although this is costly and time consuming as discussed in chapter one, there could be a greater focus on research and studies that can be conducted on University level in order to address these limitations. This brings out the question of what to do in the meantime?

Given current debates and the questionability of the use of projective techniques in the South African context it is essential for professionals to approach the use of projective techniques in such a way that it is still ethically respectful and produce comprehensive results (Bain, Amod & Gericke, 2013). A holistic assessment process should be conducted when administering projective techniques on the South African population. 86

It is suggested that a dynamic assessment approach should be implemented to ensure equity in testing (Laher & Cockcroft, 2014). This approach is rooted in Vygotsky’s socio-cultural theory that believes an individual develops through their interactions with family, carers, peers and teachers, etc. This process incorporates information from all different aspects of an individual (Vygotsky, 1986). This theory links with Bronfenbrenner’s bio-ecological theory, discussed in chapter one, where an individual is influenced by different systems both directly and indirectly (Donald et al., 2010). Therefore, one can see how valuable it is to gather a holistic view of an individual during the therapeutic and assessment process.

Another approach as discussed in chapter three that is found more valid within the South African context is the Initial Assessment Consultation (IAC) approach where collaboration with parents, caregivers, teachers and other professionals is essential in order to empower individuals and their family and facilitate learning (Amod, 2013; Warburton, 2008). The IAC model incorporates an ecosystemic and holistic approach to projective techniques and can be seen as an appropriate framework within the South African context (Warburton, 2008). In combination with these approaches Ivey, Ivey and Simek-Morgan (1997) also recommends utilising community and family genograms. Furthermore, utilising Sattler’s eleven steps in the assessment process as discussed in chapter one includes the gathering of background information from all relevant parties.

Lastly, projective techniques should not be used in isolation but should be used as part of the assessment process to understand an individual in their context through their history and responses to other assessments (Bain, Amod & Gericke, 2013). By using Satter’s guidelines and eleven steps as well as Bronfenbrenner’s bio-ecological systems theory one can gain an overview of an individual which with assessment results can provide accurate and reliable results.

To illustrate, working in a LSEN school environment the background history and systems that play a role in a child’s life are important aspects to keep in mind and explore when conducting therapy or assessment. In order to gain a holistic view of a child one should gather information from all parties involved including the parents or caregivers, as well as professionals at school that are involved in the child’s life directly. Gathering information from both parents, other professionals and teachers

87 enables one to pick up themes and patterns. Furthermore, different systems that may influence a child should be explored and investigated. For example, a learner in grade four is struggling to concentrate in class and based on the teacher’s feedback the learner is daydreaming, not paying attention and struggling to cope with the work done in class. Based on classroom observation and evidence in the learner’s books it is evident that the learner is struggling to complete the work in class, his work is incomplete and untidy and he does not participate in classroom activities. These behaviours were described by the parents during interview process. Based on all the information gathered a theme could be identified. However looking at the systems theory discussed in chapter one it became clear that the mother have lost her job and that the family is struggling financially. Although this system does not affect the learner directly, it affects the learner indirectly through the parents’ behaviour and stress and limited financial availability. Given this information and information gathered in the therapeutic process through informal interviews and projective techniques it became evident that the learner is affected by this change in the house and the stress from the parents and instead of focussing in class and concentrating on the work the learner is distracted and thinking about the home situation. It is therefore clear from this example that all aspects should be investigated in order to understand an individual. So how does this relate to the use of projective techniques in South Africa?

Current projective techniques as discussed throughout this research study are outdated and not appropriate for the South African population and therefore they should be used with caution. Due to the inappropriate norms that are not normed for the South African population, projective technique should be used qualitatively using a holistic approach through gathering relative information in order to understand the individual and possible projections. Consequently, projective techniques should never be used in isolation without considering all relevant information and investigating all aspects that may also have an effect on an individual’s current behaviour or assessment results. Therefore, it is essential to conduct projective techniques in a holistic approach, using ethical practice, valid and reliable assessment practice, and consider all contextual focus (Donald et al., 2010; Flanagan & Esquivel, 2006; Foxcroft & Roodt, 2005; Grigorenko, 2009; Hood, 2009; Murphy & Maree, 2009). Based on all the information gathered in this research study the following guidelines (Figure 4.2.)

88 can be implemented when administering projective techniques to gain holistic and reliable results.

Projective technique

Case conceptualisation Assessment Factors that influence interpretation assessment results

Sattler’s 11 steps – • Language assessment process Quantitative • Culture interpretation • Tests administration • Test environment Sattler’s pillars – Qualitative • Test bias assessment process interpretation • Training • Gender and age Validity, reliability and Bronfenbrenner bio- • Race suitability ecological model • Socio-economic status • Educational background Initial Assessment • Environmental factors, Consultation model etc

TRIANGULATION

Figure 4.2. Guidelines to administering projective techniques

Figure 4.2 illustrates all aspects discussed during this research study. These can be used as guidelines when administering and interpreting projective techniques on South African individuals in order to triangulate and gain a holistic picture of the results. When administering projective techniques, it is essential to conceptualise the case before and during the assessment. Case conceptualisation can be done by utilising multiple processes to gain a full overview of an individual. These processes include Sattler’s 11 steps and four pillars of the assessment process (Sattler, 2001, 2014), Bronfenbrenner’s bio-ecological model (Donald et al., 2010) and the IAC model (Amod, 2013; Warburton, 2008). These are the models that were discussed during this

89 research study however it is important to note that there are multiple other models that can be used when administering assessments. As discussed in detail in chapter three the factors that may have an influence on the assessment results should be taken into consideration before interpreting the results. These factors can involve biological, social and methodological factors. Thereafter the projective technique can be interpreted by making use of both quantitative and qualitative interpretations. The validity, reliability and appropriateness should also be taken into account when completing this step.

4.5. CONCLUSION

In South Africa individuals come from diverse backgrounds which can affect the results, validity and reliability of assessment measures. According to Sattler (2001; 2014) a psychologist must take aspects of ethnicity into account when working with individuals and their families. Therefore, when conducting projective techniques, one has to be aware of an individual’s background, abilities, language and cultural background in order to gain a valid and holistic view of the individual and to consider all these aspects when scoring and interpreting both informal and standardised projective techniques.

The purpose of this study was to review projective techniques in the South African context. This chapter provided a summary of the study, and discussed the findings, which emerged from the literature. It further aimed at providing recommendations based on the literature findings.

As researcher conducting this literature review it is evident that despite the criticism connected to the use of projective techniques on the South African population most practitioners still use these techniques in practice. This is confirmed by studies done by Foxcroft, Paterson, Le Roux and Herbst (2004) and the HPCSA (2017). The limited availability of appropriate tests and the limited research of these tests on the population limits practitioners. However, regardless of the drawbacks one should be aware of them and incorporate a holistic approach to assessment in order to ensure that the test results are a true reflection of an individual’s abilities.

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