SIS Journal of Projective Psychology & Mental Health

January 1998

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is published twice a year (January & July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counselling, cross cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION : Manuscripts should be typewritten (double spaced throughout) submitted in duplicate to B.L. Dubey, Ph.D. Editor- in - Chief SIS Journal, P.O.Box 1107, Sector-15 Post Office, Chandigarh 160015 (India). E-mail : sisdubey@hotmail.com Manuscript can also be submitted to Wilfred A. Cassell. M.D., Editor, 4501E, 104th Avenue, Anchorage, AK-99516 (USA). The Editors reserve the right to refuse manuscript submitted and to make minor additions/deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment. SUBSCRIPTION : The journal is free to members of the Society, Annual membership fees are US $50 for foreign members and Rs. 250, for Indian members, Institutional subscriptions are US $100 for Foreign institutions and Rs. 500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 1500 for Indian members. Non-members may subscribe for $30 or Rs. 150/- per issue. Cheques should be made payable to 'SOMATIC INKBLOT SOCIETY’ Chandigarh and should reach Dr. B.L. Dubey, Editor- in -Chief, (Address given above). Please add $5./Rs. 30 if you are sending subscription through cheque. CHANGE OF ADDRESS : Society / journal members should inform Mrs Padma Dwivedi, Secretary, SIS Center, Post Box 1107, Sector-15 Post Office, Chandigarh-160015 (India), Tel/Fax 91-172-710986, E-Mail: sisdubey@hotmail.com and Foreign Members should inform, Anand Dubey, Joint Editor, SIS Journal, Post Box 244045, Anchorage, AK-99524 (USA), E-Mail : adubey@hotmail.com of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT SOCIETY

STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : T-2/15, Sector-25 Chandigarh - 160014 PERIODICITY OF PUBLICATION : Half Yearly EDITOR'S PRINTER'S Name : Dr. B.L. Dubey PUBLISHER'S NATIONALITY : Indian ADDRESS : T-2/15, Sector 25, Chandigarh - 160015 OWNER : SOMATIC INKBLOT SOCIETY I, Dr. B.L. Dubey, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. B.L. Dubey, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Printed and Published by Dr. B.L. Dubey on behalf of Somatic Inkblot Society from T-2/15, Sector 25, Chandigarh - 160014 & Printed at Juneja Trading Agencies Pvt. Ltd. Printing Press, SCO 131-132, Sector 17-C, Chandigarh. Tel. : 702675, 704715. Editor : Dr. B.L. Dubey

SIS Journal of Projective Psychology & Mental Health Volume 5, Number 1, Jan 1998 Contents Page Nos. 1. Editorial : Somatic Inkblot Series : a Therapeutic Tool for 21st Centry Wilfred A Cassell. 1-2 2. Application of Somatic Inkblot Series in Personality 3-32 Assessment, Diagnosis , Screening and Therapy Wilfred A. Cassell and B.L. Dubey 3. An Indepth Study of Summarization in Heroin Addicts 33-39 thrugh SIS-I & Rorschach Inkblot Test. Shubhra Banerjee, Anjana Mukhopadhysy and Usha Singh 4. Piotrowski’s Alpha Index Validities with Schizophrenics 41-45 Varying in Duration of Illness S.C.Haudhary and S.G.. Jyothi 5. Use of SIS-II and Other Projective Test in the Treatment 46-50 Of a Case of Schizophrenia N.L. Dosajh 6. Re –Exemining TAT Alexithymia Indices 51-58 A Preliminary Study Seema Mehrotra 7. Projective Psychotherapy 59-62 S.K. Verma and Ashima Nehra 8. A Comparative Study of Managers and Students on SIS-II 63-68 M.P. Singh and Padma Dwivedi 9. The Somatic Inkblot Series (SIS) and Eye Movement 69-70 Desensitization and Reprocessing (EMDR) Wilfred A. Cassell

Editorial Somatic Inkblot Series : a Therapeutic Tool for 21st Century Since the original work on the Somatic Inkblot Series (SIS) method of projection begin in 1959, at attempts have been made to incorporate state of the art technology in the evolving forms of the procedure. In May of 1996, one of these was initiated with the assistance of Dr. Gilbert Roth. It involved developing a web site on the internet at http/www.owt.com/isi/. Since then, over 12,000 people have visited this site. May have contributed responses which may then be assessed by all subsequent viewers. At this time, it appears that this site has the possibility to be an important 21st century e-mail network. Given proper development, it could become an important vehicle for informing students and professionally accomplish this goal, much more time and effort must be put into optimizing the potential of this communication forum. In addition, the existing curiosity about inkblot suggest that the internet could also be developed to become a rich resource for international education, con-salutations and treatment. Consistent with this, it has been found that the vast majority of viewers have been lay people not trained in projective assessment. Yet, may have expressed considerable interest in inkblot perception as a unique way of understanding themselves and others. They are intrigued by this approach, appreciating that the SIS releases the “inner cry”. They quickly realize that the SIS approach can effectively penetrate beyond the superficial level of everyday social facades and “masks”. However, the capability to release the “inner cry” of internet viewers is like a sword that cuts both ways. On the one hand, it provides an educational opportunity for the appraisal of oneself in comparison with other internet responds. On the other hand, activation of repressed emotional images and traumatic memories in subjects who have pause unresolved grief can pose problems. While the revised internet page now includes warnings for those in treatment, along with other precautions, this remains a concern. More consultative attention needs to be given to the needs of nonprofessionals. Dr. Bankey L. Dubey has graciously offered to provide active leadership meeting the demands of both professional and nonprofessionals. In order to assist those interested in reveiving formal training and accreditation, he will set up and supervise SIS staff in coordinating and educational program. He has also agreed to coordinate international certification training for therapists who wish to incorporate the treatment versions of the SIS. The later consultative treatment program could be made available to nonprofessional internet viewers. The funds arising from the above services may be used to augment the Somatic Inkblot Society in India in its may actibvities. In association with these development highlighting the leadershop role of the Indian Society, the web page will eventually be transferred to Dr. Dubey’s location in Chandigarh. We invite input, suggestions and criticisms from all members of the society in this fascinating team project. Wilfred A. Cassell, M.D., FAPA, APC. President Somatic Inkblot Society, Director Somatic Inkblot Center, 4105, Tudor Center Drive, B-6, Anchorafge, AK-99508 (USA)

SIS J. Proj. Pst. & Ment Health (1997) 5:1, 3-32 Application of Somatic Inkblot Series in Personality Assessment, Diagnosis , Screening and Therapy Wilfred A. Cassell and B.L. Dubey Somatic Inkblot Series is the latest inkblot test. It is a structured, projective , diagnostic instrument and an adjunct to psychotherapy. It has high erectility and content validity. The series was tried on different groups of clinical and normal subjects and was found to have discriminating ability. It was also found to be a successful screening tool during selection in industry. Its reliability, validity, discriminating diagnostic ability and screening value have been emphasized in various issues of Journal of Projective Psychology and Mental Health by many researchers. The test has attracted researchers and clinicians and different parts of the world. The present paper is devoted to readers interested in understanding the Somatic Inkblot Series. In many countries, performing psycho-diagnosis is a major role of the psychologist who works in a clinical setting. Among the psychological test most frequently used inkblot techniques are the most favored. (Sunder, 1961; Hinkle, Morton, and Baker, 1978; Dubey 1982). Published in 1921, the Rorschach psycho-diagnostic test occupied a major position in the inkblot technique until 1956 when Wayne Huntsman developed his technique, to overcome some of the limitations of the Rorschach. The needs of the busy clinicians and the increasing demands for psycho-diagnosis inspired Wilfred Cassell to develop a system of inkblot technique. He uses modern video technology to make it usable as a self –administered technique. Before discussing the various limitations of existing inkblot techniques, it is worth while to tease the history of the use of inkblot procedures in psychological investigation. Existing Inkblot Tests There are three major standardized tests based on inkblots. The pioneer amongst them was the Rorschach Inkblot Test published in 1921. Use of this test to explore the subject’s psychopathology and basic personality structure is well known. A research publication by Reynolds and Sandburg (1976) ranked the Rorschach test as number one. They based their findings on Burros Mental Measure Year Book. A survey conducted on the members of The American Psychological Association Division-12, and The Indian Association of Clinical Psychologists showed concern from respondents about the limitations of the test (Wade et al 1978; Sharma, Ojha and Vagrecha, 1975; Dubey, 1982). Zubin (1965) has charged seven major failures as follows: Wilfres A. Cassell. M.D., FAPA APC, Director Somatic Inkblot Center, 4105 Tudor Center Drive, B-6, Anchorage. AK 99508 (USA) Fax (907) 563-3746. e-mail : drcassell@coreco .com and B.L. Dubey, Ph.D., DPM, FSIS., Director Somatic Inkblot Center India. P.O. Box 1107, Sector 15 Post Office, Chandigarh – 160 015 (India)Telefax : 91-172-710986, 710985, e-mail: Ssisdubey@Ch1.vsnl.net.in

1. Failure to provide an objective system, free of arbitrary conventions, and showing high inters corer agreement. 2. Lack of satisfactory internal consistency, or test-retest reliability. 3. Failure to provide cogent evidence for clinical validity. 4. Failure of the individual Rorschach scoring categories to relate to diagnosis. 5. Lack of prognostic, or predictive validity with respect to the outcome of treatment, or later behavior. 6. Individual differences between groups of normal subjects. 7. Failure to find any significant relationships between Rorschach scores and intelligence, or creative ability. In 1953, Fiske and Baughman reported that practitioners feel that the variation in the total number of responses is too much to be able to interpret the ratio scores adequately. Also, the meaning of the indices changes depending upon the length of the protocol, because the relationship between Rorschach scores and the total number of responses is complex and curvilinear. Many workers compute percentage ratio in an effort to control the length of the protocol. Holtzman (1956) pointed out that such procedures were very unsatisfactory, not only because of the non-linear relationships between R and other Rorschach’s scores, but also because of the crude, unstable and metric qualities of most Rorschach variables. Holtzman et al (1956) pointed out that much of the controversy over the Rorschach arises from the failure to distinguish between the Rorschach as a projective technique in the hands of a skilled clinician, and the Rorschach as a psychometric device, that yields scores having relevance for personality assessment. The analysis of responses to inkblots has ranged all the way from one extreme to the other of the projective psychometric continuum. Wayne Holtzman developed an inkblot test to overcome some of the limitations of the Rorschach. The main limitation of the Rorschach, as experientially determined, was the problem of variation in the length of the protocol (Fiske and Baughman, 1953; Dubey et al, 1978, 1979, 1989). As Fiske and Baughman pointed out, the relationship between Rorschach scores and the total number of responses are complex and curvilinear. Consequently, the usual effect of R linear regression methods for removing the confounding effect of R will generally fail. Dubey, (1982), in a study of 300 subjects, found that most of the Rorschach indices are dependent upon the number of responses. When the groups of Normal, Neurotics, and Schizophrenics were divided, on the basis of number of responses, into high produc- 4 Cassell & Dubey

tivity and low productivity, many indices, which were found to be significant lost their significance. It further strengthened the findings of Fiske and Baughman, and supported the intention of Holtzman. The advantage, which Holtzman introduced in his test, was to offer an alternate series of the inkblot stimuli test for reassessing the personality after some type of intervention. Holtzman provided 45 cards in each series. The subject is required to give one response per card. Holtzman categorically selected only 22 variables such as: reaction time, location, form definiteness, form appropriateness, color, shading, movement, pathogonomic verbalization, integration, human, animal, anatomy, anxiety, hostility, barrier, penetration, popular, etc. His test is said to measure almost the same aspects of personality that are measured by the Rorschach. Holtzman has clearly emphasized the psychometric approach. The Holtzman test has wide application and is popular. However, the research output is not as prolific as that of the Rorschach test. The Somatic Inkblot Series (SIS)is a recent extension of the traditional inkblot projective techniques. The test was developed specifically to understand the manifestation of problems through somatization, and to hear the suffering individual’s “inner cry.” The test images are viewed on a television using a videocassette recorder (VCR). The subject’s responses are recorded on a separate response sheet. The procedure can be done while the patient waits for his/her turn at a clinic or a hospital. In some cases where the individual has good ego strength, he procedure can be completed at home. Enough obvious anatomical structure to evoke spontaneous verbalization, but not enough to limit the responses solely to the naming of body parts or colors. In this way, obvious anatomical structure provides a feeling of security, which makes deeper and more symbolic repressed material more accessible to the person taking the procedure. The SIS provides clinicians and researchers with a new diagnostic aid for body percept assessment. It can be used to assess the depth and significance of somatic symptoms, conversion reactions, somatic delusions and sexual dysfunction. Psychoanalysis of mutilated or distorted anatomy responses can assess the possibility or level of castration anxiety (Cassell, 1980). Responses depicting themes of body assault may further clarify the extent of aggressive impulses (Cassell, 1977). As a diagnostic tool, the series can help to evaluate undetected affective disorders. Kielholz (1974) referred to these as masked depression, where depressive feelings are denied during the interview and in non-projective psychological tests. The responses to inkblots might uncover body perceptual disturbances such as in catatonia, or the cognitive defects of early schizophrenia. Death anxiety in those facing major surgery, or those with a terminal illness may be signaled by excessive anatomical responses (Cassell, 1979). The Somatic Inkblot Series can be used to help design a Application of SIS Test 5

treatment program, which might include body awareness, exercises, such as physical therapy. It also may be used in other therapies, such as sensory feedback training, behavioral therapy, and desensitization for psychophysiological symptoms associated with pathological anatomy responses (Cassell, 1977). This technique has been described in the book, “Body Symbolism” (Cassell, 1980), which has been translated into Italian and published in Florence, Italy. Somatic Inkblot Series-II Booklet (62 Images) In 1980, after initial success with SIS-I, the development for SIS-II in booklet form was initiated. It consists of an A Series and a B Series, each with 31 images, for a combined series total of 62 images. There is also a sample image in the beginning. The stimulus images are printed in rectangles measuring about 5x6 cm., each with a space provided below the image for writing the response. All the images are contained in an eight-page booklet. The first seven pages consist of the stimulus images and the space for responses. The last page is printed with instructions for self-administration, and a place for a brief health history and personal data. Unlike SIS-I, it consists of images printed with blue ink on grey paper. The SIS-II can be used in a variety of ways, but was designed for self-administration after supervised instruction. Some clinicians use the booklet with the patient or to unobtrusively observe the self- administration to observe reaction times and significant verbal and nonverbal responses for each inkblot (delays, overreaction, content shock). Others prefer to allow the patient to take the booklet home and write in responses whenever they have the time to relax and review the figures (intermittent administration), or if they prefer, at one time (continuous administration). Some have found it useful to have the patient complete the test booklet before going to bed, to stimulate the unconscious to process repressed materials in dream during sleep. None of the existing inkblot tests are designed to be self-administered. Projective testing accesses information about the individual not readily available from history taking, interview, and mental status examination or from other forms of testing. It also elicits information, which is not consciously known to the patient, or reported as a problem. Usually, clinically significant, blocked material, will over-ride typical normative responses directly (manifest), or it will appear in symbolized imagery, similar to dream work (latent). Because there is no time limit, “test anxiety” is greatly reduced, and the individual is free to react in his own time, often exhibiting significant verbal and non-verbal clues to each of the inkblots. Since there is no text to read, the Somatic Inkblot Series does not require a high reading level, therefore, it is applicable to most ages, and a wide variety of cultures. In SIS-II, the subject is asked to rate the three-inkblot images that he “most liked” and the three images that he “least liked.” This inquiry invites positive or negative affectual 6 Cassell & Dubey

discharge. The subject’s emotional investment provides valuable diagnostic clues to his/her psychological function. The SIS-II can successfully identify various groups of clinical subjects, and can be used to screen out abnormal subjects from normal subjects. Somatic Inkblot Series II -Video Sometimes psychological tests are threatening. Occasionally, the subject becomes anxious or uncooperative during the testing. This is also true for projective inkblot tests. To make the procedure more interesting and dream-like, the video version of SIS-II was developed by Cassell in 1984. The subject’s interest is sustained by using light, soft music, floral presentation in the background and zoom-in and zoom-out impressions. During the experimental stages, it was observed that this innovative video technique was quite encouraging. The rejection rate dropped considerably, the subject’s interest was maintained throughout, and the exposure time of images became constant. The SIS video begins with pictures of flowers and soft background music, followed by stimulus images, one at a time. Each image stays on screen for approximately 30 seconds. Many of the images are colored, and for some, impression of movement is also created. Many of the images are sharper on screen than they are in the booklet. The background music continues up until the presentation of the sample image, and then it stops. The floral presentation, however, precedes each image. The floral presentation, with soft background music, induces the subject to relax. Since the test works as a time machine and takes the subject back in time, relaxation images are presented at the end to bring the patient back to reality. Images with human content assess the subject’s emotional maturity. For instance, image B28 represents the mother-child relationship. Clinical issues such as patienttherapist communications are represented in image B5. Suicidal-homicidal ideation is represented in images B15 and B21. Likewise various images help in assessing different areas such as interpersonal relationship, healthy body imagery, erotic imagery, self/ego strength, reality contact, hostility/aggression, insecurity etc. SIS-I Video It is video form of SIS-120 card test and was developed in 1992. All the 20 cads of SIS- I are transferred on video tape. Like SIS-II it begins with picture of flowers and soft background music followed by stimulus images one by one. It is designed for supervised sell/group administration. It takes about 30 minutes in its administration. The subject is required to writ responses on a record sheet. The subject is also asked to select 3 responses which (s) he likes the most and 3 responses which (s) he likes the least at the end of the test. Application of SIS Test 7

SIS- Living Image The test consists of 40 images and these are altogether different from those in the earlier test series. This form has primarily been tried on sexually traumatized female subjects and has been successful in processing their traumas. The test has all the characteristics of earlier tests except that it is designed particularly for female subjects. It follows the same procedure as the SIS-II and tried only individual administration Reliability and validity are concepts, which are very useful and can be arrived at statistically for psychometrically oriented objective instruments. Any projective test, however, cannot give numerical values for all of its parameters, on a single scale, and projective tests are also considered to be more of a measure of state rather than traits. Therefore, any slight difference in the environment or self can make some change in the precept or responses. Because of these limitations, the reliability and validity of projective tests are in true sense, a little difficult to determine. Nevertheless, in terms of consistency of responses, some scientific evidence is possible over a period of time, with the assumption that the time interval will not be so long that it will influence the perception of individual. Intra and inter-scorer reliability may be considered more in terms of interpretation or the concepts verbalized onto the images presented to the individual. Response Consistency In psychometric terms, it is known as score consistency. Since, in the Somatic Inkblot Series, there are no scores in true sense, we are calling it response consistency. Unlike Rorschach and similar to Holtzman, the length of the protocol does not vary considerably from one administration to another. It has been found from various sources that the agreement in total number of responses when the test is repeated after a short time was very high. The detailed response consistency was undertaken for SIS-II images on Indian subjects (Dubey and Cassell, 1993 he correlation for the content categories over a period of four weeks, on repeat testing was found to be more than .69 Split-half Reliability Split-half reliability requires splitting of the test into two equal halves. Inkblot images cannot be split into two equal halves because they are heterogeneous. The task of categorizing the test into two equal halves is theoretically not only difficult but also impossible, provided that the test is projective in its true sense. Many researchers, however, have tried to establish split-half reliability of the Rorschach test, not in terms of material, rather in terms of responses elicited on the test (Vernon, 1933; Hertz, 1934). Te split-half reliability of SIS-II and SIS-Video was established by splitting the test into two equal halves. These equal halves are the natural divisions of the test that consists of two series, A and B. Cassell, claims that the SIS is a structured projective test, where images are selected, by and large, to elicit anatomical response. Therefore, it can be assumed that it is possible that Cassell might have something in mind to develop two parallel forms. However, in view of rigorous field testing, he chose to combine both sets “A” and “B” into one single test. 8 Cassell & Dubey

Table 1 Means and Correlation between Series A and Series B (n=220) Set A Se B t r Total Responses M 36.22 32.16 6.22 0.89 SD 7.92 5.60 P=.01 Most Typical Responses M 6.49 6.21 1.92 0.51 SD 1.68 1.39 n.s Human Responses M 8.49 8.27 0.71 0.61 SD 3.59 3.08 n.s. Animal Responses M 5.52 3.63 5.79 0.71 SD 3.28 2.56 P=.01 Anatomical Responses M 5.59 4.56 3.41 0.66 SD 3..53 2.75 p=.01 Sex Responses M 2.15 1.66 2.52 0.67 SD 3.53 2.75 p=.02 Moveement Responses M 4.69 4.12 1.85 0.66 SD 3.62 2.81 n.s. Rejection of Images M 0.73 1.38 2.86 0.766 SD 1.70 2.90 P=.01 The parallel form reliability was tested on 220 subjects (100 normal, 41 schizophrenics, 39 neurotics and 40 American neurotics) cindering both set A and set B. Both the test SIS-II and SIS- Video are alternate forms. The demeans and correlation of the two sets for the Total number of responses, Human responses, Animal responses, Anatomical responses, Sex responses, Movement responses Most Typical responses, and Rejection of images are presented in Table 1. All the correlation between sets A and B of the SIS images were found to be statistically, highly significant for the eight variables considered. The lowest correlation was .51 for the “Most Typical’ responses. The highest correlation was .89 for the length of responses between sets “A” and “B.” This suggests that sets A and B may be considered as independent series for quicker assessment of the patient by the busy clinician. The two series can be used independently whenever a repeat assessment is suggested, after a short interval. Inter-scorer Reliability The same protocol was scored separately by a trained and experienced clinical psychologist, having experience with the SIS, and by a fresh psychologist who was provided with a set of definitions for the variables as reported in a subsequent chapter. It Application of SIS Test 9

was discovered that there was no difference between their two independent scorings. It can be argued that it was not a scoring, but merely a counting of the responses under different categories (Total number of responses: Human responses, Animal responses, Anatomical responses, Sex responses, Movement responses, Most Typical responses and Rejection of images). VALIDITY The validity of a psychological test is an essential characteristic that must be demonstrated beyond any doubt. Its validity can be based on theoretical assumptions, clinical experiences and its utility in the field. The division of tests into objective and projective requires different standards for measuring validity. The projective tests, such as the SIS, can not be tested for validity, like objective tests. The SIS is a method of observation and appraisal. With regards to a test that measures some aspects of personality, it is legitimate to ask, “Is it valid?”. However, in regard to a method of observation, the appropriate questions are: “Is it useful?”, “Is it productive?”, “Does it conform to some construct?”. The SIS is an objective procedure for observation; therefore validity in psychometric terms cannot be determined. The question then arises; can we still call it a valid procedure? The clinical interview and the diagnostic procedures are based on the information elicited from the patient and his observations. Has anyone doubted the validity of such clinical interviews and diagnostic procedures? If not, the validity of the projective test, the SIS in particular, cannot be doubted if its utility is adequately established. The SIS is a test that elicits mostly somatic responses and is based on the theories of body perception of Schema (body orientation) and body symbolization. The content validity of the test can be demonstrated if the patient with somatic problems is found to give more somatic responses. This was assessed in a study of pregnant women and non-pregnant controls. The pregnant women projected more responses of a pregnancy theme than non-pregnant women (Cassell, 1990). In a number of studies, it has been demonstrated beyond a doubt that relationships exist between an individual’s physical disturbances and his/her projected anatomical responses (Cassell, 1969, 1971, 1972, 1977, 1980; Dubey and Cassell, 1993, and Green grass and Adamson, 1977). To have construct validity on the basis of existing literature on inkblot technique, it can be assumed that Most Typical responses and atypical responses have to be different in broad psychiatric diagnostic categories compared to healthy controls. This hypothesis was tested on Neurotics, Schizophrenics, and healthy Normal subjects. The following tables clearly confirm that Atypical responses were significantly higher in Psychotics than Neurotics and Normal. 10 Cassell & Dubey

Table 2 Diagnostic Indicators of SIS-ii /Video Indices Normal Neurotic Schozo, Disorder N=300 N=100 N=100 Total Responses 61-75 53-65 50-65 >62 <59 <62 Most Typical Response (out of 18) >13 <11 <8 Typical Response >50% 35-50% <30% Atypical Response <12% 15-20% >20% Human Content 20-25% >25% >25% With Poor Form Animal content <11% >12% >16% Anatomical Content <15% >15% >18% Sex Content About 6% About 4% About 6% Movement <13 <8 <10 Rejection of Images <1 Image >5 >4 Pathological Almost More of HAS More of Paranoid Responses (PAP, HAS, D,) Absent & Depression & PAS Reproduced from Dubey Cassell Pershad & Dwivedi (1995) Hard-core Indices: Mt. Rejection. Pathological Atypical Soft Indices: H, A AT Sex Analysis Based on Data Published in SIS Jr. of Proj. Psy & Mental Health – (1994) and Brij Jr. Psy (1993) on over 5000 cases. Likewise, Most Typical responses were significantly higher in normal subjects compared to psychiatric patients (Cassell, 1991, 1994, 1996; Cassel and Dubey, 1996, 1996, 1997, 1997; Dosajh 1996, 1997, 1997, Dubey 1996). The following table also helps as NORMS for diagnostic purposes. The Somatic Inkblot Series was found helpful in assessing various areas such as Interpersonal Relationship, Ego/Self Image, Healthy Body Imagery, Erotic Imagery, Hostility/ Aggression, Insecurity and Thinking in Group Conformity. Keeping the above indices in view the SIS was tried during the selection of employees as a screening test. The findings are very encouraging. The subjects, who did not reject any images, gave more than 13 MT responses, more then 20 percent of Human responses, less then 15 percent of Animal and Anatomical responses and no pathological responses were recommended for inclusion. However, none was rejected on the basis of psychological test. Selection was finalized on the basis of overall performance Fifty Normal, fifty Neurotics (Anxiety & Depression) and fifty with Schizophrenic Disorder were given SIS and Rorschach and their protocols were scored on nine indices. X 2 test suggests that both the test are compatible on following nine indices total R, H, A, Anat, Sex , Movement, Most Typical & Rejection of Images (Mishra 1996). Application of SIS Test 11

Values of Kendall’s coefficient of concordance between the nine indices of SIS and Rorschach (given in Table-21) could reveal significant relationship suggesting their concordance on nine indices. The SIS appraises the same construct as the Rorschach test. However, because of its emphasis on self-administration and use of video technology, it moves beyond the Rorschach. It can be concluded that Somatic Inkblot Series Test is a reliable and valid test. Various types of reliability such as Test-Retest reliability, Split-Half reliability and Parallel Form reliability was found very high. The test has high content validity. Both the series A & B have high correlation and can be used independently for quick assessment; however, administration of the full test is necessary for complete assessment. The test is able to discriminate normal subjects from clinical groups (Anxiety Neurotics, Depressives, Schizophrenics, Alcoholics, Drug Dependents and many more ). The Rorschach test and the SIS were compared on nine common indices such as R, H, A, M, FM, Anatomical, Sex, Rejection, and Most Typical/ Popular and found compatible. The SIS appraises the same construct as the Rorschach test. However, due to the use of selfadministration and video technology it reaches beyond the Rorschach test. The Somatic Inkblot Series has taken care of the lacunae of Rorschach test and is carrying on the work started by the Father of Inkblots, Hermann Rorschach. ADMINISTRATION PROCEDURE AND INSTRUCTIONS The objective of this Introduction and Guide is to describe the SIS-II booklet and the videotape version of the SIS-II, both of which are provided with the basic procedure kit. The purpose is to present administrative and interpretive guidelines for the professional use of the procedure. The booklet serves to collect personal information, such as age, gender, education and other relevant health data separated from the pages for personal responses to the images. The reason the subject is asked to complete the health questionnaire immediately before viewing the Booklet or Videotape is to bring to mind any physical problems. This momentarily creates a perceptual set for projecting clinically relevant material. As appropriate or necessary, the response form booklet can be used by itself, independent from the video application. A unique advantage of the SIS procedure is that it can be “self-administering” should the therapist, counselor, psychologist, physician, research scientist, or educator find it appropriate to application circumstances and goals. Video Procedure When the SIS video is to be presented in the professional’s office, the assessment room needs to be equipped with a color television monitor and a video cassette recorder (VCR). In addition to comfortable seating for two or more persons, it is best to provide a small table or desk to facilitate the writing of observations and responses in the answer booklet. Adequate and adjustable lighting and privacy from interruption and extraneous sounds will enhance the experience of the procedure. 12 Cassell & Dubey

The initial instructions and assistance provided by the professional will induce the relaxed mood intentionally cultivated on video. This is accomplished through the use of pictures of flowers, peaceful scenes of natural environments and musical interludes. A calm mind and semi-hypnotic state will serve to promote the release of deeply repressed and/or painful material that might never be recalled. Ordinarily, traumatic material is less likely to be verbalized directly in an interview situation or through nonprojective psychometric tests. The professional will provide full disclosure of potential benefits and risks associated with each procedure administered. This assures fully conscious and voluntary willingness to enter into the experience. Risks include the potential to bring repressed or controlled post-traumatic experience and feelings into full awareness. In most instances, similar to a subject’s experiencing dreams or “nightmares,” the SIS viewer is able to reconstitute psychological defenses immediately afterwards. In rare instances, the professional needs to be available to assist. Fortunately, there has been no reported instance of major or lasting effects. For children and adolescents, appropriate informed consent must be obtained from a parent or legal guardian. If, for any reason, the examiner is concerned about the potentially disruptive impact of the SIS Video (e.g. psychotics, borderlines, etc.), the procedure is available in a black and white version, which elicits content without the potentially emotionally-disruptive color shock. A salient and dramatic benefit is the identification of forgotten, traumatic experiences. In certain cases, the identification of these may serve to inhibit mental mechanisms and subvert effective coping with present life situations. When the video tape version of the SIS-II was completed in 1984, it was intended primarily for supervised administration by a professional in an office or hospital setting. Subsequently, it has proven to be useful in group situations. With certain individuals who are psychologically intact, the administrator may choose to give the SIS as a “take-home” assignment. The subject is instructed to complete the procedure in the evening in a relaxed setting, when psychological defenses are lower. The viewing of the threatening images immediately prior to sleep may serve to stimulate dreams of a clinically relevant nature. As part of the instructions, the individual is asked to record any such material and bring it to the follow-up interview for detailed inquiry. This is normally scheduled for the following morning. The first step for professional analysis and interpretation of responses involves studying the there responses hat threatens considered “least liked,” along with the reason (s0 for their negative impact. Next the responses for the entire series of 62 images are scanned for psychopathological material, such as responses depicting humans in conflict or suffering, diseased anatomy responses, symbolic anatomy (e.g. broken heart as a sign of depressing), excessive sexual content, etc. Preservation of a theme, fro one image to another, may suggest important unresolved material on a constant issuer (i.e. repeatedly seen fetuses in someone who has repeated miscarriages). Alternatively, it may signal the in someone who has repeated miscarriages. Alternatively, it may signal the need to consider the diagnostic possibility of neuropsychological impairment. Application of SIS Test 13

Examination Instructions This viewing procedure is to be administered under the direct supervision of a trained professional who has explained its risks/benefits, clinical relevance and value in better understanding your problems. If, at any time, questions or difficulties should arise during or after this procedure, please feel free to contact your clinician who will be pleased to assist. Before the clinician administers the SIS procedure, it is important that a reasonable comfort level is established with the person who is to view the SIS images. The professional may begin by going over the instructions listed on the back page of the answer booklet. First, have the subject fill in the brief health history. Explain that a series of flowers will be shown to help the person relax. Next, indicate that there will be video instructions on how to fill in the answer booklet. Turn the booklet over and point to the example at the top of the first page. Tell the person that he is to simply label the images, just like in the example, and to include any emotions that relate to each image. When the subject indicates that the viewing is complete, it is necessary to conduct a short debriefing interview. This is to ensure that the procedure was completed according to the instructions. Reassure the subject that things have gone well. It is very important to make certain that no special therapy techniques are required to assist the individual if unduly painful material has been released. The examiner’s detailed inquiry is scheduled for the next day. The viewer is reminded to record any dreams that may be released. SIS-II Booklet Procedure The paper test booklet version of the Somatic Inkblot Series (SIS-II) can be used in a variety of ways but was designed for self administration after supervised instruction. The subject is provided eight pages booklet consisting 62 images in two series A and B each with 31 images and asked to read the instructions printed on last page of the booklet. “ Most people find this test fun and interesting. First, please relax, take a few deep breaths, and prepare to enjoy. Please turn this booklet over, and study the sample response. Notice that you may write on the picture or in the space below it. Label each in terms of what they resemble or look like to you. Please include everything you see even if it reminds you of something remote, vague, dreamlike, highly personal or even potentially embarrassing. Please include everything you see with as much detail as possible. Also include any outstanding emotional reaction that might occur in responding these images. Please begin on the first page study the sample, and continue until completed.” The subject is asked to complete the identification data and the brief health history as instructed in video procedure. Reassure the subject that: 1. There are no right or wrong answers. 2. Different people see different thing in the inkblots. 3. It is important to write whatever the inkblot looks like regardless of whether or not it makes sense or how it might seem to others. 4. The test may take about one hour in its completion. 14 Cassell & Dubey

Like video procedure, the subject is asked to select three image which (s)he liked the most and three images which (s)he liked the least After the completion of the test, the clinician will quickly go through the responses and will decide if an specific response needs further exploration. This helps particularly in understanding the psychopathology behind an “Atypical response” or a response helping in hearing the inner cry of the individual. Except the procedure of presentation (Booklet Form or Videotape), both the procedures follow the same administration SIS-I (20 Cards) Test There are 20 cards in the Series printer in Black, Red and Gray, description the test is given earlier in the text. The subject is presented with the 20 cards set and us asked to select 3 most threatening cards. The remaining 17 cards are presented to him one after another and his responses are noted in the record sheet. In depth interview is done to underst5and the persona associations\traumatic experience, which he is being reminded of by the3 most threatening cards. Mostly clinicians we’ll versed with the SIS procedures fang sufficient material for therapeutic intervention from these 3 cards. The video procedure of SIS-I is similar to the procedure of the SIS-II video test. The SIS-I video is a self-administered test and can also be administered to a group. BENEFITS It is readily apparent that the SIS instrument has many applications in traditional medical and psychiatric populations. When the SIS was first developed, its research and diagnostic uses were given high priority. With time and experience, it became evident that employing this technology in clinical populations had value as an adjunct to traditional therapy procedures. In certain instances, the SIS proved to shorten the time of treatment and to be cost effective. Because it is a video procedure that is linked to computerized scoring, it has multiple additional applications, especially in screening candidates for the military and law enforcement agencies. Why hire an individual who may have long-forgotten, repressed traumatic life experiences in employment situations where there is a high occupational risk of further trauma? Such persons have a lower threshold to future job-induced stress, which could jeopardize the effectiveness of a particular group or company. The SIS procedure can be employed as a measure of the effectiveness of any treatment program which deals with traumatized individuals (e.g. soldiers and policemen). If these people do not have appropriate early identification and active therapy, they will be at high risk to develop alcohol and drug problems, physical symptoms, mental disorders and a variety of behavioral difficulties. SCORING AND CHARTING DEFINITIONS OF SCORING INDICES Mental health professionals with training and experience in projective techniques will have little difficulty integrating the scoring and charting conventions used with the Application of SIS Test 15

Somatic Inkblot Series. “Body Symbolism” (Cassell, 1980), can be a resource for increasing one’s skill in the interpretation of the original 20 cards SIS responses. There are variations in test taking, with important clinical applications. People who have difficulty in completing the test and who do not respond to a number of video images may be exhibiting denial, avoidance, blocking or repression. Excessively detailed responses suggest obsessive-compulsive traits. Exaggerated verbal responses, while discussing inkblots least liked, suggest affect-laden content. This should be further explored for relevance and meaning to the individual. In some cases, repressed material can burst into conscious awareness, triggered by the semi-ambiguous inkblots. The underlying dynamics of many somatic complaints and personality traits can become accessible with this technique. The eleven categories found to be important in understanding and interpreting protocols are: 1. Total Number of Responses 10. Rejection of Images 2. Human Responses 11. Pathological Scales: 3. Animal Responses a. Pathological Anatomy (PAS) 4. Anatomical Responses b. Depression (D) 5. Sex Responses c.Hostility and Aggression (HAS) 6. Movement Responses d. Paranoia (P) 7. Most Typical Responses 8. Typical Responses 9. Atypical Responses Each category is designed to stimulate consistency among the raters, and to afford commonality in acquiring information for research and normative data collection. The Somatic Inkblot Series has a very simple scoring system. It is less complicated than existing inkblot tests, since it emphasizes content analysis. The following scoring categories have been found to be the most important: 1. Total Number of Responses (R) The total number of responses is arrived at by counting all the responses given by the subject on the 62 images of the SIS-II / Video. This number suggests imaginative capacity and functioning intelligence of the subject. Psychiatrically ill patients will have a poor imaginative capacity and poor functional intelligence. 2.Huamn Responses (H) Hhuman responses included the whole human body, or external parts of the human body like face, ear, nose, legs,etc. The category does not include mutilated forms ofte whole body or parts of it, such as crushed human being, broken legs or smashed face. These multilated responses are included in the Anatomical responses. The number of Human responses suggests the patients interpersonal relationship with human being. When responses are loe, it might be indicative of a desire tobe away from humans and 16 Cassell & Dubey

schizoid or social isolation tendencies. 3. Animal Responses (A) Animal responses include living or dead animals such as wild and pet animals, reptiles, birds and sea animals. This category also includes external parts of the animals such as wings, legs, claws, beak, etc., but it does not include mutilated parts of the whole animal such as crushed birds or animals, pulled out wings, etc. Whenever a large number of animal responses are given, interpretation should be that the respondent is more comfortable with animals than people or psychologically immature. 4. Anatomical Responses (At) Anatomical responses pertain to internal parts of living beings and their mutilated forms, both of humans and animals. These responses are consistently high in those who have a poor self-image and who are preoccupied with internal body organs. 5. Sex Responses (Sex) Sex responses pertain to the internal or external reproductive system and to sensuous parts of the body. These responses include thighs, buttocks, breasts, fallopian tubes, ovaries, etc. Heightened anxiety and pathology may be associated with either heightened projections or impaired recognition of imbedded sexual structure. These may signify sexual anxiety and/or dysfunction. 6. Movement Responses (M) Movement responses indicate movement in human beings or animals. Examples include “talking human being,” “flying bird” or “running tiger.” 7. Most Typical Responses (MT) Most Typical responses are those, which are given by more than 75 percent of normal subjects on a particular image (Dubey and Cassell, 1993). The total number of such responses is limited to 18. A higher number of Most Typical responses is suggestive of coherent, logical thinking, and ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept. The following is the list of Most Typical responses along with the images eliciting them 8. Typical Responses (T) Typical responses are those, which are commonly seen by healthy people on a particular image. 9. Atypical Responses (AT) Atypical responses are those of poor quality and with vague percept, either in structure or verbalization. A response that markedly departs from the category of Typical responses is also scored under Atypical category. For example, if the viewer gives the response “flower” on image A20 it should be considered as atypical because this image should elicit body anatomy such as kidney/lungs. The number of Atypical responses is proportionate to the degree of psychological or psychiatric disturbance. Application of SIS Test 17

Perseveration may be a sign of neuropsychological impairment, and is usually absent in normal people. : SIS-II A: Image Responses A7 Apple/fruit A7 Dancing lady A9 Two human beings/ladies A12 Ear A13 Raised hand A20 Kidney/lungs A27 Breast A30 Skull A31 Two faces of persons SIS-II B: Image Responses B4 Two faces of persons B5 Two persons talking B9 Kidney/lungs B22 Man/boy sleeping or resting/dreaming and soul going up B27 Child/children B28 Mother and child/standing lady B29 Running man B30 Ears B31 Family-father, mother and two children List of Typical and Atypical responses on each image of SIS-II /Video are giving in the SIS-II /Video Manual. 10. Rejection of Images (Rej) If the subject is unable to give any response on any of the 62 images, the response is considered as rejected. Verbalizations like spot or inkblot are not considered as responses, and are treated as Rejections. To determine the percentage of Rejection of Images, the total number of rejected images is divided by 62 (total number of images shown) and multiplied by one hundred. Rejection of images shows thought blockage and an inability to think properly. 11. Pathological Scales Four pathological scales have been used (Cassell,1980) for the evaluation of individuals. They are: a) Pathologic Anatomy Scale (PAS); b) Depression (D); c) Hostility and Aggression Scale (HAS), and Paranoia Scale (P). Some of them are based on the work of Wayne Holtzman (1956). The scales are as follows: 18 Cassell & Dubey

a) Pathological Anatomy Scale (PAS). Subjects who have personal health concerns, or who are pathologically identified with the health of others, may project responses in which the body is seen as diseased. These responses are usually related to specific regions involved in the subject’s body image, and can be appraised by evaluating the qualitative nature of the somatic material projected. The anatomical imagery is similar to that described by De Vos (1952) in Rorschach responses involving “diseased anatomy.” Body parts might be reported as red, inflamed, infected or cancerous. Organs may be sore, painful or hurting. Passages may be blocked or obstructed. Bones may be out of place or broken. It is possible to assess pathologic anatomy by summing up all such responses. All of these responses are scored under PAS. Individuals who project these responses should be further evaluated for either hypochondriacal or excessive concern about physical health. This material should be explored, clarified and assessed in the detailed inquiry and follow-up interview, since the subject may still have unresolved anxiety about this alteration in body concept. The total number of such responses is counted to form a score for PAS. b) Depression Scale ( D ) A depressed subject’s emotional state can be viewed as either overt or covert. Subjects with overt feelings of depression readily admit them, and are good reporters of their own mental state. They usually exhibit nonverbal behaviors, such as sighing, weeping, downcast eyes, etc. which are consistent with the experienced affect. Subjects in a state of masked depression often conceal or deny their feelings. Frequently, they are preoccupied with their bodies hypochondriacally, and project anatomical responses, which are likely to be pathological. A depressed mood can be assessed by inkblot responses with high morbid or depressive content. The severity of these thoughts and feelings can be assessed by a study of their frequency and content quality. A four-point scale can be used to score the depressive content of inkblot imagery: Score 0: No depressive content Score 1: Slight or mild depressive content in the face of humans or animals (i.e. a sad face) Score 2: Moderate depression associated with the “inkblot’s” expression. An expression with a marked, or strong affect (e.g. a weeping person, a griefstricken person) Score 3: Sadness or depressed affect associated with an anatomical response. For example a heavy heart, a breaking heart, or a heart with a clamp on it. Something that is suicidal, or hanging from roof, or a dead man. Individuals who are clinically depressed, but fail to recognize it, may have similar Application of SIS Test 19

difficulty recognizing content in the SIS. In the absence of neurological disorder, a high number of Rejection responses may signify masked depression. c) Hostility and Aggression Scale (HAS) Hostility and Aggression can be reflected in projective responses involving physical assault or body injury (Cassell, 1977) and are scored as follows: Score 1: Animals that are predatory or hostile to humans; an implement of aggression in a dormant state; a human or an animal that is seen as fierce, aggressive, or dangerous; a hostile attitude seen in humans or animals; references to bowel function or defecation with hostile content; a knife or a snake. Score 2: Animals or humans seen as angry or in aggressive struggle, either verbal or physical; furious snakes; or abstract expressions of direct conflict or oral aggression. Score3: Homicidal scenes and/or anatomical responses involving body destruction. Subjects with histories of acting out hostile impulses have been found to project anatomical responses with murderous themes. d) Paranoia Scale (P) A cardinal projective feature of paranoid ideation involves a heightened awareness of threatening faces that are “looking” at the individual. This may be experienced as an exaggerated sense of self-consciousness in social situations. An emphasis on the eyes” of people or animals may be present in anxiety-laden dreams. It may be clinically indicated in art therapy, with figure drawings emphasizing “eyes.” The patient may hallucinate images of such staring faces. The paranoid scale quantifies such responses. INTERPRETATION AND APPLICATION OF SIS RESPONSES The SIS employs mainly two methods of interpretation: 1. Quantitative Analysis and 2. Content Analysis 1. Quantitative Analysis: Analysis of various indices, such as number of responses to images, number of human, anatomical, sex, and animal content; most typical, typical, atypical responses, movement and four categories of pathological responses have been created. These were established for evaluating a series of mental constructs in various normal and clinical groups. If the number of atypical responses and the rejection index, along with the total pathological score becomes elevated, then the prognosis is estimated to be more guarded. 2. Content Analysis: Content analysis is given more emphasis in interpretation since it 20 Cassell & Dubey

frequently helps to bring out the unprocessed unconscious material. What is seen through the response profile, along with the affect linkage, may have direct or symbolic significance either in the present or in the viewer’s past. It is quite analogous to assessing such material as the in-depth study of dreams. While the professional’s own theoretical frame of reference will strongly influence the interpretative process, it is the authors, viewpoint that in most clinical therapeutic situations, content analysis for any given individual is a richer approach. CASE-1 A Case of Headache and Stammering The detailed interpretation of this case may help clinicians to learn the system in practice. A much shorter report is sufficient to understand the psychopathology of the patient and to communicate case information to any referring agency for their case management (The case in detail is decribed in "Interpreting inner world through somatic imagery written by Wilfred A. Cassell & B.L. Dubey"). Mr. X. a 35-year-old man was tested in India on June 5, 1990. He reported that he recently had a throat infection, but his main problem was stuttering. He denied having any pain, although he reported that since 1975 he had been feeling sensations of abnormal pressure in his head. Least Liked Images In reviewing his responses to the Somatic Inkblot Series, A24 was found to be the least liked. Instead of seeing material related to the female pelvis, he saw “a monster kidnapping two children - someone’s having a bad dream”. Here he avoids reference to the female pelvis, and substitutes the very threatening image material of the kidnapping of children. This material shows age regression and trauma, which are characteristics of children’s dreams. The source of symbolism needs further evaluation. It might be noted that in Rorschach procedure, he gave several responses depicting aggression. These responses were consistent with his SIS scores and his long-term conflicting relationship with his mother. The second least liked image was B10. In B10, he again overlooked an image depicting female pelvic content and saw “a very strange looking dog - something frightening about it”. Again the symbolic defense that he uses in defending against the female pelvic area is highly threatening. Since this times it is a dog. It is consistent with his perception of women being threatening. Since his relationship with his wife, at least on the surface, appears relatively normal, it would seem that this reflects some degree of threat in terms of a woman’s body, which relates to his long-term conflict with his mother. The very last image that was threatening was B28. On B28, he saw “a very evil-looking thing - seems like a cross between a man and a dog”. He said that he found this threatening because the figure has “a very evil presence”. It may be recalled that the Application of SIS Test 21

normal response here is a loving image of a woman holding her child. Again, the patient cannot see this because of his long-term conflict with his mother. He uses the symbolic defenses of a man and again, a dog. Unable to see the shape of a woman, he changes it to a man, and then instead of seeing a child, he sees a dog. The evil connotation comes through because, at some level, he does recognize the image as his mother’s. He senses and associates a negative feeling, interpreting the image as “evil”, because he did not get satisfactory nurturing from her as a child, and because of present, long standing feelings of anger towards her. The Most Liked Images B5 is the image he liked the most. He saw it as a “very happy scene”, reminding him of domestic bliss between couples. This reflects his happy marriage. It is remarkable, that in spite of the problems with his mother, and some deep-seated problems he has in the area of sexuality, he reports that his own marriage is okay. One wonders the validity of this report, but certainly his response to B5 is consistent with a happy and harmonious marital relationship. His second most favorite image was B29. He saw this “as a child coming from school”. Many individuals see this as a man running, sometimes with a leg off. He sees this in a regressive way, perhaps wishing for the happy childhood, which he never had. One does not know from his history whether his early relationship with his mother was positive or not, but he certainly wishes to regress to what he perceives as a happier existence. He saw B31 as “a very happy family”. Many individuals, in fact, do see it in this way. Perhaps it is of some note that he didn’t refer to children. It may be that his childhood experience was not happy. Description of Images in Order A1. Was seen as “looks like an Arab lying in bed.” This is unremarkable, except that a man in bed may be going along with what was noted in the Rorschach, which was a high degree of sexual preoccupation, and it could have sexual connotations. A2. He stated, “It reminds me of a heart with all the arteries and veins cut.” This is somewhat unusual, in that it shows heightened cardiac symptoms. It is possible that in states of anger and arousal, with his irritation, he was more conscious of his heart beating. A3. He could not give a response. This was rejected, which is somewhat unusual. A4. Was seen as “ a funny-looking flower.” This is remarkable. A5. Was seen as “a very happy, though ugly person.” This shows a capacity for gestalt, and the fact that it projects happiness is consistent with his overall happiness, in spite of his stammering. The theme of evil and ugliness does 22 Cassell & Dubey

project through. The ugliness reflects his conflict at home with his mother. A6. Was seen as “a woman in her child’s room.” This is somewhat unusual, and may reflect a wish for that. It is not consistent with the fact that in B28 he avoided reference to the maternal-child content. It’s also possible that the woman in the child’s room could reflect some conflict with his mother on a sexual level, which may have occurred in childhood. This makes sense. In view of his sexual preoccupation, he has been threatened by mother-child images. A7. Was “Eve looking at the apple.” This is unremarkable, although the symbol Eve does get at the thought of sexuality, which is conflicting and may reflect certain Oedipal issues involving himself and his mother. A8. Was seen as “a naked man with a crooked smile.” This is probably not remarkable. A9. Was seen as “a man and woman exchanging sweet nothings.” This is a good response and probably relates to his happy marital situation. A10. Was seen as “a woman in the front seat of a car, and man in the back seat. The woman is crying.” Here this is seen as being emotionally upset. It’s interesting that no further association comes to mind. What he has reported so far has reflected a happy, harmonious marriage, or it could refer back to his mother’s troubled mental state. A11. Was seen as “a couple making love.” Instead of seeing nasal content, he projected a theme of sexuality and intercourse, which is again consistent with his Rorschach material. It is not consistent with what he reports in the clinical interview, that all is well sexually in his marriage. His response shows a heightened preoccupation with sexuality. A12. Was seen as “an earlobe.” This is a normal response. A13. Was seen as “someone asking for the help with his hand.” Assuming that this is good because he probably identifies with the person asking for help. It also states his motivation to receive therapy. A14. Was seen as “a child asleep on the floor by the side of a statue.” Here, instead of picking up something related to the stomach, he introduces somewhat regressive material. This again may go back to his need for the nurturing he never received from his mother. A15. Was seen as “a kidney, or it could also be fetus.” Both are unremarkable. A16. Was seen as “two fish caught in the same hook.” Here he avoids reference to the anatomical content in the image, and sees fish on a hook. This may be suggestive of his traumatic experience when his mother, who incorrectly suspected sexual play, beat him and his cousin. A17. “A woman looking at herself in the mirror. She has a big heart.” This shows a heightened awareness of a family image. Also his emphasis on a big heart is consistent with the heightened cardiac awareness noted in A2. Who the woman Application of SIS Test 23

is, needs to be evaluated. Does she represent his wife, his mother, etc.? A18. “The female genitalia.” This in itself is not a remarkable response, but it is consistent with his heightened sexual imagery, as noted with the Rorschach. A19. “A diagrammatic view of the human body with intestines clearly seen.” This is a normal response. A20. Was seen as “the kidneys, bladder and penis.” This is a normal response, except that it looks like the human excretory system, which is an unusual response. It may reflect a type of perseveration from A19, or some unusual preoccupation with his bowels. A21. “It looks like a very large man dancing on one foot with his children.” Probably an unremarkable response, except that if one is going to see children here, it would perhaps be more usual to see maternal imagery, but this is equivocal. A22. Was seen as “trachea and lungs - it could also be a man with a very long nose.” This is somewhat unusual. He correctly picks up the anatomical structure in the inkblot, but because the threat of the phallic material comes through displaced in the safer image of a “very long nose.” A23. Was seen as “a vertebral column or perhaps a millipede.” This is a normal response. A24. Was previously commented on. A25. Was seen as “a vagina.” A normal response. A26. Was seen as “an unborn baby curled up.” A normal response. A27. Was seen as “a woman’s breasts swollen with milk.” Whom she is feeding is not clear. Here, in a regressive fashion, he wishes for a nurturing relationship with his mother, which he never had. On Rorschach Card 1, the second response was “a breast with a nipple.” This again reflects a wish for the nurturing he presumably never had, or he wants to go back to that stage of his life. A28. Was seen as “a shapely woman trapped in a test tube.” Here, the return to the eroticism occurs. He avoids reference to the male thigh. The woman trapped in a test tube may reflect his being trapped in a test tube, or it may reflect some erotic relationship between him and his mother, where feelings have not been expressed. A29. Was seen as “ looks like an evil thing straight out of a horror film.” He is capable of having evil and horrifying thoughts and fantasies. These go back to the horror of his relationship with his mother. A30. Was seen as “a skeletal skull.” This is not remarkable. A31. Was seen as “a boy and girl talking to each other. Something serious is the matter.” In this image, he sees conflict in the relationship. It is interesting that he sees a boy and girl, instead of a man and woman. This has regressive connotations and shows his projection of conflict between males and females. 24 Cassell & Dubey

B1. Was rejected. B2. Was seen as “ a top view of a man lying on his stomach.” This is unusual. The image of a man lying on stomach is seen in A20, the human excretory system. This may indicate some sexual trauma he had experienced at some time. B3. Was seen as “a ghostly face seen through a broken window.” Again, this reflects some material from the past that’s threatening to him. It may elicit some paranoid feeling he has, or he might be concerned about what the SIS is bringing up in his consciousness, and the fear that the clinician will see some of that material. B5. Was seen as “a very happy scene.” This reminds me of the domestic bliss between a couple that was commented on previously. B6. He stated that “seems like a woman suffering from venereal disease”. It continues perseveration of the theme of sexuality, through the idea of venereal disease. Whether he has been faithful to his wife, or there are problems or fears in the area of his sexuality, needs to be explored. B7. Was seen as “a fly with a crushed insect stuck to his sides.” This response is consistent with the theme of aggression and violence. B8. Was seen as “a full moon.” “It reminds me of a lady wearing a funny hat holding something in her hand. It also looks like the profile of a nose.” This response is significant, because it look him awhile to ultimately see the nose. Prior to this he sees the image of a woman. Again, what is accounting for the fact that he consistently sees the image of females when typical responses are image of males? B9. Was seen as “kidneys again.” Unremarkable. B10. This was previously described. B11. Was seen as “a funny looking blouse or a jacket.” It is very unusual to see a blouse, or a jacket. He may well have some sort of feminine identification in his body image. Even though he didn’t get nurturing from his mother, he may have identified with her in an aggressor type of way. B12. “A man in anguish,” was his comment. Many people see this as such, but it certainly fits him. He is stammering because of strong inner conflict and emotional feelings that he cannot express either to himself or to others. B13. “A cottage by the moonlight,” was his comment. This is unremarkable. B14. “Dark in a power outage,” was his comment. This is unremarkable. B15. “Mountains being spoiled by pollution,” was his comment. It is probably unremarkable. He doesn’t see anything aggressive, such as knives in it. He is not a person who is aware of strong aggressive feelings. He is not likely to harm himself or others. Yet, there may be lot of inner aggression that he has repressed along with his sexuality. B16. “A pregnant millipede trapped in a test tube,” was his response. This is a most Application of SIS Test 25

unusual response. Instead of seeing the spinal content, he sees a female organism that is pregnant. The issue of pregnancy and the female imagery has previously been emphasized both by his Rorschach and SIS responses. This is his second reference to a woman being trapped in a test tube. The first was in A28. It may be, that at some level, the feminine psychology within him is not being expressed. Perhaps it is trapped inside himself, symbolically, in a test tube. It may be part of his stammering problem. If he could express and deal with his feminine psychology and come to terms with his mother, he would be able to speak better. B17. It is remarkable that he rejected the image even though it reflects the heart. It may be recalled that previously, on A2 and on A17, he shows some heightened cardiac awareness. When he is shown something that looks like the heart, and he avoids reference to it, this reflects perceptual inhibition. This may relate to cardiac anxiety and psycho-physiological heart symptoms. Symbolically, the mental representation of his heart is associated with anxiety. B18. Was recognized as “the penis and the vagina.” This is unremarkable. B19. Was recognized as “those creatures found at the bottom of the sea.” This is unremarkable. B20. Was recognized as ”the human brain.” This is unremarkable. B21. Was recognized as “a pistol and its barrel has burst.” Seeing a pistol is a usual response. Seeing a pistol with a broken barrel picks up some concern about the effects of expressing aggressive feelings. It may be that, years earlier, he did verbalize aggressive feeling to his mother, and as a result she stopped talking to him, and this has been a major trauma to him. We also know that he was traumatized when his mother falsely accused him of early sexual behavior with a female relative. This probably was done in a very aggressive way. B22. Was recognized as “a dead woman lying on the floor.” This is a most unusual response. He may be projecting his feminine body image, or in a deeper way, it may reflect repressed homicidal feelings towards his mother. B23. He saw “ cancer.” Here, again, it is remarkable that he avoided any reference to the chest content and simply saw “cancer.” This is a pathological anatomical response. At this instance, it is not venereal disease, but cancer. He may have some feelings of depression and sadness, or hypochondriacally concerns which are translated into fear of cancer. Of course, it may simply be that some relative may have cancer, and that is his concern. B24. He saw “a strange snake-like creature with two heads and a large bulging eye.” Here, the emphasis on eyes is quite unusual, and shows a heightened awareness of the eye. It reflects a paranoid feeling of being observed. It may be his sexual conflicts coming to the surface, as shown from his response to B2, heightened bowel awareness and a man lying on his stomach. There may also be 26 Cassell & Dubey

some latent homosexual issues related to the paranoia. B25. He saw “a naked woman with thighs spread wide apart.” This continues the theme of sexuality. B26. His response “reminds me of female genitals.” This is a normal response. B27. His response “embryos. One black and the other white.” This is a normal response. B28. He viewed “A very evil looking thing, seems like a cross between a man and a dog.” This suggests his aggression towards his mother. Psychoanalytically it reveals hatred and aggression towards a woman, as generally people see “a mother with a child” on this image. B29. He saw “a child coming home from school.” This is again somewhat regressive. B30. He saw “two earlobes.” This is unremarkable. B31. He saw “a family.” This is a normal response. Interpretation of SIS Responses on Re-Administration (After 10 sessions of Hypnotherapy) : His experience of chronic pressure in the head started with a conflict with his mother. The pressure in his head reflects his own inner anguish and pain all of his built-up feelings of aggression, hurt, and sexuality in regards to his mother; all that have been in conscious awareness as a result the therapy provided by one of the author (Dubey), he became more conscious of his inner feelings and eventually his physical symptoms became less painful. Those responses, which appear to be clinically relevant, in terms of, change after 2 nd testing will be noted. After 10 sessions of psychotherapy, image A4 was seen as “a woman about to hit some giant creature on the head”. Now he feels safe enough to allow himself to see an image of a woman being aggressive, and safe enough to allow it to come into a higher level of consciousness. This shows that he is now handling the abusive relationship involving conflict with his mother in a more acceptable way. It is also consistent with his marked improvement. The next image shows a change in response is A10. In the re-test situation, he sees it as “a woman confessing before a priest”. The confessing woman is of interest, because it may be an expression of working through of the mother son conflict. It’s as though a type of confession has occurred between him and the therapist. Another interpretation is that if this is his mother, there has been some confession or admission to him of guilt on her part. Since therapy began, there has been minimal communication with his mother. The mother and son are now somewhat closer. A16 On re-administration was seen as “two birds singing a song“ rather than “two fish caught in the same hook”. He was able to process his traumatic experience of childhood, and now had normal perception on this image. A17 Was seen more appropriately as “a couple of sea-horses face to face” rather than “a woman holding herself in the mirror with a big heart“. The reduction in the emphasis on the woman reflects a restoration of, and returns to, a more Application of SIS Test 27

normal perception. As his relationship with his mother improves, he is less preoccupied with female imagery. A24 The next response, which is dramatically better, is A24. In this, he sees “three children sleeping together”. It is no longer like a bad dream. Through therapy he was able to process some of his trauma. The result is that he is less childlike and is not so pre-occupied with that type of trauma. A27 He sees “a child breast feeding”, which has helped him to come closer to his mother. A28 Was seen as “a distorted female figure without head and legs”. There is still a persistence of female imagery, which is most unusual. This time, the female is no longer seen as “trapped”. The female part of him has been expressed in therapy, and he has also had a chance to talk about his conflict with his mother. The feelings are no longer trapped in a test tube. His speech is better because he doesn’t have to stammer in holding back this type of material. B1 It is interesting that for B1 he is able to give a response. Previously he was unable to do so. The response that has emerged is “a blood stain on a white handkerchief”. This is a pathological response, and it may reflect a theme of violence and aggression, but now he is more comfortable talking about them and his aggressive feelings. Previously, he was inhibited and felt like he had to repress those feelings. This is consistent with his improvement and reduction in stammering. One would also expect from his response that the feeling of pressure in his head would lessen. Clinically, this was the case. B2 Was seen as “a very untidily made keyhole”. The response here is much more healthy than his original response of “a top view of a man lying on his stomach”. This second response does not have homosexual connotations. It does, however, continue the theme of paranoia, which may appear to him as “looking through a keyhole”. B3 His response to B3 is also less threatening. Instead of seeing it as “a ghostly face”, he see it as “two persons standing in a forest fire at night”. B6 Was seen as “mother and child“. This is a much healthier response than seeing “a woman with venereal disease”. Again, there has been significant improvement. B8 Was seen as “a spotlight illuminating the nose and cheeks of a man”. This is a very appropriate, sexual response. Now, he is identifying more with a masculine role, and his therapist, in a positive way. The female aspect of himself has been expressed, so the preoccupation with maternal imagery is fading. The therapy has been helpful. B15 He recognized as “reminds me of war and disorder with bombers flying”. This is a reflection of his increased awareness of his aggressive impulses and feelings. This is a healthy response because he is now conscious of his feelings and verbalized some of them in therapy. This has been good. 28 Cassell & Dubey

B17 This is the most interesting response. This time it reflects the pubic region of a woman. No doubt, at some level of consciousness, this was what he saw in the first viewing, but it was too threatening. Therapy has allowed this threatening material of a sexual nature to come into full conscious awareness. Of course, the response is still pathological, and still avoids reference to the heart. But, at least he is dealing with this, and is feeling more comfortable. B21 It is noteworthy that the pistol is still seen as having burst with B21. This shows consistency with the first response. B22 There is consistency in seeing a woman in B22, but this time it becomes “a woman meditating”, rather than “a dead woman lying on the floor”. He no longer has homicidal feelings towards his mother. These feelings have been resolved, and the communication is now better. B23 Was “reminds me of a crab”. This response is much more normal. He is not seeing “cancer”, because he is feeling clinically better. Some of his bad feelings have been “gotten out”, and he is no longer hypochondriacally. B26 This is seen as “a leopard or a dog belching on the back of a chair”. For a man, this is a more normal response. Not seeing the female genitals here shows that he is working through his conflict with his mother, and therefore he is less preoccupied with sexuality. B27 This was interesting. He saw “the good and evil aspects of a person”. Here he is beginning to come to grips with the good and evil within himself and his mother. He is able to love, yet see the relation as problematic. This is a good prognosis for therapy. B28 This was seen as ”a very evil looking person-more of an animal”. His aggression towards his mother has reduced considerably. B29 This was seen as “an athlete finishing in a race”. He has moved from an aggressive childlike position to one of victory in an adult. He is certainly not as regressed now. The therapy has helped him. B31 He doesn’t see a “happy family”, but he sees “a father, mother and two children”. He is happier with his own past, and this has been integrated as a result of therapy. Interpretation of SIS Responses on 3 rd administration (after 6 months of termination of psychotherapy) The Somatic Inkblot test was again administered (3rd time) after 6 months of termination of psychotherapy. His responses at this time were almost normal. The patient improved significantly and became symptom free. His relationship with his mother not only improved but also became very cordial and he started talking to her after many years. A few clinically significant responses are discussed below. 6A This was seen as “Playing football with Teddy.” This is a typical response suggesting that he has resolved his childhood traumatic experiences. Application of SIS Test 29

8A This was viewed as “A smiling man”, symbolizing his happy mood. 13A This is seen as “waving good-bye or trying to attract attention”. This again suggests his improved interpersonal relationship, particularly with his mother. 16A This was seen as “Two birds on a branch singing a love song”. Once again the happy mood concept is projected. 24A This was perceived as “a nude female though not very clear”. This suggests a love-hate relationship, maybe with his mother, though in a very mild form. 27A This was seen as “a baby holding his mother’s breast”. This shows that psychologically he is back to his mother and is resolving the love-hate relationship. 22B This was seen as “a sleeping woman”. He has resolved his aggression and instead of seeing a dead woman, he has seen a sleeping woman. 28B This was viewed as “a mother and a daughter in tender embrace”. This suggests that he is emotionally closer to his mother. Mother and child is the most common response on this image. Clinically significant responses given by the patient at each administration are shown below to highlight the improvement in the quality of responses on the SIS images. Comparison of SIS Responses on 1st, 2nd and 3rd Testing for Quick View First testing : When sick Second testing : After 10 sessions of Hypnotherapy Third testing : Six months after termination of Psychotherapy 6A A fat woman in her child’s room. A woman in her child’s room. Playing football with Teddy. 8A A naked man with a crooked smile. A happy person. A smiling man. 10A A woman in the front seat of the car and a man in the back seat (woman is crying) A woman confessing before a priest. Also looks like a half-veiled face. Funny looking birds perched on paper. 13A Someone asking for help with his hand. A hand asking for help. Person seems under great stress. Waving good-bye or trying to attract attention. 16A Two fish caught on the same hook. Two birds in a tree singing a song. Two birds on a branch singing a love song. 24A A monster kidnapping two children. Someone having a bad 30 Cassell & Dubey

dream. Three children sleeping together. Nude female though not very clear. 27A Woman’s breast swollen with milk. Whom she is feeding is not known. Child breast-feeding. A baby holding his mother’s breast. 28A A shapely woman trapped in a test tube. Distorted female figure without head and legs. A female with sagging breast. 6B Seems like a woman suffering from venereal disease. Mother and child. An owl, one eye open and the other shut. 22B A dead woman lying on the floor. A woman meditating. A sleeping woman. 28B A very evil looking thing, seems like a cross between a man and a dog. A very evil looking person-more of an animal. A mother and a daughter in tender embrace. The case analysis suggests that Somatic Inkblot Series is a powerful projective diagnostic instrument. It works as a time machine and helps in processing repressed material. It works like a thermometer and helps in detecting the severity of emotional problems. References Cassell,W.A.(1977) Aggressive Imagery and Clinical Symptoms in Schizophrenia, British J. of Proj.Techniques, 16:21-31 Cassell,W.A.(1980) Body Symbolism and the Somatic Inkblot Series. SIS Center, Anchorage(USA) Cassell,W.A.(2001) SIS Exploration of Human Consciousness, SIS J. Proj. Psy. & Mental Health: 9:3-14. Cassell, W.A. and Dubey, B.L.(1997) Somatic Inkblot Series Video/SIS-II Manual. SIS Center, 4501E, 104th Ave, Anchorage, AK-99516(USA). Cassell, W.A, and Dubey, B.L.(1997) Therapeutic Dream Stimulation with SIS- Video, SIS J. Proj. Psy. & Mental Health, 1997, 4: 3-23 Cassell, W.A, Dubey, B.L.and Gilbert J.Roth (1997a) Medical, Psychological and Spiritual Application of the SIS Inkblots. SIS J. Proj. Psy. & Mental, Health, 4: 89-112 Cassell, W.A, and Dubey, B.L. (1998) Application of Somatic Inkblot Series in Personality Assessment, Screening, Diagnosis and Therapy, SIS J. Proj. Psy & Mental Health, Application of SIS Test 31

5:3-32. Cassell, W.A, and Dubey, B.L.(1998) Mental Disorders Triggered by Exposure to Violent Imagery in the Media and in Electronic Games, SIS J.Proj.Psy & Mental Health ,5:87-104 Cassell, W.A; Dubey, B.L.; Molchanov, E. and Roth, L (1999) Stimulating Beacon Images for Meditation and Projective Psychotherapy, SIS J.Proj Psy. & Ment. Health, 1999, 6: (2) 7-30 Cassell, W.A; Dubey, A. and Dubey, B.L.(2000) SIS Projective Responses in PTSD and Dissociative Disorder, SIS J.Proj Psy. & Ment. Health, 2000, 7: 93-108 Cassell, W.A; Illardi, F.J.; A. Collins; Mishra, M. and Dubey, B.L (2001) Optimizing Spiritual Healing by Assessing Dream and SIS Imagery, SIS J.Proj Psy. & Ment. Health, 8:75- Cassell, W.A, and Dubey, B.L.(1996) The Use of the Rorschach and SIS in Releasing Somatised Grief. J. Proj. Psy. & Mental Health, 3: 3 -32 De Vos (1952) A Quantitative Approach to Affective Symbolism in Rorschach Responses, J. Proj.Tech and Personality Assessment,36:133-150 Dubey,B.L. and Cassell, W.A.(1993)Some Experiences with Somatic Inkblots-II, British J. of Proj.Psychology,38:,1,19-41 Dubey,B.L. and Cassell, W.A.(1997)Clinical Utility of Somatic Inkblot Series- Video. Perspective in Psychological Researches, 20:10-15 Dubey,B.L. and Cassell, W.A.(1997Application of Somatic Inkblot Series in Personality Assessment and Psychotherapy, Indian Journal of Psychology, 72:73-80 Dubey,B.L. and Cassell, W.A.(2000) Inkblot Responses as an Aide to Therapy, SIS J.Proj Psy. & Ment. Health, 7: 3-10 Dubey, B.L., Cassell, W.A, Pershad D. and Dwivedi,P.(1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Mental Health,2: 77-84 . Dubey, B.L., Cassell, W.A, Pershad, D and Dwivedi,P.(1995) Diagnostic Significance of the Indices of the SIS-II and the Rorschach Inkblot Tests. SIS J. Proj, Psy. & Mental Health, 2: 165-170 . Dubey, B.L., Cassell, W.A, Dwivedi,P. and Mishra, M.(1995) Inner Cry Through Somatic Inkblot Series. J. of Proj. Psy. And Mental Health, 5, 2: 119-128 Holtzman,W.H.(1956)Inkblot Perception and Personality,University of Texax Press, Texas. 32 Cassell & Dubey

Kwiatkowska,H.Y.(1978)Family Therapy and Evaluation through Art. Springfield,IL, Charles C. Thomas. Ulman,E.(1965) A New Use of Art in Psychiatric Diagnosis, Bulletin of Art Therapy, 4:91-116 An Indepth Study of Summarization in Heroin Addicts thrugh SIS-I & Rorschach Inkblot Test. Shubhra Banerjee, Anjana Mukhopadhysy and Usha Singh This investigative report is an attempt to trace the salient feature of SIS measure on the basis of subtle common indices of the Rorschach test by Klopfer’s method. The SIS-I and the Rorschach Inkblot Test were administered on 15 heroin addicts and 15-matched normal. Series common indices of the tests ere considered as comparative measures assessed on the two samples. Four indices each were proved to be successful discrimination index between heroin addicts and normal. Ambiguity in Rorschach image reported higher number of responses in 5 our of 7 indices. Still lower number of responses of the SIS was reported to be more in the predicted direction. The concept of somatic on has emphasized the unique response o somatic region in one’s conscious world which receives a feed back from his unconscious vicinity. It is high-personalized system and projected with spatial entity. Summarization is, however, seen much more frequently than free-floating anxiety or depression parse in our culture. This empirical clinical observations supported by a mass of published material (Teja and Aggrewal, 1971, Srinivasan 1986; Chaddha and Bhatia, 1990). Victims of drug dependence are possibly preoccupied with their inner or suppressed cry for help. Sensitivity of the affective body part symbolically surfaces unions pious suffering and the diagnostic measures establish the pathological components. Heroin addicts were found to be affected with psychology (Mukbhopadhyay, st. al. 1996). Projective measures like inkblot techniques effectively penetrate the over defensive behavior and relief may new teased to revamp their mental health. Widely applied Rorschach technique and the latest framing of SIS in terms of body imagery acclaimed and equal potentiality in the assessment of troubled psyche (Dwivedi, et. Al. 1994). Use of Somatic Inkblot Series, has been demonstrated in a number of studies that relationships existed between individual physical disturbances and projected anatomical responses 9Cassell, 1969, 1971, 1972, 1977, 1980; Dubey and Cassell, 1993). Present investigation Attempted to assess Heroin Addicts both by Rorschach and Somatic Inkblot Series-I do it measure the level of indices and comparison of symbolic expres- SIS J. Proj. Pst. & Ment Health (1998) 5:1, 33-40

sions. Objectives: (a) To study the levels of SIS indices of normal and drug-abusers. (b) To study the levels of Rorschach variables of normal and drug abusers. (c) To study whether the indices traced by SIS are being supported by Rorschach Material & Method: Sample: The sample in the present study consisted of 15 male Heroin drug addicts 9M.age=27 ys. Registered for treatment at ‘Nav Chetna’ Drug-Dead diction Center, Vinaika Varanasi. A matched control of 15 adult (non abuser) normal (M. age-24ys) were also selected for the comparative measures. Tools: Somatic Inkblot Series-I : A set o 20 cards was administered to each subject individually, following standard procedures 9Cassel, 1980). The obtained SIS-I protocols were scored in the light of various indices of SIS and reaction time for each card was also recorded for each subject. Rorschach Inkblot Test: A set of 10 cards was administered individually following Klopfer’s method (1954). Rorschach responses were measured as per indices as well as reaction time taken for each card was recorded. Procedure: After initial enquiry of personal information the addicts when found fulfilling the required criteria of habitual drug abuse for at least past one year period where included in the dimple. The tools were administered individually through face-tofacet interview method. The protocols of the subjects on both the tests were scored one. Serve common indices are Human Animal Anatomical Most typical/ popular Rejection of images/cards, Atypical responses and Sex responses. Time taken to initiate responses by the subject for each card (both for SIS & Ror- 34 Banerji et. al.

schach) was also noted. Means, SDs and t-values were computed to find out the differences of indices between the two tests the SIS-I and the Rorschach. Results: Results obtained room the investigation re-establish the efficacy of diagnostic components of the Rorschach and SIS measure. Diagnostic indices scores are tabled in percentage values. Common indices considered from both the tools significantly discriminate the drug addicts for normal, Rejection and Atypical responses of the Rorschach test, However, could not statistically discriminate heroin addicts from normal. Table 1 Mean Scores, SDs and t-Values on Serve Indices of Rorschach for Normal & Heroin Addicts. Scoring Normal Heroin Indices (n=15) Addicts t.values Level of (n=15) significance Human Response M 13.35 12.95 0.17 NS SD 7.54 4.10 Animal Response M 23.95 36.02 3.13 .01 SD 12.32 7.56 Anatomical Response M 15.80 17.14 0.46 NS SD 8.660 6.68 Atypical Response M 50.84 54.12 0.39 NS SD 25.89 18.12 Popular/Most Typical Response M 14.61 40.91 5.74 .01 SD 7.52 15.42 Dr. (Smt.) Shubhra Banerjee. Reader & Head Deptt. Of Psycho, AMDC. Varanasi. Dr. Anjana Mukhodhyay Sr. Lecture, M.M.V., Deptt of Psycho., B.H.U. Varanasi Smt. Usha Singh Lecturer, Deptt. Of Psycho. Maharani Banaras Mahila Manavidhyalya Ramnagar Varanasi. SIS in Heroin Addicts 35

Rejection of Images M 1.06 45.60 8.52 .01 SD 1.85 14.70 Sex Response M - 27.83 SD - 5.28 Table 2 Mean scores, SDs and t-Values on Seven Indices of the SIS-I for Normal and Heroin Addicts (scores in percentage). Scoring Normal Heroin Addicts t-values levelof Indices (n=15) (n=15) Significance Human Responses M 13.44 9.97 1.64 NS SD 5.35 5.83 Animal Response M 25.11 21.28 1.04 NS SD 3.98 13.23 Anatomical Response M 28.58 22.01 2.43 .05 SD 4.67 8.97 Atypical Response M 7.26 15.38 2.77 0.1 SD 4.79 9.85 Most Typical / M 22.56 12.22 3.96 .01 Popular Response SD 7.31 6.47 Rejection of Images M 0.91 18.25 8.14 .01 SD 1.661 7.83 Sex response M 1.69 2.82 1.03 NS SD 1.72 3.75 Table 2 compares the drug addicts and normal in terms of qualitative indices of SIS. Significantly high mean difference score have been reported for the drug addicts for Atypical responses and Rejection of images as well. A contrary, significantly low score percentages were contained or the Anatomical and Most typical responses. Human responses, ANIMAL RESPONSES AND THE Sex responses measure of SIS reported insignificant results. A contributory component of comparative reaction high (p<.01) for the Heroin Addicts both for SIS and Rorschach tests (table3). Increased reaction time is a sign of emotional distur- 35 Banerji et. al.

bance and the psychopathology is often manifested by higher RT or rejection of cards wheals fast reaction or decorated reaction time was observed for abnormal responses found in schizophrenics. Normal reaction time is supposed to be under 30 seconds whilst the Addicts have reported an average of 31.40 seconds for Rorschach responses and an average of 33.27 second for SIS responses which clearly signifies emotional disturbances / maladjustment 9Joshi, 1968). Table 3 Differences in Percentage Magnitude of Rorschach and SIS-I indices Values of the Heroin Addicts. Measurable T-values Level of Discriminately Indices Ror. & SIS-I Significance Higher responses Human Response 1.57 NS Animal Response 3.62 0.01 Rorschach Anatomical Response 1.63 NS Atypical Response 7.03 0.01 Rorschach Most Typical Response 6.42 0.01 Rorschach Rejection of Images 5.59 0.01 Rorschach Sex Response 14.46 0.01 Rorschach Table 4 Mean scores, SDs t-Values of Time Taken by the Heroin Addicts and Normal for SIS-I and Rorschach Test Normal (n=15) Addicts (n=115) SIS RORS t-value SIS RORS t-value Mean Score 22.57 24.12 33.27 31.40 SD 5.98 6.23 .65 NS 11.03 5.48 .344 NS SIS (A) SIS (N) 6.444* RORS (A) ROS (N)3.34* Significant at .01 level. Common indices of SIS and Rorschach when compared for the same drug addicts group Rorschach percentage scores reported substantially higher. Ex cept in Human responses percentage scores reported substantially higher. Except in Human response and Anatomical response, all the t-value are found to be significant at 0.01 level (Table 4) SIS in Heroin Addicts 37

Discussion & Conclusion: The concept of affective body schema signifies that perception of body is not just perception of organs and system but the process in an emotional outcome 9Gaetani, et. Al. 1995). The myth of somatic region symbolizes a worth of trait components. Mishra (1997) pointed out some “head-core” responses for the succulent discrimination-indicate for both the test, have extracted support for the SIS scores with significantly low MT scores (P<0.01) among drug addicts. Popular responses on the Bided of Rorschach, however contrary to expectation are providing significantly high (P, 0.01) responses among addicts. Human responses is another hardcore component which indicated normality for the Rorschach technique as well as for SIS, a support t this effect is there in the earlier studies (Cassell, 1980; Dubey andCassell, 1993; Dwivedi, et.al. 1995; Mishra & Dwivedi, 1997). Reports revealed a lower pwecenbtile mean for the addictis. However discrimination could not reach the level of significance for both the tests SIS the Rorschach. In a cultural study conducted by Dubey, et. Al. (1994) it was found that normal subjects provide more responses than neurotics and schizophrenics; consequently the rejection of images was found to be more in clinical groups than in normal group. Similar trend has been observed in the present study with rejection of responses (i.e. t=8.52 and 8.14, p< .01 level). Anatomical responses which needs a qualitative treatment could not significantly discriminate the normal and clinical group. Pathological projection of anatomical part restates the psychology (Cassell, 1980). SIS being a semi-structured tool for the somatic body imagery could bring higher anatomical responses for the normal. Anatomical structure perceived less in number as the rejection of imagery has possibly gone through the ceiling effect. Ramachandra (1994) observed that neurotics took more reaction time on SIS images than the normal subjects. Preset study also reports of high reaction time of Heroin addicts which always denoted the emotional maladjustment (Joshi, 1968; Klopfer, 1954). The profiles of two test have been worked out and t has been concluded that indices (i.e. Anatomical responses, Atypical response, Most typical/ popular responds and Rejection of Images). Rorschach responses also discriminated addicts significant from normal on four indices out of seven (Animal responses Most Typical / popular response, rejection of images and ex response). Encases of 37 Banerji et. al.

animal response which denotes low socialization and frustration was present in its expected direction. However, findings on SIS are in its reverse direction. Images based on somatic body part for SIS and ambiguity in Rorschach is against the assumption from the Rorschach measure, which is questionable. No bout out of 7 indices Rorschach responses proved to be higher in its mean percentage on the 5 indices suggesting the ambiguity of the test. Thus, the results of the present study reveal that the indices of SIS-I are comparable direction and could better discriminate the notmal subjects from addicts. It may severs a diagnostic and therapeutic tool for the drug addicys as suggested by Mishra (1996), Finally, It can be concluded that the Somatic Inkblot Series-I is anew successful addition into projective techniques which its limited number of responses can judge better the hidden pathology of the clinically affected per sons than the Rorschach. References Cassell W.A. (1996). Rorschach to inkblot configurations resembling the heart, J. Proj. Tech. And Personality Assessment,3. 123-126. Cassell, W.A. (1971) Body consciousness in exhibitionism. Brit. J. Proj. techniques., 16, 21-31. Cassell W.A. (1972) “Individual differences in Somatic perception. “ Advances in Psychosomatic Medicine 8. 84-104. Cassell, W.A. (1977) Aggressive imagery and clinical symptoms in Schizophrenia Brih J. Proh Techniques. 22, 21-34. Cassell W.A. (1980) Body Symbolism and Somatic Inkblot Series Alaska, Aurora Publishing Co. Chandha, E.E. and Bhatia, M.S. (1990) A clinical study of summarizing patients attending psychiatric outpatient clinic. Indian. J of Psychiatry. 32, 39-43. Dubey B.L. Mishra M., Divedi C.B. and Mishra N. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Series II and Rorschach J. Proh. Psy. And Mental Health 1 19-26 Dwivedi P. Mishra M. and Cassell, W.A. (1994) Somatic Inkblot Series Video in Adolescent J. Proj Psy and Ment. Health 1, 27-32. Joshi M.C. (1968) Manual of Word Association Test Rupa Psychotically Corpo- SIS in heroin Addicts 39

ration , Vadnais. Klopfer, B. Anisworth M.D. Klopfer, W.G. and Holt R.R. (1954). Development in the Rorschach Technique. Vol.1. New York World Books. Mishra M. and Dwivedi C.B. (1997) content Scale based diagnostic compatibility of the SIS-II with Rorschach text in normal neurotics and schizophrenics. J. Proj Psych. And Mental Health 4. 121-140. Mukhodhyay. A., Banerjee. S. and Mitra, G. (1996) A comprehensive profile of personality characteristics of male drug addicts” J Proj. Psych. And Menal Health 4. 121-140. Mukhopahdhyay, A. Baberjee S. and Mitra, G. (1996) A comprehensive profile of personality characteristics of male drug addicts” J. Proj Psy. And Mental Health 3. 33-141. Ramachandra S (1994) Rorschach and the creative artists J. Proj Psy. And Menal Health 1, 39-50. Srinivasan K., Murthy R.S. and Jankiramaiah N. (1986). A ontological study of patients presen6ing somatic complaint Act Psychiatrica Seandinavics, 73, 1-5. Teha, J.S. and Agrawal, A.K. (1971) depression across Cultures British J. of Psychiatry 119. 253-260 40 Banerji et. al.

Piotrowski’s Alpha Index Validities with Schizophrenics Varying in Duration of Illness S.C.Haudhary and S.G.. Jyothi Three groups of 20 schizophrenics each with mean length of hospitalization 3.2 months 3.7. years and 11.2 years were given the Rorschach test by Klopfer’s method Conditions for applying Piotrowski’s alpha index were present in 29 schizophrenics out of whom 28 (96.6% were correctly diagnosed. The alpha index was equally valid for all three groups of schizophrenics indicating that the alpha index diagnosis a specific subtype of schizoid – hernia rather than a transited of mild stage of disorder. The Rorschach alpha index was designed to aid in distinguishing quickly and reliably an early psychotic from a patient with neurosis or less severe psychopathology. Although the alpha index has been shown to be quite effective in detecting psychosis initial studies indicated that it was mainly applicable to the early mild latent or pseudoneurotc forms of psychotic states. In partial corroboration of this one study reported that with increasing deterioration the excess of control is lessened and in conducting with this the alpha score tends to drop. However, a subsequent study reported opposite results (Goldfried et. Al. 1971; Piotrowski’s & Berg 1955; Abrams 1964). In view of the contradictory results and paucity of Indian studies, the present work was undertaken. Material and Method: The sample for the study was drawn from male in patients of Military Hospital Merit and Methods Hospital, Barely, who had been diagnosed as schizophrenia following DSM III R criteria (APA 1987). Duration of hospitalization was employed as the criterion for level of tonicity. Three groups of 20 patients each were included in the study. The first group consisted of patients who had been hospitalized for less than a year. The second group had been continuously hospitalized at Mental Hospital Barely for 2 to 6 years. The third group of chronic schizophrenics had been in the institution forborne than 7 years. The Rorschach test was administered individually to the patients and score by Klopfer’s method. The alpha index takes into account the number of W responses given by the subject, the sun C (scored in the usual way). Sun c (scored salary to sun C with 1.5 assigned to each c response 1.0 for each FC response and 0.5 for watch subordinate c response viz Mc. CFc), the dark shock and the F+% In order to arrive at the alpha score, weights are assigned to the various levels of Suprakash Chaudhary, MD. Ph.D., Psychiatrist, Command Hospital (North Comd) C/o 56 APO., S.G. Jyothi, Specialist Knurs (Psychiatry), Military Hospital, Meerut – 250 001 SIS J. Proj. Pst. & Ment Health (1998) 5:1, 41-45

W, Sum C, Sum minus Sum C, dark shock and F+% less than 70 details of which are given in Table 1 Table1 Piotrowski’s Alpha Score Weights Weighted W Sum-c-SumC C” shock f+%<70 Score o <4 3,5-4 0.5 2.5-3 3-4 1-1.5 1.5-2 Present Present >4 2-2.5 0-1 -1 3-4 -2 >4 The alpha index is scored only when W is less than 7 and Sum c is more than or equal to Sum C. When these two conditions do not prevail the alpha index is not applicable. It is intended for use only with subjects aged 16 years or order. In addition, the patient must be of average or above average intelligence if the formula is to be useful because it tends to five results of varying validity when used with people of differing intelligence. However, as the number of W response F=% and light shading responses on the one hand and the intellectual capacity ion the other are correlated, it is doubtful whether individuals with less than average intelligence would produce records that may fulfill the first two conditions (Prabhu, 1970). A score of three or more on the alpha index is taken as an indication that the subject is more severely disturbed than a merely neurotic condition. The score went through the individual Rorschach protocols and marked the presence or absence of each sign and recorded the total weighed score on each protocol. Statistical comparisons were performed using the median (chi-square) test. Results: Demographic characteristics of the three groups of subjects are given in Table 2. The mean Hospitalities period was 3.2 months for patients hospitalized less chronic schizophrenics hospitalized for more than 7 years it was 11.2 years Analysis of the Rorschach results showed that three groups of subjects had almost equal productivity through there was a tendency to higher from level scores and increasing alpha scores in the chronic schizophrenics 9Table 3). 42 Chaudhury & Jyothi

Table 2 Demographic Characteristics of the Schizophrenia Patients with Varying Duration of Hos pitalization. Characteristics Duration of hospitalization (in years) <1 2-6 >7 (n=20) (n=20) (n=20) Age (in years) Mean 24.8 29.2 40..05 Range 17-48 23-57 23-55 Age distribution <21 - - 21-30 31-40 41-50 51-61 - Education 0-5 Class 6-10 Class > 10 Class Religion Hindu Muslim Sikh - - Christian - - Domicile Rural Urban Marital Married Unmarried Widower - - Table 3 Rorschach Scores of Schizophrenics with Varying Duration of Hospitalization. Characteristics Duration of hospitalization (in years) <1 2-6 >7 (n=20) (n=20) Total response Mean 9.8 9.05 9.5 Range 6-14 5-13 5-16 F+% Mean 33.74 39.47 448.17 Range 0-66.67 0-100 0-100 Alpha score Mean 2.40 3.45 3.75 Range 1-5 11-5 0-7 Piotrowski's Alpha Index 43

Calculation of the alpha index indicated that only 29 (48.33%) of the60 subjects studied met two necessary conditions for employing the alpha index. Out of these 29 schizophrenics, 28 (96.6%) obtained an alpha score of 3 or more. In further testing the reformulate to determine its effectiveness when only one condition was met only 8 (44.4% out of 18 attained a sufficient alpha score allowing them to be diagnosed correctly. When neighed requirement was met 92.3% false negatives were found 9Table 4). No difference existed among the three groups with regard to the number of subjects who attained the critical score, through there was tendency for the number to increase with tonicity 9Table 4). Table 4 Comparison of Canonicity levels of Schizophrenics and Alpha Index Results. Years of Conditions of Number of Number of Hospitalization aloha index met subjects over subjects under Critical score Critical score 1 year None One Both 2-6 years None One Both >7 years None One Both In comparing the Rorschach protocols of alpha schizophrenics 9alpha score.3) with those of no alpha schizophrenics (alpha score<3) it was seen that the former group contained a mean from level of 49.5 compared to 33.04 by the latter. This difference, however, was not significant 9Median test-chi-square=3.13, df=1; p>0.05). In line with their under productivity, the alpha subjects gave fewer responses (mean responses = 9.09) compared to the no significant (median test=chi square=1.0; df=1:p>0.30. The Rorschach protocols strongly suggests contained a number of responses that are considered to be strongly suggestive of schizophrenia, of the 28 alpha subjects, 12 (42.9%) gave responses of this nature. This was comparable to findings in non – alpha subjects, 40.6% of whom responded similarly. Discussion: The finding of a high proportion of alpha positive patients among schizophrenics 44 Chaudhury & Jyothi

when both the conditions of the alpha index where met is in agreement with earlier studies (Goldfried et. Al. 1971; Piotrowski’s & Berg; 1955 Abrams, 1964), and indicate that the alpha index is a high accurate means of detecting schizophrenia in both early and more chronic patients. The limiting factor was that the alpha index was applicable to only 48.3% of the subjects. However, previous investigations have also found that between 25% to 55% schizophrenics at tainted the necessary two schizophrenia patients to whom the formula could be a high proportion of false negative results showing that the alpha index is of relatively little value when used in this manner. Rorschach signs, which are considered highly suggestive f schizophrenia, were found in 42.9% of the subjects indicating that a diagnosis could easily have been made in these subjects without the aid of the alpha index. However in the remaining 57.1% cases there were little suggests could pathology in the Rorschach protocol and the alpha score in these subjects could have been a definite asset in solving a difficult diagnostic problem. The findings of the present study are in agreement with the findings of Abrams (1964) but in contrast to Piotrowskiu & Berg’s (1955) earlier belief, indicate that the alpha score nor only detects earlier, Ming or borderline psychotic disorder, but seems to be equally effective in later stages of illness as well, enviously the index does not identify a transited or borderline condition, but it probably detects a specific subtype of schizophrenia. Evidence indicates the alpha psychotic, regardless of duration of illness, to be inhibited, aphetic withdrawn, under active successful employs to retreat from the stresses of life. Evidence indicated that approximately 25% to 55% of schizophrenic patients employ this technique in an attempt to achieve a degree of security. Further research into this subtype f schizophrenia and their response to treatment would be of interest. References: Abrams. S (1964) A validation of Piotrowski’s formula with schizophrenics varying in duration of illness. American Journal of Psychiatry 121: 45-47. American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders. 3 rd Revised. Washington DC: APA. Goldfried M.R. Striker, C. and Weiner I.B. (1971) Rorschach handbook of clinical and research applications. New Jersey : Prentice – Hall Inc pp 291-295. Piotrowski Z.A. and Berg. F.A. (1955) Verification of Rorschach Alpha Diagnostic formula for under – active schizophrenics. American Journal of Psychiatry, 112: 4443- 450. Piotrowski's Alpha Index 45

Use of SIS-II and Other Projective Test in the Treatment Of a Case of Schizophrenia N.L. Dosajh This is the case history of a gird having early schizophrenia. The case-history shows the etiology of this disease, which has been systemically worked out and confirmed. The author’s technique of Combination of various Therapies including Projective Tests like Somatic Inkblot Seers-II (SIS-II). Rorschach. “d” Test and Thematic Apperception Test have been used for treatment. A general plan of etiology and treatment of early schizophrenia of less than fve years duration, has been suggested. Talking this case study as an illustration. Further SIS-II has been found to contribute a lot to the treatment t the patient. This is the Case History of a Schizophrenic girl aged 29 years, who was successful treated by the author using ‘A New Combination of Therapies ———(1995). He was originally a patient of the Department of Psychiatry in Command Hospital, Patchouli since August 1994. She was diagnosed as schizophrenic and was being administered Escaping and Pakistani. She was not satisfied with this treatment and so she contacted the author for psychotherapy in May, 1997. After establishing report, she was administered Rorschach test on May 31, 1997. The results are as follows:- W responses ——— 5(2+&3-) D “ ———13 d “ ———6 F+ “ ———5 F- “ ———18 FC “ ———4 CF “ ———2 Cn “ ———3 M “ ———2 The result only confirms diagnosis, as there are a few W+ responses (Beck). Many f the W responses are crude and undifferentiated type. She has picked out bizarre and unclear details. M Reponses are below normal. Cn is fairly common (Beck, Rickers- Ovilankina). F+ decreased whereas F-is increased as compared to the normal. She describers RR cards as –Ink-spread and Design (VI & VII cards), thus confirming the disease as Schizophrenia (1978, 1982). However, Piotrowski’s alpha is blot applicable because the number of shady responses is smaller than color responses (1945, 1955). During her earlier days, she was performing the following Yogic Asana:- SIS J. Proj. Pst. & Ment Health (1998) 5:1, 46-50

1.Cobra Pose, 3. Bow Pose 7. Shoulder Stand 15. Corpse Posture (1983) She was asked to resume those Asana and perform, them regularly. She was then administered SIS-II (1990). The following images drew her inner cry that is purged out the pent-up emotions: Image 10A: She says, “Human Eyes and eyes for me indicate crying as if at the time of death” DOSAJH : Do they remind you of something? Patient: (With tears in her eyes) Yes, they remind me of the death of my mother, I cried bitterly and my eyes became like that Image 21A: It looks kite a monster. I like to avoid it. It arouse fear in me Dosajh : Does it remind you of something? Patient; Yes the finance & Development Officer, who harmed me. I fear him. It creates a fearful in me. His commanding voice still resounds in my ears. I hear a voice ‘ Ab Bata’ (Now tell me and it resounds in my ears many a time. Image 30A: Skull. I don’t like it. I read about it in my VII & Viii classes. Ddosajh : Why don’t you like it? Patient: It reminds me of deaths in our family. When my mother died I cried very bitterly. Image 2B: It is again a monster. It is spread out and looks very fearful. Dosajh : Does it remind you of something? Patient: Yea, it reminds me of different fearful incidents in my life. Image 7B: It is a rubber bottle. It reminds me of the hot water rubber bottle that my brother uses in his quilt. I fill it with hot water many a time to help my brother, whose illness, they say, is incurable. I feel it a lot. I always think of my brother. Twelve years have passed, but there is no relief. PGI doctors say that this trouble is incurable. Homeopathy has also failed. We tried it my brother was a Bank Manager in Kerala but her had to give up the job on account of this trouble. SIS in Schizophrenia 47

This trouble start in Keala itself. Then on account of this trouble, his wife and child left him. She got divorced and she remark ride. I feel all this immensely and very often. Image 12B: Long nose-It is the picture of an overall cure person. Dosajh : Does it remind you of something? Patient : Yes, of my curl grand – mother who was always quarreling with my mother and making our home a hall. Image 17 B: Solar eclipse. It is not a good picture. Dosajh : Why is it not a good picture? Patient: It reminds me of my own life which is eclipsed. There are miseries and misries. I have lost all hope about my further. It seems quite dark. Dosajh: But the eclipse does not remain forever. After the eclipse for some time there is always a bright sun. Patient: That true let me hope my bright days will come soon. Dosajh: Yes sure. Then on August 8, 1997 she was administered ‘D’ Test (1992). Her responses to various rectangles are:- Turnip B. Clouds in the sky (This is what my life is-miseries and miseries C. Alphabet. D. In action while boxing. E. Bride. F. Ducks swimming G. A. person sitting in the chair. H. A lady with a necklace I her neck. K. Show pike. L. Earthworms in water. M. Cartoon. N. Mushroom. O, Flower in a grade. Then on August 21, 1997, he was administered the following pictures of The antic Apperception Test (TAT):- 1,4,5,10,11,13 MF, 14,15,16,20. She did project herself in the various stories of the TA. In most of the stories the hero sufferers a lot but towards the end of the stories the harp always comes out successful. This shows that the prognosis of the patient is good. On August 26, 1997, she felt that she was all right. This way confirmed by administering the Rorschach Test again. The results of this testing are shown ahead: 48 Dosajh

Evaluation with the Rorschach Test Categories Patient’s Normal Score Score Sandhu (1978) Asthana(1971) (1982) Total number Pf responses Location W 4.65 9.33% D 13.06 16.97% D 1.68 - Determinants F 10.65 20.17% M 0.45 3.83 FM 2.06 - FC 0.32 3.08 CF 0.48 1.661 C - 2.12 - K - 0.35 - Contents H 1.66 2.60 Hd 1.77 - A 4.77 6.18 Ad 0.42 - Nature 1.23 - Bot 1.48 - Objects 1.71 - Rejection - 39% - The results of the Rorschach administration comparer very favorably now with Normal (India) as worked out by Sandy (1978) and Asthenia (1971) and thus establish the fact that the patient is completely cured of schizophrenia. Discussion of Results: This case study very well illustrates the etiology of schizophrenia. These are generally an early history of wrong bringing-up accompanied by many frustrations. In this particular case, when she was a child, there easy many quarrels between her mother and grand mother. In fact the home atmosphere was always surcharged with tension. The mother died in her forties because of brain home moorage (a clear sign of tension in the family). This was a great shock to the girl because she loved her mother immensely. This continuous tension in the family for a number of years in the early life of this girl has affected adversely her development and especially the nervous system. This must have resulted in an indult tension. SIS in Schizophrenia 49

Then there were a number of frustrations in her life-Her elder brother because invalid because of an incurable sodalities. His wife divorced him because of his sodalities and left the house thanking along with her only child. This girl loves her elder brother a good deal and sends most of her time serving him. Her husband divorced her elder sister, because he complained that she as darkish in colour. This also was a great shock to this girl (patient). Her constitution was quite weal and delicate. Before the start of schizophrenia, she was working as an account 9by virtue of her B. Com degree) wit a firm. On account of slight mistake in accounts, the Finance & Development Officer of the firm got her dismissed from service. Since then she started having attacks of schizophrenia. This dismissal became a precipitating factor for the disease. During my practice of about fifty years as a Clinical Psychologist, I have dealt with many such cases of schizophrenia. In almost all work bring yup followed by a particular serious frustrating situation precipitating this disease and when treated early (less than five years duration) is curable by ‘A new Combination of Therapies For the Treatment of Schizophrenia ——————(1995). Afterwards biochemical changes start taking place. Which cannot be managed with psychotherapy alone. Another outcome of this study is that SIS-II. As compared to other projective tests, is able to elicit more of repressed emotions (inner cry) and so is to a large extent responsible for the sure of the patient. References : Asthna H.S. (1971) Normative data on Rorschach Inkblot for Indian Sample, unpublished research report. Department of Psychology, Sagar University Sagar. Beck, S.J.L (1949) Rorschach Test Gurne and Stratton New York. Cassell. W.A. (1990) SIS Manual SIS Center. Anchorage Alaska. Dosajh N.L. (1983) Psychotherapy Including yoga Therapy, 148-158.Kohi Publishers. 34 Industrial Area Phase II. Chandigarh –160 015. Dosajh, N.L. (1995) A New Combination of Therapies for the Treatment of Schizophrenia of Less Than Five Years Duration, SISJ. Proj Psy & Mental Health 2: 135-138. Dubey B.L. (1982) a pragmatic View of Rorschach Inkblot Technique, 42-43, National Psychological Corporation . Bhutan 4.230, Kachri Ghat Agra. Klopfer B. and Kelley M. (1946) The Rorschach Technique. Worlds Book Company, New York Pitiwski. Z.A. (1945) Experimental psychological diagnosis of mild from s of schizophrenia Rorschach Res. Each 9:189. Piotrokwski Z.A. Berg D.A. (1955) Verification of Rorschach Diagnostic Formula for under active schizophrenics, American Journal of Psychiatry, 112: 143-450/ Sadhu J.S. (1978); Rorschach Responses In Schizophrenia Ind J. Psycho. 5:2 . 145- 153. 50 Dosajh

Re –Exemining TAT Alexithymia Indices A Preliminary Study Seema Mehrotra The report describes a preliminary attempt to examine the Interco relations between TAT alexithy mia indices (proposed by Volant’s et. Al. (19867) in normal adolescent population and to explore the fictiveness of these indices from other constructs such as emotional usability and emotional control. The Scale of Emotional Arousability (Brithwaite. 1987) the Courted Emotional Control Scale Watson and Free. 1983) and sets of three TAT cards were administered to a sample of forty study (mean age: 16.5 years). Moderate to high positive correlations were obtained between the TAT alexithy mia indices applicable in the present sample, i.e. length of narrative, imaginative thinking and affective reference, Imaginative thinking and affective reference were unrelated to gender, whereas the moonlight of narrative was higher in males. Length of narrative had small positive correlation with emotional reusability. Emotional control was not correlated with any of the three-alexithy mia indices. Upholding the hypothesis of the multidimensionality of alexithy mia; the results suggested the utility of separately examining the Interco related but distinct TAT indices of alexithy mia. The findings also suggested that imaginative thinking and affective reference indices as assessed, were un-correlated with and thus probably distinct from emotional reusability and emotional control. The issue for further investigations is highlighted. Difficulties in identifying and communicating specific emotional states, com stricter imaginative thinking and tendencies to focus on bare concrete details of external events are some of the affective and cognitive features that are embedded in the concept of alexithy mia (Taylor et. Al. 1991). Although clinical intuition suggests that projective measures (e.g. TAT) relying heavily in imagination and not explicitly demanding a verbal access to or description of one’s own feelings may be useful for assessment of specific intensively investigated as self-report measures, with the consequence that the findings have been inconsistent, probably discouraging attempts are refinement, validation and standardization their scoring systems (Sriram, 1989). The present study is a preliminary report of the initial phase of an ongoing project concerned with the examination of projective measures of alexithy mia. Apart from examining the Interco relations between TAT alexithy mia indices as proposed by Volhardt et. Al. (1986),this report also attempts to investigate data Seema Mehrotra, Ph.D., Assistant Professor Department of Psychiatry, K.M.C. Manipal 576 119. SIS J. Proj. Pst. & Ment Health (1998) 5:1, 51-58

on the discriminate validity of the alesithy mia construct as assessed with the help of TAT measures. Emotional control and neuroticism (emotional reusability) are two such variables focused on, in this context. Emotional control refers to conscious preempts to control expression of (negative) emotions (Watson bad Greer, 1983). Theoretically, the construct is distinguishable from deficits in identification, differentiation and communication of emotions which characterize alexithy mia. The study attempts to empirically test out the independence of these constructs. As far as neuroticism is concerned, Eysenck (1967) conceptualized it in terms of individually (Williams, 1989( and adults high on beuroticism tend to develop faster and more frequent recall of negativity to negative mood situations (Lease and Ketelaar, 1989). As far as its relationship with alexithy mia is concerned, some studies on psychiatric patients have shown a positive association between the two variables (e.g. Wise and Mann, 1993). On the other hand a few studies in non-psychiatry settings indicated a negative correlation be twine the alexithy mia and neuroticism measures use (e.g. Kreitlker et. Al. 1990; Mendel son, 1982). This apparently contradictory set if findings indicate that the association between neuroticism and falsity constructs needs further investigation. Method: Sample-Frothy adolescents (age range: 16 years to 17.5 years, Mean Age: 16.5 years) were randomly selected from the population of XIIth standard English Medium students of a regional centrally located junior college. Informed consent was obtained after explaining the board objectives and nature of the study. Material: 1. A set of three TAT cards (Indian adaptation) was selected on an apriority basis (card number 1, 3, M and 5 for males and 1,4 F and 5 for females). The cards providing potential for fantasy based on stimuli related to interpersonal interaction included but all cards with overt sex related themes were excluded to minims inhibitions in responding. No time limit was imposed. On the whole, the time taken to complete the set ranged from 15 o 20 minutes. 2. The Scale of Emotional Reusability is a fifteen items scale that focuses on assessment of neuroticism as originally conceptualized by Essence (1967). It attempts to avoid the use of negatively worded items and items which tend to reflect heavily the consequences of emotional reusability (e.g. neurotic symptoms). The reliability and validity data have been reported by Brithwaite (1987). Higher scores on this scale indicate higher emotional reusability. 52 Mehrotra

3. The Courted Emotional Control Scale (Watson and Greer, 1983) evaluated the degree to which individuals report controlling the expression of feelings of anger, anxiety and badness. A shorter 14 item version developed in an earlier study of the author (Mehrotra 1995) was used. The reliability and validity data have been re-examined in that study. Higher scores are indicative of higher degree of control over expression of (negative) emotions. The administration of tests was carried out in small subgroups (of 5-6 subjects each) and the order of presentation of the three tasks/tests was randomized. Data analysis and results: TAT protocols were rated as per the scoring categories developed by Volhardt and Colleagues (1986). Each grammatical clause was rated for the presence of absence of the following scoring categories: Somatic reference (P1) for clause containing words referring to body state or function, Imaginative thinking (p2) for clause containing narrative of co tinning story, Length of narrative (p3) or word count of the story, Operator thinking (p4) for clause containing description of details of the picture and Affective Reference (p5, for clause containing words which explicitly state experience of a feeling or an emotion. The guidelines promotion word’s Taylor et. Al. (1981) were used for elaboration of the criteria for coding emotion words or affective reference. Somatic reference and operator thinking were applicable in less than 15% of the cases and when applicable, the scores did not exceed a count of one on any of the protocols, for each of the two categorized. Further analysis made use of only Imitative Thinking (p2) Word Count (p3) and Affective Reference (p5) categories. For obtaining a crude estimate of inter-rater agreement; initially, five sets of TAT protocols were jointly scored by the author and another psychologist after mutual discussions, to clarify common guidelines for scoring and then fifteen sets of randomly selected protocols (15x3=45 cards) were independently rated by the two professional (blind to each other’s rating) Perfect agreement on raw scores were contained for p3 (Word Count), on 40 (89%) or the protocols for p2, on 37 (82%) and p5 on 36 (80%) of the protocols. On the protocols with less than perfect agreement, the variations in raw scores were of the size+_3. For each case, average p2, p3 and p5 score were obtained by using there sponges on all the three cards. As the number of emotion words or affective reference count and the imaginative thinking count are likely to be influenced by the length of stories (p3); p2% and p5% were derived on the basis of proportion of p3 reflecting imaginative thinking (p2) and affective reference (p5). TAT in Alexithy mia 53

Table 1 Intercorrelations relations Between TAT Alexithymia Indices Variables Correlation-values ® based on Correlated Raw-scores Transformed Scores Present Score P2-P3 0.89*** 0.93*** -0.06 NS P5-P3 0.66*** 0.73*** 0.14 NS P2-P5 0.69*** 0.74*** 0.32 ** Note P2 = Imagainative Thinking. P3 – length of Narrative, P5-Affective Reference ***P<-0.01** p<- 0.05 Table 1 shows the degree of correlation between average P2, P3 and P5 scores. Thelength of narrative (P3) has vary high correlation with imaginative thiking and moderately high correlation with affective reference. Volhardt and Colleagues (1986) had suggested the use of transformed scores, obtained by multiplying P2 and P5 scores by the square root of the owrd count (P3) in order to adjust for different word counts per protocol. In thepresent sample, the use of transformed scores resulted in high positive correlations of Imaginative thinking (P2) and Affective reference (P5) with Lengh of narrative (p3). On the other hand, when the correlations based on (P2) and P5 percent scores are examined (Table1); it is observed that the use of such percent scores results in indices (p2% and p5%) unrelated to the length of the stproes and having small positive correlation with each other. Table 2 Gender Differences on theTAT Alexithy mia Indices Males Females t-value (n=20) (n=20) Mean P2% 7.89 7.665 0.433 NS (1.80) (1.70) Mean P3 88.49 57.95 2.68 ** (41.0) (29.30) Mean P5% 1.93 22.34 0.85 NS (1.48) (1.54) Note Mean p2% - Average of percent Imaginative Thinking, Mean p3 – Average Length of Narrative, Mean P3% - Average of percent Affective Reference Figures in parentheses indicate the standard deviations of corresponding means. ** -p<- 0.05 (2-tailed test). 54 Mehrotra

Table 2 examines the percent P2 and P5 (Imaginative thinking and Aggecitive reference) and average length of narrative (p3), separately in males and females. It is seen that males and females do not differ significantly on percent P2 and P5 but males produce significantly longer stories and thus differed from females on P3. Table 3 Correlating TAT Alexithymia Indices with Emotional Arousbility and Emotional Control Length Imaginative Affective On Narrative Thinking Reference Percent Transformed Percent Transformed Score Score Score Score Emotional Reusability 0.39** -0.03NS +0.38** -0.14 NS -0.36** Emotional Control 0.15ns -0.02 ns +0.12 ns -0.09 ns -0.01 NS Note All the values entered in the table refer to the Person’s r values for the corresponding variables. ** p<- 0.05 Table 3 Examinations the correlation of P3, P2% and P5% (Length of narrative percent Imaginative thinking and Affective reference respectively) with Emotional arousability thinking and Affective reference respectively) with Emotional reusability and Emotional Control which are in themselves insignificantly correlated with each other (r=+0.20). The length of the narrative in the only variable which had a significantly positive correlation with Emotional reusability. The other correlations examined are insignificant. When the transformed scores, these turn out to be significantly correlated with Emotional arousability. Discussion: The pattern of result suggests the potential unity of recent Imaginative thinking (p2%) and percent Affective reference (p5%) scores, over and above the use of averages based on raw scores or transformed scores (as suggested by Volhardt et. Al. 1986) in the present context. The use of percent scores tends to take into account the variations produced by protocols f varying length and such an adjustment for variances in word-count results in measured unconfirmed by Emotional reusability. Percent emotion words or percent of words with affective loading have been used in earlier studies such as those by Warmer et.al. (1995) and Ten Houten et. Al. (1986). Loe positive correlation between P2% and P5% TAT in Alexithy mia 55

suggests that they share a common pool of variance and yet may not be conceived as redundant measures of the same facet of alexithymia. Somatic reference category in the present study was too in-frequently applicable to be utilize. A study by Taylor et. Al. (1992) revealed that in psychiatric outpatients, alexithymics scored higher on measures suggestive of a diverse range of somatic symptoms and bodily concern as well as anxiety, depression and psychological turmoil. The authors speculated that alexithymics are prone to ‘function’ somatic symptoms and emotional turmoil as they are inadequately equipped psychologically, several possibilities may be speculated upon, to explain the infrequent scoring in the somatic reference category in the present sample. The present study used a normal sample unlike the other studies cited. It is possible that somatic concerns (and symptoms) become more prominent under stress, resulting in emotional distress, which becomes difficult for alexthymics to regulate. Another possibility is that, as suggested by Sriram (1989), TAT may not pick up the ‘alexithymics’ tendency to focus on bodily sensations. In the present study, male and females did not differ either on percent Imaginative thinking or Affective reference. Alexithymia scores in normal have been reported to be unrelated to gender in the studies by parker et. Al. 91989) and Sriram (1989). The present study finding of ales producing longer stories can bot be explained by the other variables used in the study as there were no gender differences on Emotional reusability or Emotional Control. As males that differences in herbal expression or linguistic competence maul account for such differences inkling the of narrative. However, this hypothesis needs to be specifically tested by incorporation of the relevant measures (e.g. vocabulary). Tailor and Bosy (1985) had also suggested that length of stories may not always be reflective of fantasy. Moving on to the external correlated of alexithymia, the study indicated that the TAT alexithymia indices used, were unrelated to Emotional Control, i.e. the percent Imaginative thinking and Affective reference measles were not condisciminant validity of the indices. As far as the assessed. The result adds on to the discriminate validity of the indices. As far as the association of neuroticism with 56 Mehrotra

alexithmia is concerned, in the present study, the use of parentalexithymia scores results in indices unrelated to neuroticism. But the length of narrative is by Wise and Colleagues (1992) suggested that alexithymis is a unique personality trait not fully explained by the five factor model of personality (including neuroticism). It was found that in the psychiatric outpatients, neuroticism contributed the most in prediction of alexithymia (probably reflecting the state of fact of distress elevating neurotics). On the other hand in normal, introversion was the most significant predictor of alexithymia. Neuroticism had been described to becharacterzed by emotional sensitivity or over responsiveness (Essence, 1967). The results of an experimental study (Warmer et. Al. 1995) provided evidence (in a normal sample that alexithymia was not associated with heightened physiological or subjective receptivity to extrinsic emotional elicitors. Although a few studies discussed earlier showed a positive association between alexithymia and neuroticism; these have generally been conducted on adult psychiatric samples unlike the present one and as pointed out by Wise and Colleagues (1990) alexithymia as a trait can be confounded by state phenomena secondary to physical or emotional illness. Moreover, the present study made use of the Scale of Emotional reusability for assessment of neuroticism, as initially conceptualized no Eugenic (1967) rather than other measures of neuroticism like the Essence Personality Inventory (Eysenckk and Essence, (1964). The item-contents of the latter have been found to overlap with septum measures of neurosis such as the General Health Questionnaire (Goldberg, 1972) and the anxiety and depression scales of the Delusions-symptoms-Agates- Inventory (Bedford et. Al. 1976). The use of such measures which tend to focus on unpleasant experiences of emotional arousal may have a bearing on the positive associating between neuroticism and alexithyumia in the emotionally distressed’ psychiatric populating. The present study suggests that the TAT indices used, do not measure/ tap other variables (such as emotional reusability or emotional control\) thereby lending support to the discriminate validity of the measures. Further, organ investigations are aimed at replicating the study on larger sales of normal subjects in different age-groups, examining the utility of additional TAT alexithymis indices (e.g. those TAT in Alexithy mia 57

suggested by Ten Houston et. Al. 1986) enhancing the specificity of the guideline for scoring, establishing the inter-rater reliability of such scoring systems and studding the association of these dice with other measures of alexithymia to obtain data on their convergent validity. 58 Mehrotra

Projective Psychotherapy S.K. Verma and Ashima Nehra Psychotherapeutic use of projective techniques is not new. These techniques have been on use quite sometime. The recent emphasis through the use of SIS makes it a rich and more pleasurable experience. A new way of looking at one’s thoughts, perceptions and behavior (including one’s emotions) helps n modifying an correcting one’s philosophy of life as well as one’s maladaptive thoughts, feelings and actions. As it is nicely put by a researcher-Psychotherapy refers to “a group of unidentified techniques, applied to unspecified problems, with unpredictable results.: There is a multiple use of “u” (You). We tend to address each other as “you” and make take our turns to call others and be called ourselves as “you” only. In self analysis we tend to project ourselves outside and analyze it, not as ‘I’ ‘me’ but as ‘you’ only, accusing /praising/accepting/rejecting – be kind or cruel –revel if cancel, hug or kick – addressing this outside mysteriously unfamiliar object or conceal, hug or kick – addressing this outside mysteriously unfamiliar object as ‘you’ only. No wonder it is unidentified, unspecified, unspecified and unpredictable. Even when we, measure (psychometric) it –sometime ir reveals something interesting but often it conceals something vital –just like statistics or a bikini. Our perceptions of self start changing from real to actual, to ideal and move back aso, adding only to the existing confusion about our real identity. The basic anxiety remain about our aimless vague strivings and whenever, on our way, we catch hold of something concrete, our feeing of superiority starts expressing itself and repressing our m0ore basis feelings of inferiority – leading on to a sense of fulfillment and satisfaction, that at last, we have actually realized out hidden potentials. Coming out of our own self imposed detachment and gaining confidence, we become defiant and /or compliant, to different degrees, under different circumstances. In this, we are often surprised, how little we know about ourselves and agree with the poet that ‘the proper study of man- kind is man”. Most of out so-called “revelations” remain our own projections – actually that is how different school of thought, religions, beliefs, even psychotherapies emerge (giving fulfillment to our one wishes ideals fears and aspirations) and have described them. Psychoanalysis is no different from this self – analysis and self evaluations (Atma Vishleshan or, Atma Chintan), with or without use of self administered, structured and/ or unstructured tools. Instead of self-analysis – it is another S.K. Verma, Head Division of Clinical Psychology and Ashima Nehra., Vocational Guidance Instructor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh – 160 012. SIS J. Proj. Pst. & Ment Health (1998) 5:1, 59-62

trained persona who doe this for us. It has its advantages in that in may not be enough trained in the techniques of doing self- analysis and a critical and close look by an outside agency – a trained person – may help one. It may provide another view, from another angle and may provide some useful insights in one’s win motivations, perceptions thoughts, attitudes, behaviors, etc. One the other hand this, “other one”, however trained or unbiased he/she may be, will have his/ her own view of the world which may affect his interpretations. After all it is de pendent upon one’s own personal constructucts and philosophy of life, some of which would be available only to the person. It may not have been voiced be fore nevertheless it is available to the person concerned. So why not ask him to tell how he perceives himself? Actually a combination of the two may be better than any one extreme viewpoint. One may decide and choose one’s path and yet keep an open eye on oneself for a better more comprehensive, more lapsable and more useful alternative explanation i.e. for the maladaptive behavior patterns for which same help is considered needed and asked for. The two viewpoints, from different angles, may give depth to it. What is Projective Psychotherapy? Al these processes are ones and never ending. One has to be prepared for a shifting balance of forces. It is here that projective psychotherapy can be so some help. A question might be asked what is this projective psychotherapy. It is useful to remember that out life is unstructured to a greet extent and the child is like “a big blooming buzzing confusion”. To this, one has to give some meaning in this sear5ch for meaning and to understanding the purpose of life, one can utilize the existing contracts through the medium of family. Later on a word view emerges through these shared as well acne’s own personal constructs. This process goes on and on. These constructs sometimes; use their meaning, become modified and newer ones with new meanings come in to existence. Projective techniques also use unstructured or se structured material and ask the subjects (or patients) to give meaning to it while structuring / completing creating or, dealing with this material. When we use this method in bringing about a change on one’s attitudes or behaviors, we call it projective psychotherapy. One may argue that all psychotherapies have the same aim – of chafing one’s perceptions, attitudes, behaviors; in a desired direction, redacting distress in one and all, giving satisfaction and a sense hope will being to the subject and benefit to society at large. Only the methods and tools are different. There is nothing wrong with this line of thinking. There is enough evidence to support this viewpoint. We are in fact all for it. 60 Verma & Nehra

In fact, different bynames have been given to different psychotherapeutic tech niques, depending upon the emphasis which is given to this or that factor an d/ or denying the relative importance of other factors 9Rao 1980; Varma, 1995; Verma and Rao 1996; Rang swami 1996;etc.). Personal constructs are used, personal biases are introduced, colored glasses are applied to look at the same phenomena and descriptions are given in almost different languages. Different roads lead to the same goal. Different doors and windows give part views of the same whole. Tall persons prefer tall doors, fat persons require broader doors, while small persons can pass through all doors including small holes. Then there are front doors and back doors, side doors. Entries to knowledge can be from top (roofs) and (floors) tunnels also. Some dyers and windows give fuller views of the whole house – still some angle maul be missed. Again combination is better than a single view (view-point). Prohibitive psychotherapy makes use of vague, unstructured/ semi structured stimulus materials to stimulate persons to come out of the darker sides, i.e. from dark to light and see for themselves what they lo like through different topes of glasses. Somatic inkblot provide ample opportunities with varied stimulus materials (booklet from card fro and video versions) making free use of pleasing coolers, sound (background music to suit different needs of the subjects (and the size of their pocket also). In this it had definite advantage our other projective techniques. One does not have to leave with a bad tastin one’s mouth it is bothersome ot some. Using the video from of SIS the soothing effects of beautiful, colourful presentation f flowers and music reduces any negative side effects in comparison to any other projective technique in use at present. Inkblot amongst the projective techniques areknown xto give rise to marked anxiety in the same normal subjects also, hence thwy are used as the last test/technique with any person. SIS overcomes this limitation to a great extent. Qualitative and therapeutic use of SIS has been advised by Cassell and other also (Cassell 1977, 1994; Cassel and Dubey 1996, 1997; Dosajh 1996, Dubey et. Al. 1994; Verma 1994, 1996; Veram & Rao 1996, Nehra et. Al. 1977). Therapeutic use of fearful/ painful; unstructured / semi structured (projective) material and situations are well described. For example – a psychotherapist in Variasis (India) was using a completely dark room where the patients were taken to and asked to describe their experiences. These experiences were they analyzed and interpreted by the psychotherapists to the patient, in their own language, using constructs familiar to them. Extortionist uses more or less the same technique by making use of prevailing beliefs in the community. Many religious therapies have more or less a similar basis. The situation however need not be a painful one. Many Gurus use these techniques – e.g. prestige suggestions and explaining vague situations in terms of prevailing beliefs in the mases to establisg Projective Psychotherapy 61

rspport with the masses/ individuals – before interpreting the patient’ symptoms and pronouncing cures or, ways to get these curse. By explaining the unexplainable/ so gar unexplained (structuring the unstructured) an aura of power (Shakti is created, which is utilized to obtain the desired change in behaviour. Often this is achieved also,in suggestible persons, be other means also. Thus thhe projective poscyhotherapy need not be anxiety producing of use painful/ traumatic methods. SIS has dhown us the way it can be useful, helpful – yet by a pleasant experience, where one trusts one feelings and enjoys the pleasres of life, while solving one’s life problems with ease. In this sens, projective psychotherapy, perhaps using SIS, is a better method than other psychotherapies. References: Cassell W.A. (1977) desensitization therapy for body image anxiety. Canadian Psychiatric Association Journal, 22: 239 – 242. Cassell, W.A. (1994); The somatic Inkblot Series; continuing Rorschach’s conceptualizations. Journal of Projective Psychology and Mental Health 1: 3- 12. Cassell, W.A. and Dubey B.L. (1996) The use of Rorschach and Somatic Inkblot Series in realizing summarized grief. Journal of Projective Psychology Mental Health 23: 3-32. Cassell, W.A. and Dubey B.L. (1997) Therapeutic dream stim,ulation with the Somatic Inkblot Seers – Video Journal and Menthol Health 3: 58-68. Dubey B.L. Mishra M., Dwivedi C.B. and Mishra n. (1994) Diagnostic and therapeutic utility of Somatic Inkblot Series – II and Rorschach Journal of Projective Psychology and Ment Health 1: 19-26,. Rangaseami, K. (1980) India system of psychotherapy India Journal of Clinical Psychology 23: 62-75. Rao A.V. (1980) Gita and mental series. India Journal of Psychiatry 22 19021. Verma S.K. (1994) Maintain mental health yoga. Health for tight Millions 20: 26-27. Verma S.K. (1996) newer trends in inkblot techniques (Editorial ). Journal of Projective Psy chology and Mental Health 2: 1-2. 62 Verma & Nehra

A Comparative Study of Managers and Students on SIS-II M.P. Singh and Padma Dwivedi The present study aims at studying the difference of responses on SIS-II variables of managers and students. He sample consists of 50 managers and 100 students. Findings showed significant differences in total number of responses animal responses and sex responses, where no significant differences were found in other response categories. Pathological responses were negligible in both the groups. Somatic Inkblot Series-II is a powerful technique which is capable to reflect the total personality of an individual;. It works like andX-Ray’ which enters not the inner depths of the mind and brings internal characteristics of the person, often not known to the person himself. Good quality of the test lies in its use as an individual and a group test. Another aspect. It is a reliable and valid test. It has been proved a gild diagnostic instrument. It has been found that even a single image of SIS-II, is powerful enough to diagnose a particular case (Cassell, 1994; Dosajh, 1997). The number of responses affects Rorschach indices. Various measure have been advised to control this productivity. One such method was to prepare norms on the basis of number of responses 9Fire and Baughman 1952; Dubey 1982). The Somatic Inkblot Test has taken care of this problem. The present study aims are finding out if the exposure of managers makes any difference on the perceptions of images of SIS-II as compared to students. Objectives: 1. To compare th e profiles of SIS-II between Managers and Students 2. To compare the findings of the present study with the earlier studies on SIS- II. Material and Method: Somatic Inkblot Series-II is a self-administered projective test. The test was administered individually to each subject following standard procedure 9Cassell and Dubey, 1997). It was an dental sampling. Fifty Managers of above 35 years of age and hundred students in the age range of 20 t 22 were taken for the study. M.P. Singh Lecture in Psychology, Desh Bhagat College Dhuri. Punjab. Padma Dwivedi, Social Worker, Department of Cardiology, PGIMER, Chandigarh – 169 012. SIS J. Proj. Pst. & Ment Health (1998) 5:1, 63-68

Procedure: The subject was provided with SIS-II booklet along with response sheet. He was asked to read the instructions of the test. He was further assured that there is no right or wrong answer. Please write whatever comes to your mind after seeing these images. It takes about one hour to complete the test. Results and Discussion: SIS responses were analyzed for nine indices such as number of responses human responses, animal responses, anatomical responses, sex responses, movement responses, most typical responses, rejection of image ad pathological Reponses. Mean, S.D. and significance of difference between response of Managers and students were calculated. Findings are shown in table 1. Comparison of present study with the previous studies have been shown in able- Table 1 Mean Score, SDs and Values of Nine Indices of the SIS-II for Managers and Students Scoring Managers (N=50) Students (N-100) C.R.(t) Indices Mean SD Mean SD Number of Responses 64.82 4.888 62.92 1.669 2.79 ** Human Responses 19.26 5.40 18.09 4.97 1.30 NS Animal Responses 6.46 2.74 7.533 3.18 2.14 * Anatomical Responses 8.46 3.35 8.10 3.45 1.02 NS Sex Responses 2.50 1.60 1.35 2.23 3.64 ** Movement Responses 6.32 3.60 6.24 4.34 0119 NS Most Typical Responses 14.42 2.02 13.95 2.45 0.85 NS Rejection of Images 0.34 0.43 0.77 0.64 NS Pathological Responses 0.08 0.34 0.12 0.38 0.02 NS **Significant at 0.01 levels. * Significant at 0.05 level., 64 Singh & Dwivedi

Table-2 Comparison of Present Study with Previous Studies Managers Student Scoring present study Dudey, 1995 Present Study Dwivedi, Mishra & Mishra & Dwivedi 1997 Indices (n=50) (n=300) (n=100) Cassell, 1994 (n=50) Mean S.D. Mean Mean S.D. Adults Adolescents Mean S.D. (n+100) (n=48) Mean S.D. Mean S.D. Number of Responses 64.82 4.88 69.50 62.92 1.69 74.08 12.4 59.31 3.02 64.34 4.21 Human Responses 19.26 5.40 17.40 18.09 4.97 14.66 5.46 20.44 6.26 21.86 4.34 Animal Responses 6.46 2.74 9.20 7.53 3.18 8.65 4.69 3.79 4.01 7.80 3.23 Sex Responses 2.50 1.60 5.58 1.35 2.23 4.12 2.58 1.46 2.35 1.12 1.32 Movement Responses 6.32 3.60 5.00 6.24 4.34 9.60 5.30 0.69 0.96 2.30 1.86 Most Typical Responses 14.42 2.02 12.0 13.95 2.45 13.68 1.98 7.10 2.70 16.30 1.32 Rejection of Responses 0.34 0.88 1.43 0.43 0.77 0.82 2.0 2.81 3.19 0.58 1.40 Pathological Responses 0.08 0.34 - 0.12 0.38 - - - - - - SIS-II in Managers & Student 65

N.S. : Not Significant. The presents the earns, SDs and ‘t’ rations for all the nine indices, which have been computed and presented separately for managers and students. Mean of total number of responses of managers was found to be 64.92, SD=2.79. The difference was significant at .01 level. The results show higher number of responses by managers. This difference may be due to the differences of perception and maturity levels of the two. Animal responses were found to be higher in students (M= 7.53, SD = 3.18) as compared to managers (M=6.46, SD=2.74). The difference between the two groups on Animal responses has been found to be significant at 0.05 level. High animal responses in students may be due to their immaturity and poor adjustment with the enviournment as compared ti managers. Significant difference has also been observed in sex responses. The mean of the managers was found to be 2.50 (SD=1.60) as compared to the students 1.35 (SD=2.23). The difference was significance at 0.01 level. It might be due to maturity and openness of managers towards the images depicting sensuous parts of the body. Whereas students have not come out freely on these images. No significant differences have been found in human responses, anatomical responses, movement responses have been found in human responses. However, men’s ion these indices were slightly higher in managers. Rejection of images were very low in both the groups. Mean rejection of images for managers and students was found to be .34 and .43 respectiv4ly. Pathological responses were found to be .34 and .43 respectively. Pathological responses were found to be negligible. It be because both the groups were from normal population. The results confirm the finding of the previous studies. The findings of managers were compared with the findings of Dubey and Cassell (1993) and the students sample was compared with the findings of Dwivedi Mishra and Casell (1994); and Mishra and Dwivedi (1997). The managers of present study have obtained more number of responses, human responses, movement responses, most typical responses and gave low number of animal responses and anatomical responses (Table-2). Table 2 also shows comparison of adults and adolescents. Adults and adolescents 66 Singh & Dwivedi

show the mean of 74.08 and 59.31 respectively, whereas mean of total responses of students in present study is 62.92, which is lower than adults but high than adolescents. Mean of human responses (M=18.90 in present Mean of animal responses in the present study was found t be 7.53 which is lower than adults (M=8.65) and high than adolescents (M=3.79), Mean of anatomical responses in the present study is 8.10, where adults and adolescent showed high mean i.e. 9.18 and 13.10 respectively in the previous studies. Sex responses in adults (M=4.12) were higher than adolescents (M=1.46) and both the means were found to be higher than the students of the present study (M=1.35). Movement responses (M=9.60) were found to be higher in adults as compared to the present study (M=6.24), wheals low movement responses were shown in adolescents (M=0.69). Mean of the most typical responses (M=13.95) in the present study was higher than adults (M=13.68) and adolescents (M=7.10). Rejection(M=.82) and adolescents (M=2.81) of the previous studies. The present study has also been comported with the findings of Mishra and waved (1997). Table 2 shows that the Mean number of responses (M=21.86), animal responses (M=7.80), anatomical responses (M=12.20), most typical responses (M=16.30) and rejection of images (M=.58) were found to be higher than those of present study. The mean of sex responses *M=1.12) and Movement responses (m=2.30) were found to be lower than those of the present study. Since all the groups were normal, they hardly gave pathological responses. Conclusion: It can be concluded that managers gave more number of responses – human responses, anatomical responses, sex responses and most typical responses than student. The findings of the study are comparable with the findings of previous studies on managers. It further suggests that SIS-II can safely be used for different age groups shuns pre adolescents, adolescents, adults and aged persons. References: Cassell, W.A. (1994); The somatic Inkblot Series; continuing Rorschach’s SIS-II in Managers & Student 67

conceptualizations. Journal of Projective Psychology and Mental Health 1: 3-12. Cassell, W.A. and Dubey B.L. (1997) Therapeutic dream stimulation with the Somatic Inkblot Seers – Video Journal and Menthol Health 3: 58-68. Dosajh, N.L. (1977) Some Experience with Somatic Inkblot Series –II J. Proj. Psy. & Mental Health 4: 25-33. Dosajh, N.L. (1997) How a Singh Image of SIS-II Leads to Complete Psycho diagnosis. J. Proj.Psy. & Mental Health 4: 153-154. Dubey B.L. (1982) A pragmatic view of Rorschach Inkblot Technique. National Psychotically Corporation. Agra. India. Dubey, B.L. and Cassell, W.A. (1993) Some Experiences with Somatic Inkblot Seies- II British Journal Of projective Psychology 38, 1: 19-41. 68 Singh & Dwivedi

Clinical Notes: The Somatic Inkblot Series (SIS) and Eye Movement Desensitization and Reprocessing (EMDR) Wilfred A. Cassell Most readers of this journal are quite familiar with the various forms of the Somatic Inkblot Series (SIS). Previous reports have described how the SIS enables clinicians to release the “inner cry” of suffering individuals. Unlike most other projective tests, the SIS asks the subject to rate responses o an anxiety – threat subjective retag scale. It specifically determines in order, the three inkblots considered to be most disturbing. The one ranked highest has subsequent port – traumatic dreams of such events. Using that SIS inkblot on the answer sheet as a stimulus object for projective perception, the therapist has the capability retest situations of activating past traumatic imagery for therapeutic reprocessing. There are various ways that innovative clinicians can activate this imagery depending upon their theoretical orientation. Those who employ free associates interpretations. Cognitive therapists’ techniques may willies such responses in correcting disturbed think9ng such as exaggerated feelings of helplessness. Hypnotherapies and those skilled in active meditation therapy have also developed interesting applications for this projective approach. Another involves the use of the SIS in desensitization procedures. For example with the video version, there can be therapeutic benefits from the respected temporal association of presenting relaxing nature scenes immediately followed by presentation of the electronically – evoked painful traumatic imagery. Biofeedback technology may be used along with this for appraising the psychophysiological disturbances associated with traumatic SIS released memories. This presentation outlines how the SIS may prove to be and aid for those therapists trained in Eye Movement Desensitization and Reprocessing (EMDR). This appears to be significant, yet controversial method, which was discovered in 1987 by Shapiro (1995) for the treatment of a variety of conditions Wilfred A. Cassell , MD, FAPA, APC, Director Somatic Inkblot Center, 4105. Tudor Center Drive B-6, Anchorage, AK 99508 (USA). SIS J. Proj. Pst. & Ment Health (1998) 5:1, 69-70

Tubing thoughts and noticed a spontaneous tendency to experience specific eye movements. The parallel between these and the repaid we movements REM sleep has aroused considerable theoretical interest. The clinical activation of painfully PTSD memories while replicating dream-like eye movements in a suffering individual may trigger some yet to be determined homeostatic healing mechanism in the nervous system. There are many programs in the United State for training clinician s with EMDR. In first considering this approach, it seemed that thesis might prove to be a useful aide for activating traumatic imagery while implementing the required eye movements. Clinical work with victim of abuse indicated that frequently figures and the human content projected depict the perpetrators of abuse. The facial features in 10 A appear to be particularly effective in this regard. This blot maybe cut out of the answer sheet and attached to a penlight. The EMDR therapist can use this as a visual stimulus inject for activating the traumatic image5ry while causing the victim’s eyes to move in the prescribed manner. The SIS inkblot has certain advantages over to move in the prescribed manner. The guilty in the Inkblot has certain advantages over a photograph as a stimulus. The ambit guilty in the inkblot enables the subject to project disported cognitive and emotional feeling related to the perpetrator on a fashion that moor closely approximated post traumatic dreams. Investigators are encouraged to design controlled clinical redials to evaluate the efficacy of combing the SIS approach with EMDR. References: Shapior, F. (1995) Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York. Guilford Press. 70 Cassell

THE SOMATIC INKBLOT SOCIETY I wish to be a Member __________ a Life Member ________ of the Somatic Inkblot Society. Please submit this request to the Membership Committee. NAME ____________________________________ Birth date __________________ (Print or type) First Middle Last ________________________________________________ Zip _________________ Business/Office Address : ________________________________________________ ______________________________________________Tel. : (W)_________________ ___________________________________________________(H)_________________ EDUCATION Degree Year Institution Major Field of Study EMPLOYMENT : Current position, employer, dates (Graduate Students indicate area of study and degree toward which you are working). MEMBERSHIP : ________________________________________________________ TRAINING AND EXPERIENCE IN PERSONALITY ASSESSMENT : SPONSOR (S) Name Address Telephone 1. ____________________________________________________________________ 2. ____________________________________________________________________ SIS subscription payable every year in January through Cashier Cheque/Draft I certify that the information provided above is accurate and correct. An APPLICATION FEE Cheque is enclosed for Foreign Members ($40) & Life Membership ($300). For Members in India Rs. 250/- & Life Membership Rs. 1500/- Total Cheque $/Rs._______________Drawn at________________________________ Signature of applicant : _______________________________ Date :_______________ PLEASE RETURN with your cheque to : B.L. Dubey, Ph.D., Vice-President, Post Box No. 1107, Sector 15 Post Office, Chandigarh – 160 015 (India). Tele/Fax : 91-172-710986, Tel. : 91-172-710985, E-mail : sisdubey@hotmail.com Make cheques payable to Somatic Inkblot Society, Chandigarh (India) N.B. : Please add Rs. 50/- as one time registration fee; and $5 / Rs. 30 if you are sending subscription through out station cheque.

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITOR-IN-CHIEF : B.L. Dubey, Ph.D., Director SIS Center India, Post Box 1107, Sector 15 Post Office, Chandigarh-160 015 [Res. : T2/15, Sector 25, Chandigarh-160014 (India)] Tel/fax : 91-172-710986, Tel.: 91-172-710985, E-Mail: sisdubey@hotmail.com OR sisdubey@sancharnet.in EDITORS : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK 99516 (USA) Fax: (907) 563-3746 E-Mail: drcassell@corecom.net : Padma Dwivedi, M.A., Social Worker, Dept. of Cardiology, Post Graduate Medical Institute, Chandigarh-160 012 Tel/fax : 91-172-710986, Tel.: 91-172-710985, E-Mail: sisdubey@hotmail.com : C. B. Dwivedi, Ph.D., Prof. Dept. of Psychology, Banaras Hindu University, Varanasi-221005 (INDIA) Tel. : 91-542-317430 : Ravi S. Palia, M.S.W., Vice President HRD, Brar Group of Co. 68-70, Sector 17C, Chandigarh-160 017 e-mail : ravipalia@hotmail.com : S. K. Verma, Ph.D., 5522 Modern Housing Complex, Manimajra, Chandigarh-160001. Tel. : 91-172-730993 JOINT EDITORS : D. Saldanha, M.D., Psychiatrist, Dept. of Psychriatry, Military Hospital, Meerut U.P. India, E-mail : danval4@hotmail.com : A. Dubey, MBA, SIS Center, 4220 Edinburg Drive, Anchorage, AK 99515 (USA) E-Mail: adubey@hotmail.com ASST. EDITORS : M.P. Singh, Ph.D, Lecturer, 1329, Sector 70, Mohali-Chandigarh Tel. : 91-172-223658 (H) E-mail : drmps@usa.net : Mridula Mishra, Ph.D., Lecturer, Bihar Yoga Bharati, Munger-811201 (India) Tel. : 91-6344-22430 E-Mail : sisdubey@hotmail.com EDITORIAL CONSULTANTS R. N. Agnihotri, M.Sc., India Anil Agrawal, MBA,India Phillip W. Baker, Ed.D., U.S.A Mahesh Bhargava, Ph.D., India D.K. Bhatt, B.E., India J.C. Bubber, MBA, India S.Chaudhury, M.D. Ph.D., India Alfred Collins, Ph.D., U.S.A. Carina Coulacoglou, Ph.D., Greece K.V. Kaliappan, Ph.D., India Anatoly B. Khromov, Russia Nalini Mishra, Ph.D., India Vipul Mittra, IAS, India Anjana Mukhopadhyay, Ph.D. India Ravi Palia, MSW, India Rakesh Pandey, Ph.D., India Paul E. Panek, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy S. Ramachandra, Ph.D., India C.S. Rao, Ph.D., India Barry A. Ritzler, Ph.D., U.S.A. Ferro Roberto, Ph.D., Italy Ann C. O'Roark, Ph.D., U.S.A. M. Sahay, Ph.D., India Abhayman Sidhu, MBA, India B. P. Singla, LL.B., India Amool R. Singh, Ph.D., India David Sperbeck, Ph.D., USA M.K. Tewari, MS, M.Ch., India M.S. Thimmappa, Ph.D., India Ailo Uhinki Ps.D., Finland De-Cicero E. Vaz, Ph.D., Brazil Yasho V. Verma, Ph.D., India Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi