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You are watching: Difference between projective and objective tests

Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.


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Definition

A psychologic test is a set of stimuli administered to an individual or a group under standard conditions to obtain a sample of behavior for assessment. There are basically two kinds of tests, objective and projective. The objective test requires the respondent to make a particular response to a structured set of instructions (e.g., true/false, yes/no, or the correct answer). The projective test is given in an ambiguous context in order to afford the respondent an opportunity to impose his or her own interpretation in answering.


Technique

Psychologic tests are rarely given in isolation but as a part of a battery. This is because any one test cannot sufficiently answer the complex questions usually asked in the clinical situation. Most diagnostic questions require the assessment of personality, intelligence, and perhaps even the presence of organic involvement. A typical battery of tests includes projective tests to assess personality such as the Rorschach and the Thematic Apperception Test (TAT), an objective personality test such as the Minnesota Multiphasic Personality Inventory (MMPI), a semistructured test like the Rotter Incomplete Sentence Test, and an intelligence test, usually the Wechsler Adult Intelligence Scale Revised (WAIS-R).

The most important consideration for the physician is when to ask for psychologic assessment. As with medical diagnostic procedures, we are interested in finding answers to diagnostic questions that cannot be obtained through direct observation or interview. In our clinical experience, there are a myriad of circumstances requiring psychologic consultation either to assist in or rule out medical intervention. Some of the more typical situations include compliance, behavioral management, affirmation of clinical findings, the use of supportive drug therapies, and continuity of care issues.

Five case examples are offered to illustrate the above situations.

Mr. S. was a 35-year-old single salesman hospitalized for gastrointestinal problems associated with a previous operation. He had a history of noncompliance with both drugs and nutrition regimens. Severe debilitation would ensue following outpatient treatments, after which he would be hospitalized. This pattern repeated itself several times. Psychologic assessment data were consistent with a pattern of addictive behavior and poor coping mechanisms under stressful conditions. Recommendations included a drug rehabilitation program and stress management techniques.

Dr. L., a 68-year-old retired dentist, had severe behavioral management problems with the nursing staff. He was verbally punitive and intrusive of other patients" privacy. Psychologic assessment revealed an organic brain syndrome indicating greater individual care and a lower expectation of his performance.

A 21-year-old single male, Mr. N., was admitted for hospitalization complaining of severe stomach pains and rectal bleeding. Psychologic testing was administered because the internist could find no evidence of physical pathology. Test battery results described a young man under an inordinate amount of stress due to a huge difference between his intellectual capabilities and the demands of his work place. The recommendation was to find other employment and to work with a counselor to develop more realistic vocational goals.

Ms. C. was a middle-aged housewife complaining of panic attacks of unknown origin. She also said that she was in severe depression because of the death of her daughter 2 years previously. The clinical question was whether she should be given antidepressants or antianxiety agents as an adjunct to psychotherapeutic intervention. Test results were consistent with a state of anxiety as opposed to an affective disorder.

Ms. B. was a 23-year-old single female who was hospitalized following a drug overdose from a suicide attempt. Information was needed to determine how dangerous she was to herself, how restrictive an environment she needed for treatment, and what type of therapy was appropriate. Test results confirmed a compulsive personality with a dramatic flair. Ms. B. needed extensive individual psychotherapy but did not require lengthy hospitalization. Nevertheless, it was essential to link her with outpatient care while she was still motivated to receive care.

Although the above examples are by no means exhaustive, they do point out the variety of commonly occurring circumstances in which psychologic assessment may be useful. It is important when ordering testing to formulate the diagnostic question in as specific a manner as possible. Such requests as "describe personality dynamics" or "rule out psychologic disturbance" are too general to answer in an effective and efficient manner. Do not hesitate to ask exactly what you want to know. The psychologist will inform you if he or she is unable to answer. Use the examples described above to formulate your question: Is this patient depressed? Is this patient psychotic? Why is this patient not conforming to the treatment regimen?

When presenting a patient to a psychologist for evaluation, it is helpful to have demographic data and a detailed history of the client. Also, the description presented of the problems should be in behavioral terms. Saying that a patient appears to be depressed is not as helpful as describing him or her as having a loss of appetite, early morning rising, or slowness of speech. If the patient is a management problem, give a concrete description of what this entails: won"t go to rehabilitation therapy, won"t let a technician draw blood.

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Finally, the referring physician may request either a specific test or an abbreviated battery. While some psychologists will go along with this practice, we do not encourage it. Psychologic tests, particularly personality ones, are only as good as the skills of the individual who administers and interprets them. The psychologist must feel confident and competent in the battery that he or she administers. Therefore, the number and choice of tests should be those of the psychologist, just as the medical procedures chosen for a patient are the responsibility of the physician in charge.