In the years leading up to World War II, the Rorschach approach blossomed in Japan; many Japanese researchers and intellectuals at the time spoke German, Rorschach’s native tongue. In the 1940s and 1950s, American researchers published extensively on techniques for using the Rorschach, and the Japanese psychological community, heavily influenced then by Western clinical psychology, devoured these texts. In 1958, the Rorschachiana Japonica, a journal that presented case studies and methodologies, was launched. Today, the membership of the International Rorschach Society is 52 percent Japanese, according to Noriko Nakamura, director of the Nakamura Psychotherapy Institute and president of the society.

In the United States, meanwhile, the test was hit hard by the 2003 publication of What’s Wrong With the Rorschach?, a blistering critique that equated the methods for scoring the Rorschach to wizardry. The authors, four clinical psychologists, found the Rorschach unreliable, and its interpretation vulnerable to the administering therapist’s subjectivity. Wikipedia’s publication in 2009 of widely used ink blots further imperiled the Rorschach’s credibility, as patients who had seen the images ahead of time could not then provide truly spontaneous responses to them. But already many psychologists had abandoned Rorschach.

“A lot of times when people are coming into therapy, they already have a sense of what they want to work on,” said Kevin Meehan, an associate professor of psychology at Long Island University. “The reason patients would be given the Rorschach, as part of a larger assessment battery, is if it’s not clear why they’re struggling.”

More often, first-time patients in the United States fill out a questionnaire in which they self-report their emotional state. “A questionnaire assumes you’re aware of your feelings and that you're willing to share that,” Meehan said, which could be unpleasant for those from a culture that does not embrace direct expression. “With the Rorschach, you have no idea if you’re giving a ‘good’ or a ‘bad’ response. I could imagine that that test would be more appealing in a culture where there’s a greater need for social desirability.”

However, in Japan, the Rorschach still ranks among the most frequently administered projective tests, and is used particularly often in hospitals and psychiatric settings, Toshiki Ogawa, a clinical psychologist with the Japanese Society for the Rorschach and Projective Methods, told me. While the test is often associated with psychoanalysis in the United States, in Japan, “the Rorschach is widely used in practice, independently of doctors’ theoretical orientation,” Ogawa said. “Students who major in clinical psychology in Japan inevitably study the Rorschach—it is an obligatory subject.”

The test has broader applications in Japan, too. “The way I use the Rorschach is more behavior-based,” said Nakamura. “My job is to translate Japanese into the Rorschach language. The benefit is I can then access that patient’s psychological map.”