SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 13 Number 1 January, 2006 SIS ISSN 0971 - 6610 Vol. 13, No. 1, Pgs. 1-84 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 2006

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is a refereed journal and 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, counseling, 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 (doublespaced throughout) submitted through E-mail or in CD to B.L. Dubey, Ph.D. Editor Emeritus, SIS Journal, E-mail:sisdubey@rediffmail.com. or sisdubey@yahoomail.com with a copy to Amool Ranjan Singh, Ph.D. Editor In Chief,Prof. of Clinical Psychology,RINPAS,Kanke,Ranchi-834006. E-mail:dr_amool_r_singh@rediffmail.com. 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/ SIS Journal of Projective Psychology & Mental Health. SUBSCRIPTION: The journal is free to members of the Society, Annual membership fees are US $40 for foreign members and Rs. 300, for Indian members, Institutional subscriptions are US $60. for Foreign institutions and Rs. 600 for Indian institutions. Life membership is US $300. for foreign members and Rs. 2500/- for Indian members. Non-members may subscribe for $30 or Rs. 200 per issue. Cheques should be made payable to "SIS Journal of Projective Psychology and Mental Health" and should reach Amool Ranjan Singh, Ph.D. Editor In Chief. Members in foreign countries should send the cheque to B.L. Dubey, Ph.D. Editor Emeritus, 4406 Forest Road, Anchorage, AK-99517 (USA) Please add $5./Rs.60/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform B.L. Dubey Ph.D, Director SIS Center, Email : sisdubey@rediffmail.com Copyright @ 1994. SOMATIC INKBLOT CENTER, India/Anchorage U.S.A. Website: http://www.somaticinkblots.com

SIS Journal of Projective Psychology & Mental Health Volume 13, Number 1, January 2006 Contents Page Nos. 1. Editorial : The Aging Population: A Challenge for 1-2 Projective Psychology, Paul E. Panek 2. The Lowenfeld Mosaic Technique: An Introduction 3-16 to Its Clinical Use and Application, David Miller 3. Interpersonal Style and Gastrointestinal Disorder: 17-24 An Exploratory Study, Paul E. Panek, John J. Skowronski, Edwin E. Wagner and Carol F. Wagner 4. SIS Cognitive Psychotherapy For Spouse Induced PTSD, 25-36 Wilfred A. Cassell 5. The Relationship between Early Memories and 37-54 the Rorschach Inkblot Test, Edward M. Petrosky 6. Shifting Modalities of Communication in Psychotherapy: 55-60 Use of the Lowenfeld Mosaic Technique to Promote Self-Understanding and Mental Health, John B. Ruskowski and David Millerp 7. Gender Differences in SIS-I Profile of Manic Patients, 61-64 D. Kumar, B.L.Dubey and R.Kumar 8. Distinction of Novelty and Meaning Contexts of Creativity, 65-79 Umed Singh

Important Announcement Dr. Amool Ranjan Singh, Ph.D. Professor and Head , Department of of Clinical Psychology, RINPAS,Kanke,Ranchi-834006(India) E-mail:dr_amool_r_singh@rediffmail.com. has taken charge of the office of Editor In Chief SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH From January 2006 Institutional Members (Libraries of National and International Universities) are requested to send their Annual Subscription/Dues to Dr. Amool Ranjan Singh, Ph.D. Professor and Head, Department of of Clinical Psychology, RINPAS,Kanke, Ranchi-834006 (India) The Subscription Cheque should be made in favor of “SIS Journal of Projective Psychology & Mental Health” payable at Ranchi (India)

Editorial The Aging Population: A Challenge for Projective Psychology Over the last few decades, the United States and other industrialized nations of the world have become “aging societies.” Longer life expectancy, coupled with a general decline in the birth and death rates, has lead to a dramatic shift in the proportion of older adults within the general population. For example, in the United States the percentage of persons age 65 and older was 12 % in 1990, and approximately 20 % in the year 2000, and with greater longevity this relative percentage will increase in the future. Similar trends are observed in other industrialized nations of the world. Psychological assessment is among the primary functions performed by psychologists in clinical work with the aged. In this context, one significant function of projective tests is to aid in making valid and reliable diagnoses of pathology, and/or differentiation of psychopathology from the “normal” aging processes (Hayslip & Lowman, 1986; Panek, Wagner, & Kennedy-Zwergel, 1983). Older adults experience many of the same types of mental illness as young people, such as depression, as well as unique types of mental illness associated with aging such as Alzheimer’s disease and other forms of dementia. Therefore, a challenge for projective psychology is to address the assessment needs of the older population. Specifically, projective techniques need to: 1) develop appropriate norms for current cohort of “normal” older adults, as well as for specific diagnoses such as persons with Alzheimer’s disease; 2) develop norms for individual countries and ethnic groups within a particular country or culture (Panek, 2001); 3) demonstrate adequate validity and reliability in terms of specific diagnoses in the older population; and, 4) serve a basis for the conduction of extensive research investigating the normal changes in personality associated with aging controlling for extraneous factors such as sensory-motor problems, health condition, psychosocial problems, and verbal fluency. Additionally, the accurate assessment of older adults requires an awareness of typical/ expected behavior and functioning along social, psychological, environmental, cultural, sensory/perceptual and physical dimensions, as well as awareness of the potential interaction among these dimensions. For instance, hearing loss (e.g., the sensory-perceptual dimension) can affect the psychological dimension (e.g., lowered self-concept) and lead to less social interaction with others (e.g., the social dimension). Furthermore, projective test scores and responses must be interpreted within the context of the culture or ethnic group, rather than against an absolute or generic standard. Thus, clinicians not cognizant of these issues may be inclined toward interpretations based on test-bound reasoning which can lead to faculty conclusions or incorrect diagnoses. A last point to be made regarding projective tests is that, given the tremendous variability among older persons (Hayslip & Panek, 2002), projective tests present the clinician with an opportunity to conduct assessments and reach diagnoses that reflect the unique

Panek 2 life situations that characterize older persons. In both procedural and content-specific terms then, projective test data better reflect the realities of getting older, i.e., experiencing sensory-motor changes, as well as the unique and often cohort-specific nature of older persons’ responses to projective stimuli. References Hayslip, B. J., Jr., & Lowman, R. L. (1986). The clinical use of projective techniques with the aged: A critical review and synthesis. Clinical Gerontologist, 5, 63-94. Hayslip, B. J., & Panek, P. E. (2002). Adult Development and Aging. Melbourne, FL: Krieger. Panek, P. E. (2001). Projective psychology in the new millennium: Issues and challenges (Editorial). Journal of Projective Psychology & Mental Health, 8, 73-74. Panek, P. E., Wagner, E. E., & Kennedy-Zwergel, K. (1983). A review of projective test findings with older adults. Journal of Personality Assessment, 47, 562-582. Paul E. Panek, Ph.D. Professor of Psychology The Ohio State University-Newark University Dr, Newark, OH 43055 (USA) Email:Panek.1@osu.edu

The Lowenfeld Mosaic Technique: An Introduction to Its Clinical Use and Application David Miller The clinical use and application of the Lowenfeld Mosaic Test (LMT), an assessment instrument for which there has been renewed interest in recent years, is described. An introduction to the LMT is provided, including guidelines regarding its administration and projective interpretation. The procedure for conducting a sequence analysis of individual mosaic constructions is also provided, along with a case example. Limitations of the technique as well as future research needs are discussed. The Lowenfeld Mosaic Test (LMT), also known as the Lowenfeld Mosaic Technique (because it has no right or wrong answers and no formal scoring system, the LMT is probably more accurately viewed as a technique rather than a test), is an assessment instrument that has been in existence for over 75 years. Developed by Margaret Lowenfeld in 1929, it was widely used for a variety of assessment and diagnostic purposes during the first half of the twentieth century, including the assessment of schizophrenia and other mental disorders (Diamond & Schmale, 1944; Dorken, 1952; Ellenberger, 1954; Kahn, Cameron, & Giffen, 1975; Lowenfeld, 1954; Wertham, 1950), traumatic brain injury and organicity (Colm, 1948; Wertham, 1950), mental ability (McCulloch & Girdner, 1949; Reiman, 1950; Woolf & Gerson, 1953), and school readiness (Ames, 1963). Although various aspects of the LMT continued to be examined by researchers during the 1950s and 60s (Chase, 1965; Levin, 1956; Stewart & Leland, 1952), particularly with children (Ames & Ilg, 1962; Stewart, Leland, & Strieter, 1957; Walker, 1957; Wertham, 1963), thereafter use of the LMT and research conducted with it declined (for a more complete discussion of the history of the LMT, see Ames, 1986). After languishing in relative obscurity for many years, however, there has recently been a renewed interest in the clinical use and application of the LMT, particularly as a projective technique for assessing individuals’ functional capability (Ames, 1986), for attaining a greater understanding of the individual and the unique way in which a person experiences his or her world (Miller & Ruskowski, 2003; Perticone & Tembeckjian, 1987), and as potentially useful tool in psychotherapy and mental health promotion (Miller, 2005; Miller & Ruskowski, 2003; Perticone & Tembeckjian, 1987; Ruskowski, 1992; Ruskowski & Miller, in press; Woodcock, 1984, in press). Moreover, although originally developed in Great Britain, where it is still frequently employed (Anderson & Hood-Williams, 1985; Woodcock, in press), it has been increasingly used and examined in several other countries and cultures (Woodcock, 1986, in press), particularly in Japan (Abel, 1981, 1982-1983; Hirano, 1982-1983) and India (Azad, 1991; Bhargava, 1997; Pani & Mishra, 1995; Sharma, 1993). Earlier work with the LMT, including notable publications by Lowenfeld (1954) and Ames and Ilg (1962), emphasized the potential diagnostic uses of the instrument, as David Miller, Ph.D.,University at Albany, State University of New York, ED 244, Albany, NY 12222. , Phone: (518) 442-5038. Email: dmiller@uamail.albany.edu Key Word : Mosaic Technique

4 Miller well as normative aspects of interpretation (e.g., developmental maturity). More contemporary approaches to the LMT, however, have placed a greater emphasis on its value as a projective technique for revealing unique individual personality patterns, and it is this perspective the present author will take in discussing its potential utility. The purpose of this article is to introduce the LMT to readers who may not be familiar with it, to provide a brief overview of its administration and interpretation, and to discuss how the LMT might be used effectively in the context of clinical and projective assessment. Administration of the LMT: Administration of the LMT begins with the examiner placing a paper-lined tray directly across from the individual being assessed, along with an open box of tiles to one side of it. The box contains 456 plastic tiles of five geometric shapes presented in six different colors. From left to right and from top to bottom, this arrangement of colors is: black, green, yellow, red, white, and blue. White paper is placed inside the tray to provide a working surface for the individual; this surface area is bounded by a slightly raised rim along each edge of the tray. The examiner then says, “Here is a box of pieces in different shapes and colors. Let me show them to you.” The examiner demonstrates by placing one tile of each shape on the tray, selecting a different color each time. As this is done, the examiner says, “You see, there are some like this, some like this,” and so on. Returning the sample tiles to the box, the examiner then states: “Now, I’d like you to make something on the tray using some of the pieces. You may make anything at all, and you may use as many or as few pieces as you wish. Please tell me when you have finished.” (Perticone & Tembeckjian, 1987). The examiner carefully observes and records the behavior of the individual during the mosaic construction, noting not only the final product but also the individual’s entire manner of approaching the task (Ruskowski, 1992). The examiner simultaneously observes and monitors a number of pertinent variables exhibited by the individual being assessed, including the amount of time devoted to the task, the sequence of chosen colors, areas of the tray being used, the spontaneous questions or comments offered, the method of handling the tiles, the ease or difficulty with which the individual becomes involved with the test materials, and other noteworthy aspects of the individual’s performance, such as any hesitations in the individual’s response or any changes in tempo (Perticone & Tembeckjian, 1987; Ruskowski, 1992). Collectively, these observations “are regarded as significant data from which useful hypotheses may be generated” (Ruskowski, 1992, p. 34). Conducting meticulous observations of an individual during his/her mosaic construction is critical, because from the perspective of projective psychology it is assumed that all behavior (verbal and non-verbal) is meaningful, that no behavior is accidental, irrelevant, or capricious (Perticone, 1998), and that the role of the examiner is to observe the manner in which an individual expresses his or her uniqueness (Miller & Ruskowski, 2003). Such an approach requires that the examiner have an acute understanding of personality dynamics and places great emphasis on the careful observation of the living person rather than simply his or her completed product (Perticone, 1998). When

observing individuals in the act of creating mosaics, the examiner should be engaged in what Reik (1948) referred to as “free-floating” or “poised” attention. That is, maintaining a heightened level of awareness by simultaneously attending to multiple variables within the assessment context. Failure to engage in or maintain this level of awareness may result in valuable albeit subtle clues to an individual’s unconscious conflicts being overlooked. Because the LMT is a projective rather than an objective (i.e., nomothetic) personality assessment instrument, its ambiguous nature allows an infinite variety of response possibilities. It is therefore hypothesized that in creating a mosaic an individual “will exhibit in the test situation his/her characteristic manner of bringing structure to an ambiguous situation, his/her method of problem-solving, and that his/her responses will contain hints, if not frank expressions, of current preoccupations and conflicts” (Ruskowski, 1992, p. 34). As with any projective technique, it is assumed that the unstructured nature of the assessment task will force the individual to rely on “highly personal sets, expectancies, and attitudes” (Perticone & Tembeckjian, 1987, p. 11) and that as a result, both conscious and unconscious defenses can be expected to be mobilized (Perticone, 1998). Once an individual completes his/her mosaic construction, an inquiry is typically conducted in which the individual is asked to respond to various questions regarding it (e.g., “What did you make?”; “What does your design make you think of?”; “What does your design make you feel?”). As with earlier phases in the assessment process, the examiner continues to carefully observe the individual for signs of parallel communication, including the possible symbolic implications of particular verbalizations or behaviors (Perticone & Tembeckjian, 1987). At some point following the completion of the inquiry, the final design is traced and colored in by the examiner so that a permanent record of it can be preserved. Classifying Mosaic Designs: Although normative data for the use of specific colors and design shapes in children and adolescents ages 2 to 16 are available (Ames & Ilg, 1962; Perticone & Tembeckjian, 1987) and should be consulted prior to making any clinical hypotheses, the LMT has no formal scoring system. Instead, mosaic designs are classified by type, and hypotheses are developed based on the mosaic construction in relation to the individual’s overall response pattern (Perticone & Tembeckjian, 1987; Ruskowski, 1992). Ames and Ilg (1962) and Perticone and Tembjeckjian (1987) identified four types of mosaics, including (1) representational designs; (2) nonrepresentational designs with pattern; (3) nonrepresentational designs without pattern; and (4) mixed designs. Each of these categories is briefly described below. Representational designs are those in which specific objects or concepts are depicted (Perticone & Tembeckjian, 1987). Examples of representational designs include human figures, animal figures, natural objects (e.g., tree; flower); man-made objects (e.g., house; car); scenes (multiple objects which the individual indicates are thematically related), and abstract concepts (e.g., when a produced mosaic is described by the individual as symbolizing a concept, such as “freedom” or “movement”). On rare occasions, an individual who completes a mosaic may refuse to name the design. Lowenfeld Mosaic Technique 5

Nonrepresentational designs with pattern is a type of design in which “the presumption is that no specific object was intended by the subject in constructing the design…However, the fact that some pattern or schema was planned is demonstrated by the presence of design features such as symmetry, repetition of shapes or colors and systematic utilization of locations on the tray” (Perticone & Tembeckjian, 1987, p. 22). Ames and Ilg (1962) and Perticone and Tembeckjian (1987) identified five subdomains of this type, including (1) fundamental designs (simplest cohesive patterns that can be made using pieces of a single shape, such as when four square tiles are arranged to make a single large square); (2) central designs (consisting of pieces of the same or different shapes arranged either symmetrically or asymmetrically); (3) rim designs (constructions in which the pieces are placed at the edge or in a corner of the tray, but which do not extend beyond one-third of the tray’s overall area); (4) tray-filling designs (constructions in which the overall area of the tray is utilized); and (5) separate designs (comprised of several separate but patterned designs which the individual does not indicate are thematically related). Nonrepresentational designs without pattern “are distinguished by the absence of both an intended representational object and a systematic pattern” (Perticone & Tembeckjian, 1987, p. 23). Ames and Ilg (1962) and Perticone and Tembjeckjian (1987) include five subcategories within this type, including (1) dropped or piled (a handful of pieces are allowed to fall, or the tiles are simply pushed, onto the tray); (2) scattered singly (usually consisting of a few pieces which are placed one at a time and typically do not touch one another); (3) prefundamental designs (combinations of two or three pieces, usually of the same shape, that do not achieve the full gestalt of fundamental patterns); (4) slabs (pieces placed with each tile touching the one next to it, forming either a large or small cohesive mass, but without a meaningful or cohesive pattern); and (5) overall formless designs (all of the tray, or a major portion of it, is covered with tiles, but no pattern is attempted). The final type of the four design categories is referred to as mixed designs. In this category, “both representational and nonrepresentational elements are included in the finished design. Furthermore, the nonrepresentational portion of such productions may be characterized by the absence or presence of a discernable pattern” (Perticone & Tembeckjian, 1987, p. 32). Response Time, Color Use, and Special Design Features: Total response time (TRT) is the time taken by an individual to complete a mosaic design. The examiner begins timing the moment the directions have been given until the individual indicates the task has been completed. Total response time is expressed in minutes and seconds (e.g., 7:18). In terms of color usage, Perticone and Tembeckjian (1987) suggest this can be classified into four patterns, which include (1) color use follows no evident plan (designs in which color appears to be used indiscriminately or at least without a readily discernable plan); (2) only one color is used; (3) color is repeated systematically, but arbitrarily (pattern involves the purposeful selection of colors, but their placement within the design is arbitrary); and (4) color is used naturalistically (this only occurs in the case of representational designs). 6 Miller

Based on their experience with the LMT, Perticone and Tembeckjian (1987) also identified three additional design features which they believe to be clinically significant. These include compactness (the extent to which the tiles used in the construction of the design are in contact with or spaced apart from one another), location (the specific area of the tray which is occupied by the completed design), and three-dimensional effects. This last category includes piling (the more-or-less haphazard and unreflective overlapping which often occurs in the designs of very young children); superimposition (when the overlapping of tiles proceeds in a more goal-oriented manner); and stacking (when the individual places tiles, usually of the same shape, on top of one another so as to produce a column effect). Introduction to the Clinical and Projective Interpretation of Mosaics: Sequence Analysis: Due to space limitations, a complete description of the projective interpretation of the LMT, particularly given the many elements that must be individually, collectively, and contextually examined (e.g., response time; design types; color use; special design features; etc.), is outside the scope of this article. Readers interested in a more comprehensive discussion of the clinical and projective interpretation of the LMT are encouraged to review other sources, including Lowenfeld (1954), Ruskowski (1992), and Miller and Ruskowski (2003). The most complete and thorough discussion of LMT clinical interpretation can be found in Perticone and Tembeckjian (1987), and a clear understanding of the ideas, concepts, and principles presented in that text is essential for clinicians interested in the projective use of the LMT. In order to give the reader a general sense of how projective interpretation of the LMT is accomplished, however, a case example employing a sequence analysis of an individual’s mosaic construction will be provided. The term “sequence analysis” refers to a process in which both the mosaic pattern and the individual’s approach to its construction are interpreted simultaneously (Perticone & Tembeckjian, 1987). In conducting a sequence analysis, the examiner “deemphasizes the more usual standardized approaches to assessment and relies predominantly on his or her perception of the flow of the subject’s actions and outcomes from the moment the test is introduced, to the point at which the testing session has been concluded” (Perticone & Tembeckjian, 1987, p. 103). Viewed from this perspective, it is assumed that the particular manner in which an individual constructs a mosaic – the unique ebb and flow of each individual’s idiosyncratic response style, as well as the sequence in which particular tiles are selected and placed – will provide as much or even greater interpretive material as the final product (Miller & Ruskowski, 2003; Perticone & Tembeckjian, 1987). Because of the fluid nature of the events being monitored and the wide variability encountered in the response patterns of individuals, providing a precise description of the procedure for conducting a sequence analysis is difficult (Perticone & Tembeckjian, 1987), particularly in a single article. The following guidelines, however, which are presented in the form of questions, may be viewed as useful staring points. These questions include: (a) How does the individual respond to the examiner’s directions?; (b) How quickly and in what manner does the individual make contact with the box of Lowenfeld Mosaic Technique 7

tiles?; (c) On what area(s) of the tray are the tiles placed?; (d) How is color employed by the individual?; (e) What is the tempo of the individual’s performance?; and (f) What verbalizations occur during the assessment? (Perticone & Tembeckjian, 1987). The utility of a sequence analysis can perhaps best be seen in the context of a case example, which is provided below. In this case example, reprinted from Perticone and Tembeckjian (1987), the individual being assessed is an adult female exhibiting symptoms of depression and tension associated with marital and career-related frustrations. For each step in the sequence, the observed behavior is reported first, followed by a projective interpretation of the behavior (a more complete discussion of the rationale for these interpretations can be found in Perticone and Tembeckjian, 1987). The reader should note that the projective hypotheses presented below are just that – hypotheses – and that they are not presented as facts to be applied in a mechanical, “cookbook” fashion. Rather, they should be seen “as points of departure for the examiner’s thinking about what a subject’s behavior might mean” (Perticone & Tembeckjian, 1987, p. xvii). The hypotheses developed through use of the LMT may be supported, modified, or even discarded based on the information gained from other assessment instruments and procedures (Miller & Ruskowski, 2003). Sequence Analysis: A Case Example: (1) Observation: The individual makes contact with the box as soon as directions are completed. No verbalizations occur at his time. Interpretation: Compliant; reacts passively to authority (rapid response without question or comment). (2) Observation: She selects red diamonds. Interpretation: Presence of hostility (chooses red first). (3) Observation: She arranges them in a fundamental (star) pattern. Interpretation: Hostile feelings are directed toward others; also experiences hostility of others toward her (diamonds simultaneously point away from and toward center of design). (4) Observation: She arranges them in the center of the tray. Interpretation: The hostility (red) is a core issue at this time (central location). (5) Observation: She then selects yellow isosceles triangles. Interpretation: Hostile impulses are still present, but repression is occurring (chooses yellow). (6) Observation: She inserts the yellow triangles between points of the star so that only the very tips of the red diamonds are exposed. Interpretation: Energy is expended to inhibit the hostile impulses (apex of the triangles turned inward; red almost completely encircled, i.e., constrained). (7) Observation: Blue tiles of assorted shapes are removed from the box. Interpretation: Prepared to mobilize intellectual defenses (chooses blue). This implies that repression is not sufficiently strong and that secondary defenses are required. (8) Observation: Blue tiles are placed in a pile on the tray. Interpretation: Insecure; requires time to organize intellectual defenses (delay in placing blue; stockpiles them first). 8 Miller

(9) Observation: Equilateral triangles are then selected from the pile and placed edge to edge against the yellow pieces so as to encircle the existing design. Interpretation: Some recovery shown (makes use of pieces previously selected). Hostile impulses persist (apex of triangles pointed outward) but will be expressed in an intellectual manner (chooses blue) so as not to be recognized as such. (10) Observation: Following this, blue scalene triangles are taken from the pile and fitted to each side of the outward-pointing equilateral triangles. Interpretation: Need to strengthen intellectual defenses even further to control hostile impulses (added tiles make encirclement of yellow more complete; also serves to blunt the spike effect created by equilaterals). (11) Observation: The remaining pieces in the pile, blue diamonds, are inserted in the spaces left in the ring of blue which is now the outer boundary of the design. This creates a spike effect. Interpretation: Hostility continues to seek expression (diamonds point outward), but still in an intellectualized manner (chooses blue); may also anticipate hostility of others (diamonds also point toward center). (12) Observation: The individual works at a slower pace while working with blue tiles. Interpretation: Is cautious in use of intellectual defenses (tempo). (13) Observation: Green scalene triangles are selected next and placed around the design. Interpretation: Desire to give the appearance of health (chooses green). (14) Observation: The individual subsequently shifts the position of the green triangles. Interpretation: Has difficulty maintaining appearance of well-being (disrupts previous placement). (15) Observation: Individual attempts to insert blue pieces between green triangles. Interpretation: Resorts again to intellectualization (chooses blue). (16) Observation: She takes this arrangement apart, removing the blue pieces. Interpretation: She recognizes overuse of the defense (removes blue). (17) Observation: She leaves pairs of green scalene triangles in place on the circumference of the design. Interpretation: Again projects appearance of health to others (chooses green; apex of triangle formed by each pair points outward); adjustment is strained and requires unnecessary effort, i.e., she does things the “hard way” (uses two small triangles to produce effect of one larger triangle when such are already available, but remain unused in the box). (18) Observation: The individual then selects black scalene triangles. Interpretation: Some depression is experienced (chooses black). (19) Observation: Selected black pieces are butted against each side of the protruding blue spikes. Interpretation: The depression results from final effort to inhibit hostile impulses (black surrounds and blunts the spike effects created by protruding blue diamonds). The depression also may involve two people or two issues (black triangles are arranged in pairs) that are in conflict with one another (apexes of triangles point toward each other). Lowenfeld Mosaic Technique 9

(20) Observation: The individual’s pace is even slower while working with black tiles. Interpretation: Fatigue and exhaustion are the result of energy expended on defenses (tempo). (21) Observation: She next selects red scalene triangles. Interpretation: Hostility again threatens to break through (chooses red). (22) Observation: She fits the red triangles against the side of the green pairs positioned at the four cardinal points of the design. Interpretation: Although some hostility is expressed (red), she attempts partial inhibition of anger by directing it toward self (base points outward; apex points toward center). (23) Observation: Yellow scalene triangles are chosen last. Interpretation: Hostility is further disguised (chooses yellow). (24) Observation: Yellow tiles are placed against the sides of the remaining green pairs. Interpretation: Covert displays of hostility alternate with displays of depression and cheerfulness (pattern of red, black, yellow repeats itself). (25) Observation: The individual works silently during the entire construction process. Interpretation: Guardedness and lack of spontaneity are suggested. (26) Observation: She looks up at the examiner after placing the last tile. Interpretation: Indirectly signals that she is finished; passivity. (27) Observation: She then says, “I don’t see where to go from here.” Interpretation: Seeks justification for her action; tentative when relating to authority figures; insecure and unsure of self. (28) Observation: When the examiner asks what she has made, she responds, “A lone star…” Interpretation: “Lone” implies feelings of isolation or, perhaps, a need for distance from others; “star” connotes a wish or drive. In this case, hostility is suggested by the red star at center of design. The impulse to express hostility is seen as resulting in feelings of interpersonal isolation (lone star). (29) Observation: The individual then says, “Star of Bethlehem”. Interpretation: Undoing is used as a defense; distances self further from the impulses which threaten her. “Bethlehem” lends a holy and benevolent connotation which disguises the hostility symbolized by star’s red color. A religious orientation is also suggested, implying the presence of a strong superego. (30) Observation: The individual then says, “Passion flower”. Interpretation: Dependency and feminine identification are indicated by “flower”. The intensity of her own suffering and the feelings of which she is capable are reflected in the word “passion”. In summary, the sequence analysis conducted on the mosaic construction of this individual suggests that she is a woman who tends to defer to authority. She is likely to be emotionally constricted, as she appears to expend energy to inhibit the intense hostility that she experiences. She seems to feel very guilty because of her anger, and as a result is likely to be intra-punitive. Further, she probably fears rejection and anticipates interpersonal isolation if she should act on her impulses. Given the 10 Miller

compulsive intricacy of her design, she is likely to be highly intelligent, and to rely heavily on intellectualization and related defenses (e.g., rationalization) to support her repression. Her pervasive tendency to inhibit self-expression is probably paralleled by a lack of assertiveness in her marriage and her career, and these tendencies likely result in personal frustration and the intensification of the hostility so that a vicious cycle is established. Finally, alternation in moods is likely, and there is a strong possibility that she will act out intra-punitively as stress tolerance is exceeded. The need for individual psychotherapy to explore these various issues is indicated. Marital therapy and career exploration activities are also recommended (Perticone & Tembeckjian, 1987). Utility of the LMT in Projective Assessment: When applied in the manner described above, the LMT would appear to have several advantages in comparison to other projective techniques. For example, although other assessment methods such as human figure drawings (Hammer, 1980) and the Bender-Gestalt Test (Perticone, 1998) can be interpreted projectively, both of these procedures are more structured and likely elicit more response sets than the more ambiguous LMT (Perticone & Tembeckjian, 1987). Moreover, the LMT may be less likely to meet with client resistance than other projective measures, such as inkblot tests (e.g., Rorschach; Somatic Inkblot Series) or apperception tests (e.g., Thematic Apperception Test). As both the Rorschach and the Thematic Apperception Test require extensive verbal responding, and can therefore be overtly or covertly resisted, the LMT can be used and interpreted based on what is directly observed rather than what is reported or described (Ruskowski, 1992). The largely non-verbal nature of the LMT also makes it ideal for those individuals who may be verbally limited, inarticulate, shy, and/or withdrawn (Perticone & Tembeckjian, 1987). Similarly, the LMT may be less culturally biased than other, more verbally dependent assessment instruments (Ruskowski, 1992). The LMT also has the advantage of being useful for assessing both developmental maturity (normative perspective) as well as personality dynamics (projective perspective), and can be used with individuals of virtually any age, from toddlers to elderly adults (Perticone & Tembeckjian, 1987). Further, because the LMT contains no “correct” or “incorrect” responses and is therefore not susceptible to practice effects, it can be repeatedly administered to the same individual without sacrificing clinical utility or interpretive value (Ruskowski, 1992). The LMT may be particularly useful when used in combination with other projective techniques. For example, using the LMT in conjunction with human figure drawings has been recommended because, as with figure drawings, “use of the LMT may provide an intrinsically appealing activity that offers an opportunity for building rapport in the assessment session. The informal nature of the task is conducive to the exploration of feelings and thoughts that may be further amplified through synthesis with other assessment measures” (Miller & Ruskowski, 2003, p. 122). Using the LMT in conjunction with the Rorschach has also been recommended, as the latter often is viewed as being Lowenfeld Mosaic Technique 11

more useful for assessing how an individual perceives the world whereas the former may be more useful for assessing how an individual actually functions in it (Ames, 1986). Additionally, “while the Rorschach provides an opportunity to see the personality in reaction to complex intellectual and emotional stimuli, the Mosaic provides a greater opportunity to observe, in a quick and direct way, the personality in spontaneous action” (Colm, 1948, p. 232). Unlike the Rorschach and other projective techniques, however, the LMT typically is much more time-efficient as well as easier to learn – aspects which have important implications for busy, practicing clinicians. Finally, although the LMT has not demonstrated adequate statistical reliability and validity for diagnostic purposes and should therefore not be used for the classification of psychological disorders (Miller & Ruskowski, 2003), it may be useful for supporting a diagnosis once it has been made and for enhancing the understanding of the person and the unique way in which an individual experiences his or her world (Perticone & Tembeckjian, 1987). As such, the LMT may be a useful tool for developing a more empathic understanding of an individual’s experience (Miller & Ruskowski, 2003), as well as “broadening the clinician’s understanding of the subject’s characteristic way of thinking, feeling, and behaving, and of the particular personality dynamics that result in, or contribute to, any current problem” (Ames, 1986, p. 433). Limitations and Needs for Future Research: When utilized in the projective manner described in this article, the clinician using the LMT bases its value primarily on his or her professional judgment and experience with it (and projective techniques generally) rather than on its psychometric properties. The utility of the technique is evaluated from an experiential rather than a normative framework, and an idiographic (as opposed to nomothetic), conceptual (as opposed to empirical/psychometric), person-centered (as opposed to a test-centered), clinical approach to assessment is emphasized (Lerner, 1996, 2000). Within this conceptual framework, exemplified in the writings of Rapaport (1952), Schafer (1954), Lerner (1996), and Perticone (1998), “the examiner is seen as a vital ingredient, and the role accorded him or her is far broader and less prescribed” (Lerner, 2000, p. 41) than in a more standardized approach to assessment. As with other projective techniques, the usefulness of the LMT is largely dependent on the knowledge, skill, and experience of the individual examiner who uses it. For many, however, the use of the LMT (as well as other projective techniques) may be viewed with substantial skepticism, given the limited reliability and validity data available regarding it as well as most other instruments of this type (Panek, 2001). Although some have criticized traditional psychometric approaches to assessment and called for alternative conceptualizations (e.g., Friedman & MacDonald, 1997; Lerner, 2000), given current assumptions and values of orthodox, western psychology (e.g., the historically greater value placed on the study of overt behavior rather than covert mental processes; Tart, 1983) and the emphasis placed by academicians on 12 Miller

statistical analysis and evaluation, it is clear that more research regarding various reliability and validity aspects of the LMT is needed before its use as an assessment instrument is likely to become more widely accepted. In addition to the need for examining traditional reliability and validity indices of the LMT (e.g., test-retest reliability; construct validity), attention needs to be given to examining its degree of incremental validity (i.e., the degree to which the assessment procedure contributes to understanding beyond that which is already known) and treatment validity (i.e., the degree to which the assessment procedure contributes to a beneficial treatment outcome). Perhaps most important, research conducted with the LMT should focus on aspects for which it is best-suited (e.g., assessing functional capability) rather than on purposes for which it is not recommended (e.g., clinical diagnosis). For example, one fruitful area of research might involve clarifying/validating the role of defensive operations in causing and/or perpetuating psychological disorders and examining the possible utility of the LMT in this process. Because the LMT has no standardized scoring system, examining various aspects of its reliability and validity presents a significant problem, at least from the perspective of academic psychology. Until such research is reported, the LMT (as well as other projective techniques) will continue to be open to a number of criticisms from academicians, including possibilities of illusory correlations between assessment responses and client behavior (Gresham, 1993), difficulties in defining specific constructs the technique is purported to assess (Merrell, 1999), and an overreliance on clinical judgment in making assessment decisions (Dawes, 1994; Garb, 1989). These criticisms underscore the need for those who use the LMT to critically examine hypotheses and interpretations derived from it, and to ensure they are using it in an appropriate, skillful, and ethical manner. Given the increased questioning of projective techniques in general (Panek, 2001) as well as the call for greater accountability and evidence for psychological assessment instruments (Dawes, 1994; Panek, 2001), the issues discussed above are critical ones. Because of the limited and frequently outdated research conducted with the LMT, as well as the potentially high level of inference involved in its projective use, clinicians are encouraged to be cautious in their interpretations of mosaic constructions. The LMT should be employed as only one component of a comprehensive, multidimensional assessment and should not be used in isolation or for diagnostic or classification purposes. Moreover, for clients who do not accept the notion of unconscious processes influencing adjustment, use of the LMT may be contraindicated and the use of other types of measures, such as behavioral assessment procedures, should be explored (Miller & Ruskowski, 2003). Clinicians with appropriate training and experience, however, particularly those with an intuitive, phenomenological, empathy-based orientation to projective assessment (Lerner, 1996; Perticone, 1998), may find the LMT to be a valuable addition to their arsenal of clinically useful assessment instruments. Lowenfeld Mosaic Technique 13

Notes: For those interested in acquiring the LMT, kits may be purchased from Dr. H. Beric Wright, Chairman of the Dr. Margaret Lowenfeld Trust. Dr. Wright may be contacted at Brudenell House, Quainton, Aylesbury Bucks HP224AW, United Kingdom. Those interested in acquiring the text The Mosaic Technique in Personality Assessment: A Practical Guide, which is currently out of print, should contact either Dr. Eugene Perticone (55 Jackim Road, Oswego, New York 13126; e-mail: epertico@twcny.rr.com) or Dr. John Ruskowski (83 Jackim Road, Oswego, New York 13126; e-mail: jruskows@twcny.rr.com). References: Abel, T.M. (1981). Color preferences in the Lowenfeld mosaic designs of university students in five cultures. Academic Psychology Bulletin, 3, 173-176. Abel, T.M. (1982-1983). Psychodynamics as reflected in the Lowenfeld Mosaic Test among university students in five cultures. Hiroshima Forum for Psychology, 9, 3-16. Ames, L.B. (1963). Usefulness of the Lowenfeld Mosaic Test in predicting school readiness in kindergarten and primary school pupils. Journal of Genetic Psychology, 103, 75-91. Ames, L.B. (1986). The Lowenfeld Mosaic Test: A review of its use. Journal of Personality Assessment, 50, 428-435. Ames, LB., & Ilg, F.L. (1962). Mosaic patterns of American children. New York, NY: Hoeber- Harper. Anderson, V., & Hood-Williams, J. (1985). Handbook for use with the Lowenfeld Mosaic Test. London, UK: E.G. Bond. Azad, G.S. (1991). Applications of the Mosaic Test upon children of different intellectual levels. Journal of Personality and Clinical Studies, 7, 103-107. Bhargava, V. (1997). Anxiety as a function of mosaic performance. Indian Journal of Psychometry and Education, 28, 19-24. Chase, J.A. (1965). Color preference in the Lowenfeld Mosaic Test: Position influence. Journal of Genetic Psychology, 106, 259-263. Colm, H. (1948). The value of projective methods in the psychological evaluation of children: The Mosaic Test in conjunction with the Rorschach and Binet tests. Journal of Projective Techniques, 12, 216-233. Dawes, R.M. (1994). House of cards: Psychology and psychotherapy built on myth. New York, NY: Free Press. Diamond, B.L., & Schmale, H.T. (1944). The Mosaic Test: An evaluation of its clinical application. American Journal of Orthopsychiatry, 14, 237-250. Dorken, H. (1952). The Mosaic Test: A review. Journal of Projective Techniques, 16, 287-298. Ellenberger, H. (1954). The use of the L.M.T. in the study of mental disorders. In M. Lowenfeld, The Lowenfeld Mosaic Test (pp. 241-281). London, UK: Newman Neame. Friedman, H.L., & MacDonald, D.A. (1997). Toward a working definition of transpersonal assessment. Journal of Transpersonal Psychology, 29, 105-122. Garb, H.N. (1989). Clinical judgment, clinical training, and professional experience. Psychological Bulletin, 105, 387-396. 14 Miller

Gresham, F.M. (1993). “What’s wrong with this picture?”: Response to Motta et al.’s review of human figure drawings. School Psychology Quarterly, 8, 182-186. Hammer, E.F. (1980). The clinical application of projective drawings. Springfield, IL: Charles C. Thomas. Hirano, K. (1982-1983). The difficulties of using the Lowenfeld Mosaic Test in Japan. Hiroshima Forum for Psychology, 9, 17-18. Kahn, T.C., Cameron, J.T., & Giffen, M.B. (1975). Methods and evaluation in clinical and counseling psychology. New York, NY: Pergamon. Lerner, P.M. (1996). Introduction. In R.K. Misra, M.K. Kharkwal, M.A. Kilroy, & K. Thapa, Rorschach test: Theory and practice (pp. 21-31). Thousand Oaks, CA: Sage. Lerner, P.M. (2000). Martin Mayman: His work and his place. Journal of Personality Assessment, 75, 33-45. Levin, M.L. (1956). Validation of the Lowenfeld Mosaic Test. Journal of Consulting Psychology, 20, 239-248. Lowenfeld, M. (1954). The Lowenfeld Mosaic Test. London, UK: Newman Neame. McCulloch, T., & Gardner, J. (1949). Use of the Lowenfeld Mosaic Test with mental defectives. American Journal of Mental Deficiency, 53, 486-496. Merrell, K. (1999). Behavioral, social, and emotional assessment of children and adolescents. Mahwah, NJ: Lawrence Erlbaum. Miller, D. (2005). Mandala symbolism in psychotherapy: The potential utility of the Lowenfeld Mosaic Technique for enhancing the individuation process. Manuscript submitted for publication. Miller, D., & Ruskowski, J.B. (2003). The Lowenfeld Mosaic Technique: Its clinical use and potential for facilitating self-actualization. Journal of Humanistic Psychology, 43, 119- 130. Panek, P.E. (2001). Projective psychology and the new millennium: Issues and challenges. Journal of Projective Psychology and Mental Health, 8, 73-74. Pani, B.S., & Mishra, P.K. (1995). Impact of therapy on objective features of the Mosaic Test performance in mildly disturbed (neurotic) persons. Psychological Studies, 40, 7-10. Perticone, E.X. (1998). The clinical and projective use of the Bender-Gestalt Test. Springfield, IL: Charles C. Thomas. Perticone, E.X., & Tembeckjian, R.M. (1987). The Mosaic Technique in personality assessment: A practical guide. Rosemont, NJ: Programs for Education. Rapaport, D. (1952). Projective techniques and the theory of thinking. Journal of Projective Techniques, 16, 269-275. Reik, T. (1948). Listening with the third ear: The inner experience of a psychoanalyst. New York, NY: Noonday Press. Reiman, M.G. (1950). The Mosaic Test: Its applicability and validity. American Journal of Orthopsychiatry, 20, 600-615. Ruskowski, J.B. (1992). The Lowenfeld Mosaic Test: An illustration of its application in the schools. British Journal of Projective Psychology, 37, 33-40. Ruskowski, J.B., & Miller, D. (in press). Shifting modalities of communication in psychotherapy: Use of the Lowenfeld Mosaic Technique to promote self-understanding and mental health. Journal of Projective Psychology and Mental Health. Lowenfeld Mosaic Technique 15

Schafer, R. (1954). Psychoanalytic interpretation in Rorschach testing: Theory and application. New York, NY: Hartcourt Brace & Jovanovich. Sharma, S.N. (1993). Projective performance as a function of mental ability of school going children. Psycholingua, 23, 71-75. Stewart, U., & Leland, L. (1952). American versus English mosaics. Journal of Projective Techniques, 16, 246-248. Stewart, U., Leland, L., & Strieter, E. (1957). Mosaic patterns of eighth grade children. Journal of Projective Techniques, 21, 73-79. Tart, C.T. (1983). Some assumptions of orthodox, western psychology. In C.T. Tart (Ed.), Transpersonal psychologies (pp. 59-111). El Cerrito, CA: Psychological Processes. Walker, R.N. (1957). Children’s mosaic designs: A normative and validating study of the Lowenfeld Mosaic Test. Dissertation Abstracts, 19, 367-368. Wertham, F. (1950). The Mosaic Test: Technique and psychopathological deductions. In L. Abt & L. Bellak (Eds.), Projective psychology (pp. 230-256). New York, NY: Knopf. Wertham, F. (1963). Review of mosaic patterns of American children. American Journal of Psychotherapy, 17, 142-143. Woodcock, T. (1984). The use of the Lowenfeld Mosaic Test in child psychotherapy. British Journal of Projective Psychology and Personality Studies, 29, 11-18. Woodcock, T. (1986). The Lowenfeld Mosaic Test in the study of cultural differences. British Journal of Projective Psychology and Personality Studies, 31, 25-31. Woodcock, T. (in press). Expressing the shape and colour of personality: Using Lowenfeld mosaics in psychotherapy and cross-cultural research. Brighton, East Sussex, UK: Sussex Academic Press. Woolf, H., & Gerson, E. (1953). Some approaches to the problem of evaluation of mental ability with the Mosaic Test. American Journal of Orthopsychiatry, 23, 732-739. Acknowledgements: The author would like to extend his appreciation and gratitude to Dr. Eugene X. Perticone and Dr. John B. Ruskowski, whose previous work with the Lowenfeld Mosaic Technique served as the primary inspiration for this article, for their helpful comments regarding this manuscript. 16 Miller

Interpersonal Style and Gastrointestinal Disorder: An Exploratory Study Paul E. Panek, John J. Skowronski, Edwin E. Wagner and Carol F. Wagner The purpose of the present exploratory study was to determine whether patients with chronic gastrointestinal symptoms have distinguishing psychological traits, the knowledge of which might be useful in planning management and treatment. The projective Hand Test (HT) was administered to 29 individuals seeking treatment in a pain clinic for chronic gastrointestinal disorders and 29 individuals seeking treatment for chronic back pain. Participants in these groups were matched on gender and age (+ or - 5 years). Results indicated medium effect sizes (d > .50) between individuals in the gastrointestinal pain group and individuals in the chronic back pain group for the HT variables of Acting-Out-Score (AOS) and Communication (COM). These results are consistent with the psychodynamic hypothesis that persons with gastrointestinal disorders may be suppressing or repressing hostility, resulting in psychosomatic symptomology. Irritable bowel syndrome (IBS) is a common and often debilitating functional gastrointestinal disorder (Lydiard, 2001; Mach, 2004). Although the exact etiology of the disorder is not known both physiologic and psychosocial variable appear to play important roles in the development and maintenance of IBS (Lydiard, 2001). For example, the literature suggests there is a high prevalence of various psychiatric disorders in patients with functional bowel disorders, particularly, IBS (Lydiard, Fossey, Marsh & Ballenger, 1993). Also, psychological stress and anxiety may exacerbate GI symptoms in normal as well IBS patients (Mach, 2004). Further, the literature does suggest that there are consistent personality differences among individuals as a function of the type or locus of the chronic pain (Kinder, Curtiss, & Kalichman, 1992). Many of these personality characteristics, such as depression, anger, hostility, and anxiety are often linked to the “disease-prone personality”(see Friedman & Booth- Kewley, 1987). For example, Sammons and Karoly (1987) hypothesized that depression and anxiety are linked to the etiology of Irritable Bowel Syndrome (IBS). Weinryb, Roessel, Gustavsson, Asberg, and Barber (1997) found that ulcerative colitis patients with excessive impulse control had problems coping with aggressive affects. Further, there is considerable evidence that prolonged, unresolved emotional distress may ultimately afflict the body (Lomranz & Mostofsky, 1997). Psychoanalysts have long grappled with the etiologies of psychosomatic illnesses (Gerson, 2002) and have offered a psychodynamic perspective suggesting that the distress resulting from the long-term denial of negative feelings could produce psychosomatic consequences, such as gastro intestinal pain (Lomranz & Mostofsky, 1997). This is referred to as the “suppressed hostility hypothesis” (Harrell, 1980). Thus, the psychoanalytic literature has long endorsed the notion that gastrointestinal disturbances in general can arise from the suppression or repression of hostile emotions Dr. Paul E. Panek, Professor of Psychology, The Ohio State University at Newark, Newark, OH 43055, USA. e-mail (panek.1@osu.edu); John J. Skowronski, Northern Illinois University:Edwin E. Wagner, Alabama Pain Center, Huntsville, AL.and Carol F. Wagner, Isle of Palms, SC. Key Word: Interpersonal Style

and behaviors. For instance, the working psychoanalytic premise regarding ulcerative colitis symptomology is “individuals with characterological difficulty in expressing rage, when threatened by seperation from an important object, implode the rage inward and thereby inflame and damage their intestinal lining (Harrell, 1980). However, the empirical evidence for a link between psyche and soma in inflammatory bowel disease is minimal Gerson, 2002; Drossman, 1999), and it is difficult to obtain support for the suppressed hostility in psychosomatic disorders is still a matter of debate. Thus, the purpose of this exploratory research, therefore, was to furnish some empirical evidence for this hypothesis. The association of such traits with gastrointestinal disturbances suggests possible repression or suppression of hostile emotions and behaviors that should be detectable on personality measures that are sensitive to such tendencies, such as the projective Hand Test (HT; Wagner, 1962/1983). Past research has shown that the HT has been effective in detecting discrete personality traits associated with chronic pain patients (Panek, Skowronski, & Wagner, 2000; 2002b; Wagner & Young, 1999). Of particular interest in these patients is the HT’s Acting-Out-Score (AOS), a widely-researched and validated index (see Sivec, Waehler, & Panek, 2004). The AOS reflects the extent to which reports of positive interpersonal action tendencies reflecting affection (AFF), communication (COM) and dependency (DEP) exceed reports of negative interpersonal action tendencies dealing with direction (DIR) and aggression (AGG). Thus, the AOS score is an approximate index of whether a person will interpret the HT cards in terms of positive and affiliative interpersonal behaviors as opposed to negative, “acting-out,” interpersonal behaviors. In line with the psychodynamic perspective, it was hypothesized that pain patients suffering from gastrointestinal disorders will tend to emphasized affiliative over hostile interpersonal interactions, which, in turn, should be manifested in a high HT AOS as compared to a control subjects. That is, if gastrointestinal patients are suppressing or repressing hostility, thus generating psychosomatic symptoms, they should not produce many responses involving direction and aggression and/or should produce more responses involving affection, dependency, and communication. The present study investigates this hypothesis by contrasting the scores obtained by chronic gastrointestinal pain patients and a matched control group of chronic back pain patients on the AOS and other quantitative HT scoring variables. Method: Participants: Participants were 29 (M age = 42.83 yrs., SD = 10.51) individuals seeking treatment in a pain clinic in the southeastern United States for chronic gastrointestinal disorders (GI) and 29 individuals (M age= 42.69 yrs., SD = 9.92) seeking treatment for chronic back pain (CB). Patients in the GI group were medically diagnosed with conditions 18 Panek et al

such as ulcers, pancreatitis, Crohn’s disease, ulcerative colitis, diverticulosis, and irritable bowel syndrome. We defined a gastrointestinal disorder as a visceral organ dysfunction that caused chronic pain and was not due to physical trauma, infection or neoplasm (cancer). Therefore, although “organ weaknesses” and unhealthy life styles might be contributory, it was assumed that psychological factors played a substantial role in the onset and maintenance of their pain. In all instances the gastrointestinal symptom was the major reason for referral for chronic pain, but some gastrointestinal patients evinced additional symptoms, such as shoulder or arm pain. We used back pain patients as a control group because they constitute the bulk of the referrals to pain clinics. Participants in these groups were matched on gender (15 females and 14 males) and age (+ or - 5 years). Materials: Each participant was asked to take the Hand Test (Wagner, 1962/1983). Briefly, the Hand Test (HT) consists of 10 cards, 9 of which portray hands in various ambiguous positions. The tenth card is blank. The person’s task is to describe “what the hand could be doing.” Responses are scored on the basis of the behavioral tendency expressed in the response, such as communication, aggression, and activity. There are 15 separate quantitative scoring categories. These are subsequently combined into a number of other summary scores and ratios. The first summary scale, Interpersonal (S INT) involves responses with other people, and is the total of the number of Affection (AFF), Dependence (DEP), Communication (COM), Exhibition (EXH), Direction (DIR), and Aggression (AGG) responses in the protocol. The number of Acquisition (ACQ), Active (ACT), and Passive (PAS) responses are summed to comprise the Environmental (S ENV) summary scale. These responses are relatively impersonal in nature, but reflect a response to, or coming to grips with, the environment. The third summary scale of the HT is the Maladjustive score (S MAL). This summary scale reflects responses that suggest difficulty in carrying out various action tendencies successfully due to subjectively experienced inner weaknesses and/or external prohibition. It is formed by summing responses classified as indicative of tension (TEN), physical disability (CRIP), and fear (FEAR). The final summary scale on the HT is the Withdrawal score (S WITH), which consists of the total number of Description (DES), Bizarre (BIZ), and Failure (FAIL) responses in the protocol. These responses reflect the abandonment of meaningful or effective life-roles. Two other important index scores on the HT are the Pathology score (PATH) and the Acting-Out-Score (AOS). PATH is computed by doubling the WITH score and adding that quantity to the MAL score. This score is considered to provide an overall estimate of the total amount of pathology in the protocol. AOS is computed by subtracting the sum of the scores reflecting negative interpersonal behavior tendencies (AGG and DIR) from the sum of the scores representing positive interpersonal behavior tendencies (AFF, DEP, and COM). Thus, the AOS score is considered to provide an index of the tendency to interpret the cards in terms of positive interpersonal behavior relative to the tendency to interpret the cards in terms of negative interpersonal behavior. Gastrointestinal Disorder 19

Procedure: The HT was administered as part of the routine admission procedure to a pain clinic. The test was administered individually according to standard instructions. The administrator was either a licensed psychologist employed by the pain clinic or a supervised psychological intern training at the clinic. Scoring: The protocols provided by all 58 participants were scored blind by the developer of the HT (E.E.W.). To assess the accuracy and reliability of the scoring, 20 protocols were selected at random and the quantitative variables were re-scored by the first author of this article. Correlations between the values provided by the two scorers were above .8 for 11 of the 15 HT variables, with a high of 1 (for FAIL and BIZ) and a low of .59 (for FEAR), all p’s < .006. The correlations between scorers’ were also high for the summary scores and the AOS. These were: S INT, r = 0.96 (p < .0001); S ENV, r = 0.87 (p < .0001); S MAL, r = 0.91 (p < .0001); ( WITH, r = 0.99 (p < .0001); and, AOS, r = 0.96 (p < .0001). To further assess the adequacy of the scoring, within-subject ANOVAs were conducted on the scores provided from this subset of 20 protocols. These analyses compared the mean scores provided by each scorer on each of the 15 HT individual variables and on the 4 calculated summary scores. These analyses indicated that there were no significant differences in the mean scores generated by the two scorers. The F values were less than 1 for 12 of the 15 individual variables and for all 4 of the summary scores. The largest differences in the mean scores provided by the scorers were observed on the DEP (F(1, 19) = 2.67, p < .12, d = .351) and ACQ (F (1, 19) = 2.17, p < .13, d = .320) variables. The high correlations indicate that the two scorers ordered scores in the same way (e.g., if a subject’s score from one scorer on one variable was high, it was also high on that variable for the other scorer). The absence of significant differences among the average scores derived from the two scorers indicates that they provided scores that were similar in value for each participant. However, we note that the large effect sizes for some ANOVAs do suggest that the absence of significance in these tests may be due to low statistical power. Nonetheless, taken together, both the correlations and the ANOVAs suggest that the scores provided by the principal scorer (EEW) were not substantially biased. The scores provided by that scorer were used in our subsequent statistical comparisons. Results: Single-factor analyses of variance compared each HT score obtained from participants in the gastrointestinal group to each HT score obtained from participants in the back pain group. We analyzed proportional scores that were derived by dividing the frequency count obtained for each scoring variable by the total frequency count across the scoring variables (see Panek et al. 2002a). These proportional scores were calculated for each of the individual quantitative variables scored in the HT, as well as for the summary scores, and the AOS. 20 Panek et al

Table 1 Response proportions and ANOVA results for all between-groups comparisons on the variables measured by the Hand Test. Hand Test Variable Back Pain Gastro F(1, 56) p<d or Index Group M Group M Affection (AFF) .111 .124 .27 .61 .136 Dependency (DEP) .037 .046 .50 .49 .185 Communication (COM) .180 .247 4.06 .05 .529 Exhibition (EXH) .026 .055 3.06 .09 .460 Direction (DIR) .101 .090 .19 .67 .115 Aggression (AGG) .111 .074 2.68 .11 .430 Acquisition (ACQ) .064 .033 3.07 .09 .460 Activity (ACT) .119 .139 .47 .50 .153 Passivity (PAS) .063 .037 2.75 .11 .231 Tension (TEN) .081 .101 .55 .46 .196 Crippled (CRIP) .063 .044 .78 .38 .231 Fear (FEAR) .005 .015 1.70 .20 .344 Description (DES) .019 .023 .10 .75 .083 Failure (FAIL) .013 .069 .44 .51 .175 Bizarre (BIZ) .002 .003 .02 .88 .043 Acting-out Score (AOS) .116 .244 4.07 .05 .529 Interpersonal (INT) .565 .638 1.65 .21 .342 Environmental (ENV) .246 .209 1.08 .31 .278 Maladaptive (MAL) .148 .160 .10 .76 .084 Withdrawal (WITH) .035 .033 .02 .90 .253 As can be observed in Table 1 significant between-group differences emerged for the Hand Test variables of Communication, F (1, 56) = 4.06, p < .05, d = .529 and Acting Out Score (AOS), F (1, 56) = 4.07, p < .05, d = .529. Examination of the means for these effects indicate that patients in the gastrointestinal group gave a significantly higher proportion of Communication responses (M = 0.25, SD = 0.14) than patients in the back pain group (M = 0.18, SD = 0.11) and were significantly higher on the AOS index (M = 0.24, SD = 0.24) than individuals in the back pain group (M =0.12, SD = 0.24). The COM variable reflects the extent to which participants’ responses reflect cooperative, informative, but relatively affect less, communications with others (e.g., signaling for a left turn). Hence, the COM means suggest that the gastrointestinal pain patients were more likely to interpret the HT cards in terms of such communicative behaviors than the back pain patients. The differences in the COM variable contributed substantially to the differences that emerged on the AOS index. Therefore, as far as the results of this study are concerned, Gastrointestinal Disorder 21

it is the relative preponderance of COM which distinguishes the gastrointestinal group. The AOS index reflects the difference between those action tendencies that are “negative,” involving a disregard for the rights and feelings of others (DIR, AGG), and those that are “positive” and socially cooperative (AFF, DEP, COM). The AOS index means show that persons in the gastrointestinal group produced a significantly higher combined number of socially positive responses compared to the control group of back pain patients. Discussion: Results of the present exploratory study confirm that specific personality traits or predispositions are associated with different types of pain experiences Kinder et al., 1992; Panek, et al., 2000; Panek, et al., 2002b). Thus, as demonstrated by previous research psychological factors in patients with IBS influence the illness experience (Mach, 2004). With regard to COM which, reflects the extent to which subjects’ responses reflect cooperative, informative, but relatively affectless, information exchanges (e.g., signaling for a left turn) the significant difference between the means suggests that the gastrointestinal pain patients were more likely to interpret the HT cards in terms of such socialized but unemotional interactions than the back pain patients. Thus, it would appear that communication is used as a buffer to out-weigh or mask aggressive and controlling action tendencies. That is, that this suppression is largely accomplished by favoring behaviors involving socialized but affectless exchanges of information that may mask underlying hostility. This difference in interpersonal style is consistent with the hypothesis that patients suffering from gastrointestinal ailments suppress or repress hostility and that unresolved emotional distress may ultimately afflict the body producing psychosomatic consequences such as gastrointestinal pain (Lomranz & Mostofsky, 1997). Further, these findings are similar to those of Weinryb et al. (1997) who found that ulcerative colitis patients had problems coping with aggressive affects. However, these findings point to communication and an avoidance of negative affect as the operative coping mechanism in terms of problems coping with aggressive affects. Further, results are consistent with previous research indicating specific personality traits or predispositions are associated with different types of pain experiences (e.g., Kinder et al., 1992; Curtiss, Kinder, Kalichman, & Spana, 1988; Lichtenberg, Skehan, & Swensen, 1984; Panek et al., 2000; 2002b). Results also confirm the potential effectiveness of the HT for detecting personality differences among individuals reporting different types of chronic pain (Panek, et al., 2002b) and suggest that it may provide a useful complement to objective personality tests such as the MMPI. However, results on the present exploratory study are limited in terms of a small sample size. Thus, future investigations with larger sample sizes are necessary in order to validate the findings of the current study. 22 Panek et al

References: Curtiss, G., Kinder,B. N., Kalichman, S. & Spana, R. (1988). Affective differences among subgroups of chronic pain patients. Anxiety Research: An International Journal, 1, 65-73 Drossman, D. A. (1999). Psychological factors in ulcerative colitis and Crohn’s disease. In: J. B. Kirsner (Ed.), Inflammatory bowel disease(5th. ed.). Philadelphia, PA: W. B. Sanders. Friedman, H. S., & Booth-Kewley, S. (1987). The “Disease-Prone Personality”: A Meta-Analytic View of the Construct. American Psychologist, 42, 539-555. Gerson, M. J. (2002). Psychosomatics and psychoanalytic theory: The psychology of ulcerative colitis and Crohn’s disease, 19, 380-388. Harrell, J. P. (1980). Psychological factors and hypertension: A status report. PsychologicalBulletin, 87, 482-501. Kinder, B. N., Curtiss., G., & Kalichman, S.(1992). Affective differences among empirically derived subgroups of headache patients. Journal of Personality Assessment, 58, 516- 524. Lydiard, R. B. (2001). Irritable bowel syndrome, anxiety, and depression: What are the links? Journal of Clinical Psychiatry, 62, 38-45. Lydiard, R. B., Fossey, M. D., Marsh, W. & Ballenger, J. C. (1993). Prevalence of psychiatric disorders in patients with irritable bowel syndrome, 34, 229-234. Lichtenberg, P. A., Skehan, M. W., & Swensen, C. H. (1984). The role of personality, recent life stress and arthritic severity in predicting pain. Journal of Psychosomatic Research, 28, 231-236. Lomranz, J., & Mostofsky, D. I. (1997). The psychology of pain and suffering. In D. I Mostofsky and J. Lomranz (Eds.). Handbook of Pain and Aging. Plenum Press, New York. Pp. 3-18. Mach, T. (2004). The brain-gut axis in irritable bowel syndrome-clinical aspects. Medical Sciences Monitor, 10, 125-131. Panek, P. E., Skowronski, J. J., & Wagner, E. E. (2000). The effects of age and gender on Hand Test responses of chronic pain patients. Journal of Projective Psychology & Mental Health, 7, 109-117. Panek, P. E., Skowronski, J. J., & Wagner, E. E. (2002, a). The advisability of routinely computing percentages when comparing groups across projective test variables. Journal of Projective Psychology & Mental Health, 9, 2-4. Panek, P. E., Skowronski, J. J., & Wagner, E. E. (2002, b). Differences on the projective Hand Test among chronic pain patients reporting three different pain experiences. Journal of Personality Assessment, 79, 235-242. Sammons, M. T., & Karoly, P. (1987). Psychosocial Variables In irritable Bowel Syndrome: A Review and Proposal. Clinical Psychology Review, 7, 187-204. Sivec, H. J., Waelher, C. A., & Panek, P. E. (2004). The Hand Test: Assessing Prototypical Attitudes and Action Tendencies. In M. Hilsenroth & D. Segal (Eds.), Objective and projective assessment of personality and Psychopathology. Volume 2 in M. Herson (Ed.-in-Chief), Comprehensive handbook of psychological assessment. New York: John Wiley & Sons. Pp. 405-420. Gastrointestinal Disorder 23

Wagner, E. E. (1962/1983). The Hand Test: Manual for administration, scoring and interpretation. Los Angeles: Western Psychological Services. Wagner, E. E., & Young, G. R. (1999). Hand Test characteristics of pain clinic patients. In G. R. Young and E. E. Wagner (Eds.). The Hand Test: Advances in application and research (pp. 205-211). Malabar, FL: Krieger Publishing Co. Pp. 205-211. Weinryb, R. M., Roessel, R. J., Gustavsson, J. P., Asberg, M., & Barber, J. P. (1997). The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being. Psychoanalytic Psychology, 14, 495-515. Footnotes: The cooperation of K. Dean Willis, M.D., and J. Michael George, Psy.D. in securing the sample used in this research is greatly acknowledged. Requests for reprints should be addressed to: Dr. Paul E. Panek, Professor of Psychology, The Ohio State University at Newark, Newark, OH 43055, USA. e-mail (panek.1@osu.edu) SOMATIC INKBLOT SOCIETY is an International organization. It is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH a half yearly publication in January and July. It has 2 Awards of $250 employing the use of Inkblot Tests SIS & Rorschach. For details please contact : Wilfred A. Cassell, M.D., FAPA, APC, FSIS, Director, Somatic Inkblot Center, Editor Emeritus, SIS Journal of Proj. Psy. & Mental Health, 4501E, 104th Avenue, Anchorage, AK 99516 (USA) E-Mail : siscassell@yahoo.com Web Site at http: //www.somaticinkblots.com OR B. L. Dubey, Ph.D., DPM, FSIS, President Somatic Inkblot Society, Director Somatic Inkblot Center India, Mob.: 91-9417036655 E-mail : sisdubey@rediffmail.com E-mail : sisdubey@yahoo.com 24 Panek et al

SIS Cognitive Psychotherapy For Spouse Induced PTSD Wilfred A. Cassell The presentation uses the Somatic Inkblot Series-II Vide to examine two clinical case histories of individuals whose erroneous premarital perceptions made them vulnerable to unsuspectingly entering a highly traumatic marriage. Eventually each experienced psychiatric and medical problems. The first case involves a Russian woman who married a sociopath, who intentionally presented a false positive social image of himself. Ultimately he became homicidal and she was fortunate to survive with her life. The second involves a successful business man who married a woman who appeared normal. Unbeknown to him, she had Borderline Personality Disorder (BPD). His marriage took him to the edge of bankruptcy and for a while shattered his mental health. “LOVE CAN BE BLIND” When two people initially meet in a potential love relationship, each begins to construct an image of the other. For mature individuals who have complimentary religious/cultural backgrounds, as well as having experienced love in their family, the outlook may be positive. Yet initial impressions can be misleading, especially in hormone driven young people. One’s mental picture of another can also be in error for a variety of non biological reasons. Theses can cause an irrational love mesmerized individual to view a potential spouse with “Rose covered glasses”. Such premarital social blindness can set the stage for an abusive marriage, which over time can lead to stress induced illness. This presentation uses the SIS-II video (Cassell, 1984, 1990) to examine two clinical case histories of individuals whose erroneous premarital perceptions made them vulnerable to unsuspectingly entering a highly traumatic marriage. Eventually each experienced psychiatric and medical problems. There is an extensive literature on the temporal relationship between life stressors and subsequent illness. In regard to assessing the stress factors in marriage the Social Readjustment Scale (www.cop.ufl.edu/safezone/doty/dotyhome/wellness/holrah.htm) was first published by Holmes and Roche in 1967. This rates the relative intensity level of various stressful events in the preceding twelve months of an individual’s life. The highest stress score of one hundred was estimated to be death of one’s spouse. This phenomenological study is presented as an illustration of the stressful effects of blindly marrying a spouse having a severe Axis II Personality Disorder. The first case involves a Russian woman who married a sociopath, who intentionally presented a false positive social image of himself. Ultimately he became homicidal and she was fortunate to survive with her life. In America, she is not alone. According to a Nov 7, 2005 Reuters News report, mail-order bride Web sites are now being prowled by predatory abusers and serial rapists. Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Ave. Anchorage, AK 99516 (USA). E-Mail: siscassell@yahoo.com Key word : Cognitive Psychotherapy, PTSD

The second involves a successful business man who married a woman who appeared normal. Unbeknown to him, she had Borderline Personality Disorder (BPD: www.nimh.gov/publicat/bpd.cfm). His marriage for a while almost shattered his sense of “Self” and its neurological foundation (Zimmer, Carl, 2005) producing stress related physical symptoms. For the unsuspecting bride or bridegroom, such marital mistakes involve exposure to a double stress: first the psychological death of a premarital romantic fantasy and second being traumatized. When children are involved, the magnitude of the stress can increase exponentially. Such a victim may present for evaluation in a mental health setting suffering with symptoms of Posttraumatic Stress Disorder (PTSD) in association with various types of Affective disorder. In medical clinics they can request treatment for a variety of stress related illnesses. The two case histories will illustrate how the SIS-II video may be used as an aide during ongoing cognitive psychotherapy and psychotropic medication management. Those SIS Images designed to stimulate human content often prove particularly capable of stimulating relevant material. The projected human figures envisioned either directly or in disguised symbolic forms can provide guides to structure therapeutic interviews. These can access memories of the original positive impressions of a deceptive spouse, the loss of the fantasy relationship, and then the subsequent abuse by the marital partner. Therapeutically processing the somatic imagery released by the anatomical SIS structure can assist. This may especially apply if there are significant stress induced somatic symptoms and/or sexual trauma. The inanimate structure capable of bringing to projective consciousness violent scenes, such as included in SIS 15 B (i.e. “Knives”, Broken glass” and 21 B (i.e. “Handgun firing”) may also be useful in releasing memories of suicidal and homicidal threatening situations. The same benefit can result from reviewing those SIS stimuli which depict death (i.e. 30 A and 22 B). This overall treatment strategy can be helpful in correcting distorted memories and PTSD nightmares of the perpetrating spouse. It can also facilitate psychotherapy designed to improve de the victim’s mood and damaged self esteem. The inclusion of techniques derived from SIS body-mind-spirit theory can enhance the therapeutic power of traditional atheistically based spiritually sterile “scientific” cognitive psychotherapy. SIS structure denoting joy as portrayed by the figures in 9 A with their beating hearts in red can be used by the therapist for suggesting that the in future relationships, love may be possible. These can provide soothing for to the painful wounds of betrayal, existential anxiety, loneliness and rage. This calming may have considerable clinical value in treating severely depressed or even psychotic individuals. It can be particularly helpful for correcting cognitively imbalanced victims experiencing suicidal/homicidal impulses in providing avenues of opportunity for introducing reality testing. Such tormented individuals need alternatives, apart from seeking relief through the analgesic path leading to death. 26 Cassell

Spiritually oriented victims warrant special considerations, after being betrayed by a spouse. They can benefit from turning to higher spiritual powers for direction. Entirely outside their personal intelligence, this guidance usually comes in symbolic messages. These may appear in visions, night time dreams and in SIS released positive symbols. Such a transfer in faith can enhance psyche healing thereby enabling them to gradually a restore trust in humans. During this painful period, the person of the psychotherapist can represent a transitional communication bridge between the wounded soul and God. The Mail Order Bride: Case I: The first case history involves a young intelligent and musically gifted Russian woman. Early in life through introspection, she had learned to appreciate her special sensitivity to positive spiritual symbols in dreams. These played an important restorative role after she answered a California man’s advertisement for a wife. At the time, she was motivated by a romantic fantasy of having a happy married life in America. This as well as her enduring optimism perhaps clouded her judgment. She allowed herself to become mesmerized by a sociopath who lied about the quality of their future lifestyle. In visiting Russia, he initially deceived her by playing the role of a “good man”. She had no practical way to check out his glowing descriptions about his family thousands of miles away. For a short “Honey moon” period, she maintained her erroneous fantasy of having a loving husband. However, gradually there was a negative transformation in her impression. She observed that he tended to watch television programs presenting immature themes, sex and explicit violence. A more rapid decline in his social image took place after she became pregnant. At that time, he no longer was able to maintain a façade. He became irritable, threatening and chose to reveal the truth about his childhood. She learned that his father had repeatedly beaten him with a belt. On one occasion his father had sadistically pushed a pin through his hand; on another he had run over him with a car. At age nine he had been had placed him in a foster family after his deranged father had threatened to shoot him. She realized that such a horrible childhood was consistent his being a violent sociopath. For a while she tolerated verbal abuse. Then it became physical. He manifested what she believed were deviant sexual interests and accused her of being unfaithful. He insisted that she stay in the home and monitored her with hidden video cameras. When she requested a divorce, he threatened to kill her and their child. After driving them to a secluded place, he would point to a shovel saying: “That’s what I will use to bury your bodies!” Due to her still poor English, as well as her economic dependency, she felt trapped. Eventually with the assistance of an American friend, she obtained a divorce. With her new freedom, she was able to seek professional help. She initially consulted an internist who diagnosed Crohn’s Disease. A few days later, on psychiatric examination, she was found to be suffering from PTSD. SIS in PTSD 27

SIS Interviews: She was given an opportunity to view the SIS-II video at home one two occasions separated by a week: first Part A and then part B. In each instance, the therapeutic review of her responses was completed the next morning. In order to facilitate _expression of PTSD projections, she was advised to first write her responses in her native language. Of course the detailed enquiry necessarily had to be done in English. Immediately after the review of each SIS stimulus, she repeated what she had seen and felt by speaking in Russian into a tape recorder. This repetition enhanced the therapeutic the SIS cognitive psychotherapy in a manner comparable to asking a victim to document in writing past traumatic experiences. It also established a record for the time when she could consult a Russian speaking therapist. In the overall series, she selected SIS 3 B as the most threatening. Here she envisioned “An unreal mystical figure”. When asked to elaborate on her projective response, she indicated that the he “Was not from a good place…maybe Hell!” This was a direct symbolic reference to her demonic husband His angry facial manner was also brought to mind by other projections. Thus for example SIS 12 B was seen as “A very angry man”. The duality in his nature between good and evil was symbolized in what she imagined SIS 17 A to look like. A transcript of that portion of the interview follows: “It is like I see part of the body…the bone…the chest…it is hard inside…Oh I see two animals that are looking at a heart…” Dr C: Any feelings? “I am feeling bad when I look at this picture…because it is two animals…my heart…I don’t know…they not look too bad…but when I look on them…for me…seem both bad” Dr C: Does that bring to mind any of your past pain that you have had? “I think that it is all about my husband.” Dr C: In what way? “Like he break my heart…like a double person…one head is like a good one…and all together good and bad eat me…they eat me both…even good person…the same person and he eat me…so I see in him both…two personalities…but they are both personalities…break my heart” Dr C: You are going to get through this and be a lot better! (The therapeutic power of positive thinking was interjected.) Next her response sequence to 18 A will be presented. It may be noted that the “Heart broken” symbolism continued: “I see animal inside heart but it is heart broken…and this animal…it makes me feel really bad…so it is like the same picture…but make me feel like…so many emotional at the same time…too many emotions “ Such threatening SIS imagery served as a trigger for releasing a flow of PTSD memories. These set the stage for further correcting her distorted cognitions and positively reorganizing their negative affect linkage. 28 Cassell

When asked to recall how her body felt during such episodes, she described “Heart palpitations. The beating image elicited by 8 B brought to mind her past stress induced psychophysiologic symptoms, when he assaulted her. SIS 14 A brought to mind in a similar fashion her abdominal symptoms related to Crohn’s Disease. Next an attempt will be made to show the relationship between her recollections of her stressful past reality, and her PTSD dreams, as well as their parallel with content specific SIS symbolism. Excerpts from the transcript of when she was speaking about dreaming follows: 1.“I have so many dreams…but I see exactly the person and I see action…I have to figure out in my brain what I see…I already see what exactly happens…it is like real life to me…history” (Here she indicated that some PTSD dreams closely approximate the reality of the trauma.) 2.“I saw my husband…how he push me on drugs…and he give me shots with drugs so I can’t stand up and I can’t move…and he abuse me more in my dreams than actually in real life…sometimes I saw he is a good person in my dreams” Dr C: He put you on drugs? “No, No. No.…just in dreams…dreams make me sometimes feel real inside…how he impressed me in real life with his movement…but it wasn’t real(His premarital social image.) Dr C: So at times you would see him as evil and sometimes as good in the dreams? “Yes” Dr C: How would you feel in an evil dream? “Very bad!” Dr C: And in a good one? “Good of course!: Dr C: “So it tore you apart…even when you were sleeping?” “Yes…even in dreams he had an evil head.” Dr C: “That is right!” “Double face” (Like the SIS symbolism projected with 17 A) 3. The third dream sequence depicted to be reviewed her ex-husband’s threats to kill her and their child. It has been found that the He twice almost smothered her. His perverse behavior resembled “Snuff” – a sexually sadistic scenario in which the murderer strangles or smothers the victim. In terms of experiencing such a near death suffocation, her response sequence to 11 A is relevant: “I see a nose…somebody stick something in nose…it is something which can’t make me breath too good…but I can still breath because it is open.” Dr C: “Did your ex-husband try to choke you?” “Yes…a couple of times with a pillow on my face so I can’t breath”. SIS in PTSD 29

Dr C: How did it feel? “I don’t know…when I see in that picture…just because I see open hole…I don’t feel that I can breath because it is open…but with stick it is making me feel…it is my mouth open.” The negatively loaded symbolic dream complex follows: “ I saw dream, someone’s spirit, maybe a man’s, maybe another spirit jumping in my body and I saw how he inside me and trying going into my child too, but I push him already on myself, so he hurt just me. And I saw under the skin, going around, push, like squeeze me in my stomach and chest and I can’t breathe, and I need help. Dr C: “And what was the visual part of the image? “Man. Man’s spirit.” Dr C: And what does a man’s spirit look like? “I can’t see because it was too dark a room. In one room I try to sleep with my child, and I see that man going to door, but he turn around to look for me. I see just spirit. But then the spirit is not real man. Spirit man…and he right away, jumping into my body and I feel him and try to pull him out and I try to pray. But just because I am so… so scared, my pray go away” (In this dream the terror immobilized her. Temporarily she could not pray. The severity of this is consistent with the PTSD literature ( Krakov et al 2002). The more severe the attacks in female sexual assault survivors, the more frequent were their nightmares.) Next the manner in which the SIS stimulated positive spirituality will be illustrated in two SIS projections. In this connection, 8 B reminded her of “The face of an angel”. In 10 B she envisioned a scene as two people looking at a religious symbol depicting God’s love. Then in further revealing her spirituality, she went on to speak about her heavenly recurrent dreams. In these she regularly experienced the healing power of calming spirituality. These would enable her to temporarily travel away from earth’s stresses. She would awake feeling restored and more able to care for her child. “It is like I am flying. So a couple of times, in dreams, but a little bit. I am flying under water. Sometimes, it is landscapes, but lately it is water. But underneath the water I feel big, big huge castle. And it is so beautiful, and it is a little bit old fashioned. And I fly inside and I see huge, huge, mirrors. I feel like something, and I am just like flying over there, and I see beautiful, beautiful furniture…so beautiful pictures. .chandeliers…and sometimes I go down and I find, little river, or something, a creek...a little creek, but nobody is working there because it is so much, but some of them ..a definitely sweet place and I found diamond rings there, and sometimes jewelry. And peace and quiet.” 30 Cassell

Case II: Bewitched by a woman with Borderline Personality Disorder This involved a forty six year old Seattle business man originally referred for treatment of Major Depression. During the initial evaluation it quickly became evident that he also was also suffering from PTSD. When he married, his beautiful bride she had seemed quite loving. Little did he realize that she was concealing the external manifestations of a Borderline Personality Disorder (BPD). Her mental disorder manifested itself when she was on a winter vacation living for a short time by herself in their Arizona vacation home away. This timing was consistent with the extreme vulnerability to the stress of separation characteristically experienced by unstable individuals with BPD. Prior to marriage, she had indicated that her European childhood had been happy. He had no opportunity to meet his future in-laws, so was readily taken in by her deception. After she began to decompensate psychologically she revealed that she had been socialized in a dysfunctional family. For the first she revealed that her mother had an extensive psychiatric history: severe mood swings, multiple suicide attempts, sexual promiscuity, and failed marriages. As his premarital blindness was replaced by insight into the terrible reality of his mistake, he became disillusioned and depressed. It was hard for him to accept her crumbling image. Yet it was dawning on him that he had been dubbed into marrying a woman, who was like her mother. He stayed in the marriage with the unrealistic hope of marital therapy being effective and for his two girls. Eventually was able to divorce her but not before his health became impaired. SIS Interviewing: He selected SIS-II video 11A as the one he most “Disliked”. It reminded him of a “A broken toilet”. Over time in therapy, this became a powerful referent for symbolizing painful memories about his marital life. He repeatedly referred to his marriage as like “Living in a toilet”. Speaking in an analogous way provided empathetic support. Thus he was asked: “Tell me more about your “shitty” life. Speaking in the vernacular can often be more therapeutically effective, than using “clean” socially acceptable words. During such interviews, the therapist is advised to wait for the appropriate time for interjecting SIS symbolic hope. This strategy can serve to reinforce the correction of depression determined hopeless. For example, in viewing SIS A5 he envisioned “A smiling man!” Such a vision can be interpreted in a hopeful manner: “What you see here indicates that your life will eventually be much happier”. Since such a hopeful comment appears to come directly from what he saw himself, it can carry significant suggestive power. In any one session, it is essential for the therapist not to be obsessively concerned about exploring responses to the entire SIS series. If the stress related critical symbolic SIS imagery is being effectively processed, than a goal for that session has been achieved. Moreover it might prove counter therapeutic to explore other SIS stimuli. It is SIS in PTSD 31

essential to use sound clinical judgment in order to maintain an optimal anxiety level without flooding the viewer with PTSD imagery. Moreover, the therapist might well keep in mind that there is always the opportunity for further SIS viewing at subsequent stages in the therapy. Moreover, repeating the procedure can utilize the anxiety/threat reconditioning provided by the floral imagery. The second most threatening SIS Image 6 A was seen as “A man and a bear”. This superimposed aggressive imagery of an adult threatening “Bear” over the inkblot’s the child like “Teddy Bear” embedded structure. Here his associations led him to discuss past threatening episodes, when his ex-wife would attempt to provoke him through verbal abuse. When this failed she became physical threatening, so eventually he had to obtain a restraining order. He realized that if he responded physically, she would use this information in court to get full custody of their children. The adult “Bear” response provided a therapeutic opening for processing his rage. It enabled the interviewer to bring reality testing for coping with and cognitively redirecting his homicidal impulses. The third that bothered him was 2 A visualized as “A flower over a tunnel”. Historically the “Flower” represented his beautiful bride. The tunnel symbolized his painful passage having fallen from wedding bliss to the terrible abusive world of his marriage. A few other illustrative responses will be briefly reviewed: A3 A “A bleeding heart – pulled out by the roots!” This portrayed in body language his “Broken heart” and depressive core. 4 A “A partially opened or damaged suitcase!” This symbolized his damaged masculine self concept. 5 A “A human stomach…dead”. Prior to treatment he was suicidal as well as suffering from stress induced anorexia. The imagery denotes both aspects of his inner world. 1 B “A fist holding a dead cockroach!” This relates to residual memories of his homicidal rages experienced consciously and in murderous dreams. Prior to treatment, he had been strongly tempted to act out his aggressive fantasies towards the men who betrayed him. 2 B “A Devil’s face”. Within himself, this related to what he considered to be his own “evil” homicidal daytime impulses, as well as his violent uninhibited dreams. In his interpersonal world, it symbolized the “Devil” like behavior of his sexually promiscuous wife and his former so-called friends. 3 B “Two men with a woman trying to lead them into Hell!” This symbolized the above mentioned seduction scene. He was tortured at night by recurrent PTSD dreams of imagery depicting his wife’s sexual encounters. She had taunted him with vivid recounting of her promiscuous acting out. . 4 B “Being with two faces…the face behind a false face”. This depicted his ex-wife both as a loving wife and then as a “witch”. 15 B “Knives flying at a woman”. This denoted homicidal impulses that had been directed towards his ex-wife. 32 Cassell

Two final response sequences warrant brief review because of their positive spiritual and philosophical connotations: B 16 was seen to represent “Hummingbirds over a sacred heart”. This symbolism opened the subject of his strong religious faith. As his marriage failed, he recalled that it was only “Through prayer and trust in God” that he was able to carry on. This loving image was supported in spiritual based psychotherapy. The second relevant SIS response which enabled the interviewer to inject hope, as a psychological antidote for his periodic bouts of hopeless was evoked by 19 B. This was seen realistically, as depicting “Sperm entering egg”. Afterwards his depressive inner cry was projected into the SIS stimulated symbolism as “The broken heart of life”. After repeated review of this imagery in cognitive psychotherapy, he became convinced that there was “A light at the end of the tunnel”. Discussion: Eskimos have several words to describe snow conditions. When something is important in a particular culture usually the descriptive aspects of this lead to specific unique words. In contrast to such utilitarian linguistic specificity, the English language is limited in existing terms to communicate emotions. Critics have viewed the British in the stereo typed image as emotionally repressed individuals, with limited empathetic skills. Historically it may have made the original British military immune to the suffering that they sometimes inflicted throughout the world. In spite of such inherent language limitations, the traumatized victims in this phenomenological case history study were able to effectively express their stressful experiences. This was facilitated by the SIS stimulated symbolism which provided an additional communication vehicle. The word pictures that they envisioned to describe their visual responses having the highest negative emotional valence were particularly effective. For example, in selecting 3 B as the most threatening scene, the immigrant woman symbolically was able to more effectively communicate. It may be recalled that her sociopath husband was portrayed as “A figure from Hell”. In discussing this, she was able to cognitively reorganize her memories and feelings about her marital trauma. With empathetic support, she was then able to grieve the loss of the premarital fantasies, express her PTSD feelings and then accept positive suggestions regarding her future life in America (Cassell, 2000, 1996). The second case involved a middle aged man who was successful in business but not in his personal life. Like men in western culture, he imagined it to be a weakness leaning on a psychotherapist. The SIS stimulated symbolism provided insight for him. He realized the value therapeutically of speaking in symbolic language, including that associated with exploring dream symbols. Imagining SIS 11 A to be “A broken toilet” without any such SIS structural reality for him was convincing (i.e. “Seeing is believing.”). The authorities who publish English language dictionaries might well consider the adoption of new descriptive words to communicate emotions. Evolving from the Russian emigrant woman’s most threatening SIS response, one might coin the word to describe a sociopath spouse as “Fighell”. Consistent with the business man’s anguish, one SIS in PTSD 33

might coin the word “Brotoil” to describe the subjective anguish of a being married to a spouse with BPD. Of course realistically, at this time linguists are far from creating building a universal emotionally rich language. SIS stimulated symbolic imagery can provide an important communication aide in clinical interviews where translation issues exist. Even though the Russian woman’s English was limited, she expressed considerable appreciation for her rapid relief following the SIS intervention. It helped to reorganize her traumatic memories and emotions by first exploring the significance of a SIS stimulated responses, and then second, this help was reinforced by immediately afterwards exploring the significance of her symbolically related dreams. For example, she had horrible memories of her husband’s attempts to smother her. When she was able to communicate through the SIS “hole in the nose” symbolism projected in relation to 11 A and then further in symbolically related “spirit man” assault dreams, therapeutic efficacy was maximized (Cassell, 1997, 1999). Moreover, it represents a new confluence of memories, dreams and projective symbolism not readily available with other procedures. It clinically demonstrates significant SIS Incremental Validity - the extent to which a procedure contributes information to diagnosis/treatment above and beyond that already available (e.g. scores on more easily organized tests) ( Meeh, 1959, Sehrest, 1963). Just as the business man was reluctant prior to SIS symbolic interpretation to communicate his inner cry, in most cultures there still exist emotional denial and repression. From an early age children are taught that it is often better to suffer in silence, than express feelings. Even mental health professionals are subject to such pressures. They are often pressured to avoid revealing the true extent of epidemiologic statistics revealing high rates of psychiatric morbidity world wide. Researchers and clinicians who elect to use projective inkblot technique are subjected to similar pressures. With the Rorschach, it is scientifically scandalous to witness the extent that clinicians rely on scoring systems that totally ignore emotionally charged symbolic content. While such approaches have a measure of diagnostic merit and appear to be mathematically sound through documentation with statistical norms, they represent a form of professional perceptual blindness. The clinician does not have to feel the empathetic suffering reading numbers and may feel smug in the erroneous bias that analyzing inkblot symbols is scientifically invalid. Their ethics are highly questionable and their intellectual crime is tantamount to real criminality. Vast sums of private and public health money are wasted by clinicians and computer companies who provide their emotionally sanitized sterile data. Researchers and clinicians who choose to use the various forms of the SIS instrumentation must be prepared for some degree of inhibitory pressure from within themselves as well as from others. In attempting to conceptualize this most complex process, the following model is proposed. In regard to the former, the interviewer may have to cope with personal professional biases. Certain of these may stem from dogmatic educators who may have advocated Rorschach scoring systems, which ignore projection. 34 Cassell

In terms of counter transference issues, those who enter the mental health field often have their own unresolved issues. Marital discordant images in the therapist’s brain memory bank may well distort perception of SIS human content. Occupational exposure to PTSD imagery from treating trauma victims may be quiet analogous to acquiring a computer virus. For those who fail to maintain empathetic but still safe professional psychological boundaries, this material can be potentially neurologically toxic. Consider the situation when the business man was projecting the response “broken toilet” .When the interviewer concurrently looks at such a SIS stimulus, the process is complex. There is a fusion in visual consciousness between the viewer’s own idiosyncratically determined vision and of the reality based SIS norms. This then becomes superimposed on imagery projected by the traumatized victim. This creates a situation which is analogous to both viewers sharing a “nightmare”. While this has many empathetic advantages, it can be stressful. Apart from the multiple clinical uses of SIS technology, there would appear to be applications in the field of premarital screening. Behavioral scientists and marital counselors know much more than in the last century. In western culture when cowboy films were first made in Hollywood, the plots were relatively simple. The audience knew who the “good guys” were on the basis of clear-cut visual cues. The hero usually might wear a white hat the villain a black one. At the end of the movie the hero usually romantically connected with a beautiful woman. Yet the high divorce rate in Hollywood films stars was quite inconsistent with this simplistic fantasy. In modern movies it is often unclear who represented “good” characters in a film and who depicted “evil”. Now there is a tendency to bring audiences into theatre be presenting plots in which negative characters are portrayed as worthy of emulation. Rarely is a married couple is presented in a wholesome and loving fashion. Now American films seduce their audience with scenes of explicit sex and vivid violence. They pander to the baser fantasies of mass television audiences, ignoring the positive spiritual aspects of marriage. Habitual exposure media portraying the dark side of human nature can negatively program day time fantasies, SIS inkblot imagery and dreams. Entering a committed marital relationship should not be taken lightly or on impulse. In western cultures, with their over emphasis on personal freedom, this can lead to tragic mistakes. Divorce rates are incredibly high, as is the extent of psychological damage for children involved. To prevent such tragedies some futuristic planers advocate (http:/ /surveycentral.org/?x=x&V=5890&ReSort=1) the unpopular idea of requiring licenses to have children. In the United States, this would pose a major financial threat to entrepreneurs of the expanding private prison industry. Some cultures take the sensible approach of incorporating premarital input from responsible family members, religious authorities, or a “matchmaker”. With the advent of long distance travel, special premarital judgment issues arise. Individuals, such as those presented can not always benefit from the reality testing that comes from meeting with prospective in laws. A consultant utilizing SIS body-mind-spirit insights perhaps might have thrown illumination on the passions of their “Blind love”. SIS in PTSD 35

References: Cassell Cassell, W. A., Somatic Inkblot Series Video, SIS Center . Anchorage, Alaska (USA), 1984. Cassell, W. A., Somatic Inkblot Series Manual, SIS Center, Anchorage, Alaska (USA), 1990. Cassell, W. A. Dubey, Asheem and Dubey, B. L. SIS Projective Responses in PTSD and Dissociative Disorder. SIS Journal of Projective Psychology & Mental. Health, 2000, 7: -93-108. Cassell, W. A. and Dubey, B. L. The Use of the Rorschach and SIS in Releasing Somatised Grief. Cassell, W. A. Dubey, B. L. and Roth, G. J. Medical, Psychological and Spiritual Application of the SIS Inkblots. SIS J. Proj. Psy. & Mental, Health, 4, 1997, 89-112. Cassell, W. A., Dubey, B. L., Molchanov,E. and Routh,L.C. Stimulating Beacon images for meditation and projective psychotherapy. SIS J.Proj Psy. & Ment. Health, 1999, 6:7-30. Cassell, W. A. and Dubey, B. L. Inkblot Responses as an Aid to Therapy. SIS Journal of Projective Psychology & Mental. Health, 2000, 7:3-10. Krakov, B. et al (2002) Nightmare Frequency in Sexual Assault Survivors with PTSD. Journal of Anxiety Disorders 16, 175-190 Meehl, P.E. (1959) Some Ruminations on the Validity of Clinical Procedures. Canadian Journal of Psychology 13: 102-128 Sehrest, L. (1963) Incremental Validity: A Recommendation. Educational & Psychological Measurement 12: 153-158 Zimmer, C. (Nov 2005) The Neurobiology of the Self: Scientific American, 93-100 36 Cassell

The Relationship between Early Memories and the Rorschach Inkblot Test Edward M. Petrosky An early memory scoring system was developed to identify manifestations of present personality traits based on the type and nature of events and interactions reported in subjects’ earliest memories. In a within subject design, 23 adult psychiatric inpatients reported their 3 earliest memories, their earliest memory about a chore and of school, and were administered the Rorschach Inkblot Test. Unconventional Chore (UNC), Unconventional School (UNS), Attachment Seeking (AS), Egocentric (EGOC), and Experience of Failure (EF) early memory scores were created to assess unconventionality, a strong desire for interpersonal contact, egocentricity, and a damaged self-concept, respectively. It was predicted that: the UNC and UNS scores would be associated with a below average number of Popular responses and an elevated number of White Space responses on the Rorschach; the AS score would be associated with production of the Food Response on the Rorschach; the EGOC score would be associated with an elevated Egocentricity Index on the Rorschach; and that the EF score would be associated with an elevated number of Morbid responses on the Rorschach. It was found that earliest memories of a chore in which the subject did not comply with the expectations that were placed on him or her as well as earliest memories of school involving transgressing a rule or an implicit norm when used in conjunction with the former type of memory, were associated with unconventionality on the Rorschach. Alfred Adler (in Ansbacher & Ansbacher, 1964) argued that a person’s earliest memory features an event that exemplifies one’s over-arching goal in life (i.e. the “final fictional goal”) and his or her characteristic means of approaching it (i.e. the “style of life”). Consider as an example a person whose earliest memory is: being in a sandbox at nursery school, another child takes his or her pail, and he or she tells the teacher who in turn returns the person’s pail. This memory reflects a goal in life of eradicating injustice, which is done by appealing to authority, in this case in the form of the teacher. Perhaps such a memory might come from an attorney - one who fights against injustice by appealing to the authority of the judge. More recently, Bruhn (1990) argues that early memories (EMs) are graphic representations of one’s schemas. The nature of the events and interactions in one’s EMs are those the person presently expects to occur in general. Empirical investigations have supported the utility of EMs as a personality assessment technique. For example, Bruhn and Schiffman (1982) created a scoring system that enabled them to predict with 83% accuracy whether their 153 subjects had an internal or external locus of control. Their findings included that subjects who reported a memory of being injured as a result of another’s deliberate intent tended to have an external locus of control, whereas subjects who reported a memory of being injured by accident and receiving kind responses from others tended to have an internal locus of control. As another example, Fowler, Hilsenroth, and Handler (1996) found significant, positive correlations between EMs reflecting dependency, such as of passively and helplessly being fed, and both therapist ratings of dependent client behavior and indications of dependency on the Rorschach. Edward M. Petrosky, 1 Station Square, Suite 102, Forest Hills, NY 11375. Email: EPetrosky@iona.edu Key word: Early Memories and Personality

The present author set out to advance the empirical basis of EM interpretation by creating an objective scoring system to identify EMs that reflect unconventionality, a strong desire for interpersonal contact, egocentricity, and a damaged self concept. In addition to the discussing the specific results this study yielded, the author also wished to utilize the present article as a means of introducing this scoring system for use in future research. The scoring system specifies ways in which the above concepts are operationalized, or reified, in the types of events recalled, and in the way in which the memory narrative is organized. The scoring criteria were developed based primarily on theoretical considerations, and secondarily on data from 10 pilot subjects. In a within subject design, this study examined if EMs meeting the criteria of these scores would be associated with established Rorschach variables that measure similar constructs. The Rorschach was used as the criterion variable because self-report personality tests, because their items are generally face valid, have been recently conceptualized as measuring aspects of the client’s personality of which he or she is aware and to which he or she is willing to admit (Acklin, 1993; Lovitt, 1993; Finn, 1996). As a result, self-report personality tests are more amenable to conscious attempts at impression management. The Rorschach on the other hand, is a relatively unobtrusive measure that provides a behavioral sample of the client’s functioning (Lovitt, 1993), which yields information about the client’s personality organization (Acklin, 1993), of which the client may be unaware. Unconventionality on the Rorschach is tapped by the Popular (P) wand White Space (S) responses. Popular responses are a set of 13 specified responses that are frequently given, namely at least once in every 3 protocols, on average (Exner, 1995). The degree to which one produces at least an average number of P responses is the degree to which one has responded similarly to how most people would. This is interpreted as evidence that when faced with situations in real life in which most people respond in a particular way (i.e. “structured” situations), the person is likely to respond as most people would; that is, to act conventionally. Conversely, when the number of P responses is below average, the person “is likely to make less conventional, more individualistic responses, even in situations that are simple and/or precisely defined” (Exner, 1991, p. 211). Providing indirect support to this interpretation is the finding that samples of “abnormal” individuals – that is, those with schizophrenia, depression, and personality disorders - produce less P responses than non-clinical adults (Exner, 1993). Abnormal client samples are by definition people who are away from the norm, or what is conventional. In summary then, a below average number of P responses suggests the person engages in unconventional behavior. White space responses on the Rorschach occur when one uses white space in one’s response, either by using only the white space or by integrating it with the other blot areas (Exner, 1993). An elevated number of S responses indicates an oppositional stance towards others (Exner, 1991), which thus “can become detrimental to the formation of harmonious social relationships” (Exner, 1993, p. 499). An elevated number of S responses has been associated with such manifestations of unconventionality as oppositionality, an elevation on the Psychopathic Deviate scale on the Minnesota Multiphasic Personality Inventory, and paranoid schizophrenia (Exner, 1993). 38 Petrosky

A strong desire for interpersonal contact can be inferred from the Food (Fd) response on the Rorschach, which is defined as:any edible common for humans, such as fried chicken, ice cream, fried shrimp, vegetables, cotton candy, chewing gum, steak, a filet of fish, or for animals eating a food that is natural for their species, such as a bird eating a worm or insect (Exner, 1995, p. 53). Food (Fd) responses on the Rorschach reflect a strong desire for interpersonal contact in the form of dependency and an unrealistic reliance on others to meet one’s needs. People who produce Fd responses on the Rorschach tend to “rely on others for direction and support” (Exner, 1993, p. 523). Exner and Kazaoka (1978, in Exner, 1993) found that, of 16 subjects taking part in an assertiveness training program, the 4 that were rated highest for number of dependency gestures had at least one Fd response in their Rorschach records. This prompted a follow up study in which 24 6th grade students were administered the Rorschach and observed during art class. Seven of the students with at least 1 Fd response, “made nearly twice as many requests for help and asked nearly four times as many follow-up questions after the help was provided than did the other students” (p. 438). Exner (1993) also reports that the majority of 54 protocols of outpatients diagnosed as Passive-Dependent according to the Diagnostic and Statistical Manuel of Mental Disorders - Third Edition, Revised had at least 1 Fd response. In summary, the Fd response is indicative of passive and dependent behavior. Excessive neediness and reliance on others represents a form of a desiring interpersonal contact. The former is a narrower construct nested within the latter. The texture response was not used as a dependent measure in this regard because of the low base rate of texture responses in the population from which the subjects were drawn. The investigator examined the Rorschach protocols of 21 consecutive patients referred for psychological testing, from this population, up until shortly before the study commenced. He found that over three quarters of the protocols (76%) had no T responses, and only 10% contained an elevated number of T responses(i.e. at least 2). Egocentricity is assessed on the Rorschach by the Egocentricity Index (EI). The EI is an empirically derived scale, computed based on the number of responses in which the subject reports a reflection, and on the number of responses in which the subject reports a pair of objects based on the symmetry of the blot (Exner, 1995). Overall, the EI is an index of self absorption or “self-focusing or self-attending behavior” (Exner, 1993, p. 506). Exner (1993) describes a study in which 750 non-patient adults completed a sentence completion blank form in which responses were scored “S” if the focus of the response was on the self and “0” if the focus was on another. The study compared the Rorschach protocols of the 40 subjects with the highest number of S responses with the 40 subjects with the highest number of 0 responses. Thirty seven of the 40 high S subjects produced reflection responses, whereas only 2 of the 40 high 0 subjects did. Additionally, the study found that subjects in the high S group produced almost 2.5 times as many pair responses as the subjects in the high 0 group. Exner (1973, in Exner 1993) obtained similar results. Early Memories and Rorschach Test 39

In another study described by Exner (1993), job candidates for an engineering position were escorted to the interview room and waited alone for approximately 10 minutes until the interviewer arrived. Candidates were video taped, and the amount of time each subject spent looking in a mirror in the room was recorded. Subjects were divided in terms of mirror viewing time based on a median split, resulting in 2 groups of 10. The upper half of subjects had an average mirror viewing time of 68.5 seconds, whereas the subjects in the lower half of the distribution had an average of 27.1 seconds. These 20 subjects were then administered the Rorschach. The upper 10 subject produced a total of 6 reflections and 103 pair responses, yet the lower 10 subjects produced 0 reflections and 68 pair responses. This study also examined the number of times subjects used first person pronouns during the first 10 minutes of the actual interview (Exner, 1993). Using a rho correlation, the investigation found that the number of personal pronouns used and EI value was correlated at .67 (p < .01). Of note was the additional finding that the 6 subjects who had used the most personal pronouns were the 6 subjects in the sample that had produced reflection responses. Indirect support for the construct validity of the EI is provided by the Rorschach age norms of children. Developmentally, young children are expected to be self-centered, with this characteristic declining as they get older (Exner, 1993). Accordingly, the average EI values of non-patient 5, 9, 11, and 16 year olds is .69, .57, .53, and .43, respectively (Exner, 1993). These studies indicate that the EI reflects the degree of self absorption one has. Erdberg (Personal Communication, February 3, 1995) suggests that the EI might be more aptly thought of as the “Self / Other Balance Index.” He notes that the EI provides an index of the degree to which one perceives oneself as having more, less, or the same amount of “clout” or importance as others. Research has also indicated that the EI is associated with one’s level of self esteem. Thomas, Exner, and Baker (1982, in Exner 1993) had 225 college students complete the Gough Adjective Checklist. In a counter-balanced design, each subject completed the checklist twice, once with instructions to describe themselves as they were, and once with instructions to describe themselves as they would like to be. The difference between the latter and former was calculated, forming a difference score. Subjects at the upper extreme had an average difference score of 9.4, whereas the average score of subjects in the lower extreme was 38.9. Thomas et al. (1982) then recruited the 20 subjects at each extreme to take the Rorschach. Subjects in the upper extreme yielded average EI values of 48.9, with 11 of the protocols containing 16 reflection responses. Subjects in the lower extreme yielded average EI values of .31, with none of these subjects producing reflection responses. Thus, this study demonstrates the relationship between the EI and self esteem. Subjects with a high difference score were essentially indicating that they were far from how they would like to be. That is, they had low self esteem. In contrast, subjects with a low difference score, by producing little discrepancy between their real and ideal selves, were essentially stating that they were their ideal self. That is, they are manifesting high self esteem or grandiosity. In summary, the EI is associated with both one’s level of self-absorption and self esteem. Based on the 40 Petrosky

distribution of EI scores of 700 adult non-patients, Exner (1991) cites an EI value of greater than .45 as indicative of an abnormally high amount of egocentrism. A damaged self concept on the Rorschach is tapped by the Morbid (MOR) response. A MOR response is any response that is described by the subject as dead, damaged, injured or spoiled (e.g.s a bear that is hurt, a decaying leaf), or which has a dysphoric quality (e.g. an unhappy person) (Exner, 1993). Most of the research performed on the MOR response has been within the context of depression and suicide (Exner, 1993). Whereas the mean and modal number of MOR responses for non-patient adults is .7 and 0, respectively, 70 % of the 315 people in a depression reference sample had 2 or more MOR responses, and 57% had 3 or more (Exner, 1993). Greater than 3 MOR responses were found in 71% of 101 Rorschach protocols that were collected within 2 months of the person committing suicide (Exner, 1993). Thus, the MOR response is more frequently observed in depressed and suicidal samples. Exner (1978 in Exner, 1993) examined the Rorschach protocols of a group of 430 patients participating in a long term treatment effects study. He compared the therapists’ ratings of patient attitude, completed early in treatment, of 76 patients who had produced 3 or more MOR responses, with 76 patients drawn randomly from the remainder of the sample. Exner found that the patients who had produced 3 or more MOR responses were rated to have significantly more pessimistic attitudes towards the self, their presenting problems, and the future. Exner (1993) argues that since MOR responses are embellishments of the blot by the subject, they “invariably include some projected material” (p. 514). Furthermore, the finding that the MOR response reflects, at least in part, a pessimistic orientation towards the self, suggests the person conceptualizes the self as possessing negative, possibly damaged features (Exner, 1993). This is especially the case when the number of MOR responses equals or exceeds 2 (Exner, 1993). This interpretation is indirectly supported by a study that found that the number of MOR responses was significantly negatively correlated (r = -.41) with the Egocentricity Index, which taps self esteem (Exner, 1993). The degree to which the MOR response reflects one’s concept of self is increased the more unique the response is, and the more it converges with other data (Exner, 1991). For example, one of the subjects in the present study who had a chronic backache, a history of hypertension, was obese, and had a hearing impairment, responded to Card V with, “Looks like a screwed up butterfly with physical problems...maybe he got hit by a couple of cars on the way...looks like a bat [the client was vacillating between butterfly and bat] that was run over by a truck.” While a butterfly and a bat are frequently given responses to this card, this type of elaboration is not. Furthermore, while an animal that has been run over is a frequent MOR response to this card, when a MOR response is given (Exner, 1993), the patient’s opening description of the butterfly being “screwed up” with “physical problems” is highly idiosyncratic. The patient’s elaboration in light of the background information suggests that he conceptualizes himself as damaged (i.e. “screwed up.”). In summary, an excessive number of MOR responses suggests pessimism in general and a conceptualization of the self as damaged in particular (Exner, 1993). While the number of MOR responses needed for significance on the Depression Index and Early Memories and Rorschach Test 41

Suicide Constellation is greater than 2 and 3, respectively, Exner (1991) sets 2 as the threshold for interpretive significance. This number was selected as a cut off value for this study to increase the investigation’s sensitivity. The present investigation utilized an inpatient clinical sample, which offers several benefits. Most studies on EMs have utilized college students or outpatients. Thus, by using a psychiatric inpatient sample, the results of this study offer greater applicability to clinicians working in inpatient settings. In addition, the use of this subject population facilitates the study of personality traits since, because of their psychopathology, these subjects are more likely to fall towards the extreme ends on dimensions of personality functioning. Thus, they are likely to demonstrate personality traits in a pronounced or “amplified” fashion. In summary then, this study attempted to expand the boundaries of EM research by introducing and examining an objective EM scoring system assessing a range of personality constructs and using an inpatient sample. Method: Subjects: Following the advice of Dies (1995), the present sample is described along numerous dimensions so that the results of the study can be appropriately generalized. This is particularly important since overgeneralization of results is one of the prominent errors in Rorschach research (Exner, 1995b). Twenty three subjects, 11 male and 12 female, voluntarily participated in the study, and were drawn from an acute, inpatient psychiatric unit located in an urban area. The sample was composed of subjects randomly selected from a list of voluntary (i.e. noncommitted) patients on the unit (n = 19) combined with subjects referred for psychological testing by their psychiatrist during the time the study was in progress (n = 4). The age range was 21-71, with a median age of 36 years. Fifteen subjects were Caucasian, 6 were African-American, 1 was Hispanic, and 1 was Asian-American. The median day of hospitalization on which data was collected from subjects was the 4th day, with a range of 2 - 16. Data was also collected pertaining to the number of subjects’ previous psychiatric hospitalizations. For 2 subjects data was not available on this variable. The range of previous hospitalizations was 0 - 3, plus 3 subjects who were reported to have had “multiple” previous psychiatric admissions. The median and modal number of prior hospitalizations was 1, with “multiple” treated as indicating >1. An effort was made to minimize the presence of psychosis in this sample to reduce the likelihood of collecting invalid data in the form of incoherent memory narratives. This was accomplished as follows. Subjects who were randomly selected were drawn from the group of patients voluntarily admitted to the unit because involuntarily admitted patients (i.e. those who are “committed”) tend to carry psychotic diagnoses. The randomly selected subjects were excluded if they carried an admitting diagnosis that was primarily psychotic in nature (e.g. Schizophrenia). Patients whose diagnosis contained psychotic features as secondary elements of their disorder were included (e.g. Major Depressive Disorder, Severe, with Psychotic Features). Patients who were diagnosed with a Bipolar Disorder were included, except those currently presenting as manic. Patients with a Bipolar Disorder diagnosis who presented with manic symptoms were excluded because 42 Petrosky

the accelerated thought processes and speech of such patients makes it difficult to record their verbalizations verbatim as required by the test instruments used, and since psychotic symptoms are often prominent in this phase of the disorder (e.g. disorganized speech, delusions, etc.). Subjects referred for psychological testing were included along with the randomly selected subjects to increase the N of the study. Unlike the randomly selected subjects, they were not excluded if they had a psychotic diagnosis. Patients with a diagnosis of mental retardation were excluded from the study to reduce the likelihood of collecting impoverished testing protocols. In addition, subjects who were referred for psychological testing to determine their IQ were excluded since such subjects are usually referred for this reason when they have already demonstrated cognitive impairment suggestive of mental retardation. Patients whose referral questions concerned malingering were excluded since such patients are suspected of fabricating clinical information and thus would compromise the validity of the study. Approximately half of the subjects originally randomly selected for the study ultimately agreed to participate. Table 1 Distribution of Subjects’ Principal Diagnosis on Admission Mood Disorder n Depressive Disorder Bipolar Disorder, Not Otherwise Specified Bipolar Disorder, Depressed* Unspecified mood disturbance Other Psychotic Disorder Not Otherwise Specified Table 1 presents the distribution of principle diagnoses on admission. Substance abuse or dependence was not counted as a principle diagnosis in this tabulation because the setting in which the study was conducted is not specifically a drug treatment facility. As a result, a diagnosis of substance abuse or dependence does not accurately reflect the subject’s presenting problems on admission, and is secondary to the psychopathology that precipitated admission. As can be seen, the sample can be characterized as predominantly mood disordered. Eighty seven percent of the sample had a mood disorder (Depressive Disorder, Bipolar Disorder, or an unspecified mood disturbance) as the principle admitting diagnosis, with most of those patients (70%) having a Depressive Disorder. Only 17% (n = 4) of the sample had a principle admitting diagnosis that reflected psychotic symptoms, with 3 patients having a diagnosis of Psychotic Disorder Not Otherwise Specified and 1 patient having a diagnosis of Major Depressive Disorder, Severe, with Psychotic Features. Also of note, 48% (n = 11) of the sample presented with substance abuse or dependence. All 23 of the subjects were taking psychotropic medication at the time of testing, which is representative of an inpatient population. In summary then, the sample can be characterized as adult psychiatric inpatients of mixed gender, with a history of psychological problems, tested relatively soon after Early Memories and Rorschach Test 43

admission, on psychotropic medication, most of whom had a mood disturbance, and many of whom had substance problems. All subjects were coherent, oriented, and attended to the instructions of the experiment. Therefore, the tests results they produced should be considered interpretively valid. The intricate subject selection process described above might raise questions about possible unique sample characteristics and how that might affect the validity of the study. In this regard it is important to point out that the problem of subject idiosyncrasies serving as potentially confounding variables, which might threaten the internal validity of the study, has been obviated by utilizing a within-subject design. That is, if potentially confounding variables are present, they do not offer competing explanations for the results since they are held constant across all conditions, being that each subject produced data on both measures - EMs and the Rorschach. In terms of external validity, it is hoped that the thorough description of the sample provided above creates a clear picture of the sample to allow the reader to make appropriate generalizations of the results. Design and Procedure: Two separate unconventional EM scores were developed for subjects’ earliest memory of a chore and of school. Unconventionality is defined here as the degree to which one does not comply with social expectations in the form of norms or rules. The strategy of asking subjects for their earliest memories in particular content domains is adapted from Bruhn’s (1990) “Early Memories Procedure,” and is designed to elicit client attitudes or schemas for specific areas of functioning (Bruhn, 1990). Chores reflect an early instance in which a person is asked to comply with a set of expectations bestowed on one by a “larger” other. Thus, it was predicted that the disposition reflected in the Chore EM towards the task demands of the chore would parallel one’s present disposition towards societal expectations, or conventions, in general. The criterion for the Unconventional Chore (UNC) score is as follows: Unconventional Chore Score: A memory is scored positive on this score if the following criterion is true: The subject disregards or fails to cooperate or comply with the expectations placed on him or her. Lack of compliance includes not fulfilling expectations because the subject did not expend nearly the effort he or she could have to fulfill the expectation. This score does not include failures to meet expectations in which the subject expended most of his or her available resources and/or energy to fulfill the expectations. “Most” is defined as the amount an average person customarily would have. If the subject operationalizes his or her effort numerically, giving 75% of his or her effort or higher is considered “most.” E.g.: “I remember one night I was told if I didn’t do the dishes I couldn’t watch my favorite movie on TV. I rushed through it. I didn’t do a real good job - some parts were clean some parts weren’t.” Bruhn (1990) uses subjects’ earliest memory of school to assess “attitudes toward achievement, mastery, [and] independence” (p. 125). The present investigator argues, however, that in addition the school environment represents another prominent context in which a set of expectations for particular behavior is placed on one. Thus, the investigator predicted that one’s disposition towards rules as reflected in the School 44 Petrosky

EM, would parallel one’s present disposition towards societal conventions in general. The criterion for the Unconventional School (UNS) score is as follows: Unconventional School Score: A memory is scored positive on this score if the following criterion is true: 1a) The subject voices transgressing a rule.E.g.: “I remember one day we decided to skip school.” This includes behaviors that break obvious, implicit norms. E.g.: “I remember when I ruined the school play by pushing over the set.” Note: A rule transgression does not qualify when the subject broke the rule by accident (E.g. a), or out of ignorance of what to do (E.g. b). E.g. a: “I got so caught up in playing on the swings, by the time I realized recess was over and I had gone back inside, I was 10 minutes late.” E.g. b: “My first day of Kindergarten I followed my teacher into the building from the parking lot and got yelled at - I didn’t realize I was supposed to stay in a single file line.” (Sub-criterion 1b is only applicable if Sub-criterion 1a is positive.) 1b) Blame is not attributed to external factors. E.g. (in which blame is attributed to external factors thus the subject fails to meet this sub-criterion): “I got into trouble one day for not paying attention, but I couldn’t help it. There was a dog running around outside the window distracting me.” Although oppositional people may externalize blame for their actions (DSM-IV, American Psychiatric Association, 1994), people who externalize blame may very well not be oppositional. Therefore, sub-criterion 1b was included to provide a purer sample of people with oppositional traits by excluding people that do not “own” their noncompliance in their memory accounts. Unconventionality was operationalized on the Rorschach both by a below average number of P responses and an elevated number of S responses. Five or less P responses was designated as below average, following Exner’s (1991) interpretive guidelines. Exner (1991) accounts for both the number of S responses and their position in the record in setting the cut off point for interpretive significance. If the number of S responses equals 3, at least one of them must occur after Card II to be interpretively significant, whereas 4 or more S responses is interpretively significant regardless of where in the record they are given (Exner, 1991). Based on Exner’s (1991) interpretive guidelines, an elevated number of S responses was operationalized as either producing 3 S responses with at least one of them occurring after Card II or 4 or more S responses located anywhere in the protocol. Hypothesis # 1 was: Subjects who are positive on the UNC score will be more likely than subjects who are negative on the UNC score to have a below average number of P responses on the Rorschach. Hypothesis # 2 was: Subjects who are positive on the UNC score will be more likely than subjects who are negative on the UNC score to have an elevated number of S responses on the Rorschach. Hypotheses #s 3 and 4 were identical to #s 1 and 2, respectively, except they were with regard to the UNS EM score. Thus, Hypothesis #3 Early Memories and Rorschach Test 45

was: Subjects who are positive on the UNS score will be more likely than subjects who are negative on the UNS score to have a below average number of P responses on the Rorschach. Hypothesis # 4 was: Subjects who are positive on the UNS score will be more likely than subjects who are negative on the UNS score to have an elevated number of S responses on the Rorschach. The Attachment Seeking (AS) EM score was constructed to indicate a strong desire for interpersonal contact. The criterion for the AS score is as follows: Attachment Seeking Score: A memory is scored positive on this score if the following criterion is true: The subject indicates he or she wanted another person’s presence or company, attention, approval, or reassurance in one of the following four ways. the door waiting, but he never took me with him.” Note : Loss or absence of another person per se, without indication of a desire for the presence, company, attention, approval, or reassurance from that person, does not qualify as meeting the above criterion. E.g. (in which loss and absence is expressed yet the subject fails to meet the criterion): “I remember the day my favorite relative died. I was lead into a room, and people were trying to explain it to me.” A strong desire for interpersonal contact was operationalized on the Rorschach by the production of at least 1 Fd response. Hypothesis #5 was: Subjects who are positive on the AS score will be more likely than subjects who are negative on the AS score to produce one or more Fd responses on the Rorschach. The Experience of Failure (EF) EM score was designed to correspond to a damaged self concept. The criteria for the EF score is as follows: Experience of Failure Score: A emory is scored positive on this score if ONE of the following 3 criteria is true. 1) Criterion 1 is positive if Sub-criteria a, b, and c are all true. a) The subject articulates an intent of his or hers that was not accomplished. The intent must be clear and explicit as defined by the subject using language such as “wanting” or “trying” (or synonymous verbs) to achieve an end. E.g.: “I remember we tried to build a snowman once but never got it to look right.” (Sub-criteria b and c are only applicable if Sub-criterion 1a is positive) b) Blame is not attributed to external factors. E.g. (of blame being attributed to external factors, causing the person to fail to meet this sub-criterion) “One time I was looking all over for the cookies, but I couldn’t find them because my uncle had hid them.” c) The person does not compensate for the failure by successfully completing an alternative task. E.g. (of a person compensating causing the person to fail to meet this sub-criterion): “I remember one time I was in the school yard at recess. I kept messing up hopscotch, but then I showed the other kids by making a basket on the basketball court.” 46 Petrosky

2) The subject voices a negative self characteristic. E.g.: “One day I got punished for spilling a pitcher of lemonade at dinner - I was so clumsy.” 3) Criterion 3 is positive if Sub-criteria a and b are both true. a) The subject voices a physical injury to him or herself. Receiving a “spanking” per se would not qualify as an injury, unless the person cited an injury it caused, such as leaving a bruise. (Sub-criterion 3b is only applicable is Sub-criterion 3a is positive.) b) The subject internally attributes the cause of the injury, defined as verbalizing a self characteristic or aspect or behavior of theirs that caused the injury (E.g.s a-c), or precluded the person from preventing it (E.g. d). E.g. a: “I was so hyper that one day I was running in the house, and I tripped and fell into the table - I had a huge bruise.” E.g. b: “I remember one time I got beat up - I was too small to defend myself.” E.g. c: “One day I left my mittens at home. I played in the snow so long with bare hands I got frost bit.” E.g. d: “One time I was on my tricycle and it started rolling down a hill. I was bare foot so I couldn’t stop it. I went right into a cactus, and had to walk back to the house with needles stuck in my feet and arms.” Criteria 1 and 3 represent a damaged self concept in the form of diminished self efficacy and a physical injury, respectively. With regard to Criterion 2, the person outrightly gives him or herself a pejorative label. A damaged self concept on the Rorschach was operationalized by the MOR response. Exner (1991) sets 2 MOR responses in a protocol as the threshold for interpretive significance. Hypothesis #6 was: Subjects who are positive on the EF score will be more likely than subjects who are negative on the EF score to have MOR > or = 2 on the Rorschach. The Egocentric (EGOC) EM score was designed to indicate egocentrism defined as entitlement, an inability to perceive others’ perspectives, or the perception that one is the center around which events and others’ behavior revolve. The criteria for the EGOC score are as follows: Egocentric Score: A memory is scored positive on this score if ONE of the following 7 criteria is true. 1) The subject makes a reference to he or she being somebody’s “favorite.” This includes references to having special, elevated status. E.g.: “Being the only girl in the family, I had a special place in my family, and one time...” 2) The subject describes one or more of his or her traits, aspects, or abilities in positive, superlative terms. E.g.: “I was the fastest kid in class.” Early Memories and Rorschach Test 47

3) The subject makes a reference to it being his or her birthday or birthday party. This does not include memories in which the strongest feeling is negative (e.g. disappointment, sadness, anger, frustration), nor a memory which is scored positive on the Experience of Failure or Attachment Seeking scores. 4) The subject refers to a wish to have been an only child, or refers to gratitude that he or she was an only child. E.g.: “It was when the first of my two sisters was born. I wasn’t an only child anymore. I had a real problem with that. I had anger at my mother for having another child.” 5) The subject describes him/herself as being admired, defined as: a) Looking fondly at him or her. E.g.: “My grandfather held me and smiled proudly at me.” b) Paying him or her a compliment E.g.: “A woman on the supermarket line said ‘Wow, you have such beautiful green eyes.’” c) Offering the person praise. E.g.: “My aunt was saying ‘you’re so good.’” 6) The subject expresses that he or she deserved something that somebody else in the memory had or wanted, based on simply on the fact that the subject wanted it. E.g.: “My sister and I were arguing over the last piece of candy. I pleaded with the baby-sitter that I should have it since I really liked candy.” 7) The subject describes him/herself as being the center of attention or focus, defined as an event, outing, trip, celebration, or game that was organized or revolved around the subject. E.g.: “All of my friends came to my first Holy Communion party.” “Organized” and “revolved around” include occurrences whose direction or content was shaped by the participant’s will. E.g.: “One time we had to decide where to go on vacation. I picked California, so that’s where we went.” Note: This does not include dyadic interactions. The above mentioned scenarios must include at least 3 people (this includes the subject as a character). Criteria 1, 2, and 5 reflect a memory in which the person is set apart and above others, as does Criterion 3 in that one’s birthday is one’s day of honor. Criteria 4 and 6 indicate egocentrism in that they entail a resistance to accommodate to others. Criterion 7 reflects a memory in which an event revolves around the subject, as does Criterion 5 in that the person is made the reference point of others’ behavior. Egocentricity on the Rorschach was operationalized by subjects’ values on the Egocentricity Index. Exner (1991) defines an EI greater than .45 as indicative of egocentricity. Hypothesis #7 was: Subjects who are positive on the EGOC score will be more likely than subjects who are negative on the EGOC score to have Egocentricity Indexes greater than .45 on the Rorschach. 48 Petrosky

Subjects were blind to the purpose and hypotheses of the study. All data was collected by the investigator. Subjects’ EMs were collected first, followed by the Rorschach, which was administered and scored according to Exner’s (1995a) Comprehensive System. This patient population tends to find the Inquiry phase of Rorschach administration particularly demanding and at times frustrating. Thus, the Rorschach was always administered after eliciting EMs in an attempt to maintain subject motivation throughout the experiment. Adapted from Bruhn’s (1990) “Early Memories Procedure,” subjects were asked to provide their earliest memory of a specific event. Following the first EM, 2 additional EMs were elicited, resulting in a set of 3 EMs. Subjects were then asked their earliest memory about a chore and of school, resulting in a “Chore” and “School” memory, respectively, for a total of 5 EMs in all. Also adapted from Bruhn (1990), each memory was followed with the prompts “What is the clearest part of the memory?” and “What is the strongest feeling in the memory?” “General memories,” such as for example, “we used to barbecue in the summer,” were considered invalid. If a subject produced a general memory he or she was asked to provide a memory of a particular event instead. Memories that otherwise failed to describe a specific event were also considered invalid (e.g. memories in which the subject expressed his or her thoughts on life as opposed to a particular event). The Chore criterion is positive if the subject fails to comply with the expectations placed on him or her in regard to the chore. Thus, if it was unclear if the task was completed, the examiner asked, “Did [the task] get finished?” The Chore criterion is not positive if the subject fails to comply with the task demands if he or she expended most of his or her energy in an effort to comply. Therefore, if this aspect of the memory was ambiguous the subject was asked, “How much energy did you spend [insert task]?” The last criterion of the EF score is positive if the subject internally attributes the cause of a physical injury (e.g. as due to his or her own actions). Therefore, if subjects voiced a physical injury and it was ambiguous as to whether its cause was attributed to internal or external factors, the examiner queried, “How did it happen that [repeats the injury]?” A complete listing of the queries that were used is provided in Appendix A. Early memories were scored by 5 paid judges, 3 male and 2 female. Judges were advanced doctoral candidates in clinical psychology with extensive didactic and experiential training in psychological testing, who thus had the appropriate background qualifications as scorers of psychological test data. In addition, the judges were trained in the EM scoring system by the investigator who ensured the judges accurately comprehended the scoring rules, prior to the scoring of any protocols. All 5 judges were blind to the subjects’ Rorschach responses and scored the EMs independently of one another. Subjects were classified on the EM scores based on the majority decision of the 5 judges. Multiple judges were used to ensure that subjects’ EMs were accurately classified. Subjects’ verbiage to the initial prompt and the “Tell me the clearest part of the memory,” prompt together comprised the entire scorable response. Verbiage to the prompt, “What was the strongest feeling in the memory?” was only utilized to resolve scoring decisions when it was ambiguous in the response proper if a subject met an EM score criterion or not. Early Memories and Rorschach Test 49

The first 3 EMs elicited were scored only in terms of the AS, EF, and EGOC scores. If a subject was found to meet the criteria of a given score for any of these 3 memories, he or she was classified as “positive” on this score; that is, as having produced that type of memory. If a subject produced less than 3 of the first 3 EMs requested, he or she was excluded from the examination of Hypotheses #s 5-7. Chore and School memories were only scored in terms of the UNC and UNS scores, respectively. If a subject did not produce a Chore memory, he or she was not included in the examination of Hypotheses #s 1 and 2. If a subject did not produce a School memory, he or she was not included in the examination of the Hypotheses #s 3 and 4. Because it was possible for a subject to be included in some but not all of the hypotheses tested, there are different numbers of subjects across different comparisons. In summary, each subject (that produced the corresponding memories) was classified as either positive or negative on the UNC, UNS, AS, EF, and EGOC scores. The investigator scored the Rorschach protocols and then read the responses verbatim to a second judge, who is a licensed psychologist with extensive Rorschach experience. He was blind to the subjects’ EMs and privately scored the Rorschach responses on the variables used in the study. Each response on which the investigator and second judge’s scoring disagreed, for any of the variables, was then scored by a third, tie breaking judge. The third judge was one of the EM judges, but was blind as to which subjects’ Rorschach responses he was scoring. In order to avoid influencing the third judge, he was not told on which Rorschach variable(s) the first 2 judges disagreed. Rather, for each response he scored, he scored every Rorschach variable the study was examining. Results and Discussion: The small N precluded use of the Chi square statistic for hypothesis testing; thus Fisher’s Exact test was used. All probability values are one-tailed. In order to provide a fuller description of the data, certain comparisons are also described via odds ratios. Thirteen of the 23 subjects produced a valid Chore EM (with most of the rest producing a General EM in response to the Chore EM prompt). As predicted, subjects who were positive on the UNC score were more likely to produce a below average number of P responses on the Rorschach (p = .016). As shown in Table 2, of the 5 subjects who were positive on the UNC score, 100% (5) produced a below average number of P responses. In contrast, of the 8 subjects who were negative on the UNC score, only 25% produced a below average number of P responses. Thus, Hypothesis #1 was supported. In the predicted direction, 80% (4) of the subjects who were positive on the UNC score produced an elevated number of S responses on the Rorschach. In contrast, 50% (4) of the subjects who were negative on the UNC score produced an elevated number of S responses. Thus, subjects were 4.00 times more likely to produce an elevated number of S responses when they were positive on the UNC score than when they were negative on it. However, this difference was not statistically significant (p = .315). Thus, Hypothesis #2 was not supported. 50 Petrosky

Table 2 The Relationship Between The Unconventional Chore (UNC) Early Memory Score and the Popular (P) Response on the Rorschach Inkblot Test Below Average # of P Responses Yes No Total Yes Positive on The UNC Score No Total Table 3 The Relationship Between The Unconventional Chore (UNC) and Unconventional School (UNS) Early Memory Scores and the White Space (S) Response on the Rorschach Inkblot Test Below Average # of P Responses Yes No Total Yes Positive on the UNC and/or UNS Scores No Total Twenty subjects produced a valid School EM. Contrary to prediction, subjects who were positive on the UNS score were not more likely to produce a below average number of P responses (p = .455). Although subjects positive on the UNS score were 2.67 times more likely to produce an elevated number of S responses on the Rorschach than subjects who were negative on the UNS score, this difference was not statistically significant (p = .314). Thus, Hypotheses #’s 3 and 4 were not supported. Since subjects positive on the UNC score and subjects positive on the UNS score both produced a higher number of S responses than subjects negative on each score respectively, a post hoc analysis was performed collapsing these two data sets. It was found that subjects who were positive on the UNC and / or the UNS score were more likely to produce an elevated number of S responses than subjects who were negative on both scores (p = .035). As shown in Table 3, of the 9 subjects who were positive on the UNC and/or UNS score, 78% (7) produced an elevated number of S responses. Of the 11 subjects who were negative on both scores, only 27% (3) produced an elevated number of S responses. Thus, subjects were almost 3 times (2.89) as likely to produce an elevated number of S responses if they were positive on either the UNC or UNS score or both, than if they were negative on both. Thus, collapsing these two data sets increased the difference between cells to that of statistical significance, and suggests that the utility of these two scores is enhanced when they are used in tandem. Only 4 subjects were positive on the AS score. Of note, however, 75% (3) of them produced at least 1 Fd response. In contrast, only 31% (5 of 16) of the subjects who were negative on the AS score produced a Fd response. Thus, subjects were 2.42 Early Memories and Rorschach Test 51

times more likely to produce a Fd response when they were positive on the AS score than when they were negative on it. However, this difference failed to reach statistical significance (p = .153), thus Hypothesis #5 was not supported. Contrary to prediction, subjects who were positive on the EF score were not more likely to produce 2 or more MOR responses on the Rorschach than subjects negative on the EF score (p = .724). Thus Hypothesis #6 was not supported. Only 2 subjects were positive on the EGOC score; 1 yielded an EI greater than .45, and the other did not. Thus, contrary to prediction, subjects who were positive on the EGOC score were not more likely to produce an elevated EI on the Rorschach than subjects who were negative on the EGOC score (p = .81). Thus, Hypothesis #7 was not supported. Discussion and Conclusion: Subjects whose earliest memory of a chore was of not complying with the expectations placed on him or her were more likely to evidence a lack of conventionality on the Rorschach, in the form of a below average number of P responses. As noted by Exner (1991), such individuals are “likely to make less conventional, more individualistic responses” (p.211), even in structured situations. In addition, subjects whose earliest memory of a chore was unconventional as defined above and/or whose earliest memory of school was of transgressing a rule or an implicit norm were more likely to produce an elevated number of S responses on the Rorschach. An elevated number of S responses indicates, on a general level, an antagonistic stance towards the environment, which can manifest specifically as oppositionality, negativity, or anger (Exner, 1991). Because of the small N the above results need to be viewed with caution. This being stated, the results of the present study do however suggest that the UNC score and the UNS score when used in tandem with the UNC score, have promise as measures of unconventionality - that is, a tendency against acquiescing to convention and towards dissenting from the norm. The AS, EF, and EGOC scores did not demonstrate a relationship to Rorschach variables corresponding to constructs the early memory scores purport to measure. Even though only 4 subjects were positive on the AS score, the fact that 3 of them evidenced a strong desire for interpersonal contact on the Rorschach (in the form of having produced at least 1 Fd response) warrants further investigation of the usefulness of this score. Both the AS and EGOC scores appeared to lack sensitivity, identifying a relatively small number of subjects as positive on each respective score. Future research exploring the use of early memory scores to assess a strong desire for interpersonal contact and egocentricity should increase the sensitivity of these scores by modifying the scoring criteria and/or providing scorers with more training on how to use these scores. In addition, future research should examine the relationship of all of the scores used in this study to self-report instruments, to determine the types of consciously experienced phenomenology that is associated with each score as well as utilize a larger sample to increase the power of the study. Finally, using the majority decision of multiple judges to classify subjects as positive or negative on the EM scores ensured that subjects were accurately classified on the EM scores for the purposes of the present study. However, in clinical practice scoring 52 Petrosky

decisions are usually made by individual clinicians, not multiple scorers. Therefore, in order to have practical application, the ability of EM scores to be accurately scored by a single scorer will need to be established in future research. References: Acklin, M. W. (1993). Integrating the Rorschach and the MMPI in clinical assessment: Conceptual and methodological issues. Journal of Personality Assessment, 60 (1), 125-131. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: American Psychiatric Association. Ansbacher, H. L., & Ansbacher, R.R. (1964). The individual psychology of Alfred Adler. New York: Harper and Row Publishers. Bruhn, A. R. (1990). Earliest childhood memories volume 1:Theory and application to clinical practice. New York: Praeger Publishers. Bruhn, A. R. & Schiffman, H. (1982). Prediction of locus of control stance from the earliest childhood memory. Journal of Personality Assessment 46 (4), 380-390. Dies, (1995). Subject variables in Rorschach research. In J. E. Exner (Ed.). Issues and methods in Rorschach research (pp. 99-121). Mahwah, NJ: Lawrence Erlbaum and Associates. Exner, J. E. (1991). The Rorschach: A Comprehensive System volume 2: Interpretation (2nd ed.). New York: John Wiley & Sons. Exner, J. E. (1993). The Rorschach: A Comprehensive System Volume 1: Basic foundations (3rd ed.). New York: John Wiley & Sons. Exner, J. E. (1995a). A Rorschach workbook for the Comprehensive System. Asheville, NC: Rorschach Workshops. Exner, J. E. (1995b). Introduction. In J. E. Exner (Ed.) Issues and methods in Rorschach research (pp. 1-24). Mahwah, NJ: Lawrence Erlbaum and Associates. Finn, S. E. (1996). Assessment feedback integrating MMPI-2 and Rorschach findings. Journal of Personality Assessment, 67 (3), 543-557. Fowler, C., Hilsenroth, M. J., & Handler, L. (1996). A multimethod approach to assessing dependency: The early memory probe. Journal of Personality Assessment, 67 (2), 399-413. Lovitt, R. (1993). A strategy for integrating a normal MMPI-2 and dysfunctional Rorschach in a severely compromised patient. Journal of Personality Assessment, 60 (1), 141-147. Author Note: This study was part of a doctoral dissertation entitled “The Use of Early Memories as an Assessment Technique.” A portion of this study was presented as a poster at the Midwinter Meeting of the Society for Personality Assessment, Albuquerque, NM, March 24, 2000. The author wishes to gratefully acknowledge the Society for Personality Assessment whose dissertation grant helped fund this study, Maurice Prout, Ph.D., Virginia Brabender, Ph.D., Frank Masterpasqua, Ph.D., Beth Howlett, Ph.D., and Richard Estell, Ph.D., for their helpful feedback on this research, and to Capital Health Systems whose patients participated in this study. Early Memories and Rorschach Test 53

Appendix Early Memory Query Sheet Subject Resistance Example Subject Responses Examiner Responses My memory isn’t good Just take your time - something will come to mind I don’t have a memory - or - [Subject is unduly hesitant] Take your time; everyone can think of something Subject Reports a Memory He or She Was Told as Opposed to Actually Remembers Examiner Response Please choose an event that you actually remember happening General Memory Examiner Response Examiner states one phrase from each of the following 4 columns below in any combination: Think of one specific event in as much detail as Remember the idea particular thing that happened your memory of the is to choose one instance time event permits. Choose one [Optional add on phrase]: ...such as one time... Ambiguous Physical Injury Attribution Examiner Response How did it happen that [repeats physical injury]? Ambiguous if Party Verbalized Was Subject’s Birthday Party Examiner Response What was the party for? - or - Whose birthday was it? Chore / School Memory Sounds Similar to One of 3 Earliest Memories Examiner Response Is that the same memory you said before, or a different one? If answer is “yes” or memory is one of 3 earliest memories verbatim Examiner Response: Tell me another early memory about [a chore/school]. General Chore Memory Examiner Response Tell me about a [specific or particular] [time or instance] with regard to [insert general chore]. Unclear if the Chore Was Completed Examiner Response Did [insert task] get finished? Unclear Level of Energy Expenditure for Chore Examiner Response How much energy did you spend [insert task]? Ambiguous Attribution for Breaking School Rule or Implicit Norm Examiner Response How did that happen? 54 Petrosky

Shifting Modalities of Communication in Psychotherapy: Use of the Lowenfeld Mosaic Technique to Promote Self-Understanding and Mental Health John B. Ruskowski and David Miller Successful treatment outcomes for a wide range of psychotherapeutic approaches often involve, to some extent, the development of insight by the client. Psychologists are challenged practically and ethically to facilitate client change in an efficient, as well as compassionate, manner. The ability to help the individual overcome conscious and/or unconscious blocks to therapeutic progress in an expeditious manner is often a key in achieving this goal. The authors have found that shifting modalities of communication and creating intermediate steps for client self-expression can be facilitative in this regard. A case example utilizing the Lowenfeld Mosaic Technique for illustrating this process is presented, along with practical suggestions for facilitating clients’ selfunderstanding and mental health. Although it is widely, though not universally, acknowledged that insight and selfdisclosure can be important aspects of psychotherapy (Pennebaker, 1997; Pennebaker & Francis, 1996), this does not imply that uncovering unconscious or deeply personal material is always desirable for, or of benefit to, clients. Clearly, such is not the case. Also, the mere uncovering or verbalizing of material that was previously consciously or unconsciously denied expression by the client, when such an intervention is indicated, is assumed to be a step in the therapeutic continuum and not the culmination of the intervention. Recent trends in psychotherapy research and practice reflect the emphasis placed upon reducing the length of time required to bring about self-understanding and its therapeutic effects (Hayes, Barlow, & Nelson-Gray, 1999; Kivlighan, Multon, & Patton, 2000). Procedures such as end-setting techniques (Carlson & Sperry, 2000; Flegenheimer & Pollack, 1989), hypnosis (King, 1993), and therapeutic assessment (Finn & Tonsager, 1997; Finn & Tonsager, 2002; Harrower, 1956) have been found to expedite the goal of promoting self-understanding. The authors’ experiences have shown that the additional technique of shifting modalities of expression can likewise expedite the treatment process. Shifting modalities of expression includes such tactics as having the client write or draw, enact, visualize or otherwise create some form of symbolic expression of his or her experience which may then be used as a vehicle to broach the block to awareness or expression of conflict. Entire therapeutic approaches have been based upon artistic expression or dramatic enactment (Axline, 1989; Kipper, 1996; Landreth, 2002; Lantz & Alford, 1995). However, one need not be an art or play therapist to make use of some of the beneficial effects of these therapies. Shifting temporarily and tactically to alternative modes of communication can be facilitative in a number of clinical situations. John B. Ruskowski, Ph.D. State University of New York, College at Oswego and David Miller, Ph.D., University at Albany, State University of New York (Please address all correspondence regarding this manuscript to Please address all correspondence regarding this manuscript to the second author, David Miller, at: University at Albany, State University of New York, ED 244, Albany, NY 12222. Phone: (518) 442-5038. E-mail: dmiller@uamail.albany.edu Key Word: Mosaic test

The purpose of this article is to describe how the introduction of a projective device known as the Lowenfeld Mosaic Technique (LMT) may be useful for assisting clients to overcome blocks to the awareness and verbal communication of troubling thoughts, feelings, behaviors, and/or impulses. The following case example illustrates the potential usefulness of shifting modalities in such circumstances, as well as demonstrating the potential utility of the LMT in this process. Shifting Modalities to Promote Client Insight: A 26-year-old man was plagued by anxiety attacks, inhibition of emotional responses, and a deep sense of loneliness. He reported that he felt uncomfortable around most people and he avoided many social situations. It appeared that at least a portion of his difficulties lay in a profound sense of loss and perhaps grief. Yet, the man was highly intellectualized about disappointments in his relationships with girlfriends, co-workers and the death of his father ten years earlier. While he was able to describe his difficulties and their behavioral effects, he was unable to articulate the corresponding emotional experiences. At various times during therapy sessions, he would report being suddenly anxious when unwanted emotions seemed about to arise. He found it impossible, however, to allow himself to experience the emotions or to understand the personal ideas, associations, and images that were attached to them. In spite of encouragement by the therapist and the client’s stated desire to enter into the emotional experiences in order to discover their underpinnings, he consistently distanced himself from such experiences through intellectualization. This tendency was recognized by the client and he was receptive to the therapist’s suggestion that an alternative strategy to help overcome this impasse be implemented. At this point, the therapist introduced the Lowenfeld Mosaic Technique (because it has no right or wrong answers and no formal scoring system, the LMT is probably more accurately viewed as a technique rather than a test), a projective technique originally developed by Margaret Lowenfeld in 1929. A constructive task that requires the user to make something on a plain white paper using a box of colored, plastic tiles placed before him/her (Lowenfeld, 1954), the LMT may be used as both an assessment instrument as well as a potentially useful tool for promoting client self-understanding (Perticone & Tembeckjian, 1987). In constructing his mosaic, the client completed the task in a very brief (i.e., 19 seconds) time. His design consisted of a horizontally placed blue diamondshaped tile with a black triangle tangent to its right end. The ambivalence and inhibition that had been reported by the client appeared to have been reflected in his approach to the task. On one hand, the client cooperated and constructed a mosaic. On the other hand, he spent only 19 seconds manipulating the tiles and made no apparent attempt to consciously portray the disturbing conflict he was experiencing. However, as the process proceeded, he appeared more able to access significant, previously unconscious, material. On inquiry, the client reported that his creation represented “a salmon”. With encouragement, he went on to describe his love of salmon fishing and how he was now reminded of going salmon fishing with his father after the wood-cutting chores were done in the autumn of the year. The client expressed amazement that this simple task was eliciting such associations. When the therapist then asked, “What do salmon do?”, the client paused, then answered quietly, 56 Ruskowski & Miller

“They die.” At this point, the client became highly emotional and, for the first time, was able to consciously acknowledge and accept the experience of grief related to the loss of his father. From this point, the client became open not only to explore and work through this traumatic event from his life, but to contemplate and understand other areas of emotional conflict as well. Fostering Insight Through a Non-Verbal Modality: What is particularly significant about using the technique of shifting modalities through use of the LMT is that the client creates his or her own bridge from the present impasse to the therapeutic insights that promote self-understanding and growth. If one accepts the premise that significant life experiences need to be given expression in some way, then it is clear that verbal expression represents only one, and often a relatively final form, of that expression. Other means of expression might include mental images, dreams, various psychological symptoms, play (especially in children), or artistic productions. In the illustration above, the client voiced his astonishment at the LMT’s uncanny ability to evoke such images and emotions. Naturally, the therapist helped him to understand the role of the LMT as a vehicle for a process that was not inherent in the plastic tiles but in the client himself. He had created an external, condensed symbol which helped to elicit, focus, organize, and ultimately to verbalize his own unarticulated inner conflicts. In this case, the client’s creation of a symbol, without the apparent conscious intention of doing so, provided a vehicle for the release of pent-up emotions and the development of insight. Many clinicians are familiar with the use of projective techniques and their potential role in discerning repressed, unacknowledged, or otherwise inaccessible conflicts within the individual (Perticone, 1998; Perticone & Tembeckjian, 1987; Ruskowski, 1992). Frequently, however, such approaches are relegated to the initial assessment phase of therapy and their utility as dynamic, interactive media for promoting insight are overlooked. This is unfortunate, because the utility of techniques such as the LMT is probably enhanced as the therapeutic alliance develops and the relationship progresses. Not only is there a greater willingness on the part of the client to take perceived risks, but the specific areas of impasse and conflict often become more apparent and focused. In addition, conscious attempts to deal with unconscious conflicts often result in disturbance of the dynamic balance between the experience seeking expression and the client’s defenses. Therefore, both the elements of experience and defensive operations are likely to be reflected quite readily in the client’s choice and manner of symbol formation (Perticone, 1998). This will, if nothing else, contribute to the therapist’s understanding of and empathy for the client’s struggles, in a manner similar to a more standard approach to assessment involving the use of projective techniques (Miller & Ruskowski, 2003; Perticone & Tembeckjian, 1987). Additionally, the client is encouraged and supported in his or her own exploration of the meanings of his or her creation, allowing an individual to proceed at a level of anxiety or threat which is largely self-selected. Finally, the process lends itself to a process of self-discovery which is seen as selfgenerated and which is usually experienced by the client as both significant and Lowenfeld Mosaic Technique and Mental Health 57

reinforcing. At the same time, there is often the opportunity to reify the client’s capacity for insight and self-direction, while reducing transference and dependence effects. Although it is generally agreed that no one projective technique can measure all aspects of personality and behavioral functioning (Panek, 2001), it would appear that projective instruments such as the LMT would have particular utility in this process. Needless to say, a firmly established therapeutic alliance between therapist and client is of great importance in working effectively with such techniques. Also, it is helpful if the client indicates some willingness to consider that unconscious processes may play a significant role in his or her personal adjustment and adjustment difficulties. Some clients enter therapy with this understanding, whereas others can readily recognize these dynamics with some educative assistance by the therapist. While the assessment value can be great, the prospects for self-generated insight resulting from the use of techniques such as the LMT are rather poor in the case of clients who are resistive to the concept of unconscious processes playing a role in adjustment. In such cases, it is probably best to use other alternatives, at least until some acceptance of the role of unconscious processes is discerned by the client (Miller & Ruskowski, 2003). In addition to the quality of the therapeutic relationship and the client’s receptivity, another important consideration in the application of the LMT in the context of psychotherapy is the timing of the modality shift. The therapist should be alert for indications of dynamic, active struggle on the part of the client during particular stages in therapy. Finally, it is helpful to ascertain the client’s conscious desire to move beyond the present impasse and even to elicit an overt commitment to work with the therapist in an unreserved effort to gain further self-understanding. Conclusion: Many approaches to psychotherapy are highly verbally-oriented and involve the client’s development of insight. Although the individual may desire and/or recognize the need for better self-understanding, barriers to improved self-understanding may arise from conscious as well as unconscious sources. It is a practical and perhaps ethical imperative that the therapist utilize the most efficient means at his/her disposal to facilitate progress toward therapeutic ends while remaining respectful of the client’s integrity and personal freedom of choice. A technique, or perhaps more appropriately a principle, that the authors have found useful in meeting these challenges is that of changing modalities from direct, verbal communication to alternative, non-verbal modalities. The tactic of shifting modalities can be very useful for creating a bridging effect, within the client, from unconscious to conscious and, between client and therapist, from private to shared experience. Thus it is useful in a variety of clinical situations, with clients who differ significantly with respect to needs, levels of psychological sophistication, and personality styles. As with therapeutic relations generally, attention to the quality of the therapeutic alliance, as well as to the timing of the intervention, may facilitate productive and rewarding therapeutic gains. By introducing projective, constructive tasks such as the Lowenfeld Mosaic Technique and/or other tasks which do not rely primarily upon verbalizations by the client, barriers to the development of insight may be reduced and overcome. 58 Ruskowski & Miller

The twofold process of circumventing the client’s typical censoring operations and allowing for incremental steps toward disclosure and insight can therefore often facilitate and promote self-understanding and mental health. Acknowledgement: The authors wish to express their appreciation and gratitude to Dr. Eugene X. Perticone for his valuable comments and suggestions regarding this manuscript. Notes: Readers interested in more information regarding the LMT, particularly its clinical and projective applications, are encouraged to review other sources, including Ames (1986), Lowenfeld (1954), Perticone and Tembeckjian (1987), Miller and Ruskowski (2003), and Ruskowski (1992). For those interested in acquiring the LMT, kits may be purchased from Dr. H. Beric Wright, Chairman of the Dr. Margaret Lowenfeld Trust. Dr. Wright may be contacted at Brudenell House, Quainton, Aylesbury Bucks HP224AW, United Kingdom. Those interested in acquiring the text The Mosaic Technique in Personality Assessment: A Practical Guide by Perticone and Tembeckjian (1987) should contact either Dr. Eugene Perticone (55 Jackim Road, Oswego, New York 13126; e-mail: epertico@twcny.rr.com) or Dr. John Ruskowski (83 Jackim Road, Oswego, New York 13126; e-mail: jruskows@twcny.rr.com). References: Ames, L.B. (1986). The Lowenfeld Mosaic Test: A review of its use. Journal of Personality Assessment, 50, 428-435. Axline, V. (1989). Play therapy. New York: Churchill Livingstone. Carlson,J., & Sperry, L. (Eds.) (2000). Brief therapy with individuals and couples. Phoenix, AZ: Zeig, Tucker, & Co. Finn, S.E., & Tonsager, M.E. (2002). How therapeutic assessment became humanistic. Humanistic Psychologist, 30, 10-22. Finn, S.E., & Tonsager, M.E. (1997)Therapeutic assessment: Using psychological testing to help clients change. Unpublished M anuscript. Flegenheimer, W.V., & Pollack, J. (1989). The time limit in brief psychotherapy. Bulletin of the Menninger Clinic, 53, 44-51. Harrower, M. (1956). Projective counseling - A psychotherapeutic technique. Journal of Psychotherapy, 10, 74-86. Hayes, S.C., Barlow, D.H., & Nelson-Gray, R.O. (1999). The scientist practitioner: Research and accountability in the age of managed care. Boston, MA: Allyn & Bacon. King, M.E. (1993). Existential hypnotherapy. New York: Guilford Press. Kipper, D. (1996). The emergence of role-playing as a form of psychotherapy. Journal of Group Psychotherapy, Psychodrama and Sociometry, 49, 99-119. Kivlighan, D.M., Multon, K.D., & Patton, M.J. (2000). Insight and symptom reduction in time-limited psychoanalytic counseling. Journal of Counseling Psychology, 47, 50-58. Landreth, G.L. (Ed.). (2002). Play therapy. Springfield IL: Charles C. Thomas. Lantz, J., & Alford, K. (1995). Art in existential psychotherapy with couples and families. Contemporary Family Therapy, 17, 331-342. Lowenfeld Mosaic Technique and Mental Health 59

Lowenfeld, M. (1954). The Lowenfeld Mosaic Test. London, UK: Newman Neame. Miller, D. & Ruskowski, J.B. (2003). The Lowenfeld mosaic technique: Its clinical use and potential for facilitating self-actualization. Journal of Humanistic Psychology, 43, 119- 130. Panek, P.E. (2001). Projective psychology and the new millennium: Issues and challenges. Journal of Projective Psychology and Mental Health, 8, 73-74. Pennebaker, J.W. (1997). Opening up: Tthe healing power of expressing emotions. New York: Guilford Press. Pennebaker, J.W., & Francis, M.E. (1996). Cognitive, emotional and language processes in disclosure. Cognition & Emotions, 10, 601-626. Perticone, E.X. (1998). The clinical and projective use of the Bender-Gestalt Test. Springfield, IL: Charles C. Thomas. Perticone, E., & Tembeckjian, R. (1987). The mosaic technique in personality assessment: A practical guide. Rosemont, New Jersey: Programs for Education. Rogers, C. (1961). On becoming a person. Boston: Houghton Mifflin. Ruskowski, J.B. (1992). The Lowenfeld Mosaic Test: An illustration of its application in the schools. British Journal of Projective Psychology, 37, 33-40. APPEAL Members of Somatic Inkblot Society are requested to kindly sent their Annual dues before the 31st of January each year to enable the society to meet its expenses and smooth publication of SIS Journal of Projective Psychology and Mental Health. Nalini Mishra, Ph.D., Secretary Plot No. 196, Saket Nagar, Naria, Varanasi-221005 (India) E-mail : sisdubey@yahoo.com Mob.: 91-9415977731 60 Ruskowski & Miller

Gender Differences in SIS-I Profile of Manic Patients D. Kumar, B.L.Dubey and R.Kumar The present study was designed to find out the pattern of responses on SIS-I in Manic male and female patients. The sample comprised of 50 Manic Patients ( 25 Male and 25 Female) and 50 Normal Subjects (25 male and 25 Female).. The Somatic Inkblot Series-I Card form (SIS-I) was administered individually. The mean, SD and t-test was computed to compare the two groups. The Manic Male patients scored significantly higher number of Animal responses and lower number of Most Typical responses than Female Manic patient. Except slightly higher Rejection of images by normal female subjects, no significant gender differences were noticed in normal population. The Inkblot techniques have a major contribution in psycho diagnostic evaluation and therapeutic intervention. Because of the overloading on indices based interpretation, the Rorschach Inkblots Test and Holtzman Inkblots Test are kept aside by many practicing psychologists. They prefer to use computerized version of MMPI and 16PF as an alternative to arrive on diagnostic evaluation. The questionnaire techniques have their own inherent demerits particularly because of the transparency of the questions. The Somatic Inkblot Technique has taken care of the fore said problem by introducing only eleven scoring category such as Total Number of Responses, Human Responses, Animal Responses, Anatomical Responses Sex Responses ,Movement Responses, Most Typical Responses, Typical Responses, Atypical Responses, Rejection of Images and Pathological Scales. It also emphasizes more on content analysis and psychoanalytic interpretation of the responses. It has made a great contribution in the area of therapeutic intervention. The Somatic Inkblot Series is an extension and advancement of the traditional inkblot projective techniques (Cassell, 1994). The test was developed specifically to understand the manifestation of problems through somatization, and to hear the inner cry of suffering individuals. The test images are viewed on a television using a videocassette recorder (VCR)/ CD. The subject’s responses are recorded on a separate response sheet by the subject. It’s a self administered test. 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, the procedure can be completed at home. Because of the use of Video technology (SIS-I Video and SIS-II Video, Cassell, 1980, 1984, Cassell and Dubey 2003) it has attracted researchers widely. In a way it has brought a revolution in the area of inkblot techniques. It is a powerful tool for broader diagnostic evaluation. The SIS images penetrate into the deeper self of the individual and help the subject to bring out the inner cry (Cassell and Dubey, 1996, 1997, Dubey et al 1994). Various cases reported in SIS Journal of Projective Psychology and Mental Health (Vol 1-13) reveals the efficacy and pulling power of Somatic Inkblot Series. Deepak Kumar, Ph.D, Lecturer in Psychology, Girls P.G. College, Alwar (Rajasthan), Bankey L.Dubey,Ph.D.Director SIS Center, 1671 Sector-49B,PUSHPAC Society, Chandigarh-160047 Email : sisdubey@rediffmail.com and Rakesh Kumar, Ph.D., Senior Clinical Psychologist, Institute of Mental Health and Hospital, Agra. Email: pastlifeindia@yahoo.co.in (For Correspondence please write to Rakesh Kumar) Keywords: SIS-I, Mania, Inkblot Techniques

The SIS has been used to assess body awareness (Cassell,1964), drug addicts (Mukhopadhyay et,al. 1996), coronary cases (Rathee et.al 1994), schizophrenics (cassell,1977;Kumar et,al 2001, Dwivedi,et al 1995, Mishra, 1996) and Manic patients (Kumar at, al 2003). There is no study conducted in depth discriminating male and female manic patients which is precisely the objective of the present study. Material and Method: The sample consisted of 100 subjects - 50 manic patients and 50 normal. Manic patients were taken from psychiatric hospital in Agra. 50 normal subjects matching with manic patients were taken from normal population. The sample characteristics are shown in Table-1. SIS-I Card form(Cassell,1980) was administered individually to all subjects. Mean, S.D. and t-tests were calculated on the percent score of SIS-I. Table 1 Sample Characteristics Characteristics NORMAL MANIC Gender Male Female Age 18 to 35 yrs. 35 Above Education Upto 5th 5th + Domicile Rural Urban Results and Discussion: The obtained results are presented in Tables 2. It revealed that the Normal subjects have given significantly higher number of Total Responses (R), Most Typical responses and Movement responses. The Manic patients have scored higher number of Anatomical responses, Atypical responses and rejection of images (cards). The manic females have given lower Animal responses and more human responses than manic male patients. While manic male patients are significantly higher on Atypical responses and Rejection of cards as compared to normal subjects. No significant gender differences were noticed in normal population. The gender differences emerged only on Animal responses in Manic group. Manic female patients scored significantly higher on Atypical responses, Anatomical responses and Rejection of cards than the Normal female subjects. The Manic female patients scored significantly lower on Total Number of Responses, Typical responses, Movement responses and Animal responses as compared to Normal subjects. Kumar et,al. (2003)have also reported that Manic patients were significantly higher on Atypical responses as compared to Normal subjects. The similar findings are also observed in the present study. 62 Kumar et al

Table 2 Mean and S.D of Normal and Manic Patients Indices Normal Manic Male (n=25) Female (n=25) Male (n=25) Female (n=25) Total No. of Responses M 34.52 34.52 28.12 S.D. 18.88 9.32 6.08 6.29 Most Typical Responses M 14.43 12.34 9.79 16.50 S.D. 6.82 5.30 3.91 4.50 Typical Responses M 62.35 63.12 54.46 53.93 S.D. 9.88 11.66 13.81 10.40 Atypical Responses M 22.57 25.77 33.81 35.58 S.D. 13.26 13.84 14.22 10.26 Movement Responses M 4.25 4.73 1.02 1.40 S.D. 4.01 6.48 2.12 3.10 Human Responses M 15.26 14.75 15.53 18.63 S.D. 6.23 7.46 8.26 10.89 Anatomy Responses M 14.94 14.38 21.18 21.42 S.D. 11.13 6.00 14.23 16.09 Animal Responses M 30.96 32.46 32.60 26.14 S.D. 9.64 10.19 9.88 9.79 Rejection of Cards M 1.15 .35 5.58 6.57 S.D. 2.28 .95 7.58 7.71 Table 3 t-value of Normal vs Manic Patients Normal Male Manic Male Normal Vs Normal Vs INDICES Vs Female Vs Female Manic Male Manic Female Total No. of Responses 0.00 .64 1.89 2.85* Most Typical Responses 1.78 .50 3.58* 1.32 Typical Responses .25 .72 1.75 2.94* Atypical Responses .83 .50 2.89* 2.85* Movement Responses .31 .50 3.56* 2.32** Human responses .21 1.13 .18 1.47 Anatomy Responses .21 .05 1.73 2.09** Animal Responses .54 2.32** .59 2.24** Rejection of Cards 1.13 .45 2.74* 4.0* * Significant at .01 level; ** SIS in Manic Patients 63

Conclusion: The Manic Male patients have scored significantly higher number of Animal responses and lower number of Most Typical responses than Female Manic patient. Except slightly higher Rejection of images by normal female subjects, no significant gender differences were noticed in normal population. The findings are based on a small sample hence the results particularly differentiating Male and Female subjects can not be generalized. References: Cassell, W .A.(1964) A Projective Index of Body Interior Awareness. Psychosomatic Medicine, 26: 172- 177. Cassell, W. A.(1977) Aggressive Imagery Kumar, S. Singh, R. and Mohanty, S. (2001). A study as Somatic Inkblot Series-I in hospitalized male chronic schizophrenic. SIS J. Proj. Psy. & Mental Health, 8: 31-37 Cassell, W. A., (1980) Body Symbolism and the Somatic Inkblot Series. Anchorage, Alaska. Aurora Publishing. Cassell, W. A. (1980) Computerized Projective Testing as an Aid in Medical Diagnosis. Alaska Medicine, 26: 1-9. Cassell, W. A. (1984) Somatic Inkblot Series Video, SIS Center . Anchorage, Alaska (USA) Cassell, W. A.(1994) The Somatic Inkblot Series: Continuing Rorschach’s Conceptualization, SIS J. Proj. Psy. & Mental Health, 1: 3-14 Cassell, W. A . and Dubey, B. L. (1996) The Use of the Rorschach and SIS in Releasing Somatised Grief. SIS J. Proj. Psy. & Mental Health, 3 : 3 -32 Cassell, W. A. and Dubey, B. L.(1997) Therapeutic Dream Stimulation with SIS- Video, SIS J. Proj. Psy. & Mental Health, 4 : 3-23 Cassell, W. A . and Dubey, B. L. (2003) Interpreting Inner World Through Somatic imagery, SIS Center, Anchorage, AK(USA) Dubey, B.L. Mishra , M., Dwivedi, C. B. and Mishra,N.(1994) Diagnostic and Therapeutic Utility of SIS-II and Rorschach, J. of Proj. Psy. & Mental Health, 1:19-26. Dwivedi, C. B. Mishra, M. and Dubey, B. L. (1995) Diagnostic Significance of the Indices of the SIS-II and the Rorschach Inkblot Tests. SIS J. Proj, Psy. & Mental Health, 2: 165-170 Holtzman, W. H.,(1956) Inkblot Perception and Personality. University of Texas Press, Texas. Kumar, and Clinical Symptoms in Schizophrenia. British J. of Projective Techniques, 16: 21-31. Mishra, M. (1996) Compatibility of SIS-II and the Rorschach Indices in Normal, Neurotics and Schizophrenics,. Ph.D. Thesis , Banaras Hindu University, Varanasi, Mohanty, S. and Kumar, R. (2003). SIS-I profile and its correlation with Rorschach in manic patients. SIS J. Proj. Psy. & Mental Health, 10:201-204. Mukhopadhyay, A. Benerjee, S. and Mitra, G.( 1996). A comprehensive profile of personality characteristics of male drug addicts. SIS J. Proj. Psy. & Mental Health, 3:33-41 Rathee, S.P. Goel, D.S. Chawla, M.L. Saldanha, D. and Dubey, B.L. (1994). A study of SIS-I in coronary cases. SIS J. Proj. Psy. & Mental Health, 1: 51-64 64 Kumar et al

Distinction of Novelty and Meaning Contexts of Creativity Umed Singh The present study was designed to examine relationship between two contexts of creativity i.e. novelty and meaning. Psychometric measures of creativity are considered to index novelty context whereas projective tests, particularly inkblot tests are considered to tap meaning context. To realize the main objective of the study 202 high school male students were randomly drawn from various school of Kurukshetra District, Haryana. The selected subjects were administered with Holtzman Inkblot technique and Torrance tests of creative thinking (both verbal and figural). Obtained data were analyzed by applying Pearson’s Method of Product Moment Correlation, and Inter-battery Factor Analysis. Both the corelational analyses have clearly revealed the strong positive overlap between verbal and figural measures of creativity assumed to be indexing novelty context. Analyses have demonstrated weak association between psychometric and projective indices of creativity. Projective tests like HIT are taken as indexing meaning context of creativity. Thus, clear-cut distinction has been found between two contexts. The quality of human life is greatly influenced by the creative contributions of certain individuals. From the time of Galton (1883), psychology has evidenced an abiding interest in understanding creative act. Much of this research has been carried out in the hope that a sound understanding of the phenomenon would lead to more effective use of this precious social source. In recent years, the mission has become substantially more important because of the high premium placed on creative latent in a world of rapid evolutionary, social, and technological changes. The year 1950 is being considered as a starting point for empirical investigation of creativity when Guilford in his APA Presidential Address, challenged the psychologists to pay attention to what he found a neglected but extremely important attribute, namely, creativity. He stressed on construct independence between creativity and intelligence; and also highlighted the paucity of research in this basic area of human mental functioning. Guilford’s emphasis alongwith a number of other factors i.e. increase in post world War II scientific inventions, arrival of space age, advent of computer and electronic revolution, and economic globalization helped to launch the contemporary investigation of creativity. More so, these developments led to the planning of wide scale research projects, which endeavoured to illuminate different facets of creativity. Many scholars (e.g. Guilford, 1950, 1959, 1970; Getzels & Jackson, 1962; Torrance, 1966; Guilford & Hopfner, 1966; Wallach & Kogan, 1965; Taylor & Barron, 1963; Taylor & Holland, 1964; Albert & Runco, 1989; MacKinon, 1983/1960, Mumford & Gustafson, 1988; Sternberg, 1988a, 1999, 2003; Runco, 2004) have attempted to explore creativity in its own right and endeavored to depict the relative autonomy and fairly complex and multifaceted nature of this highly important psychic phenomenon. On account of widely different contexts in which the term creativity has been used, it is difficult to evolve a consensual definition of creativity, which could be all inclusive as well as exclusive of similar psychological characteristics. This lack of most agreed conception of creativity may be attributed to the fact that, like intelligence, creativity Umed Singh, Ph.D., Reader Department of Psychology, Kurukshetra University, D-78,University Campus, Kurukshetra -136119 (Haryana India). Key Word: Creavity and Holtzman Test.

represents highly complex and multifaceted construct. Since a person can behave creatively in many different ways, it is no strange that we have many definitions. Complexity of creativity is manifested in numerous definitions which Rhodes (1961, 1987), Mooney (1963), Kneller (1965), and Runco (2004), endeavour to condense into four distinct approaches – (a) As product, (b) As person, (c) As press, and (d) As process. The product approach to creativity focuses on outcomes and those things that result from creative process. It is concerned with important characteristics that distinguish more creative from less creative products as perceived by different people for different purposes. Products considered creative are emphasized for elements of newness, freshness, and inventiveness they have. The quality of originality is represented in these products, involving fusion of perception in a new way, finding new connections and relationships, producing new insights, moulding of experiences into new organizations. Creative products can include behaviours, performances, ideas, things, and all other kinds of outputs with any of the channels and types of expressions. This criterion of creativity has encouraged a number of experimental studies of quantitative analysis (Barron, 1982; Hyman, 1964; Wallach & Kogan, 1970; McKinnon, 1978) as well as qualitative analysis (Gruber, 1974; Heller, 1979; Reiss & Renzulli, 1991; Westberg, 1991) of creativity which identify creative individuals through the products of their labours. These analyses have described that products of creative thoughts are solutions to problems, responses on creativity tests, and explanations for phenomena. Technological innovations and artifacts, novel ideas and new styles, designs or paradigms have been emphasized as creative products by Barron (1988), Fieldman (1986), Gruber & Davis (1988), Simonton (1984b), Sternberg (1988), and Torrance (1981). Creative products are novel – they are not imitations, nor they are massproduced. Such products are powerful and generalizable, exhibit parsimony, cause irreversible changes in human environment and are valuable and useful to the society or at least to the specific domain in which they are formed. Attempts have been made to put forth to qualify the creative products but no single criterion is enough to be equally relevant in different fields (e.g. Arts and Science). The value of this approach is supported by the amazing productivity of Piaget, Picasso, and other luminaries (Simonton, 1984). The problem with this approach is that it often informs us only about productivity and not about creativity. An individual can be productive without being original. In methodological terms, productivity and creativity are correlated but not synonymous Gardener (1993), and O’Quin and Bersemer (1989) have also reported that product approach has been mainly used with eminent individuals and findings of these studies may not be generalizable to noneminent population. The person approach is based on research on personal characteristics. Propounders of this approach have attempted to identify personality and motivational characteristics, cognitive abilities, and behavioural or biographical dispositions associated with individual’s creativity. The research on personality and creativity relationship has tended to emerge in one of three ways: (i) attempts by personality theorists to explain in terms of various personality theories i.e. cognitive, humanistic, psychoanalytic, behaviouristic, etc., (ii) investigations regarding the personality and biographical 66 Singh

dispositions of eminent individuals and/or creative activity in a variety of fields; and (iii) work narrowly focused on one or few specific personality dimensions for possible relationships to creative behaviour. Barron and Harrington (1981) have summarized the research pertaining to personality and creativity indicating that creative individuals have a “high valuation of aesthetic qualities in experience, broad interests, attraction to complexity, high energy, independence of judgment, autonomy, intuition, selfconfidence, ability to resolve antinomies or to accommodate apparently opposite or conflicting traits in one’s self-concept, and finally a firm sense of self as creative”. The concept of domains (e.g. arts and source) is also very important in this regard as there may be differences in traits that contributes in creative performance in various fields. Personality research have also considered intrinsic motivation as a core characteristic of creative persons. Motivation may be related to states or drives as much as to personality but creative persons are more regulated by intrinsic interests, and the intrinsically motivated tasks being free from the evaluations and constraints inhibiting creativity (Amabile, 2003; Stohs, 1992). Creative efforts may also sometimes be extrinsically motivated (Rubenson & Runco, 1992) but some kinds of extrinsic factors (e.g. evaluation) may also inhibit creative performance (Amabite, 2003). Among the cognitive correlates of creativity well identified cognitive factors are field independence /dependence (Noppe & Gallagher, 1977), problem solving styles (Kreshner & Ledger, 1985), cognitive complexity (Quinn, 1980), divergent thinking (Guilford, 1967), & Wisdom (Sternberg, 2003). An extreme position has been stated by Eysenk (1983) who argued that creativity and originality are not aspects of operations of mind, rather are exclusive traits of personality, and are essentially non-cognitive, The press approach to creativity typically includes the total complex situation (press) in which creative processes are initially stimulated and sustained through completion. The concept of ‘press’ was proposed by Henry Murray (1938) and is used in the creativity literature to describe pressures on the creative processes or on creative persons. Rhodes (1961/1987) has taken press “referring to the relationship of human beings and their environment.” Press influences may be general, and operate through implicit evaluation and tradition or more specific. Amabile & Cryskiewicz (1989), and Witt & Beorkroem (1989) have identified some situational influences on creativity such as freedom, autonomy, good role models and resources (including time), encouragement for originality, freedom from criticism, and norms which reward innovation, and do not punish failures. Inhibiting influences have also been identified such as lack of respect, red tape, constraints, lack of autonomy and resources, inappropriate norms, unrealistic expectations, over competition, etc. Family structure and school environments have also been found to be relevant contributors in the development of creative potentials (Gaynor & Runco, 1992; Hasirci & Demirkan, 2003). Process research have been less personal and more behavioural. Work in this area has been oriented to delineate various steps, styles, and strategies within creative process. Generally, creativity is taken as a process of seeing or creating relationships comprising process of discrimination from many alternatives and synthesizing elements in altogether new and original ways. Theses relate creative mechanisms to removal of repression, or drive discharge (Freud, 1963), preconscious functions (Kubie, 1958), Contexts of Creativity 67

gestalt mehchanisms (Werthemier, 1945), cognitive factors (Bruner, 1962) or to perceptual openness and now meta cognitions (Pesut, 1990). Torrance (1966) has defined creativity as a “process of becoming sensitive to problems, deficiencies, gaps in knowledge, missing elements, disharmonies, and so on; identifying the difficulties, searching for solutions, making guesses, or formulating hypotheses about the deficiencies, testing and retesting these hypotheses and possibly modifying and retesting them; and finally communicating the results”. He has described it as a natural process. Czikszentmihalyi (2003) has presented a systems model describing creative process in which creative ideas originate within an individual, may then influence a particular field; and may eventually even have an impact on more general domain. Associative processes also seem to be involved in divergent thinking and problem solving, at least when the problem at hand is open-ended (Martindale & Hasanfus, 1978; Runco, 1991a). Cognitive psychologists i.e. Gardner (1986), Perkins (1983), & Sternberg (1986, 1988, 2003) have described creative process involving an active research for gaps in existing knowledge, problem finding or conscious attempt to break through the existing boundaries, and limitations of one’s field. Although it has been observed that creativity involves the simultaneous interaction among elements of all the four themes as described above, many past investigators tended to involve only variables from single dimension using reductionist approach (Isaksen, 1987; Puccio, 1990; Treffinger et al., 1993). They have rightly recommended that creativity is a multidimensional phenomenon and hence be studied with multivariate methodologies. Another important point that emerges from the critical review of literature of creativity research is that majority of research have been skewed to psychometric approach. It implies that these researchers belonging to categories of person, process, press and product have investigated only the novelty context of creativity and ignored the meaning or traditional context of creativity. Kreuter & Kreuter (1964), Muller (1964), Stark (1965a, 1965b) have blamed these psychometric approaches to be based on a limited conception of creativity i.e. scientific creativity. These investigators have further alleged that there is sharp contrast and discontinuity between psychometric conception of creativity and the traditional or historical meaning of creativity. They have emphasized the essentiality of understanding this traditional conceptualization of creativity. This view was first proposed by Snow (1962) in his theory of “Two Cultures”. Actual credit goes to Stenaley Stark (1965a,b) who developed dualistic conception of creativity most systematically. These two contexts are (a) context of Novelty as in originality (McKinon, 1965) or scientific invention (Barron, 1955); and (b) context of Meaning as in dramatic drawing (Demaicit, 1965). These two contexts roughly correspond to creativeness in the domains of science and arts respectively. Stark further believed that these two contexts are ultimately related to two types of cognitions, temperaments or ways of knowing or looking at the world. Stark has strongly contended that the modern psychometric tests of creativity are biased in favour of scientific creativity (novelty), and are deficient in measuring the traditional type or meaning type of creativity. Drawing upon investigations by Roe (1946, 1949, 1950, 1951a, 1951b), Knapp (1956), Barron (1955), Arnheim (1951), Bieri & Blacker (1956), Consalvi & Canter (1957), Stark has proposed that projective tests, particularly inkblots, are the true measures of 68 Singh

meaning context of creativity. Stark’s meaning context is much near to Vedic conception of creativeness, which has been largely artistically and spiritually oriented with heavy emphasis on the inner process of intuition and imaginativeness. Thus keeping these indications in mind, the present study has been designed to understand more systematically the distinction or overlap between two contexts of creativity i.e. novelty and meaning contexts. Method: Sample: The sample for the present study was drawn from 9 th and 10th grade male students of various schools of Kurukshetra District in Haryana. The sample was restricted to the urban areas with the assumption that small towns represent sample from all walks of life and from all communities. Only boys were included in the sample keeping in view the reported sex differences in creativity by many researchers i.e. Yamamato (1960), Torrance (1965), Torrance & Aliotti (1969), Ruth et al. (1985), & Richardson (1986). The age of the participants ranged between 13 to 16 years with a mean of 14.5 years. Initially 250 male students were tested with selected measures, but 48 subjects were eliminated at the time of scoring on some technical grounds i.e. taking, random ticking of responses. Thus, the data for 202 subjects were processed for required analysis. Measures: 1. Holtzman Inkblot Technique 2. Torrance tests of Creative Thinking (Verbal and Figural) 1. Holtzman Inkblot Technique: Holtzman Inkblot Technique (HIT) was developed by Holtzman et al. (1961). HIT is one of the popular projective techniques with psychometric advantages over Rorschach Inkblot Test. The test consists of two parallel forms (A and B). With 45 cards along with two trial cards X and Y in each – comprising vague, formless, and rocklike formulations with systematic variations in symmetry, form, color, and shading as a stimulus. The test involves a well standardized procedure of administration and scoring of 22 variables viz. Reaction Time, Rejection, Location, Space, Form Definiteness, Form Appropriateness, Color, Shading, Movement, Pathognomic verbalization, Integration, Content (Human, Animal, Anatomy, Sex, and Abstract), Anxiety, Hostility, Barrier, Penetration, Balance, and Popular. The most important feature of the test is that it has psychometric properties to the extent of most of the psychometric tests. For each variable, percentile scores are reported for several normal samples ranging from 5 years old to adults, and for a number of deviant groups (Hill, 1972). These norms were derived from nearly 2000 persons. Intrascorer, interscorer, and test-retest reliabilities of HIT have been studied (Kobler & Doiron, 1968) and formed inter-scorer reliability ranging from .89 to .99; inter-scorer consistency ranging from .39 to .82 over a period of one weak; and test-retest from .24 to .75 over the interval of one year. Authors have also reported test-retest reliability ranging between .34 and .80 with time interval from 3 months to one year. Considerable validity data on HIT have been Contexts of Creativity 69

accumulated (Gamble, 1972; Holtzman, 1968, 1975; Swartz, 1973). Available results are promising, but more data are required for establishment of diagnostic significance of various scores, and the construct validity of variables indexed by this test (Cundik, 1985; Dush, 1985). Clark et al. (1965) & Richter & Winter (1966) have reported the relationship of few HIT variables with divergent thinking. Notable of these indices are Location (L), Color (c), Movement (M), Anxiety (Ax), Hostility (Hs), and Penetration (Pn). These measures have been, regarded as indices of ‘meaning context’ of creativity. Gray (1969), Kamlesh (1979), Suman (1990), Jalodia (1995) have also reported the usefulness of these HIT variables in indexing creativity. 2. Torrance Tests of Creative Thinking: Torrance Testis of Creative Thinking comprises a verbal battery (seven subtests) and a pictorial or figural battery (three subtests). The first battery is labeled as “Thinking Creatively with Words”, and the second, “Thinking Creatively with Pictures”. The tests are considered suitable from kindergarten to graduates, although below the 4 th grade these are to be administered individually and orally. Two equivalent forms (A and B) of each battery, are available. Both the verbal and figural tests have been used in the present study to index the ‘Novelty Context’ of Creativity. In the present study, the creative thinking of subjects was assessed by using Torrance Test of Creative Thinking with words and Torrance Test of Creative Thinking with Pictures. The verbal test (Torrance, 1966) consists of seven subtests’ battery known as “activities”. Figural test consists of three activities. Each activity is believed to bring into play somewhat different mental processes, yet each requires the subject to think in divergent directions. Scoring of these activities provides scores for four basic dimensions of creativity namely, fluency, originality, flexibility, and elaboration. The Torrance tests of creative thinking being group tests were administered in classroom setting in groups of 15 to 25 subjects according to the prescribed procedures. HIT being an individual test was administered individually strictly following the instructions mentioned in manual. Torrance Figural Test of Creativity was scored for four factors of creativity i.e. fluency, originality, flexibility and elaboration whereas figural test was scored only for three factors i.e. fluency, originality and flexibility. Elaboration was not scored on some technical grounds. HIT was scored only for six variables viz. location, movement, anxiety, hostility, color, and penetration following Richter and Winter’s (1966) recommendations, that they index the “meaning context” of creativity. Results and Discussions: The obtained data were processed for Pearson’s Product Moment Correlation and Inter-battery Factor Analysis. Frequency distributions for all the 13 variables used in the study were set up for the total group of 202 subjects. Means, standard deviations, skewnesses and kurtoses were computed (Table -1) to ascertain the normalcy of these distributions. 70 Singh

Table 1 Mean, SD, Skewness and Kurtoses of 13 variables HIT Figural creating Verbal Creativity Test Test L CO M AX HS Pn O Flu Flx El O Flu Flx Mean 32.17 19.50 25.12 10.01 10.15 6.75 29.55 21.32 14.69 59.00 27.63 54.23 15.98 S.D. 10.05 11.90 11.78 4.89 5.45 3.11 9.93 7.63 4.06 16.94 11.68 17.76 3.52 S.K. .07 .21 .05 .18 .48 .45 .17 1.14 .01 .00 2.55 .18 .03 K.U. 2.82 2.54 2.64 2.69 3.10 3.45 2.65 4.98 2.39 3.61 8.14 3.50 3.63 Despite minor discrepancies in some of the distributions, particularly HIT variables, it was felt that normalizing transformation is not required. After ascertaining that obtained data more or less meet the requirements of Product Moment Method of Correlation, correlations were computed among all the thirteen variables used in the study as reported in Table - 2. It may be noted that degree of freedom being 200(N-2), correlation coefficients of .14 and .18 are significant at .05 and .01 levels respectively. Table 2 Intercorrelations Matrix HIT Figural creating Verbal Creativity Test Test L CO M AX HS Pn O Flu Flx El O Flu Flx L — -26 -18 -08 -24 -06 -07 -02 CO — -06 -03 M — 55 -07 -03 -04 -08 -03 AX — -07 -05 HS — -03 -10 -01 -05 -02 Pn — -08 -12 -06 -05 O — Flu — Flx — El — O — Flu — Flx — Decimal points omitted. r =.14 p < .05; r = .18 p < .01 A perusal of intercorrelations matrix reveals that about 60% of correlations among HIT variables are significant beyond .05 level of significance. Location has correlated negatively with color (-.26), movement (-.18) and hostility (-.24). Here the negative correlations show the positive association because of scoring procedure of location. Color has shown significant positive association with movement (.22). Movement has been found to be significantly correlated with anxiety (.38), and hostility (.55). Anxiety has corresponded positive hostility (.59) and penetration (.26). Correlation between hostility and penetration equals to .33. The pattern of correlations among HIT valuables indicate that most of these indices share substantial amount of their variance among themselves. Contexts of Creativity 71

Correlational pattern of projective indices of creativity (HIT) with those of psychometric ones indicates that two types of measures of creativity are more or less independent of each other. Only two of 24 correlations between projective and figural measures of creativity are significant i.e. between location and fluency (.15) and between location and flexibility (.20). Similarly only two correlations are significant between projective and verbal indices of creativity i.e. between color and originality (.15), and between penetration and fluency (.20). It implies that projective and psychometric measures are indexing distinct aspects of creativity i.e. meaning and novelty contexts. All the correlations between verbal and figural measures of creativity are positive though some of them are low. Nine of twelve correlations are significant at or above .05 level. Originality of figural test has correlated significantly with fluency (.17) and flexibility (.18). Figural fluency has yielded positive correlations of .07, .16 and .21 with verbal originality, fluency and flexibility. Figural flexibility has shown significant positive association with all the three verbal measures i.e. originality (.14), fluency (.15), and flexibility (.22). Elaboration of figural test has marked positive association with verbal originality (.11), fluency (.15), and flexibility (.15). Inter-Battery Factor Analysis: Following inter-battery factor analyses were performed to discover overlapping factors between projective and psychometric measures of creativity: 1. Inter-battery Factor Analysis of projective and figural measures of creativity. 2. Inter-battery Factor Analysis of projective and verbal measures of creativity. 3. Inter-battery Factor Analysis of figural and verbal measures of creativity. Results of each of the above analyses are taken up separately for discussion in the following section. Tucker’s (1958) method of Inter-battery Factor Analysis was applied to locate the common factors between Battery I and Battery II in various analyses. Intercorrelations matrix R12 in each analysis was taken out of main correlation matrix. The intercorrelations matrix R12 that represented intercorrelations between indices of Battery I and indices of Battery II. As a first step in each analysis, R12 was multiplied with its transpose (R21) to get a symmetric matrix (H). All the eigen vectors for Battery I (Wf 1) and the corresponding characteristic roots (rf 2) were computed for the H matrix using Jacobi’s method. The eigen vectors of Battery I were arranged in descending order of magnitude of their corresponding characteristic roots and the eigen vectors for Battery II (Wf2) were computed applying the following equation: R12 x Wf 1 x rf -1= Wf 2 (No. of eigen vectors) The factors, Af 1 and Af 2 for the two batteries were then computed by the following equations: Af 1 = Wf1 rf 1/2 AF 2 = Wf2 rf 1/2 72 Singh

After extracting the two factors (AF 1 and AF2) the sum of squares of residual correlations was obtained. The Chi-square test as recommended by Tucker (1958), was applied in order to determine the number of factors to be rotated. This involved the computation of values Sf 1 and Sf 2 and finally ?u. After the extraction of first factor, the p value as tested against Chi-square value for the corresponding degrees of freedom was found to be non-significant. Since only one factor was extracted, no rotation was realized to be needed. So, the first factor of Battery I and Battery II in each analysis was considered to be legitimately representing common elements in Battery I and Battery II. If two or more than two factors (significant against Chi-square value) would have obtained, these could have been rotated by applying any method of rotation. Thus, the main objective of Inter-Battery Factor Analysis was to find the overlaps among variables of Battery I and Battery II (Table 3) Table 3 1. Inter-Battery Factor Analysis of Projective and Figural Measures of Creativity: Factor Structure Battery I Battery II Variables Loadings Variables Loadings Location .47 Originality .13 Movement .16 Fluency .36 Anxiety -.11 Flexibility .35 Hostility -.12 Elaboration .27 Penetration .25 Here in this analysis, six projective measures of creativity and four figural measures of creativity constituted Battery I and Battery II respectively. Here, all the figural measures of creativity are having positive loadings on this factor, showing positive association among themselves. All these figural measures of creativity are having positive association with Penetration and Movement; and negative association with Location (positive loading of location indicates the negative association because of scoring procedure of this projective measure). Overall, this analysis highlights that figural measures of creativity show little overlap with projective measures of creativity. Only one of six projective measures of creativity i.e. penetration has overlapped with figural measures. It also highlights that novelty context (indexed by psychometric measures) and meaning context (represented by HIT) are conceptually distinct (Table 4). In this analysis Battery I and Battery II consisted of six projective measures of creativity and three verbal measures of creativity, respectively. On this factor, two of three verbal measures of creativity (Originality and Fluency) are having positive loadings, showing positive association between them. Other side, among the projective measures of creativity, one i.e. Movement, is having negative loading on this factor. Location is also having low negative loading (Here negative loading indicates positive association because of scoring procedure of this test. Two other projective measures of creativity i.e. Anxiety and Penetration load positively on this factor. Overall, three projective Contexts of Creativity 73

Table 4 2. Inter-Battery Factor Analysis of Projective and Verbal Measures of Creativity: Factor Structure Battery I Battery II Variables Loadings Variables Loadings Location -.12 Originality .21 Movement -.22 Fluency .42 Anxiety .15 Penetration .37 measures are showing positive association among themselves and one is showing inverse association with them. None of the remaining projective measures shows noticeable loading on this factor. But only one of six projective measures of creativity (Penetration) is having significant loading. Similarly, only one out of three verbal measures of creativity (Fluency) load significantly. This finding highlights that only Fluency dimension of verbal creativity has some overlap with only Penetration, a projective measure of creativity. This analysis provides supports to hypothesis positing distinction between verbal (novelty) and projective (meaning) creativity (Table 5). Table 5 3. Inter-Battery Factor Analysis of Figural and Verbal Measures of Creativity: Factor Structure Battery I Battery II Variables Loadings Variables Loadings Originality .37 Originality .31 Fluency .36 Fluency .40 Flexibility .45 Flexibility .52 Elaboration .30 This analysis consists of four figural measures of creativity (Originality, Fluency, Flexibility, and Elaboration) in Battery I. Battery II consists of three verbal measures of creativity (e.g. Originality, Fluency, and Flexibility). It is evident from the above factor loadings that all the three verbal measures of creativity are having positive association with all the four figural measures of creativity. Significant loadings on all the seven measures of both the batteries brings a general factor of creativity (i.e. novelty context) into picture. Discussion: Both the Pearson’s correlations and Inter-battery factor analysis have clearly revealed the structured overlap between both the verbal and figural measures of creativity. It implies that both being psychometric measures, tap novelty context of creativity as asserted by Stark (1965), Sternberg (1986) & Pickard (1990). On the other hand, in 74 Singh

both the analyses, weak overlaps have been found between the projective measures (HIT) and psychometric indices of creativity (TTCT). Inter-battery factor analysis between projective and figural measures of creativity reveals that all the four variables of figural test i.e. originality, fluency, flexibility and elaboration are having positive association among themselves but very weak or negative association with six projective indices. Similarly, inter-battery factor analysis between projective indices (HIT) and verbal measures of creativity has remarked the weak association between two types of measures of creativity. Overall, the obtained findings support assertions made by Snow (1962), Stark (1965a, 1965b), Kreuter & Kreuter (1964), Muller (1964), Richter & Winter (1966), Kamlesh (1979), Minhas (1981), and Jalodia (1995) that psychometric tests like TTCT are limited in scope as these index only novelty context of creativity and are not competent to tap more traditional or meaning context of creativity which is indexible only through projective measures, particularly inkblot techniques. Hence, the present study recommends the investigation of the construct of creativity in terms of dual conceptions i.e. novelty and meaning contexts. Some researchers have attempted to label these two conceptions of creativity as scientific and artistic creativity as well. References: Albert, R.S. & Runco, M.A. (1986). The threshold theory regarding creativity and intelligence: An empirical test with gifted and non gifted children. The Creative Child and Adult Quarterly, 11(4). Ambaile, T.M, & Gryskiewicz, N.D. (1989). Creative Environment Work Scales: Work Environment Inventory. Creat. Res. J., 2, 231-54. Ambile, T.M. (2003). Within you, without you: towards a social psychology of creativity, and beyond. In Runko (ed) Creativity Research Handbook. Bachelor, P.A. & Michael, W.B. (1991). Higher order factors of creativity within Guilford’s Structure of Intellect Model: A re-analysis of a fifty three variable data base. Creativity Research Journal, 4(2), 157-175. Barron, F. & Harrington, M. (1981). Creativity, Intelligence, and Personality. Ann. Rev. Psychol., 32, 439-476. Barron, F. (1988). Putting creativity to work. In Sternberg, R.J. (ed.), The nature of creativity. NYC : Cambridge Press, 76-98. Bruner, J.S. (1962). On knowing. Cambridge: Harvard. Csikszentmihalyi, M. (1988). Society, culture, and person: a systems view of creativity. In Sternberg, R.J. (eds.), The nature of creativity: Contemporary Psychological Perspectives. Csikszentmihalyi, M. (2003). The domain of creativity. In Runco and Albert (ed.) Creativity Research Handbook: Cresskill, NJ: Hampton Press. Dement, W. (1965). An essay on dreams. In T.M. Newcomb (eds.), New Directions in Psychology .II. New York: Holt Rinehart and Winston, 135-257. Eysenck, H.J. (1983). The roots of creativity: Cognitive ability or personality trait ? Roeper Review, 10-12. Frued, S. (1963). General Psychological Theory: Papers in Metapsychololgy, NYC: Cillier Books. Galton, F. (1883). Inquiries into human faculties and its development. London: Macmillan. Contexts of Creativity 75

Gamble, K.R. (1972). Holtzman Inkblot Technique: A review. Psychological Bulletin, 77, 172-194. Gardner, H. (1986). TheCleveland Plain Dealer. October 23. Gardner, H. (1993). Creative Minds. New York: Basic Books. Gaynor, J.L.R. & Runco, M.A. (1992). Family size, birth order, age-interval, and the creativity of children. J. Creat. Behav., 26, 108-118. Getzels, J.W. & Jackson, P.W. (1962). Creativity and intelligence: Exploration with gifted students. New York: Wiley and Sons. Gray, J.J. (1969). The effect of productivity on primary process and creativity. Journal of Projective Techniques and Personality Assessment, 33, 2‘13-218. Gruber, H.E. (1974). Darwin on man : A psychological study of scientific creativity. Guilford, J.P. & Hoepfner, R. (1966). Sixteen Divergent Production Ability at the Ninth-Grade Level. Multivariate Behavioural Research, 1, 43-64. Guilford, J.P. (1950). Creativity. American Psychologist, 5, 444-454. Guilford, J.P. (1959). Traits of creativity. In H.H. anderson (ed.), Creativity and its cultivation. New York: Harper, 142-161. Guilford, J.P. (1967). Creativity, today and tomorrow. Journal of Creative Behaviour, 1, 3-14. Guilford, J.P. (1970). Traits of creativity. In Vernon, P.E. (ed.), Middlesex, England: Penguin, 37- 59. Hasirci, D. & Demirkan, H. (2003). Creativity in learning environments: the case of two sixth grade art rooms. J. Creat. Behav., 37, 17-41. Heller, S. (1979). The construction of noevel ideas in Piaget’s universal theory of human intelligence and in the creative thinking of the gifted. Unpublished Qualifying paper, Harvard Graduate School of Education. Heyman, R. (1964). Creativity and the prepared mind. In Taylor, C. (ed.), Widening horizons of creativity. NYC: John Wiley and Sons Inc., 69-79. Hill, F.F. (1972). Holtzman Inkblot Technique : A handbook for clinical application. San Fransisco : Jossey – Bass. Holtzman, W.H. (1968). Holtzman Inkblot Technique. In A.I. Robin (ed.), Projective techniques in personality assessment (PP. 136-170). New York: Springer. Holtzman, W.H. (1975). New developments in Holtzman Inkblots Techniques. In P. McReynolds (ed.). Advances in psychological assessment (Vol. 3, pp. 243-247). San Francisco: Jossey-Bass. Holtzman, W.H., Thorpe, J.S., Swartz, J.D. and Herron, E.W. (1961). Inkblot perception and personality – Holtzman Inkblot Technique. Austin: University of Texas Press. Isaksen, S.G. (1987). A new dimension of creativity research: Examining style and level of creativity. Paper presented at the KAI 10th Anniversary International Conference, London, England. Jalodia, U.S. (1995). A Study of relationship between types of creativity and types of intelligence. Unpublished Doctoral Thesis, Kurukshetra University, Kurukshetra. Kamlesh (1979). Personality and motivational correlates of projective and psychometric measures of creativity. Unpublished Manuscripts, Kurukshetra University, Kurukshetra. Knapp, R. (1956). Demographic cultural and personality attributes of scientists, Personality Committee Report. In C.W. Taylor (ed.) The 1955 University of Utah Research Conference on the Identification of Creative Scientific Talent. Salt Lake City: University of Utah. 76 Singh

Kneller, G.F. (1965). The Art and Science of Creativity. New York: Holt, Rinehart and Winston. Kobler, F.J. & Doiron, R.G. (1968). Review of W.H. Holtzman, J.S. Thorpe, J.D. Swartz, and E.W. Herron. Inkblot Perception and Personality. Psychometrika, 33, 126-132. Kreshner, J.R. & Ledger, G. (1985). “Effects of sex, intelligence and style of thinking on creativity: A comparison of gifted average IQ – Children. Journal of Personality and Social Psychology, 48(4), 1033-40. Kublie, L. (1961). Neurotic Distortion of the creative process. Lawrence, K.S.: University of Kansas Press. Mackinnon, D.W. (1960). The highly effective individual. In R.S. Albert (Ed.) Genius and Eminent. A social psychology of creativity and exceptional achievement (pp 114-27), Oxford : Pergamon (Original work published in 1960). Mackinnon, D.W. (1965). Personality and the realization of creative potential. American Psychologist, 20, 273-281. Mackinnon, D.W. (1978). In search of human effectiveness. Buffalo, NY: Creative Education Foundation. Martindale, C. & Hasenfus, N. (1978). EEG differences as a function of creativity, stage of creative process, and effort to be original. Biol. Psychol., 6, 157-67. Mckinnon, D.W. (1978). In search of human effectiveness: Identifying and developing creativity. Bufalo, NY: Creative Education Foundation. Mooney, R.L. (1963). A conceptual model for integrating four approaches to the identification of creative talent. In C.W. Taylor and F. Barron (eds.), Scientific Creativity: Its recognition and development (pp. 331-340). New York: Wiley. Mueller, R.J. (1964). Can the public school foster creativity? Saturday Review, 19, 48-49. Mumford, M.D. & Gustafson, S.B. (1988). Creativity Syndrome: Integration, Application and Innovation. Psychological Bulletin, 103, 1,27-43. Murray, H.A. (1938). Explorations in Personality. New York: Oxford University Press. Noppe, L.D. & Ballangher, J.M. (1977). A cognitive style approach to creative thought. J. Pers. Assess., 41, 85-90. O’Quin, K. & Bessemer, S. (1989). The development, reliability, and validity of the revised creative product sematic scale. Creat. Res. J., 2, 268-78. Perkins, D.N. (1988). The possibility of invention. In Sternberg, R.J. (eds.), The nature of creativity: Contemporary psychological perspectives, 362-385. Pesut, D.J. (1990). Creative Thinking as a Self-Regulatory Metacognitive Process – A model for Education, Training and Further Research. The Journal of Creative Behaviour, 24, 2. Puccio, G.J. (1990). Person-environment fit: Using Kirton’s Adaptor-Innovator Theory to determine the effect of stylistic fit upon stress, job satisfaction and creative performance. Unpublished doctoral thesis, University of Manchester Institute of Science and Technology, Manchester, England. Quinn, E. (1980). Creativity and cognitive complexity. Social Behaviour and Personality, 8, 213- 215. Rhodes, M. (1961). An analysis of creativity. Phi Delta Kappan, 42, 305-310. Rhodes, M. (1987). An analysis of creativity. In Frontiers of Creativity Research: Beyond the Basics, ed. S.G. Isaksen, pp. 216-22. Bufalo, NY: Bearly. Contexts of Creativity 77

Richardson, A.G. (1986). Sex Differences in Creativity Among a sample of Jamaican Adolescents. The Journal of Creative Behaviour, 20(2), 147. Richter, R.H., & Winter, W.D. (1966). Holtzman Inkblot Correlates of Creative Potential. Journal of Projective Techniques and Personality Assessment, 10, 62-67. Roe, A. (1946). Rorschach study of a group of scientists and technicians. Journal of Consulting Psychology, 10, 317-327. Roe, A. (1949). Analysis of group Rorschachs of biologists. Rorschach Research Exchange. Journal of Projective Techniques, 13, 25-43. Roe, A. (1950). Analysis of group Rorschachs of Physical scientists. Journal of Projective Techniques, 14, 385-398. Roe, A. (1951a). A psychological study of eminent biologists. Psychological Monograph, 65. Roe, A. (1951b). A psychological study of eminent physical scientists. Genetic Psychology Monograph, 43, 121-239. Rubenson, D.L. & Runko, M.A. (1992). The psycho-economic approach to creativity. New Ideas Psychol., 10, 131-47. Runco, M.A. (1991a). Divergent Thinking. Norwood, NJ: Ablex. Runco, M.A. (2004). Creativity. Annual Review of Psychology, 55, 657-87. Ruth, J.E., & Birren, J.E. (1985). Creativity in adulthood and old age : Relations in intelligence, sex and mode of testing. Int. Journal of Beh. Dev., 8(1), 99-109. Simonton, D.K. (1984a). Scientific eminence historical and contemporary : A measurement assessment. Scientometrics, 6, 169-182. Simonton, D.K. (1984b). Creative productivity and age : A mathematical model based on a two step cognitive process. Development Review, 4, 77-111. Snow, C.P. (1962). The two cultures and the scientific revolution. New York : Cambridge University Press. Stark, S. (1965a). An essay on romantic genius. Rorschach movement and definition of creativity. Perceptual and Motor Skills, 20, 409-418. Stark, S. (1965b). Toward a psychology of knowledge : Hypotheses regarding Rorschach movement and creativity. Perceptual and Motor Skills, 21, 839-859. Sternberg, R.J. (1986). “Intelligence, Wisdom, and Creativity”. Educational Psychologist, Vol. 21(3), 175-190. Sternberg, R.J. (1988). The nature of creativity (Ed.) Cambridge : Cambridge Uni. Press. Sternberg, R.J. (1988a). Counting the ways: The scientific measurement of Rove. In J. Brockman (ed.) The reality club I (pp. 151-173). Sternberg, R.J. (1999). Handbook of creativity. New York: Cambridge University Press. Sternberg, R.J. (2003). Wisdom, Intelligence, and Creativity Synthesized. New York: Cambridge University Press. Stohs, J.H. (1992). Intrinsic Motivation and sustained art activity among male fine and applied artists. Creat. Res. J., 5, 245-52 Suman (1989). A study of projective and psychometric correlates of creativity. Unpublished M. Phil. Dissertation, Kurukshetra University, Kurukshetra. 78 Singh

Swartz, J.D. (1973). Gamble’s review of the Holtzman Inkblot Technique : Correlations and Clarifications. Psychological Bulletin, 79, 378-379. Taylor, C.W., & Barron, F. (1963). Scientific Creativity. New York : Wiley. Taylor, C.W., & Holland, J.L. (1964). Predictors of creative performance. In Taylor C. W. (Ed.) Creativity; Progress and Potential. New York : McGraw Hill. Torrance, E.P. (1962). Guiding Creative Talent. Englewood Cliffs, H.J. : Prentice Hall. Torrance, E.P. (1963). Education and the creative potential. Minneapolis : University of Minnesota. Torrance, E.P. (1965). Rewarding creative behaviour. Englewood Cliffs, NJ : Prentice-Hall. Torrance, E.P. (1966). Torrance tests of Creative thinking : Norms – Technical Mannual. Princeton, New Jersey : Personal Press. Torrance, E.P. (1981). Predicting the creativity of elementary school children (1958-1980) and the teacher who made a “difference”. Gifted child Quarterly, 25, 55-62. Torrance, E.P., & Aliotti, N.C. (1969). Sex differences in levels of performance and test-retest reliability of the Torrance tests of creative thinking. Journal of Creative Behaviour, 3, 52-57. Treffinger, D.J., Sortore, M.R., and Cross, J.A. (1993). Dimensions of Creativity. Sarasota, FL: Center for Creative Learning. Tucker, L.R. (1958). An inter-battery method of factor-analysis. Psychometrika, 23, 111-136. Wallach, M., & Kogan, N. (1970). A new look at the creativity-intelligence distinction. In Vernon, P.E. (Ed.) Creativity. Middlesex; England : Penguin Books. Wallach, M.A., & Kogan, N. (1965). Modes of thinking in young children. New York : Holt, Rinehart and Winston. Wertheimer, M. (1945). Productive thinking. New York : Harper. Witt, L.A. & Beorkrem, M. (1989). Climate for creative productivity as a predictor of research usefulness and organizational effectiveness in an R and D organization. Creat. Res. J., 2, 30-40. Yamamoto, K. (1960). The role of creative thinking and intelligence in high school achievement. Research Memorandum. BER-60-10. Bureau of Educational Research, College of Education, University of Minnesota, 1-25. Contexts of Creativity 79

SOMATIC INKBLOT SOCIETY is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH a half yearly publication in January and July. It started in 1994 and has published 24 issues in 13 years. The Journal is available on Society’s Web Site at http: //www.somaticinkblots.com The Journal from Volume 1-13 is available in C D (Acrobat and Page Maker) Members of Somatic Inkblot Society can get it on a nominal prize of US $50 (for Overseas Members) and Rs.1000/- (for Indian Members). The Individual and Institutional Members of Somatic Inkblot Society/ SIS Journal of Projective Psychology and Mental Health Can get the current issue and future issues of the Journal through Electronic mail free of charge Please indicate if you wish to get the Journal in Hard Copy or through Electronic mail to: Bankey L. Dubey, Ph.D., DPM, Editor Emeritus, SIS J. of Proj. Psy. & Mental Health, E-mail : sisdubey@rediffmail.com E-mail : sisdubey@yahoo.com Web Site at http: //www.somaticinkblots.com OR Wilfred A. Cassell, M.D., FAPA, APC, Editor Emeritus , SIS J. of Proj. Psy. & Mental Health, Director, Somatic Inkblot Center, 4501E, 104th Avenue, Anchorage, AK 99516 ( USA) E-Mail : siscassell@yahoo.com

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Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi EDITORIAL CONSULTANTS SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITOR EMERITUS : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Ave. Anchorage, AK 99516 (USA). E-Mail: siscassell@yahoo.com : Bankey L. Dubey, Ph.D., Director SIS Center, 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail: sisdubey@rediffmail.com EDITOR-IN-CHIEF : Amool Ranjan Singh, Ph.D. Prof. & Head, Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. Tel.:91-651-2233687 E-mail:dr_amool_r_singh@rediffmail.com EDITORS : S. Chaudhury, MD, Ph.D., Prof. Dept. of Psychiatry, RINPAS, Kanke,Ranchi-834006.Mob.:91-9371019351 E-mail : suprakashch@hotmail.com : Prakash Chandran,Ph.D. Dhanya Nursing Home, Palarivattom, Edappally P.O. Kochin-682024 (India) Mob.: 91-9847039971 Email: prakasharackal@rediffmail.com : Anand Dubey,B.E., MBA, SIS Center, 4406 Forest Road, Anchorage, AK 99517 (USA) E-Mail: anand.dubey@gmail.com : Padma Dwivedi, M.A., 1671, Sector 49-B, Pushpak Society, Chandigarh 160 047 (India) : L. Sam Manickam, Ph.D. Prof. Dept. of Cl.Psy., SRMC and RI, Porur, Chennai-600116 (India) Tel: 91-044-24765512, Cell:91-9447009032 E-mail : sammanickam@sify.com : Rakesh Pandey, Ph.D. Reader, Dept. of Psy., M.G.Kashi Vidya Peeth, Varanasi-221001. Tel.: 91-542-2318246 E-mail : rpan_in@yahoo.com : Tamera Randolph, PO Box 244045, Anchorage, AK 99524 (USA) E-mail: tamerarandolph@hotmail.com John Baby, Ph.D., India Philip W. Baker, Ed.D., U.S.A. Mahesh Bhargava, Ph.D., India T.K. Chakraborty, M.D., India Carina Coulacoglou, Ph.D., Greece Philip Greenway, Ph.D, Australia K.V. Kaliappan, Ph.D., India Arvind Keshary, Ph.D, India Anatoly B. Khromov, Russia R. Kumar, Ph.D. India Sudhir Kumar, M.D. India Lisa Milne, Ph.D., Australia David Miller, Ph.D., U.S.A. Mridula Mishra, Ph.D., India Nalini Mishra, Ph.D., India Paola Nicolini, M.A., Italy Paul E. Panek, Ph.D., U.S.A. Edward M. Petrosky, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy C.S. Rao, Ph.D., India Stefano Reschini, M.A, Italy Barry A. Ritzler, Ph.D., U.S.A. D. Saldanha, M.D., India Archana Singh, M.A., India M.P. Singh, Ph.D., India R.N. Singh, Ph.D., India Umed Singh, Ph.D.India David Sperbeck, Ph.D., U.S.A. Ajay K.Srivastava, Ph.D., India Ramjee Srivastava, Ph.D., India Ailo Uhinki, Ps.D., Finland Yasho V. Verma, Ph.D., India