SIS Journal of Projective Psychology & Mental Health

Journal of Projective Psychology & Mental Health SIS ISSN 0971 - 6610 Official Publication of the Somatic Inkblot Society Editorial : SIS Guided Outer –Inner Focusing 89-90 Wilfred A.Cassell How to Delete Viruses and Reconfigure the Brain's Hard Drive 91-116 Wilfred A.Cassell, B.L. Dubey, Padma Dwivedi and Amool R. Singh Projective Methods in the Study of Eating Disorders- An Update 117-123 Silvia Daini Factor Structure of SIS-I in Adults 124-127 Rakesh Kumar SIS-II Indicators of Creativity 128-133 Umed Singh, Nidhi Verma and Naseeb Singh Personality Profile of Schizophrenia and Bipolar 134-137 Affective Disorder (Mania) on SIS-II Dolly Kumari, Jai Prakash, Amool R. Singh and Suprakash Chaudhury Personality Assessment of Drug Dependent Patients with 138-146 Antisocial Personality Disorder Kristian Aleman Effect of Psychotherapy and Vipassana Meditation on 147-151 Pathological Gamblers M.G. Sharma and Vandana Sharma SIS-I Indices as a Measure of Ego Strength in Schizophrenia 152-154 J. Mahapatra, D. Sahoo, P.K. Mishra and R. Kumar Quality of Life and Mental Health of Indian Managers 155-159 Naveen Gupta and Pankaj Handa Diagnostic Value of the Fairy Tale Test as Compared 160-165 to CAT: A Case Study Nilanjana Sanyal and Manisha Dasgupta Projection and Projective Methods: A brief Theoretical Comment 166-168 Rui C. Campos A Preliminary Study of the Psychotherapy Process 169-177 Pallavi Banerjee, Jayanti Basu and Ushri Banerjee SIS –II Profile of Medical Practitioners 178-179 Sarika Alreja, Deepak Kumar Mishra, K.S. Sengar, Amool R. Singh and S. Chaudhury Volume 16, Number 2 July, 2009

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MEN- TAL 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 (double-spaced 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@yahoo.com with a copy to Amool Ranjan Singh, Ph.D. Editor In Chief and Head, Dept. of Clinical Psychology,RINPAS,Kanke,Ranchi-834006. E-mail:editor_ sis@rediffmail.com & sisamool@yahoo.com, Mob 91- 9431592734.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 $50 for foreign members and Rs. 300, for Indian members, Institutional subscriptions are US $100. for Foreign institutions and Rs. 1000 for Indian institutions. Life membership is US $400 for foreign members and Rs. 2500/- for Indian members. Indian institutional life membership is Rs. 10,000/-. Non-members may subscribe for $60 or Rs. 250 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 $10/ Rs.50/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society/journal members should inform B.L. Dubey Ph.D, Director SIS Centre, Email : sisdubey@rediffmail.com of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT CENTRE, India/ Anchorage U.S.A. Website: http://www.somaticinkblots.com OFFICE BEARERS President : B. L. Dubey (USA) Vice President : Brig. D.Saldanha (India) Gen. Secretary : Masroor Jahan (India) Joint Secretary : P.K.Singh (India) Treasurer : Mrs. Padma Dwivedi (USA) Editor in Chief : Amool R. Singh (India) Editors : S. Chaudhury (India)

Anand Dubey (USA)

Padma Dwivedi (USA)

Jai Prakash (India)

Umed Singh (India) Executive Members : Wilfred A. Cassell (USA) Nalinini Mishra (India) Mridula Mishra (India) Arcahna Singh (India) K. S. Sengar (India) Manisha Kiran (India) Mary Cassell (USA) Asheem Dubey (USA) George Savage (S.Africa) Mrs. Silvia Daini (Italy) Somatic Inkblot Society

Abstracted in “APA’s PsycINFO “ Regd. No. 71632/99, RNI Delhi JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH Volume 16 Number 2 July 2009 EDITORIAL CONSULTANTS : Kristian Aleman, Ph.D., Sweden Mahesh Bhargava, Ph.D., India K.R.Banerjee. MRCP India Saugata Basu, Ph.D., India Carina Coulacoglou, Ph.D., Greece N. G. Desai, M. D., India Philip Greenway, Ph.D, Australia S. Haque, M. D., India M. Jahan, Ph.D., India Arvind Keshary, Ph.D, India Anatoly B. Khromov, Ph.D. Russia H. Kumar, Ph.D. USA R. Kumar, Ph.D. India Sudhir Kumar, M. D. India A. S. Kundu, Ph.D., India RamJee Lal, Ph.D. lndia Anu S. Lather, Ph.D., India Lisa Milne, Ph.D., Australia Mridula Mishra, Ph.D., India Nalini Mishra, Ph.D., India A. K. Nag, M.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 Kiran Rao, Ph.D., India Stefano Reschini, M.A, Italy Barry A. Ritzier, Ph.D., U.S.A. D. Saldanha, M. D., India Nilanjana Sanyal, Ph.D., India K. S. Sengar, Ph.D., India D. K. Sharma, MHA, India T.R.Shukla.Ph.D.India Radhe Shyam, Ph.D.lndia Archana Singh, Ph.D., India V. K. Sinha, M.D., India David Sperbeck, Ph.D., U.S.A. A. K. Srivastava, Ph.D., India Kalpana Srivastava, Ph.D., India Ramjee Srivastava, Ph.D., India Ailo Uhinki, Ps.D., Finland A. N. Verma, Ph.D., India Yasho V. Verma, Ph.D., India EDITORS EMERITUS : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK.99516 (USA). E-Mail: siscassell2@yahoo.com Bankey L. Dubey, Ph.D., Director SIS Centre, 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail: sisdubey@rediffmail.com, bldubey@gmail.com, Cell : 907-250-8834, EDITOR-IN-CHIEF : Amool Ranjan Singh, Ph.D. Prof. & Head, Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi- 834006 (India). Tel. : 91-651-2233687(H), Mob.:91 -9431592734, E-mail:sisamool@yahoo.com EDITORS : Suprakash Chaudhury, MD, Ph.D., Prof. & Head, Dept. of Psychiatry, RINPAS, Kanke, Ranchi- 834006 (India). Mob.:91-09334386496, E-mail: suprakashch@gmail.com Anand Dubey.B.E., MBA, SIS Centre, 4406 Forest Road, Anchorage, AK 99517 (USA), E-Mail: anand. dubey@gmail.com Padma Dwivedi, M.A., 4406 Forest Road, Anchorage, AK 99517 (USA), E-mail: sisdubey@ yahoo.com Jai Prakash,Ph.D., Associate Professor of Clinical Psychology, Dept. of Clinical Psychology, RINPAS, Kanke, Ranchi-834006, (India). Cell: 91- 9934582290, E-mail: drjaiprakashrinpas@rediffmail. com Umed Singh, Ph.D., Dept. of Psychology, Kurukshetra University, Kurukshetra, Haryana, (India). Email Umedsingh_78@yahoo.com. Tel: 91- 1744-238267(H), Cell: 91-9416511077

JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH : ACHIEVEMENTS Journal in WHO Listing Members of Somatic Inkblot Soceity will be glad to know that SIS Jr. of Projective Psychology and Mental Health has been listed by World Health Organisation (Global Forum for Health Research) among 25 indexed journals that have published the highest number of articles on mental health from LMICs in Latin America, Africa and Asia (Medline and PsycINFO). Extract from table-6 of “Research Capacity for Mental Health in Low - and Middle - Income Countries : Results of a Mapping Project “ (www.globalforumhealth.org) is given below : Rank Journal Country Language Revista de Psicoanalisis Argentina Spanish Revista de Neurologia Spain Spanish Revista Brasileria de Psiquiatria Brazil Enlgish, Portuguese, Spanish Arquivos de Neuro-psiquiatria Brazil Portuguese Acta Psiquiatrica y psicologica de Amercia Laina Argentina Spanish Journal of the Medical Association of Thailand Thailand English, Thai British Journal of Psychiatry United Kingdom English Acta Psychiatrica Scandinavica Denmark English Salud Mentale Mexico Spanish Vertex Argentina Spanish Journal of Personality and Clinical Studies India English Social Psychiatry and Psychiatric Epidemiology Germany English Revista Medica de Chile Chile Spanish South African Journal of Psychology South Africa Afrikaans, English Psychological Reports USA English South African Medical Journal South Africa Afrikaans, English The Australian & New Zealand Jr. of Psychiatry Australia English International Journal of Social Psychiatry United Kingdom English Psychiatry Research Ireland English Social Science & Medicine United Kingdom Engish Revista De Saude Publica Brazil Portuguese International Journal of Geriatric Psychiatry United Kingdom English SIS Jr. of Projective Psychology and Mental Health India English Jornal Brasilerio de Psiquiatria Brazil Portuguese Psychiatry and Clinical Neurosciences Australia English Journal in ProQuest Listing We are glad to inform you that SIS Journal of Projective Psychology & Mental Health has been listed in academic research database ProQuest Psychology Journals™. ProQuest is a company in Michigan, United States. It is a leading provider of electronic databases for academic libraries. Databases are used in over 20,000 academic libraries around the country and around the world including some of the most prestigious higher education institutions such as Harvard, Yale, Princeton, Oxford ect. ProQuest provides abstracts and indexing for more than 640 titles, with over 540 titles available in full text. Users get access to charts, diagrams, graphs, tables, photos, and other graphical elements essential to psychological research.

Editorial SIS Guided Outer – Inner Focusing Thanks to all those, who over the year have contributed, and especially to Dr..Bankey L. Dubey, for his active leadership, this journal is now getting the recognition that it deserves. Now, it is regularly reviewed in reputable publications that expose it to a wider international scientific audience. As it evolves, our editorial board will have the opportunity to publish a wider range of evidence based studies. As a starting point in understanding the human condition, encouragement will be given to those from the basic neurosciences, and then, those encompassing psychosocial studies. At the less tangible pole of this scientific spectrum, welcome will be given to those who attempt to unveil the intangible mysteries of dreams and spirituality with projective imagery. In covering this wide range of subject material, the future goal will be to facilitate author-reader communication between geographically distant, but intellectually close internet participants. Thanks to Anand Dubey, who updated SIS web page, this facilitation can now be completed more easily through the internet and related electronic devices. SIS scientist can now explore with modern technology the body-mind-spirit insights derived from the inner directed focusing of traditional yoga meditation. This mysterious, yet powerful beneficial technique has the potential to benefit all introspective peoplespecially the young. Hopefully our new section on our SIS web page will provide an opportunity for many to “Delete Brain Viruses”. Once their mind becomes free of restrictive authoritarian dogma and open to scientific based concepts of reality ideas, web visitors may then more effectively want with guiding SIS Society elders. In futuristic scientific studies, the outer body structured SIS stimuli has the methodological power to direct attention from the outer world on to the individuals own somatic cell. Structure suggestive of the internal organs can further redirect this focusing to the innermost aspects of the body gestalt (e.g. the heart, GI tract). It was well known that the psychological activity in such inner regions can be mysteriously altered by a meditating yoga master. This has long been validated by scientific instrumentation, yet the under lying mechanisms pose challenges for future SIS investigators. Once these processes are better illuminated by the application of SIS concept, more affective technique may be developed for training the public in meditation practices. Not only as a daily beneficial standardized yoga practice, SIS guided image subjective program can be developed for special life situation. One example involves learning from a SIS trainer conscious control to activate professionally conceived image defenses to deal with deleterious effects of severe psychological stress. In the absence of such, susceptible individual historically have to solely rely on inbuilt brain mechanisms associated with the Dissociative Disorder. Rather than having to become depersonalized would not it be better for an individual in a high stress occupation to have been previously trained in activating positive imagery? An example of this was presented in a case history reported earlier in this Journal and noted in the new web. it was courageously given during a SIS television recorded SIS educational interview. This was provided by a psychologist who at age 16 was severely traumatized by being in Auschwitz. She avoided fracturing her ego or sense of self by retaining her personal identity within her “Body Gestalt”. Thus, when ordered to dance for her tormentors, she fantasized that she was on a concert stage dancing to beautiful music for an appreciative ballet audience. Members of this society are also challenged by the need to develop effective operational guide lines for developing an optimal daily balance for focusing on outer world reality issues, as opposed to inner subjective emotionally colored processes. Regarding the illumination of the former attention field, as another example of its many applications, the SIS can serve as a modern day “Dream Catcher”. It has been repeatedly observed that the PTSD “nightmares” of individuals subjected to severely stressful situations are readily projected in either a carbon copy type fashion or disguised in symbolism. Since life situations for all people inevitably lead to some degree of stress, SIS practitioners can also provide training in this area. Motivated web visitors may benefit from introspective dream analysis designed to understand their outer world relevance. It may also help grieving individuals to explore envisioned spiritual connections to deceased loved one. There are many other examples concerning the application of yoga based and SIS elaborated concepts. One involves an ethically troublesome, but valid, extension of SIS work in to the applied

90 Cassell field of Industrial Psychology. Certain aspects of this in America are restricted by professional standards and laws preventing practitioners from SIS testing in industrial settings. It is proposed that our SIS Society needs to review the various issues involved and establish its own official guidelines. As a logical extension of this application, future SIS works involving young people. The public section of the SIS web page, devoted to “Deleting Brain Viruses” represents a preliminary project in this regards. One of its goals is to provide an internet opportunity to check subjective reality against the consensus background of an electronic group of observers in a Blog like safe setting. Consistent with this, future work can be directed to developing valid concepts and effective SIS image technology to recognize gifted young people. One direction involves designing input with more “Human content” for others, as opposed to the ego/ body field of attention. Such envisioned technology could provide future guidelines for educational programs to train community leaders to pursue an optimal outer-inner focus of attention. The last visual field, which can be enriched by the design of new SIS stimuli, involves the least tangible one, namely the “spiritual” dimension. While it would be possible to explore this by artistically altering in a semi-ambiguous fashion the color/form structural aspects of traditional religious symbols associated with the worlds great religions, this method will be avoided. Why expose SIS scientists to the vitriolic anger and threats that religious bigots, who preach “love” and “peace” spout out when the spiritual validity of their symbols are questioned? Instead, an attempt will be made to develop a SIS series ambiguously focusing on a subject, that religious authorities historically have traditionally emphasized, namely the position of the human race in the physical universe. Although this methodological strategy may seem less likely to arouse strong negative emotions in members of religious groups, it still involves some degree of risk. Recall the treatment of Copernicus by the Catholic Pope. There are many “Religious” people worldwide who would be emotionally threatened by inkblot art reflecting issues of evolution and astronomy, even when such projective stimuli could provide useful avenues for exploring “Spirituality”. In spite of this, let us have the courage and intellectual honesty to proceed using the power of projection. Wilfred A Cassell, M.D., FAPA, APC. Editor Emeritus SISJournal, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK - 99516 (USA) E-Mail : siscassell2@yahoo.com

My Shell Though you know me not, why look at me so? But a shell of me you gaze upon Inside lies the reality you seek. Look deeper and know me That is my inner cry. Does not the cry reach out to you? Can you not feel it? For feel you must. My inner self cannot be seen. I am but a prisoner, struggling To escape this, the shell. Look deeper, enter, come walk with me in thoughtful silence. This poem was written by a sufferer who was unable to express feelings. To most people this person appeared OK on the outside. Yet on the inside, there was grief. The poetic words sprang from a tormented heart. Visitors to this internet site are invited to e-mail their personal reactions to this person’s cry for help to their internet friends. Have you ever known anyone like this? Have you ever felt this way? Perhaps you know someone who also seems to have an outer “Shell” inhibiting expression of emotions. If so this web site might be relevant. Moreover, it might prove of interest to professionals whose occupation requires interviewing skills. Interviews reveal only what a person chooses to reveal and is able to recall. Interviewing can not access memories defensively blocked from recollection. Verbal communication is also restricted by the limitations of languages as a mode of emotional expression. Also invited are poets, artists, musicians, philosophers, the “spiritually” inclined and all others fascinated by human body-mind-spirit symbolic expression. This class in cyberspace examines how false information and traumatic life experiences accumulates in the brain’s hard drive. In addition, particular attention will be given to examining the unique way that traumatic life experiences gets vividly stored in the central nervous system memory centers. Individual histories of traumatized individuals will be presented illustrating how such stressful virulent imagery then gets incorporated into “Nightmares” and a variety of distressing disturbances. Examples will be given of how such emotionally charged imagery may be activated and subsequently reconditioned by a projective technique called the Somatic Inkblot Series (SIS). Welcome Welcome to this internet classroom provided by the Somatic Inkblot Society in India! This is a nonprofit international society based in India comprised of mental health professionals and behavioral scientists. These are dedicated to developing techniques for exploring inner space and for releasing a suffering person’s “Inner cry”. They publish their work in the SIS Journal of Projective Psychology & Mental Health. This publication is abstracted in “APA’s Psychological Abstract” (Regd. No. 71632/00, RNI Delhi, India. This section of the web page is open to visitors eighteen years of age and older, who might share this interest but lack formal credentials in the field. We extend a particularly warm welcome to any members of the lay public, who might like to contribute their support and energy to our goals. The society has a special interest in the body-mind development of young people. As a technical example of this organization’s achievements for children, you are welcome to view the short presentation “Poppa”. This presents a series of positive images to be viewed at bedtime which can program restorative paternal dreams. If so, click on the symbol “P”. Sadly, too many young people fail to experience a positive relationship with their biological father. Fortunately, they still may benefit from real life loving experiences with father surrogates either in real life or in electronic fantasy imagery situations. What are brain hard drives “viruses”? In an analogous fashion to computer viruses, these are verbal messages and externally implanted cognitive/emotional/behavioral codes of a negative nature. This web site capitalizes on the power of ambiguous pictures to stimulate imagery ranging from the positive to the negative. The SIS Center has a video illustrating the former entitled “Poppa”. This was designed to program positive paternal dreams at bedtime.If abused, physically, psychologically or spiritually, the child may incorporate this negative input into the self image. Later in life, a trauma victim may be prone to acting out this implanted code on immature subjects or vulnerable adults. Prevention is the ideal approach, but the world is unfair! Clearly any preventative approaches require How to Delete Viruses and Reconfigure the Brain’s Hard Drive Welfred A. Cassell, Bankey L. Dubey, Padma Dwivedi and Amool R. Singh Wilfred A.Cassell, M.D., FAPA, Director SIS Center, 4501 East, 104th Ave, Anchorage, AK 99508, Email:siscassell2@yahoo.com, Bankey L.Dubey, Ph.D.,DPM, Director, and Padma Dwivedi, M.A., SIS Center, 4406 Forrest Road, Anchorage, AK 99507(USA) Email:bldubey@gmail.com, and Amool R. Singh; Ph.D., Prof & Head, Dept of Clinical Psychology,RINPAS, Kanke, Ranchi-834006 Key Words: SIS Imagery, therapeutic intervention

socioeconomic, health and education reforms beyond the scope of this web site. Given the large numbers of young people who lack food, shelter and health care it obviously is of less priority for these suffering souls to speak about “Deleting Brain Viruses”. Yet many are fortunate to have their basic life needs met, yet are mentally imprisoned. Some may have the potential for deleting such viral material, even if it is sometimes a very, very difficult restorative task. Are you one of these or are you interested in supporting this modest attempt to provide an internet aide for breaking their mental imprisonment? Vast numbers of children throughout the world are traumatized. Internet visitors interested in how later in life as adults this may lead to citizens who become warlike are invited to plug into an internet search engine “Psychohistory”. In spite of its many advantages, an example is America. To an outsider, it appears that the prison industry is flourishing because too many young people are offered little in the way of preventative and early care before viral implants become firmly bound to memory neurons. In 2005, 7 million people or one of every 32 American adults were behind bars, on probation, or in parole by the end of the year. Many of these suffer from major mental illness. These would be more appropriately cared for in public psychiatric facilities. However, these are not provided the financial support required. Vast sums are spent in foreign countries, as the inner American schools become more dysfunctional with increasing violence and drug use. For many middle school students the drug dealer provides the false role model imagery, having money and power. Alcohol and street drugs are the way that most sufferers numb their mental pain. Can you help in any way? Since you have access to a computer, it appears that you are already blessed with socioeconomic and educational advantages. Moreover, your ability to read English represents an important communication skill. While this language is second only to Spanish in worldwide usage, many cannot read it, or if so only poorly. If you have difficulty in interpreting the words, assuming you are blessed with an intact visual perception system and normal brain function, an apology is deserved. Perhaps you might know a translator who could assist in putting this web page in your own language. This contribution would be sincerely appreciated. In fact, we would sincerely appreciate all constructive criticisms and positive suggestions. This web page is designed to be user friendly. If you know someone who lacks access to the internet and you believe what follows might be helpful to this individual, feel free to print the material as a gift. All, who care about optimizing freedom of expression through evidence based science, are invited to contribute. The SIS Society appreciates the epidemiologic research suggesting that participation in religious organizations may be statistically associated with improved health. The SIS Society also accepts the healing power of positive spirituality. This may be present in the beauty of Nature, as well as stimulated in human consciousness by the trance inducing dances, rituals and symbols of religions. Although scientists avoid the religious notion of “Evil”, be prepared to view symbolic imagery in dreams and projective responses having this connotation. Please consider participating and helping in any way that you can. Remember “giving is better than receiving.” We live in a shrinking interdependent world. There is a positive value in reaching out to provide a mental beacon for those struggling to overcome roadblocks in their inner world life journey. Orientation Poetry is a time honored modality of symbolic expression. Yet it does not readily lend itself to evidence based scientific interviewing of another soul’s “Inner person”. For such purposes “A picture is worth a thousand words”. In this internet classroom, a visual stimulation projective technique provides the methodological vehicle for “looking deeper” into the recesses of the brainmind complex. Some pictures need no written explanation or language translation. A photograph of a starving child, or an injured child, or a child dying of a preventable illness such as AIDS readily cuts through international language barriers. Just as telescopes enable an observer to search outer space; this web site uses state of the art electronic based projective procedures for visualizing and reconditioning inner space. The observation technique uses ambiguous “abstract art” and “Inkblots” to evoke imagery. What is revealed can reflect directly, or in symbolically disguised form, deep seated material, which otherwise might be blocked from expression. Traditional educational settings ordinarily bypass this “Real” but intangible inner world. Teachers in most countries around the world are censored either directly or indirectly by administrators, who wish for political reasons; to minimize the high prevalence of preventable stress related mental disorders in children. Warning! This classroom in cyberspace presents material of an adult nature. It is not recommended for anyone less than eighteen without strict parental supervision. This projective technique can access the brain’s 92 Cassell et al

source of daytime fantasies and nighttime dreams. Consequently the imagined scenes may reflect real, but socially unacceptable material. Although sexual/aggressive imagery may be imagined to be present, the ambiguous pictures to be viewed definitely were not designed to be pornographic. Like dream symbolism, the evoked stream of inner world imagery may sometimes seem incoherent and illogical. Learning to interpret the “logical” meaning of confusing symbolic projective imagery is comparable to learning a foreign language. Yet most people have an ability to interpret symbolic material. With regard to dreams, most are able to see through symbolic material of others, much more accurately than their own. In any case, because of the potential stress of such activity, this web page should by avoided by any web visitor suffering from mental disorder. Anyone tormented by thoughts to harm themselves or others are advised to seek immediate mental health emergency care in their local area Are you ready to view some SIS stimuli in a “Brain- Mind Puzzle”? Visitors to this classroom are invited to participate in a free, fun and interesting visual puzzle. Individuals interested in participating will be given the opportunity to respond to ambiguous pictures. These may depict in various degrees what is present or imagined to exist in the inner world of personal perceptions, thoughts and emotional feelings. In sharing what is experienced, an honest viewer may reveal their deeper aspects of consciousness. These may provide a window for inspecting otherwise symbolically hidden mental material. Moreover, it enables the participant to learn by peering into the minds of other viewers, who have previously volunteered their visions. Sometimes this will related to the imagery experienced in fantasies and dreams. The response data bank includes a range of responses depending upon the evaluation criteria the participant wishes to select. Examples of various assessment scales sometime applied are as follows: from the immature to the mature, from the normal to the abnormal, from the happy or humorous to the sad, from contentment to anger, from the relaxed to the anxious, from understanding to confusion, from the reality based to the fantastic, from the honest to the deceptive, from the trusting to the suspicious or paranoid etc. Perhaps you have already developed cognitive skills for judging mental content in the mind of others. If so, try and realize that some participants may have only relatively immature brains. Their neural memory circuits will still seem to be flooded with irrational viruses distorting their perceptions. Yet their life experiences and authority figures will likely be different from yours. Therefore their response styles should provide you perspective, for further reconfiguring the neuron foundation energizing your own personal identity. By contrast, other internet participants may have already achieved more advanced levels of biological and psychosocial maturity. Peering into their brainmind symbolic connections could provide you more effective mental techniques for introspection and judging others. This internet exercise could also enhance your ability to empathetically, as the poem requested: “Walk with them in thoughtful silence”. This requires a conscious decision to incorporate into your own thinking, the complex insights stimulated by this educational internet site. Just as “Rome wasn’t built in a day”, building a powerful brain requires considerable time and effort. It may be compared to the challenge of learning to be competent in a demanding sport or to be fluent in a foreign language. Please report what each brings to mind and any emotional feelings associated with the imagery. Image A2 Image A5 How to Delete Viruses 93

Image B28 Image A31 Image B31 SIS Images Remember to include what memories, dreams, and emotions each brought to mind. Note all recollections with as much detail as you wish. Afterwards, please select your favorite and your least favorite image and state your reasons for the selection. Finally tell us whether or not you want these responses presented on the internet. If so, you will be given an opportunity to view the responses of others. Include your e-mail address if you wish to discuss your viewing experience with other participants. Please realize that because of the large number, only a representative sample of responses will be made available Learning to live with ambiguity Look forward to exploring the inner world of human consciousness. If you already are puzzled or have difficulty understanding the written material, you are not alone. Most people do, even those familiar with the scientific literature in the field. It may take considerable study to comprehend the highly interesting, yet mysterious viewing process. In regard to its significant complexity, this internet classroom curriculum begins with the physics of light from the outer world, and then moves to the optics of vision, then to the retina’s transmission of the sensory stimulation via the optic nerves to the visual receptive areas of the brain and then on to the higher brain circuitry. There are many internet sites that provide this basic background information that may be studied by inserting “Optics of vision” in a search engine. At the final stage of awareness the scientific knowledge becomes murky. No neuroscientist currently knows how the brain-mind-spirit complex translates this sensory input into color-form patterns having cognitive/emotional connotations. This interpretative phase touches on the frontier of knowledge bordering on the ambiguous term “Spiritual”. Yet a web page visitor does not have to understand this mysterious process in order to have an interesting and worthwhile voyage into inner space! If you consider enrolling in this internet course, an important point to consider is the following: Remember that most people have some innate ability to appreciate the meaning of symbolism, in poetry, art or dreams. The same applies to interpreting the symbolic meaning of SIS stimuli, fantasies, day time flashbacks, visions, hallucinations etc. In contrast, everyone’s brain has psychologically defensive neurophysiologic restrictive processes to 94 Cassell et al

inhibit the emotional charge of threatening scenes from disrupting sleep. However, when these fail “Nightmares” break through. While it can be immensely helpful to try to understand your own dreams, as indicated most individuals are restricted in interpreting their own. Even an untrained viewer may often be more insightful in interpreting someone else’s dreams, than the dreamer is able. Moreover, if the dream symbolism is reviewed in a Blog internet setting, the group may further enrich the interpretative process of ambiguous input. “Nightmare” residual in daytime Perhaps you wonder why there is such an emphasis on dreams. After all, wasn’t this web page supposed to be about ambiguous pictures? A partial explanation follows: during a severely stressful event associated the body’s alarm reactions release adrenaline. This causes the traumatic imagery to be recorded vividly in memory neurons, especially in an area of the brain called the hippocampus. The first night afterwards these vivid memories appear as “Nightmares”, depicting the real outer life experience. Gradually over time the brain’s natural healing mechanisms recondition the anxiety laden imagery. This takes place in a homeostatic function as the sleep relaxation chemically begins to unbind the neurochemical linkage to the traumatic memory neurons. Prior to the enzymatic washing out of this binding, scene specific symbolism may intrude in dreams or in daytime consciousness in “Flashbacks”. Years later, the long forgotten anxiety laden traumatic emotions may be activated by external stimulating events .For example, a soldier traumatized by explosions may experience a full blown attack of panic in a thunder storm. During this dormant phase, in clinical diagnostic/treatment situations the memories may only be recalled during hypnotic or barbiturate states of deep relaxation. Under these memory releasing conditions, residual evidence of the trauma may still spill over as symbolic imagery projected onto ambiguous pictures. Time is a critical factor in this brain-mind process. Severely stressful experiences take a while to solidify or gel in the brain’s memory storage neurons. Reactivation of this neural network may subsequently be triggered by symbolically associated life events. Some research suggests that memory gelling may be blocked by the administration of medications such as propanolol. Psychopharmacological investigation in this area may lead to more effective therapies. These memory based brain-mind alterations also occur for low level stressful experiences that never require clinical attention. Sometimes such old unresolved stress related imagery chronically circulates in neurochemical bound neural networks underneath conscious awareness giving rise to occasional symptoms. Most traumatized people do not have the opportunity for treatment. Yet it can be helpful years later to rethink and clarify confused thoughts occurring during the stressful period. Web site visitors might be interested in viewing a Russian film made by Arkadi Kordon. The film portrays a poet suffering from alcoholism. In the plot, his abstinence was repeatedly enhanced by viewing the SIS stimulated symbolism. This was viewed at moments during vulnerable phases, when he was tormented by internal impulses to relapse. It is available in English and Russian. Blind Seeing Sometimes, a viewer with functioning optic mechanisms for transmitting the color-form properties of the visual stimulation is blind to the embedded structure. This occurs when the responder sees nothing or defensively substitutes another image. Perhaps this might be best illustrated with a clinical example involving chest pain. Cardiologists frequently consult on healthy a patient, who complains of somatic symptoms resembling a “Heart attack”. Frequently, the onset of symptoms followed the sudden death of a friend, who died of a sudden heart attack. In such sympathetic situations, fears of dying cause the survivor to focus anxiety on cardiovascular function. Such a medical patient might typically fail to detect SIS red valentine like anatomical structure suggestive of the heart. This process occurs outside conscious awareness. This visual repression usually is associated with the brain’s substitution of a low anxiety similar appearing image, such as a “Strawberry”. Internet Communication Exercises This web page provides an opportunity to peer beyond the shell of social facades, into inner subjective reality. It presents internet exercises for reconfiguring viral implants in the brain’s hard drive. A motivated participant can learn and practice communication skills with other internet viewers, family members and real life friends. If you elect to share mutual drawings of what you imagine to be present in abstract art having disguised content, you can even avoid the limitations of language. For example, if someone is experiencing problems in a conflictual love relationship, the communication exercises might be helpful. Such a person could request his partner to assist in the internet program. In viewing, interpreting the disguised meaning How to Delete Viruses 95

inherent in certain ambiguous pictures, a man may be relatively blind. By contrast, his lover may easily see through and be able to point our viral inhibitions in his defensive “Shell”. Removing blind spots and restructuring the brain’s hard drive may seem more discomforting at times than a dental root canal. Yet this extraction may be less painful than losing a close relationship. In addition, the educational imaging exercises may facilitate identifying and reconditioning stressful memories recalled by the visualization exercise. Most people in life are subject to a variety of common stressful events. While these may seem disproportionally significant at the time, usually these are resolved. As indicated, some are persistent and linger on, making their presence known in various vague discomforts. The exercises available are designed for practicing communication skills. Prior to the internet, with the advent of writing and mail, strangers in various countries learned to become friends or “pen pals”. Similarly the visual program to be outlined can serve as a vehicle, securing friendships worldwide. When common issues are addressed, it also can lead to problem solving on subjects of mutual concern. Moreover, the projective exercises may foster maturation of an individual’s own sense of personal identity. Psychological Identity within the animal-like Body Image Exercise 1: Human identity exists within the body image. When people are asked to locate themselves within the special realm of the human body, most tend identify their location as just behind their foreheads. Many Hindu people in India and elsewhere mark their forehead as shown in the following photograph. You now are invited to focus your attention on this area in your own body. HELLO IN THERE! It seems that you are somehow looking out at this web page trying to make sense of this wordy and complex web page. Perhaps it would clarify your thinking if you participated in a voluntary “Within the Body Image Visualization Exercise”. If you elect to do so, this may be completed in the privacy of your bedroom by following these instructions: Shut your eyes, take deep a few breaths and relax. Now imagine that you are walking down a sunny private garden path with beautiful flowers. Leave all cares behind in the outer world. Envision coming to a calm reflection pond with magical healing waters. Feel warm, cozy, safe and oh…. so relaxed! After a few moments of enjoyment, you will feel magically drawn to the edge. Since this is entirely a private room in your imagination, respond to an impulse to completely undress. Look at your naked body’s reflection from several viewpoints. Next visualize, the scene quickly changing and you are notice a sign “Pool Instructions”. You are amazed to read that you if you immerse in the pool, your body will be magically transformed in any way you desire. You then make your personal wish and enter the warm magic water. You feel wonderful as you momentarily fulfill your body image fantasy .Now move to the edge of the reflection pool and look at yourself. If you care to, you may draw a picture of it to remind you later of your “Idealized body image”. } Now gradually end the pool fantasy. Your next assignment involves assembling, as accurately as you can, your “Real body image”. You can obtain recent photographs of body from various angles. Supplement these in total privacy with views from mirror reflections. Now compare this assembled mental picture with the idealized one. The closer these two images, the more content you will be with your appearance. In this imaging exercise many people find discrepancies which make them uncomfortable. Unfortunately fashion agencies and cultural influences largely dictate what is considered to represent an ideal male or female appearance. In many instances these messages are quite inconsistent with the normal distribution in appearance of healthy bodies. These represent viral implants that need to be deleted. Some people have implants about their sexuality because a dominating parent wanted a child of the opposite gender. Such children are sometimes dressed in cloths of the opposite sex because of parental attitudes .It is important but not easy to begin deleting biases which are inconsistent with your biologic heritage. Lastly recall the animal like features of your external anatomy in the imaginary reflection pool. In your mind’s eye, you visualized the body of a young Homo sapiens. Now study textbook pictures of the higher apes, or visit a zoo for comparison with your body. In comparing the two physical structures, your mind will be strongly influenced by information planted by your authority figures concerning theories of evolution. Trying to distinguish the implanted biases concerning scientific theories of evolution versus “Intelligent Design” can be challenging. No doubt this would be especially problematic if you are a student in a dogmatic fundamental religious school. 96 Cassell et al

When you similarly inspect what appears to resemble “Human bodies” or “People” in the ambiguous pictures please keep in mind the following. What you “SEE” will sometimes reflect more your inner mind, than the external visual stimulus. There is an old joke which illustrates this as follows: A sexually preoccupied person is confronted by a Rorschach inkblot interpreter for projecting repeated scenes of sex. In denying the interpretation, the individual blames the professional by saying “Nope Doc! It’s not in my mind. You drew the dirty pictures!” Exercise 2. Below you will find a photograph of a beautiful bird showing three enlargements of it’s eye. Focus your attention of the image in the bird’s eye. Imagine that this creature is looking at you beyond your exterior “Shell“ and can magically sense any heart felt suffering you might feel either now or previously. Can you visualize your outer reflection in its eye? What do you believe that it might be understanding of your inner self? You are strongly advised to only share this with a person whom you trust. Afterwards, perhaps it might interest you to learn that many internet visitors perceive this bird with human like characteristics. Some actually fantasize sharing suffering with it and find relief. Moreover when they see birds in Nature, it reminds them of their positive experience. Please take a few moments to share how your experience in the following checklist: It looks to be warm and friendly Yes____No____ It seems to very wise like a wizard Yes____No____ It seems genuinely sensitive and empathetic to my inner discomfort Yes____No____ When I share my problems it makes me feel relieved and hopeful Yes____No____ It looks scary to me Yes____No____ It looks comforting to me Yes____No____ Looking at it its eye makes me feel sad Yes____No____ Such birds remind me of death and terrify me Yes____No____ I don’t like my reflection in its eye and it angers me Yes____No____ Next time a I see a bird like this one in Nature I will be happy Yes____No____ Many Professional Therapist May Wish Professional Help While the projective exercises to be offered at this web site may be helpful for reconditioning low level stressful experiences, they are not a substitute for diagnostic/treatment procedures. These are required for the severely traumatized and/or mentally ill. These require direct consultation with licensed clinicians in a web visitor’s own locality. If,after the viewing exercise, material emerges which suggests a need for professional consultation, you may communicate in English or Hindi with Prof. B. L. Dubey, or his wife Padma Dwivedi and Prof.Amool R.Singh at (bldubey@gmail.com or sisdubey@rediffmail.com and sisamool@yahoo. com) and many professional therapist. These web How to Delete Viruses 97

hosts also have available for worldwide internet referral, on a fee for service basis, experts trained in SIS diagnostic/treatment procedures. In addition, training services are available for Yoga and bodymind exercising techniques. Web instructors are also available regarding longevity enhancing Indian herbs and diets capable of enhancing sexual energy, mood and memory. If you have a computer system with a camera, you can use Skype or a related internet service to have a visual as well as auditory consultation. Dr Dubey and Dr.Singh also has access to English speaking cost effective licensed mental health resources in India for treating chemical dependency and mental disorders. No attempt will be made to identify past stressful events stemming from alleged or real episodes of sexual abuse. Even experienced psychotherapists can experience pitfalls in this complex area, as evidenced by the extensive clinical and legal literature on so-called “False memories. Similarly this service is not set up to identify internet subjects who might be experiencing irrational impulses to hurt themselves or others. Such persons require immediate emergency professional clinical local care. Nonprofessional Participation Encouraged An ongoing goal of the SIS nonprofit organization is to gradually make revisions based upon input from nonprofessional viewers. An established model for this is Alcoholics Anonymous (AA). Their program was originally established after the failure of professional clinicians to provide effective relapse preventative care available on a 24 hour basis 7 days a week. Members embrace spirituality through the notion of a “Higher Power”. AA has a support program with no economic barriers or formal ties to any restricting religious/political authorities.. Their philosophy is to use “Sponsors” or mentors who role model sobriety for new members. In giving of themselves, in turn, they receive. What they get back psychologically is the benefit of incorporating additional inner controls for resisting recurrent impulses to drink. Similarly, participants in these web page exercises should experience support in deleting brain viruses and in the control of negative impulses. It is hoped that some viewers who have access to tape and video recorders will record home interviews. These might involve videos of subjects viewing ambiguous pictures presented here. Imagery could be shared in various settings, including other internet sites such as “Blogs” and “You Tube”. By submitting your responses, comments and suggestions for revising this web page, you will be recording your own thoughts for posterity to this interactive internet data bank. What you will be missing by not consulting with a dogmatic authority figure is the magic power of the “Placebo effect” in healing. Of course, for more severe problems clinical consultation is indicated. Illustrative Theoretical Cases 1. Communication blocks in a love relationship: A common example seen in couple counseling involves an individual who is partially blind to his own problems. All communication difficulties may be falsely attributed to the partner. Viewing 31A with human couple content, such as shown below, can result in the same undermining in value of the imagined scene. It can be insightful for such an introspectively dumb person to learn that the negativity projected is coming from within. No one can change another in a conflict type relationship. Each participant in the conflict needs to address internal issues first, if mature communication is to occur. 2. Imagine giving first aide at an accident: Many perceive A2 as reflecting people in ordinary activities. In sharp contrast, imagine that a few days earlier you had assisted at an automobile accident. The victims were family members who had been seriously injured. You heard their screams and gasps for breath. You witnessed their bleeding broken bodies and smelled body odors. You didn’t know who you should first help but you rendered first aide. This included saving a child’s life by giving mouth to mouth resuscitation. After you left the accident scene, you were still confused and so emotionally upset that you vomited. You were embarrassed by your reaction and felt irrational guilt for not having saved everyone. You decided never to share your traumatic experience with anyone – not only your partner you loved! If this had been reality, in all likelihood for several days, traumatic memories and scene specific upsetting images would have intruded on your daytime consciousness. At night, emotionally charged accident scenes would likely have appeared in your dreams. Eventually most of the posttraumatic symptoms probably would be forgotten, unless triggered by the sounds of emergency vehicle sirens. A few years later, imagine that you became clinically depressed after your love relationship failed. The person complained that you never communicated what was in your mind, or expressed your feelings. She had noticed these communication blocks about the time that you had started waking with 98 Cassell et al

“Nightmares”. Since you had never told her, your lover had no idea that your communication inhibitions had been aggravated by an accident in which you saved a child. Due to the severity of depressive symptoms at work, imagine that you were advised to seek professional mental health services. Your psychotherapist correctly noted that your depression had followed the loss. In addition, your family history suggested that a genetic based pattern of emotional repression. However, it was not until A2 was shown that a comprehensive posttraumatic treatment plan could be established. Imagine that you responded as follows: I see a family. There is a father and mother with children. There has been a terrible accident. A drunk driver has smashed into their car head on There is blood all over. I still can hear their screams. Comparable stress specific scenes haunt the dreams of emergency workers, traffic police and in combat veterans. The same applies to the “Nightmares” of children in war torn countries. Most cultures choose to look the other way or actively deny the existence such material by claiming: “That is normal for children to have nightmares. They mean nothing!” Many cultures advocate the myth that masculinity and certain professional roles require denying painful emotions. Consistent with this, traumatic events in children are ordinarily neglected, especially in inner city dysfunctional schools. Yet a suffering child may, in disguised form project his inner turmoil by creating art forms ,or in symbolic sand tray play with dolls or toy human/animal figurines. A SIS psychotherapy approach supplemented by Sand tray educational video is available illustrating the diagnostic/ treatment value of combining these approaches in traumatized children. (The above theoretical case is based on a real clinical case as follows: In 1989 when an Alabama policeman viewed the SIS “inkblot” A2, PTSD imagery surfaced. The colorform structure in the SIS presentation reminded him of an accident scene that he had attended 15 years earlier. He visualized critically injured people with blood pouring out of their multiple wounds and remembered how emotionally upsetting this had been. The next morning when interviewed, it was learned for a considerable period of time he had suffered from PTSD symptoms which had been previously untreated. With the SIS he vividly recalled an incredibly stressful automobile accident that he had attended years previously. A transcript of the interview follows: Dr : I appreciate you coming here and participating in this educational video program. How many days ago did you look at it.? J.: It’s been about two weeks. Dr : Two weeks. We’re going to look at it again and this time we’ll begin by looking at A1 and get your responses and then we’ll ask some questions about your responses. Does that sound okay? J: Sure. Dr : I appreciate that. Let’s go to A1 and see what that looks like for your tonight, John? J: Might it look different than last time? Dr : It might look different than last time, yeah, or it might look the same. We’re interested in really how you see it tonight and if it’s different then you can share that with us. Here’s image A1. What do you see there, John? J: It looks like an image of two sea horses. Those little tiny sea animals facing each other with a glass up the middle. Dr.: And how do you feel looking at that? J: I really don’t have much feeling about that one. Dr : Okay. I know the A2 seemed to evoke a lot of feelings first time around. What do you see here and how do you feel about what you’re seeing? J: That one. I see a man on the left side here. He’s holding on. He’s got his arms out. I see a child here on the right side and the man is trying to reach him, he’s trying to reach the child but he can’t reach the child. He’s going to fall off what he’s holding on to, but he can’t reach the child. Dr : And how do you feel looking at that tonight, John? J: I, that one bothers me. It bothered me before. And un … Dr : In what way did it bother you originally and in what way does it bother you now. What is it bringing to mind? J: It, the first thing that it was an automobile accident that I went to and the father couldn’t get to his kids. Dr.: And when was this accident? Could you tell us about it? How long ago? J: It was in the late ‘70s, I think around 1978. It was, it was pretty hot out that day and. How to Delete Viruses 99

Dr : So it was summer time? J: It was in summer. Dr.: And you were a state trooper Alabama at that time? J: Yeah, I was in the uniform and I was on patrol. I was on the highway and I got a radio call. It said that they needed help. It was a real bad accident. I drove really fast and I got to the accident. It was on a curve. It was a left hand curve in a two lane road and I came around the curve and the first thing I saw was an engine, the front of a car, the frame, and the wheels had been completely torn out of the car. I didn’t know what it was when I first saw it. I mean it was … Dr.: What did you think it was, John? J: I don’t know, I mean I looked at it and it didn’t make any sense. It was just right there in the middle of the road, smoking and there was a pickup truck on my left. It was sitting on the shoulder with the front wheels just touching the pavement. There was a red small Ford product and it was just past the pickup, 50 feet, maybe and it was facing the opposite direction. The pickup’s this way and the car was that way. There was a woman; she was lying on the ground just outside the passenger door. It had been torn open. She was partly under the car and there were two children, a little boy and a little girl. Dr.: What were you feeling at this time? What was your emotion? J: It didn’t make any sense. I got out of the car and I, there was traffic backed up and I just blocked the road to keep people out of there. I told them to get the hell out of there. Dr.: Yeah. J: You know, and … Dr.: It didn’t make sense but did you know what you were feeling as an emotion inside? J: It was overwhelming. They were all screaming. None of these people were unconscious. They were in pain. They were all, oh, the kids were just screaming, they were calling out. The mom, she couldn’t see them, she could hear them. One was lying off in the ditch. They had all been thrown out of the vehicle and they had all been torn up. Dr.: What did they look like? Pretty beat up? J: Oh, God, there was bones and stuff sticking out. There was blood in the hair and I was trying to wipe it out of their faces. I mean it was overwhelming; I only had a little bit of emergency gear and … Dr.: When we talked about it before you said something about a bone in your hand. J: That was after I was trying to do the triage and seeing who needed help first. I went to each of the kids and they were still quiet and trying to move and couldn’t … Dr.: What did they say to you, the kids? J: They were calling for their mom. Dr.: I see. J: And just crying and there was blood running down on their faces and it was horrible and I looked at the dad. I’ll never forget this. He’d not been thrown out of his vehicle. Dr.: So he was still in the truck? J: His door had been torn open. He’d hit the steering wheel and his face had been smashed, really smashed bad. Dr.: What did it look like? J: It was blood. It was bubbly when he breathed. Dr.: I see. J: Bubbles would come out and he’d try to talk and would drool and fall over and he could hear his kids because he, I could make out part of what he was saying; he wanted to get to his kids. And … Dr.: So he was desperate to get to his kids? J: Oh, yeah. Oh, yeah. The poor man could hear them and I went over and looked at the other guy that hit and run into them. He’d hit them head on. There wasn’t even a skid mark that you could see who had hit them. He was going as fast as his car would go. Dr.: And why was that the case? J: He was speeding and, he went around the corner in the wrong lane and these people didn’t ever have a chance. They didn’t have a chance. This guy hit them just hard and the car flew apart and I went over to him and looked. He was an older guy. He was breathing and you could smell booze all over him. He’d been drinking a lot. There was a bottle in the car. Dr: So he was intoxicated? J: Oh yeah. Yeah he was drunk and I left him and I went back to the kids and I wanted to start putting 4x4’s over the open wounds. And 100 Cassell et al

I was leaning in the gravel next to this child and she was crying. Then I started to very carefully pick her up. Dr.: Right. J: I looked right underneath her and I found this bone. Dr. : How did you feel when you saw this bone? J: It was a piece, it was an end of a bone and I knew what it was, it was an end of a bone. My head is hurting, really hurting (grieving tearfully). Dr.: Are you hurting now? J: My head is hurting, I’m sorry. Dr.: What is the emotion that you are feeling now as we talk about it? J: Pressure, really, really bad pressure. Dr.: Have you cried about this? J: No, no. Dr.: You never have? J: No. I told my wife I had a bad accident today. I didn’t want to look soft and … Dr.: Police aren’t allowed to cry? J: There’s people watching and I’m supposed to be helping, you know, I’m supposed to be in charge and it was my accident scene and these people they needed help so bad. It was 57 miles to an ambulance. Dr.: Wow! J.: And I knew it would take almost an hour to get there and I didn’t have enough medical stuff and I didn’t know where to put the bone and I didn’t know whose it was. There were three people hurt there and there was some chips and stuff I didn’t know. Dr.: You didn’t know what person it was? J: Yeah. I didn’t know what to do with and finally I just I put it with them and left it with the child. I thought it might be hers. And I went to the mother and she had crushed her pelvis and she’d broken both legs and both fingers were broken. Dr.: What was her psychological condition? J: She was crying. It was really, really painful, her injury. The only way I knew to make the pain stop on her femur was to put on this air traction splint. Dr.: Right. J: And I was scared to put it on her because of her pelvis and I thought I might kill her. Dr.: Yeah. J: If I pulled the traction. Dr.: What a horrible thought. j: Well yeah and I didn’t know what to do after that. She just, I just had to leave her lay there. She couldn’t see her kids because she was laying on her back and her children were behind her, but she could hear them. Dr.: Um, huh. J: She was crying and the little boy he was the farthest away. Dr.: What’s your head feeling like now, John?: Pressure, hurts. Dr.: Do you have any other feelings like in your throat or chest? J: I just can’t catch my breath. Dr.: That’s right. J: I’m sorry. You can cut part of this out, can’t you? Dr.: You’re doing fine. So then what happened? J: I got out the supplies I had and I started with the bleeding. I knew I had to get the bleeding stopped on all of them. And then I put big bandages and these big triangular things on them and on one of these bones that poked out. And then these kids they didn’t want me you know, they wanted their mom. They could see me. Dr.: Were they frightened by your help? J: No, but they would try to reach and yell for mom and say “Mom.” Dr.: They were calling mom. What are you feeling when these kids were calling their mommy? J: It just broke my heart. These poor little things and what the son of a bitch had done this to them. Dr.: You felt sadness and then rage toward this … J: I was angry at this man for what he had done and these poor little kids. My little baby was her age too, they were close in age. Dr.: It was cruel. J: Yeah, and I thought it was and then. Dr.: You need to cry if you can cry. You might as well let it out because don’t you feel that pain now? How to Delete Viruses 101

J: Yeah. I feel real self-conscious too. Dr.: Okay, you got it. So then what happened? J: I was the only one that had EMT training and I was trying to do all four of them : Oh, that poor man. And I didn’t have enough equipment I mean, I just. Dr.: You felt helpless in a way. J: I couldn’t do what they needed to do in that period of time. I mean, Dr.: Have you felt guilt about that, John? J: No. I never really thought about it. Dr.: You never dealt with it. J: I needed to do more and I couldn’t do more. Dr.: Um huh. J: And the ambulance finally got there. Dr.: How long was it before the ambulance got there and you went through this suffering with the kids? J: Oh, it was almost an hour before they got there because it was a volunteer ambulance. They had to all run down there and drive 40 some miles and then they weren’t that good EMTs. They just kind of wanted to shovel everybody up and there was just blood everywhere. There was just so much blood I didn’t think those kids had enough blood in them and the father, his shirt was sopped with blood. His teeth, his teeth were gone. Dr.: It was a mess. J: And I kept thinking God, what if he dies or if he stops breathing. I didn’t know how to do CPR because he hadn’t nothing left to support it. Dr.: Right, right. J: I just knew he was going to quit breathing before we could get an airway there. I didn’t have an airway for him, but he didn’t. I just kept trying to talk to him and running back to the kids and. Dr.: You were desperate? J: Yeah and at the time it took forever for that damn ambulance to get there. Dr.: So it seemed like a year waiting? J: Oh my God and these people kept coming up and wanting to gawk at this shit, you know. Dr.: How did you feel about the spectators getting involved? J: I finally told another cop who eventually arrived to tell them to get the hell out of there and if they didn’t see it they were to go and block both ends of the road. II didn’t want anybody, anybody coming up to those poor kids and the mom and dad. They weren’t something to be gawked at. Dr.: So what happened after that? J: I didn’t have enough blankets for them, I think I only had three, yeah, I didn’t even have enough blankets for them. Dr.: It’s hard for you to cry even now isn’t it? J: Yeah. I don’t know. I don’t really want to cry. Dr.: Why? J: I don’t know, I just… Dr.: It’s hard to cry. You need a cry. What about what happened from then on? J: We picked them up. We couldn’t get them all in the ambulance; we had to stack them because it wasn’t big enough. The kids never, never were unconscious, never. And I wanted to, I wanted them to stop, to stop crying. Dr : So after the scene was cleared and all, what were you feeling because you must have a lot of thoughts and feelings about it there for a while. Dr.: You were still pretty angry at the drunk driver? J: Yeah and I was angry. Dr.: What was the anger like at that point? J: I thought they were going to die. I thought those kids were going to die. I thought maybe even the husband would die. Dr.: Um huh.

Let’s take a coffee break shall we? Dr.: We took a little break here, John and you were telling me about the little girl. Your feelings, could you share them again, please? J: I hadn’t thought about it very much. I don’t like to think about it, the one. Dr.: It’s painful isn’t it? But what do you remember? J: When I close my eyes I can smell, I can feel that heat off the pavement and blood. Blood has a special smell. Dr.: Yeah. Keep your eyes shut and just tell us about the smell of blood. What is it like? 102 Cassell et al

J: It’s kind of, it’s a sickening odor and the pavement was hot, really hot and when I picture it in my mind I see my daughter who was almost a year old at the time. I see her. She had the same brown hair. Dr.: It brings images of your little girl to mind. Tell us more about that, please. J: I see. I mean she didn’t look like my little girl, but that’s what I feel like is lying there, is my little baby is laying there. Dr.: How would you have felt if it had been your baby lying there do you think? J: Oh God. I probably would have wanted to hurt him in some way… I mean this little child just didn’t deserve this and. Dr. C: Okay, John. Let’s come back to what you’re remembering and how you’re feeling and like … it’s sort of an interesting thing, you know this has apparently been buried for thirteen or so years and the video brought it out. Does it puzzle you how that could happen? And there it is, it’s like it’s today (Pointing to the video monitor.) J: It’s so sad. Dr.: You feel a lot of sadness looking at it? J: It hurts… yeah. Dr.: Can you see expressions on the people’s faces? J: He looks desperate, like he’s clinging to it and he is going to lose, he’s going to fall. Dr.: Yeah. J: And he can’t quite touch him, he just can’t quite reach them. Dr.: What about the child? J: The child is hanging on. The child is reaching. I see him reaching but they can’t touch each other, they’re separated. Dr.: So what does that symbolize? J: That’s what, that’s the car, that’s the man who’s sitting in the car, to me. He’s trying to reach his babies. Dr.: God, he must have felt awful. J: He was crying, too. Dr.: I bet he was. That’s the stuff nightmares are made of. But that was real life. Did you ever dream about that, the accident scene or did it ever come back to you any other way. J: It came back. The time it hit me the hardest when I was connected with another case that I was involved in. And it was so sad. Dr.: How many years after was this other case? J: I don’t remember. I was still at the same post. I was still stationed in the same place. Dr.: So it was in the same general two or three years. And what this other case that came back and reminded you of the first case? J: I got a call and all the call said was that there had been a drowning. I went over there….I asked somebody where the body was and they said it was in the house and it was this little shack, the house. There were people in there and these people were crying. And there was a little girl (Grieving more profusely) Dr.: You need to cry, John. J: I’m trying to stop. Dr.: You need to cry, John. You need to let it out. So what did you see, there was a little girl? J: This little girl was lying on the table, the kitchen table. She was so small. Just a little thing. And she was so quiet. She wasn’t moving. Dr.: How did you feel when you saw her body? J: She was all wet and there was stuff in her hair. And I started trying to pull things out of her hair and stuff. Dr.: What was it that you were feeling when you were trying just to clean her up? J: I wanted to cry, to just bawl. Dr.: So you were feeling great sadness? J: Oh, it just tore me up. Oh it was so sad. She drowned in a mud puddle for God’s sake. She drowned in a mud puddle! Dr.: Senseless! She got cheated! J: She did. And she was getting cold. I wanted to get mad at this mom and dad because they hadn’t watched this child. They’d let her play and she drowned in a God damn mud puddle. Dr.: It’s an outrage! J: Yes. And you couldn’t be mad because they were crying and. Dr.: Yeah. You had your police uniform on, too. How did that affect your having feelings about this? You thought you had to play a role? J: I had to be strong. I was the only one there. How to Delete Viruses 103

Dr.: So you had to be strong, in spite of your grief. J: I had to take charge. I had to do things. I had to try and interview these people and then I had to carry this poor little baby to the airplane with me. Dr.: When you had her in your arms, how did you feel? What was the grief like? J: I had to take her away from her dad. He didn’t want to let her go. Dr.: What was his emotional state at that time? J: He was crying. He was holding on to her. I said I have to take her. I have to take this child with me and he wanted to keep her. Dr.: How about the mom? J: She was screaming and crying and wanted to keep the baby. Dr.: It was terrible. J: I had to have an autopsy and finally I had to just pull and say “I’m sorry, I’m so sorry.” Dr.: You had to tear the baby away from the dad’s arms. And you felt guilty? J: Oh, yeah. I didn’t know what to do. He was just devastated. Dr. C: Yeah. J: So I carried her out wrapped her in a little blanket. I wouldn’t go to her autopsy. I just couldn’t see that little … Dr.: One of the saddest things I ever saw in medical school was a child on an autopsy table. It was awful. J: I couldn’t stand the thought of it when I was supposed to go; I told them I couldn’t get away. I’m supposed to go. I’m supposed to do those things. I’m supposed to see the case through all the way to the end. I just couldn’t see that baby cut up. Dr.: How were you feeling when they were insisting that you go to the autopsy? J: They said Okay. Make it if you can make it. I said I had so much investigation to do and lied to them and I just could not face … Dr.: Were you thinking about your own little girl at this time? J: Oh yeah. Dr.: Tell me about that would you? J: She’s … It just scared me to death. I thought my God, this is my baby here and. Dr.: It was hell for you wasn’t it? J: Oh God, I called the dispatcher and I couldn’t talk to her. She thought something was wrong with me. Dr.: Policemen aren’t supposed to have feelings, right? J: No. And I just had to say “I’ll call you back.” I breathed really deep and tried to get calm and then I called her back and she said, “are you all right?” And I said, “No, I’m not all right.” Dr.: You weren’t all right. You haven’t been all right since. J: I said, “I’ll do this and take care of it…” Dr.: This has been part of your unconscious all these years. Because if you don’t react and cry, the grief it just stays in. What way did this second accident bring forth images of the first one; can you tell us about that please, John? J: These little kids are so helpless. I just think that somebody needed to be there protecting them. And that somebody failed. Dr.: That’s right. : I couldn’t get there fast enough for this drowned little girl to help her…And nobody knew what to do. They might have been able to save her and they didn’t even try. Dr: No CPR available. J: No, nothing. She was just lying in a puddle of water around her and on the table she was so quiet. Dr.: In what way did this episode remind you of the first one that we talked about earlier with the accident on the highway? J: Just think of a child that’s hurt and I had to take her away from her dad. : And I wouldn’t want to let my daughter go. If something happened like that I’d want to keep her and think something good will happen and she’ll come back, you know. Dr.: Yeah. J: I couldn’t, I couldn’t do that.

If some one was taking my daughter I’d have to fight. Dr.: You love your daughter a lot don’t you? J: I’d want to keep her so bad, to protect her from those kinds of things. Dr.: So what would it be like at home the night after these episodes? Let’s talk about the accident scene. How would it be at home with your wife after one of these accidents? 104 Cassell et al

J: I had blood all over me so she knew something was wrong when I came home. It was just all over me. I didn’t even wash my hands. There was blood all over me and I had touched my face and she knew that something really bad had happened. And I just didn’t even want to talk about it except to say it was a really bad, bad, accident. Dr.: How do you mean you didn’t want to talk about it Mike? J: I just didn’t want to think about it any more. Dr.: You wanted to push it out of your mind. J: Oh yeah. God those poor kids Dr.: Very painful. Did you dream about that any time do you know? J: I might have. But never the whole thing. It was always. Dr.: Just fragments? J: I’d see my kids. I dream sometimes that my children are hurt and sometimes keeping me, like you know, your legs are heavy. Dr.: Right. J: You want to get to them but I can’t get to my kids. Dr.: Right. You feel terrible panic right? J: Desperate you know. I want to do something and I can’t. Dr.: Would their image change to remind you of this accident somehow? J: Oh, yeah. I’d see it was like the same smell. I would even smell it in my sleep. Dr.: You’d smell the blood? J: Smell that smell that you get from people bleeding, that need to have, their gasping and stuff. Dr.: And so you smell and the sound. What about the vision? What would you be seeing of the accident scene? J: That piece, that car. Dr.: That piece of the car? J: The blood, the tears, the kids were crying and blood was running down their faces and keep bleeding. Dr.: That would be in your dream? J: Oh, I can see blood on them and it would be my little girl. My little girl would be there. Dr. You’d see your little girl? J: It would be Sandy (His little girl). Yeah my little girl would be there. Dr.: And how would you feel in a dream like that? J: I’d wake up all sweaty and just scared really. Scared that I don’t want to let my kids go. I don’t want to let them go out by themselves. Dr.: You’re very protective of your own kids? J: Oh yeah, it scares me to think of the violence in Alabama schools…so many kids have weapons here and you hear about school shootings across the country! Dr.: Oh yeah. J: But I know I’ve got to give them some freedom but it just scares the hell out of me if I’m not right there where I can protect them. Dr. : How about the accident, the drowning accident? How did you feel on the night after that one? J: That one I cried. Dr.: It’s good that you cried. What were you feeling and thinking about? J: Nobody could see me… I was holding this little baby in my arms. I didn’t want, I couldn’t put her in a body bag. I was holding her… her eyes… I was crying a little. I was trying not to cry because I didn’t want to look…. Dr.: You had your uniform on and you were concerned…so that night what did you feel when you were home? J: As I recall I just went to bed. I just didn’t want to think about it. I wanted to sleep. I just wanted. Dr.: Did you dream about it? J: I thought about that when that image about coming into the room and seeing that baby for the first time she’d have leaves and stuff in her hair. Dr.: That image would, of the baby with the leaves in her hair, would be in your dream, would it at times? J: Not in a long dream that I would see. I can still see the road and I would, that what I would see that in my dreams but it didn’t fit in with the mud puddle. It would just be, a dream where I would see this child and I’ve never been able to forget it. I mean, I’ve seen so much death over the year, that never comes back. Dr.: Right. A death of a child is different. How to Delete Viruses 105

J: Right. You know I cannot go anywhere after that to SIDS to. Dr.: Yeah. J: I’d call up another trooper and when I got one and I’d say look, its too sad Dr.: It’s terrible. Yeah. J: I didn’t want to, you’ve got to take the babies from the moms and dad and I just could not do that anymore. Dr.: How long would these dreams continue on either dealing with this first accident or the second or any of them? J: Well, they’re not real frequent. It seems that they’re always there in the back of my mind. When I see a child hurt, they all of a sudden come back to me. Just like it was yesterday. In fact I think I could draw that accident scene. Dr.: Just like it was yesterday. J: Yeah. Dr.: You know, in your unconscious yesterday is just like today and last week is just like today, last month, last year, 10 years ago is just like today if it’s not processed. I’ll ask you one other question. Aside from dreams would these images come back like if you were conscious, if you were awake would they come back at times, you know? J: I see children. Dr.: Tell me about that please? J: I see children. When I am up at the hospital and I hear children crying. Dr.: Yeah. J: In a room. I got to get away from it. I can’t listen to it. Dr.: Right. How do you feel at that time? J: I feel that they’re helpless. They’re beating on the door saying “Don’t lock me in, don’t lock me in.” Dr.: Yeah. J: I can’t. Dr.: You feel all that stress. J: I can’t stand to be around it, it hurts. Dr.: We appreciate your courage in sharing. I wanted to ask you now can you recall the image that bothered you most on this series? J: That was it, right up here? Dr.: That’s A2 right? J: That one. Look at it. You can see his head. You can see his feet here and his arms clutching (Pointing to the video monitor) Dr.: Yeah. Very vivid. What was the one that bothered you next in order do you know? Do you remember? J: I’m not sure which one it was. It’s been a while. . Dr.: Let’s then do this. Shall go through and any of these that both you … any on this first page on the answer sheet? J: The baby A4. Looks like a baby in a papoose like back pack. Dr.: Right and how do you feel about looking at that baby then? J: She looks safe. Dr. What about the next page? J: The hand. A13. Dr.: Now what do you see in that? J: This is the man trying to reach out of his truck. Dr.: The man is trying to reach out of his truck. So that’s the accident scene in twelve years ago that you’re seeing? J: Yeah. Dr.: How do you feel when you look at A13 this morning John? J: I see the man in the pick-up truck and he’s reaching, he’s reaching out for his children. And he couldn’t get out of the truck. He couldn’t get out because he was so broken up. He, his hand was reaching for them like it was that day, that afternoon. He can’t go any further. He’s going to lose; he’s going to fall back. Dr.: What do you think he was feeling? J: He was so scared for his kids and not himself. You know, he never asked me about himself at all. He just. Dr.: Not once. J: Not once. Not once. Just where’s my babies? Where’s my kids? Where’s my little girl? And it was hard to understand because of all this stuff in his mouth and I’d have to get right next to him and he could, the blood was bubbling, and you know blood makes big bubbles when it’s coming out of the mouth. But I knew what he was saying because he kept repeating the same names. 106 Cassell et al

Dr.: His wife as well? J: Oh yeah. At one point at the beginning he couldn’t hear or he didn’t know, he thought they were dead and I said, “No! No, they’re not dead.” I said … Dr.: So he was reassured when he heard the screams? J: Well, he said he wanted to get out and be with his kids and I said “you can’t, you can’t move. I’ll take care of your kids. I’ll take care of them.” Dr.: What about your responsibility at this point? What do you think you were feeling and what are you feeling in relationship to looking at this and remembering this at this time? J: It’s so sad to me. It’s just … Dr.: It’s sadness, right. J: It’s just, it hurts to see. I know how he would feel. I know that’s. Dr.: How would you feel being in his shoes and … J: It’s the kind of image where I can’t quite get through it. I can’t quite reach the goal, to give the help I need to give. Dr.: When you can’t reach through in those dreams how does it leave you feeling? J: Scared! Really scared! You’re dreaming along and wake up and … Dr.: Your heart is pounding? J: Oh, yeah. It takes a few minutes you know, a while before you realize where you’re at. Dr.: You must feel inadequate in those dreams. J: Oh yeah. I can’t reach them. I never do reach them. My legs won’t go fast enough. I’ve gotten up and I’ve gone to look at my kids. I used to have a horrible time sleeping when my babies were less than a year. Dr.: Yeah. J: Infant death, I was petrified that my kids and they would always tell me. Dr. 30A was upsetting and what did it remind you of, John? J: That’s a skull. That just, to me that represent danger and it represents death. You know, just a scary image. Dr. So when you think of death and you look at that, what does it bring to mind? J: It is sort of like something I see kind of hovering, you know. It’s not, it doesn’t have a face with it or people. For people it’s death. It’s an adult. An adult. To me it doesn’t look like a child. I don’t feel sadness when I see it. Dr.: It’s a lot worse to see a child die. J: Oh God, it’s bad! They haven’t had a chance to live! ) Plea for Patience and Tolerance Perhaps your brain has already been psychologically damaged by negative messages from oppressive figures. Realize that every person has both good and evil inside. Please try to activate the positive decent side of your character. Gain self respect by resisting any impulse to hack into this web page with destructive computer viruses. Also kindly restrain from e-mailing abusive comments to other participants. Consider submitting constructive suggestions for correcting or revising what you may consider erroneous material. When challenged by new information foreign to one’s own belief system, becoming angry is understandable. Being destructive is not! Interpreting the black and white symbolic patterns posed by a language’s alphabet (i.e. the psychophysiology of reading) enables you to peruse the minds of others whom you have never met. This amazing and scientifically ill understood bodymind activity allows one to transcend time and space. You can acquire insights into the thoughts and emotions of dead individuals whose brains have now turned to dust. Introspection Inner mental life is complex and mysterious. Peering beyond the external “Shell” into the “Inner reality” can present illusive images and confusing perceptions. Most individuals conceal what is inside by presenting a social façade or persona to the world. This defensive shield may in turn obscure introspective views. Civilized humans have the capacity for good, yet even for such positive people primitive impulses giving rise to a dark side or “Shadow” lurking within. Remember that these can be projected onto your image of others. Such mental deception can serve as a rationalization for blaming them and falsely justify aggression. The visualization exercises in this web site can be a growth exercise to modify negative belief systems. It is challenging to learn to see with your own eyes, in order to independently judge what is true. It requires acquiring perceptual skills early in body-mind development. Everyone can learn how to reappraise irrational and superstitious viral like beliefs programmed into their brain’s hard drive by How to Delete Viruses 107

early life figures. A child’s nervous system records biased information long before neural maturation permits independent judgment. It requires maturation for a child to stop believing erroneous viral input to ones brain’s hard drive such as: “That if I swallow a watermelon seed, which a watermelon will grow in my stomach”. Reviewing Posttraumatic Stress Disorder (PTSD) As indicated earlier, it may also be a challenge to weed out, rethink, and emotionally recondition severe traumatic memories. These result from stressful life experiences which result in intense fear, helplessness or horror. Under these conditions the stress specific imagery is recorded in neural memory centers more vividly than other life experiences. These records tend to intrude into daytime mental activities in a recurrent disruptive fashion - often for years. In the initial posttraumatic period, this imagery tends to appear almost nightly in the form of recurrent “Nightmares”. These involve a recurrence of the original intense disturbing emotions linked to images depicting the trauma., In the daytime. awareness of such material may be triggered by external or internal cues that represent directly, or in symbolic form, the original stress. These can surface as intrusive distressing recollections which have the capacity to be distracting and disrupt concentration. With severe trauma they may be associated with concurrent image specific illusions and/or hallucinations. In this disrupted body-mind state. some persistent aspects may tend to be more reasonably categorized as “Body” than “Mind”. A victim may experience confusing impulses providing internal pressure to experience stress specific body sensations and/ or motor impulses. In such a state the individual may tend to feel or act as if the traumatic event were recurring. There may be hyper vigilance, irritability and an exaggerated startle response. In a more scientifically observable way, attesting to the reality of persistent biological changes, various clinical studies have detected ongoing alteration in body functions. Examples of this are investigations measuring the physiological correlates of nervous system arousal during experimental conditions, in which the victim is asked to view a photograph ,or drawing pictures, bringing to mind traumatic imagery. As a defensive inhibitory maneuver, there is often persistent avoidance of stimuli associated with the trauma and the onset of a general numbing to environmental situations. Such an individual may try to avoid conversations about the trauma or specific activities, places or people that arouse recollections. There may be inability to recall important related information and a general deadening of emotions. Eventually, many of the disturbances tend to fade as the natural pacifying aspect of sleep reconditions the emotional linkage of the recurrent imagery. In the burned out phase, their emotional residual may be felt only occasionally in the day. At night, there may only be rare sleep disturbing dreams containing disguised symbolic representations of the original stressor. Conceptual Model As indicated, following severe stress certain individuals are predisposed to suffer PTSD. A cluster of symptoms develop which are well documented in diagnostic manuals and internet search engine. The SIS system relates to these through the common thread of the traumatic matching SIS stimulus serving as a projective “inkblot” with sufficient structure to mimic the original stressful scene. The SIS-II video/computer monitor version initially presents a series of 62 flowers which are moving in a direction to produce a hypnotic state of altered awareness. The viewer senses being pulled away from the current time/reality setting the bodymind stage for the surfacing of PTSD imagery. The opening phase includes audio instructions indicating how to report responses on an answer sheet. These are stated in a hypnotic fashion with suggestions to “Relax” further augmenting the trance like projective experience. This methodology was designed specifically to replicate the solitary aspect of dreaming and to circumvent day time brain inhibition. These viewing conditions activate PTSD imagery for reconditioning with healing nature scenes. It also permits the individual to clarify confused and distorted thinking that always occurs during the stressful period. It is important in the use of this projective treatment approach to emphasize the critical importance of the artificially created the time-space dimensions. Instantaneously after viewing a stress releasing SIS “inkblot” one of the original flowers appears for a few seconds. During this period, the “afterglow” of PTSD imagery lingers in consciousness. Concurrently the specific stress bonded neurons which originally recorded traumatic memories in the brain’s memory circuitry such as the hippocampal region are activated recapitulating the neurophysiological state of the original stressor. The presence of detoxifying neurotransmission chemicals, triggered by floral visual cortical stimulation may then begin to wash out of the stress linked neurochemical binding to the PTSD memory neurons. 108 Cassell et al

At the end of the viewing procedure and to further reinforce the desensitization process the SIS presentation is concluded with the calming nature scenes accompanied by the comforting sound of Pachelbel’s “Canon in D”. Subsequently to further facilitate the PTSD- chemical unbinding, the procedure may be repeated until PTSD symptoms gradually subside. Moreover, for greater therapeutic augmentation custom made viewing systems for a particular individual may be designed. These can solely employ the SIS “inkblot” which most effectively triggered the release of that particular individual’s PTSD imagery. This recapitulates the natural healing process of recurrent PTSD dream imagery. In the untreated state, repeated experience of PTSD dream imagery under gradually lowering levels of neurophysiologic arousal naturally has restorative effects. Eventually in recovery, the original stressful scenes may be replaced by less threatening dream symbols. For example, on victim of PTSD initially had vivid “Nightmares” of an actual explosion in which serious injuries were sustained. Eventually with SIS treatment this imagery was replaced by occasional low anxiety dreams of the microwave malfunctioning. For maximal therapeutic efficacy, the SIS approach is best complimented with brief cognitive therapy correcting stress engendered irrational thinking. While suggestive of the diagnostic/treatment value of the SIS technology, such individual clinical case histories need to be more rigorously examined in cross over controlled statistical based trials. Until the latter become available no real legitimate claims may be made about the potential therapeutic efficacy of SIS technology. Biases of This Web Site The views here represent biases of the web designers. Implied is the notion that examining earlier belief systems and stressful memories, using a biologically maturing brain empowers cognitive and emotional maturity. Tragically enough, many unfortunate souls lack the basic brain power for achieving this idealistic sounding goal. A restricted dependent role may be their only option in life. Others may not be able to achieve an independent life style for lack of education, poor socioeconomic conditions or for living in an oppressive culture. It may be safer to conceal what ever level of independent thinking that they are able to achieve, while overtly subscribing to repressive rules. Humans only represent a small percentage of the creatures living on the planet earth. While this internet site focuses on human to human imagery, it recognizes the potential of behavioral studies with animals. Web visitors with pets may be familiar with communication studies suggesting that certain higher forms of life have consciousness and emotional feelings. Many higher forms can recognize and respond to a large number of words and non verbal cues. Sometimes in hospital settings the introduction of an animal may bypass communication blocks experienced by even the most withdrawn patients. Please respect those who have a reverence for animals and reflect this in their projective responses. Humans need to learn how to communicate and appreciate living creatures more for their “spirituality”, than their bodies as food. Individuals, who abuse animals in real life, reflect this in their SIS imagery projected onto disguised animal content in ambiguous pictures. Such people are prone to violence and need help. Visions, Dreams & Spirituality Many modern scientists are uncomfortable with the vagueness of the term “Spiritual”. To them, nothing exists in reality except those things that can be proven by combining intelligent logic with observation methods of scientific technology. They are reminiscent of the character “Spock“, in the television series “Star Wars“. While Spock’s intellectual presence in the plot was valued, often his blindness to emotional life made for vulnerability. This web page is open to the illogical and unscientific notion that there is more to the universe than can be proven by the standard quantifiable methods of science available to the human brain. It is hoped that SIS technology may provide an approach which more effectively bridges the methodological gap between science, philosophy and religion. Historically, religious leaders have long considered visions and dreams to represent symbolic communications from the deceased and/or “God”. Perhaps the SIS projective systems for accessing inner space may tap into the same spiritual symbolic stream. Identity Theft A child or adolescent who never had positive parental figures may only develop a vague personal identity. Later in life this person is easily taken in by authorities who maliciously wish to use their robot like energies. The invasive power programming viral instructions into a vulnerable brain can easily undermine independent thought. This can be done subtly, so that the victim fails to realize that a major identity theft is occurring. Moreover, in the absence of insight the robbery may be associated with apparent positive feelings and the power derived from the new identity facade. How to Delete Viruses 109

The transformation may feel positive emotionally, since the robbed person does not have to face up to the existential anxiety always associated with independent mature thought. There also may be the emotional support of group participation reducing isolation and loneliness, so often experienced by the socially inept. In addition, there may be the acquisition of new powers associated with those possessing the group’s identity. Of course such apparent benefits may only be illusionary, as demands are made by the external forces exerting mind control. Adolescents developing self awareness needs to defend his/her brain from those who would peal layers off their self image and attempt to paste to substitute fraudulent ones. False images may be recognized in that they often have similar characteristics. The viral imagery projected by an external authority may depict a loving supportive parental figure, either male of female. Since most authority figures are men, it usually is the former. Many can be a tempted to regress in their fantasized relationship with powerful figures. There is almost a universal unconscious wish in all people to be cared for as in childhood. This wish can surface at moments of stress. For an immature individual, who may have never experienced proper nurturing in childhood; this temptation represents an ongoing state of vulnerability, - especially if drugs and/or alcohol are available to anesthetize painful thoughts and emotions. The imagery depicted in modern television, films and electronic games tends to be more and more related to escapist sexual/aggressive fantasy than the real world. Clues for Recognizing “Wizard of Oz” False Images There are many ways to recognize viral input containing omnipotent imagery. The most fundamental way for authority figures to deceive their basic animal nature and human vulnerability is to mask their own biological existence. They can do this by wearing clothing symbolizing superstition and power. Their various costumes and power symbols may communicate nonverbal messages implied by the authoritarian actor playing the nurturing parental role. Image generating visual stimuli may be presented in public places and modern media supporting subliminal and overt sexual symbolism. The setting can also be used to manipulate the naïve. Powerful figures may chose to address their followers from a high place overlooking a crowd. People in such situations may be lectured for hours until their fatigue overcomes their judgment. They may be subjected to mind controlling visual techniques. A skilled orator can use dominating eye control to infiltrate hypnotic like suggestions. There may be the use of other symbols of power. The political actor might create imagery surrounded by the trappings of modern warfare. Such an individual might chose to supplement the parental supportive image with cues suggestive of threat. Here the message may be “If you do not obey, you will be punished”. Religious leaders may do the same by threatening punishment in “Hell”. The potential candidate submitting to mind control usually has to accept that the goals of the leader are in the best interest of patriotic causes. For religious organizations it may be contended that it is “God’s will”. The novice may be asked to perform certain behaviors which unmask their sense of biologic identity. A basic one involves instructions to change their appearance. They may be asked to cut off all their hair, grow beards, or become tattooed with a group symbol. They may have to adhere to rigid rules for diet and daily physical routines. They may be requested to starve for periods of time. In celibate religious orders the prescribed rules may involve denying all erotic feelings and sexual expression. The organization may also demand wearing depersonalizing group clothing and/of uniforms. They may be asked to give up physical objects of a personal nature that serve to remind them of their past life. They may even have to give up their name and accept a new one assigned by the group. In the indoctrination phase they may have to avoid conversations with family, friends and other novices. Eventually their loyalty may be tested by having to perform acts which would be unacceptable to them previously. For example, they may show acquiescence to a higher member in the group by washing the dominant person’s feet. In some inner city areas to join a street gang, the leaders may demand that the new comers be initiated by committing criminal acts. Curiosity, Humility & Reverence Scientists have acquired much information which might be helpful as a travel guide. Yet there are present day limits to basic knowledge. Beyond this there are many uncharted areas. This void highlights the need for adopting humility and reverence in this fantasy journey into the inner world. Present scientific terminology is totally inadequate, as are the concepts and methods of investigation. Probing the depths of consciousness is analogous to planning a trip into outer space, by means of an imaginary vehicle, to an ill defined destination. 110 Cassell et al

Proposed Travel Schedule into Inner Psychic Space Here the fantasy “travel schedule” into inner space involves initially inspecting pictures with various degrees of color-form connotation. Next the “traveler” will be first invited to share personal impressions and feelings in regard to the imagined scenes for “The most favorite” and “The least favorite” picture. Then an opportunity will be presented to review the subjective experiences of other internet viewers, who have already volunteered their trip experiences. The next step is strictly elective. It should be taken cautiously with a great deal of reservation, if at all. Participants who so elect to do so will then be able to communicate directly with those responders who wish to. Perhaps communicating with them directly could further assist you in comparing your perceptions, and feelings with theirs. After multiple contacts and internet discussions, motivated participants should gain a degree of insight concerning what brain records distinguish them from others. This could provide assistance for introspecting and judging what mental content warrants keeping, as opposed to deleting. This exercise can assist in modifying mental characteristics in many ways. Each person’s brain is genetically unique, as are his life experiences. Consequently one’s inner world will necessarily differ from those previously programmed into immature neural memory centers, without voluntary screening. Most children have these external information implants from family, other early life associates and their region’s culture. These days the international media as well as electronic games can also impact the brain’s memory storage. Although the neurochemistry is not as yet understood, games of violence implant particularly toxic viral distortions. For some players this has a numbing effect reducing their capacity to empathize in real world situations. Unfortunately in the real one, many deranged people get arousal and pleasure from sadistic behavior. Such malignant and confusing linking of sexual-aggressive impulses material can be reflected in the characteristics ascribed to ambiguous human content. Yet a sociopath can deceive even professionals by falsely reporting positive imagery. This extreme example is included as a warning. Never agree to visit in person anyone that you have met in this exercise. If money becomes an issue, beware. The current worldwide economic downturn may relate to white collar sociopath criminals can masquerading as honest bankers, hedge fund operators etc. Invite Web Visitors You Know and Trust For more personalized childhood comparisons purposes, another step in might further facilitate growth. As a suggestion when practical, consider inviting as possible participants others you know in real life. These might be family members and others, who you suspect may have colored your early beliefs. Perhaps you might inform them that their participation in this internet exercise might be helpful. If available, this information then might enable you to compare, not just with strangers, but also with those who configured your developing brain. Remember if you are under eighteen, it is mandatory that you obtain permission from them. Learning to identify your personal thoughts and emotions is essential for developing personal identity, autonomy, and psychological maturity. Without such inner psyche foundation, many such individuals only masquerade as robot like characters. Each represents the shadow of a human being, housed in the shell of an apparently mature body, but missing solid identity. As indicated such people are particularly vulnerable to having their inner self stolen by outside forces. It is important to recognize that not everyone needs an extensive social network, or adheres to authority figures’ propaganda in order to have a positive life. Some of the world’s most brilliant people have lead isolated lives, totally committed to their chosen field of expertise. The ability to enjoy solitude for such gifted people can serve to optimize their potential. A fundamental step towards maturity involves identifying your own body as a vulnerable personal physical space. You reside in this ever changing vessel on the ocean of life. Realize that it will go through a series of genetically programmed transformations that is largely beyond your control. Learn how to best take care of it. Optimal mental life depends upon good overall physical fitness and a healthy toxin- free brain. Keep in mind that your body is the only one you will ever have. Try to be realistic in your life plans. For example, you may be outstanding in a particular sport such as basketball. However, if you are not unusually tall, forget fantasies about a professional career. Remember too that it will slow with age. Even with organ transplant surgery, some day it will stop functioning. Likely this will be in the distant future, but its demise is inevitable. Afterwards your survivors may either burn it and scatter the ashes, or place it in a coffin to rot away in the ground. If you are an optimist, you may expect that the earth’s future involves restoration of the atmosphere, How to Delete Viruses 111

resolving global issues involving sanitation, infectious disease, population control and so on. If you take care of your health, you may expect to expand your horizons. The Inevitability of Death Below is the last SIS stimulus that you will be given the opportunity to view. Please record your impressions and feelings as you did on the first five “inkblots” Unforeseen events of a negative nature may occur. Modern international news in the media provides a sobering summary of potential lethal pitfalls. Many aggressors are energized by primitive impulses. Civilization has historically been fragmented by wars. As a civilian you may think that you own your body, this may not always apply. In wartime, the government may seize control, regardless of your political views. Maybe the biological vessel that supports your psychological and spiritual existence will be vaporized in a nuclear blast, infected with lethal germs or poisoned from chemicals of modern warfare. Whatever its fate, its remains will likely ultimately provide nourishment to simpler life forms. Eventually these too will die. Then the trillions of drifting inanimate atoms which previously gave you life will be set free to once again wander about the universe. Where will you be? Thinking about the inevitable can be uncomfortable, yet sobering. Most individuals in their daily activities choose to avoid such unpleasant thoughts. People frequently delude themselves though mental denial mechanisms that make them feel invincible. Many get mental highs from neurochemicals released in the brain by flirting with dangerous adventuresome activities. Yet mental invincibility does not equate to physical invincibility, so play it safe. Death is a one way trip that some day everyone takes. Why not postpone it, so you can have ample opportunity to achieve the best the life style possible for your particular cultural and socioeconomic situation? While it helps to have health, money, status and power, keep in mind that these advantages do not always bring happiness. When your brain stops functioning, your spirit will be set free or be forever extinguished. Your preprogrammed religious beliefs will determine what you imagine will happen. No presently living sane person has ever crossed the border into death long enough to return, and explain what it was really like. Yet in your mind, probably you already may have some preconceived notions. These in all likelihood were derived from your past exposure to your culture’s particular religious authorities. Throughout history religious ceremonies and doctrine have provided spiritually oriented souls both socially useful behavior guidelines, and emotional support of group identification. Ancient temples provided the public a place to explore with others the spiritual and healing significance of dreams. With the advent of Christianity, there continued for a while emphasis on the spiritual messages implicit in dreams and “Visions” as reflected in certain Biblical passages. However, as some historians of religion have observed eventually most early Christian church leaders learned to bypass in their teaching this healing spiritual stream. Now this healing and restorative inner energy is largely ignored. Powerful administrative forces directing mind control indoctrination avoid preaching about the immense value individual dream symbolism since it undermines their authoritarian control. Yet healing images of Jesus can appear in dreams as well as inkblot imagery. In regard to the latter, for devoted Christians images of their Savior can appear in projective consciousness to defensively block out socially unacceptable sexual/aggressive impulses. Of course, atheist scientists rightly point out that all the visual representations of Christ are based upon the fantasies of artists. (This subject is easily accessed at other web sites.) Another important religion is Hindu. This involves the use of other pictorial and structural 112 Cassell et al

representations having great spiritual significance and value to believers. India has a rich religious heritage with less cultural restriction on exploring imagery for healing and personal growth, Moreover, Indian Yoga teachers developed a practical set of beliefs and practices for extending conscious control over otherwise uncontrollable mind-body— spirit processes. It enables trained practitioners as well as the masses to affect positive effects in many areas. There are many other examples of the benefits from participation in organized religion. Yet religion has often provided rationalizations for persecuting nonbelievers, torture, atrocities and war. Throughout history there have existed many intellectual impostors with erroneous answers concerning all ambiguous body-mind-spirit issues. Playing a “Know it all role” enables them to take over control of their mesmerized followers. Everyone tends to be vulnerable to such false mentors. This is one reason that mind control techniques such as involved in individual and group hypnosis are so powerful. Subjects Overlooked in Traditional Education Publishers of textbooks experience economic and political pressure from a wide variety of power sources. In advertising the same tendency to hide reality with a smoke screen of falsehoods and deception sometimes applies. For example, tobacco company executives profit motivation override their ethics. Through the media they implant into the brains of vulnerable young people the viral message that smoking is “Cool and sexy”. All people need to learn how to protect their brains from such propaganda and how to delete such false messages. Eventually they may want to delete such a virus but the nicotine induced neurochemical changes in the brain’s pleasure centers may override voluntary abstinence. When it comes to conquest, violence, human atrocities and war, most countries have historians who are willing to create sanitized versions of history. For example, perceptually blind to abundant historical data many prominent international religious leaders still deny the Holocaust. An educational video of a SIS activated interview of a Jewish survivor who in her sixteen year was in Auschwitz is available. Cultural biases also can slant and distort what is taught. These viral contaminating forces show up in certain educational areas more than others. Examples involve curriculum content related to the origin of life, the nature of racial differences, economics, sex roles, dress codes, health, and drug/ alcohol use and so on. What was intentionally omitted from early education also may be important to determine. In this web site, participants will learn about many ill defined mysterious processes that many consider socially unacceptable to discuss. One reason that these are not covered in traditional formal education concerns their ambiguous nature. This stymies traditional numerical scientific quantification for classroom presentation. Some critics contend that the ill defined subjective content more closely approximates philosophical and religious domains. A more basic reason for actively avoiding exploring potentially emotionally charged material in a classroom setting pertains to the teacher’s need to establish discipline. In America and elsewhere, due to the infective nature of violent viral input from the media, there is a generalized fear of violence in schools. “Copy cat” incidents are now becoming too frequent an occurrence. Another reason stems from the education gap between middle class and higher children and the poor. There are fundamental familial, cultural, and socioeconomic problems. Millions of the poor and minority kids come from dysfunctional homes. Their mother’s intrauterine exposure to toxic substances can destroy brain cells, later putting a child at a great learning disadvantage. Many grow up in situations which lack appropriate role models, especially for fatherless males. Abandonment and victimization from violence tends to be the norm. In order to teach writing and math teachers are challenged to push from the troubled minds of such students any lurking dream residue. Yet, especially in the mornings, many students will be distracted by the residual emotions from the previous nights “Nightmares”. In hormonally charged adolescents these are often sexually colored and violent. It is hypocritical to demand that such suffering young people concentrate only on the core subjects. Few educators are able or competent in giving such troubled dreamers an opportunity to verbally express such emotionally charged memories. Yet these can be brought to the surface of day time consciousness by open morning group discussion or by viewing semi ambiguous stimuli. However, teachers are not psychotherapists, nor are sexually mixed classrooms the appropriate setting for such discussion. Unless a young person appears to be an immediate danger to themselves or others, they are overlooked in government support mental health clinics which focus on the care of the severely mentally ill. The same reservations apply in this setting. This web site is not intended for those suffering from severe mental disorder. Moreover is not a suitable media for sharing erotic fantasies or dating. How to Delete Viruses 113

Neutralizing Traumatic Imagery with “Spiritual“ Imagery Traditional psychotherapies for erasing painful life experiences sometimes need to be supplemented by those involving positive spirituality. With the SIS beautiful nature scenes are presented to recondition traumatic imagery released from memory storage. An expansion of this is to encourage a view to enjoy nature in restorative activities after the SIS projective interviewing. In a similar fashion, the substitution of religious symbols with positive emotional connotations can also serve to effectively replace the disturbing imagery. In fact, for severely stressed individuals, with fragile identities, their “peace of mind” may depend upon the substitution of positive imagery evoked by religious dogma, ritual and symbols. Of course agnostics argue that such beneficial effects need not relate to historical reality, They contend that any statistically documented benefits stem from the hypnotic healing power of myth based religious symbolism. Unfortunately Satanic cult leaders use evil ritualistic patterns to temporarily inhibit inner suffering. They do so by evoking behavior which directs aggression outwardly by sadistically inflicting in a pain. They further addict their followers by ending ceremonies with dances and sexual orgies. In these, the pleasure of sexual intercourse is temporarily substituted over the inner pain. Of course, these are only temporary and do not delete the brain virus but rather add new ones. Reconfiguring Discomfort ( General Concept) No one really comprehends the multiple mysteries of inner psychological space. Yet as indicated for centuries many authorities have claimed magical powers. Perhaps some of their antiquated viral preaching may have already been implanted in your brain and provide false comfort as contrasted to the discomfort reconfiguring your brain Questioning viral validity can trigger a sense of loss and even prolonged sadness .It sometimes is more painful than unmediated dental extraction. This may especially apply if it threatens losing rigid thinking family members or friends. It can even tend to undermine one’s preexisting sense of personal identity. However, the alternative of being blind to reality may be worse. For example, clearly defending one’s country in a valid foreign attack is clearly patriotic. By contrast, recall the fate of so many idealistic young solders who historically have acted like robots. Incredible numbers have sacrificed their lives in unjust wars. In World War I it used to be said that they provided “Canon fodder” to fulfill the commands of ill informed grandiose leaders. This guide for mental adventuring has many potential pitfalls. Traverse this frontier with courage. The trip should foster mental maturity not available to the faint of heart that turn back. Many fall by the intellectual wayside because their minds are irreversibly infected with thought blocking viruses. Some individuals have only a faint image of personal identity. They may be totally unable to function without the implanted social role instructions. The world is full of dictators partly because so many never learned how to think in a mature and independent fashion. Stressful Sex Role Imagery in a Downturn Economy The international economy began a serious downturn in 2008. The reasons are complex, but appears it partially relate to the creation of false “Money Symbols” called “Derivatives” etc. etc . While these deceptions have enriched sociopath economic manipulating the image value of money, they have made it very difficult to access the true value of currencies worldwide. It also has significantly contributed to stresses associated with job loses and the changing sexual roles, especially for men. An example is America where data from the U.S. Bureau of Statistics is available and relevant. At the beginning 0f 2009, about 1.1 million fewer men are working than the previous year. By comparison 12,000 more women are working. As men become unemployed living sat home their self esteem and sense of masculinity becomes undermined. For many, their focusing on domestic duties, while their wife works outside the home is not consistent with their image of the ideal male role. The inherent sex differences in brain function give females certain occupational advantages. These include their early educational advancement in reading and writing, where the average girl is one and a half years ahead of the average boy. The opposite is true in quantitative, spatial skills and mathematics. Now more women than men graduate from college. They tend to enter occupations less susceptible to economic downturn layoffs such as health care, social services and education. Women now equal men in law and economics. The differences are greatest for pharmacists and veterinarians, where now they represent two thirds of the graduates. Lastly, it might be noted that stress issues show up early in life. In school boys get in trouble with higher rates of disciplinary problems, suspensions and expulsions in educational settings. Later in life various forms of criminal behavior 114 Cassell et al

emerge. Ninety percent of Americans in the prison system are men. While females have a higher incidence of Major Depression, males, suicide rates are much higher. For example, in the overall age group 20 t0 24 the sex ratio is four to one. In America the differences are even greater in certain minority groups, such as Alaskan Natives1. The long term implications of these trends need to be considered by futuristic thinkers. Risk/ Benefits of Deleting Brain Viruses It is good but uncomfortable to give up false preconceived notions of reality. While the dissolving neural networks make be discomforting, it will free up neurochemical energy for those brain cells responsible for mature independent thought. Yet focusing attention away from the outer world may have drawbacks. It transfers mental energy allotment away from every day responsibilities. There is a critical balance in committing energy between outer world and inner world responsibilities. Each intelligent being needs to prioritize the relationship between these two attention fields. Research in neuroscience poses the philosophically formidable task of relying on what is inside the observer’s brain in attempting to investigate brain function. How can a living object the size of a grapefruit, study a replica of it to determine how that brain builds a sense of self? Be reminded that such complex issues can sometimes carry much more emotional threat than astronomical research. Insight into the human mind always has the potential of being disconcerting. Independent thinkers historically have often faced social criticism and persecution. Remember if you have a history of severe psychological problems or only a vague sense of your identity, for your own mental health, for safety reasons you must check out now. For example, a person suffering from Schizophrenic Disorder with delusions of grandeur might decompensate. It could prove highly stressful to learn from a series of internet strangers for example, he is not the “Inspector General” or “Jesus Christ”. Recall that: “A little knowledge is a dangerous thing.” Remember your heartfelt sense of sadness that you may have experienced realizing that a soothing childhood myth was false. Goodbye “Santa Clause”. Goodbye “Tooth fairy”. Hello painful reality. “Ouch!” Throughout the world there are millions who choose to minimize such intellectual discomfort with soothing addictive behavior. As indicated earlier, serious consequences may result from clinging to irrational belief systems. Unquestioning acceptance of cultural myths and superstitions versions can undermine even more brain endowed members of society. Blind belief in dogmatic figures concerning preconceived yet false versions of reality is unwise. It can set the stage for being victimized. When individuals are confronted with information which challenges preexisting belief systems it is natural to become anxious. Emotions become particularly intense if the challenge undermines a false sense of personal identity. An example is the modern ascending power of women and the resultant intensification of the battle between the sexes and within the sexes regarding sex roles. Some individuals may incorporate new facts with appreciation and only minimal discomfort. Yet these are relatively rare. Independently appraising new information presents a life long challenge for those wishing to expand their minds. The basic mental task involves learning how to discriminate which brain records are worth keeping. As promised, this travel guide will present you with a technique for peering into and studying the minds of many different people. It can be immensely helpful to consider how your inner thought processes work, as compared to theirs. In viewing their perceptions of ambiguous inkblot like structures, you may be reminded of personal material reflecting your own body sensations, perceptions, images and dreams. You will soon observe that here is much more hidden suffering experienced in consciousness under social facades. Be prepared to experience empathetic emotional anguish. Mental health professionals are often subject to secondary empathetic PTSD. Remember the expression: “No pain no gain!” It is not easy to identify childhood beliefs imprinted at a stage in life when you lacked ability to consciously edit them. If you are fortunate to have mature loving family members and trustworthy friends, initially try sharing with them. Yet be careful, even with those you trust. It takes a period of projective learning before you can recognize what is socially and/or politically safe to express. Occasionally everyone needs a defensive “Shell” to guard one’s “Inner” self. SIS Inspirational Clinical Case History There are many well documented cases in the medical literature, where intensely motivated people have overcome physical and emotional problems. One clinical case history involving the SIS follows,: The individual was a patient hospitalized on a neurological ward of a general hospital. SIS consultation was requested to develop innovative How to Delete Viruses 115

treatment strategies to supplement traditional physical therapies. When shown the SIS this individual was paralyzed from the waist down as a result of a severe spinal cord injury. What was remarkable was the exceptionally high number of SIS responses depicting movement in the projected imagery. This directly correlated with an extremely high motivation this person had to walk again. Remarkably enough this “ goal was achieved through super human mental motivation. The neurologist had said that this level of recovery was totally impossible”. There always is hope for a motivated person to overcome body-mind suffering because of the power of “Mind over Matter”! Essay and Prizes At the first of each month a communication award of one hundred dollars will be awarded to the participant judged to be most helpful in internet communications to SIS friends in cyberspace. Please submit your nominations to the web hosts including the way that discussing SIS imagery helped you the most. Donations Appreciated Any web visitors who would like to donate their time and energy to the international Somatic Inkblot Society are encouraged to contact our web hosts. This nonprofit organization also accepts gifts such as real estate, vehicles, boats and other physical objects of economic value. As might be expected, financial contributions are also appreciated. Please let our web host know all comments, criticisms and suggestions that you might have. We encourage you to join the layman’s branch of the SIS Society. If you are able to translate this web page into another language it would be most appreciated. Also, we are especially interested in welcoming those with skills in building internet virtual reality body-mind exercise technologies. Footnote Web visitors interested in learning more about these statistics may do this by inserting “Suicide rates of Alaskan Natives” in an internet search engine. There are many theories why Alaskan Native males turn their stressed cultural rage into self directed suicidal aggression. Pertinent are the views of one member of this culture, William L. Iggiaguk Hensley expressed in his book entitled “Fifty Miles From Tomorrow - A Memoir of Alaska and the Real People” published in 2009 by Sarah Crichton Books, Farrar Straus and Giroux 18th, West, 18th Street, New York 10011. Relevant to the above is the following material from page 213:”As I pondered our history, my initial reaction was rage. There were so many villains in the piece that it was almost impossible to settle on who was to blame. The government had taken our children away and turned them against our language and culture. The missionaries had dammed our dances and silenced our songs and denounced our spirit world as unworthy. The greedy traders had gypped our people and happily siphoned off their hard won earnings as payment for swapping with tobacco and alcohol. Silently, furiously, during those days at Ivik I tallied up; the list of those who had damaged us so deeply. There were the GIS who made our men feel impotent as they chased our women and the judges who wielded life defining power over people who had no knowledge of the language of the court. There were faceless politicians in Washington who made fish and game rules we had to break in order to feed our families, and the politicians who barred our elderly from the Pioneer Homes and who had permitted the despicable sign NO DOGS OR NATIVES ALLOWED. There seemed to be no end to the oppressors who had taken advantage of us as we tried every way that we knew to be good citizens. But finally I settled on what in my mind was the most destructive force of all: The Bureau of Indian Affairs and its repressive school system, which had served as the main weapon against our language, our culture, and our children’s spirits. The material has been taken from our web site (www.somaticinkblots.com). This web page currently is under development. Comments and suggestions are welcome. 116 Cassell et al

In the 80’s and 90’s the use of projective tests in the researches on Eating Disorders, has substantially been focused on the definition of the diagnostic subgroups and on the exploration of personality background of these syndromes. The most recent researches primarily use questionnaires instead, while the use of the projective tests has been reduced, both for the quantity of time necessary to data collection and scoring, and for the necessity to use Experts for this coding. In the specific field of Eating Disorders, similar tendencies to those of the psychological research of the last years can be found: the necessity to confirm on wider, and therefore more reliable, samples, those results that have been anticipated on the previous researches with less numerous samples; the choice of simpler tools, even if less sensitive, for the data collection and for the clinical evaluation; the tendency to seek evidences in the results of the therapies, and to simplify the diagnosis in this view of procedure. A point of view, therefore, more directed to a practical vision than to the understanding and description of the psychopathological complexity. These tendencies seem to be the product of the managed care policy (Piotrowski, 1999), where the containment of the economic costs and time influences both the choices of the tools of clinical assessment and the research project. In fact, Piotrowski himself, even if he noticed the persistent interest in the projective techniques, referred to increasing preferences of the clinicians for the interview techniques in comparison to the projective ones, particularly in comparison to the Rorschach and to the TAT. Similarly, a comparison among the choices of the clinical psychologists in the 80’s and ten years later, has found a progressive diminution of the use of the projective tests, both as number of psychologists that use them, and in terms of time dedicated to these techniques. Moreover, in the 2000’s, and in the United States circles, methodological polemics are flourished about the Rorschach validity as a diagnostic tool (Wood, 2000). These objections about the use of the Rorschach have been based on the scarce correlation with the increasing international use of nosographic diagnoses, as specified by the DSMIV. Besides, the scarce concurrent validity with self-report tools has been noticed, and, for some Authors, also with other projective tests. This despite the fact that Studious like Weiner (2000) had underlined the distinction between the Rorschach method, finalized to the measurement of personality structures and dynamics, and methods based on the symptomatology expression, like the DSM classification. According to this last Author, in effects, the projective methods identify rather strong and weak points of the personality that have implications with the behavioural forecast of single patients or diagnostic groups. As a result of both managed care policy and methodological debates, in the last ten years studies of Eating disorders are few numerous, except the single case reports or small case series. Beyond a symptom definition- the personality background: In 2002, Mizuta et al analysed the eating disorders psychopathological characteristics, besides with questionnaires, with two projective tests: the Three Drawing Test (Baum Test) and the Sentence Completion Test (SCT). A sample of 126 patients with eating disorders, divided in Anorexia, anorexiabulimia and bulimia, formed by outpatients between 15 and 30 years, has been compared with a healthy control group. The patients with mixed forms and bulimia have shown significant differences compared with controls, also in the projective tests: in particular they have drawn smaller and less detailed trees by comparison with normal subjects, and significantly more situated to the left in the sheet, while in the SCT test they have given more negative answers and less positive answers. In the group formed by anorexic patients (n: 27), nevertheless, a separate psychopathological profile has not clearly Projective Methods in the Study of Eating Disorders- An Update Silvia Daini The projective methods are currently less used in comparison to the self-evaluation methods in the study of Eating Disorders. The correlated psychopathology cross-sectional studies bring into focus two key problems: the presence and quality of the depressive dynamics, as in anorexia and bulimia as in obesity, and those of the gender identity. Difficulties in gender identification are underlined especially in the male eating disorders. Some longitudinal studies on the therapeutic changes also appear, pointed out after a psychodynamic psychotherapy with the projective tests. The usage of the projective methods to emphasize the thematic concerning these patients’ true Self, with the inclusion of the diagnostic phase in integrated therapeutic projects, both traditional psychodynamic type and Art Therapy type, constitutes a further development of the clinical applications of these tools with patients with Eating Disorders. Silvia Daini, M.D., Aggregate Professor of Medical Psychology, Institute of Psychology and Psychiatry, Università Cattolica S. Cuore, Roma . e-mail daini@katamail.com Key Words: Eating Disorders , Projective tests, personality, therapy.

appeared, but an intermediary position between the bulimia subgroups and the group of control. The only significant result to the SCT test has been the greatest frequency of”blank” answers by the anorexic patients. The Authors interpret this result as an expression of a strong tendency to denial in the anorexic patients that goes beyond the simple negation of the state of illness. This work, even if it doesn’t permit concluding considerations about the psychopathological profile of the patients with restrictive anorexia obtainable with the Baum test or with the SCT, shows its utility in the study of the eating disorders. It contains besides an important methodological innovation in the analysis of the graphic tests: in fact the Baum test has been analysed, other than with the measure of the dimensions, the position and through the clinical judgment, through the fractal mathematical technique, finalized to the calculation of a fractal value that would have had expressed the complexity of the drawing. The Authors have compared this value with the clinical judgment expressed by the clinicians about energy and wealth of the drawing elements, finding it positively correlated. In effects, one of the salient problems concerning the reactive graphics reagents has been, and still it is, the difficulty in reading the quantification and subjectivity of the results, in contrast with the richness of the clinical information, difficulty that has limited its use in the research works. This proposed technique could open new perspectives for future researches, considering the easy application of graphic tests, too. While in the 80’s and 90’s the study of the Eating Disorders with projective methods has been finalized to the differentiation of the bulimic pictures from the anorexia, starting from the definition of the bulimia as a separate psychopathological picture by Russell (1979), besides the study of personality background of these diagnostic groups, some more recent studies are dedicated to obesity and iperphagia, given their increasing diffusion in the western countries. Elfhag et.al. (2003) conducted a study on obesity using the Rorschach method, in order to evidence various possible subgroups on the basis of two indexes from the comprehensive system of Exner: DEPI (Depression Index) and CDI (Coping Deficit Index).Following this method, 100 obese subjects have been divided into one subgroup with depression (37% of the subjects) and one subgroup with coping difficulty (26%), while the others showed intermediary or combined characteristics. The first subgroup showed great introversion, emotional difficulties connected with food and low self-esteem. The subgroup with elevated values of CDI showed instead difficulty face the day to day life problems, smaller psychological resources and smaller intellectual achievement, and the obesity is more connected to a chaotic style of life. Moreover, the vulnerability to deregulation made these subjects more similar among them, according to their personality profiles, to samples composed by subjects depending from alcohol and drugs. The Authors connect these different psychopathological profiles to different therapeutic needs and indications. While in the first subgroup insight oriented psychotherapies could be more suitable, in the second case the behavioural approach could reach the best results. Naturally the purpose to identify subgroups in a sample of obese subjects, using concepts defined “a priori” as depressive features and coping liabilities, appears reductive in comparison with the ample range of personality information provided by this projective test. In fact, the groups seem more studied for their correlations with psychosocial variables, instead of purely psychological ones (e.g. the results of the fundamental variables of the Rorschach have not been reported, but only the two indexes and the scores that compose them). In fact, in this study the subgroup with elevated DEPI resulted formed by subjects with higher education, best socio-economic status, with more regular alimentary habits, and with more frequent episodes of binge eating than the subgroup with elevated CDI, and, moreover, it seemed to attribute more psychological importance to the body size. The emotional eating appeared instead in this research as an element shared by all the subgroups and a comparison with a sample of normal subjects would have been interesting. The conclusion of the Authors is that the food can be used as “self medication” to overcome frame of mind of depression or existential uneasiness. While the anorexia and the bulimia are recognized and encoded psychiatric syndromes, the opinions about obesity are less concordant, both for the ample diffusion of this trouble, and for the discordant results of the research based on questionnaires. In fact, the hyperphagia involves a more clear definition of compulsive eating, but it is not present in all the obese subjects. Also in these subjects, nevertheless, a difficulty has been found in the expression of their own emotions and their own alimentary behaviours, in line with the psychosomatic hypothesis of the alexitimia (Allison and Henschka,1993); the impairment of symbolization and the difficulty of the expression of emotions could be therefore a common denominator also in these different disorders. As to the relationship between eating disorders and depression, an always-open matter in this circle, a recent comparative case-control study with the 118 Daini

method Rorschach has been administered in Spain (Garcia Alba 2004) on 50 teen-age patients with restrictive anorexia, in comparison with depressed patients and with a healthy control group. This work, that has used for the Rorschach the Comprehensive Method of Exner (2003), has chosen the statistic analyses on the DEPI and CDI indexes, that, in this case, have been supported by the MMPI scale 2 and by questionnaires. The results of the study put the anorexic patients in an intermediary position between the normal subjects and the depressed ones (DEPI index), while the observed samples do not differ significantly with regard to the values of CDI index. Regarding the MMPI, instead, the group of the anorexic subjects is appeared more similar to the normal one, while the depressed patients have shown a more precarious personality organization. In fact, the co-morbidity with the depression is present in the 36% of these patients according to the Rorschach test, and in 56% according to the MMPI test. The Author concludes that MMPI and Rorschach correspond to different aspects of the personality and that, within the anorexia, two subgroups are distinguishable, in which the depression is more evident. After all, in works using the MMPI (Cumella, 2000; Nozaki, 2006; Extercate 2007) patients with restrictive anorexia showed values of the fundamental scales similar to the norm, with scarce elevations of the psychopathological scale, especially in the first years of illness; and above all, in this test, they show inferior scores in comparison with subjects with others Eating Disorders (Walitza 2001). These results let think that the questionnaire MMPI doesn’t have enough sensibility in describing the anorexic psychopathology. Another emergent subject in these last years is the study of the male anorexia, much more spread nowadays than in the past. Works with projective methods are not numerous and limited due to the small male samples. One of these (Orgiazzi et al., 2002) relates a psychoanalytic reading of the Rorschach and the TAT for five hospitalised anorexic boys in pre-pubertal age (12-15 years). The psychoanalytic reading follows the clinical methodology delineated by C. Chabert in 1983. In these particularly acute cases of male anorexia, the Authors have found both the presence of a remarkable depressive-anxious syntomatology, up to the presence of suicidal ideas, and difficulty related to the aggressiveness management towards the doctors, with oscillations between passivity attitudes and aggressiveness attitudes, in case violent. The Rorschach projective data underline a deteriorate and lacking of integration body concept, expressed through the representations of rarely entire bodies (human or animals), more often confused and not delimited, or contaminated. We would deduce a “missing body experience”, which is a container of the image of their own body. The representations of human beings are scarce and connected to double representation or reflecting modalities. In these cases, concerning the sexual identification, both the Rorschach and the TAT show a gender identification problem. The Authors claim the emergency to the projective tests oh a homosexual relation with the paternal image, while the maternal image is relatively absent. In the debate about differences and similarities between feminine and male anorexia, the Authors affirm an important psycho-pathological connection with homosexuality and with psychosis, placing it in a pre-oedipal or reversed Oedipus complex developmental stage. In these cases, the relationship with the father seems to be erotic, idealized in a positive or negative way, but never in a “sane distance” that could permit a structuring identification. In this way, the eating disorder would update an archaic problem that compromises the value of sense of self. In this work a small series of clinical cases has been studied, very homogeneous, nevertheless, respect to the age and the seriousness of the psycho-physic situation. Studies on wider samples (Daini et al., 2007.), although not comparable directly for the differences in the method of reading of the Rorschach, show a more attenuated problem on the gender identity and great similarities in the psychopathological profile with the female anorexia. Predictive and Prognostic value of projective tests: The predictive value of projective tests has been used both in some studies about the adolescent population both and in relationship to the forecast of the result of surgical procedures of correction of obesity. A study by Narduzzi and Jackson (2002) has used the Rorschach Inkblot Test, and particularly the ROD scale (Rorschach Oral dependency scale) to individualize vulnerability factors in the development of Eating Disorders. In this casecontrol study, the subjects with Eating Disorder have shown more elevated scores in the ROD, in addition to traits of more elevated autonomy and sociothropy in comparison to the group of control. These results bring the Authors to conclude that the Eating Disorders belong to the “anaclitic” line of psychopathology, characterized by evaluative problems concerning the dependence. Particularly, it is about ultra-committed subject in maintaining a sense of separation from the others, Projective Methods in Eating Disorders 119

but also ultra-committed in the interpersonal relationships as a self-esteem source. It could be observed, to this end, that narcissistic development problems in these subjects have been pointed out far-back, only in apparent contradiction with the “anaclitic” hypothesis: these two different attitudes can show a dramatic fracture in the subjects with eating problems that is expressed with the impossibility of survival. The dependency that in this study has been also measured like sociothropy through an instrument of self report would not be pure unconscious (as measured by the ROD) and more elevated autonomy desire would have a compensatory characteristic. Therefore, the elevation of these indexes (autonomy, sociothropy and oral dependency) could identify the subjects at-risk to develop compulsive eating. Among obesity studies, projective tests have been used to select the candidates to the surgical treatment of the obesity (Fabricatore et.al.2006). The preoperative psychological evaluation is motivated by difficulty inherent to the preparation to these interventions, such as the necessity of compliance of patients in the post-operating period. While the clinical interview is appeared as the most used method by psychologists and psychiatrists in this specific field, and a big group of professionals use personality test, only a minority, in the mentioned review, has used projective methods (3.6%). Probably the reasons that de-motivate the use is the quantity of time necessary for many projective tests and the lack of consent about the key elements of the personality correlated with the indication or the contraindication to the surgical intervention. Another strand recently under development is the exploration of these problems with familiar projective techniques, making an attempt to confirm with research data the clinical observations made for a long time about the familiar configuration role in the pathogeneses of Eating Disorders (Wailin, 2004). A recent Hungarian work explores, through the Consensus Rorschach, the interpersonal dynamics of the mother-son relationship in 20 subjects of developmental age with anorexia or bulimia (Szili and György, 2005). Results indicate a tendency, particularly in the bulimic subjects, to dysfunctional interactions with the mother that could be to the origin of a more self-punishing coping style regarding the subjects of control, associated to a fragile self-image. A family version projective test has been also used recently by Faldt Ciccolo (2008) for a study casecontrol on 37 patients with anorexia and bulimia. The group of patients has expressed more discord in the family environment, with greater coldness in the relationships and less confirmation feeling by the family compared to the control group. The familiar discord way of life has turned out to be correlated to fear of the maturity (found out with the EDI 2) and to difficulty of socialization. Usage of projective tests in therapy: a dialogue about the true Self: One of the stages traditionally connected with the clinical use of the projective methods is the return of the diagnosis to the patient himself. There are no works dedicated to this matter, except the clinical accounts about the projective family techniques. The return of the diagnosis is an important moment of the approach to the patient, also in the individual setting. Since the thought of the food can become obsessing, until touching the characteristics of the dominant idea in the more critical status, in the eating disorders a decisive necessity is to recreate a mental space where other important contents can become thinkable. It is clear that the obsessing thought of food has got a compensatory nature, compared with the risk of chaotic disintegration of these patients’ psyche, and it becomes the central point around which the conscience rotates uselessly. The clinical experience on the followed long-term cases shows how much difficult is this reconstruction. And besides the therapy focalisation on the alimentary rehabilitation and the body-image experience reinforce this attempt of compensation and moves the doctors away from an effective emotional contact with the patients. Often, at a distance of years from the critical episode, the patients with eating disorders have not grasped the meaning of the cure, or clarified their relationship with the doctors, or elaborated a more integrated affective position. All this leads to the creation of further difficult life and relational situations and less psychologically elaborated by the patients (as unsatisfactory weddings, inadequate relationships in the job circle, difficult pregnancies, conflict relationships with the children, Kiriike et.al.,1998)), not only to the chronicization of the problem. Therefore one of the priority problems in the knowledge and therapy of eating disorders is really to enter in contact with the true self of the patient, like the only possible source of meaningful changes. The apparent psychopathological equilibrium of these subjects is characterized by extremely rigid and primitive defences, not only in the anorexic subjects that elude a effective dialogue with the doctors: often is only during the period of crisis that starting this dialogue becomes possible, because, in this phases, defences are less structured and patients are more willing to ask for an help. In 120 Daini

this context the projective methods, also available as diagnostic instruments in the crisis (as well as during an hospitalisation) constitute a mediator element since the first moments of dialogue and of acknowledge of the patients, naturally focused on the whole personality and on the mental functions varieties. Analogous observations can be made regarding the family settings; these are currently used especially with young patients, with continuity between the diagnostic phase and the beginning of the therapy (or within a short therapy). In this field the execution of the Rorschach or the TAT from everyone of the members of the family, in order to discuss together later, can evidence the unconscious defences of the family towards the growth of one of its members (the patient), that expresses difficulty in separating from the familiar nucleus in evolutionary age (Szily and Gyorgy, 2005). Also in this sphere projective basic themes permit to evidence and to communicate about the authentic emotional problems, only indirectly expressed by alimentary behaviour problems. Therapeutic changes: The projective studies about the changes produced by the therapy are still more limited. One of these studies (Bréchon, 2004) compares the defences present in various evolutionary phases of the anorexia in two cases of female adolescent anorexia. Through the Rorschach and the TAT has been possible to evidence, in the critical phases of the problem, a prevalence of archaic defences, of projective type particularly, that configure a narcissistic frame similar to the psychosis, for the confusion between instinct intensity and object (first malfunctioning narcissistic experience). At a distance of four years the evolution towards more efficient and neurotic narcissistic defences has been observed, and minors signs of psychosis. The Author interprets these results, and particularly the appearance of more explicit depressive affects, as one of the favourable elements of prognosis. Between the naturalistic studies on more extended samples of patients, on the outcomes of the psychodynamic psychotherapy in eating disorders (e.g. Kachele, 2001, Von Wieterscheim et al., 2001, regarding the hospitalised patients), the projective methods are used very rarely, compared with the evaluations of the physical symptomatology (somatic index of the problems) and with the valuations by self-evaluation scales. Gaudriault et al., (2007) have valuated a sample of bulimic subjects before and during psychodynamic psychotherapy with the Rorschach test. Four Rorschach properties: determinants, reaction to symmetry, recurrence and contents of the response, are areas in which the therapeutic changes can be manifested. Rorschild et al., (2008) have analogously evaluated two samples of adolescents (anorexic subjects of restrictive type and bulimic subjects) at time of admission and iat time of discharge from the hospital through the Rorschach according to the Exner Comprehensive Method. These Authors notice that, while the physical situation of the patients appears improved, and so the self-evaluation measures of the psychological distress, the projective measures evidence a persistent implicit affective distress (D, sumShd). This contrast makes to think, as is common knowledge in the clinical experience, that changes in the defensive style are much more difficult and slow then the improvement of the physical symptomatology. Starting from the most traditional drawing projective tests, like the Human Drawing Figures test, numerous drawing tests have been recently developed within of the Art Therapy (Betts, 2008): among the others, the Bird’s Nest Drawing (BND), the Bridge Drawing, the Diagnostic Drawing Series (DDS), the Child Diagnostic Drawing Series (CDDS). These instruments have been used, besides in the diagnostic phase, in the sphere of the therapy and the study of the therapeutic changes, and they recognize to the base of their development, the necessity to facilitate the expressivity of some groups of patients, among those with Eating Disorders, in order to permit the elaboration of deeper psychological problems that patients cannot cope with by verbal communications. According to the Art Therapists themselves, it is about techniques still in phase of elaboration and still now with validity and reliability problems. Starting from studies about clinical cases (Diamond and Orrell- Valente, 2002) these techniques seem to have promising clinical results, especially in the therapy with adolescent patients, for the capacity to make emerge non-recognized aspects and to increase progressively, as a consequence, the self-control. The Art Therapist tries to understand the imagery of the patient through individual symbols expressed by the patient’s drawings, and moreover it departs from the assumption that all the individuals have the ability to project their own conflicts in a visual form. Also in this therapeutic application, the diagnostic elements and those of projective psychology seem to mix with the therapeutic path, with a purpose of facilitation of the successive reflection and verbal expression of the unconscious conflicts (Rabin, 2003). These techniques share with the more traditional formulations, like the psychodynamic one of Bruch (1973), both the supportive formulation of the relation with the patient, and the modification Projective Methods in Eating Disorders 121

necessity of the classic psychoanalytic technique, that crashes with the communicative difficulties of the patients with eating disorders. It still remains to clarify the modality, and the dynamic process, for which the evolution of the non-verbal expression occurs, and more concrete, of the drawing, and that of the not concrete verbal symbolic expression. In parallel, the evolution modality from the supportive attitude to a more interpretative one, based on the insight. The question that remains open for all the forms of dynamic therapy of these problems. Among the promising elements, instead, of these forms of therapy, there is their applicability in the context of an admission and in case of crisis, too: in this way the facilitation assumes a particular meaning, considering the state of psychical regression that is present in these phases. Discussion: The study of the eating disorders with projective methods has been affected, during the last few years, by the most general tendencies and by the time and resource economy within the research field and by the same tendency in the clinical frame, joined with the research of the characteristic efficiency of the “evidence based medicines”. However, a consent of many scientists that take care in the long term of the therapy of these problems, that changes in the psychopathologic order are particularly difficult, beyond the symptomatological improvements, and that the psychopathological nucleus continue for along time modifying the quality of the life of these patients. From this point of view, the projective methods currently conserve their role, too, as finalized to the direct exploration of these psychopathological modalities, especially the latent and most unconscious ones. Two general concepts seem very important in the field of these problems: that of false Self and that of Alexitimia, both recognized and studied in the subjects with eating disorders. The tendencies to an organization of false Self are accountable to the discrepancies found by numerous authors between the self report measure and the latent state of mind, where the first seems to approach normality, unlike the other, for stable denial defence. These tendencies make the questionnaire measures not particularly reliable in the psycho-diagnostic of this type of patients, while the projective tests, as indirect measures, permit to move around the defensive barriers and show a greater sensibility to the psychopathological nucleus. The second concept, intending the Alexitimia especially in the meaning of symbolic thought difficulty, helps to understand the persistent difficulties of these patients in the elaboration of the psychological meanings of their own symptomatology. The clinical role of the projective methods, in evidencing these meanings and making them available to the reflection of the same patients, both in the form of the psycho-diagnostic return that in the highlighting of relevant thematic for a successive psychotherapy, keeps its fundamental importance for the psychological evolution, although its greater difficulty compared with other diagnostic methods. References: Allison D.B. and Heshka S. (1993) Emotion and eating in obesity? A critical analysis. Int J Eat Disord, 13(3):289-95. Betts J. (2008) Art Therapy Approaches to Working with People Who Have Eating Disorders, In Brooke (Ed.), The creative therapies and eating disorders. Springfield, IL: Charles C Thomas. Bréchon G. (2004) Evolution de deux cas d’anorexie mentale de l’adolescence, Psychologie Clinique et projective (10):6-7. Bruch H. (1973) Eating Disorders: obesity, anorexia nervosa and the person within, Basic Book, New York, Chabert C. (1993) Narcissisme et relations d’objet à l’adolescence  : apport des épreuves projectives, Bulletin de la Société Francaise du Rorschach et des Méthodes Projectives, 37:183-194. Cumella E.J., Wall A.D. and Kerr-Almeida N. (2000) MMPI-2 in the inpatient assessment of women with eating disorders, J Pers Assess. Dec; 75(3):387-403. Daini S.,Carotti L. Manzo A., Minerva C. and Mancano C. (2007) A projective sight on male anorexia: a Rorschach test exploration, Journal of Projective Psychology and Mental Health, Diamond-Raab L., and Orrell-Valente J.K. (2002) Art therapy, psychodrama, and verbal therapy. An integrative model of group therapy in the treatment of adolescents with anorexia nervosa and bulimia nervosa. Child Adolesc Psychiatr Clin N Am, 11(2):343-64. Elfhag K., Carlsson A.M. and Rössner S. (2003) Subgrouping in obesity based on Rorschach personality characteristics, Scand J Psychol, 44(5):399-407. Exterkate C.C., Bakker-Brehm D.T. and de Jong C.A. (2007) MMPI-2 profiles of women with eating disorders in a Dutch day treatment sample.J Pers Assess. Apr; 88(2):178-86. 122 Daini

Fabricatore A.N., Crerand C.E., Wadden T.A., Sarwer D.B. and Krasucki JL (2006) How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. May;16(5):567-73. Fäldt Ciccolo E.B. (2008). Exploring experience of family relations by patients with anorexia nervosa and bulimia nervosa using a projective family test, Psychol Rep, 103(1):231-42. Gaudriault P., Bélandre C. and Sellem C. (2007) Bulimia in the Rorschach self and object representations in multivariate analysis, Pratiques Psychologiques, 13 (1):81-104. Kächele H., Kordy, H.,  Richard, M.  and Tr-Eat R.G. (2001) Therapy Amount and Outcome of Inpatient Psychodynamic Treatment of Eating Disorders in Germany: Data From a Multicenter Study, Psychotherapy Research, 11,( 3):239-257. Kiriike N., Nagata T., Matsunaga H., Tobitan W. and Nishiura T. (1998) Single and married patients with eating disorders, Psychiatry Clin Neurosci, 52 Suppl:S306-8. Mizuta I., Inoue Y., Fukunaga T., Ishi R., Ogawa A. and Takeda M. (2002) Psychological characteristics of eating disorders as evidenced by the combined administration of questionnaires and two projective methods: the Tree Drawing Test (Baum Test) and the Sentence Completion Test, Psychiatry Clin Neurosci, 56(1):41-53. Narduzzi K.J. and Jackson T. (2002) Sociotropydependency and autonomy as predictors of eating disturbance among Canadian female college students, J Genet Psychol, 163(4):389- 401. Nozaki T., Takao M., Takakura S., Koreeda-Arimura C., Ishido K., Yamada Y., Kawai K., Takii M. and Kubo C. (2006) Psychopathological features of patients with prolonged anorexia nervosa as assessed by the Minnesota Multiphasic Personality Inventory. Eat Weight Disord. 11(2): 59-65. Orgiazzi B., Galland J. and Chappaz M. (2002) Anorexie féminine et masculine: comparaison. Cahiers de Psychologie Clinique, 1 (18) : 139- 157. Piotrowski C. (1999) Assessment practices in the era of managed care: current status and future directions, J Clin Psychol, 55(7):787-96. Rabin, M. (2003) Art therapy and eating disorders: The self as significant form, New York: Columbia University Press. Rothschild L., Lacoua L., Eshel Y. and Stein D. (2008) Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach comprehensive system and self-report measures. J Pers Assess, 90(4):356-67. Russell G. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa, Psychol Med, 9(3):429-48. Szili I. and György S. (2005) The role of motherchild relationship in development of selfimage, dysfunctional attitudes and coping strategies, Psychiatr Hung, 20(2):126-40. Von Wietersheim J., Malewski P., Jäger B., Köpp W., Gitzinger I., Köhler P. and Grabhorn R. (2001) The effects of psychodynamic inpatient treatments on personality data of patients with anorexia nervosa and bulimia nervosa - results of the German multicenter study (TR-EAT), Z Psychosom Med Psychother, 47(4):366-79. Walitza S., Schulze U. and Warnke A. (2001) Differences between adolescent patients with anorexia and bulimia nervosa with reference to psychological and psychosocial markers, Z Kinder Jugend Psychiatr Psychother, 29(2):117- 25. Wallin U. (2004) Eating disorder and the family--a review, Tidsskr Nor Laegeforen, 9;124(17):2251-3. Weiner I.B. (2000) Using the Rorschach properly in practice and research, J Clin Psychol, 56(3):435-8. Wood J.M., Lilienfeld S.O., Garb H.N. and Nezworski M.T. (2000) Limitations of the Rorschach as a diagnostic tool: A reply to Garfield (2000), Lerner (2000), and Weiner (2000), J Clin Psychol, 56(3):441-8. Zucker N.L., Losh M., Bulik C.M., LaBar K.S., Piven J. and Pelphrey K.A. (2007) Anorexia nervosa and autism spectrum disorders: gided investigation of social cognitive endophenotypes, Psychol Bull, 33(6):976-1006. Projective Methods in Eating Disorders 123

There are multiple ways of examining and interpreting the associations to inkblots produced by an individual. Broadly, they are classified as quantitative and qualitative. In quantitative methods, the inkblot responses are scored in terms of defined variables as per the preferred system of scoring. The scored variables are summarized and interpreted to derive the intended information about an individual. In qualitative methods, the responses are perused to decipher a particular set of characteristics. Most of the researchers and clinicians combine both quantitative and qualitative approach for the interpretation of the protocol. However, the primary base remains the quantitative, variables. The quantitative variables are generally interpreted as single variable or in a combination of two or more variables to reflect different psychological attributes. The Somatic Inkblot Series has adopted only 11 scoring indices such as: Total Number of Responses (R ), Human Responses (H), Animal Responses (A), Anatomy Responses (At), Typical Responses (T), Atypical Responses (AT), Movement Responses (M), Sex Responses (Sex), Most Typical Responses (MT), Image Rejection (Rej), Pathological Responses: Pathological anatomy Scale(PAS), Depression(D), Hostility Agression Scale(HAS) and Paranoia (P) (Cassell and Dubey, 2003). The responses to SIS images are quantitatively scored and compared against the established norms to examine the existence of deviations if any. In addition to comparison of individual scoring indices, the responses are examined across certain predefined areas to explore the existence of conflicts and problems. The test have been found successful in identifying certain important areas such as Interpersonal Relationship, Ego/Self-image, Healthy Body Imagery, Erotic Imagery, Hostility Aggression, Insecurity, Thinking in Group Conformity (Dubey et al, 1995). The identification of these areas are based on the nature of images and the expected content produced by these images. Technically, empirically derived identification of areas should be superior to the ones derived intuitively. Advanced techniques of factor analysis permit the mapping of underlying structure in a test. Singh (2007) explored the gender differences in factor structure of SIS- II. The Principal Component Analysis revealed five principal components in both the genders. However, the composition of the factors was found a little different across genders. As such no attempts have been made to identify the areas for SIS-I and the factor structure has also not been explored. SIS-I has a few unique features. This is a card form which is required to be administered by an examiner. It’s CD/DVD version can be taken as self administered test under supervised administration. It consists of 20 inkblot images printed on white cards, each measuring 16.5 X 20.5 cms. The images are printed in black, red, and gray screened black). Eight of them are black and red (serial numbers 1, 2, 3, 4, 5, 6, 7, and 8); three are exclusively red (serial numbers 10, 11, and 12); and nine are achromatic (serial numbers 9, 13, 14, 15, 16, 17, 18, 19, and 20). Images provide enough obvious anatomical structure to evoke spontaneous verbalization, but not enough to limit the responses solely to the naming of body parts or colors. Because of its unique features, it would be of interest to explore the Factor Structure of SIS-I quantitative indices. Further, given the semi-structured nature of the SIS-I with obvious anatomical structures, exploration of factor structure of its quantitative indices is likely to uncover certain content or structure based areas of psychological functioning. Such empirically derived psychological content areas of SIS-I would facilitate not only its clinical utility but would also provide empirical grounds to quantitative indices. Material and Method: A sample of 100 adults was drawn from general population. The age range was 18-45 years. There were 41 males and 59 females. SIS-I was individually administered on each participant. The raw scores Factor Structure of SIS-I in Adults Rakesh Kumar The present study aimed at delineating underlying factor structure of SIS-I quantitative indices in adults. SIS-I was individually administered on a sample of 100 participants drawn from general population. Principal Component Analysis was performed on SIS-I indices which identified four components with eigen value greater than one. However, only three components were rotated subsequently as only one index loaded significantly on the fourth factor. The first factor loaded significantly on typical, most typical (positive) and atypical responses and was labeled as ‘objective thinking’. The second factor loaded positively on movement, human and anatomy responses and negatively on animal responses. On the basis of the psychological implications of the constituent indices this factor was labeled as ‘emotional maturity’. The third factor loaded significantly on total number of responses (positive loading) and image rejection (negative loading) and was labeled as ‘reaction to stress’. Results are presented in the paper. Rakesh Kumar, Ph.D., DM&SP, Clinical Psychologist and Co-ordinator, Department of Clinical Psychology, Institute of Mental Health and Hospital, Agra – 282002 Email: mindpowerlab@gmail.com Key Words : Objective thinking, Emotional maturity, positive loading, negative loading

on SIS-I were transformed into percent scores using Total Number of Responses as denominator. SPSS 11.5 version was used for statistical calculations. Results and Discussion: The inter-correlation matrix of the Following SIS-I indices were subjected to Principal Component Analysis (PCA):- Total Number of Responses (R), Typical Responses (Ty), Atypical Responses (Aty), Animal Responses (A), Anatomy Responses (An), Most Typical Responses (MT), Human Responses (H), Image Rejection (Rej) and Movement Responses (M). Principal Component Analysis for Adults: Prior to performing PCA, the suitability of data for factor analysis was assessed. The correlation matrix of adults sample revealed that 41.67% co-efficients were significant. The Kaiser-Meyer-Oklin value was .51 which is a little lesser than the recommended value of .60 (Kaiser, 1970, 1974). The Barlett’s Test of Sphericity (Barlett, 1954) reached statistical significance (Approx. Chi Square: 350.02; df: 36, p<.000). Taken together these statistical observations suggest that suitability of the present data for factor analysis. Principal component analysis revealed the presence of four components with eigenvalues exceeding 1. The fourth component was composed of only one index – Total Number of Responses, hence it was decided to extract less than four components. Three components were extracted which explained 25.26%, 22.24% and 15.67% variance respectively. To aid in the interpretation of these three components, Varimax rotation was performed. The rotated solution is presented in table-1. Coefficients below .32 were considered non-significant and hence suppressed in the output. Factor-I: Factor- I loaded significantly on three SIS-I indices – Atypical Responses, Typical Responses and Most Typical Responses. All three indices loaded exclusively on this factor. The Atypical Responses, however, have negative loading on this factor. Typical Responses are scored when an individual produces shape appropriate responses to the identified blot area. Atypical Responses are polar opposite of the Typical Responses and both are mutually exclusive. An Atypical Response is scored when the shape of the perceived object does not match to the identified blot area. A series of cognitive processes are involved in production of Typical/Atypical Responses. When presented with an SIS-I image, an individual scans the image, either selects the complete image or isolates a portion of blot area for response production, recollects the mental images resembling the blot area and produces the response. In a normal person, preponderance of Typical Responses is observed. The clinical groups particularly psychotics produce higher Atypical Responses. Typical Responses are indicative of reality testing. When typical responses fall short of average level, there is corresponding increase in Atypical Responses, which are indicative of impairment in reality testing. Most Typical Responses are high frequency responses to a particular blot area. A small portion of Typical Responses constitutes Most Typical Responses. None of the Atypical Response falls in the domain of Most Typical Responses. The Most Typical Responses are indicative of group conformity. When an individual fails to produce average number of Most Typical Responses, it is considered as a sign of departure from group thinking. It is evident from the preceding description of the constituent indices of Factor-I that it taps the blend of Reality Testing and Group Conformity. Higher level cognitive processes are involved in the production of both Typical and Most Typical Table 1 Varimax Rotation of Three Factor Solution for SIS-I in Adults Sample SIS-I Indices Components Communalities Atypical Responses -.912 * * .89 Typical Responses .877 * * .86 Most Typical Responses .772 * * .68 Movement Responses * .847 * .76 Human Responses * .793 * .65 Animal Responses * -.580 * .35 Anatomy Responses * .467 * .27 Total Responses * * .861 .75 Image Rejection * * -.640 .46 * Suppressed Co-efficients less than .32 Factor Structure of SIS-I in Adults 125

Responses and production of atypical responses might be suggestive of impaired or disturbed cognitive functioning. Though Atypical response in very good form level may indicate intelligence and higher imaginative ability. This factor, therefore, can be labelled as the factor of “Objective Thinking”. This empirically derived objective thinking factor is characterized by greater number of typical/ most-typical responses and lower number of atypical responses. The objective thinking can be conceptualized as the ways of thinking which is least influenced by subjective feelings and biases. It is the thinking pattern which is shared by others. In both reality orientation and group conformity objective thinking is required. A person who has lost his capacity of objective thinking would not be able to produce sufficient magnitude of typical and most typical responses and would have impaired reality testing and group conformity. Further, such individual is likely to produce more atypical responses, the polar opposite of the typical/mosttypical responses. Factor-II: Factor-II is composed of four SIS-I indices – Human Responses, Movement Responses, Animal Responses and Anatomy Reponses. All these four indices loaded significantly and exclusively on this factor. Anatomy Responses, Human Responses and Movement Responses have positive loading where as Animal Responses have negative loading on this factor. Human, Anatomy and Animal Responses are based on the content whereas Movement is a response attribute. In inkblots, Movement Responses are considered as reflective of imaginative, creative, fantasy processes. Somatic Inkblot Series have anatomical structures embedded in the images. Because of embedded anatomical structures, a preponderance of anatomical responses is produced by the subjects on the series. Low scores on anatomy indices results because of anatomy illiteracy or problems in body functions where defence mechanism denial operates. An average number of anatomy responses indicate adequate body awareness in an individual. Perception of human beings on the inkblots usually reflects interpersonal relationship. A low score on human indices reflect problems with interpersonal relationships. On SIS-I more anatomy and human responses are produced by a subject than animal responses. The negative loading of animal responses suggests the bipolar nature of this factor. Further, more animal responses in SIS protocol are suggestive of immaturity. Thus, the observed pattern of loading indicates that this factor is defined by greater number of human responses, anatomy responses and movement responses and fewer anima responses. Based on the psychological implications of the constituent indices it is evident that this factor represents a latent trait characterized by capacity for creativity/ imagination, awareness, and harmonious interpersonal relationship along with fewer signs of immaturity. This factor most likely corresponds to the awareness and dynamic creative process. This factor can be termed as “Emotional Maturity”. An average or high level of Human, Movement and Anatomy responses coupled with lower level of animal responses would indicate emotional maturity whereas high animal content with low level of human, anatomy and movement responses would indicate the emotional immaturity. Factor-III: The total number of Responses and image Rejection loaded significantly and exclusively on this factor. The total number of responses has a significant positive loading whereas image Rejection has a significant negative loading on this factor. Total Number of Responses in inkblots is indicative of productivity. Image Rejection on the other hand reflects low stress tolerance. Moreover, both of these indices are antagonistic to each other in as much as with higher number of Total Responses there is less likelihood of image rejection. If a person has poor stress tolerance, the number of rejection increases. When presented with an unstructured or semi-structured stimulus, a person is required to organize the entire inkblot or extract a portion of it to make meaningful associations. There are enough cognitive loads on the individual. At times an image of the inkblot is linked to negative psychological experience of an individual and it activates the conflict which becomes overwhelming and the subject tends to reject the image. The rejected images are of particular interest to the therapist as it helps to unlock the inner cry of the subject. Since responding to unstructured images involve cognitive load and ability to handle the stress inherent in ambiguity, this factor can be labelled as Reaction to Stress. If more rejections are noticed, it could mean that an individual tend to shut out in the face of stress. The higher responses and less rejection would mean that an individual over-reacts to a stressful situation. Conclusion: Principal Component Analysis was performed on SIS-I indices of 100 adults to explore underlying factor structure. The analysis revealed three factors. Factor-I was defined by more Most Typical, Typical and less Atypical Responses suggesting the capacity for original thinking. Factor-II represents the latent trait of ‘emotional maturity’ characterized by 126 Kumar

more Movement, Human, Anatomy response and less Animal Responses. Factor-III represents the dimension of ‘reaction to stress’ and is defined by higher Total Number of Responses and lower Image Rejection. The findings of the present study, though, provide support to the existence of three theoretically meaningful factors that can best summarize the quantitative indices of SIS-I, the meaning and interpretation of these factors should be empirically substantiated through future researches. Further, the present factor analytic study was conducted on a relatively small sample (N = 100) and therefore the stability of this factor solution should also be tested in future research. It would also be of interest to explore stability and comparability of these factors in various psychiatric conditions. References: Barlett, M.S. (1954) A note on the multiplying factors for various chi square approximations, Journal of the Royal Statistical Society, 16 (Series B):296-298. Beck, S.J., Beck, A.G., Levitt, E.E. and Molish, H.B. (1961) Rorschach’s test: Basic processes, New York: Gurne & Strattons. Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World Through Somatic Imagery Manual of Somatic Inkblot Series, Somatic Inkblot Center, Anchorage.Alaska Catell, R.R. (1966) The scree test for number of factors, Multivariate Behavioral Research, 1:245-276 Dubey, B.L. Cassell, W.A. Pershad, D. and Dwivedi, P. (1995) Diagnostic Utility of Somatic Inkblot Series, SIS Journal of Projective Psychology and Mental Health, 3: 61-67 Kaiser, H. (1970) A second generation little jiffy, Psychometrika, 35:401-415. Kaiser, H. (1974) An index of factorial simplicity, Psychometrika, 39:31-36. Singh, U. (2007) Gender Differences in Factor Structure of SIS-II Responses, SIS J. Projective Psychology and Mental Health, 14(2):21-27 Factor Structure of SIS-I in Adults 127 SIS Instruments can be Obtained from : Somatic Inkblot Center 4501E, 104th Avenue Anchorage, AK.99516 (USA) E-Mail: siscassell@yahoo.com & Somatic Inkblot Center 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail:sisdubey@rediffmail.com

The world is becoming more and more complex because of information boom and technological advancements. Such changes reflect cultural evolution, which is unlike biological evolution in its rapidity. All this implies that creativity is a useful and effective response to evolutionary changes (Runco, 2004). Since Galton, Psychology has evidenced an abiding interest in the understanding of creativity and taken it as an important and fascinating area of study. However it is difficult to define creativity. This difficulty is due, in part; to its diverse expression i.e. it plays a role in technical innovation, teaching, business, the arts, and sciences and many other fields. Another kind of diversity is apparent in the cultural variability in idiosyncratic modes and media for expressing creativity. Diverse expression is one reason that creativity is an important topic for investigation (Runco, 2007). Thus, creativity is a vital form of human capital and it both contributes to the information explosion and helps us in coping and adaptation. In this perspective, creativity has been rightly conceptualized as a syndrome or complex. Both of these labels denote the idea that creativity can be expressed in diverse ways (e.g., art v/s science), and sometimes involves different processes (e.g., cognitive or social). It also denotes that it is influenced by many different kinds of things including personality, genetics, social and environmental setting, and culture (Runco, 2007). Guilford’s (1950) APA presidential address is considered as the starting point for empirical investigation of creativity in which he advocated to explore it in its own right. Guilford’s emphasis along with a number of other factors i.e. increase in scientific inventions after World War-II, advent of space age, computer and electronic revolution, and economic globalization helped to in launching the contemporary research in creativity. Many researchers (e.g. Guilford, 1959, 1970; Getzels and Jackson, 1962; Torrance 1966; Taylor and Holland, 1964; Mumford and Gustafson, 1988; Sternberg 1999, 2003) have attempted to understand creativity in its own right and endeavored to depict the relative autonomy of creativity from intelligence, and fairly complex and multifaceted nature of this highly important human mental capital. This empirically demonstrated separation of creativity from traditional intelligence; and complexity and multifactedness of its nature has given this field its identity and respect (Runco, 2007). Because of various contexts in which the term creativity has been used, diversity in expression, and cultural differences in the modes and media for expressing creativity, it has been difficult to evolve a generally agreed definition of creativity which could be all inclusive. As a result, there have been numerous approaches to define and conceptualize creativity which Rhodes (1962), Mooney (1963), Kneller (1985), Richards (1999), and Runco (2004, 2007) have condensed into four distinct approaches: (a) as product; (b) as person; (c) as press; and (d) as process. Simonton (1990) added persuasion; and Runco (2004) has lobbied for potential. The product approach has mainly focused on outcomes and those products that result from creative process. It defines creativity as one whose end products are both novel and useful (or influential) in particular setting (Halpern, 2003; Mumford, 2003). This definition denotes the cultural relativity and the distinction between the creative and merely eccentric or mentally ill (novelty without utility) (Flasherty, 2005). Creativity involves an original approach to a problem or product within a given domain of study (Solomon et al., 1999). One essential component of creativity is originality ... a second component of creativity is utility... and a final component is product of some kind (Andreason, 2005). Thus, as per this approach creative products are emphasized for elements of newness, freshness, inventiveness, and originality. Creative products can include behaviors, performances, ideas, things, and types of expressions. The definitions under this perspective have, no doubt, taken highly objective SIS-II Indicators of Creativity Umed Singh, Nidhi Verma and Naseeb Singh The present study was designed to explore SIS-II indicators of creativity. To realize the main objective, 100 male students of 11th and 12th grade were randomly selected from Senior Secondary Schools of Kurukshetra District of Haryana. The subjects were administered Somatic Inkblot Series-II and Torrance Test of Creative Thinking with Words. Obtained data were analyzed by applying descriptive statistics, Product Moment Method of Correlation and Principal Component Factor Analysis. Obtained inter-correlations and factor structure have depicted some structured overlap between two types of measures. Six of SIS-II scales i.e. Typical, Most Typical, Human, Movement, and Depression have emerged significant projective indicants of creativity. Umed Singh, Ph.D. Faculty Member, Nidhi Verma, M.A. Research Scholar and Naseeb Singh, M.Phil. Student, Deptt.of Psychology, Kurukshetra University, Kurukshetra -136119(India) Email:umedsingh_78@ yahoo.com Key Words: SIS-II, Indicators, Creativity.

view of creativity, but a view that is biased toward products and biased against individuals who have potential but are not yet expressing it in more recognized ways. It may be more parsimonious to conceptualize creative products as inventions, and the process leading up to them as creative or innovative. The person approach is based on the personality characteristics of creative persons. There has been copious research on the traits that characterize creative persons. Barron and Harrington (1981) summarized the research pertaining to personality correlates of creativity depicting that creative individuals have high valuation of aesthetic qualities in experience, broad interests, attraction to complexity, high energy, independence of judgment, autonomy, intuition, self-confidence, ability to resolve antinomies, or to accommodate opposite or conflicting traits in one’s self concept, and finally, a firm sense of self as creative”. This approach also acknowledges the relevance of concept of domains (e.g. art v/s science), however, for there may be differences in the traits that allow creative performances in different fields. More recently, personality research have included intrinsic motivation, openness to experiences, sensitivity, playfulness, risk taking, psychological androgyny, self-efficacy and wide interests, and curiosity in the list of personal antecedents of creativity (Runco, 2004, 2007). Extrinsically motivated efforts, sometimes, may result into creative products. (Rubensen and Runco, 1995). Amabile (2003) has empirically demonstrated that some extinct factors (e.g. evaluation) may also inhibit creative thoughts. Among empirically exposed cognitive factors relevant in creativity are field independence /dependence, (Noppe and Gallagher, 1977), problem solving styles, (Kreshner and Lodger, 1985), divergent thinking (Guilford, 1970), and wisdom (Sternberg, 2003). Eysenck (1983) taking extreme position has 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 typically includes the total complex situation (press) in which creative processes are initially stimulated and sustained through completion. Rhodes (1987) has conceptualized press as “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. Some highly relevant press influences on creativity are freedom, autonomy, good role models and resources (including time), encouragement for originality, freedom from criticism, and norms which reward innovation not failures. Family background and school environments have also been found to be relevant contributors in the cultivation of creative potentials (Gaynor and Runco, 1992; Raina, 2003; Hasirci and Demirkan, 2003). Process approach has been less personal and more behavioral. Work under this approach has been mainly oriented to delineate various steps, styles, and strategies within creative process. Generally creativity is taken as a process of seeing or creating relationships comprising the process of discrimination from many alternatives and synthesizing elements in altogether new and original ways. These relate creative mechanisms to removal of repression, or drive discharge (Freud, 1963), preconscious functions (Kubie, 1958), gestalt mechanisms (Wertheimer, 1945), associative processes (Runco, 1991), memory (Pollert et al.,1969), attention and knowledge (Rubenson and Runco,1995). 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. Csikszentimihalyi (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 have an impact on more general domain. Cognitive psychologists i.e. Gardner (1986), Perkins (1988), and Sternberg (2003) have described creative process involving an active research for gaps in existing knowledge, problem finding or conscious attempt to bided an extended continuum of creativity process including imagination, originality, innovation, invention, discovery, serendipity and change, adoption, flexibility, memes, evolution, pro-activity, and elaboration. Persuation has been advocated by Simonton (1990) with the idea that creative people change the way other people think. Runco (2004) has emphasized to study creativity as potential in an attempt to redirect research and educational attentions back to “the people that need us to the most” namely those with potential but lacking the skills to express themselves. Although it has been observed that creativity involves simultaneous interaction among elements of all the above mentioned themes or approaches i.e. product, person, press, process, persuasion, SIS-II Indicators of Creativity 129

and potential. Many past investigators have tended to involve only variables from single dimension using reductionist approach. Isaksen (1987), Puccio (1990), and Treffinger et al. (1993) have rightly contended that creativity is a multidimensional phenomenon and hence be studied with multivariate methodology. Another point that has emerged from the literature that majority of research investigating creativity has been skewed to the use of psychometric approach. Some scholars (Muller, 1964; Stark, 1965a, 1965b) have blamed the psychometric approach be biased on the limited conception of creativity i.e. ‘novelty context’; and further have emphasized the essentiality of understanding the traditional or “meaning context” of creativity. The two contexts roughly correspond to two types of cognitions. Projective Tests, particularly inkblots are considered true measures of ‘meaning context’ of creativity. Among the inkblot tests, Rorschach and Holtzman Inkblot tests have been mainly used indexing creativity but there is not even a single mention for using Somatic Inkblot Series for it. Here, the present study is an attempt to explore and examine SIS-II correlates of creativity. Method: Sample: The sample (N=100) for the present study was drawn from 11th and 12th grade male students of various Govt. Schools of Kurukshetra District in Haryana. The sample was restricted to rural areas with the assumption that Govt. Schools in rural areas represent the typical school environment and cater the educational needs of common rural folk. Only the male students were included in the sample in view of reported gender differences in creativity (Yamamato, 1960; Torrance, 1965; Richardson, 1986). The age of participants ranged between 16 and 18 years with the mean age of 17 years. Measures: Following tests were used for data collection: Somatic Inkblot Series-II (SIS-II): The Booklet form consisting of 62 images was administered individually after establishing proper rapport with the subjects. Obtained SIS-II protocols were scored for 14 categories of variables i.e. Total Number of Responses (R), Human Responses (H), Animal Responses (A), Anatomical Responses (At), Sex Responses (Sex), Most Typical Responses (MT), Typical Responses (T), Atypical Responses (AT), Rejection of Images (Rej), Pathological Anatomy (PAS), Depression (D), Hostility & Aggression (HAS), and Paranoia (P) as per scoring system described by Cassell and Dubey (2003). Torrance Test of Creative Thinking with Words: (Torrance, 1966) consists of seven subtests known as activities. It was administered in group setting and scored for four basic dimensions of creativity, namely Originality, Fluency, Flexibility, and Elaboration. Results and Discussion: Frequency distributions for all the 18 variables were set for the data of 100 subjects. Descriptive statistics i.e. means, standard deviations, skewnesses, and kurtoses were computed to ascertain the normalcy of data. After ascertaining the normalcy of data and requirement of application of Product Moment Method of Correlation, inter-correlations were computed between/among all the 18 variables included in the study. Degree of freedom being 98 (N-2), the correlation coefficients of .20 and .25 were found to be significant at .05 and .01 levels of significance respectively. Inspection of intercorrelations matrix (Inter-correlations matrix is not presented for economy of space and use of factor analysis) reveals that inter-correlations among 14 scales of SIS-II are in general low ranging from .648 to -.343. Twenty four of 91 correlations are significant at or above .05 level of significance, of which 17 are positive and 7 are negative. Some significant correlations among scales of SIS-II may be because of their association with some factors at second order level. Correlations between fourteen scales of SIS-II and four measures of creativity are in general low ranging from .438 to -.155. Thirteen of 56 correlations are significant at or above .05 level of significance, of which all are positive. Originality has correlated positively with Total Number of Responses (.298) and Typical Responses (.270). Flexibility has marked significant positive association with Total No. of Responses (.438), Human (.271), Most Typical (.312), Typical (.296), and Depression (.264). Fluency has corresponded positively with Total Responses (.413), Typical (.316), and Depression (.199). Elaboration has correlated positively with Total No. of Responses (.260), Typical (.206),and Hostility and Aggression (.207). Obtained correlations depict some amount of variance sharing between two types of measures. Inter-correlations among four measures of creativity are in general positive ranging from .354 to .700. All the six correlations are significant above .01 level of significance, depicting them to have substantial amount of variance sharing among four measure of creativity, and to represent a general factor of creativity at second order level. 130 Singh et al

Factor Analysis: No doubt bivariate correlations provide significant information about the relationship between/among variables, but actual overlaps among the variables are unveiled by factor analysis. So, the intercorrelation have not been interpreted rather are factor analyzed by applying Principal Component Factor Analysis. Seven factors with eigen values greater than 1.00 were extracted which together accounted for 65.632% of total variance. Interpretation of factors was done after varimax rotation (Kaiser, 1958). Varimaxly rotated factor matrix is presented in Table I. The communalities (h2) for 18 variables range from .481 to .928. Perusal of sorted factor loadings reveals that Factor –I highly loads on all the four measures of creativity with the loadings ranging from .674 to .893 apparently suggesting it to be a general factor of Creativity. It has accounted for 20.81% of total variance. Three scales of SIS-II, namely Total No. of Responses, Typical Responses, and Depression have also marked positive association with the markers of this factor suggesting them to be common SIS-II correlates of all the four dimensions of creativity. Obtained structure portrays the person having imaginative capacity; functioning intelligence; coherent, logical and creative thinking. It has shed significant light on SIS-II correlates of creative thinking. Factor-II significantly loads on five scales of SIS-II viz. Most Typical, Human, Movement, Typical and Total No. of Responses; and one of creativity i.e. Flexibility, suggesting it to be a factor of Perceptual Maturity. It has accounted for 12.50% of total variance. The negative loadings of all these markers are depicting positive association among them. The positive pole of obtained structure is indicative of organized cognition, ego-strength, team-concept, group conformity, high degree of interpersonal relationship, enthusiasm and tranquilized affect. Such perceptually mature individuals tend to have flexibility in their thoughts. Table 1 Rotated Factor Matrix Factors Variables I II III IV V VI VII H2 Total number of Responses .318 -.456 -050 .783 .020 .021 .051 .928 Human .068 -.796 -053 .007 -.018 -.094 .005 .694 Animal -.017 -.090 .393 -.291 .118 -.186 .670 Anatomy .042 -.016 -610 .231 .153 -.544 .001 .747 Sex -.032 -.127 -841 .041 -.124 .063 -.055 .748 Movement -.085 -.646 .126 -.070 .295 .056 -.202 .575 Most Typical .107 -.808 -048 .169 -.059 .098 .199 .748 Typical .358 -.614 -170 -.200 -.049 -.197 -.006 .615 Atypical .082 .228 .925 .059 .083 -.054 .928 Rejection -.088 -.022 -023 -.038 .002 .069 .909 .840 Patho Ant. .039 -.105 -.078 .048 .684 -.254 .250 .615 Depression .240 -.160 .096 .026 -.129 .609 .027 .480 Hostility & Aggression .108 .014 -135 .017 .773 .212 -.220 .721 Paranoia -.073 .242 -054 .159 .170 .692 .047 .601 Originality .846 -.074 .020 .201 -.043 .095 .803 Flexibility .674 -.291 -.158 .155 -.171 .144 .104 .648 Fluency .893 -.100 -.072 .112 -.070 .049 -.111 .843 Elaboration .793 .059 .066 .155 .053 -.163 .691 Eigen values 3.746 2.265 1.773 1.551 1.342 1.134 1.044 % Variance 20.81 12.59 9.85 8.62 7.46 6.30 5.81 SIS-II Indicators of Creativity 131

Factor-III has been labeled as Healthy Self-image on the basis of significant loadings of three scales of SIS-II, namely Sex, (-.841), Animal Responses (.612), and Anatomy(-.610). It has accounted for 9.25% of total variance. Factor-IV has been identified as factor of Vague Perception on the basis of significant loadings of Atypical Responses, Total No. of Responses, and Animal Responses. Obtained structure is indicative of vague percepts with poor structural quality and hypochondriacal sensitivity. It has accounted for 8.62% of total variance. Factor-V is named as Fantasized Hostility portraying the individuals who tend to perceive inkblots in terms of pathological anatomy with hostile and aggressive affect. It accounts 7.45% of total variance. Factor-VI is a factor of Delusional Depression as defined by the significant loadings of Paranoia, Depression, and Anatomy scales portraying the individuals who reflect projective responses involving depressive feelings, delusional and exaggerated sense of self-consciousness in external situations. Such individuals do not tend to perceive inkblots in terms of percepts depicting mutilated internal body structures: Factor-VII has been identified as a factor of Thought Blockade depicting the suppression of thoughts. It has accounted for 5.81% of total variance. Conclusion: Both the obtained inter-correlations and factor solutions depict some structured overlaps between two types of measures. SIS-II scales such as Total No. of Responses (R ), Typical Responses (T), Most Typical Responses (MT), Human Responses (H), Movement Responses (M), and Depression (D) have emerged significant SIS-II correlates of creativity. But the present study being exploratory, its findings can not be considered generalized. For more generalized and confirmatory findings, further study on large sample is required. References: Amabile, T.M. (2003) Within you, without you: towards a social psychology of creativity, and beyond, In Runko and Albert (ed.) Creativity Research Handbook, Cresskill, NJ: Hampton Press. Andreason, N.C. (2005) The Creating brain, New York. Dana Press. Barron, F. and Harrington, M. (1981) Creativity, Intelligence& Personality, Ann. Rev. Psych., 3:439-476. Cassell, W.A., and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot Series, Somatic Inkblot Centre, 4501E, 104th Ave, Anchorage, Alaska (USA). Csikszentimihalyi, M. (2003) The domain of creativity, In Runco and Albert (ed.) Creativity Research Handbook: Cresskill, NJ: Hampton Press. Eysenck, H.J. (1983) The roots of creativity: Cognitive ability or personality trait? Roeper Review, 10-12. Flasherty, A.W. (2005) Frontotemporal and dopamimergic control of idea generation and creative drive, Journal of Comparative Neurology, 493:147-153. Frued, S. (1963) General Psychological Theory: Papers in Metapsychology, NYC: Cillier Books. Gardner, H. (1986) The Cleveland Plain Dealer, October 23. Gaynor, J.L.R. and Runco, M.A. (1992) Family size, birth order, age-interval, and the creativity of children, J. Creat. Behav., 26:108-118. Getzels, J.W. and Jackson, P.W. (1962) Creativity and Intelligence: Exploration with Gifted Students, New York: Wiley and Sons. Guilford, J.P. (1950) Creativity, American Psychologist, 5:444-454. Guilford, J.P. (1959) Traits of creativity, In H.H. Andreason (ed) Creativity and its Cultivation, New York: Harper, 142-161. Guilford, J.P. (1970) Traits of creativity, In Vernon, P.E. (ed). Middlesex, England: Penguin, 37- 59. Halpern, D. (2003) Thinking creatively about creative thinking, In MA Runco (Ed.), Critical Creative Processes, 189-208, Cresskill, NJ: Hampton Press. Hasirci, D. and Demirkan, H. (2003) Creativity in learning environments: the case of two sixth grade art rooms, J. Creat. Behav., 37:17-41. 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. Kneller, G.F. (1965) The Art and Science of Creativity, New York: Holt, Rinehart and Winston. Kreshner, J.R. and Ledger, G. (1985) “Effects of sex, 132 Singh et al

intelligence, and style of thinking on creativity: A comparison of gifted average IQ – Children, J.Personality and Social Psychol, 48(4):1033-40. Kubie, L. (1958) Neurotic distortion of the creative process, Lawrence, K.S.: University of Kansas Press. 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: Willey. Mueller, R.J. (1964) Can the public school foster creativity? Saturday Review, 19:48-49. Mumford, M.D. and Gustafson, S.B. (1988) Creativity Syndrome: Integration, Application and Innovation, Psychological Bulletin, 103, 1:27-43. Mumford, M.D. (2003) Where we have been, where are we going? Taking stock in creativity research, Creativity Research Journal, 1:107- 120. Noppe, L.D. and Ballangher, J.M. (1977), A cognitive style approach to creative thought, J. Pers. Assess., 41:85-90. Pollert, L.H., Feldhusen, J.F., Van Mondfrans, A.P. and Treffinger, D.J. (1969) Role of memory in divergent thinking, Psycho. Rep. 25:151-156. 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. Raina, P. (2003) On Moore’s Schrodinger: Life and Thought, Creativity Research Journal, 15:303- 307. Rhodes, M. (1962) An analysis of creativity, Pbi Delta Kappan. 42:305-310. Rhodes, M. (1987) An analysis of creativity. In Frontiers of Creativity Research : Beyond the Basics, ed. S.G. Isaksen, 216-22. Buffalo, NY: Bearly. Richards, R. (1999) The subtle attraction: Beauty as a force in awareness, creativity, and survival. In S.W. Russ (Ed), Affect, Creative Experience, and Psychological Adjustment, 195-219. Philadelphia: Brunner/Mazel. Richardson, A.G. (1986) Sex Differences in Creativity Among a sample of Jamaican Adolescents, The Journal of Creative Behaviour, 20(2):147. Rubenson, D.C. and Runco, M.A. (1995) The psychoeconomic view of creative work in groups and organizations, Creativity and Innovation Management, 4:232-241. Runco, M.A. (1991) Divergent Thinking, Norwood, NJ:Ablex. Runco, M.A. (2004) Creativity, Annual Review of Psychology, 55:657-87. Runco, M.A. (2007) Creativity, Theories and Themes: Research Development, and Practice, Elsevier: New York: Academic Press. Simonton, D.K. (1990) In M.A. Runco & R.S. Albert (Eds.) Theories of Creativity. Newbury Park, CA : Sage. Solomon, B., Powell, K. and Gardner, H. (1999) Multiple Intelligences, In M.A. Runco and S. Pritzker (Eds.), Encyclopedia of Creativity, 259-273. San Diego, CA: Academic 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. (1999) Handbook of Creativity, New York: Cambridge University Press. Sternberg, R.J. (2003) Wisdom, Intelligence, and Creativity Synthesized, Cambridge University Press, NY. Taylor, C.W. and Holland, J.L. (1964) Predictors of creative performance, In Taylor C.W. (Ed.) Creativity: Progress and Potential. New York: McGraw Hill. Torrance, E.P. (1965) Rewarding Creative Behaviour, Englewood cliffs, NJ: Prentice Hall. Torrance, E.P. (1966) Torrance Tests of Creative Thinking: Norms-Technical Manual, Princeton, New Jersey: Personal Press. Treffinger, D.J. Sortore, M.R. and Cross, J.A. (1993) Dimensions of Creativity, Sarasota, FL Center for Creative Learning. Wertheimer, M. (1945) Productive Thinking, New York: Harper. 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. SIS-II Indicators of Creativity 133

Somatic Inkblot Series (SIS) technique is latest addition in the field of inkblot techniques. The Somatic Inkblot Series (SIS) is a structured, projective, diagnostic procedure and is an adjunct to psychotherapy (Cassell and Dubey, 1990). Schizophrenia is a clinical syndrome of variable, but profoundly disruptive psychopathology that involves cognition, emotion, perception and other aspects of behavior. Mood disorders are best considered as syndromes (rather than discrete diseases) consisting of a cluster of signs and symptoms, sustained over a period of weeks or months, that represent a marked departure from person’s habitual functioning and tend to recur often in periodic or cyclical fashion. Somatic Inkblot Series (SIS) has gained alluring attention amongst the professionals in the field of mental health, counseling, therapeutic management and selection. SIS-II has been used in normal, neurotics, schizophrenics and other populations by several researchers (Dubey et al., 1994; Dwivedi et al., 1995; Rathee et al., 1995, 2002; Pershad et al., 1997; Mishra and Dwivedi, 1997), psychotic patients (Verma et al., 1994; Kaur and Verma, 1998), schizophrenics and depressives patients (Pershad and Verma, 1995), manic and depressive patients (Kumar et al., 2005), Gender difference in manic patients (Kumar et al., 2006), and in chronic schizophrenics (Kumar et al., 2006). The present study was designed with the aim of comparing the SIS-II profile of patients with schizophrenia and bipolar affective disorder (mania). Material and Method: Sample: The sample consisted of patients (30 schizophrenia patients and 30 Bipolar Affective Disorder (mania) patients) in the age range of 20-50 years. There were 15 male and 15 female patients in each group. Table1 shows demographic characteristics of the patients. Personality Profile of Schizophrenia and Bipolar Affective Disorder (Mania) on SIS-II Dolly Kumari, Jai Prakash, Amool R. Singh and Suprakash Chaudhury Projective techniques particularly Rorschach and SIS tests are especially helpful in evaluating patients with psychiatric disorders. Somatic Inkblot Series has been found to be an extremely effective test to assess body imagery and somatic symptoms as well as a powerful projective tool to discriminate varieties of Psychiatric disorders. The present study is aimed at comparing the responses of schizophrenia and BAD currently manic patients on somatic Inkblot Series-II. The sample consisted of 30 schizophrenia and 30 BAD currently manic inpatients drawn through purposive sampling technique from Ranchi Institute of Neuro-Psychiatry and Allied Science, (RINPAS), Ranchi. India. 15 male and female were included in each group. The results reveal that schizophrenia and BAD mania patients obtained significantly different scores on the following SIS II indices: Total number of responses, Human responses, Sex responses, Movement responses, Typical responses, Atypical responses and, Rejection of images. Dolly Kumari, M. Phil. Jai Prakash, Ph.D., Associate Professor, Amool R. Singh, Ph.D., Prof. & Head of Dept of Clinical Psychology, Suprakash Chaudhury, M.D., Ph.D., Prof. & Head of Dept of Psychiatry. RINPAS, Kanke, Ranchi-834006 (India) Key Words: Schizophrenia, Bipolar Affective Disorder (Mania), SIS-II Profile. Table 1 Table showing characteristics of the sample Variables Schizophrenia BAD mania Sex Male (N=15) Female (N=15) Male (N=15) Female (N=15) Age in years 20-35 36-50

Education Upto matric Upto Graduation Marital status Married Unmarried Place Rural Urban

The following tools have been used in the present study. Brief Psychiatric Rating Scale (BPRS): Brief Psychiatric Rating Scale (Overall and Gorham, 1963) was used for the assessment of severity of the psychotic symptoms in the schizophrenia patients. In this scale a total of 24 items have been included. Severity of the symptoms has been measured on 0-7 points rating scale. Score ‘0’ indicates “absence of symptoms” and ‘7’ indicates “extremely severe symptoms”. Young Mania Rating Scale (YMRS): This scale has been developed and standardized by Young et al, (1978). It has been used for the assessment of severity of the manic symptoms in the patients. This scale included 11 symptoms constructs each items is rated on 0-4 point rating scale. Score ‘0’ indicates “absence of symptoms” and ‘4’ indicates “extremely severe symptoms”. Somatic Inkblot Series-II (Cassell et al. 1980): It consists of Series A and B, each series with 31 images, and for a combined series total of 62 images. The test was administered individually. Procedure: Patients were selected as per ICD-10 DCR criteria. Brief Psychiatric Rating Scale (BPRS) and Young Mania Rating Scale (YMRS) were used on schizophrenic and BAD manic patients . Patients who scored between “below mild to mild level” were included in the study. The SIS-II test was administered individually with consent of the patients. The protocols were scored for Total number of Response (R), Human Responses (H), Animal Responses (A), Anatomy Responses (At), Sex Responses (Sex), Movement Responses (M), Most Typical Responses (MT), Typical Responses (T), Atypical Responses (AT), Rejection of Images (Rej), Pathological Anatomy Scale (PAS), Depression (D), Hostility & Aggression Scale (HAS) and Paranoia Scale (P). data thus obtained has been analyzed by using mean and standard deviation. In order to find out difference if any ‘t’-ratio has been computed. Results and Discussion: The data have been analyzed and presented in table 2. Table 2 reveals that schizophrenic patients show less number of total responses, human responses, sex responses, movement responses, typical and atypical responses and high rejection than BAD mania patients. The findings are in conformity with earlier studies (Rathee, et al., 1995, Kumar et al., 2001). It is evident from table 2 that schizophrenic patients had less number of total responses (M= 58.26 ± 7.07) which indicates poor imaginative ability and functional intelligence. The BAD manic patients (M=66.47 ± 4.57) have shown more number of total responses suggesting comparatively more productivity. Most of the percepts were loaded with atypical responses in both the groups indicating Table 2 Response Pattern of the Schizophrenia and BAD mania patients on SIS II indices SIS –II Indices Schizophrenia BAD Mania t-value Mean SD Mean SD Total no of Response (R) 58.26 7.07 66.47 4.57 5.34** Human Responses (H) 15.17 6.28 23.20 7.56 4.48** Animal Responses (A) 8.07 3.72 8.13 4.19 0.06 Anatomy Responses (At) 8.23 5.84 10.17 7.34 1.13 Sex Responses (Sex) 1.43 2.08 3.03 3.57 2.12* Movement Responses (M) 4.07 4.28 8.63 5.78 3.48* Most Typical Responses (MT) 7.77 3.20 8.70 2.02 1.35 Typical Responses (T) 18.40 5.38 21.83 5.72 2.40* Atypical Responses (AT) 32.13 5.82 35.93 5.35 2.63* Rejection of Images (Rej) 5.40 5.44 1.27 1.60 3.99** Pathological Anatomy Scale (PAS) 0.60 0.97 1.30 2.02 1.71 Depression (D) 0.17 0.75 0.10 0.31 0.45 Hostile & Aggression (HAS) 2.00 2.70 1.80 2.39 0.30 Paranoia (P) 0.67 1.59 0.13 0.44 1.78 * P < 0.05; ** p < 0.01 Personality Profile of Schizophrenia 135

psychiatric disturbances like perseveration and bizarre response. Significant difference was found between schizophrenic and BAD (manic) patients in respect to total number of responses (t=5.34, P<0.01). Similar findings have been observed in earlier studies (Dubey et al.1994, Pershad et al,1995,1997, Dwivedi, et al. 1995, Mishra and Dwivedi, 1997). These studies have concluded that psychiatric patients had low productivity with poor interpersonal relationship. However, the manic patients were more interactive and were able to enjoy outer world (M= 23.20 ± 7.56) in comparison to schizophrenic patients (M=15.17 ± 6.28). The difference between two groups was statistically significant at 0.01 level (t=4.48, P<0.01). The Animal responses (A) in the present study suggest that both the groups schizophrenic (M=8.07 ± 3.72) and BAD mania (M=8.13 ± 4.19) showed psychological immaturity. Anatomical responses were within the range in both the groups (BAD manic patients M=7.34 ± 1.13 and schizophrenic patients (M=8.23 ± 5.84). Low anatomical responses in psychotic patients may indicate low self with poor mind body relationship. Verma et al (1995) have also concluded low anatomical responses in schizophrenia than other psychiatric group. No differences were found on Sex responses as both the groups perceived low number of sex responses. Usually an Indian patient rejects/ avoid the perception of sexual imagery on SIS images. The Movement responses (M) indicate imaginative capacity and functioning intellectual capacity. Findings indicate that BAD (manic) patients were more imaginative (M=8.63 ± 5.78) than schizophrenic patients (M=4.07 ± 4.28). Difference was significant at 0.01 level (t=3.48, P<0.01). Similar findings have been reported by Verma, et al. (1995). Most typical (MT) responses are suggestive of coherent, logical thinking and ability to keep up with the demands of society. It is clear that both the groups schizophrenics (M=7.77 ± 3.20) as well as BAD mania (M=8.70 ± 2.02) were having lower number of most typical responses which suggest illogical thinking and inability to keep up with the demands, poor ego strength and poor interpersonal relationships. They will also have difference of opinions while interacting with others. It will be difficult for this group to communicate properly. Similar findings have been reported by Cassell and Dubey, (2003) and Mishra and Dwivedi (1997). Typical responses (T) are in preponderance in normal protocol and low in clinical groups. Both the groups in this study have shown low number of Typical responses (schizophrenia M=18.40 ± 5.38 and BAD mania M=21.83±5.72). Low Typical responses may indicate perceptual and thought disturbances in both the groups. Kaur and Verma (1998) have also reported low Typical responses in psychiatric patients. Very high number of Atypical responses in both the groups (schizophrenia M=32.13 ± 5.82 and BAD mania M=35.93 ± 5.35) suggest more psychiatric disturbance such as elevated mood, pressure of speech, distractibility and difficulties in sustaining attention. Rejection of images (Rej) shows thought blockage and inability to think properly. Rejection in schizophrenic patient (M=5.4 ± 5.44) was higher than BAD mania patients (M=1.27 ± 1.60) and the difference was found significant at 0.01 (t = 3.99, P<0.01). Such findings have been reported by earlier studies (Cassell and Dubey,1990,1997,2003, Verma et.al,1995, Kumar et al 2001,2005, Dwivedi et. al,1995). Both the groups scored low on Hostility Aggression Scale, Depression Scale, Pathological Anatomy Scale and Paranoia. Conclusion: Schizophrenia and BAD mania patients obtained significantly different scores on various indices of SIS. Results suggest that schizophrenia patients are less productive and have poor interpersonal relationship with more thought blockage and inability to think properly and had paranoid ideation in comparison with BAD mania patients. Result also indicates that BAD mania patients were more imaginative and preoccupied with internal body organs, showed more psychiatric disturbance such as elevate mood, pressure of speech, distractibility and difficulties in sustaining attention than schizophrenia patients. Results further suggest that both the group have illogical thinking and inability to keep up with the demands of society, poor ego strength and poor team concept. The results clearly indicated the discriminating ability of SIS indices in Schizophrenia and bad mania groups. Reference: Cassell, W.A. and Dubey, B.L. (1990) Interpreting Inner world Through Somatic Imagery: Manual or the somatic in Somatic Inkblot Series, SIS Center, Anchorage, AK 99516(USA) Cassell, W.A. and Dubey, B.L. (1997) SIS-II/Video Manual, SIS Center, 450 IE, 104th Avenue, Anchorage, AK-99516 (USA). Cassell, W.A. (1980) Somatic Inkblot Series-II, Aurora Pub. Co., Anchorage, Alaska, USA Dubey, B.L. Mishra, M., Dwivedi, C.B. and Mishra, N. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Series-II and Rorschach, SIS Journal of Projective Psychology & Mental Health, 1(1):19-26. 136 Kumari et al

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 Journal of Projective Psychology & Mental Health, 2(2):165- 170. Kaur, R.P. and S. K. Verma, (1998) A Correlational Study of Selected Rorschach and SIS-II Variables in Psychiatric Patients, SIS Journal of Projective Psychology & Mental Health 5(2):115-118. Kumar, D., Dubey, B.L. and Kumar, R. (2006). Gender differences in SIS-I profile of manic patient, SIS Journal of Projective Psychology & Mental Health, 13:61-64. Kumar, D., Kumar, J. and Kumar, R. (2005) Diagnostic Indicators on SIS-I and Rorschach Among Manic and Depressive Patients, SIS Journal of Projective Psychology & Mental Health, 12(1):53- 60. Kumar, S., Singh, R. and Mohanty, S. (2001) A study of Somatic Inkblot Series-I in Hospitalised Male Chronic Schizophrenics, SIS Journal of Projective Psychology & Mental Health, 8(1):31-34. Kumar, S., Singh, R., Mohanty, S. and Kumar, R. (2006) SIS-I and Rorschach in Schizophrenia: A Correlational Study, SIS Journal of Projective Psychology & Mental Health, Vol.13 (2),118-121. Dwivedi, C.B. (1997) Content Scale Based Diagnostic Compatibility of the SIS-II with Rorschach Test in Normal, Neurotics and Schizophrenics, SIS J.Projective Psychology & Mental Health, 4(2):121- 140. Overall, J.E. and Gorhan, D.R. (1963) The BPRS: Recent development in ascertaining and scaling, Psychopharmacological Bulletin, 24 (1):93-97. Pershad, D. and Verma, S.K. (1995) Diagnostic Significance of Content Analysis of SIS‑II, SIS J.Projective Psychology & Mental Health, 2(2):128‑132. Pershad, D., Verma, S.K. and Bhagat, K. (1997) Body Image Disturbances in Psychiatric Cases, SIS J. Projective Psychology & Mental Health, 4(1):60- 68. Rathee, S.P, Pande, V. and Singh, A. (1995) Diagnostic Efficacy of Somatic Inkblot Series‑II Among Psychiatric Patients of Armed Forces, SIS Journal of Projective Psychology Mental Health, 2(1):61‑66. Rathee, S.P, Pardal, P.K. and John, T.R. (2002) Diagnostic value of SIS‑II Among Sub‑groups of Psychotic and Neurotic Patients of Armed Forces, SIS Journal of projective Psychology and Mental Health, 9(1):23‑32. Sadock, B.J. and Sadock, V.A. (2005) Comprehensive Textbook of Psychiatry, Lippincott Williams & Wilkins, Vol 1, pp. 1559-1717. Verma, S.K., Prashad, D. and Nehra, R. (1994) Cross‑validation of SIS‑II in Psychiatric Population, SIS Journal of Projective Psychology & Mental Health, 1:15‑18. Verma, S.K., Pershad, D., Kaur, R. and Nehra, R. (1995) Diagnostic significant of SIS-II, SIS Journal of Projective Psychology & Mental Health, 3:7-60. Young, R.C., Biggs, J.T., Ziegler, V.E. and Meyer, D.A. (1978) A rating scale for mania: reliability, validity and sensitivity, British Journal of Psychiatry, 133:429-435. Personality Profile of Schizophrenia 137 Appeal Members of Somatic Inkblot Soceity are requested to kindly send their Annual dues before the 31st of January each year, to enable the Society to meet its expenses and smooth publication of the Journal.

There are different opinions about the value of psychodynamic personality assessment (Norcross et.al., 2006). Nowadays, this is used in evidencebased psychotherapy outcome studies and frequently increasing in individual treatment planning. The Task Force of Alliance of Psychoanalytic Organizations constructed the Psychodynamic Diagnostic Manual, PDM (Task Force, APO, 2006), as a complement to the criteria-based Diagnostic and Statistical Manual of Mental Disorders–IV (APA, 1994) by explicating the full range of mental functioning. It embraces psychiatric disorders of adults, adolescents, children and infants. It is generally thought to deepen the clinical picture of a patient, which might contribute to a tailed treatment planning. Additionally, it focuses on empirical findings in psychodynamic, interpersonal, and cognitive behavioral treatments. Research designs investigated and summarized in the PDM are naturalistic, quasi-experimental, controlled, and randomized controlled studies. This American effort of the PDM is grounded from specific critics by, e.g., Herzig and Licht (2006) plus Westen and Shedler (1999, 2000). The latter researchers point out that DSM categories are not satisfactorily grounded on empirical grounds. In cluster and factor analyses from several empirical studies, the DSM categories do not correspond adequately with reality. Another critic is the criteria for PDs on axis II that are dichotomized on actual continuous variables. For example, there is no clear limit of how much lack of empathy is needed to fulfill the criterion of a narcissistic PD. It may not be proper to exclude the criteria for empathy and omnipotence in antisocial PD (ASPD) to make it possible to differentiate this PD from the narcissistic PD when clinicians know that patients with both of these PDs commonly have these problems. Westen and Novotny also argue that co-morbidity is too prevalent on axis II in the DSM. If a patient fulfills criteria for one PD, there is a risk that additionally up till 4–6 more PDs fulfills. The discriminant validity is not approved here and also generally the reliability is vague over six months of test re-test procedures. In a series of empirical studies (Aleman, 2004; 2005a; 2006; 2007a, 2007b) a cohort of 84 drug dependent patients was investigated with psychodynamic assessment methods. The aim was, apart from validating methods, to deepen psychodynamic knowledge of the personality organization. This is postulated to contribute treatment planning in future. In one of the empirical studies (Aleman, 2007a), the aim was to psychodynamically assess drug dependent patients with ASPD plus one more co-morbid PD with the semi-structured interview method of KAPP (Karolinska Psychodynamic Profile, Weinryb et.al., 1991) and the projective technique of the DMTm (Defense Mechanism Technique modified, Andersson and Ryhammar 1998) assessing defense mechanisms. The present paper is neither about validity nor reliability of the PDM. It is neither a hypothetical statistical study. It is rather a re-assessment by means of the PDM, exploring how it might additionally contribute with specific psychodynamic knowledge of drug dependent patients with ASPD plus one more co-morbid PD, compared to DSM-III-R and Personality Assessment of Drug Dependent Patients with Antisocial Personality Disorder Kristian Aleman The present paper aims at exploring the relatively new system of the Psychodynamic Diagnostic Manual (PDM) through re-assessing a cohort from 1994–96 of drug dependent patients with antisocial personality disorder (ASPD) plus one more co-morbid PD (n=51). The procedure was to compare personality diagnoses from earlier personality assessment methods, especially the semi-structured interview of the Karolinska Psychodynamic Profile (KAPP), but also the Diagnostic and Statistical Manual of Mental Disorders (DSM–III–R) with new diagnoses assessed with the PDM. Five (out of six) new personality disorders (PDs) and seven (out of 17) subtypes of PDs were assessed using PDM in the cohort, compared to DSM. The section of “Profile of Mental Functioning” in the PDM, which specifies nine different mental capacities, showed, e.g., severely decreased ”Capacity for regulation, learning, and attention” in these patients with ASPD (n=25), which KAPP does not measure, and the possibility via “Defensive patterns and capacities” to assess “projective identification” in particularly patients with ASPD/masochistic PD and ASPD/depressive PD, which KAPP is restricted to assess. These new profiles of mental functioning might be relevant for treatment planning of drug dependent patients with ASPD. Kristian Aleman, Ph.D., Psychoanalyst, Dept of Psychology, Lund University, Vidargatan 5, entréplanet, 113 27 Stockholm, SWEDEN, kristian.aleman@ka-psychoanalysis.se, telephone: + 46 8 32 82 08 Key Words: Psychodynamic Diagnostic Manual, assessment, drug dependence, antisocial personality disorder

KAPP. The aim is to look at new results with the PDM and discuss advantages and drawbacks from a constructive critical point of view, offering recommendations for future versions of the PDM. Material and Method: Subjects: The sample from the consecutive cohort procedure consisted of 84 injecting drug abusers recruited between 1994 and 1996 from detoxification wards at Sabbatsberg Hospital, Stockholm, Sweden. One group of 19 substance abusers (5 women and 14 men) was diagnosed as psychotic. The psychiatrist diagnosed these patients as being psychotic according to DSM-III-R (module B, axis I, general criteria for psychosis). No clear axis II PD diagnosis was found in this group. The patients had all been substance abusers for at least five years, and DSM-III-R, axis I, diagnosed as being substance-dependent. Although one of the patients in the psychotic group abused only heroin, the others were poly-substance abusers of primarily amphetamine, benzodiazepines, alcohol, and in a few cases heroin. Another group consisted of 65 non-psychotic drug abusers with the DSM-III-R, axis I, diagnosis of drug dependence, also for at least five years. The aim of the recruitment in 1994 was to polarize, as much as possible, drug abusers who were dependent on either heroin (11 women and 25 men) or amphetamine (8 women and 21 men). The reason for this was the aim of investigating (Aleman, 2005a) one hypothesis (out of four), whether “drug of choice” would result in different patterns of DMTm signs, which proved not to be the case. Therefore the 65 drug abusers in the present study were mainly mono-substance abusers, although some occasionally abused alcohol, cocaine or sometimes benzodiazepines. It was noteworthy that the investigated subjects admitted acts of criminality, pathological lying, and varieties of ruthless behavior, etc. Exclusion criteria for this sample were diagnoses of psychosis, affective uni/bipolar mood disorder, organic brain damage, long-term psychopharmacologic therapy, and major poly-substance abuse. In a first step, five psychiatrists working at the hospital underwent a formal training course in applying DSM-III-R, axis II, diagnoses of PDs (SCID II, the Structured Clinical Interview for DSM). SCID II was used to assess a clinical DSM-III-R diagnosis. Each of the five psychiatrists diagnosed 13 patients, i.e., totally 65 patients who managed the time limit of at least four weeks of detoxification, which is in consistence with the DSM recommendations (Schuckit et al., 1991). The rather complex and symptom-based DSM-III-R diagnosis of ASPD was highly prevalent (56%) in the whole sample (n=84) and solely assessed as related to a second PD, i.e., a co-morbid PD (e.g., ASPD/narcissistic PD), which resulted in forty-seven patients. At the time of interviewing with KAPP and testing with DMTm, all of the subjects had been drug-free for at least four weeks. This was confirmed by at least two negative urine samples. While one of the five psychiatrists made the formal DSM-III-R diagnosis, the author of this paper performed all KAPP interviews and DMTm assessments of the 65 subjects. The patients were given both verbal and written information on the test procedures and feedback sessions. The doctor in charge documented the verbal consent in the medical journal. At this hospital ward, the battery of personality assessment methods used was perceived as an important opportunity for diagnosis. The drug abusers were therefore stimulated and encouraged to participate. All admitted patients fulfilling the inclusion criteria during this study period agreed to participate. Eight of them failed during the first admission, but could on a later occasion participate in the research project. In the study published in 2007 (Aleman, 2007a, for a more detailed description of methods) data were compared to three larger representative samples. Fridell (1991) investigated the prevalence of psychiatric disturbances in a sample (n=814) from a complete consecutive cohort (n=1052) of drug abusers. Fridell and Hesse (2006) presented this data in relation to Craig (2000), who reviewed 14 studies of international literature, and Verheul (2001), who reviewed 6 studies. It was shown that the percentages of PDs in the Aleman (2007a) study are fairly stable. Despite the relatively few subjects in this sample (n=84), the prevalence of PDs seems comparable with the representative studies, i.e., it increases the generalizability of the empirical findings. Personality Assessment: KAPP is used to explore fairly stable personality traits and modes of mental functioning as they come into view in self-perception and interpersonal relationships. It is a semi-structured interview where the responses from the interviewer are very active, sometimes on the verge of formal interventions. The transactions constitute a basis for interpretation from the patient’s verbal and non-verbal acts. There are 18 subscales in all, on an ordinal level. The first 17 subscales assess specific personality traits within various areas, such as: object relation quality, specific aspects of personality functioning, differentiating affects, bodily experiences, sexuality, etc. The last subscale is more of an abstraction to estimate personality organization. Personality Assessment of Drug Dependent Patients 139

When exploring each subscale, a psychoanalytic construct, definition is provided from the manual on three defined levels, but there are also two intermediate levels, resulting in a five-point scale: 1, 1.5, 2, 2.5, and 3. Level 1 represents the “most normal” and level 3 the “least normal.” The three defined levels on each scale are not primarily defined in terms of personality pathology, such as neurotic (1), borderline (2) and psychotic disorder (3), although there may be some correspondence to Kernberg’s (1984) construct. Interrater reliability proved satisfactory correlations between different raters of varying psychoanalytic expertise and experience (Weinryb, Rössel, & Asberg 1991). Later comparisons, also with a non- Swedish rater with psychoanalytic training, proved satisfactory. Generally, the interrater correlations were high (median 0.81, range 0.44–0.98), suggesting that KAPP has interdisciplinary and cross-cultural reliability. Weinryb, Rössel, and Åsberg (1991) showed that KAPP discriminated between patients with and without DSM-III, axis II diagnosis. Major life events did not seem to affect the results of KAPP. Comparisons have been made between interview-based ratings and projective test-based ratings, showing satisfactory agreement. KAPP thus has demonstrated both discriminative and construct validity. The content of the subscales reported in the results (Aleman, 2007a) is presented here (Weinryb, Rössel, and Åsberg, 1991, for all subscales). The scale of Dependency and separation (Object relation quality) involves various sorts of dependency, from infantile dependency to a more mature form of dependency. Coping with aggressive affects (Specific aspects of personality functioning) involves modes from non-adaptive inhibition of aggression, impulsive and destructive expression to more adaptive and goal-directed attitudes and behavior. Alexithymic traits (Affect differentiation) involve modes from severe intricacy in distinguishing between various emotions and sensations, also in verbalizing or expressing them by gestures (mimics etc.) to good capacity in identifying, experiencing and articulating nuances in emotions. Normopathic traits involve global sensitivity to social norms and over-adaptation to the norm system the individual identifies with. The scale goes from lack of personal expressions and originality to good capacity for perceiving personal expressions. Sexual satisfaction involves sexual interest, wish, and satisfaction in relation to a partner, from severe inhibition and passivity, to acting out destructive sexuality, further to mature forms of an active attitude toward sex and empathetic involvement with the partner. The projective technique of the DMTm measures defense mechanisms related to different forms of anxiety, interpreted in terms of the Andersson and Ryhammar (1998) psychoanalytic model of the mind. In the DMTm administration the patient looks into a tachistoscope. Two picture motifs are presented, both in series of 20 exposures each. The exposure time increases successively in each series from 5 to 1150 milliseconds. After each exposure, the subject reports verbally what is perceived and experienced, while at the same time drawing a simple picture. At the center of both pictures, a young person of the same sex as the test person can be seen. This person, termed the hero or heroine (H), is also equipped with a disguised sexual attribute (A). An older person of threatening appearance is shown peripherally (Pp). In the first picture it is a woman and in the second picture it is a man, representing the threatening mother and father. Perceptual deviations from the correct reporting of the picture motif are empirically predefined (operationalized) and interpreted as signs of defense and anxiety. Additional signs are analyzed neither as defense nor anxiety and are still under empirical evaluation (for a more detailed description of method and reliability, see Aleman, 2007a). Statistics: The KAPP ordinal subscales were calculated with Oneway ANOVA, between the DSM-III-R clusters A (n=8), B (n=21), and C (n=18). This approach implied satisfactory statistical power. Descriptive data as mean and standard deviation were calculated for all ten groups of PDs, classified into the three DSM-III-R clusters, on the five KAPP scales significant to cluster B. This approach of descriptive data specified what group contributed to the highest pathological score on a specific KAPP subscale. The DMTm signs were on a nominal scale to show the prominent distribution of the four current DMTm signs among the PDs in the three clusters presented below. The intention of such a restricted data analysis (distribution of DMTm signs) was to avoid a mass significance problem performing repetitive and iterative statistical comparisons with, e.g., Fisher’s exact probability test. Results: The prevalence of a DSM-III-R (co-morbid) PD diagnosis (n=47. Note, 6 patients were assessed as unspecified/UNS concerning their co-morbid PD) in drug abusers with a primary ASPD (ASPD= 53) was as follows: Odd Cluster: ASPD/paranoid, n= 3 (6%); ASPD/schizoid, n= 3 (6%); and ASPD/schizotypal, n= 2 (4%) 140 Aleman

Dramatic Cluster: ASPD/borderline, n= 8 (17%); histrionic, n= 4 (9%); and ASPD/narcissistic, n= 9 (20%) Fearful Cluster: ASPD/avoidant, n= 5 (11%); ASPD/dependent, n= 7 (15%); ASPD/obsessive-compulsive, n= 3 (6%); and ASPD/passive-aggressive, n= 3 (6%) Five (5) out of 18 KAPP subscales were significant to cluster B, i.e., the “dramatic” cluster including drug abusers with ASPD/borderline, ASPD/histrionic, and ASPD/narcissistic PDs compared to clusters A, “odd” and C, “Fearful”. The most significant result was on the scale of Normopathic traits (p=.000) and secondly, Alexithymic traits (p=.001). In third place as regards statistical significance were the subscales of Coping with aggressive affects and Sexual satisfaction (p=.003). Dependency and separation also showed significance (p=.009). From mean values and standard deviations it was shown that these five significant KAPP subscales, all correlated most frequently to patients with ASPD/ narcissistic PD. Pathology on the scales of Coping with aggressive affects plus Sexual Satisfaction correlated to ASPD/borderline PD. Defense mechanisms, measured with the DMTm, were chronologically, ASPD/narcissistic PD confirmed a high occurrence of marked denial and ASPD/dependent PD confirmed reversal II 1–2 (reaction formation). Patients with ASPD/borderline PD showed the defense of introaggression and the additional sign conceptualized as disappearance of threat (for detailed Tables of above-mentioned results, see Aleman, 2007a). Method and Procedure Applied in 2009: The author of this paper compared KAPPdocumentations from all 53 drug dependent patients with ASPD fulfilling the procedure as described above. From this KAPP-material, gathered and scored between 1994–96 by the author of this paper (inter-reliability trained and approved at Karolinska University Hospital) and from the DSM- III-R diagnoses (gathered and scored also between 1994–96 by five psychiatrists), a re-assessment was made according to the PDM system. Method: The first section of the PDM, P Axis of Adults, constitutes clinical material of personality patterns and disorders, complementing the Axis II in the DSM system. There are elaborations of several different and new personality disorders (PDs), which are discussed below. In the PDM the diagnosis of borderline PD is taken away, seen rather like an organization-level (from psychosis, borderline, and neurosis) and can be specified in other PDs that are offered. Section II, M Axis, constitutes a “Profile of Mental Functioning” to assess different capacities in a patient important to treatments. It is a “Profile” consisting of several psychodynamic methods empirically supported. Some subscales and ideas from KAPP are incorporated in the PDM. Section III, S Axis (symptom patterns), complements the DSM, Axis I, of clinical syndromes. The PDM emphasizes the subjects´ experience of symptoms. There are clinical illustrations offered in each section. The PDM constitutes a more clinical-based manual and the first psychodynamic effort to collect outcome studies and discussion papers of evidence-based nature. Perspectives from neuroscience and cognitive-behavioral psychotherapy are embraced in the manual. In the last section (IV) of the PDM there are plenty psychotherapy outcome studies comparing Psychodynamic psychotherapy with Cognitive (behavioral) therapies, Interpersonal therapy and other psychotherapy methods in relation to PDs and clinical syndromes. Some studies are also compared to psychopharmacology. Results: In the P Axis (personality patterns and disorders) five (out of six) new PDs and seven (out of 17) new subtypes of PDs were assessed in the cohort. The prevalence of a clear co-morbid (axis II) PD diagnosis increased from 47 (DSM) to 51 (PDM) in drug abusers with a primary ASPD (ASPD=53). It means that number of unspecified co-morbid PD was lower with the PDM. Forty-three (out of 53) patients with a primary ASPD were assessed with the subtype of “aggressive” version and ten patients were assessed with “passive/parasitic” version. The following results were shown. P Axis: Odd Cluster: ASPD/paranoid PD remained as earlier, i.e., n= 3 (6%); ASPD/schizoid PD increased with 1 diagnosis to, n= 4 (8%); and ASPD/schizotypal PD does not exist in the PDM. Dramatic Cluster: ASPD/histrionic PD remained as earlier, n= 4 (8%), but according to the PDM subtype: all 4 demonstrative or flamboyant and 0 inhibited; and ASPD/narcissistic PD decreased with 2 diagnoses, n= 7 (14%), and according to the PDM subtypes: 2 arrogant/entitled and 5 depressed/depleted. The PDM system does not allocate PDs in clusters like the DSM system, but their new constructions of sadistic and sadomasochistic PD, n= 2 (4%); (ASPD/) masochistic PD, n= 5 (10%) and all 5 patients fit to Personality Assessment of Drug Dependent Patients 141

the subtype of relational masochistic version and 0 moral masochistic version; and (ASPD/)dissociative PD, n= 2 (4%) might be placed in this cluster. Fearful Cluster: ASPD/avoidant (Phobic) PD remained as earlier, n= 5 (10%); ASPD/dependent PD increased with 1 diagnosis, n= 8 (16%), but specified with the PDM subtypes: passive-aggressive version, n= 5 and counter dependent version, n= 3; (ASPD/) depressive PD, n= 5 (10%), subtype: all 5 anaclitic version and 0 introjective version; ASPD/obsessivecompulsive PD remained as earlier, n= 3 (6%); and finally the new construction of (ASPD/)anxious PD, n= 3 (6%). In summary, five (out of six) of the new suggested PDs and even seven (out of 17) of the new subtypes of PDs according to the PDM were assessed in this sample of patients as a co-morbid PD. Therefore, ASPD as a primary diagnosis with a co-morbid PD increased with 4 diagnoses, n=51 (60%) as compared to earlier results (n=47, 56%). M Axis: The PDM section of “M Axis,” consists of nine capacities of mental functioning is shown in Table 1. There is a continuum with 7 artifacts constituting a scale, from (1) “Optimal Age- and Phase- Appropriate Mental Capacities with Phase- Expected Degree of Flexibility and Intactness”, (2) “Reasonable Age-…”, (3) “Age- and Phase appropriate Mental Capacities with Phase-Specific Conflicts or Transient Developmental Challenges”, (4) “Mild Constrictions and Inflexibility”, (5) “Moderate constrictions and Alterations in Mental Functioning”, (6) “Major Constrictions and Alterations in Mental Functioning” and finally the most severe degree on the continuum, (7) “Defects in Integration and Organization and/or Differentiation of Self- and Object Representations”. In Table 1, the results of mental capacities are solely distributed dichotomously. It means the definition of having problem or not having problem in a specific capacity. Not having problem was defined by the three first artifacts (1) “Optimal Age-…”, (2) “Reasonable Age-…”, and (3) “Age- and Phase appropriate Mental Capacities with Phase-Specific Conflicts or Transient Developmental Challenges”. The other four artifacts down to the severe degree Table 1 Distribution of PDM Mental Capacities among Drug Dependent Patients with ASPD and a Co-morbid PD. PDM PDs Regula-tion, attention, learning Relation-ships, intimacy Internal experience Affective experi -ence, expres-sion Defen -sive patter-ns Form internal representations Differentiation, integra-tion Self-obser-ving capa-city Internal Stand - ards, ideal & morality “ODD” ASPD/paranoid ASPD/schizoid 0/3 0/4 1/3 3/4 1/3 1/4 1/3 2/4 3/3 3/4 1/3 0/4 2/3 3/4 1/3 2/4 2/3 2/4 “DRAMATIC” ASPD/histrionic ASPD/narcissistic ASPD/sadomasoch. ASPD/masochistic ASPD/dissociative 2/4 2/7 2/2 5/5 2/2 2/4 6/7 2/2 5/5 1/2 2/4 5/7 2/2 5/5 2/2 2/4 6/7 2/2 5/5 2/2 3/4 6/7 2/2 5/5 2/2 3/4 6/7 2/2 5/5 1/2 2/4 5/7 2/2 4/5 2/2 2/4 4/7 1/2 3/5 2/2 3/4 7/7 2/2 5/5 2/2 “FEARFUL” ASPD/avoidant ASPD/anxious ASPD/dependent ASPD/depressive ASPD/obs.-compul. 2/5 2/3 3/8 4/5 0/3 1/5 1/3 6/8 2/5 1/3 1/5 2/3 4/8 3/5 0/3 2/5 2/3 3/8 3/5 1/3 2/5 2/3 3/8 2/5 2/3 1/5 2/3 4/8 1/5 0/3 3/5 2/3 3/8 3/5 1/3 1/5 2/3 3/8 1/5 0/3 3/5 2/3 4/8 3/5 1/5 NO CO-MORBID PD 1/2 1/2 1/2 0/2 1/2 1/2 1/2 1/2 1/2 Note: The first figure is indicating the number of patients who have difficulties in the current capacity. The second figure shows the total number of patients in that specific group of PD. 142 Aleman

of (7) “Defects in Integration and Organization…” constituted the definition of having problem in a specific capacity. In summary, although new and different kinds of capacities in the PDM in comparison to KAPP were assessed, the same distribution of pathological scores was observed as in the study of 2007 (Aleman, 2007a), i.e., most of them are seen in cluster B, “dramatic” patients. S Axis: In this section of the PDM, emphasis is grounded in the patient’s subjective experience of his symptoms. Symptoms are not seen as isolated and independent phenomena as in DSM, but related to the overall mental functioning of the personality organization. In the series of empirical studies by Aleman, mentioned above (see Introduction), Axis I in the DSM had not a large impact as indeed Axis II had. Only dependence on drugs, psychosis (in study I), panic disorder and depression (study II) were assessed. What concerns the PDM it can furthermore assess with higher prevalence “Anxiety Disorders” in the specific form of “Psychic Trauma and Posttraumatic Stress Disorders” in the investigated sample of the 53 patients with ASPD and a comorbid PD. It involves typically catastrophic events of terror, robbing, threats to death and emotional losses that constitutes complex grief. Out of the 53 drug dependent patients 39 were assessed as having Psychic Trauma and Posttraumatic Stress Disorder. S Axis will not be discussed further here below. Discussion: The PDM system requires much psychodynamic theoretical- (and clinical) experience. It is not a manual for laymen. The psychodynamic orientation is so complex that avoiding this is probably impossible. The PDM is a descriptive manual and complement the DSM system, which include a criteria-based system. Surprisingly, the new suggested PDs and subtypes in the PDM do not include any criteria. This must be developed and included to be in line with those criteria-based disorders embraced in the DSM, otherwise it is inconsistent. There are several interesting aspects from the results of personality patterns in PDs. For instance, researchers may wonder which DSM PD category patients were taken from and re-assessed in a new PDM PD category. In the PDM it is postulated that borderline PD should not constitute a single PD category, but instead be viewed as an overall mental personality functioning organization on a continuum from Neurotic, borderline, to psychotic organization. I agree with this postulation, likewise there is no single PD category for “neurosis”. It was shown that the earlier 8 patients assessed with ASPD/borderline PD now all became assessed in the PDM categories of ASPD/masochistic PD, n= 5 (10%) and ASPD/depressive PD, n= 5 (10%) all patients in the subtype of anaclitic version, in which 3 were from the earlier borderline PD category. This is in line with clinical experience and empirical research, even in groups of minority (e.g., Sherwood & Cohen, 1995; Aleman & Doctor, in press). Masochism and depressive states are prevalent in patients functioning with Borderline organization. From the ASPD/narcissistic PD category, 2 patients were re-assessed to the new category of ASPD/sadistic and sadomasochistic PD, n= 2 (4%). The present result is in correspondence with psychoanalytic clinical experience of severe violence with sadomasochistic character in the “psychopathic” narcissist (Rosenfeldt, 1971; Kernberg, 1989; Aleman, 2003, 2005b, 2008). The overweight of the depressed subtype (5 against 2 arrogant) in ASPD/narcissistic patients is not unpredicted with drug dependent patients. What is more astonishing no one of the patients seemed to go from ASPD/narcissism to ASPD/depressive PD in their re-assessment. Very commonly, otherwise is the close link between the depressed subtype of the narcissist and the introjective subtype of depressive PD. This differential diagnosis is worth observing in both clinical practice and in research. It is today well known empirically (Blatt & Bers, 1993; Blatt, 2004; also cognitive psychologist researchers like, Peterson & Seligman, 1984) that the introjective subtype of depressive PD do not respond very well either to psychopharmacological medicine nor short-term psychodynamic therapy because of their problems with self-criticism (cognitive nosology “attributional styles”), perfectionism (procrastination), guilt and regulation of sense of self. Interestingly, these patients seem to respond better to long-term psychodynamic therapy (e.g., Leichsenring & Rabung, 2008). The section of Mental Capacities (M Axis) in the PDM includes a score scale system with seven artifacts, mentioned above. This challenges a quantitative scientific approach that is unusual in psychoanalysis. The “Capacity for regulation, attention and learning” was widespread over the whole sample of drug dependent patients with a primary ASPD and a second co-morbid PD (n=25), except the PDs in the ODD clusters, whose personality patterns lack rewarding reciprocal relations and maybe therefore sharpen this capacity to learn instrumentally of the environment. Of Personality Assessment of Drug Dependent Patients 143

course this result is not unexpected compared to our experience of substance abusers, but a real step forward in assessment of personality. No manual of personality assessment so far, has formulated a psychodynamic concept embracing this phenomenon rather it is within the interdisciplinary area of neuropsychology. This capacity is probably crucial for planning, e.g., what orientation of psychotherapy might be chosen. The “Capacity for relationships and intimacy” together with the “Capacity for affective experience, expression and communication” are really similar if not identical with the scales of “Intimacy and reciprocity” and “Alexithymic traits” in KAPP. Therefore in the present study, the distribution of these results in Table 1 is very similar to the results in 2007 (Aleman, 2007a), i.e., allocated to the “dramatic” cluster. Another parameter in the PDM, the “Capacity for differentiation and integration” is not identical, but similar to the scale of “personality organization” in KAPP. It is an overall mental functioning description of internal capacity to differentiate self and non-self, self and others, fantasy and reality, past, present and future, and a range of desires, affects, thoughts etc. The “Capacity for quality of internal experience” is important for psychic health. The aim is to find out how the patient regulates a sense of wellbeing, vitality, and realistic self-esteem even under stress. Does a patient recover in those mentioned senses after stress or is there a feeling of emptiness, depletion and incompleteness if the scenario is not perfect? The result in Table 1 is prototypical for clinical practice. ASPD patients with narcissistic PD (5 out of 7) and ASPD/masochistic PD, the former borderlines (5 out of 5) had more severity in regulating well-being, vitality, and realistic selfesteem than other PDs showed. This result is also, partly in correspondence with empirical studies of “mentalization” or “reflective functioning” emerging from safe attachment, which is lower in borderline PD (Fonagy, Steele & Steele 1991; Fonagy, Steele, Moran et al. 1991; Fonagy et al., 2002). Fonagy and Target (2003) believe that an individual’s capacity to understand mental states of the self and interpersonal behavior comprises a key determinant of self- organization and affect regulation that influence self-esteem. This is much about why an individual might sense vitality, wellbeing in self-esteem. However, it is not exactly the same parameters but very close to each other. On the other hand, mentalization or reflective functioning is exactly the same as the “Self observing capacity” in the PDM, which resulted in severity for patients in the “dramatic” cluster (see Table 1). This capacity is relevant to observe in patients that might be treated in psychodynamic therapy. In addition to the above-mentioned capacities there is another one that might influence self-esteem but in a totally different manner, i.e., the “Capacity to construct or use internal standards and ideals: sense of morality”. It is known that patients with drug problems and ASPD have deficiency in constructing realistic/healthy internal standards forming a sense of morality. This was clearly shown in Table 1, where all drug dependent patients showed severity in moral standards. Again, most deficiency was shown in the dramatic cluster. With this magnitude of severity in constructing and using internal standards as a sense of morality, it is probably totally denied in these patients and lacks meaning emotionally, i.e. lack of empathy. It is difficult to speak about a sense of self-esteem with this kind of predicament around a patient. It connotes to ASPD and narcissistic PD, especially the arrogant subtype that uses denial as a defense mechanism (Aleman, 2006). The only one of the capacities that is tangibly problematic is the “Capacity to form internal representations”. It constitutes a mix of the subscale “Impulse control” and “Alexithymic traits” in KAPP, in combination with the “Capacity for differentiation and integration” in the PDM, but with a theoretical focus on internal representations as a base. It is unnecessarily complicated and vague descriptions here in the PDM. Measurement is almost impossible with this theoretical base. A suggestion here until next version of the PDM is to merely focus on the impulse control, which otherwise is lacking in the overall capacities. The “Defensive patterns and capacities” constitutes a wide spectrum of experiences in thoughts, affects, and regulating self-esteem in relations, in the best case with minimal use of defenses that suppress or alter emotions and ideas. An optimal use of defense mechanisms, according to the PDM, supports flexibility, healthy emotional functioning, sublimations, altruism, and humor. It is noteworthy that in KAPP interviews, specifically for the patients assessed with ASPD/borderline PD (now assessed according to the PDM as, masochistic and depressive PDs) there are notes on projective identifications in the transference. The current emotions were aggressions and seductiveness that became important to handle for the interviewer. The patient could say: “Why are you so aggressive, don’t you like me?” and “Do you like to talk about this “sex-issue” more than the other issues?” The interviewer suddenly felt anger and locked in the forced feeling to explain that this is not true about the expansive interest of the scale of Sexual satisfaction, and interpreted; “You are the one who don’t like yourself. You attack yourself and behave 144 Aleman

self-destructively in many ways” and “you want me to be embarrassed about exploring the sexual satisfaction, which is one out of 18 scales to cover in this interview. Maybe you want to feel triumph in this way of controlling me”. This group of patients scored pathologically highest on the KAPP scales of “Coping with aggressive affects” and “Sexual satisfaction” (Aleman, 2007a). Unfortunately, the KAPP instrument does not pick up defense mechanisms on any scale. In the projective test of DMTm, it was shown that “introaggression” (a sign of self-destruction, aggression toward the self, via e.g., violent sexualization) and “disappearance of threat” (difficulties in perceiving aggression continuously) were significantly present in patients diagnosed as ASPD/borderline PD (Aleman, 2007a). It is certainly strength in the PDM to have the freedom to assess the defense mechanism of “projective identification”, which is not possible in the KAPP nor in the DMTm to score. Projective identification that is not primarily communicative, but intrusive, also correlates to the new constructed masochistic and depressive PDs in the PDM (with a primary ASPD in this paper). The intention of the section of M Axis is one of the best in the PDM, I think. Mental professionals have the chance of assessing different important unique capacities in patients, relevant to treatment planning, not solely pathology. But, I am afraid it is also the worst section to comprehend. The PDM book comprises 857 pages, all sections very carefully worked through, but not this section. The description of these 9 capacities and a scoring system constitutes little more than 10 pages. A much more comprehensive version of this section must be made in future versions. It is not clear how to use this section. As a professional one has to guess what some descriptions mean, which is not appropriate to a scientific approach. Otherwise, the PDM is a truly empirical-based, first in its form, good piece of work that offers quantifications of complex psychological phenomena. The PDM also seems to be open for interdisciplinary research, which is a new psychoanalytic approach. Now, the future will tell how reliability and validity will result in empirical studies. On the other hand, Allen Frances, Chair of the DSM-IV American Psychiatric Association Task Force, lately acknowledged (Spiegel, 2005) that the desired reliability in the DSM system has not been reached. References: Aleman, K. (2000) Differences in terms of Defense Mechanism Technique modified (DMTm) between psychotic and non-psychotic drug abusers, Manuscript presented on 6 October 2000 at the international conference, “Addiction analysis 2000,” Tavistock Center, London, UK. Aleman, K. (2003) Envy and violence in confused sexuality, In: R. Doctor (ed.), Dangerous patients: A psychodynamic approach to risk assessment and management (pp. 115–125), Forensic Psychotherapy Monograph Series. London: Karnac Books. Aleman, K. (2004) Differences in terms of the Defense Mechanism Technique modified (DMTm) between psychotic and non-psychotic drug abusers, Journal of Projective Psychology & Mental Health, 11:25–35. Aleman, K. (2005a) Defense Mechanism Technique modified (DMTm), DSM-III-R clusters and personality disorders in drug abusers, Journal of Projective Psychology & Mental Health, 12:9-19. Aleman, K. (2005b) Percept-genetic symbolization, personality and defense of drug abusers—a psychoanalytic exploration, Manuscript presented on 20 August 2005 at the Kodera Seminar Hall. Foundation of Psychoanalytic Study, administered by the Japanese Psychoanalytic Society (International Psychoanalytic Association). Tokyo, Japan. Aleman, K. (2006) Psychoanalytic conceptions of the mind in relation to personality disorders of drug abusers, Journal of Projective Psychology & Mental Health, 13:125-138. Aleman, K. (2007a) Object relation quality, alexithymia, and defense mechanisms of drug abusers with antisocial personality disorder, Social Behavior and Personality An International Journal, 35, 10:335-352. Aleman, K. (2007b) Four problems with psychodynamic assessment of drug abusers, Nordic Psychology: Theory, Research, Practice, 59, 4:303–316. Aleman, K. (2008) Personality traits and defense mechanisms of drug dependent patients with antisocial personality disorder. An empirical study, Manuscript presented, and 45-minutes workshop on 11 April at Isola di San Servolo, The International Conference: Security and Terror: States of Mind, arranged by The Royal College of Psychiatrists and The International Association for Forensic Psychotherapy, Venice, Italy. Aleman, K. and Doctor, R. (in press) Lesbianism and mental health, In: The Oxford Textbook of Womens’ Mental Health. Oxford University. American Psychiatric Association. DSM–III–R (1987) Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author. Personality Assessment of Drug Dependent Patients 145

American Psychiatric Association. DSM–IV (1994) Diagnostic and statistical manual of mental disorders (4th ed.), Washington, DC: Author. Andersson, A. L. and Ryhammar, L. (1998) Psychoanalytic models of the mind, creative functioning and percept-genetic reconstruction, Psychoanalysis and Contemporary Thought, 21:359-382. Blatt, S. J. (2004) Experience of depression: Theoretical, clinical and research perspectives, Washington, DC: American Psychological Association. Blatt, S. J. and Bers, S. A. (1993) The sense of self in depression: A psychodynamic perspective, In: Segal, Z. V., and Blatt, S. J. (Eds) (1993) The self in emotional distress: Cognitive and psychodynamic perspectives, New York: Guilford Press. Craig, R. J. (2000) Prevalence of personality disorders among cocaine and heroin drug addicts, Substance Abuse, 21:87­-94. Fonagy, P. and Target, M. (2003) Psychoanalytic theories: Perspectives from developmental psychopathology, London: Whurr Publishing for Professionals. Fonagy, P., Steele, H. and Steele, M. (1991) Maternal representations of attachment during pregnancy predict the organization of infant– mother attachment at one year of age, Child Development, 62:891-905. Fonagy, P., Gergely, G., Jurist, E. L. and Target, M. (2002) Affect regulation, mentalization, and the development of the self, London: Karnac Books. Fonagy, P., Steele, H., Moran G. S., Steele, M. and Higgitt, A. (1991) The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment, Infant Mental Health Journal, 13:200-217. Fridell, M. (1991) Personlighet och drogmissbruk, En forskningsöversikt Stockholm Centralförbundet för alkohol- och narkotikaupplysning CANs PM-serie, Nr 10. Fridell, M. and Hesse, M. (2006) Personality disorders in substance abusers, In: M.U. Pedersen, V. Segraeus, & M. Hellman (2006). Evidence Based Practice. Nordic Council Herzig, A. and Licht, J. (2006) Overview of empirical support for the DSM symptom-based approach to diagnostic classification, In: PDM Task Force Psychodynamic Diagnostic Manual. Silver spring MD: Alliance of Psychoanalytic organizations; 2006. Kernberg, O. F. (1984) Severe personality disorders, New Haven and London: Yale University Press. Kernberg, O. F. (1989) The narcissistic personality disorder and the differential diagnosis of antisocial behaviour, Psychiatric Clinics of North America, 12:553-570. ­Leichsenring, F. and Rabung, S. (2008) Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis, Journal of American Medical Association, 300(13):1551-1565. Norcross J. C., Beutler L.E. and Levant R. F. (2006) Evidence-based practices in Mental Health: Debate and dialogue on the fundamental questions, American Psychological Association. PDM Task Force. Psychodynamic Diagnostic Manual (2006) Silver spring MD: Alliance of Psychoanalytic organizations. Peterson, C. and Seligman, M. E. (1984) Causal explanations as a risk factor for depression: Theory and evidence, Psychological Review, 91:347–374. Rosenfeld, H. (1971) A Clinical approach to the psychoanalytic theory of the life and death instincts. An investigation into the aggressive aspects of narcissism, International Journal of Psychoanalysis, 52:169-178. Schuckit, M., Helzer, J., Crowley, T., Nathan, P., Woody, G. and Davis, W. (1991) DSM-IV in progress, Substance use disorders, Hospital and Community Psychiatry, 42(5):471-473. Sherwood, V. R. and Cohen, C. P. (1995) Psychotherapy of the quiet borderline patient: The as-if personality revisited, Northvale, NJ: Jason Aronson. Spiegel, A. (2005) The dictionary of disorder: How one man revolutionized psychiatry, The New Yorker, 56-63. Verheul, R. (2001) Comorbidity of personality disorders in individuals with substance use disorders, European Psychiatry, 16:274-282. Weinryb, R. M. and Rössel, R. J., and Åsberg, M. (1991) Karolinska Psychodynamic Profile – KAPP, Acta Psychiatrica Scandinavica, 83 (supplement 363):1–23. Westen, D. and Shedler, J. (1999) Revising and assessing Axis II: Developing a clinically and empirically valid assessment method, American journal of Psychiatry, 156:258-272. Westen, D. and Shedler, J. (2000) A prototype matching approach to diagnosing personality disorders toward DSM–V, Journal of Personality Disorders, 14:109-126. 146 Aleman

Though DSM III classifies pathological gambling under the residual category of “Disorder of Impulse Control” there is a strong evidence to regard it has an addictive disorder with many dependence features those found in drug and alcohol dependence (Spitzer, 1980,Dickerson, 1984, Blaszczynski et al. 1985, Wray and Dickerson, 1981, Moran, 1970). In the developed countries pathological gamblers are treated in alcohol and drug addiction centers. Individual, group psychotherapy and education programs which are common  to Alcohol and drug dependence these also apply to Gamblers as well. Gamblers Anonymous is modeled on the principles and format of Alcoholics Anonymous. The experimental analysis of addictive behaviours is strongly affected by Skinner’s (1853) operant conditioning paradigm. If pathological gambling is conceptualized as an addictive disorder then similar processes may also be seen to be operating with subjective excitement generated by gambling as the reinforcing factor. Moskowitz (1980) commented that the thrill and excitement are so pleasurable that they are virtually addicting…. It is this charged-up feeling, a mixture of super confidence, enthusiasm, fear and guilt that seems to drive the patient towards the gaming table with subjective excitement and physiological arousal as the major motivating factor. Individual differences in autonomic / cortical arousability in interaction with irregular schedules of reinforcement have been postulated to be important determinant factors in the pathogenesis of pathological gambling (Anderson and Brown, 1984).Gamblers frequently described their excitement as analogous to the euphoric mood state of ‘fix’ experienced by drug addicts (Blaszczynski et al., 1986). Anderson and Brown (1984) postulated a model of gambling based on individual differences in autonomic and cortical arousal which, in interactions with irregular reinforcement schedules, led to the development of pathological gambling. They also found mean heart rate increases of 23.1 beats / minute in response to real-life casino gambling with half their sample of twelve gamblers reporting excitement as their main motivation from gambling. Leary and Dickerson (1984) showed that exposure to gambling cues did not alter base line arousal in their high or low frequency poker machine players. Playing was associated with increased arousal in both groups, significantly so for the high frequency players. Their mean heart rate increase of 13.5 beats / minute was lower than that observed by Anderson and Brown (1984) but was most likely accounted for by differences in stimulated versus actual gambling conditions and average bet siz. Increased subjective ratings of anxiety as measured by a shorted from of the Speilberger’s State-anxiety Inventory paralleled heart rate increases’. Elevated MMPI, Psychiatric Deviate and Depression Scale Scores have been consistently found in pathological gamblers (Bolen, 1975; Lowenfeld, 1979). Custer and Custer (1978) surveyed 150 Gamblers Annonymous members attending a conference and found only 5 percent had reported early, premorbid sociopathic behaviours. Mc Cormick et al. (1984) found 76 percent of a sample 50 gamblers seeking treatment to meet Research Diagnostic Criteria for major depressive disorder. Fourteen of their subjects reported that the depression commenced prior to the emergence of their compulsive gambling. Ferioli and Cimenero (1981) describe similar characteristics in their gamblers: depression, low self esteem, lack of assertiveness, inability to handle stress and the inability to identify or express feelings. Sharma and Sharma (2008) used Eysenck Personality Effect of Psychotharpy and Vipassana Meditation on Pathological Gamblers M.G.Sharma and Vandana Sharma This paper examines the effect of psychotherapy and vipassana meditation on pathological gamblers. 50 treated and 50 un-treated pathological gamblers were evaluated at S.I. Mental and Physical Health Society (SIMPHS) Varanasi district in India. They were matched for age (range 21 to 60 years with a mean age of 23.69 years) and had gambled for an average of 13.7 years with a mean length of uncontrollable gambling of 8.7 years. Seven cards of TAT (Indian Adaptation) 1, 3 BM, 4, 6 BM, 7 BM, 13 MF and 16 were used to ascertain personality characteristics on the five selected dimensions viz: form, need, press, subjective state of feelings and interpersonal relations. Mean scores obtained on different variables were analyzed using‘t’ test of significance. Results showed that the characteristics associated with treated pathological gamblers were language, organization, dominance, outcome, achievement, counteraction, affiliation, sex, guilt, dejection, affection, good interpersonal relations and happiness visa vis emotional tone, aggression, passivity, anxiety, inferiority and press in un treated pathological gamblers. M.G.Sharma, Ph.D., Lecturer, Sri Agrasen Kanya Autonomous P.G. College, Parmanandpur, Varanasi- 221003 and Vandana Sharma, Ph.D., Psychologist, S.I. Mental and Physical Health Society (SIMPHS), C.33/204-1B-1, Chandua Chhittupur, Varanasi-221002 (India) Key Words: Vipassana Meditation, TAT on gamblers.

Questionnaire and found that treated pathological gamblers had significantly higher on extraversion and lower on neuroticism, psychoticism and lie, and group therapy is more effective for pathological gamblers in comparison to the individual therapy (Sharma, 2001). Psychotherapy is the treatment, by psychological means of problems of an emotional nature in when a trained person deliberately establishes a professional relationship with the patent with the object of (i) removing modifying or retarding existing symptoms, (ii) mediating disturbed patterns of behavior and (iii) promoting positive personality growth and development. Unquestionably one of the most significant changes in psychological treatment in the past twenty years has *   been the group therapy movement. Treatment in groups has the obvious advantage of saving time and money. In seeing only one client per hour, the therapist can handle perhaps eight or ten. This means that each client pays less for the therapist’s time. It also means that more people, in absolute terms, can receive help an important advantage in a society where mental health professionals are in short supply. However, cost efficiency alone does not account for spectacular rise of group therapy, Rather, the popularity of this type of treatment is due primarily to the current belief that many psychological difficulties are basically interpersonal difficulties-problems in dealing with other people and that consequently these difficulties must be worked out in a interpersonal context – that is with other people. The number of a group may be selected because they are having similar difficulties, or they may have nothing more in common than the fact that they are all human being with problems. Group therapy is one of the best techniques for the treatment of pathological gamblers. In group patients can express their needs, emotions, sentiments, thoughts, ideas and views during session before the therapists and this is very important for the treatment point of view. When pathological gambling can manifest in somatic, affective, cognitive and / or behavioral forms. Hence various methods have been resorted to in clinical practice for such disorders namely, medication, hypnosis, bio feed back, progressive relaxation, cognitive behaviour therapy,mental rehearsal, systematic desensitization, implosion, positive thinking, physical exercise etc. Vipassana Meditation is one of the India’s most ancient meditation techniques; long lost to humanity, it was rediscovered Gautama, the Budha more than 2500 years ago “Vipassana” is a Paliword meaning insight. It is a system of self transformation by self observation. The meditation conducts a penetrating self examination by focusing on the physical aspect of self, on the ways in which mind affects body. So, the aim of the present research was to see the effect of psychotherapy and Vipassana meditation in pathological gamblers which was compared on the Projective Test by Chowdhury (1967). Material and Methods: Hundred thirty-nine pathological gamblers were taken from the S.I. Mental and Physical Health Society (SIMPHS), Varanasi, India out of these 50 treated and 50 un-treated subjects were admitted for this study, who completed the Indian adaptation of the TAT. All the subjects had gambled for several years and were gambling over half their weekly income. Psychotherapy and Vipassana meditation were provided by a group of three experts yoga and clinical psychologist including researchers of this study. The subjects of experimental group were doing meditation daily in a group at a particular time and place about 60 minutes under the supervision of yoga experts, and psychotherapy was provided by skilled clinical psychologist for six months (1st month – 4 times / week, 2nd months – 3 times / weeks, 3rd months – 2 times / week, 4th months – 1 time / week, 5th months – 1 time /10 days and 6th months – 1 time / 15 days). Results and Discussion: Scores obtained by the two groups on form, need, press, interpersonal relations, subjective state and feelings and outcome variables were analyzed using ‘t’ test of significance and results of such analysis are presented in tables 1 to 4 respectively. A perusal of treated and non-treated pathological gamblers on form variable reveals that the two Table 1 Comparison of Treated and Non-treated Pathological Gamblers on Form Variable Treated pathological gamblers Non-treated pathological gamblers ‘t’-value df. p. M SD M SD Language 23.16 3.69 20.27 4.01 3.80 .01 Organization 22.63 4.80 19.67 3.96 3.40 .01 Emotional tone 18.64 5.01 22.03 5.76 3.16 .01 Imagination 22.06 5.18 23.67 3.98 1.76 N.S. 148 Sharma and Sharma

groups differ significantly on language organization and emotional tone, and treated pathological gamblers groups having higher mean value on language and organization and non-treated pathological gamblers groups higher mean value on emotional tone and imagination category. This means, the non-treated pathological gamblers are very sad, unhappy, nervous, emotional labile, fearful and more imaginative in comparison to the treated pathological gamblers and the treated pathological gamblers do possess superior organization capacity, clear expression, rich vocabulary, grammatically correct sentences. Sharma and Sharma (2008), however, in a study found that non-treated pathological gamblers were unhappy, nervous, emotional unstable and depressed. This finding is quite similar to the present study. Scores obtained by the two groups on need variable were analyzed using‘t’-test of significance and results are presented in the following Table 2. A glance at table no.2 that the two groups viz: treated and non treated pathological gamblers do differ significantly on aggression, dominance, autonomy, achievement, passivity, counteraction, affiliation and sex  needs of which treated pathological gamblers do have higher mean score on autonomy, achievement, counteraction, affiliation and sex needs i.e. aggression, rejection, and passivity. The treated pathological gamblers have high avoidance whereas lower mean scores on rejection and acquisition. This means treated pathological gamblers were dominating person, autonomy in nature, Non-treated pathological gamblers did not think any kind of achievement, higher capacity of counteraction, affiliation and have sex needs, and they have more aggressive tendencies and have less passivity, as passivity is not a good an effective quality of life as compared to the treated pathological gamblers. In a study of Sharma (2008) reported that non-treated pathological gamblers were psychotic in nature. In other words they are more aggressive, tough minded and dominating persons in comparison to the treated pathological gamblers. With a view to comparing mean scores of treated Table 2 Comparison of treated and non-treated pathological gamblers on need variable Needs Treated pathological gamblers Non-treated pathological gamblers ‘t’-value df. p. M SD M SD Cognizance 5.03 2.99 4.06 3.17 1.59 N.S. Aggression 8.93 3.23 10.97 3.09 3.24 .01 Dominance 14.00 4.03 11.34 4.01 3.32 .01 Rejection 3.09 1.76 4.07 4.06 1.48 N.S. Autonomy 6.71 3.06 4.39 3.73 4.93 .01 Achievement 12.00 4.61 9.00 4.04 3.49 .01 Passivity 2.91 2.01 3.90 1.94 2.60 .05 Harm avoidance 3.75 4.09 2.47 4.03 1.60 N.S. Counteraction 6.97 3.99 4.99 4.01 2.50 .05 Affiliation 8.66 5.03 6.19 4.09 2.71 .01 Acquisition 5.11 2.47 6.39 3.73 2.06 N.S. Sex 9.93 3.99 7.03 4.01 4.60 .01 Table 3 Comparison of Treated and Non-Treated Pathological Gamblers on Subjective State and Feelings Variables. Variables Treated pathological gamblers Non-treated pathological gamblers ‘t’-value df. p. M SD M SD Anxiety 13.09 5.47 18.08 5.01 4.79 .01 Inferiority 9.06 6.18 12.60 5.94 2.95 .01 Guilt 8.61 3.92 6.03 3.01 3.73 .01 Dejection 6.01 3.00 4.01 2.01 4.00 .01 Affection 13.09 4.91 8.31 3.99 5.43 .01 Pathological Gamblers with Psychotherapy and Vipassana 149

and non-treated pathological gamblers on subjective state and feelings ‘t’ test of significance was used on anxiety, inferiority, guilt, dejection and affection variables and the results are given in Table  3. It may be traced out  from the table no.3 the treated pathological gamblers and the non-treated pathological gamblers do differ significantly on five variables i.e., anxiety, inferiority, guilt, dejection and affection. The treated pathological gamblers do have higher mean values on guilt, dejection and affection and the non-treated pathological gamblers on anxiety and inferiority. This means guilt was the outcome of super ego which was the integral part of personality development in Indian younger/ elder persons those had higher mean value were quite natural and such people were not acceptable in family and society therefore affection was a possible from the treated pathological gamblers side. Anxiety might be cause of regular gambling. The non-treated groups had appropriate degree of anxiety. In therapy reduction of anxiety would be an important approach to get outcome, Due to gambling, pathological gamblers did not like to meet other people, due to inferiority complex. In a recent study of Sharma and Sharma (2009) used MHQ and reveled that non-treated pathological gamblers had higher range of anxiety level as compared to the treated pathological gamblers. An attempt was also made to compare mean scores of the treated and non-treated pathological gamblers on press, interpersonal relations and outcome variables using ‘t’-test of significance. Results of such comparison are given in table 4. The table 4 shows that of the press (beneficialharmful), interpersonal relations (Cordialconflictual) and outcome (happy-sad) the two groups i.e., the treated pathological gamblers and nontreated pathological gamblers do differ significantly on press, interpersonal relations and outcome variables. The treated pathological gamblers do have higher mean scores on interpersonal relations and outcome and lower on press variables. It was quite expected the people did like them in general and in turn, they did like the social situation and this type of interaction resulted in higher degree of interpersonal relations. Due to regular gambling the mean value was high, this means they had more requirements from the environment. This living requirement was limited to this continue gambling behavior why this result was found? The gambling lack in requirement, hence, the mean value of press was high. Conclusion: The present study has shown that the characteristics associated with treated pathological gamblers are grammatically correct language, superior organization capacity, dominance, autonomy, achievement, counteraction, sex, guilt, dejection, cordial affectionate relations and happiness whereas characteristics associated with nontreated gamblers are emotional tone, aggression, passivity, anxiety, inferiority and press.

References: Blaszczynski, A.P., Winter, S.W. and Mc Conaghy, N. (1986) Plasma endorphin levels in pathological gambling, Journal of Gambling Behaviour, 2:3-14. Blaszczynski, A.P., Buhrich, N. and Mc Conaghy, N. (1985) Pathological gamblers, heroin addicts and controls compared on the E.P.Q. “Addiction Scale”, British Journal of Addiction, 80:315-319. Bolen, D.W., Caldwell, A.B. and Boyd, W.H. (1975) Personality traits of pathological gamblers, Paper presented at the Second Annual Conference on Gambling, Lake Tahore, Neveda. Brown, R.I.F. (1984) The investigation of arousal and sensation seeking factors in the explanation of gambling and gambling addictions, Paper presented at the 6th Conference on Gambling and Risk Taking, Atlantic City, New Jersey. Chokhani, R.M. (1983) Coping with stress the ‘Vipassana Meditation’ way, The Bombay Hospital Journal, 30:27-30. Table 4 Comparison of Treated and Non-Treated Gamblers on Press, Interpersonal Relations and Outcome Variables Variables Treated pathological gamblers Non-treated pathological gamblers ‘t’-value df. p. M SD M SD Press 2.96 1.98 4.67 2.01 4.50 .01 Interpersonal Relations 4.65 2.07 2.97 2.19 4.09 .01 Outcome 2.97 1.97 1.93 1.09 3.46 .01 150 Sharma and Sharma

Chowdhuri, U. (1967) Manual of the Indian adaptation of the T.A.T., Bookland Private Limited, Calcutta. Custer, R.L. and Custer, L.F. (1978) Characteristics of the recovering compulsive gambler : a survey of 150 members of Gamblers Anonymous, Paper presented at the Fourth Annual Conference on Gambling, Reno, Nevada. Dickerson, M.G. (1984) Compulsive gambling, Long Mans, Sydney. Ferrioli, M. and Ciminero, A.R. (1981) The treatment of pathological gambling as an addictive behaviour, In W.R. Eadington (ed). The Gambling Papers : Proceedings of the Fifth National Conference on Gambling and Risk Taking, Bureau of Business and Economic Research, University of Nevada, Reno. Kallick, M., Suits, D., Dielman, T. and Hybels, J. (1979) A survey of American gambling attitude and behaviour the University of Michigan Survey Center, Institute for Social Research. Leary, K. and Dickerson, M.G. (1984) Levels of arousal in high and low frequency gamblers, Unpublished Manuscript. Lowenfeld, B.H. (1979) Personality dimensions of the pathological gamblers, Dissertations, Abstracts International, July, 40:456. Mc Cormick, R.A., Russo, A.M., Ramirez, L.F. and Taber, J.I. (1984) Affective-disorders among pathological gamblers seeking treatment, American Journal of Psychiatry, 141:215-218. Moran, E. (1970) Gambling as a form of dependence, British Journal of Addiction, 64:419-428. Moskowitz, J. (1980) Lithium and Lady luck, New York State Journal of Medicine, 80:785-788. Sharma, M.G. (2001) Treatment of pathological gamblers with behaviour therapy, Proceedings of the International Conference on World Optometrists, IMS, B.H.U. Sharma, M.G. and Sharma, V. (2008) Pathological gamblers and psychotherapy compared on the E.P.Q., Indian Journal of Applied Psychology. 45:31 - 34. Sharma, M. G. and Sharma, V. (2008) Treatment of pathological gamblers with counselling and group therapy compared on the MMHSI and TDAS, Psycho-Lingua, Vol.  38:152-156. Sharma, M.G. and Sharma, V. (2009) The effect of meditation and psychotherapy on pathological gamblers : A comparative study, Journal of Indian Psychology, Vol. 27, (in press). Spitzer, R.I. (1980) DSM  of Mental Disorders, Third Edition. American Psychiatric Association, Washington, D.C. Skinner, B.F. (1953) Science and human behavior, Mac Millan, New York. Wray, I. and Dickerson, M. (1981) Cessation of high frequency, “Gambling Withdrawl” symptom, British Journal of Addition, 76:401-405. Pathological Gamblers with Psychotherapy and Vipassana 151 A case study is reported in every issue of the Journal. The readers are requested to send their comments to: Prof. Amool R. Singh, Ph.D., Editor in Chief, SIS Journal of Projective Psychology and Mental Health for publication in next issue of the journal. Also, please send your case study using projective test for publication in next issue of the journal.

Ego psychology is probably the most widely used model for understanding the conceptual underpinnings of thought disorders. Links between ego pathology and psychotic disturbances in thinking and reality testing were hinted by Sigmund Freud in 1911 before he developed his tripartite model of the mind; the links were subsequently elaborated by Tausk (1919) who viewed schizophrenia as a loss of ego boundaries and deficiency in egostrength. After the advent of his structural model (Freud, 1923), Freud stressed that disturbances in ego play a determining role in symptom formation in schizophrenia. Hartman (1953) extended the role of ego impairments in the process of schizophrenia but indicated that it was important to specify which ego functions were impaired. Arlow and Brenner (1964) listed “thought” as a central function of the ego. With thought and reality testing being the key domains of the ego, it naturally followed for ‘disturbances in thinking’ to be considered a constituent of ego functioning. In discussing the cognitive processes that underlie the formation of Rorschach responses, Rapaport focused on two related aspects of ego functioning – perception and association. He used the term ‘association’ to mean the ideational process whereby the subject draws on internal images, ideas, and memories in response to the stimulus inkblot. According to Rapaport, the response process involves a delicate ‘cog wheeling’ of the processes of perception and association. When these critical processes are not in synch, the subjects’ responses may wander excessively from the inkblot or become overly constrained by the perceptual reality of the blot. Disturbances in thinking were always related to the perceptual reality of the inkblot. Subjects who showed little consideration for basic features of the inkblot, such as contour, size, color and so on, or embellished their responses with details that went beyond these basic features were said to have responded with an increase of distance from the inkblot. The general observation of ego in Schizophrenia is weak. Ego boundary disintegrates resulting in confusion between ego and environment, thought and feeling, and therefore reality is falsified. The resultant production of delusions and hallucinations then leads to withdrawal from reality and ego regresses to states of childhood functioning with the appearance of previously unconscious mental contents in consciousness. Concisely, the central features of schizophrenic disorder process are a disturbance of the development and maintenance of adequate ego-boundaries between self and nonself and a deficiency in ego feeling. The present study was planned to explore if SIS-I indices taps ego-strength in schizophrenic patients. Ego strength is hypothesized to be measured by total number of responses (R), most-typical responses (MT), typical responses (T) and atypical responses (AT). Following hypotheses were formulated: 1. There would be lesser R in schizophrenics as compared to the normal. 2. There would be lower MT responses in schizophrenics as compared to the normal. 3. There would be reduced T responses in schizophrenics as compared to the normal. 4. There would be elevated AT responses in schizophrenics as compared to the normal. Method: The sample consisted of 100 participants - schizophrenics (n = 50), normal (n = 50). The clinical group was drawn from Psychiatry OPD, V.S.S. Medical College Hospital, Burla, Orissa, diagnosed on the basis of DSM – IV. The normal SIS-I Indices as a Measure of Ego Strength in Schizophrenia J. Mahapatra, D. Sahoo, P.K. Mishra and R. Kumar Impaired Ego Strength is a characteristic feature of schizophrenia. Projective techniques are commonly utilized to estimate the extent of ego strength. It was tried to explore if SIS-I can also effectively gauge ego strength in schizophrenic patients. SIS-I was individually administered on 50 schizophrenic patients drawn from Psychiatry OPD of VSS Medical College, Burla, Sambalpur. A matched control group of 50 normal participants was also drawn from general population. Consistent with the hypotheses of projective techniques, following SIS-I indices were identified as measures of ego-strength – Total Number of Responses (R), Most Typical Responses (MT), Typical Responses (T) and Atypical Responses (AT). The results clearly indicated that like other projective tools, SIS-I indices successfully measures ego-strength in schizophrenic patients. J. Mahapatra, Ph.D; FIACP, Asst. Professor in Clinical Psychology, Dept. of Psychiatry, S.C.B. Medical College, Cuttack-753007,(India) Email : jashobanta.orissa@gmail.com, D. Sahoo, Ph. D, FIACP, Consulting Clinical Psychologist, “The Mind” Bhubaneswar, P. K. Mishra, Professor of Psychology, Centre of Advanced Studies in Psychology, Utkal University, Vani Vihar, Bhubaneswar and R. Kumar, Ph. D., Senior Clinical Psychologist, Institute of Mental Health & hospital, Agra – 282002, Email – mindpowerlab@gmail.com Key Words: Ego strength, Schizophrenia, SIS - I

subjects were drawn from general population who were screened through PGI Health Questionnaire N–1 (Verma et al 1985). SIS–I was administered individually on each subject and scored as per the procedure laid down by Cassell and Dubey (1998). The groups were matched on gender, age, education and domicile. There were 25 male and 25 female subjects in each group with equal distribution from rural and urban domicile. 60 percent schizophrenics and 54 percent normal subjects were above matriculate and remaining up to matriculate. 68 percent schizophrenics and 50 percent normal subjects were above 34 years and remaining below 35 years. Scores on each variable of SIS – I were converted into percent scores by taking total number of responses as denominator. Mean, S.D. and ‘t’ tests were used to analyze the data. Results and Discussion: The results are presented in Table 2. A lower total number of responses (R) were observed in schizophrenics as compared to the normal subjects. Productivity (R) on SIS–I indices indicates individual’s imaginative power, functional intelligence and interpersonal relations. These psychological functioning appeared to be low in schizophrenics but not in normal. Break down of perceptual filtering mechanism is hypothesized in psychiatric population. This break down permits crowding a large number of stimuli which are condensed, developing most probably symbols (formation of imagery experiences in occipital cortex.), that are blocked / inhibited resulting in low number of response in psychiatric population. Most Typical (MT) response was evidenced to be decreased in Schizophrenics as compared to the normal. The lower MT responses in Schizophrenics most possibly indicate avoidance of harsh reality indicating a flight to land of unreality, the land of fantasy, which is exception to rules of probability (Freud, 1915). Cassell and Dubey (2003) commented that a higher number of MT responses is suggestive of coherent, logical thinking and ability to keep up with the demands of society. It may also be interpreted as a measure of ego-strength and team concept. The study demonstrated a significantly lower Typical response in Schizophrenics as compared to the normal. Typical responses indicate perception and projection of gestaltian image on SIS – I and a sign of positive health. It is an index of good egostrength that evaluates reality in its own perspective, and utilizes individual’s physical as well as psychological resources with optimal functioning in a dynamic and coherent mode to adapt with reality: The study confirmed the potential proposition that there would be elevated Atypical responses in Schizophrenics as compared to normal subjects. Atypical responses represent poor quality. It is because perceived sensations are not processed and organized by secondary elaboration mechanism which involves ego functioning. Higher involvement of ego-functioning is linked with higher functioning of secondary elaboration that makes up poor, vague percept a more logical, coherent and meaningful percept. Therefore, a decline of atypical responses is an indication of sound ego functioning. The findings of the present study are in conformity with the conceptualization of Cassell and Dubey (2003) that the number of atypical responses is proportionate to the degree of psychological or psychiatric disturbance. Conclusion: The findings of the index study clearly demonstrated the potentiality of SIS–I in differentiating the schizophrenics from normal on measures of ego strength in terms of different SIS – I indices. References: American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), Washington D.C. Arlow, J. A. and Brenner, C. (1964) Psychoanalytic Table 2 Mean, S.D. and t-values of SIS-I Indices in Comparison Groups Indices Normal (n = 50) Schizophrenics (n=50) t-values Mean S.D. Mean S.D. Total Number of Responses 37.70 15.618 20.12 5.058 7.572* Most Typical Responses 12.32 5.577 7.17 6.813 4.136* Typical Responses 62.26 10.13 46.45 18.088 5.392* Atypical Responses 25.78 12.274 48.14 19.428 6.783* * Significant at .01 level SIS-I Indices as a Measure of Ego Strength 153

Concepts and the Structural Theory, New York: International Universities Press. Cassell, W.A. and Dubey, B.L. (1998) Application of Somatic Inkblot Series in Personality assessment, Screening, Diagnosis and Therapy, SIS Journal of Projective Psychology & Mental Health, 5:3-32. Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot Series, Somatic Inkblot Center 4501E, 104th Ave, Anchorage, Alaska, 99516 (USA) Freud, S. (1915) Some Character-types met with psychoanalytic work, In Joan Riviere (Trans.) Collected Paper-IV, 318-344, The Hogarth Press Ltd., London, 1950. Freud, S. (1923) The ego and the id, Standard Edition, 19:12-66. London: Hogarth Press Hartman, J.L. (1953) Perceptual regression in schizophrenia: An hypothesis suggested by the use of the Rorschach test, Journal of Protective Techniques, 17:171-185 Tausk, V. (1919) On the origin of the “influencing machine” in schizophrenia, Psychoanalytic Quarterly, 2:519-556. Verma, S.K., Wig, N.N. and Pershad, D. (1985) PGI Health Questionnaire, National Psychological Corporation, Agra. 154 Mahapatra et al

The quality of life has been emphasized by researchers as a predictor of mental health (Diener and Diener, 1995; Kaliterna and Prizmic, 2006). It is affected by various factors such as job satisfaction, relationship with family members and others, physical, psychological and spiritual well being and channelization of emotions (Aminabhavi,1966; Bhardwaj and Wilkening, 1977; Stock et al., 1983. The present research was carried out to find the relationship between, satisfaction, socio economic status and its impact on quality of life of executives in business organization. Material and Methods: Two hundred and seven executives (167 Males and 40 Females) in the age range of 30-57 years, working in Manufacturing and Service industries in Delhi region were included in the study. It was a purposive sampling. Quality of Life, as a dependent variable, was measured by 54-factors of the instrument, designed by Brown, Raphael and Renwick (1998). The extent of a person’s QOL in each of the three main-domains, Being; Belonging; and Becoming is determined by two factors: ‘importance’ and ‘satisfaction’. Each main-domain is further constituted of three subdomains amounting to a total of nine sub-domains of Quality of Life. QOL consists of the relative importance rating and satisfaction rating attached to each factor/ dimension under each sub-domain. A set of 25-independent variables included in this study were grouped in eleven major categories: socio-economic status, personal background characteristics, physical being, psychological being, spiritual being, physical belonging, social belonging, community belonging, practical becoming, leisure becoming and growth becoming. Socioeconomic status comprised education and annual salary of executives only. The satisfaction measure in Physical Being domain covers physical health and nutrition; Psychological Being covers mental health and freedom from worry and stress; Spiritual Being covers beliefs of right and wrong, and helpfulness (acting in altruistic manner); Physical Belonging includes housing and personal space; Social Belonging covers ‘closeness to family’ (similar to ‘informal familial participation’) and ‘speaking to acquaintances (similar to ‘informal non-familial participation’); Community Belonging includes, ‘the amount of money I have’ and ‘connection to meaningful activities and other resources available to most members of the community’; Practical Becoming embraces ‘the work being done at the job’; Leisure Becoming accounts for ‘availing vacations and holidays for recuperation’ and finally the Growth Becoming domain includes all the five items of the instrument that cover ‘adjusting to life’s changes and improving self . Results: Of the eleven major factors, only Socio-Economic Status (education; salary) was non-significantly related to Quality of Life, which echoes a similar observation made by Aminabhavi (1996) that the Quality of Life of Indian professionals is not associated with their Socioeconomic Status. Of the background characteristics, only ‘Age’ is positively and significantly (r = 0.180) related to Quality of Life. Similar findings have been reported by Horley and Lavery,1995, (r = 0.27 between Age and Generalized Well-Being rating of SWB) Stock et al. 1983, between SWB and Age), Herzog and Rodgers, 1981, between General Life Satisfaction and Age. Looking at each of the nine categories or nine sub-domains of QOL, positive correlations (‘r’) are observed of satisfaction scores of all satisfaction variables/factors with QOL (range 0.411 to 0.670). Higher positive correlations (r > 0.48) with QOL are observed of fourteen (14) satisfaction variables in eight (8) sub-domains of quality of life. Quality of Life and Mental Health of Indian Managers Naveen Gupta and Pankaj Handa The multi-domain Quality of Life (QOL) in terms of Multi-factor predictors and Nine domain predictors have been studied in this paper. Controlling for Socio-Economic Status (SES) variables, significant partial beta-coefficients revealed: success in relationships of age and other independent variables with QOL among managers in North India. Standardized beta coefficients revealed that best factor predictors are ‘coping with changes in life’, ‘one’s ideas of right or wrong’, ‘trying out things’, ‘physical health’, and ‘resolution of conflict with others’, my mental health’ and being free of worry and stress; and best domain predictors are satisfaction with: ‘growth becoming’, ‘spiritual being’, and ‘physical being ’domains. The implications for future studies and theory construction are explored. Naveen Gupta, Ph.D., Director General, Advent Institute of Management Science and Technology, Fernio- Ka-Guda, Thoor, Udaipur. Rajasthan, (India), E-mail: dr_naveengupta@yahoo.com and Pankaj Handa, B.Sc.(Chem Eng),MBA, U. P Technical University, Lucknow. India, Mailing address: B-23, New Saraswati Society, Plot No. 26/1, Sector-9, Rohini, Delhi -110 085. (India), Email: handap1@rediffmail.com Key Words: Quality of Life, Mental Health, Domain Predictors, Being, Belonging, and Becoming.

With these relationships, it was tried to explore whether the general relationships noted with respect to 25-independent variables and scores of overall QOL remains a measure of quality of life. Results obtained suggest that most of the variables are significantly related to QOL; independent of SES. The gender factor however, had no relationship of QOL. Age was found to have significantly relationship with QOL. All significant zero order correlations indicate somewhat higher relationships and none of them was eliminated when controlling for SES. The results are shown in Table 1. The multiple correlations of 25-variables set comprising SES (Education and Salary), Age, Sex, Table 1 Relationship of Selected Variables with Quality of Life Category / QOL Sub Domains Predictor Variable / QOL Sub Domain Factor. Correlation X Partial Correlation Y. Socioeconomic status. Education 0.073 -- Salary 0.100 -- Background Variables Age 0.180* 0.192* Sex -0.072 -0.122. Satisfaction with QOL factor No: - Physical Being. (My body and health) 4. My nutrition and food I eat 0.614* 0.615** 5.My Physical health 0.565* 0.571** Psychological Being, (My thoughts and feelings). 8.Being free of worry and stress 0.439* 0.450**. 10.My mental health 0.488* 0.491** Spiritual Being, (My beliefs values). 17. Helping others in need 0.411* 0.424** 18.My own ideas of right or wrong 0.571* 0.573** Physical Belonging, (Where I live and spend time). 20. Having space for privacy 0.595* 0.597** 22.The House or apartment I live in 0.559* 0.559** Social Belonging, (The people around me) 25.Being close to people in my family 0.572* 0.572** 28.speaking with acquaintances 0.476* 0.482** Community Belonging, (My access to community resources) 34. Access to meaningful work activities 0.500* 0.506** 35. Access to Services-medical social. 0.525* 0.531** 36. The amount of money I have 0.416* 0.420** Practical Becoming, (The daily things I do) 42. The work I do at my job 0.579* 0.583** Leisure Becoming, (The things I do for fun and enjoyment) 47.Taking vacations and holidays 0.420* 0.439** Growth Becoming, (The things I do to cope and change) 49.Coping with changes in life 0.670* 0.675** 50.Improving my physical skills 0.498* 0.505** 51. My learning about new things. 0.516* 0.524** 52.My resolving conflict with others 0.511* 0.526* 53.My solving my own problems 0.617* 0.622** 54.My trying out things 0.430* 0.432** X. Zero Order Pearson correlation of each of variable with Quality of Life. Y. Partial Correlation of each of variable with Quality of Life controlling simultaneously for Educational attainment and Salary status. *Statistically significant at p < .05; and ** Statistically significant at p =. 000 156 Gupta and Handa

and 21-Satisfaction Factor scores with QOL have been examined and shown in Table 2. Education, Sex and Age failed to predict Quality of Life. Age, is not a predictor of happiness, is also reported by Oliviera (2008). The examination of magnitude of significant ‘beta coefficients’ of 11 variables in the overall multiple regression analysis (R2 74.88% and multiple correlations = 0.865) showed that: (i) ‘Coping with changes in life’ (Growth Becoming Domain), ‘My own ideas of right or wrong’ (Spiritual Being Domain), ‘My trying out things’ (Growth Becoming Domain), ‘My resolving conflict with others’ (Growth Becoming Domain), ‘My Physical health’ (Physical Being), are the Five (5) significant positive Strong Factor Predictors of Quality of Life. (Betas 0.49 to 0.24) explaining total variance of 54.59 %. (ii) The next Five Betas in descending order, from 0.224 to 0.21, correspond to ‘Speaking with acquaintances’ R2 2.73 % (Social Belonging - similar to ‘Informal non-familial participation’), Table 2 Summary of Partial and Multiple Correlations between Predictor Variables and Quality of Life Predictor Variables / Satisfaction with QOL factor No: Multiple Correlation Z Cumulative Variance. (%R2) Beta (Slope) 49.Coping with changes in life 0.675 45.52** 0.49 4. My nutrition and food I eat 0.750 56.21* 0.22 18.My own ideas of right or wrong 0.792 62.70* 0.305 53.My solving my own problems 0.814 66.28 0.15 28.Speaking with acquaintances 0.831 69.01* 0.224 10.My mental health 0.838 70.27* 0.217 52.My resolving conflict with others 0.846 71.61* 0.24 20. Having space for privacy 0.852 72.52* 0.21 Salary 0.855 73.14* -0.194 54.My trying out things 0.859 73.79* 0.266 5.My Physical health 0.862 74.38* 0.24 8.Being free of worry and stress 0.863 74.59* 0.21 47.Taking vacations and holidays 0.865 74.88 0.116 Z Step-wise prediction of Quality of Life. Significant at *p < 0.05; ** p = 0.000. Relationship of remaining individual independent variables with QOL, while holding constant the other independent variables, was not strong enough to be entered in to the stepwise multiple regression analysis Table 3 Zero Order and Multiple Correlations between Predictor Variables and Quality of Life Independent Variables / Satisfaction with QOL Domains. Correlation with QOL. Multiple Correlation with Q.O.L. Z Cumulative Variance. (%R2) Beta (Slope) Growth Becoming. 0.740** 0.739 54.71** 0.657. Social Belonging 0.661** 0.812 65.98* 0.246 Physical Being 0.690** 0.841 70.81** 0.44 Spiritual Being 0.693** 0.852 72.58** 0.41 Leisure Becoming 0.613** 0.857 73.46* 0.29 Physical Belonging 0.645** 0.860 73.93 0.21 Z Step-wise prediction of Quality of Life. Significant at *p < 0.05; ** p = 0.000. Relationship of remaining individual independent variables with QOL, while holding constant the other independent variables, was not strong enough to be entered in to the stepwise multiple regression analysis Quality of Life and Mental Health 157

‘My nutrition and food I eat’ R2 10.69 % (Physical Being Domain), ‘My Mental Health’ R2 1.26 % (Psychological Being), ‘Having space for privacy’ R2 0.91% (Physical Belonging Domain) and ‘Being Free of Worry and Stress’ R2 0.21% (Psychological Being). (iii) Unexpectedly, contrary to the positive nonsignificant zero order correlation of ‘Salary’ with QOL, the negative coefficient (beta = -0.194) appearing in the stepwise regression causes significant negative variance, but of less than 1% in overall QOL. (iv) Although the factor ‘My solving my own problems’ (Growth Becoming) explains 3.58% variance (R2) in QOL, it remains nonsignificant. The factor,’ Taking vacations and holidays’ (Leisure Becoming) yielded positive but non-significant variance in overall QOL. The multiple correlations of 13-variables set comprising SES, Age, Sex, and 9-Domain Satisfaction scores with QOL (Table 3) was examined to find out the QOL domain satisfaction as predictor. The results suggest: (i) First strongest domain predictor ‘Growth Becoming Domain’ (b = 0.657) explains highest 54.71% variance in overall QOL. Achievement in Life had been a third strongest predictor of Happiness (b = 0.14, p = 0.001) as reported by Kaliterna and Prizmić (2006). (ii) Second primary strong domain predictor ‘Physical Being Domain’ (b =0.44) explains incremental R2 of 4.83% in overall QOL. Rojas (2006) reported ‘health domain’ as the second strongest significant predictor of Life Satisfaction (b = 0.0097, additive model), and again Kaliterna and Prizmić (2006) established, ‘satisfaction with health’ as a second strongest predictor of ‘happiness’ (b = 0.21, p = 0.001). (iii) Third primary strong domain predictor ‘Spiritual Being Domain (b = 0.41)’explains incremental R2 of 1.77 % in overall QOL. (iv) The fourth and the fifth domain predictors are ‘Leisure Becoming (b = 0.29, incremental R2 0.88 %)’ and ‘Social Belonging (b = 0.246; incremental R2 11.27 %)’, respectively. (v) Interestingly, the ‘Social Belonging Domain’ (b = 0.246) explains a second highest incremental variance R211.27 % in QOL. Rojas (2007) identified that the ‘family domain’ is the strongest significant predictor of Life satisfaction (b = 0.0151). The satisfaction with ‘family and friends’ as the fourth strongest predictor of Happiness, is also confirmed by Kaliterna and Prizmić (2006, b = 0.15, p = 0.001), who point out that it is a common finding from the literature (Diener, Oishi, and Lucas, 2003). Several findings, close to ‘Social Belonging Domain’, with regard to the importance of satisfaction with ‘family and friends’, are read, such as Diener and Diener (1995 – Friendship: b = 0.21 and Family: b = 0.15), Mastekaasa (1984 – Family: b = 0.273 and Friends: b = 0.112), Kennedy, Northcott and Kinzel (1978 – Friendship: b = 0.286, incremental R2 23.3 % and Family: b = 0.129, incremental R2 2 %), and Bharadwaj and Wilkening (1977- Family: b = 0.26) Discussion: In terms of zero order correlations no substantial support for previous research is found as far as SES and Sex are concerned, but for the Age. Switching to the partial correlations, the significance of SES (education and salary) fail to eliminate significant relations of zero order, and prove not efficacious in accounting for QOL. Age, Sex and Education do not serve as predictors while Salary is a negative predictor but with a very limited variance in QOL. Satisfaction with ‘The people around me’ or ‘Social Belonging Domain’, (similar to ‘Informal familial participation’ and ‘Informal non-familial participation’/ ‘Friendship and Family’ / ‘Family and Friends’), serves as a potential positive domain satisfaction predictor with a second highest variance in QOL, thus supporting the past research. The strongest QOL factor ‘Coping Changes in Life’ and strongest QOL domain satisfaction predictors belonging to the Growth Becoming domain, and also stronger QOL factor satisfaction predictors such as ‘My Own Ideas of Right or Wrong’ (Spiritual Being domain), ‘My Nutrition and Food I Eat’ and ‘My Physical Health’ (Physical Being domain), and ‘My Mental Health’ and ‘Being Free of Worry and Stress’ (Psychological Being domain) signal to us that there is a shift underway in the industry. The first three domain satisfactions (R2 61.3 %) outweigh significantly other domains in predicting Quality of Life in the industry. To stay competitive and growing, managers need to have good nutrition and health, mental health, to be free of worry and stress, possess personal values, beliefs of right or wrong and connection to people around. Our study of correlates of quality of life offers potential for future research in this direction. Also, the earlier research shows significant relationships amongst Job Involvement, Quality of Life, and Quality of Work Life (Handa and Gupta, 2007). This study suggests that a theory-building research, using linkages among Quality of Work 158 Gupta and Handa

Life and Job Involvement and Quality of Life could be undertaken in the future studies, possibly to unveil tangible propositions to the Human Resource Management for interplay of issues related to both Quality of Work Life and Quality of Life in the industry. References: Aminabhavi V.L.A. (1996) Quality of life of professionals in relation to their job involvement and socio-cultural background, Paper presented in 32nd Annual Conference of Indian Academy of Applied Psychology, Aligarh Muslim University, Aligarh, U.P., (India). Bhradwaj L. and Wilkening E.A. (1977) ‘The prediction of perceived well being’, Social Indicators Research, 4:421- 439. Brown I., Raphael D. and Renwick R. (1998) Quality of Life Profile (Adults), Centre for Health Promotion, University of Toronto, Canada. Diener, E. and Diener, M. (1995) Cross-cultural correlates of life satisfaction and self - esteem, Journal of Personality and Social Psychology, 68(4):653 - 663. Diener E. Oishi S. and Lucas R.E. (2003) Personality, Culture, and Subjective Well Being: Emotional and Cognitive evaluations of life, Annual Review of Psychology, 54:403-425. Handa P. and Gupta N. (2007) Quality of Life and Job Involvement of Indian Managers – The Relationship and Implications, Proceedings of the Fifth AIMS International Conference on Management, Dec 29- 30, pp. 398 – 406, Hyderabad (AP) India: Association of Indian Management Scholars International. Herzog A.R. and Rodgers W.L. (1981) Age and Satisfaction; Data from large surveys, Research on Aging, 3:142-165. Horley J. and Lavery J.J. (1995) Subjective wellbeing and Age, Social Indicators Research, 1995, 34:275-282 Kaliterna L. L. and Prizmić L. Z. (2006) What makes Croats happy? Predictors of happiness in a representative sample, U: Delle Fave A. (ur) Dimensions of Well-being. Milano: Franco Angeli, 60 - 74. Kennedy L.W., Northcott H.C. and Kinzel C. (1978) Subjective evaluation of well-being: Problems and Prospects, Social Indicators Research, 5:457-474. Mastekaasa A. (1984) Multiplicative and additive models, Social Indicators Research Series 14:141-146. Oliviera D. R. (2008) Predictors of Happiness, Retrieved May 16, 2008, from http:// e z i n e a r t i c l e s . c o m / ? P r e d i c t o r s - o f - Happinessandid=1134519. Rojas M. (2006) Life Satisfaction and Satisfaction in Domains of Life: Is it a Simple or a Simplified Relationship? Journal of Happiness Studies, 7(4):467-469. Stock W.A., Okun M.A., Haring M.J. and Witter R.A. (1983) Age difference in Subjective well-being: A meta analysis, In R.J.Light (Ed), Evaluation Studies; Review annual, vol. 8, pp 279-302. Beverley Hills, CA: Sage. Quality of Life and Mental Health 159

Assessment of children’s personality, for basic research (Dasgupta and Sanyal, 2006; Malik, 1985; Pestonjee, 1984) or for clinical diagnosis (Kumar, 1960, 1961, 1962, 1963; Tuber, 2000; Fowler et. al. 2000; Sanyal, et al. 2006, Sanyal and Dasgupta, 2008) is not an uncommon phenomenon. Attempts are found on the part of test developers to design new tests, so that assessment becomes more comprehensive and helpful in designing therapeutic interventions complementary to the Children’s Apperception Test (CAT). In case of children in India, the most common projective test is the CAT (Chowdhury, 1964; Mathur and Kumar, 1967). An additional test has been found in recent times, which seems to have a penetrative orientation of a different nature. The test is named as the Fairy Tale Test (FTT). The Fairy Tale Test (FTT; Coulacoglou, 1993; 2000; 2003) is a projective personality test for children aged 7-12 yrs. Its broader purpose is to help the therapist assess the child’s personality dynamics, offering information, not just on single personality variables, but also on their combination. Its rationale rests on the relation between fairy tales and unconscious processes (Bettelheim, 1976). Its appropriate use is restricted to: i) Administration to children for the purpose of diagnostic evaluation; ii) Demonstration to students for the purpose of education and training, and iii) Use as a research instrument, with the necessary safeguards for ethical issue and confidentiality. The test permits a detailed profile analysis of aggression and assesses twenty-nine personality variables in total. First order factor analyses resulted in the formation of twelve primary factors: anxiety and depression, assertiveness, primitive and hostile aggression, instrumental aggression, insecurity, possessiveness, relationship with the parents, helpfulness, moral consciousness, envy, social withdrawal, ambivalence. Second order factor analyses led to the formation of six factors: envy and guilt, parent-child relations as regulators of primary needs, moral restraint and cognitive inhibition, survival coping strategies, passivity versus aggressive impulses, social isolation & parental dependency. The present paper is an attempt to investigate the efficacy of the Fairy Tale Test in clinical assessment, compared to C.A.T., especially in terms of the diagnosis and detailed analysis of findings of an 11 year-old child. Background of the case: Major Complaints: The behavioral features of the case, Neeta (name changed), aged 11 yrs., 6 months had complaints of lack of concentration, poor memory skills, poor academic performance, inhibition/lack of participation in the class, social withdrawal, poor adjustment at home and in the school. She was referred from school’s specialists for psychometric assessment regarding cognitive functions and personality profile. Family History: Neeta belongs to a Bengali middle-class joint family of thirteen members. She is the first child, having a brother 2 years younger. She has been conceived after 10 years of marriage of her parents, when they had lost all hopes of having a baby despite long-lasting fertilization treatment. Her mother is a housewife while the father remains pre-occupied with the family business, and appears unable to provide much of quality time, care and affection to his children. She perceives her father as distant, cold and authoritative and her mother to be relatively a “better” person. However, Neeta thinks that both her parents love her brother more than herself, thereby feeling deprived occasionally, and having intense feelings of sibling jealousy. She also Diagnostic Value of the Fairy Tale Test as Compared to CAT: A Case Study Nilanjana Sanyal and Manisha Dasgupta The Fairy Tale Test (FTT) is a recently developed projective test for children aged 6 to 12 yrs. It is not only used for the purpose of education and training, but also for diagnostic purposes. The test provides a rich tapestry of personality domains and as such, is increasingly being used in the clinical research and therapy perspectives. The paper highlights the application of the FTT as one of the main diagnostic instruments in assessing a child’s personality, aged 11 yrs, 6 months, hailing from a Bengali middle-class joint family. Results reveal striking congruence of the findings of FTT with that of the Children’s’ Apperception Test (CAT). Nilanjana Sanyal,Ph.D., Professor and Manisha Dasgupta,Ph.D., Lecturer Department of Psychology, University of Calcutta, Kolkata-700009, sanyal_nilanjana2004@rediffmail.com Key Words: Fairy Tale Test, diagnostic efficacy

perceives her mother to be of “nagging” character, always pressuring her to study hard. She spends most of the time playing with other cousins, who look down upon her because of her poor performance at school. As such, her interactions with her cousins are not easy. She also has to face deprecatory comments from her parents and close relatives. The home atmosphere is hostile because of the continuous presence of repeated spanking and scolding from the mother, in her vain attempts to put everything in order. This is also accompanied with occasional marital discord with her husband. Daily schedule of the case and current mental state: She attends school in the morning, coming back and rest in the afternoon, feel uncomfortable, plays with cousins in the evening and preparing the lessons with the help of the tutor. She has hardly any time to be with her parents and brother in a warm emotional interaction. She feels distant from her younger brother. Tests administered: A detailed interview was conducted with the case at the beginning. After the establishment of the rapport she was administered the Wechsler Intelligence Scale for Children (WISC-III), CAT and the Fairy Tale Test (FTT) (Coulacoglou, 2003) in two separate sessions. Procedure followed for administering the Fairy Tale Test to the case: Stories were told to her seven days before the day of assessment. The investigator introduced the child to the FTT on the day of testing as follows: “We are going to play a game with the popular fairy tale heroes that you’ve been told. I am going to ask you some questions about them and I would like to hear your opinion.” The cards were presented to the child in sets of three at a time in a standard order as instructed in the manual. The child was asked to respond to specific structured questions that relate to the set of cards presented to her. Further probing was done whenever that was felt necessary to delve into the unconscious personality dynamics of the child in relation to the different variables. In the recording of the interpretation of the FTT responses, the places where query were done were specifically indicated by the query mark (?) to signify the implication of specific probing. Behavioral observations of the child were also noted during the process of administration of the FTT for qualitative analyses. Scoring for each of the personality variables as revealed from the FTT was done by rating majority of them on a 1-3 point scale, whereby 1 is low and 3 is high in intensity.Raw scores of all variables were converted into T-scores (M = 50; S.D. = 10) as depicted in Table 1. Test behavior: She showed active cooperation and interest in the tests at the outset and responded to each of the questions slowly. It was relatively easy to establish rapport in all the sessions. However, she exhibited reluctance occasionally while answering the scales of the WISC, and said at the beginning of the administration of CAT that she does not have much to say in the context. However, the FTTadministration was relatively easier for the case in the terminal session. She appeared very absorbed in the cards of the Fairy Tale Test as well. Results: Her case was chosen for presentation because her responses and the symbolic themes reflected support to the traditional psychoanalytic interpretations (Bettelheim, 1976) of classic fairy tales. Intelligence: The Wechsler Intelligence Scale for Children (WISC-III) reveals a full scale Intelligence quotient (IQ) of 75 which is indicative of the fact that she has subnormal intelligence. Her intelligence quotients for Verbal and Non-Verbal Performance Scales are also found to be 77 and 78 respectively. Personality: A. Findings as revealed from the CAT The findings on CAT revealed poor inter-personal bondage on the part of the subject. A sense of alienation from the parents is also predominant. She feels emotionally distant from the father and perceives him to be emotionally insensitive. Yet, she seems to have Oedipal inclination toward her father and has an all-pervasive aggressive attitude toward her mother. In fact, she has passive aggression against her parents, especially her mother, and perceives her as extremely punishing. She seemed to be preoccupied with the fear of receiving the overt wrath of her mother. However, she has intense wish for soft maternal care, support and close attention. She feels not being understood by significant others around her. In addition, evidences of separation anxiety as well as an intense sense of insecurity have been found. She is unable to cope adaptively while facing a problem. She has an infantile orientation and intense oral aggression. Strong sibling jealousy and a sense of guilt are also noteworthy. She lacks initiative in interacting with others. Withdrawal appears to serve as her basic defense. CAT also reveals her poor intellectual capabilities. Diagnostic Value of the Fairy Tale Test 161

B. Findings on the FTT: Table 1 T- Scores of the Case for Each of the Different Personality Variables in Fairy Tale Test (FTT) S.N. Personality Variables Interpretation of the variables Obtained T- Scores 1. Ambivalence (AMB) Is an ego function which appears in different forms such as indecision, doubt, alternative responses and emotional conflict? 2. Desire for Material Things (DMT) Is associated with the desire to acquire material things including money, toys, clothes, cars or jewelry or material pleasures. 3. Desire for Superiority (DSUP) Reveals feelings of omnipotence and the desire for great achievements or for the attainment of higher positions or social status. 4. Aggression as Dominance (AGRDOM) Is a means to master one’s environment in order to impose one’s self or one’s will and to satisfy one’s ambitions. 5. Aggression as Retaliation (AGRET) Is a means of aggression which is motivated by a negative or traumatic event that occurred in the past. 6. Aggression as Defense (AGRDEF) Is a form of aggression which primarily focuses on defending or protecting oneself or someone else when threatened or attacked. 7. Aggression as Envy (AGRENVY) It arises when one compares unfavourably to others and is characterized by feelings of inferiority, hostility and resentment. 8. Aggression type A (AGRA) It is primarily inter-personal and hostile; the major motives being hatred and pleasure. Fear of Aggression (FA) It reflects fear of eminent attack, threat or danger. 10. Oral Aggression (OA) Most primitive or infantile form of aggression (eg. Biting, chewing, tearing to pieces etc.) 11. Oral Needs (ON) Reflects actual deprivation of food or symbolic deprivation of love and affection. 12. Desire to help (DH) Corresponds to a desire to offer assistance to others in need. 13. Need for affiliation (NAFIL) Refers to one’s need to engage in friendly behaviours, acquire friends, or be a part of a social milieu. 14. Anxiety (ANX) Reflected through thoughts about impending dangers or distressing events (eg. Harm, death, self-image, insecurity, disapproval etc.) 15. Depression (D) Refers to expression of feelings of unhappiness, rejection or loneliness 16. Need for affection (NAFCT) Expressed as a need to offer and receive love and affection. 17. Relationship with mother (REL/ MO) Reflects the quality of perceived relationship with the mother. 18. Relationship with Father (REL/FA) Reflects the quality of perceived relationship with the father. 19. Adaptation to the fairy tale content (AFTC) Reflects the child’s ability to confine the responses to fairy tale content version to which he is familiar. Reflects the child’s level of reality-testing. 162 Sanyal and Dasgupta

S.N. Personality Variables Interpretation of the variables Obtained T- Scores 20. Repetitions (R) Involves a response that is similar (meaning-wise) to the previous one and may be due to lack of imagination, boredom or preoccupation with a particular theme. 21. Self-esteem (SE) Connotes the value that one places on oneself. 22. Need for protection (NPRO) Need to seek security or assistance from others who are perceived as stronger or more powerful. 23. Morality (MOR) Reflects issues related to moral judgements, dilemmas between what is right and what is wrong. 24. Sense of property or Ownership (SPRO) Involves the determination of boundaries between “what is mine” and “what is not mine”. 25. Bizarre response (B) Refers to unique, idiosyncratic responses that may reflect the child’s level of imagination and fantasy but can also be indicative of deep personal conflicts or psychopathology. 26. Sense of privacy (SPRIV) Refers to the individual’s need for isolation or seclusion (eg. Desire to be alone, away from crowds and noises) 27. Need for approval (NAPRO) Is one of children’s most fundamental needs. Children require systematic appreciation or praise of their behaviour from others to maintain or improve their self-image. 28. Sexual preoccupation (SEXPRO) Reflect interest in or concern about sexual matters either in a socially disguised form (marriage, falling in love) or in a more impulsive way. 29. Instrumental aggression (AGRINSTR) Is a way to acquire possessions primarily for survival or for self-serving outcomes. Interpretation of the findings on personality variables as revealed from the FTT: The obtained magnitude of the T-scores for the different variables as revealed from the Fairy Tale Test (FTT) for the case significantly brings out her pathological profile of personality. In fact, Table 1 reveals that she has strikingly high desire for superiority, aggression as defense, aggression as envy, aggression Type A, fear of aggression, oral aggression and need for affiliation. Some of the most characteristic responses of the case are presented as follows: 1. Wolf: Card II “He’s thinking of plotting a trick on Little Red • Riding Hood (LRRH) so as to be able to eat her (?). He’ll be able to plot his plan and finally will be able to eat her (?). He’s feeling very nice to think about eating LRRH.”

(OA 2 [ON 1], AFTC 3) {Dynamic indicators related intense oral aggression, oral needs and high adaptation to fairy tale content} “Th • is is the wolf in the story of LRRH (Card III) because he looks very fierce (?) he has big teeth and a protruding tongue.” (OA 1, ON 1, DSUP 1) {Dynamic probing • reflected oral aggression, oral needs and desire for superiority} “This wolf (Card III) scares me the most • because he’s hanging his tongue out and looking scary.”

(FA 1) {Analytic reflections pointed out aggression of interpersonal nature and fear of aggression} 2. Witch Card II “She’s th • inking that when Snow White (SW) will be killed, the mirror will say that she’ll be the most beautiful woman (?) She’ll be able to kill the girl (?) She’s feeling very happy thinking about the same.”

(AFTC3 –stereotyped response revealing no personality variables) Diagnostic Value of the Fairy Tale Test 163

Card III “She’s thin • king that she’ll be able to live happily ever after if she’ll be able to kill SW (?). I think that she’ll be able to kill SW (?). She’s feeling that she’ll be able to get all the wealth and properties of SW if she’ll be able to kill her.”

(INSTR.AGR3, AFTC 2) {Instrumental aggression typical of Indian culture} 3. Giant Card II “He’s thinking that a tiger or some wild animal • will eat up SW if he leaves SW in the forest (?). He’ll take SW with him and go to the forest.”

(ANX2 (concern) AFTC 1) {Dynamic nature of inquiry reflected high loadings of aggression to defend SW and fear of aggression, with little emphasis on fairy tale content} 4. Scenes from the story of LRRH Card III “As L • RRH was crying bitterly, LRRH’s mother has come and is trying to make her happy (?). She’ll then become happy again for her mother has made her happy.”

(D2, REL/MO +1, NAFCT 2, [NPRO 2], AFTC 2) {Analytic probing depicted moderate levels of cravings to be protected by the mother} “I would like the story to end with Card III • because RRH felt very happy when her mother tried to make her happy.”

(NAFCT 2) {Reflected moderate levels of need for affection} Though her responses show different contents in CAT and FTT, the main themes and variables are found to be repeated, with the FTT appearing to be more effective in offering specific dimensional meanings of personality. The common trends in her personality structure as revealed by these tests are as follows: Presence of oral aggression, often vented • through passive ways; Fear of aggression; • Anxie • ty and sense of insecurity Additionally, the specific personality characteristics of Neeta, as revealed by the FTT are as follows: Need for affiliation; • Aggress • ion as defense to protect oneself when threatened; Desire for superiority and become omnipotent • (hinting at the presence of sibling jealousy) High loadings of aggression as envy (supporting • the presence of sibling jealousy) The basic conclusions of her personality organization as emerged from both psychological evaluation and clinical interview appear as follows: Her defensive personality orientation to seek • approval of significant others, especially her mother; Emotional immaturity; • Presence of high loadings of aggression; • Evidences of subnormal intelligence; • Excessive anxiety. • In fact, Klein (1932) suggests that when one’s personal security is threatened and dependent relationships are shaken, then aggressive feelings may develop. This may also explain the aggressive bouts of the present case. Conclusions: The case study sheds light to the introspective capacity of projective techniques in unfolding one’s personality characteristics, which adds to the clinical significance of projective techniques. References: Bettelheim, B. (1976) The Uses of Enchantment: The Meaning and Importance of Fairy Tales, New York: Knopf. Chaudhary, U. (1964) An Indian modification of the Children’s Apperception Test. Manasayan: Delhi. Coulacoglou, C. (1993) The development of the Fairy Tale Projective Test in the personality assessment of children. Unpublished doctoral thesis. University of Exeter. Coulacoglou, C. (2000) The cross cultural and clinical values of Fairy Tales and the Fairy Tale Test, SIS Journal of Projective Psychology and Mental Health, 7,27-38. Coulacoglou, C. (2003) Fairy Tale Test. Manual. Toronto: Multi Health Systems, Inc. Dasgupta, M. and Sanyal, N. (2006) A review of personality assessment techniques of children in India, Journal of Psychometry, Vol.XX, (2):22-36. Fowler, J.C., Hilsenroth, M.J. and Handler, L. (2000) Martin Mayman’s Early Memories Technique: Bridging the gap between personality 164 Sanyal and Dasgupta

assessment and psychotherapy, Journal of Personality Assessment, 75(1):18-32. Klein, M. (1932) The psychodynamics of children. London: Virago. (Original work published in 1932) Kumar, P. (1960) Rorschach test in some mental disorders, Psychoneurotic groups, Indian Journal of Psychiatry, 2:129-134. Kumar, P. (1961) Rorschach test in Psychoneurotic and normal groups, Indian Journal of Psychology, 36:169-172. Kumar, P. (1962) The Rorschach test in depressive and normal group, Indian Journal of Psychology, 37:89-92. Kumar, P. (1963) Rorschach test in Schizophrenic and normal groups, Indian Journal of Psychology, 38:121-124. Malik, A.K. (1985) The study of reliability of the Jodhpur Multiphasic Personality Inventory, Indian Psychological Review, 28(2):17-23. Mathur, S. and Kumar, B. (1967) A study of delinquents and non-delinquents through C.A.T., Indian Journal of Applied Psychology, 4,:272-275. Pestonjee, D.M. (1984) Second Handbook of Psychological and Social instruments, IIM, Ahmedabad. Sanyal, N. and Dasgupta, M. (2008) The application of the Fairy Tale Test in India, In Coulacoglou, C. (Ed.) Exploring the child’s personality: Developmental, Clinical and Cross-Cultural Applications of the Fairy Tale Test. Chales C. Thomas, Springfield, Illinois, U.S.A., pp. 264- 302. Sanyal, N., Dasgupta, M., Marinakis, D. and Doukas, O. (2006) Personality assessment of a child with emotional problems: A case study, SIS Journal of Projective Psychology and Mental Health, 13 (2):139-146. Tuber, S. (2000) Projective testing as a post-hoc predictor of change in psychoanalysis: The case of Jim, In J. Cohen, and Cohler, B.J. (Eds.), The psychoanalytic study of lives over time: Clinical and research perspectives on children who return to treatment in adulthood (pp. 283- 308). San Diego: CA: Academic Pres Diagnostic Value of the Fairy Tale Test 165

Perception is not, and can not be, an objective phenomenon; it is always a construction, more or less idiosyncratic, shared, but only in certain aspects. This aprioristic consideration brings us immediately to Kant’s notion of the distinction between phenomenon and noumenon. The thing in itself is not accessible to thought. The result of cognition is already the appearance not the coincidence. In fact, the objective knowledge does not exist in fact, it is just something simplistic that makes sense to believe, that reassures us, that gives us a sense of belonging, that we all have something in common. Sami-Ali states that what we see at each time is the result of the nature of things and what we are. More than being a defence mechanism the projective process contributes to shape the world in order to make it a cultural universe (quoted by Fernandes, 1994). The projection in a broad sense relates to how the individuals perceive the environment and respond to it according to their own interests, skills, habits, or durable or momentary affective states, expectations, desires, etc. (Laplanche & Pontalis, 1971). The concept of projection could be mistaken with another one - apperception - which is, or is closely related to the influence of emotional aspects in the perception of reality. Thus, projective techniques, such as the Rorschach, would allow the study of perception depending on the person’s concerns, his or her mode of establishment of relationship with the objects and his or her affects (Chabert, 1997). The concept of projection was introduced in Psychology by Freud. Initially, Freud spoke of projection as a concept linked to pathological functioning. It was an archaic defence mechanism which explained the symptoms formation in paranoia. The individual faced with inappropriate desires for his moral conscience, projects them in the external world, places them in another person. This mechanism would reduce the anxiety and conflict that these feelings produce. Therefore it would consist in the expulsion of the unacceptable wishes and feelings for the ego, what the person does not want to accept in himself. As a defence mechanisms, projection is the operation whereby the individual expels from himself and locates in another person or thing, qualities, feelings, desires, what he does not whish and repulses in himself (Laplanche and Pontalis, 1971). In fact, the individual always projects what is splited, which he excludes from his inner perception (Coimbra de Matos, 2002), the internal object - in the hallucinatory projection - his drives - in the delusional projection (the subject does not feel their own feelings and sees them in another person - projection of the id) - or an image of himself - projection of the self. In the persecutory delusion he projects the super-ego. Although Freud had originally considered projection as something linked to pathological functioning, in later writings (Freud, 1911, 1919), statements about projection more consistent with the use of the term in projective techniques can be found. Freud has expanded the concept and applied it to normality; projection would be present in normal psychological function (Rabin, 1981). It is present when someone tries to find the causes and an explanation for life events, feelings or behaviours in the outside world, rather than looking within, to his mental functioning or to his unconscious motivations. Thus It would present in our attitudes to the outside world. The projection would result from the nonrecognition of the unconscious motivations / causes for our feelings and behaviours. In Freud is evident the idea of psychic determinism. All behaviours are determined by concerns and personal reasons. There is a motivation for the behaviour. So, the projection active in projective techniques may be not only consistent with the concept of projection as a defence mechanism. Murstein and Pryer (1959) defined four types of projection: classical, attributive, autistic and rationalized. The projection, as a concept used in the context of projective techniques, would be more consonant with the broad attributive definition and also with the autistic definition, but obviously that the other two definitions are not totally inconsistent with the projection that may occurs in projective methods. The classic projection corresponds to the original concept of projection proposed by Freud. The attributive projection corresponds to the process of Projection and Projective Methods: A brief Theoretical Comment Rui C. Campos In this work we discuss the several meanings of the projection concept and the way it expresses itself in projective methods. We also give some examples of “projective responses”. We consider that projection is not enough to characterize the response process to projective methods and is actually behind the response to all psychological tests. We discuss five features which make possible to define the projective methods’ status and we state that this methods are unique instruments in psychological assessment. Rui C. Campos, Ph. D., Assistant Professor,Department of Psychology, University of Évora, Apartado 94, 7002-554 Évora. Portugal (Tel: 351 266 768050, Fax: 351 266 768 073, E-mail: rcampos@uevora.pt Key Words: projection, projective methods, theory Projection and projective methods: A brief theoretical comment

assigning motivations, feelings and behaviours to others. - it is a broader concept, in line with the later definition of Freud, including the classical concept. The autistic projection is more related to perception - the process by which the individual needs influences what he perceives - close to the apperception concept. Finally, rationalized projection is the process by which the individual uses the classical projection but justifies it, rationalizes it. This idea of projection is closely tied to the concept of projective identification, the mechanism by which the person deals with the conflicts by projecting unrealistic and unacceptable impulses, feelings or thoughts to others. Unlike the projection, the person does not completely reject the projected material. The individual is more or less aware of their impulses or affects, but attributes them wrongly, justifying them as a reaction to the maltreatment of the other. The subject tends to induce in the other person their own feelings, making difficult to know who said or did what to whom (APA, 2002). In another theoretical formulation, a process of mirrored projection may be active in the response process to a projective method - the individual projects features that he considers or wishes to belong to him. It can be performed by the indicative or by the optional mode. An example of this type of projection in the indicative mode is a person that has not one arm and in the Draw a Person Test draws a figure with just one arm - he projects, he assigns to the figure his own image. In the optional mode the individual projects features that he wishes to have - a too ‘scrubby’ child may draw a very robust figure. In cathartic projection, which corresponds to the Freudian projection, the individual projects the characteristics that refuses in himself, does not wish to have; he expels, makes a catharsis. For example, a very rigid person with high moral standards may see scenes of great aggression in the TAT cards. In the complementary projection, the individual assigns to others or projects characteristics that justify his attitudes. For example, a psychopath can describe others as unfair or harsh to justify his impulses and behavior. A phobic can see others as hostile (Anzieu, 1976). Rabin (1981) suggests that the term externalization may be more appropriate to explain what happens in projective techniques, avoiding the connotation and the incomplete meaning of projection only as a defence mechanism. Actually, the response to projective methods may not involve projection, if we consider the concept in a more restricted sense. Ávila-Espada (1993) states that, in a certain way, to avoid the term projection, it would be preferable to use the term “Qualitative methods of psychodiagnostic, geared to the individual idiosyncrasy” instead of the term “projective method”, . In this sense, it would be possible to investigate all the defence mechanisms, including projection through projective techniques. Moving away from a traditional concept of projection and focusing on the perceptual process Zubin, Eron and Schumer (1965) define projection as a process by which the individual when is faced with an ambiguous or semi-ambiguous set of stimulus and is asked to give them order or meaning would do it based on their own needs, emotions, feelings and even level of knowledge. The projection, therefore, would not necessarily involve defensive, unconscious, unacceptable or anxiety avoidance components. So, it can be said in yet another way, that in projective techniques the concept of projection will be related to all processes or mechanisms used by the individual in the treatment of the stimulus, including the defence mechanism of projection (Fernandes, 1994) But of course, that in the projective jargon we ca say that some responses are more projective than others. Those answers, by its distance from the stimulus, reveal immediately some specific modes of psychological functioning. Some times this gap reveals a total forgetting of the test situation, and the attribution of a meaning to the stimulus that it does not have, and can not have. Let’s see an the example of a response to Rorschach Card VI, quoted from Fernandes (1994), from a 32 years old man with a severe psychopathy - “Oh! My god! [continue ...] On the top I think it is a Calvary, a sacrifice. Below is a vertebra dripping blood all over.” In the inquiry he blocked when faced with the response and with the new presentation of the card - “Calvary”. The eyes riddled with tears and the silence became total. When interpolated, asks in a growing of emotion, suffering, and revolt, if the psychologist has already looked at his face riddled with scars, if she wants him to show his back marked, his arm also marked with scars…”. The inkblot was his body. There was a massive identification process, a total assimilation of what is perceived to what he has experienced, a massive projection over the stimulus. Take also the following two responses to Rorschach card I: “A mask,” and “A dark mask that represents human evil.” The first has much less of projection, if anything, than the second. And we think that no comments are necessary to explain why. There are answers which inform much more about the individual idiosyncratic aspects and because of that are so much more projective. Spectacular, is the extreme phenomenon of neomorfiasation (in the French school), which may occur occasionally in severe patients. This shows how the stimulus may be secondary, how much reality is likely to be ignored or voided by the intensity of the individual’s mental state, or be just a reflection of that state, as in a response from a schizophrenic to Projection and Projective Methods 167

a Rorschach inkblot - “This is me, this is my body” (Silva, 1986). The projective methods would be based on the classical projective hypothesis (Frank, 1939). The individual trying to deal with a vague or ambiguous stimulus, would make an interpretation of that stimulus through a process of construction that reflects his needs, feelings, experiences, thought processes, his internal world. But we can argue that behind responses to all tests (also to all human activities) would be the mark of the individuality, so we can deduce that projection is behind the response to any psychological test and not just to a projective method. In the broadest sense of projection, the individual projects all the time, when perceives and responds to the environment. It seems possible to say that in some sense, not everything is projection in projective methods, and in another complementary sense, that projection exits outside the projective methods. Projection is not enough to characterize the response process and to define these methods and the projective hypothesis is too simplistic. So, how to define the projective methods and what makes them unique and different from other instruments for assessing personality? It is frequently said that Projective techniques have ambiguous stimuli, which are constructed in such a way that the individual is encouraged to respond by interpreting them and projecting his personality. While this may be partly true, it is not this characteristic that defines a projective method. We consider relevant the classic view of Lindzey (1961), which considers five primary issues or criteria, so to speak basic aspects, which characterize a projective technique. These methods are sensitive to latent or unconscious aspects of personality, which the individual does not know and therefore can not reveal through a questionnaire or inventory, or even in an interview.  A multiplicity of answers is permitted. The individual may respond according to what he wants to, he is not confined to a limited number of response alternatives, as in a personality questionnaire or inventory. This aspect of the response freedom may be debatable. Actually it is not exactly like that. The instruction is limitative. Not everything permitted to the person. The projective methods are characterized yet by the multidimensionality of responses, ie the same answers make possible to know, or contribute to the knowledge of several personality characteristics. For example, they make possible to evaluate the self-concept, how the individual modulates his emotions and aspects of his ideations, among others. There is yet a fourth aspect, the lack of subject awareness of the purpose of the test, or at least, of what responses’ parameters are used for the interpretation of specific aspects of personality. For example, the subject does not know that the systematic use of black in Rorschach responses may be related to the presence of negative affectivity. Finally, there is the profusion and richness of the response data they elicit, which make possible a holistic analysis of the protocol. Despite the criticisms that projective methods are still suffering from many experts in psychological assessment, our view is in accordance with several authors (e. g. Marques, 1994), which state that projective techniques are privileged instruments in psychological assessment. Its advantages are related precisely with the richness of the information that may be obtained and the integrative and holistic analysis that are possible from the protocols, but also with the fact that they are indirect measures, unlike inventories and questionnaires. They provide information that would otherwise be unavailable, simply because the person does not have access to it (he is not aware of certain characteristics), or does not want to reveal it, for example, when he wants to distort the results of the assessment process. That is why we consider these methods of excellence and indispensable in psychological assessment. References : Anzieu, D. (1976) Les methodes projectives. Paris: PUF Avila-Espada, A. (1993) Las técnicas projectivas en los ultimos vinte anos: aspectos conceptuales y tendencias de la investigacion. Communication presented at the XIV International Congress of Rorschach and Projective Methods. Lisbon. Chabert, C. (1997) O Rorschach na clínica do adulto: Lisboa: Climepsi. Comibra de Matos, A. (2002) Psicanálise e psicoterapia psicanalítica, Lisboa: Climepsi. Fernandes, I. (1994) O conceito de projecção e as técnicas projectivas: A sua tradução no Rorschach e no TAT, Análise Psicológica, 12(4), 441-445. Frank,, L. K. (1939) Projective methods for the study of personality, Journal of Psychology, 8, 343-389. Lindzey, G. (1961) Projective techniques and crosscultural research, New York: Apleton-Century Crofts. Marques. M. E. (1994) Do desejo de saber ao saber do desejo: Contributos para a caracterização da situação projectiva, Análise Psicológica, 12(4), 431-439. Murstein, B. I. and Preyer, R. S. (1959) The concept of projection: A review, Psychological Bulletin, 56, 353-374. Rabin, A. (1981) Assessment with projective techniques, New York: Springer 168 Campos

Psychotherapy researchers have long been perturbed by the question which is best encapsulated in Paul’s litany: ‘what treatment, by whom, is most effective for this individual with that specific problem, and under what set of circumstances?’ (Paul,1967). This pertains to the famous specificity versus non-specificity debate in psychotherapy research. In certain instances, different approaches do show different outcomes. According to Bergin and Garfield (1994), important technical differences are found when the disorder is severe. In reference to such clients, Roth and Fogany (1996) concluded that ‘nonspecific, poorly structured treatments, such as generic counseling, non - focused psychodynamic therapy and a variety of experiential therapies are unlikely to be effective.’ Some researchers believe that a combination of common and specific factors might be necessary for optimal therapeutic effects (Beitman, 1992; Lambert, 1992). However, in the most recent and arguably, the most careful and comprehensive metaanalysis of the current psychotherapy literature, Wampold (2001, 210) drew a conclusion, “the evidence is overwhelmingly unsupportive . . . of the specificity of unique ingredients of any therapy”. This has given a huge impetus to the common factor approach, which aims at identifying and defining the common elements across all therapies that may be contributing to therapeutic change (Lampropoulos, 2000). Several sets of common factors have been suggested or identified thus far (Frank and Frank, 1991; Grencavage and Norcross, 1990; Karasu, 1986; Orlinsky and Howard, 1987). Sprenkle (2004) emphasized that models are the vehicles through which the common as well as specific factors operate. In the recent years, the specificity - non specificity debate has shifted towards integration of disparate theories and methods. Arkowitz (1995) has identified three broad trends in the effort to integrate the varied methods within the field of psychotherapy:(i) Technical eclecticism, (ii) Common factors and (iii) Theoretical integration. Research has indicated that the typical practicing psychotherapist does not do research (Prochaska and Norcross, 1983), is unwilling to participate in research (Bednar and Shapiro, 1970) and has a generally negative attitude towards research and research training (Kelly, et. al., 1978). Thus, the current generation of research is attempting to focus on effectiveness, i.e. effects of treatments as delivered in the community, outside of rigorous clinical trials, so that the practicing therapists can benefit and contribute to the scientific knowledge in this area. Psychotherapy in India: Psychotherapy is heavily influenced by the cultural background from which the participants evolve. Dhariyam, Neki and Carstairs suggested that in India, the relationship between psychotherapist and patient is one of Guru and Chela (disciple/ pupil) (Rao, 1998). It may be expected that psychotherapists trained in therapies developed in the West may face difficulty working with Indian clients. However, in a study on psychotherapists, Devdutt (2005) found no difficulties being reported by most of the therapists in using therapeutic techniques in the Indian context. In evaluating the merit of the above observations, it may be stated that researches focusing on process of change in Indian context are inadequate both in depth and number. The aim of the present study is to explore the process of change in psychotherapy, in Indian Context, as viewed by the therapists. A Preliminary Study of the Psychotherapy Process Pallavi Banerjee, Jayanti Basu and Ushri Banerjee The study explored the psychotherapists’ perspective on the change process in psychotherapy. Ten psychotherapists of Kolkata responded to an interview focusing on therapists’ views on goals in therapy, facilitative and inhibitory factors, difficulties faced and process of change. The data were coded independently by the authors. The results indicated that the therapists focused both on symptom relief and personality change. The Rogerian conditions in therapy, the client’s motivation and psychological mindedness and family support were considered important facilitative factors. Difficulties of applying western models on Indian clients were discussed. The therapeutic role of relationship and techniques were noted. Pallavi Banerjee, Ph.D., Lecturer, Dept. of Psychology, Bethune College, Kolkata, Email: banerjee_ pallavi@yahoo.com. Jayanti Basuh, Ph D. Professor and Ushri Banerjee, Ph. D. Lecturer, Dept. of Applied Psychology, University of Calcutta, Kolkata.

Materials and Method: This is a qualitative study based on interview of practicing psychotherapists. A qualitative approach was preferred over a quantitative one firstly because dearth of available data in Indian situation demands exploratory orientation and secondly therapy being a complex process, and involving numerous shades of dyadic relationship, quantification may produce not only inadequate, but even distorted understanding of the experience. Tool: An interview schedule was prepared after reviewing literature in the area of psychotherapy process research and after a pilot study on 2 experts in the area. The pilot study guided the authors in selecting questions which would elicit the required information. The suggestions given by the experts were also incorporated into the interview schedule after discussion between the authors. The interview schedule consisted of open ended questions like “What is therapy according to you?” and “What happens in psychotherapy that contributes to therapeutic change?”. The final interview schedule broadly covered the following areas: General goals in therapy • Therapist Personality: Facilitative and • Inhibitory Factors Therapist Skills: Facilitative and Inhibitory • Factors Client: Facilitative and Inhibitory Factors • Extra Therapeutic Factors • Difficulties of using western models in working • with Indian clients Working on those difficulties • How therapy works: • Therapeutic relationship and Therapeutic • Tools Sample: The sample of ten psychotherapists was selected from a population of Psychoanalysts, Clinical Psychologists and Psychiatrists, practicing psychotherapy for at least 5 years. All of them were based in Kolkata. Purposive sampling was done, based on the therapists’ availability and willingness to participate in the study. There were six female and four male Psychotherapists. Their age ranged between 30 to 65 years and experience ranged from 5 to 25 years. With respect to Professional Qualification, there were three Psychoanalysts, three Clinical Psychologist, three Psychiatrists and one General Medical Practitioner with 2 years professional training in psychotherapy. All of them claimed to be eclectic in their psychotherapy practice orientation. Procedure: The interviews were conducted following the schedule. Clarifications were sought whenever required but care was taken to ensure that all the questions were open-ended. The duration of interview for each therapist ranged from one hour to one and a half hour. The interviews were audio taped with the interviewees’ permission and transcribed for coding. The interviews were coded independently by the three authors (Mental Health professionals). The coding system was developed based on the first three interviews and was revised, whenever required, through discussion. Frequency of occurrence of each theme was noted independently by each author. Out of the 324 opportunities for agreeing, the coders agreed 311 times. The 13 disagreements were resolved through discussion. Then the percentages of occurrence of each theme were calculated. Results: The frequencies and percentages of occurrence of each theme are presented in tabular form in this section. Discussion: Goals in therapy: Emotional relief, restructuring thinking process and generating insight were most frequently reported as the major goals of therapists in working with clients, besides the targets set by the clients. Symptom reduction, improving coping through skill building and decreasing reactivity also emerged as important goals in the interviews (Table 1). Mc. Leod (1993; 6) listed as aims of counseling: Insight, self awareness, self actualization or individuation, enlightenment, problem solving, psychological education, acquisition of social skills, cognitive change, behavior change, systematic change, empowerment and restitution. Most of these are emotional and cognitive components of personality. The present study findings support, to some extent, these aims enlisted by Mc. Leod. 170 Banerjee et al

Table 1 General Goals in therapy Theme Frequency Percentage Emotional relief 60% Generating Insight 60% Restructuring thinking process 60% Symptom reduction 50% Improved coping/ skill building 50% Decreased reactivity 40% Developing positive attitude 40% Self acceptance 40% Adjustment with environment 40% Growth of personality 30% Generation of hope 30% Increased confidence 30% Emotional autonomy 20% Facilitating search for meaning 20% Flexibility: Client / Therapist 20% Improving therapeutic skills 10% Resolving dynamic complex 10% Table 2 Therapist Personality: Facilitative factors Theme Frequency Percentage Non-Judgmental attitude/ regard 70% Patience / tolerance / composure 50% Empathy 50% Genuineness / confidentiality 40% Ability to listen actively 40% Openness 30% Humour 20% Convert own distress – empathy 10% Trust client’s ability to change 10% Therapist Personality : Inhibitory Factors Negative counter transference 60% Difficulty in empathizing 50% Distress in personal life 30% Imposing personal values 20% Overrating power of therapist 10% Study of the Psychotherapy Process 171 Therapists: In most clinical trials, efforts have been made to control therapist factors through the use of treatment manuals and adherence checks (Wampold, 2001). Designs ignore the idiosyncrasies of unique contributions of therapists and view treatment as though it is separate from the persons who deliver it. However, in his comprehensive metaanalysis of the psychotherapy research literature, Wampold (2001) offers strong statistical evidence that therapists often contribute much more to outcome than the particular therapy they happen to use. In the present study, the therapists’ characteristics of non-judgmental regard, patience, tolerance and composure, and empathy have been found to be the most important facilitative characteristics in the therapists’ personality and negative counter transference, difficulty in empathizing and distress in personal life have been reported to be the

Table 3 Therapist Skills: Facilitative Factors Theme Frequency Percentage Efficient use of skills 40% Knowledge 30% Sincerity towards Work 30% Punctuality 20% Structured approach 20% Experience 10% Cognitive Flexibility 10% Therapist Skills: Inhibitory Factors Inflexibility in switching modes 20% Uncertainty in dealing with inappropriate questions and untimely calls 20% Intervention – time consuming 10% Less availability of time 10% Table 4 Client: Facilitative Factors Theme Frequency Percentage Motivation to change 70% Psychological mindedness 60% Intelligence, education level 40% Openness to others’ perspective 40% Ability to articulate verbally 30% Ability to bear pain in therapy 30% Acceptance of therapist 20% Client’s range of interest 10% Perseverance 10% Age of client - Young patients 10% Honesty 10% Treating therapist as equal 10% Humility 10% Client : Inhibitory Factors Certain types of diagnosis 40% Excessive demandingness, attempt to manipulate 30% Lack of basic honesty 30% Over dependence on therapist 20% Resistance to change (e.g. use of defense) 20% Locus of control - external 20% Power struggle with therapist 10% Misinterpreting therapist action 10% 172 Banerjee et al

Table 5 Extra Therapeutic Theme Frequency Percentage Support system (family/ close confiding relationship) 80% Financial resources for therapy 60% Family’s response to the client’s problem 50% Life events 50% Scope of environmental manipulation 10% Frequent change in the other mental health services sought 10% Attitude towards therapy of other mental health professionals involved in the client’s treatment 10% Minimum social contact with the patient 10% Table 6 Difficulties of using western models in working with Indian clients Theme Frequency Percentage Differences in values / life style 100% Related to therapy constructs 40% Client awareness 30% Lack of resources 30% External locus of control 20% Working on those difficulties Tailor making models 40% Educating the Client 40% Accepting and adjusting with it 30% Table 7 How Therapy Works Focus How it works Therapeutic Relationship Frequency% Percentage Non-judgmental, empathic acceptance of client (10; 100%) Operation of transference and counter transference (3; 25%) Generates hope / confidence 70% Client feels accepted, validated 70% Exploration / Decreased Resistance 50% Confidence in therapist 50% Corrective emotional experience 40% Therapist as a model 20% Therapist as container 20% Therapist’s sensitivity to client’s unconscious 10% Cognitive restructuring Changing perspective 80% Alternate solutions 60% Interpretation Development of insight , new perception 40% Homework assignment Continue therapy beyond sessions 40% Reminder of targets 10% Behavioural tasks Generalizations of skills learnt in therapy 40% Catharsis Emotional relief 30% Space for self exploration 10% Skill building Adaptive ways of dealing with situations 30% Search for meaning Generating aim and positivity in life 20% Free Association Emotional verification, Exploration of problem 10% Dream analysis pathway to the unconscious emotions 10% Evenly suspended attention Exploration of unconscious 10% Study of the Psychotherapy Process 173

most important impeding factors in the therapists’ personality (Table 2). With respect to therapeutic skills, efficient use of skills, knowledge and sincerity towards work have been reported as being most facilitative and inflexibility in switching modes and uncertainty in dealing with inappropriate questions and untimely calls by patients have been most frequently reported as the chief inhibitory factors in the therapist (Table 3). Evidence from previous research indicates that better therapists (aside from creating a strong alliance), offer a level of activity that is consistent with the client’s expectations and preferences, are creative in perceiving new ways of approaching problems, suggest credible new ways of learning adaptive skills, and are personally well integrated (Beutler et al., 1998, 2004). Clients: O’Brien and Houston (2007: 40), in summarizing the findings of the process outcome studies conducted so far, stated that the quality of the client’s participation in therapy stands out as the most important determinant of outcome.Tallman and Bohart (1999) speculate that the reason that a number of models work equally well is because the client’s ability to use whatever is offered overwhelms whatever differences there are in the techniques or approaches. In the present study, motivation to change and psychological mindedness of the client have emerged as the most frequently stated client factors contributing to therapeutic success. Intelligence, educational level, openness to others’ perspective and ability to articulate verbally have also been reported as facilitative factors in the client. Certain types of diagnosis, excessive demandingness and lack of basic honesty have been reported as the main impeding factors in the client (Table 4). In the study by Devdutt’s (2005), psychological mindedness and motivation to change emerged as desirable client characteristics and certain diagnostic groups were reported as difficult clients. The finding of this study support previous studies in this area. Extra therapeutic: Extra-therapeutic factors are ingredients in life and environment of the client that impact change (such as social support, community involvement, and stressful events) Lambert, (1992). But not much work has been done in the area of extra therapeutic factors’ contribution to therapy. The present study indicated that in the therapists’ view, support system from family or any close confiding relationship and financial resources for therapy are most important extra-therapeutic factors impacting therapy. Family’s response to the client’s problem and life events have also been reported, in lesser frequency, as important factors contributing to therapeutic change (Table 5). Working with Indian clients: In this section, the therapists reported not facing much difficulty in working with Indian clients, in spite of the models being developed in the West. However, difference in values and life style was reported as a difficulty by all the therapists. Irrelevance of certain western therapy constructs, clients’ awareness regarding psychiatric illnesses and therapies and lack of financial resources and proper mental health facilities emerged as the major issues in the study (Table 6). Tailor making models, educating the client regarding therapy and accepting the cultural differences and adjusting therapeutic work accordingly have been reported as the ways of dealing with the cultural issues. Neki (1977) had suggested that the Indian client and the Indian therapist may not be entirely suitable to the typical western psychotherapy tradition. However, in Devdutt’s study (2005), 95% of the therapists reported that they did not face any problem in applying psychotherapeutic constructs developed in the West to the Indian clients. However, the respondents felt that certain aspects of the therapeutic work had to be tailored. Thus the findings of the present study are more in keeping with Devdutt’s findings. How therapy works: In this section, the therapists’ models on how therapy works have been examined. For simplification, the findings have been classified into two categories: therapeutic relationship and therapeutic techniques, although the respondents had not made any such clear cut compartmentalization (Table 7). Therapeutic relationship: Non-judgmental, empathic acceptance of client has been reported by all the therapists as an important pathway through which therapy works. Operation of transference and counter transference has been reported as an important pathway by the pschodynamically oriented therapists. However, there was an overlap in the reporting of how the two relationship factors impacted therapy. Both these factors were most frequently reported to work by generating hope and confidence, client feeling accepted and validated, and facilitating exploration by decreasing resistance and building client’s confidence in therapist. Therapist’s providing a corrective emotional experience to the client, serving as a model for change and 174 Banerjee et al

acting as container for distress tolerance were less frequently reported as the pathways through which relationship factor operated in therapeutic work. One of the therapist reported the relationship factor worked to increase therapist’s sensitivity to client’s unconscious (Table 7). A strong alliance appears to make a positive contribution in all the therapies (Hovarth and Symonds, 1991). Safran et al. (1994) have developed a theoretical model of the function of alliance during therapy. According to this model, clients bring dysfunctional interpersonal relationship schemas in to the therapeutic situation and they are reactivated in therapy. If the pattern is recognized and the clients’ negative feelings towards the therapist are examined, it is possible to disrupt the cycle and assist the client to gain a better grasp of his or her pathogenic ideas. Therapeutic techniques: With regard to main therapeutic techniques, Cognitive Restructuring has been reported to work through changing perspective and producing alternate solutions, Interpretation by developing insight, Behavioral Tasks through generalizations of skills learnt in therapy and homework assignment, by continuing therapy beyond sessions and reminder of targets to the client. Catharsis reportedly works by providing emotional relief and space for self exploration, , Skill building, by teaching adaptive ways of dealing with situations and Search for meaning in life, by generating aim and positivitity in life (Table 7). In the present study, practitioners from two major orientations were included, cognitive behavioural orientation and psychoanalytic orientation. Previous researches in this area have thrown light on the role of interpretation and cognitive restructuring, in psychodynamic and cognitive behaviour therapy, respectively (Garfield, 1990, DeRubies et. al. 1990). But there is dearth of studies investigating how these factors work in therapy. An interesting finding of this study is that the practitioners reported using techniques from different therapeutic orientations, as and when the therapist felt the need to use these techniques. So, present clinical practice of psychotherapy seems to support technical eclecticism, a broad trend in the psychotherapy integration movement. The technical eclecticism movement has shown both success (e.g. Beutler, et. al. 1999) and failures (Project MATCH research group, 1997) in demonstrating differential therapeutic effectiveness. Implications: The study, conducted on practicing psychotherapists in the Indian setup, highlighted several process issues relevant to the practice of psychotherapy, such as facilitative and inhibitory factors, and indicated how the therapeutic relationship and techniques bring about changes in the recipient of psychotherapy. Although, only a preliminary one, a number of relevant cultural issues were brought up and need for tailor making therapy for Indian clients were discussed. Finally, the study indicated the trend towards psychotherapy integration in clinical practice. These findings have implications for psychotherapy training in India. However, future research may be conducted on a larger population of clients as well as therapists, whereby, the change process in specific clients can be explored. Moreover, a combination of qualitative and quantitative methods may be used to get more reliable and valid data. References: Arkowitz H. (1995) Common factors or processes of change in Psychotherapy, Clinical Psychology : Science and Practice, 2:94 -100. Bednar, R. L. and Shapiro, J.G. (1970) Professional research comment: A symptom or a syndrome, Journal of Consulting and Clinical Psychology, 34:323 – 326. Beitman, B.D. (1992) Integration through fundamental similarities and useful differences among the schools, In J.C. Norcross and M.R. Goldfried (Eds.) Handbook of Psychotherapy Integration. (202 – 230). New york : Basic Books. Bergin, A.E. and Garfield, S.L. (Eds.) (1994) Handbook of Psychotherapy and Behaviour Change, New York : Wiley. Beutler, L. E., Bongar, B., and Shurkin, J. N. (1998) A consumer’s guide to psychotherapy, New York: Oxford University Press. Beutler, L. E, Goodrich, G., Fisher, D. and Williams, R.E. (1999) Use of psychological tests / instruments for treatment planning, In M. Maruish (Ed). Use of psychological tests for treatment planning and outcome assessment, Hillsdale. NJ : Lawrence Erlbaum Associates. Beutler, L. E., Malik, M. L., and Alimohamed, S. (2004) Therapist variables, In M. J. Lambert (Ed.), Bergin And Garfield’s Handbook Of Study of the Psychotherapy Process 175

Psychotherapy And Behavior Change (5th ed., pp. 227-306) New York: Wiley. DeRubies, R. J. Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M. and Tuason, V. B. (1990) How does Cognitive Therapy work? Cognitive change and symptom change in Cognitive Therapy and pharmacotherapy for Depression, J. Consulting and Clinical Psychology, 58:862 – 9. Devdutt, N. (2005) Psychotherapeutic work and therapeutic experiences, Unpublished dissertation MIMH and NS., Bangalore. Duncan, B. L. and Miller, S. D. (2000) The heroic client: Doing client directed, outcomeinformed therapy, San Francisco: Jossey-Bass. Frank, J. D. and Frank, J. B. (1991) Persuasion and healing: A comparative study of psychotherapy, (3rd ed.). Baltimore: Johns Hopkins University Press. Garfield, S. L. (1990) Issues and methods in Psychotherapy process research, J.Consulting and Clinical Psychology, 58:273 – 80. Gordon, N. S. (2000) Researching psychotherapy, the importance of the client’s view: A methodological challenge, The Qualitative Report [On-line serial], 4 (3/4). Available: http://www.nova.edu/ssss/QR/QR4-1/gordon. html Grencavage, L. M. and Norcross, J. C. (1990) Where are the commonalities among the therapeutic common factors? Professional Psychology Research and Practice, 21:372-378. Hill, C. E. and Corbett, M. M. (1993) A perspective on the history of process and outcome research in Counseling Psychology, Journal of Counseling Psychology, 40 (1):3 – 24. Holmes, J. and Lindley, R. (1989) The values of psychotherapy, London: Oxford University Press. Hovarth, A. O. and Symonds, (1991). Relation between woring alliance and outcome in psychotherapy: A meta analysis. Journal of Counseling Psychology, 38:139 -149. Karasu, T. B. (1986) The specificity versus nonspecificity dilemma: Toward identifying therapeutic change agents, American J. Psychiatry, 143:687-695. Kelly, E.L., Goldberg, L.R., Fiske, D.W. and Kilkowski, J.M. (1978) Twenty – five years later: A follow – up study of the graduate studies and clinical psychology assessed in the VA Selection Research Project, American Psychologist, 33:746 – 755. Lambert, M. J. (1992) Psychotherapy outcome research: Implications for integrative and eclectic therapists, In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books. Lambert, M. J. and Ogles, B. M. (2004) The efficacy and effectiveness of psychotherapy, In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy And Behavior Change (5th ed., pp. 139-193). New York: Wiley. Lampropoulos, G.K. (2000) Evolving psychotherapy integration: eclectic selection and prescriptive application of common factors in therapy, Psychotherapy, 37:285 – 297. Luborsky, L., Singer, B. and Luborsky, L. (1975) Comparative studies of psychotherapy: Is it true that “Everyone has won and all must have prizes? Archives of General Psychiatry, 32:995-1008. McLeod, J. (1993) An Introduction to counselling, Buckinghham: Open University Press. Moras K. (2002) Research in psychotherapy, Encyclopedia of Psychotherapy, Vol. 2, Elsevier Science (USA). Neki, J. S. (1977) Psychotherapy in India, Indian Journal of Psychiatry, 19:1– 10. O’Brien, M. and Houston, G. (2007) Does Therapy work and How? Integrative Psychotherapy, A Practitioner’s Guide, (2nd Ed. pp. 23 – 44). Sage Publications. Orlinsky, D. E. and Howard, K. I. (1987) A generic model of psychotherapy, Journal of integrative and eclectic psychotherapy, 6:6 – 27. Orlinsky, D. E.,and Russell, R. L. (1994) Tradition and change in psychotherapy research: Notes on the fourth generation, In R. L. Russell (Ed.), Reassessing psychotherapy research (pp. 185– 214). New York: Guilford Press. Paul, G. (1967) Strategy in outcome research in Psychotherapy, Journal of Consulting Psychology, 31:109 – 18. Prochaska, J.O. and Norcross, J.C. (1983) Contemporary psychotherapists. A National 176 Banerjee et al

survey of characteristics, practices, orientations, and attitudes, Psychotherapy: Theory, research and Practice, 20:161 – 173. Project MATCH research group (1997) Matching alcoholism treatments : to client heterogeneity: Project MATCH post treatment drinking outcomes, Journal of studies on alcohol, 58:7 – 29. Rao, K. N. (1998) Indian Psychiatric Society - Karnataka Branch Newsletter, Editor Dr. Swaminath G. Issue – 1. Roth, A. and Fonagy, P. (1996) What works for whom? A Critical Review of Psychotherapy research, New York : Guilford Press. Suh, E.M. (2002) Culture, identity consistency and subjective well-being, Journal of Personality and Social Psychology, 83:1378-1391. Safran, J.D., Muran, J.C. and Wallner Samstag, L. (1994) Resolving therapeutic ruptures : A task analytic investigation, In A. O. Horvath and L.S. Greenberg (Eds., The working alliance : Theory , research and practice. New York,: Wiley. Sprenkle, D. H. (2004) Common factors are not islands - they work through models: A Response to Sexton, Ridley, And Kleiner, Journal of Marital and Family Therapy Tallman, K. and Bohart, A. C. (1999) The client as a common factor: Clients as self-healers, In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The Heart And Soul of Change: What Works In Therapy, Washington, DC: American Psychological Association. Wampold, B. E. (2001) The great psychotherapy debate: Models, methods, and findings, Mahwah, NJ: Erlbaum. Study of the Psychotherapy Process 177

More than any other of available psycho diagnostic devices, the projective techniques occupy a very important position in the area of psycho diagnosis. The most distinctive feature of the technique called “projective” when compared to other kinds of psychological test is that maximize the person’s freedom to respond. Projective techniques is the term coined by Lawrence Frank (1939) for psychological assessment procedure in which respondents project their inner needs and feeling into ambiguous stimuli. The stimuli are relatively unstructured material and tasks that a person is asked to describe, complete or respond in some other matter. Projective techniques can tap deeper layers of personality of which even the subject is unaware. The review of literature on SIS Test reveals that SIS- II (booklet form) has been used in psychotics and neurotics (Prasad et al., 1997, Rathee et al, 1995, 2002), schizophrenics and depressives (Prashad and Verma, 1995), psychiatric patients (Verma et al 1994, 1996; Singh and Dubey, 1997; Singh et al 1997), psychiatric patients of armed forces (Rathee et al, 1995), speech disorder (Nehra et al., 1997), murderer’s (Singh et al 2000), ADHD (Jain et al, 2005), drugs and alcohol dependents (Singh et al 1997) and age related changes (Pandey, et al 2001). The extensive survey on SIS reveals that the most of the studies have been conducted comparing the clinical groups with normal subjects either to highlight the power of SIS Test as diagnostic tool or as a therapeutic aid. It has also been used to assess the personality and behaviour pattern of individuals. The SIS has been used to assess various groups but there is no study to find the personality profile of medical practitioners. The present study is a modest attempt in this direction. Methodology: Sample: The sample consisted of 30 medical practitioners in the age of 27-43 years from Kanpur (India).The SIS- II was administered individually to all the subjects. They were in the age range of 25 to 45 years. SIS-II booklet form, consisting 62 images was administered as per standard procedure. It is a self administered test under supervised instructions. The protocols was analyzed on various indices such as Total number of responses, Human, Animal, Movement, Anatomical, Sex, Rejection of images, Most-typical, Typical, Atypical Responses (Cassell,1980, Cassell and Dubey, 2003). Results and Discussion: High number of total responses (M= 69.83+7.20) suggests their high productivity, imaginative SIS –II Profile of Medical Practitioners Sarika Alreja, Deepak Kumar Mishra, K. S. Sengar, Amool R. Singh and S. Chaudhury The SIS test was administered to 30 medical practitioners in the age range of 25-45 years. The profile has revealed that the medical practitioners have fair imaginative capacity, functioning intelligence, good interpersonal relationship, psychological maturity, fair ego strength, adaptability and fair social conformity. Table 1 Descriptive Statistics Variables Minimum Maximum Mean(N=30) Std. Deviation Total number of response 69.83 7.20 Most Typical 15.00 2.64 Typical 41.07 10.68 Atypical .00 30.00 13.73 9.7164 Human response 21.57 4.83 Anatomical response 26.23 8.98 Sex response 4.77 2.46 Animal response 6.17 5.14 Movement response 5.00 2.64 Sarika Alreja, M.A., Deepak kumar Mishra, M.A., Research Scholars; K. S. Sengar, Ph.D., Assistant Professor, Amool R Singh, Ph.D., Prof. & Head, Dept of Clinical Psychology; RINPAS, Kanke, Ranchi – 834006 (India), S. Chaudhury, M.D., Ph.D., Prof. & Head, Dept. of Psychiatry, RINPASS. Key Words: Medical practitioners, SIS- II profile.

capacity and functioning intelligence. They have shown good interpersonal relationship with mature behaviour (Human responses M= 21.57+4.03). They have shown controlled reaction under frustration and stressful situation (Animal responses M= 6.17+5.14). This is another indication of maturity in this group. The anatomical responses (M=26.23+8.98) are slightly higher in comparison of other normal groups (Cassell and Dubey, 2003; Rathi et al., 1995). However, higher anatomical responses in medical professionals indicate their exposure to internal body parts and their professional practice. Though the heightened anatomical responses might indicate anxiety and preoccupation with internal body parts but it is very normal among medical professionals. The mean sex responses (M=4.77+2.46) was within normal range indicating healthy sexual functioning. Movement responses (M=5.0+2.46) suggest active involvement, high creativity and high functioning intelligence enriched to fantasizing future process. The most typical responses (M= 15.0+2.64) suggest their good contact with reality, good interpersonal relationships, team concept and group involvement. High number of most typical responses is indicative of good mental health and good adjustment. It also helps in controlling emotional situations and distress. The typical responses are fairly large (M=41.07+10.68) supporting the contention of most typical responses. As usual atypical responses are within normal range (M=13.73+9.71) needs no explanation. Conclusion: The SIS test has revealed that the medical practitioners of this study have fair imaginative capacity, functioning intelligence, good interpersonal relationship, psychological maturity, adaptability, healthy sexual functioning, ability to meet demands of reality, fair ego strength, having team concept and fair social conformity. References: Cassell, W.A. (1980) Somatic Inkblot Series-II. Aurora communication, Inc. Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series .SIS, Centre, Anchorage: Alaska (USA). Jain, R., Singh, B. Mohanty, S.R. and Kumar, R. (2005) SIS-I and Rorschach Diagnostic Indictors of Attention Deficit and Hyperactivity Disorder. SIS Journal of Projective psychology and Mental Health, 12(2):141-152. Nehra, Raghunatyhan, M., Verma, S.K. and Mann, S.B.S. (1997) Recognition of Psychological Problems in Patients suffering from Speech Defects with the help of SIS-II.SIS Journal of Projective psychology and Mental Health,4,1431-151. Pandey, R., Tripathi, V. and Tripathi, S. (2001) Age Related Changes in SIS-II Responses contents. SIS Journal of Projective psychology and Mental Health, 8(1):35-40. Pershad, D. and Verma, S.K., (1995) Diagnostic Significance of Content Analysis of SIS-II. SIS Journal of Projective psychology and Mental Health, 2(2), 141-149. Pershad, D., and Verma, S.K., and Bhagat, K. (1997) Body Image Disturbances in Psychiatric Cases. SIS Journal of Projective psychology and Mental Health, 4, 75-84. Rathee, S.P., Pande, V. and Singh, A. (1995) Diagnostic Efficacy of Somatic Inkblot Series-II Among Psychiatric Patients of Armed Forces. SIS Journal of Projective psychology and Mental Health, 2(1), 61-66. Rathee, S.P., Pardal, PK. and John, TR. (2002) Diagnostic Value of SIS-II Among sub –groups of Psychotic and Neurotic Patients of Armed Forces. SIS Journal of Projective Psychology and Mental Health, 9(1), 23-32. Singh, A.R., and Dubey, B.L. (1997) SIS-II Profile of Drug and Alcohol Dependent Cases .SIS Journal of Projective Psychology and Mental Health, 4(1), 56-59. Singh, A.R. and Dubey, B.L., Sahu, L.M., and Banerjee K.R. (1997) Prognostic utility of Somatic Inkblot Series –II. SIS Journal of Projective Psychology and Mental Health, 4(2), 141-144. Singh, A.R. and Dubey, B.L., Sahu, L.M. and Banerjee K.R. (2000) SIS-II Profile of Professional Murderers .SIS Journal of Projective Psychology and Mental Health, 8(1), 28-30. Verma, S.K., Pershad, D. and Nehra, R. (1994) Cross –Validation of SIS-II in psychiatric population .SIS Journal of Projective Psychology and Mental Health,1,15-18. SIS –II Profile of Medical Practitioners 179

Important Announcement Dr. Amool Ranjan Singh, Ph.D., Professor and Head, Department of Clinical Psychology, RINPAS, Kanke, Ranchi - 834 006 (India) E-mail : sisamool@yahoo.com editor_sis@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 Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834 006 (India) The Subscription Cheque should be made in favour of “SIS Journal of Projective Psychology & Mental Health” payable at Ranchi (India)

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 30 issues in 16 years. The Journal is available on Society’s Web Site at http: //www.somaticinkblots.com The Journal from Volume 1-16 is available in C D (Acrobat and Page Maker) Members of Somatic Inkblot Society can get it on a nominal payment of US $50 (for Overseas Members) and Rs.1500/- (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 E-mail : bldubey@gmail.com Web Site at http: //www.somaticinkblots.com OR Wilfred A. Cassell, M.D., FAPA. Director SIS Centre Editor Emeritus, SIS Journal of Projective Psychology and Mental Health, 4501 E, 104th Avenue, Anchorage, Alaska - 99516 (USA). Email: siscassell2@yahoo.com

THE SOMATIC INKBLOT SOCIETY I wish to be a Member __________ a Life Member ________ of the Somatic Inkblot Society. Please submit this request to the Membership Committee. NAME _______________________________________________________Birth date __________ (Print or type) First Middle Last __________________________________________Zip ____________________________________ Business/Office Address : __________________________________________________________ _____________________Tel. : (W)__________________________H)________________________ EDUCATION Degree Year Institution Major Field of Study EMPLOYMENT : Current position, employer, dates (Graduate Students indicate area of study and degree toward which you are working). MEMBERSHIP : __________________________________________________________________ TRAINING AND EXPERIENCE IN PERSONALITY ASSESSMENT : SPONSOR (S) Name Address Telephone 1._________________________________________________________________________________ 2._________________________________________________________________________________ SIS subscription payable every year in January through Cash/Cheque at par/Demand Draft in favour of “SIS Jr of Proj Psy and Ment Health” payable at Ranchi. I certify that the information provided above is accurate and correct. An APPLICATION FEE Cheque is enclosed for Foreign Members $50 & Life Membership $ 400. For Members in India Rs. 300/- & Life Membership Rs. 2500/- Institutional Membership Rs. 1000/- Institutional Life Membership Rs. 10000/- Total Cheque $/Rs.__________________Drawn at_________________________ Signature of applicant : __________________________ Date :________________ PLEASE RETURN with your cheque to : Dr. Amool R. Singh,Ph.D. Prof. & Head, Dept. of Clinical Psychology, RINPAS, Kanke, Ranchi-834006 (India). Foreign members send their subscription cheque to B.L. Dubey, Ph.D. Editor Emeritus, 4406 Forest Road, Anchorage, AK-99517 (USA). N.B. : Please add Rs. 50 ($10) as one time registration fee; and Rs. 70 ($10 foreign Member) if you are sending subscription through out station cheque.

PROFESSIONAL QUALITY VHS VIDEOTAPES (SPECIFY NTSC, PAL OR SECAM), AS WELL AS AUDIO TAPES AND TRANSCRIPTS OF INTERVIEWS ARE AVAILABLE FOR TEACHING/CLINICAL PURPOSE. Police case—”Witnessing an Accident” Vietnam Veteran — “Unresolved Guilt” Therapeutic Dream Stimulation Anniversary Reaction to Miscarriage Grieving a Still Birth : Conversion Reaction Fear of Cancer and Hypochondriasis (includes Rorschach imagery) Alcohol and Cocaine Dependent : Father/Son Incest : Teen-age Alaska Native’s Death by Gas Inhalation Suicide Behaviour in Adolescent Alaska Native Nightmare Vision (Sexually Abused Adolescent Girl and Absence of Father Figures in Black Adolescent Boy) Auschwitz Revisited Neuropsychological Reactions to Life Threatening Accident & SIS Occupational Stress and the SIS The use of the SIS as an Aid in Meditation while Grieving a Miscarriage SIS-Video (A&B Series), SIS-II Images in CD, SIS-I Videotape and SIS-Living Images A Walk Through The Garden of Life and many more, Audio & Videotapes SIS Journal of Projective Psychology & Mental Health in C D (Acrobat and Page Maker) from Volume 1-16 Contact : SIS Centre, 4501 E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E-mail : siscassell2@yahoo.com OR sisdubey@rediffmail.com Web Site : http://www.somaticinkblots.com for getting the above material

ANNOUNCEMENT The Somatic Inkblot Society is a Non-Profit International Organization with headquarters in India. The Indian Govt. has recognized it as a Corporation for Income Tax purposes where relief is given to donators and advertisers under section 80G of Income Tax. In America, a comparable non-profit organization similarly named the Somatic Inkblot Society gives Income Tax relief for residents of the United States. Please help the Society by Donation/Advertisement for it’s smooth functioning. President, Somatic Inkblot Society APPEAL Members of Somatic Inkblot Society are requested to kindly send their Annual dues before the 31st of January each year to : Amool Ranjan Singh, Ph. D. Prof. & Head, Dept. of Clinical Psychology, RINPAS, Kanke, Ranchi-834006 (India). E-mail: sisamool@yahoo.com Tel. : 91-651-2233687(H), Mob.: 91-9431592734, The Subscription Cheque should be made in favour of “SIS Jr of Proj Psy and Ment Health” payable at Ranchi (India)

STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. India PERIODICITY OF PUBLICATION : Half Yearly EDITOR’S PRINTER’S Name : Amool Ranjan Singh PUBLISHER’S NATIONALITY : Indian ADDRESS : Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. India OWNER : SOMATIC INKBLOT SOCIETY I, Dr. Amool Ranjan Singh, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. Amool Ranjan Singh, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Published by Dr. Amool Ranjan Singh on behalf of Somatic Inkblot Society at Annapurna Press & Process, Opp. Big Bazar, 5, Main Road, Ranchi-834 002, Jharkhand (India), Ph. : 2331800 Editor-in-Chief : Amool Ranjan Singh

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