SIS Journal of Projective Psychology & Mental Health

Editorial : " Wizard of OZM Empathy Deficient Sociopaths - A Challenge for SIS "Unmasking" Wilfred A. Cassell SIS Screening for Dangerous Impulses - A Blog Based Training Exercise for Students Wilfred A. Cassell and Bankey l. Dubey Personality and Nursing Work: A Comparison between Professional and Student Nurses S. Daini, l. Petrongolo, A. Manzo and l. Bernardini Culturally Construed Dual Sources of Well-being: Preliminary Psychometric Evidences Rakesh Pandey and Nimita Srivastav Disruptions from a Traumatic Event: A Clinical VigneHe Rui C. Campos Efficacy of Comprehensive Scoring System for SIS-lin Discriminating Mania Sunita Kandhari, Jyotsna Sharma, Deepak Kumar, Neetu Kandhari and Rakesh Kumar Application of SIS in Business Organization Anand Dubey and Bankey l. Dubey SIS- II Profile of Depressive Patients Ajay TIwari, Preeti Pandey, Nalini Mishra and Anand Dubey Effect of Psychotherapy on Pathological Gamblers M.G. Sharma and Vandana Sharma Somatic Inkblots imagery in Transsexual: A Case study TIrthanker Dasgupta, Riluparna Dasgupta and Padma Dwivedi Performance of Schizophrenic and Manic Patients on Human Figure Drawing : A Comparative Study Priyanka Shukla, O.Ram and K.S. Sengar Enhancing Productivity and Culture through SIS Intervention: A Case Study Naveen Gupta and Abhilasha Singh 1-4 5-17 18-24 25-31 32-34 35-42 43-47 48-55 56-60 61-65 66-70 71-75 Official Publication of the Somatic Inkblot Society

Somatic Inkblot Society 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: Padma Dwivedi (USA) Executive Members: WilfredA. Cassell (USA) Nalini Mishra (India) Rakesh Pandey (India) Arcahna Singh (India) K. S. Sengar(lndia) Manisha Kiran (India) MaryCassel1 (USA) Asheem Dubey (USA) George Savage (S.Africa) Mrs. Silvia Daini (Italy) SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is an International 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 behavior. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences and letters to the editor. MANUSCRIPTS PREPARATION : Manuscripts should be typewritten (single-spaced throughout) submitted through E-mail to B.L. Dubey. Ph.D. Editor Emeritus, E- mail:bldubey@gmail.comwithacopytoRakeshPandey.Ph.D.Chief Editor, & Prof. Dept of Psychology, BHU, Varanasi-221005 Email: rpan_in@yahoo.com.Cell:91-9415812329.TheEditorsreservethe right to refuse manuscript submitted and to make minor additions I deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment I 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.l 000 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" at Ranchi and should reach Amool R.Singh, Ph.D. Editor In Chief, Director, RINPAS & Head, Dept. of Clinical Psychology, RINPAS, Kanke, Ranchi-834006. 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 $10IRs.501- if you are sending subscription through cheque. CHANGE OF ADDRESS: Members should inform BL. Dubey, Ph.D, Director SIS Centre, Email: bldubey@gmail.comofanychangeofmailing address. Copyright@1994.SISCenter,lndia/Anchorage Website: http://www.somaticinkblots.com ONUNETESTING: http://psyche.dubay.bz http://122,160.96,85:1001/SISTest

Editorial “Wizard of oz” Empathy Deficient Sociopaths - A Challenge for SIS “Unmasking” Recently, in a senior residence in Victoria, British Columbia, I interviewed a 91 year old man about how he acquired empathy/ compassion for animals. He related a stressful, life changing l incident that had occurred years previously when hunting deer. Apparently, he saw a mature deer in the hills above him, which he judged to be within range. Unfortunately, when he shot, the animal was at a greater distance than he expected. The bullet missed vital organs passing through its stomach causing it great agony. To his amazement and grief, he said that “the wounded deer slowly walked down the hill right up to me…bellowing loudly … crying in pain… like a baby before dying …It shook the Hell out of me…I was almost sick with sadness and regret…I never hunted deer again…I couldn’t do it again…I just gave up…you can imagine how it affected me…it was 60 some years ago … I can remember it just like yesterday!” Unlike this empathetic former hunter, I doubt if the corrupt Indian officials, who this past year sanctioned the shooting killing of two Indian “Whistle Blower” doctors had any compassionfor either the victims or family D-E-A-R to them. According to 2011 internet reports, each was courageously attempting to make the honest authorities aware of corrupted officials, misdirecting government funded medical programs. Surely they must concern all caring members of our SIS society. Reading on the internet about these murders was particularly upsetting to me. They brought to mind my own exposure in the late 1960s, when I was conducting research studies on government funded medical insurance programs in Saskatchewan, Canada. Later in the United States I found comparable corruption working in a private psychiatric hospital, where a hospital administrator approved of one child psychiatrist’s fraudulent billing. Until apprehended, he had billed over a million dollars a year by claiming on insurance forms that he worked 24 hours daily, 7 days per week. More hypocritical observations involved witnessing a religious oriented (Catholic) hospital, billing the government excessively at high room rates. A hospital “commitment to help the poor” was ignored and a man with limited finances was pressured with threats of bill collection etc. etc. In the modern internet world, all are linked empathetically in our interrelated, fragile, life supporting planet. We no longer can isolate ourselves intellectually or morally from corruption that undermines the delivery of effective health systems, by “living with blinders in ivory towers”. To attempt spiritual communication with the deceased Indian doctors, for those readers experienced with the transcending power of Yoga or other forms of meaningful meditation, please pause in your reading. I invite you to take a few moments in order to meditate/connect in reverence to their courageous fighting spirits. Before ending your transcendental voyage, perhaps you might ask for guidance on how SIS researchers might contribute in the future to the never ending battle against the forces of darkness. Our body-mind-spiritual theoretical basis, guides us to address issues that the physical scientists either are ignorant of, or have tended to ignore. Historically, they actively played roles in developing biological-nuclear-chemical weapons for mass murder, psychologically sanitized from guilt, by creating affect neutral technical labels implying “defense”. To avoid the pitfalls of this highly dangerous path into darkness and potential oblivion, SIS scientists,

2 Cassell like all introspective empathetic humans, must constantly counter through introspection the “evil” lurking within ourselves. Consciousness bending, empathy dissolving, forebrain numbing corruption is highly infectious. Professionals are not immune, even in the so-called enlightened countries. For example, during the Iraq conflict American psychologists under the command of the Bush regime participated in some of the inhumane interrogation techniques for prisoners. Sadistic questioning behaviors were apparently sanctioned by a president, who was elected with the public support of mesmerized Christians. Apparently some of these may have been taken in by a claim he made as a candidate that, that he modeled his life after “Jesus”. Of course, this religious belief, if honest, may have helped him in resolving his alcohol addiction. Yet because of his willingness to readily condone war prisoner torture, subsequent articles in the Journal of Psychohistory have speculated that it likely was more of a “mask” to hide empathy deficient aggressive issues. Of course it is unethical to make any character analysis without personally conducting a clinical interview. Moreover, in fairness, it must be acknowledged that all humans are potentially vulnerable to manipulation, seduction in one form or other and so-called “brain washing” - even heads of state. To investigate this inherent genetic based and developmentally influenced vulnerability, as SIS theoreticians, we are inspired in the East, by the fundamental insights derived from the same healing spiritual springs that nourished the ancient practitioners of Yoga. In contemplating the struggle between the world forces for enlightenment versus darkness, in the western academic world, we can build on the 20th century contributions of psychoanalysts, such as Carl Jung. It may be recalled that Jung originally labeled this deep seated complex of sexual/aggressive impulses the human psyche “Shadow”. He observed how readily even so-called “normal” people, but especially those with diminished consciences, can almost involuntarily project this onto others, in order to rationalize antisocial acts. Students who learn about the basic mechanisms of projection onto SIS inkblot structure with human content, or empathetically related anatomical structures such as the heart, can become trained in detecting this dehumanizing and empathy dissolving socially destructive practice. Historically, this reality masking mental mechanism has been highly prevalent throughout world cultures. Consistent with this, there always has existed much fanciful wishful thinking. This may be illustrated by the descriptive phrase used at the end of World War II - “The war to end all wars”. For example in America, reflecting this, a composer, wrote the music and lyrics for a much loved, American, children’s musical entitled “The Wizard of Oz”. The story involved a Kansas girl and her little dog, magically transmitted by a tornado to an imaginary “Land of Oz”. In this Cosmic fantasy, she become mesmerized by a falsified humanoid mechanical creation, which transformed the voice of a weak little old man, hidden by a curtain, into that resembling vocal threats of a threatening giant. When their little dog pulled the curtain/ “mask” aside, she then realized that she had been deceived by a contrived image. Then she was empowered to return home to Kansas. Perhaps the above lesson can be acquired as well through classroom training on SIS inkblots. Training in fundamental principles of projection could enhance an adolescent’s ability to detect such fanciful erroneous belief systems. It could make otherwise naive young people in open societies, less vulnerable. As adults, they then would be more able to “unmask” media manipulated public image disguised sociopath, economic-military-political-religious leaders.

“Wizard of oz” Empathy Deficient Sociopaths - A Challenge for SIS “Unmasking” 3 An additional benefit of classroom educational applications could be to provide a method of early detection comparable to random based community medical epidemiological surveys. If funded and implemented these might facilitate early referral for professional care of those children, who manifested severe SIS signs of empathy- deficiency and sociopathic deviance. Those manifesting less severe deviations could participate in some of the modern educational exercises designed to train children in empathy. There is very little relevant background literature. For example, an earlier article in this journal entitled “Unmasking the Devil”, illustrated how SIS psychotherapy may be a reality testing aide for cognitively correcting Satanic “nightmares” in a hospitalized adolescent. Another outlined how discussing the perceptions and affect linked visual imagery evoked by “socially acceptable” SIS stimuli in classroom settings, might educate students about recognizing false social personas, masking otherwise concealed negative personality traits. As indicated, the goal would be to enhance their ability in adult life to detect manipulation - both in their personal life and the media. Related is the applied use of the SIS in screening both in industry and the military. Although criticized by some American psychologists, on ethical grounds, the extensive work by Bankey L. Dubey and others support the value of this now empirically proven application. It might be noted that I have failed to include my envisioned SIS “diagnostic” criteria for sociopath responses. This is not just because of the difficulty in clinically defining valid signs. Unfortunately, throughout the world, such empathetic blind humans often reach positions of power through high intelligence, combined with ruthless disregard for others. Existing psychological tests having scales purported to assess “sociopathy”, such as the MMPI. However, answers can be falsified by individuals, who may have been coached on how to respond to standardized questions. Unlike communication openness in other SIS endeavors, I perhaps a few so motivated members of our society privately communicate in secret on creating statistically valid responses scales. These might initially begin with pilot studies on inmates, imprisoned for gross sociopathic crimes. Normative data might be established covertly not only for physical violence but “White Collar” crimes as well. It will be important to include the latter in international surveys. Recall that the current downturn in the world economy of western countries is partially traceable to corrupt American bankers. These got rich from both self assigned huge bonuses from government loans, as well as marketing internationally relatively worthless financial investments. They named these “Derivatives” with the fraudulent mask/image, advertised to be “secure” financial investments. Their vast and obscene wealth now enables them to influence politicians dependent on media image financing. One has to feel an empathetic concern for honest American legislators, who also face pressure from various lobbyists, richly financed by advancing other questionable causes. Some of these are only marginal moral, such as what the former World War II military general and President Eisenhower labeled “The militaryindustrial complex”. Other more potentially corrupting challenges in this century come from economic temptations hidden from the public by international drug cartels, such as the Mexican drug Lords, encroaching on southern American Border States. It is suggested that the latter dark forces would be less influential if the public had available cost effective mental health services. If the human race is to inhabitant beyond our planet, medical and behavioral scientists will have to assist in the selection and training of empathetic reality based educated leaders. The world needs those humane laws that are guided by evidence based science, not bridled by the cognitive confines of religious based mythology, racial/cultural bias, birth established economic privilege.

4 Cassell I hope that the murderers of the two Indian doctors are brought to justice. If government controlled medical insurance programs in any enlightened country are undermined by corruption, then the envisioned SIS school programs for preventative mental health and empathy training envisioned will never be funded. The future can be hopeful because of the important and growing literature on empathy “Empathy” - well summarized on the internet at Wikipedia. Apart from studies on individuals imprisoned for gross deviations, there are less valid scientific data available on formal diagnostic criteria. This may be partly due to difficulties in rigorously defining the boundaries of the medical- social definition. To illustrate this issue, on the internet today (October 10, 2011), there are vivid descriptions of armored vehicles crushing demonstrating citizens in Egyptian streets. Is this a necessary police/ military action or some form of corrupt empathy deficient sociopathic behavior? Corruption by self interested leaders has always been a dark force throughout world cultures, and likely can only be gradually controlled. As a youth in Canada, I used to listen to a mystery radio program beginning with the voice of a hidden character named the “Shadow”. This fictitious individual warned listeners that “Evil that lurks in the hearts of all men”. It ended with the warning to radio listeners with dark impulses in their hearts, that the: “The Shadow KNOWS!” To honor the ever living spirits of the “Whistle Blower” deceased Indian doctors, let motivated members of our SIS Society spiritually bond with all international enlightened groups to enhance such “KNOWING”! Wilfred A Cassell, M.D., FAPA, APC. Editor Emeritus, SIS J. of Projective Psychology & Mental Health, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK - 99507 (USA) E-Mail: siscassell2@yahoo.com

If this old tombstone engraving activates death wishes in your mind, be forewarned. This article is designed for training students in SIS technology for detecting, otherwise unreported, suicidal/homicidal ideation. Clinical case examples follow as a teaching demonstration to illustrate how this projective technique brings to the surface material hidden from standardized clinical interviewing. These will empathetically expose a reader to the inner cry of suffering souls attempting to release their pain through violent acts - either directed to themselves or others.

Realize that humans exposed to violent scenes either through direct experience, or even reading, can become secondarily infected. Moreover, those with unresolved personal issues, whose inner world has a depressive core, may be especially vulnerable, due to their painful unresolved issues. If the tombstone prescribed “preparation” activates death wishes, be forewarned when training for a career in the mental health field (De Angelis, 2011). All Mental disorders are associated with higher suicide rates (Nordentoft, et. al. 2011). For example where data are available, individuals with a history of Major Depression are about twenty times more likely to kill themselves than the general population. (1) Rates increase substantially in those also suffering from co-morbid conditions such as PTSD and Panic disorder (2). Often the association with substance abuse contaminates the data (Fazel, et. al. 2009; Harris and Barraclough, 1997). Moreover some conditions such as Schizophrenic Disorder have higher rates of homicide (Erb, 2001). Regarding the former, there are screening instruments available such as the “Patient Health Questionnaire and the Quick Inventory of Depressive Symptomatology”. However, there are no data to evaluate their effectiveness. Consequently most clinicians rely on standardized interviews. In this regard there are several assessment criteria based upon completed suicides (Gaynes, et. al. 2004). Some examples follow: men are three times more likely than women to kill themselves, physicians are at elevated risk, particularly women doctors, single people who have never married, those having a failed relationship the preceding year, hopeless individuals and psychotics with auditory hallucinations (especially with command voices to suicide). Yet sometimes severely suicidal individuals pass undetected “under the diagnostic radar

6 Cassell and Dubey screen”. Unfortunately this failure may occur despite detailed clinical interviewing. Then such ‘masked”, unreported self destructive impulses only become evident in retrospect, after an unexpected suicide. Retrospective postmortem studies reveal that in the days preceding death, a significant numb of victims consult care providers. These professionals may have to face not only their irrational guilt from such failure, but sometimes angry relatives threatening litigation. Such violent behavior might be prevented in the future, if the care victim’s care providers had included in their initial diagnostic workup a version of the Somatic Inkblot Series (SIS). When assessing dangerousness, SIS projective testing enables the examiner to bypass psychological denial defenses. (Otherwise hidden suicidal symbolism can emerge as an alerting warning). Four clinical case histories will be presented to illustrate this aide to standardized diagnostic interviewing. These will be followed by an internet exercise for Blog communication and student training. The first two cases illustrate how the projection projecting of a “Weapon” response may signify self destructive impulses denied in interviews. The third case reviews SIS responses depicting “severe sadness”, body injury, blood or death in an individual “wishing to die” but denying a conceptualized suicide plan. The fourth case illustrates bizarre dangerous SIS responses, frequently found in the early unmediated stages of an impending schizophrenic breakdown. Case 1: A 14-year-old high-school, epileptic girl was readmitted to a psychiatric hospital upon transfer from an intensive care unit in a general hospital. She had just recovered from medically overdosing of an anticonvulsant drug. When this initially failed, before she became comatose, she slashed her wrists. She was known by the hospital treatment team, since ten months previously she had been treated for severe suicidal Major Depression. Her depressed mood recurred after she stopped her antidepressant medication as well as follow-up psychotherapy. It began one week after the accidental death of her two favourite grandparents. She made her almost lethal suicide immediately after arguing with and then physically assaulting a girlfriend. Afterwards, she felt rejected and wanted to die. Later in the psychiatric hospital, she initially denied having self-destructive impulses. She claimed that she had simply overdosed so as to “go to sleep” and forget about her emotional suffering. Yet on further questioning, she readily admitted “That when the pills didn’t kill me, I slashed my wrists in order to die”.

As part of the admission assessment, she was asked to complete the following sentence completion tasks: Sentence #1: “I worry a lot about.............“. She responded “losing family and friends”. This was a direct reference to the recent death of her grandparents and rejection by her friend. Sentence #2: “Sometimes I get angry because .................“. She responded “I don’t want people to see that I am hurt or sad”. Later she cited that this was the reason that she had became so angry with an empathetic friend who persisted in questioning about her grief. In cognitive psychotherapy, to facilitate her grieving losing her grandparents, she was asked to write a goodbye note to each. Previously she had been unable to say “goodbye” directly, since her grandparents had lived outside of Alaska. She wrote the following: “Nanny: I wanted to say one last goodbye. You always wanted things to be done your way. I guess that I am a lot like you. You helped me grow into what I am today”.

SIS Screening for Dangerous Impulses 7 Granddad: “I remember going to the farm. I remember Kansas. I guess all I wanted was to say goodbye. Thanks, and I love you.” During such psychotherapeutic sessions, she realized that her previously unexpressed anger related to their loss. Direct images of suicidal behavior surfaced in art therapy as she drew “a girl with a gun pointed to her head”. When questioned about the projected imagery, she emphatically declared “It’s not me but someone trying to take pain away!” This dramatic denial, in the face of the overt reality of her drawing, reflected her mental defence mechanisms that still intermittently persisted in order to protect her conscious mind from experiencing painful grief. With regard to the SIS Video, in viewing B22, (illustrated on our SIS web page at www. somaticinkblots.com) she failed to recognize the embedded SIS form/structure depicting “body resting” or “a person dying… with the spirit leaving the body”. Instead she projected the response, “A gun under water”. Her failure to recognize the human body reflected a mental mechanism of Dissociation from her own Body Gestalt, to avoid the somatic based painful affect. In terms of the time sequence of psychobiologic events, as a conceptual model it is proposed that when she first looked at B22, the physical rays of light likely left patterns on her retina probably approximating, yours as a reader, now viewing the inkblot. However, unlike your brain based defence mechanisms, when the light sensory input was transmitted by her optic nerves to the visual centers in the cortex, then relayed to centers appraising threat, they were interpreted at a preconscious level as too threatening. Consequently their somatic connotations were actively blocked by the inhibitory central nervous system neurons. Next after this first step in perceptual inhibition or “repression“, over the normative SIS inkblot cognitive interpretation, her central nervous system’s based defensive mechanisms- in a yet to be studied by neuroimaging technology- secondarily substituted the disguised symbolism “Under Water”. This effectively blocked recognition from awareness and cognitive recognition. (Previous SIS work has shown that if this blocking mechanism persists in psychotherapy, it can be dissolved psychologically by hypnotherapy, and if highly resistant, by pharmacological agents such as intravenous barbiturates). In any case, the final step in this defensive sequence involved the projection of a Weapon response. Clearly, like the figure drawing described, this revealed that she had experienced impulses to end her life by the terminal physical act of shooting herself or conceptualized concretely, as shooting the vessel that she lived in (i.e. her body).

In such clinical cases, it always remains a challenge in the detailed enquiry for the examiner to establish, such a symbolic response time referents (i.e. were they just in the past prior to her almost lethal overdose? Or were they still lurking in her mind, but being denied assessment interviewing?). This conceptual model illustrates the manner in which analyzing SIS responses enables the examiner a living lens through which to peer into otherwise invisible mental defence mechanisms. While the SIS electronic video/ computer technology reveals more of the suicidal individual’s inner world than with Figure Drawings, assessing fluctuating illusive suicidal impulses constantly requires all of the clinician’s skills. Case 2: This 15-year-old Alaska Native girl was admitted to the psychiatric hospital with a long history of severe recurrent Major Depression associated with suicidal and homicidal ideation. Her SIS Video responses will be first presented in order of the three written responses that she subjectively rated as “Least Liked”. These were as follows:

8 Cassell and Dubey B15: “Different kinds of knives”. In the detailed inquiry, she said that it brought to minds “scary” memories dating back to age thirteen when despondent. During such periods, she frequently contemplated stabbing herself. Once when out of control withdrawing from cocaine, a friend came in, grabbed a knife out of her hand. This incident illustrated the co morbidity of substance abuse with dangerous impulses. Another association to B15 evoked in memory an incident at age nine, when she was severely stressed by witnessing her father threatening her mother with a knife. The third episode violent recollection involved an assault with a knife that she made at age 13. Then during a fight she attempted to kill a girl who ran away and was only stabbed in the back of the leg. B22 was the second most threatening affect charged response. This brought to mind “Something dropping on a person… or someone being put to death… It made me feel sad that the person was being killed slowly”. She had recently been in a high school English class, where ‘the culturally sanctioned punitive act of stoning a sexually unfaithful woman was acted out in a psychodrama class. She had to play the victim’s role. In view of her PTSD history, this was a questionable request by her female teacher. In any case, it proved “Quite upsetting!” since the violent death scene played out brought to mind her persistent dangerous ideation. B12 evoked the third most “Disliked” SIS imagery: “A person with a migraine”. This reminded her empathetically a female peer in the hospital suffering from migraine headache. It also brought to mind her 17 year old sister who suffered from frequent disabling migraine headaches. Thus her (SIS) activated recollections revealed that in spite of her grave issues; she had a capacity for empathy- a positive projective prognostic sign. Concerning the three blots that were rated as most “liked”, the first was A16 imagined to be “Two birds kissing“. This showed an ability to have positive affect bonds. B19 “A mix between the sun and the earth with a heart on it”. Here she showed a mental ability to shape Gestalt responses. Her third favourite image was B25 “A mouse, because it is so adorable.” These responses suggested that in spite of her psychological problems, she was able to experience positive, loving emotions for animals, and possibly for people (?). Thus these responses improved the overall prognosis regarding psychotherapy. Now the SIS responses will be reviewed in terms of those having some additional relevance: A24: She saw a skull that “smashed up bad.” In the detailed enquiry this brought to her mind memories at age 12 of being rearended in an automobile accident. She hurt her knee. In speaking about this she recalled the fact that her foster mother could have been severely injured. She flashed back to the deafening sound of the impact of the care striking the vehicle she in which she was riding. What she omitted was any recollection of her previous threats to “smash the heads” of her residential treatment staff. B2: “A lion’s face that is deformed“. This is a projection not only of her aggressive tendencies but also her own self concept. She felt herself, being somewhat “deformed”. B4: “A mother and child, with the mother kissing the child’s cheek”. This is consistent with her deep seated needs for nurturing. Much of her seething undercurrent of anger related to her having unmet childhood needs for nurturing.

SIS Screening for Dangerous Impulses 9 B6: “Legs ripped off a body”. Here her persistent dangerous impulses again emerged in Projective Awareness. B7: “Amelia Bedillia’s head with a flower on the hat”. She imagined this to be a character in one of her children’s books. This showed her feminine identification. B11: “Smile now, I’ll cry later.” When asked about this, she elaborated on the way she had self medicated with the street drugs/alcohol that is “party now and pay later”. B21: “A bullet shell with a gun next to the bullet shell…already shot”. Here her responses again reflected her suicidal/ homicidal issues B28: Here, rather than recognizing the structure of a nurturing image of a mother nurturing her only, imagined it to represent “A person is thinking.” This is consistent with her own impoverished and traumatic childhood. The lack of attention that her mother gave her was continuing into adolescence. This was evidenced when her mother had recently visited the hospital, yet had avoided visiting her. Case 3: This case illustrates how severe depressive dysphoria may motivate a tormented sufferer to contemplate death to escape from psyche pain, even when lacking a specific suicidal plan. Portrayed is a single suicidal woman in her mid twenties having a limited high school education? During a protracted grief reaction, hospitalization was required to protect her from dangerous ideation. Her severe depression had begun several weeks previously following the suicide of her former boyfriend “J.”. She had been traumatized during their mutually abusive relationship -especially after it ended when he shot himself. She had classical depressive symptoms during the day. Moreover at night she was tormented by PTSD “Nightmares”. These replicated stressful scenes in their past relationship. What facilitated projective enquiry into the depths of her depression, especially her desire to die, was her compliance with therapy? As instructed, she had followed in detail, the initial SIS-II Video instructions. Thus, unlike many responders, she recorded on the SIS Answer Booklet, not only her stimulated visual impressions, but also their image linked affect. In regard to the SIS stimulus pattern rated as most “Disliked” (i.e. emotionally threatening), she selected A23 as “A skeleton”, which represented a death symbol. In contrast when initially viewing the video pattern, she only had reported seeing: “A lot of scary lines”. It is suggested that her failure to recognize the somatic structure in the initial viewing was due to brain mechanisms protecting her mind from recognizing material symbolically related to her anxiety about “wishing to die”. Fortunately her ambivalence about herself destructive impulses, as opposed to her wishes to live, prevented her from conceiving a suicide plan, and then acting on it. The second most upsetting scenes were visualized with A31. She said “It looks like two people depressed, lonely and thinking”, “They look sad”. The third rating in the anxiety-threat hierarchy was A30: “Looks like J. is alive and spooky”. When describing this further after completing the series, she explained: “I didn’t like the mask with eyes…looks sad”, this represents a surfacing in Projective Awareness of PTSD dream imagery replicating abusive scenes with “J.”. Concerning the three SIS video scenes she “Liked”, these were in the following order: A5: “A heart”. She favoured it “because it is red”. Her being able to appreciate the bright color represented a hopeful prognostic symbol.

10 Cassell and Dubey B23: Here she visualized: “A spider with many legs…and looks like the sun”. Afterwards she indicated that the sun made her feel “Happy”. Thus even though she was deeply depressed, she still could imagine a positive hopeful future. B5: “Two people sitting in a chair and talking to each other”. She explained that liked it was “ two people talking to each other made her remember the good times in her past tragic love relationship. Here her projected imagery suggests the presence of communications skills - a positive prognosis sign for psychotherapy. Now her remaining inkblot responses depicting her severe sadness and depression will be presented. In addition to the two already noted (A30 & A31), the following are examples: A2: “Looks like a duck or flowers”. (Looks sad) A3: “Looks like blue…like a tree”. (Looks depressed) A10: “Clouds and eyes”. (Looks depressed” A11: “A door and road with people looking out”. (Sad) A12: “An ear and round and shaped different. (Sad) A13: “Sperm circles…Scary and spooky”. (Looks sad) A25: “Vagina”. (Sad) A28: “A tree with veins and sticks”. (Sad) A31: “Two people…depressed and lonely and thinking”. (Sad) B1: “A fire…smoke and flames”. (Sad) B4: “Two people thinking and they look depressed”. (Sad) B8: “A ball and its round…there is a person in the middle… and a heart beating”. (Depressed) B10: “Two girls praying”. (Sad) B15: “Two airplanes flying… and Stuff” (Sad) B18: “A monster with a wrench trying to get someone”. (Sad) B22: “A dead person with blood”. (Sad) B28: “A person depressed”. (Sad) B29: “The person lost his leg and he hurt it while walking”. (Sad) Apart from depicting her depression, some of the above responses reflected her associated PTSD anxiety and sexual/reproductive issues. These were also projected in relation to several other SIS stimuli. Examples follow: A6: “A Teddy bear and a rock”. (Scary) A8: “A road with lines”. (Scary) A15: “An elephant with a trunk”. (Scary A17: “A fish and rays swimming”. (Afraid) A20: “Two sperms put together moving around”. (Scary) A22: “A screw with a pot”. (Spooky) A23: “A lot of lines” (Scary) A26: “A circle round”. (Scary and Spooky B2: “A bull… and a cast with two legs” (Spooky) B3: “Two people in a boat rocking back and forth and really cloudy”, (Afraid) B12: “A brush with a lamp…trees and sticks”. (Scary) B17: “A round heart and red and blood’. (Scary) B16: “A temple…machine parts upside down (Scary) B21: “A hammer and lamp shade”. (Scary) Finally, it might be noted that her frustrated desires to have children were embodied in her responses to the following inkblots: A19: “A woman’s fetus with a baby”. (Happy) A24: “People holding a baby and celebrating”. (Happy) B27: “It looks like two babies wanted out of the womb”. (Happy) It is remarkable that none of these three blots have embedded structure suggestive of “babies”. Thus her projections reflected her frustrated desires after a failed love relationship. Remarkably enough in responding to A26 depicting a “baby in utero”, her brain inhibited this or “repressed” the blots inherent content seeing it only as “A circle…round and scary”.

SIS Screening for Dangerous Impulses 11 Case 4: This last teaching case involved a 24 year old single woman with a high school education. She had been referred by a female religious counsellor who had administered the Booklet form of SIS-II. Her inexperienced therapist only then first became aware of her client’s auditory hallucinations – an ominous symptom in Schizophrenic Disorders. Also recorded on the Answer Booklet were highly disturbing somatic symptoms: “I feel that I can’t breathe”, “I have pain in my legs”, “I have pain in my chest” (i.e. bizarre pains verging on somatic delusions). For training purposes those responses related to the early stages of her mental breakdown will be reviewed: A2: “Looks like the world with clouds around it from far away”. This response reflected her schizoid social withdrawal and her affect isolation. A3: “The cross of Jesus with blood”. This first response was consistent with religious symbolism in her Christian faith. However, the second response was not. Symbolizing her own Schizophrenic psychic splitting, she imagined seeing “A piece of material with a tear going through it”. A4: In a similar fashion, she also split the overall gestalt of the blot responding to the left side as the figure of a spirit, the upper portion being the “hand”, raised over its “head”. On the right, on the upper part she indicated “I can’t make anything but a triangle. The base was said to be a “blob”, a perception of form without recognizable structure. A5: and A9 also reflected a failure to assimilate separate aspects of the stimuli into a gestalt depicting human figures. A10: was seen as “A face …with evil eyes” consistent with her paranoid features. A11: A19 and A27 reflected somatic imagery consistent with her fragmenting Body Gestalt and emerging somatic delusions. These were respectively: “A nose being cut in half…YUK!” and “A snake inside a body?”, “A woman’s breast…cuts”. Paranoid fears of “Evil” were projected also on several of the following: A28: was seen as “An evil hand and fist”. A30: “An evil skeleton”. Lastly, several scenes reflecting her underlying fears and hidden dangerous impulses were projected throughout the series as follows: B15: “Glass breaking”, B21: “Gun shot off”, B22: “Gun?… Or a lady tied down upon the floor”, B26: “Face of a bull“, and B28: “A man who looks like a lion“. In regard to her feeling of being unable to breath, it might be noted that she projected seven “heart” responses. Her anxiety was most evident in viewing B30 where she perceived “Two hearts”. As a final educational principle for students to consider is that like the overall population, those suffering mentally from psychotic conditions may also suffer from additional real life problems shaping projected memories. For the woman under consideration, a central one was reflected in her responses to A12 and A15. For the former she wrote “Fetus full term…I love this picture…reminds me of M., my little girl who died”. For the latter, she labelled the upper portion as a “rope” and the attached “A bad dream I had…a dead baby hanging up from ceiling”. This illustrates how memories

12 Cassell and Dubey symbolizing severe stressful life events can intrude in “bad dreams” at night. In the day, they can disrupt cognition appearing as PTSD “flashbacks”. Fortunately a trained SIS psychotherapist can reactivate such imagery under reduced anxiety conditions, thereby enabling psychotherapeutic management and neutralization of dangerous impulses.

Cases for Student Appraisal: Before two real cases are presented for Content analysis, in order to qualify for a scholarship award program students will be required to qualify by fulfilling full the following requirements: 1. A letter on an official letterhead certifying their official student or clinical status from a supervising staff education or clinical member. Those who may not be able to do this still qualify by studying the information provided on the internet at www. somaticinkblots.com and then contacting Dr. B. L. Dubey at (bldubey@gmail. com). He will e-mail you a list of questions regarding your ability to understand the web page. Individuals who answers these successfully may then sends letter from a licensed professional, such as a mental health care provider, a physician, a teacher, a member of the clergy etc. documenting their moral character prior to being accepted into this training program. 2. Each candidate then must complete the Booklet version of SIS-II in privacy, without guidance and then e-mail it to Dr B.L. Dubey. He can be contacted by e-mail to provide a convenient postal address for sending it. Since the SIS is a powerful probing procedure to ensure an applicant’s privacy this will not be opened - unless requested. The goal here is to ensure that each participant establishes a normative baseline of internalized subjective responses. This will establish in each student’s “virginal memory” normative standards. Later they may be subjectively recalled to judge what is projected by others, when subsequently using the SIS in a research or clinical setting. 3. After so qualifying each candidate then needs to review in detail the two cases outlined at the end of this paper. To participate for an award, each will then e-mail Dr B.L. Dubey a written report. It is recommended that this might be best conceived as “a formal consultation to an imaginary clinical team managing diagnostic/treatment issues” for the two test cases. 4. Those found by the SIS evaluation committee who demonstrate significant understanding of SIS Content analysis, will then be asked to answer by e-mail a more specific series of advanced level questions. 5. Those found to have learned the most will then be given an opportunity to debate with each other in a Blog like fashion on the internet. In the January 2013 issue of SIS journal the names of five prize winners of one hundred American Dollars will be announced. Also an announcement will be made of the highest ranking student who will be given one Canadian Maple Leaf gold coin.

Cases for Student Analysis: Test case 1:

This involved a seventeen year old severely depressed eleventh grade girl stressed by living in a dysfunctional family. Prior to hospitalization she had experienced intrusive thoughts involving many suicide plans. Although in apparent good physical health, in completing the Answer Booklet she reported the following somatic symptoms: “abdominal pain”, Headaches, Stomach aches and earaches.

SIS Screening for Dangerous Impulses 13 Her three most “Liked” blots were as follows: A5: “A person standing with big lips and parted hair or a chef”. She liked it most because “It was funny”. A6: “A teddy bear with a person next to him rocking”. She rated it highly writing “I stuffed animals and I saw a cure Teddy bear”. A21: “A half duck and a half fish bird”. She indicated that she liked it because it was a “different picture…unusual”. Her three least liked blots were as follows: B17: “The chest of a person’s ribs and a heart in between…or two dogs staring at each other”. Later at the end of the series, she judged the scene to be most upsetting because it brought to mind “A heart that has burst”. B31: “A family that used to be happy but they are down now…like they are at a funeral”. B4: “My self image…I know that somewhere I am bright…I can’t face that I’m depressed and want to be dead”. In the rating exercise at the end she simply reiterated her original responses by writing “My self image isn’t good right now”. Lastly, in responding to the Booklet question: “how you felt about taking the test, she wrote “It was interesting…I look forward to seeing the results”. Next the responses to the remaining blots will be presented as follows: A1: “Pictures of cats staring at each other with shadows of pigs dancing”. A2: “An old woman walking with skeletons behind her”. A3: “A picture of a bloated flower with roots sticking out”. A4: “A picture of a big mouse biting some kind of a music box”. A6: “A Teddy bear with an apple next to him and a person rocking”. A7: “A lady dancing with a big but curvy, skinny with a mistle toe over her”. A8: “A Japanese lady wearing a long decorated robe”. A9: “Two people dancing holding hands with their hearts between them”. A10: “A huge mouse and an elf staring at each other”. A11: “A kind of car or a grasshopper or big frog”. A12: “An embryo or fetus in the uterus or an ear”. A13: “A huge scary monster hand reaching out of a swamp with fingers”. A14: “A stomach with food going to upchuck”. A15: “A uterus with different tissues”. A16: “Two song birds with bills (beaks) together, bloods pouring down - a heart in between” A17: “The chest with a person’s ribs and a heart in between or two dogs staring at each other”. A18: “A heart pounding with a rabbit in the middle”. A19: “The large intestines in the human body”. A20: ‘The kidneys or a water faucet dripping out”. A21: “A half duck and a half fish bird”. A22: “Some kind of a pincher that has a face in the bottom part eating toward something”. A23: “A centipede or a pincher or flowers from a stem”. A24: “An undressed fat woman or an artist’s paint set”, A25: “A man that looks sad and lonely or a mean looking bug”. A26: “A baby that looks almost fully grown in the uterus”. A27: “A pear…a pregnant woman with her hand on belly and a skeleton hand”. A28: “A muscle man…a broccoli shoots”. A29: “A shadow of someone with a gun and a body in the background”.

14 Cassell and Dubey A30: “A scary looking skull…it looks like it is in a haunted house”. A31: “Two people frustrated and mad yet wanting romance”. B1: “A bear’s paw…a fist hitting something”. B2: “Two people hanging upside down… they look torn apart”. B3: “A blotch with blood and a fist”. B5: “Two people sitting at a chair or on TV talking…they are also drinking”. B6: “A yellow flower”. B7: “An arrow pointing up with designs around it”. B8: “A person breathing in and out and moving back and forth”. B9: “Blackened kidney upside down…a black lady with big boots on”. B10: “A very confused dog”. B11: “A helmet or lungs moving back and forth”. B12: “An angry face squelched with his nose flaring with an ear ring”. B13: “A question mark…someone may be confused or a sign not to do something”. B14: “A deformed face with ink all over it”. B15: “Someone cutting themselves with knives and sharp points”. B16: “A fuzzy centipede or a lady dancing”. B18: “A screwdriver going through a pie”, B19: “A big fuzzy spider with its heart broken searching for a new heart”. B20: “A brain that looks like it is getting ready to black out”. B21: “A gun that just shot someone or some kind of poof thing”. B23: “Ribs with black in them as though someone has smoked too much”. B24: “A candle sticks”. B25: “Someone looking at a crystal ball predicting the future”. B26: “A big muscular man that feels worried about himself on the inside”. B27: “Two fetus that have been aborted or will be twins”. B28: “A mother holding her child in her arms taking care of the child”. B29: “A little boy scared and running from something or else he is missing one half his leg”. B30: “Two ears that don’t want to listen to the surroundings”. Test Case 2: This involved a depressed 45 year old college educated married man who was living in a confliction marriage. When he completed that Brief Health History on the SIS Booklet, he noted the following problems: “Co-dependency” in his relationship with his wife, anxiety attacks, tiredness, heart palpitations, lumbar spine back pain, and fears of getting colon/rectal cancer a family genetic linked disease. His Most liked inkblots were as follows: A27: “A breast of a voluptuous woman holding flowers”. At the end of the viewing he wrote that he liked it because “It was calming as well as provocative”. B17: “A warm beating heart deep inside a protective layer of cushioning”. He liked it “because a warm beating heat is calming”. A6: “A happy child in his playroom…a happy good to be alive feeling”. He liked it because it reminded him of “childhood freedom”. His Most disliked blots were as follows: A4: “It reminds me of a man about to be hit or run over by a large vehicle”. Later he wrote “It makes me feel helpless and trapped”. A29: “A foreboding landscape...gloomy”. He later wrote “Gloomy landscapes depress me”. Next his responses to the remaining inkblots (along with her emotions) will be presented as follows: A1: “Looks like two costumed women dancing”. (Happy)

SIS Screening for Dangerous Impulses 15 A2: “A man trying to clean up a pile of junk… he has a long way to go…in fact it is frustrating”. A3: “An image of a bloody cross”. (Image of pain and suffering) A5: “A Pillsbury boy on drugs”. (Looks stupid) A7: “A woman dancing seductively…apple overhead…Eve”. A8: “A small boy discovering that he was a sexual being and proud of it”. (Freedom) A9: “Two people dancing around each other both wanting the same thing but afraid to touch. Similar objects on top” A10: “A sad man looking out a narrow grimy window”. A11: “The nose of an arrogant man turned up in disapproval…Boss”. A12: “A monkey’s hand”. A13: “The hand of a drowned man reaching upward from the sea bottom”. A14: “Lump on throat…lump on stomach”. A15: “A dead dried up fetus with the cord attached”. A16: “Two lungs and a heart …two birds singing for joy”. A17: “Two gutted fish lying side by side”. A18: “Inviting female genitalia…open and full…labia and vagina”. A19: “Bowels in nausea…looks heavy and bloated”. A20: “Kidneys and bladder…a necrotic urinary system”. A21: “A loving mother hen protecting two small children”. A22: “Sacrum and spine”. A23: “Spine with sharp pincer at bottom” A24: “Female torso with some bowels showing”. A25: “Again…a very inviting female genitalia”. A26: “An unborn baby waddled in the mother’s womb”. A27: “A voluptuous woman holding flowers”. A28: “A muscled man stretching to the sky”. A30: “A spirit/demon face” A31: “A man and woman having an argument”. B1: “A drowning man tangled in ocean bottom’ B2: “A bleeding woman’s torso…ovaries… blood”. B3: “Men watching a woman dancing behind a window”. B4: “A faceless man projecting a mask with a totally different personality”. B5: “Man and woman having an argument… the balls represent verbal volleys” B6: “Torso of a man (Woman?)…ugly rolls of fat”. B7: “A hard rigid spine with strange growths”. B8: “A pensive man behind a door…we are looking through a key hole…he is depressed” B9: “Throat and lungs misshapen through disease”. B10: “A woman’s torso marked by necrotic growths”. B11: “Lungs” B12: “An angry man listening”. B13: “Gut wrenching nausea evoked”. B14: No response. B15: “Evokes a scene of domestic violence… many knives and daggers’. B16: “Spinal cord radiating pain”. B18: “A penis in a very large vagina”. B19: “a gentle heart being attacked on all sides but held together by two outside loves”. B20: “A brain”. B21: “A gun that has misfired… the barrel has exploded”. B22: “A man lying on his back with his innermost thought ascending”. B23: “A ribcage being assaulted with hard objects or a spider”. B24: “Sex organs male? Or female?” B25: “Looking out through a window to a happier place”. B26: “Female sex organs”. B27: “Two parts of an embryonic child deciding who should be delivered”. B28: “A mother comforting her child”. B29: “A boy running away from an explosion”. B30: “Two monkey’s hands held up in a pleading gesture”. B31: “A caterpillar family on their way to church”.

16 Cassell and Dubey Discussion: Most suicidal individuals, when asked by a clinician will report their suicide ideation. Yet, while this emphasizes the importance of detailed enquiry, some individuals successfully hide plans to end their lives. These may highly impulsive, yet lethal. An example, early in my first year of psychiatric training in a military hospital, involves a Korean combat veteran who was under my care. Eventually he improved sufficiently as to no longer appear clinically depressed. Since he denied suicide ideation, my supervising treatment team had judged him safe for his first weekend pass. However, according to nursing reports, his wife rejected him in a phone conversation claiming that she was “too busy” to get him. A few minutes later he impulsively leapt from a hospital window killing himself!

While I was still dealing with his loss, two days later another veteran jumped to his death from the window of a medical ward. Previously in the hospital, it had been many months since such suicides had occurred. In retrospect, it appeared that this second veteran also had been depressed with undetected suicidal intensions. This object lesson suggested that for certain vulnerable suggestive individuals, suicide may sometimes have a psychologically “infectious copycat” quality. It was for this reason that immediately after the tombstone inscription, student readers were forewarned.

Predicting suicide in an individual clinical case poses challenges. Most screening questionnaires have definite limitations. They tend to rely on some form of self reporting by the individual being screened for dangerous impulses. For example, a motivated suicidal person who has previously denied such intent in clinical interviews may well recognize what the test administrator is assessing and consequently falsify answers.

While this type of falsification may occur in a deceptive individual when reporting responses on the SIS Booklet Answer sheet and during the subsequent detailed enquiry, escaping detection is less likely because of the depth revealing power of symbolic projection. With the exception of B15 (i.e. sharp objects, knives etc.), B21 (i.e. a gun) and B22 (a dying person‘s body and spirit), which were purposely designed to access suicidal/homicidal impulses, the visualization on the remaining of “weapons”, or the body of a suicide victim should arouse alarm signals. Such responses signal the need for close observation by the treatment team, as well as concerned family members.

Denial mental mechanisms may be still more effectively circumvented by the revealing significance of highly morbid symbolic responses portraying open wounds, dying etc. For example, the response “Blood” may indicate otherwise unreported psychotic features. If such pathologic material is seen, the clinician would be well advised to ascertain if the responder had similar “Nightmares” with such symbolic imagery.. “Dream scenes in which the content explicitly portrays suicide of any characters should alert the interviewer to otherwise denied ambivalent suicidal ideations of the dreamer. Here the individual’s involuntary flood of self directed violent impulses may be conceptualized as quite comparable to perceived violence from other people, or life threatening external traumatic events which activate PTSD imagery during sleep.”

In all honesty, the clinical cases presented merely outline response patterns for clinical consideration as warning signals. No statistical studies have been completed with the SIS, or to my knowledge, any of the other tests purported to effectively identify deep seated fluctuating suicide impulses. SIS researchers are invited to contemplate the almost impossible task of securing valid data baselines preceding the suicide.

Recall that modern astronomers now scan the mysterious Cosmos with multiple technologies.

SIS Screening for Dangerous Impulses 17 In an analogous fashion, for a reality based “picture”, SIS students need training to view their projective data within the context of all other relevant scientific methods. Conclusion: The paper is designed for training students in the interpretation of projective responses of SIS procedure. Four clinical cases are presented to illustrate how SIS technique brings to the surface unprocessed painful material of real life, leading to violent behavior. It is hoped that some of such violent behavior might have been prevented if the victim’s care providers had included in their initial diagnostic workup a version of the Somatic Inkblot Series (SIS). When assessing dangerousness, SIS projective testing enables the examiner to bypass psychological denial defenses. References: Erb, M., Hodgins, E.M., Freese, R., Miller-Isberner, R. and Jackel, D. (2001) Homicide and schizophrenia: May be treatment does have a preventative effect, Criminal Behavior Mental Health, 11: 1, 6-26. De Angelis, T. (2011) Psychologist Suicide Monitor. Psychology, Nov. 42, No. 10. Fazel, S., Gulati, G., Linsel, L., Geddes, J.R., and Gunu (2009) Schizophrenia and Violence: Systematic Review and Met-analysis, Plos Med, 6 (8)( e1000120 E.. pub 2009 Aug. 11). Gaynes, B.N., West, S.L., Ford, C.A., Frame, P., Klein, J. and Lohr, K.N. (2004) Screening for suicide risk in adults: a summary of the evidence for the US Preventative Services Tech Force Ann Intern Med, 140: 822-835 Harris, E.C. and Barraclough, B. (1997) Suicide as an outcome for mental disorders: a meta-analysis. British J. Psychi., 170: 205-228 Nordentoft, M., Mortensen, P.B. and Pederson, C.B. (2011) Absolute Risk of Suicide, Arch. Gen. Psychiatry, 68: 10, 1058-1064.

Personality and Nursing Work: A Comparison between Professional and Student Nurses S. Daini, L. Petrongolo, A. Manzo and L. Bernardini Our study aimed at pointing out similarities and differences between Students and Professional Nurses with a Projective Test, hypothesizing that professional practice could improve empathic competences. Moreover, it could enhance stress pointers in Professional Nurses with respect to Students. The Wartegg Test was administered to two groups (210 Students and 111 Professional Nurses) from two University Centres following Crisi’s scoring system. The data thus obtained were analysed by using MANCOVA, with age as covariate and Chi-square test. The results suggest that the professional nurses showed a significantly higher emotional response to external stimuli, while affective personal configuration was not different in the two groups. Rational competence too resulted similar in the two groups. Professional Nurses showed significantly higher percentage of vulgar answers, an Index of adhesion to common thought. On the contrary, student nurses showed significantly more object contents, indicating more concrete thought and a greater detachment from emotional experience. In our study, nursing work shows an impact on personality variables, without producing pathological changes, and it can be studied with projective methods to point out latent aspects of personal configuration. Nursing work involves a highly charged emotional environment. They have to face overwhelming situations, like death, pain, chronic situations, their own professional powerlessness and the difficulty to communicate with patients, relatives and colleagues. The experience of any disease, both slight and acute, has a lot of psychological consequences not only for those who are directly affected, but also for their caretakers. There are repercussions both on personal and social level, and the more “fragile and sensitive” is the person affected, the more serious and complicated is the disease, the more serious and complicated are the repercussions. Responses to the work environment depend on nurse’s psychological personality, even though there is dearth of many studies on this topic. A study using MMPI , the Rorschach test and Phillipson test found that even normal persons shows increased anxiety and remarkable remedial drives during hard professional situations (Esteban,et.al. 1983). In another Silvia Daini, Luana Petrongolo, Arianna Manzo and Lucia Bernardini, Psychiatry and Psychology Institute, Università Cattolica del Sacro Cuore, Rome, Italy, Corresponding Author: Silvia Daini. Istituto di Psichiatria e Psicologia, Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito 1, 00168, Rome, Italy, Mobile Phone: 0039 339 3798428, Tel/fax (0)6 3054850, Email: daini@katamail.com Key Words: Nurses, Personality, Wartegg Test, Empathy, Defences. study, depression resulted to be less correlated to burnouts than another personality variable, i.e. the sense of personal coherence (Tselebis, et. al. 2001). Individual stress has been pointed out as a mediator, able to limit the impact of emotional stress. Problem focused coping resulted as a protective factor, while emotion-focused coping appeared as a negative one, and most frequently related to burnout (McVicar, 2003). In another study alexithymia was found to cause professional burnouts and is directly connected to depression and negative evaluation of professional self –realization (Bratis, et.al. 2009). Other studies relate the presence of somatisation disorders to depressive responses and occupational stress (Welsh, 2009). Furthermore, the nurse’s personality style could contribute to outbreaks of aggressive behaviour in patients and relatives: nurse less sociable

Personality and Nursing Work 19 and tolerant seems to be more disposed to patients’ aggressiveness (Bilgin, 2009). Personality variables and motivational values result to be significantly correlated to work stress (Gandoy-Crego, et.al. 2009). Similarly, personality variables like self–confidence and optimism show a moderating effect on work stress and satisfaction (Golbasi, et.al. 2008). Different personality features were found in female nurses in comparison with a control sample of women. The first ones showed a greater care attitude, much more thoroughness and resilience (Williams, et.al. 2009). The resilience concept was found to be widely present in nursing staff in another study (McGee, 2006). The personality features also contribute to their satisfaction/dissatisfaction and to their communication with patients (Joshi and Dubey, 1975, 1976). Studies were also conducted to find out the personality of student nurses, attending “graduate programme in nursing”, particularly on their self-esteem, underlining its importance during their studies both on single sample (Edwards, et.al. 2010), and in multicentre researches on samples with wide cultural differences (Sasat, et al. 2002). Results suggested personality features such as neuroticism could predict psychological problems and burnout at the end of the studies (Watson, et.al. 2008) and it modulates the adjustment in the first years at work. Sheu, et.al. (2001) on a sample of nursing students at the beginning of their training, found that the personality features, such as introversion/ extroversion, social ability and emotional stability, are significantly related to stress perception, coping behaviour and psychosocial status. Rebecchi, et.al. tried to find out the health workers’ professional values at the end of their studies and then after three years on job, found that the professional values change in a work context depending on emotional stress. Particularly, relational values decrease while materialistic values increase (Rebecchi, et.al. 2009). Though there is dearth of studied carried out with classic method regarding students, and the existing literature concentrates on single personality feature. The Wartegg test is shorter test amongst other projective tests and questionnaires, could offer a wide range of personality features. The test was administered to both students and professional nurses, in order to point out possible changes related to professional practice. The present study aims to examine the hypothesis that Nursing Students are more rational while Professional Nurses are more empathic. The second hypothesis is that Professional Nurses could be more stressed and may have depressive tendencies which they don’t show. Methods: Participants and Procedures: The sample consisted 322 subjects, divided into two groups (Student Nurses and Professional), has been analyzed with Wartegg test performance. The first group was composed of 210 students (102 men and 108 women) with mean age 24.46 years (SD ± 4.37). They come from two different schools: Graduate Program in Nursing at Rome University and Chieti University. Most of them were Italian; only 2% of them came from abroad. Students group was compared to a group composed of 111 Professional Nurses (49 men and 62 women) with mean age of 33 years (SD ± 5.19), with different seniority (Mean= 6.71; SD ± 5.61) and coming from different wards. Most of the nurses were Italian, only 3 % of them came from abroad. Considering the different seniority, we also took note of the different wards where each nurse worked in, at the time of this study. Measures: Wartegg test is a graphic diagnostic, semi

20 Daini, et al structured projective procedure. It is composed of eight panels with eight stimulus-signs. Subjects are invited to draw a meaningful picture for each of the eight panels starting from the stimulus-sign and choosing performance order. Through these stimulus-signs, each panel calls up different psychological dimensions and elicits answers from deep personality areas (Wartegg, 1953). Thanks to different studies (Falcone, et.al. 1986), we can couple each one of the eight panels with a diagnostic evaluation area: panel 1 is related to the actual state of identity, panel 2 to vitality and sensitivity, panel 3 to the ability to direct our own psychic resources toward aims and goals, panel 4 is connected to the relationship with rules and authority, panel 5 is related to managing aggressive dynamics, panel 6 to integrity of reality testing, panel 7 to the relationship with femininity and panel 8 to social relationship. The scales were coded by two independent scorers (Inter-rater reliability: correlation: 0,95), as per Crisi’s scoring system (Crisi, 2007). For each panel the main features were determined: The Evocative Character (EC), the Affective Quality (AQ), and the Formal Quality (FA). Afterwards, each test general index was figured out for EC, AQ, FQ, as well as the percentage of answers so called Vulgar, the Anxiety Index (AI), the Impulsivity Index (II), the Internal Tension Index (ITI). The percentage of Contents expressed in drawing was calculated. Finally, the panel executive sequence (first and last panel chosen) was also considered. The Evocative Character gives information on how the subject, both from a gestalt perceptive and associative point of view, reacts to the stimulus-signs of the test. It focuses on the perceptive functions and the associative processes of the subject and describes his symbolic ability to perceive and process stimuli of the environment. The scores vary between 0, if the evaluation of the picture completely fails the stimulus-sign;1 if the evaluation fully integrates the stimulus-sign. The Affective Quality evaluates the emotional connotation of the drawings. It gives information on the subject’s emotional trend, on his ability to be in touch with his own affective and instinctual dynamics and to show them. The scores vary between 0 when the subject draws emotionally negative contents; 0.5 when the subject draws emotionally neutral contents and 1 when he/ she draws emotionally positive contents. The Formal Quality is the evaluation of the drawings immediate and total visibility and intelligibility. It gives information on the subjects’ cognitive integration and their ability to look into reality. The scores vary between 0, when the meaning is unclear or unrecognisable; 0.5 when the meaning can only be understood after a clarification from the subject; 1 when the meaning is immediately recognisable. The resulting value (V%) measures clichés and the absence of critical capability in depressed, formal and conformist people. On the basis of the most used scores, vulgar answers are divided into vulgar answer properly gave (V= score 1), and semi vulgar (V= score 0.5). The Interior Tension Index represents a “nonspecific signal of psychological discomfort”. It describes the inadequacy feeling and/or the emotional tension degree of the subject”. The Impulsivity Index evaluates impulsiveness, acting-out and therefore subjects’ ability to deal with their sexual and aggressive energy. The Anxiety Index shows anxiety, insecurity and indecision occurrence. All the three indexes (I.T.I.; I.I.; I.A.) vary from 0 to 1. Statistical Analyses: Since the psychological tests results, particularly those of projective tests, could be affected by subject’s gender and age differences, and since the sample ages were of course different, the effect of gender and age on scores was analyzed with the help of analysis of variance (ANOVA). Age, differently from gender, showed a significant effect on

Personality and Nursing Work 21 results. The scores obtained by both groups were compared using multivariate analysis of covariance (MANCOVA), considering age as covariate. The Panel Analysis was also conducted using MANCOVA method (considering age as covariate), to point out the single panels influence on final result. At last, only for Professional Nurses, the influence that the number of wards changed along their career have had on the test results was analyzed, considering the seniority as a covariate (MANCOVA). The statistical analysis was performed with SPSS 13.0 program. Results: Table 1 shows MANCOVA results in the two analyzed samples. Significant differences appear in Evocative Character. Professional Nurses on average obtained much higher scores than Student Nurses. However, remarkable differences were highlighted in vulgar answers, again with higher scores for Professional Nurses on architectural, natural and geometric contents. Table 1 MANCOVA (groups with Age as Covariate) Variables Student Nurses(m±sd) Professional Nurses (m±sd) F p EC 66.79±15 74.10±12 5.78 .01 AQ 62.01±12 63.76±12 1.14 ns FQ 72.04±12 74.89±12 0.01 ns ITI 0.97±0.24 0.88±0.36 1.86 ns II 0.27±0.18 0.26±0.22 0.00 ns AI 0.69±0.17 0.64±0.22 1.61 ns V 10.39±10.61 21.33±12.49 25.52 .000 Arc 5.74±7.66 8.05±10.23 7.02 .008 Nat 2.72±5.98 4.09±7.68 3.96 .048 Obj 49.21±21.01 39.63±20.05 12.74 .000 Sig 9.66±11.50 12.31±12.91 3.67 .05 Wilk’s Lambda F=1.889 p.<005 Each panel analysis pointed out that panels 1, 2 and 4 are deeply related to the Evocative Character. Age affected EC of panel 1, to be more specific Professional Nurses obtained on average higher scores than Student Nurses. Groups significantly affected EC in panel 2 and 4, again with higher scores for Professional Nurses. The Affective Quality and Formal Quality, between the two groups were not found significantly different, but a panel by panel analysis shows important AQ differences in some panels. Age affected AQ in panel 1 and 7 and group affected AQ in panel 1 and 6 was observed.6. In both cases, Professional Nurses offered on average significantly higher scores than Student Nurses. A sequence analysis showed that choosing the first panel was more frequent for Professional Nurses (χ²=16.75; p=.02). The last panel choice, instead, didn’t yield significant differences between the two groups. The analysis of

22 Daini, et al Professional Nurses and their wards mobility, reported in Table 2, highlighted some different answers based on the number of wards they changed in their careers. The seniority didn’t affect those differences. Table 2 MANCOVA (Wards number with Seniority as Covariate) Variable F P V 2.24 .04 Hds 5.43 .000 Sig 5.86 .000 Wilk’s Lambda F=1.264 p.<05 In Vulgar answers, a higher score, on average, was obtained by Professional Nurses who, during their career and until test administration, changed four times their wards. The lowest scores were obtained by Professional Nurses who worked in one ward only or changed six of them. Answers representing human heads as simulacrum images were given by Professional Nurses, who changed five wards in their career. For the others, the average was near to zero. So, as the main variables (E.C.; A.Q.; F.Q.; V; I.T.I; A.I.; I.I.), are concerned, we can say that no significant differences was found on the number of wards nurses had changed, though the differences appeared regarding contents. Particularly, in answers of symbolic and geometric contents, higher scores were obtained by Professional Nurses who changed four time their wards, while those contents didn’t show up in answers of Professional Nurses who worked in five different wards. Discussion: Altogether, the data shows that Professional Nurses have more defences than Student Nurses. The present study focused to find out the elements of psychological continuity, change processes, relationship during training and working pathways of Students and Professional Nurses. From a psychodynamic point of view, we tried to find out the motivations that support them in their activity, their personality features and their emotional experiences. Our data highlighted some significant differences between Student and Professional Nurses. Both groups EC% fall within a normal range showing the integrity of their associative processes, their ability to adapt and to relate to the world outside. The significantly higher scores of Professional Nurses showed their higher sensitivity and receptivity to external stimulations thanks to their work experiences which mean a greater involvement both of individual emotionalism and self-defence patterns. Specifically, Professional Nurses showed more sensitivity in panel 1 that evokes a more personal dimension, feelings and selfevaluations of their own identity and their own self in relation with the environment, and in the panels that evoke vitality (panel 2) and the relationship with authority (panel 4). This allows us to assume that work context exposes Professional Nurses to a stress that can make them more vulnerable and make them react with a more detached attitude than Students’ (as contents show). Besides, age affecting EC% in panel 1 confirms the hypothesis that psycho-cognitive development in a work context of different pathologies can withhold Nurses’ vitality and dynamism that can subject them to work relationships where the respect of rules and roles is crucial (working control) and inevitably puts them in front of patients’ pain and suffering. Pain and suffering that, through

Personality and Nursing Work 23 self-defence patterns (as projection and identification), could affect their own identity. In sequence analysis, the fact that Professional Nurses chose more frequently panel 1 as the first one, shows that the perception of their own competences, of their productivity at work and of their personal development, level of decision-making autonomy and of adaptability to the different required skills, encourage their shaping and development of a higher awareness of being successful at work and a feeling of enrichment both personal and professional. Besides, other contents significantly higher in Professional Nurses confirm greater needs for environment approval and dependency features (ARC %) which means a higher sensitivity due to their experiences (NAT %) and consequently a defence attitude (SIG %). In Students instead a greater number of OBJ contents associated with a low number of H contents indicates the occurrence of tension in relationship, of withdrawal features with a selfretreat tendency due to either their personality and to individual motivations or to their limited professional experience. As for the affective sphere, personal identity is affected both by age and by the group the subjects come from (Student and Professional Nurses). The results show that Professional Nurses tend to get involved more than Student Nurses. Professional Nurses higher scores in panel 6 AQ, suggest a higher inclination to adapt and to be rational in order to detach themselves from those external situations that arouse their emotions. This tendency is confirmed also by a higher number of vulgar answers from them than from Students. Their mission involves a relationship with another person who asks for help, but Wartegg test seems to confirm presence of emotional detachment dynamics in professional work. Conclusions: Our data seem to be in line with other observations: among health care workers an emotional detachment is a protective factor to ensure functional assistance to patients and to increase services quality. The findings showed that the seniority doesn’t have any influence on the Ward mobility on Professional Nurses. However the more wards they changed the higher is the incidence of the Vulgar answers. From our results, Professional Nurses with experience in several wards are more able to tune to reality and to subscribe to the opinion of community. When instead a lesser tuning to work group and common values are present, significant factors are either the beginning impact with work reality (only one ward changed) or the individual difficulty to adapt to work context (six wards changed). Besides, the frequent change of wards, associated with contents (parts of H as simulacrum images) shows a difficulty to deal with relationships; the emotional detachment is even bigger if we consider that we are talking about “parts” of a human body, meaning they don’t see the patient as a whole and that those parts are simulacrum images, meaning without any emotional contents. As far as the second hypothesis, we didn’t find more depressive tendencies or others signs of psychological disease in Professional Nurses than the Students. This result could be interpreted in the light of the different wards and hospitals they come from. So, the burnout problem doesn’t seem to be related to a general variable, i.e. the nurse’s work, but eventually, it could be related to specific situations (the kind of wards or hospital), that aren’t the object of the present study. Wartegg test proved useful in quantitative and qualitative exploration of personal development and the ways to professional adjustment in nursing work. Finally, based on these first data, future researches both on motivations and adjustment to nursing profession could be developed. Acknowledgement: The authors wish to acknowledge all volunteer students and professional nurses for their participation in the study.

24 Daini, et al References: Bilgin, H. (2009). An evaluation of nurses’ interpersonal styles and their experiences of violence. Issues Ment Health Nurs., 30(4), 252-259. Bratis, D., Tselebis, A., Sikaras, C., Moulou, A., Giotakis, K., Zoumakis, E., Ilias, I. (2009). Alexithymia and its association with burnout, depression and family support among Greek nursing staff. Hum Resour Health, 11, 7-72. Crisi, A. (2007). Manuale Test di Wartegg, Roma: Magi. Edwards, D., Burnard, P., Bennett, K., Hebden, U. (2010). A longitudinal study of stress and self-esteem in student nurses. Nurse Educ Today., 30(1), 78-84. Esteban, A., Ballesteros, P., Caballero, J. (1983). Psychological evaluation of intensive care nurses. Crit Care Med., 11(8), 616-20. Falcone, A., Grasso, M., Pinkus, L. (1986). Presupposti teorici per l’uso clinico del Test di Wartegg, Firenze: Organizzazioni Speciali. Gandoy-Crego, M., Clemente, M., Mayán-Santos, J.M., Espinosa, P. (2009). Personal determinants of burnout in nursing staff at geriatric centers. Arch Gerontol Geriatr, 48(2), 246-9. Golbasi, Z., Kelleci, M., Dogan, S. (2008). Relationships between coping strategies, individual characteristics and job satisfaction in a sample of hospital nurses: crosssectional questionnaire survey. Int J Nurs Stud., 45(12), 1800-6. Joshi, H.B. and Dubey,B.L.(1975) Personality of Psychiatric Male and Female Nurses. The Nursing Journal of India, 66: 257-258. Joshi, H.B. and Dubey,B.L.(1976) Personality Dimension and Job Satisfaction of Nurses, The Nursing Journal of India, 67:191-192 McGee, E.M. (2006). The healing circle: resiliency in nurses. Issues Ment Health Nurs, 27(1),43-57. McVicar, A. (2003). Workplace stress in nursing: a literature review. J Adv Nurs, 44(6), 633-42. Rebecchi, E., Benassi, M., Bolzani, R., Santullo, A. (2009). The influence of professional values in the emergence of work stress and burn-out in newly graduated nurses. [Article in Italian] G Ital Med Lav Erg., 31(1 Suppl A), A30-5. Sasat, S., Burnard, P., Edwards, D., Naiyapatana, W., Hebden, U., Boonrod ,W., Arayathanitkul, B., Wongmak, W. (2002). Royal Thai Army Nursing College, Bangkok, Thailand. Self-esteem and student nurses: a crosscultural study of nursing students in Thailand and the UK. Nurs Health Sci. 4(1-2), 9-14. Sheu, S., Lin, HS., Hwang, S.L. (2001). The relationships among stress, physio-psycho-social status, coping behaviours and personality traits of nursing students during first time clinical practice. [Article in Chinese] Hu Li Yan Jiu., 9(3), 233-46. Tselebis, A., Moulou, A., Ilias I. (2001). Burnout versus depression and sense of coherence: study of Greek nursing staff. Nurs Health Sci., 3(2), 69-71. Wartegg, E. (1953). Schichtdiagnostik. der Zeichentest (WZT) Einführung in die experimentelle Graphoskopie. [Written in German. Göttingen: Verlag für Psychologie. Watson, R., Deary, I., Thompson, D., Li, G. (2008). A study of stress and burnout in nursing students in Hong Kong: a questionnaire survey. Int J Nurs Stud., 45(10), 1534- 42. Welsh, D. (2009). Predictors of depressive symptoms in female medical-surgical hospital nurses. Issues Ment Health Nurs. 30(5), 320-6. Williams, G., Dean, P., Williams, E. (2009). Do nurses really care? Confirming the stereotype with a case control study. Br J Nurs, 18(3), 162-5.

Culturally Construed Dual Sources of Well-being: Preliminary Psychometric Evidences Rakesh Pandey and Nimita Srivastava Researches indicate that culturally induced differences in self-perception have significant influence on an individual’s general attitude and behaviour including his/her evaluation of subjective happiness and self-worth. The individualistic cultures focus more on independence, self-sufficiency, uniqueness, and personal success leading to an independent view of self, whereas the collectivist cultures give emphasis on cooperation, group cohesion, interpersonal harmony etc. that leads to interdependent self-view. Based on such cultural differences in self-construal, it was hypothesized that culturally construed dual sources (independent and interdependent) of well-being may also exist. To test this hypothesis a 20 item inventory (10 related to independent and 10 interdependent sources) was developed that asked participants about the importance given to various sources well-being on a 5-point scale. The inventory was administered on 179 participants along with a measure of selfconstrual. The factor analysis yielded two factors. On the first factor, most of the items reflecting interdependent sources of well-being loaded significantly whereas on the second those items loaded significantly that reflected independent sources of well-being. However, a close examination of the pattern of loading revealed that some items initially considered as indicator of independent source of well-being loaded with items reflecting interdependent sources of well-being and vice versa. Thus, the thematic coherence of the items of each factor was re-examined and these factors were re-labelled as ‘interdependent and intrinsic sources’ of well-being and ‘independent and extrinsic sources’ of well-being, respectively. Further, it was noted that independent/extrinsic source of wellbeing correlated positively with both independent and interdependent self but the interdependent/ intrinsic source correlated (positively) only with interdependent self. This pattern of correlation provides some support to the validity of the dual sources of well-being. A growing body of empirical evidences collected from cross-cultural studies indicates that cultural norms, ideals, and value systems have significant influence on an individual’s behaviour and attitude. Rooted in this idea is the view that cultural value systems also shape one’s perception about the self. When the cultural values and ideals are internalized and endorsed it results in such type of selfcognition and psychological bases for selfworth that is congruent with the given cultural value system. The prototypical view of self of different cultures differs markedly depending on what behaviour, attitudes, and traits are valued by the culture. One dichotomous cultural distinction often made in cross-cultural studies is of Eastern (collectivist) and Western (individualistic) cultures. These two cultures value different characteristics and thus foster different types of self-perceptions. For example, the Western cultural value system places emphasis on independence, self-sufficiency, uniqueness, freedom from societal constraints, separateness from others, and personal success (Bellah, Madsen, Sullivan, Swidler, and Tipton, 1985; Cahoone, 1996; Lewis, 1995; Spindler and Spindler, 1990) and lead to a self-cognition that is referred to as independent self-construal (Markus and Kiatayama, 1991, 1994). The Eastern culture, on the other hand, give emphasis on coordination, cooperation, group cohesion, shame and apologies, interpersonal harmony, the importance of others, and the responsibility to the group Rakesh Pandey, Ph.D., FSIS, Professor, Dept of Psychology, Banaras Hindu University,Varanasi- 221005(India),(Correspondence to Rakesh Pandey, Email:rpan_in@yahoo.com) and Nimita srivastava Head, Psychological Counseling and Testing Cell, Training and placement Department, L.T.J.S.S, Nagpur. Key words: Culture, Independent and interdependent self, sources of well-being

26 Pandey and Srivastava (Bond, Leung, and Wan, 1982; De Vos, 1985; Hsu, 1948; Leung, 1997; Uno, 1991) and leads to the self-cognition called as interdependent self-construal (Markus and Kiatayama, 1991, 1994). Researchers have theorized that when these individualistic and collectivistic values are internalized they lead to entirely different types of behavioural constellation and selfperception. The individualistic culture fosters a self-cognition characterized by internal attribute, uniqueness, and separateness from others (independent self-view), whereas the collectivistic culture leads to self-cognition defined by connectedness, relationship and social context (interdependent self-view; see Markus and Kitayama, 1991; Singelis, 1994 for a review). There are, though, several theories that make such cultural distinctions at individual level attitude towards self and others (e.g., individualism – collectivism theory of Triandis, 1989), the present study is based on the Markus and Kitayam’s (1991, 1994) cultural theory of self also called self-construal theory. This theory proposes that the individualistic and collectivistic culture shape and nurture two entirely distinct types of self-cognitions leading to dual self-processes called independent and interdependent self construals. Self-construal is defined as an individual’s mental representation of him or herself (Markus and Kitayama, 1991). The self construal theory assumes that the sense of self, including self-concepts and selfappraisals, is constructed rather than directly perceived or experienced. An independent view of self derives from a belief in the wholeness and separateness of each individual’s pattern of internal attributes and places emphasis on such aspects as selfactualization, realizing oneself, expressing one’s unique pattern of needs, rights and capabilities, and developing one’s distinctive potential (see Markus and Kitayama, 1991, 1994). In contrast, an interdependent view of self derives from a belief in the individual’s connectedness and interdependence to others. This construal places emphasis on fitting in, belongingness, fulfilling and creating obligations, and becoming part of society. This is the representative Eastern characterization of the self, which places crucial self- representation not within the unique individual attributes, but within his/ her social relationships in which he/she feels embedded (see Markus and Kitayama, 1991, 1994). The culturally shaped psychological processes at individual level, such as independent and interdependent self-construal (Markus, and Kitayam, 1991), may provide a link between culture and SWB (See Diener and Suh 2000, for a review) and insight into how the culture determines the SWB of an individual. The meaning of SWB or happiness and satisfaction may also differ for individuals of different cultures. What does it mean to be “happy” or “well” for individuals of Western culture may not be the same for Eastern culture (see Diener and Suh, 2000 for a review). Further, it has also been noted that emotions considered positive in one culture may be considered negative in the other. For example, Scollon and associates (2004) observed that while individuals of Western culture viewed pride as positive emotion, it grouped with the unpleasant emotions in India. Empirical studies focusing on the cultural differences in the subjective viewpoint or meaning of subjective well-being have reported the existence of culturally distinct facets of wellbeing for different cultures (e.g., Ingersoll, 1985; Ingersoll and Ingersoll 1987). For example, Ingersoll-Dayton and associates (Ingersoll- Dayton, Saengtienchai, Kespichayawattana, and Aungsuroch, 2001) examined the subjective meaning of psychological well-being of Thai elders and identified five dimensions of well-being: harmony, interdependence, acceptance, respect and enjoyment. They further noted that most of the dimensions of well-being were distinct from that of Western view. Only one dimensions of well-being (i.e., social relatedness) was found to be shared

Culturally Construed Dual Sources of Well-being 27 by both Asians and Americans. The most interesting observation of this study was that the majority of the dimensions of well-being observed in Thai sample were ‘other focused’ and not ‘self-focused’. Similar cultural differences in meaning of happiness and well-being have been presented by others also. For example, Kitayama (2002) theorized that for an individual with independent self- construal happiness is a subjective state that belongs to an individual and thus experienced as a personal property. Contrary to it, for collective individuals (having interdependent self-view) the happiness is an inter-subjective state shared with others. For them, happiness is mediated by interpersonal relationships and harmony. He also argued that while evaluating one’s SWB the person of individualistic culture (with independent view of self) does the evaluation in the context of his/her internal psychological attributes and personal qualities. On the other hand, an individual of collective culture evaluates one’s life in the interpersonal context such as in relation to family and friends. Moreover, SWB for Western culture (independent self) is largely viewed as maximization of positive affect and minimization of negative effects whereas for Eastern culture it may be a balance between the positive and negative affect (Kitayama and Markus, 2000). From the foregoing studies, it is evident that individualistic and collectivistic cultural values and mandates differently influence the construal of self-perception, as well as the attitude and behavior of an individual. Further, the different cultural values and the consequent self-construal may influence differently the subjective evaluation of one’s happiness and well-being as well as the subjective meaning of happiness and well-being. The observation that such cultural differences bring difference in the subjective meaning of happiness lead to the hypothesis that these cultural differences could also bring variation in what an individual considers important for one’s well-being. In other words, the source of deriving happiness and life satisfaction may differ for the individuals of the two cultures having two different self-view. More specifically, based on the cultural theory of self (Markus and Kitayama, 1991) it was speculated that similar to culturally distinct dual self-process (independent and interdependent self-construal), two culturally distinct sources (independent and interdependent sources) of well-being may also exist. Derived from the Markus and Kitayama’s cultural theory of self, the dual sources of well-being were also hypothesized to differ in their focus on either the self or the others. The independent source of well-being was operationally defined as those sources of deriving happiness that focus on the individuals’ own worth and social status such as one’s own success, gaining material prosperity, developing one’s potential, skill and knowledge etc. Contrary, to it, the interdependent source of well-being was conceived as that source which is related to the growth, development, and happiness of the significant others like family members. To test the hypothesis of the existence of the dual sources of well-being the psychometric approach was adopted. An inventory was developed that asked the participants how much important they consider the listed sources for their well-being. After getting the ratings of the participants the data was factor analyzed with the assumption that if there would exist two distinct sources of well-being then all the items of the inventory would divide into two factorsitems related to one source would cluster together and load on one factor only. It was also assumed that for the Indian participants the first factor explaining the largest proportion of the total variance would comprise of those sources of well-being that focus on the shared happiness and growth. To validate the concept of culturally construed dual sources of wellbeing, the relationship of the dual sources of well-being was also examined with measures of independent and interdependent self. It was

28 Pandey and Srivastava hypothesized that the said dual sources of wellbeing would relate differently with the measures of independent and interdependent self. Materials and Methods: Sample: The study was conducted on an incidentally sampled group of 179 Hindi Speaking Indian participants. Out of the 179 participants, 112 were males and the remaining 67 were females. All the participants belonged to middle class socio-economic status and have an education level of undergraduate or above. The sample was relatively heterogeneous with regard to age and occupational background. The age of the participants ranged from 20 to 60 years. As far as the occupation is concerned, the present sample included, students, engineers, doctors, bank employees, clerical staff and officers from various public and private sector organizations, as well as self-employed individuals and businessmen. The attempt to get a relatively heterogeneous sample was made in order to ensure wide variations in response so that reliability and validity of the scale is not artificially truncated because of restricted response variance. Tools: Dual Sources of Well-Being Inventory was developed for the present study. For the development of this inventory, first of all an open ended questionnaire was administered to a small group of participants (N =30) that asked, “What makes you feel happy and satisfied?” The answers of each participant was content analysed and 20 different categories of sources (10 independent and 10 interdependent) that commonly appeared in the responses of most of the participants were identified. The sources classified under independent category included personal growth and development, personal achievements, praise of one’ success and achievements etc. The interdependent sources included growth, development and achievement of the family members, cordial relationship within the family, family adjustment etc. These 20 sources of well-being were presented in a questionnaire form and the respondents were asked to rate on a 5-point scale the importance given to each for their well-being. To assess the self-construal of the participants the Independent-Interdependent Self-construal Scale was used that consists of 30 items – 17 measuring interdependent self and 13 the independent self. The respondents are asked to rate each item of the scale on a 7-point rating scale ranging from 1 (strongly disagree) to 7 (strongly agree). Thus, the higher score on this scale reflects higher level of the trait being measured. Procedure: The aforesaid inventories were administered either individually or in small groups. Before the administration of the questionnaires the participants were briefed about the purpose of the study and their task. After getting the consent of the participants the aforesaid questionnaires were administered as per the standard instructions of each questionnaire. All participants were requested to ensure that they have responded to each items of every questionnaire/scale. The obtained data were subjected to a principal component analysis followed by varimax rotation. The bi-variate correlation between the measures of selfconstrual and dual sources of well-being was also examined. Results and Discussion The principal component analysis of the data yielded 20 components. However, the scree plot indicated that the first two components may be considered significant that account most of the total variance. Thus, these two components were subsequently rotated using varimax method with Keiser Normalizaton criterion. The obtained results have been displayed in Table-1. It is evident from this table that as per our expectations most of the items reflecting

Culturally Construed Dual Sources of Well-being 29 the shared happiness, growth and development (interdependent sources) loaded on the first factor. On the other hand, the items focusing on individual level growth, development and prosperity (independent sources) loaded mostly on the second factor. Thus, these two factors may be labelled as independent and interdependent sources of well-being, respectively. However, a close look at the pattern of factor loadings suggest that some of the items hypothesized to reflect independent source of well-being loaded on the first factor. For example, gaining academic excellence, better health and energy, accomplishing one’s goal, and successfully playing one’s roles (initially hypothesized to be the independent source of well-being) loaded on the first factor along with the various interdependent sources of well-being. Similarly, a few items (e.g. social popularity, identification with one’s family) initially hypothesized to be the interdependent sources of well-being loaded on the second factors with independent sources of well-being. This pattern of cross loading suggests that the observed dual sources of well-being in the present study do not completely reflect the hypothesized independent and interdependent sources of well-being. Table1 Rotated Component Matrix of Sources of Well-being Inventory Sources of Well being Component Progress and betterment of family .832 Successful fulfillment of the family responsibilities and liabilities .689 Cordial relationship with family members .687 Harmony and adjustment within family .686 Significant accomplishment and success of family members .670 Academic/professional excellence/achievement .650 Healthy body full of energy and vigor .636 Successful accomplishment of one’s own roles .624 Achievement of goals set for self .584 Happiness of the family .573 Personal progress and development .466 .412 Honour and recognition of your work by others .772 Admiration of your achievements by others .740 Obtaining means of comfort and luxury .732 Financial affluence and becoming owner of valuable assets .684 Getting recognition in society .667 To be called enlightened and knowledgeable person .658 Social popularity .618 Availability of physical means of comfort and pleasure .580 Personal achievements .444

30 Pandey and Srivastava Thus, we tried to re-examine the thematic coherence of the items of the each factor and re-label the factors. The examination of the item content of the first factors revealed that all the items on this factor can be grouped into two categories. The first consisting of items focussing on the shared happiness and growth (interdependence) and the second on the intrinsic growth. Thus, based on this we labelled the first factor as interdependent and intrinsic sources of well-being. Similarly, the items of the second factor also grouped into two categories- independent and extrinsic sources. Thus, we labelled this factor as independent and extrinsic sources of well-being. Overall, the findings of the present study suggest that there exist two distinct sources of well-being. The one consists of those sources of deriving happiness that fulfils the intrinsic need of the individual and/or the growth and development of the family members. The second source from which an individual may derive the happiness and well-being comprise the personal growth and prosperity and/or fulfilment of the extrinsic need. Given the pattern of differences in the cultural values and mandates of the individualistic and collectivistic nations, it appears that the first source of well-being (interdependent and intrinsic source) is more a characteristic of the collectivistic culture and the second (independent and extrinsic sources) that of the individualistic culture. For, example, in the collectivistic oriental culture there is a strong belief that the happiness and satisfaction is not external to an individual rather it resides within the individual. To examine the validity of the dual sources of well-being we examined the correlation of these sources with the measures of independent and interdependent self. The correlations are displayed in Table 2. Table 2 The relationship of independent and interdependent self with dual source of well being Independent self Interdependent self Independent source of well being 381** 214** Interdependent source of well being 255** The obtained pattern of correlations suggest that those who view themselves as interdependent place greater importance to both sources of well-being whereas independent individuals give significantly greater importance to independent sources of well-being but not to interdependent sources of well-being. This differential pattern of correlation of the dual sources of well-being with culturally construed dual self-process provide some support to the validity and existence of culturally determined and differential sources of deriving happiness and well-being. Despite, the encouraging evidence that there exist two distinct sources of well-being and these dual sources may reflect the values and mandates of the dual culture of collectivism and individualism, it would be premature to attribute the observed distinction in the sources of wellbeing to cultural differences. Cross-cultural studies focusing on cross-nation differences in future should be conducted to establish that these dual sources of well-being reflect differences in cultural value pattern. Further, there is also a need to extend this type of study by including some other independent/ interdependent as well as intrinsic/extrinsic sources of well-being.

Culturally Construed Dual Sources of Well-being 31 References: Bellah, R. N., Madsen, R., Sullivan, W. M., Swidler, A., and Tipton, S. M. (1985). Habits of the heart: Individualism and commitment in American life. Berkeley: University of California Press. Bond, M. H., Leung, K., and Wan, K. C. (1982). The social impact of self-effacing attributions: The Chinese case. Journal of Social Psychology, 118, 157–166. Cahoone, N. (1996). History of the Western mind. Princeton, NJ: Princeton University Press. De Vos, G. A. (1985). Dimensions of the self in Japanese culture. In A. J. Marsella, G. De Vos, and F. L. K. Hsu (Eds.), Culture and self: Asian and Western perspectives (pp. 141–182). New York: Tavistock. Diener, E., and Suh, E. M. (2000). Culture and subjective well-being. Cambridge, MA: MIT Press. Hsu, F. L. K. (1948). Under the ancestor’s shadow: Chinese culture and personality. New York: Columbia University Press. Ingersoll, F. and Ingersoll, J. (1987). Both a borrower and a lender be: Ethnography, oral history, and grounded theory, Oral History Review 15, 81–102. Ingersoll, J. (1985). Are they better off? Social well-being as a framework for judging development results. Paper presented at the Society for Economic Anthropology, Warrenton, VA. Ingersoll-Dayton, B., Saengtienchai, C., Kespichayawattana, J., and Aungsuroch, Y. (2001). Psychological well-being Asian style: The perspective of Thai elders. Journal of Cross-Cultural Gerontology, 16, 283-302. Kitayama, S. (2002). Cultural and basic psychological processes--- towards a system view of culture: Comment on Oyserman et. al., (2002). Psychological Bulletin, 128, 189-196. Kitayama, S., and Markus, H. R. (2000). The pursuit of happiness and the realization of sympathy: Cultural patterns of self, social relations, and well-being. In E. Diener and E. M. Suh, (Eds.) Culture and subjective well-being, 113-164. Cambridge, MA: MIT Press. Leung, M. (1997). Negotiation and reward allocation across cultures. In P. C. Earley and M. Erez (Eds.), New perspectives on international industrial and organizational psychology (pp. 640–675). San Francisco: Lexington. Lewis, C. C. (1995). Educating hearts and minds. New York: Cambridge University Press. Markus, H., and Kitayama, S. (1991). Culture and self: Implications for cognition, emotion and motivation. Psychological Review, 98, 224-253. Markus, H. R., and Kitayama, S. (1994). The cultural construction of self and emotion: Implications for social behaviour. In S. Kitayama and H.R. Markus (Eds.), Emotion and culture: Empirical studies of mutual influence, pp.89-130. Washington, Dc: American Psychological Association. Scollon, C. N., Oishi, S., Deiner, E. and Deiner, B. R. (2004). Emotions across cultures and methods. Journal of Cross-cultural Psychology, 35, 304-326. Singelis, M., Bond, M. H., Sharkey, W. F., and Lai, C. S. Y. (1999). Unpacking culture’s influence on self-esteem and embarrassability. Journal of Cross-Cultural Psychology, 30, 315-341. Spindler, G. D., and Spindler, L. S. (1990). American mainstream culture. In G. D. Spindler and L. S. Spindler (Eds.), The American cultural dialogue and its transmission (pp. 22–41). New York: Falmer Press. Triandis, H. C. (1989). The self and social behavior in differing cultural contexts. Psychological Review, 96, 506-520. Uno, T. (1991). Chinese ideology. (H. Park, Trans.). Seoul, South Korea: Daewon.

Disruptions from a Traumatic Event: A Clinical Vignette Rui C. Campos The paper presents a clinical vignette regarding the psychological assessment of seven years old boy, following a traumatic event, an accident with a bus that resulted in his grandfather’s death. We wish to illustrate how the administration of projective techniques, like the Rorschach, can reveal several manifestations of the impact that the traumatic event had on the child. The child comes for the assessment following a traumatic event in which he was involved, an accident that resulted in his grandfather’s death. His grandfather was hit by a bus when they were both crossing a street. The child suffered only a few injuries in one hand. The grandfather’s death was not immediate. He spent several months in state of coma. The child has seven years old, and has a brother of four. His parents seek compensation in the court for personal damages. In an interview with the mother, she described her child several fears, of dogs, of leaving home alone or of fire, for example, and also described the child’s aggressive behavior toward his young brother. With this vignette we wish to illustrate that it is possible to find in the psychological assessment process, especially when using projective techniques like the Rorschach, evident manifestations that have resulted, in a certain way, from the impact of a traumatic event on a child. It should be noted however, that we do not wish to neglect the pre-morbid internal conflict and family dysfunction that may be presented in the individual history, which of course ‘interact’ with the traumatic event in the onset of the current psychological problems. Empirical research has shown that, generally speaking, the characteristics of the traumatic response depend much on prior factors, of which we highlight the quality of the attachment (Kobak,et.al. 2001). Savage (2003) administered SIS and Hypnotic relaxation in a case of Child after the traumatic Rui C. Campos, Ph.D., Professor of Psychological Assessment, University of Évora, Portugal. Email: rcampos@uevora.pt Key Words: Rorschach, Once Upon a Time Technique, Traumatic events. experience of the divorce of his parents. This case history illustrated the effectiveness of inkblot images as a psychodiagnostic tool and also as an aid to psychotherapy. The therapist was able to help the patient to resolve his unconscious conflict. Cassell and Dubey (2003) have also demonstrated the power of inkblot images in several cases published in their book. In the present psychological assessment it is possible to admit that the traumatic event experienced previously by the child, namely the grandfather’s death and the accident with the bus in which they were involved, in interaction with other factors related to prior family relationships and experiences, have contributed to the current psychological difficulties, particularly for the painful emotional experience of the child, and manifest anxiety in the face of new or unexpected situations. Let’s see some parts of the psychological assessment process: Once Upon a Time technique: (A thematic projective technique consisting of seven cards representing several everyday situations in children’s life, Fagulha, 2008). On Card II: (The card consists on a child who is sick and lying on the bed): He made the story as “After the doctor went away, he stayed crying and then he went to give a gift, and then his mother told him a story, and then the ‘fast one’ walked away”. A

Disruptions from a Traumatic Event: A Clinical Vignette 33 card with an image of a “child, sick and lying on the bed, may had allowed the projection of his own sick condition after the accident”. The story has helped him in processing the grief. Also, the “presence” of the maternal object allowed him to “calm down” his pain. On Card III: (The card consists on a child going to the beach with the parents): the story was “Then he was asking friends if he could play and then they laughed of him and he went to lay down on his beach towel, and then a ‘fast one’ crossed the road and he did not died.” Crossing the road without any injury (“he did not died”) may be a projection of his positive ego strength and positive approach towards the hurdles in future. On Card IV: (The card consists on a child is waking from a nightmare): “After he had become frightened, ‘oh mother, the ghost scared me’, ‘I did not know! I was very surprised’, and then he took the rifle and took a shot, I died, and he stood on the top of the ghost”. The nightmare represents his unconscious fear and pain which he has undergone after the accident; “he took the rifle and took a shot, I died, and he stood on the top of the ghost”, may further be a projection of how he managed to handle the ghostly painful situation of the accident. On the Rorschach, he approached the task with a lot of difficulties. He was much disorganized, especially when he approached the end of the test. In the inquiry of the last card he could just say ‘little that made sense’. The unstructured and ‘unknown’ situation of the test was very disturbing (note that the administration of a questionnaire, the Children Depression Inventory, and in cognitive tasks as the WISC, he was at easy, and happy to show that he knows how to ‘solve’ the tasks). In the Rorschach, at times he did not cooperate at all: “I do not want to see more of these inkblots. After this we will do another game? I do not like this, I want to do another”, and sometimes questioned “How much longer?” Or says: “I do not like this game at all”. He was restless, talking about other issues, asked questions, got busy on the chair, seemed to want to “hurry”, ‘get rid of stimuli’. In the first card prevented the examiner that he will only give one response to each card: “I just want to say one to all of them.” At the end eventually he gave 25 responses. In the inquiry put aside the cards, showing not wanting to return to the stimuli that were clearly stressful and disorganizing when first observed in the free association phase. In the Children Apperception Test and in the Once Upon A Time technique, the adaptation was acceptable, regarding that these are more structured tasks than the Rorschach. A few clinically significant responses on Rorschach are given below: Card II: “Oh, this is the same as the other (V), this could be a dragon”. In the inquiry says, “Because it had horns, a kind of wings here, and here are its feet, they have cut off its belly, for him to die”. The dragon connotes the accident – the painful situation he suffered. Card III: “This is all the same, a lion, a dead lion, no, some flowers, no, a lion, no, it could not be. It could be a ‘fast one’ ... (whistles), who is whistling? I am not (and also murmur something). What is your name? [...]. Arthur, Leonard, Raphael, Saturn, lamp…” Perceiving flowers after seeing a dead lion, may project his positive attitude towards life. It may also denote some kind of splitting defense mechanism to deal with the pain Card IV: “I hope this is not the same. They are

34 Campos all the same. It can be a flower ... a flower (wheel the card on the table) ... A ‘fast one’? Not ‘a fast one’, a lion, a poppy, and nothing more, and also a dragon”. Very interesting are the answers he have given to the items brave and hero of the vocabulary subtest of the Portuguese version of the WISC, respectively: “It means a kid who is not afraid of other things” and “It means a kid who is brave and is not afraid of anything, and can do everything.” It may be related to some form of denial like it the next response; it is very difficult to accept and elaborate the painful experience of the accident. Card VIII: “Oh, a painting ... and a clock (he makes a movement with the card so not to give it to me, in my hand) ... just two more to go, just two more to go, this pen crashed (my pen stopped writing), just missing one more, two”. And in the inquiry: “This part here is this round part [?] It is this here, this seems like some letters, some letters here, I will die today, and I died.” Avoiding popular response of two animals and perceiving “I will die today, and I died” may suggest his difficulty in accepting the reality and deep rooted unconscious conflict to handle the situation after the accident.

Card X: The approach of the tenth card was chaotic. He gave five answers. The second is the most important: “A nose”. At the inquiry: “It was this part here, seems like a very big nose, like Pinocchio, here was the face, here the eyes, it was a crab because it had the legs and it was a crab like Pinocchio.” This is a paradigmatic response, showing clearly how the situation has disorganized his ideational activity. Some of the Rorschach responses are a result of the projection of his unprocessed unconscious conflict to handle the situation after painful accident. It should also be noted that the references to ‘fast ones’, symbolically connoting the bus that hit his grandfather, also appear during the initial interview and when performing other tasks, such as the drawings. Finally let’s see the story about a free drawing that this child did in the first session: “First they built the building, then the sun came and the clouds, and then it started to rain, it rained a lot and people drank water and this is a medical tent for people who drowned, then this is a balloon which a boy dropped and this is a tree that has grown because of the water”. It is possible to say that “not all of what starts badly has to end badly”, or, as it is much common to say in Portugal, “what does not kill us makes us stronger”. At least is this child whish! References: Cassell, W, A. and Dubey, B. L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. Anchorage (USA): SIS Center. Fagulha, T. (2008). “Era uma vez...”: Prova Projectiva para Crianças. In L. S. Almeida, M. R. Simões, C. Machado e M. M. Gonçalves, Avaliação psicológica: Instrumentos validados para a população portuguesa (Vol II - 2ª ed). Coimbra: Quarteto. Kobak, R., Little, M., Race, E., and Acosta, M. (2001) Attachment disruptions in seriously emotionally disturbed children: Human Development, 3, 243-258. Savage, G. (2003) The Diagnostic Value of the SIS in Treating a Child with Panic Attacks during the Post- Divorce Period: A Clinical Case Study. SIS Journal of Projective Psychology & Mental Health, 10: 219-224.

Efficacy of Comprehensive Scoring System for SIS-I in Discriminating Mania Sunita Kandhari, Jyotsna Sharma, Deepak Kumar, Neetu Kandhari and Rakesh Kumar The Somatic Inkblot Series (SIS) is based on the principles of projection and uses inkblots to interpret the responses given by an individual. The interpretation is further used to map the personality and psychodynamics. The SIS has become an effective diagnostic projective tool for the assessment of patient suffering from various psychiatric problems. The present study aims at delineating the diagnostic power of the SIS in Schizophrenic and Depressive patients. The test was administered to 200 normal subjects and 90 patients (30 maniacs, 30 schizophrenics and 30 depressives). The Scoring was done following Comprehensive Scoring System (CSS) of SIS. The results indicated that a number of CSS indices of SIS-I were able to discriminate the groups significantly. Somatic Inkblot Series have emerged as powerful procedures in projective psychology (Cassell, 1980). The conceptualization of SIS as a self-administered tool and a video procedure with computer technology has made it unique projective tests. The developers of SIS emphasize and capitalize upon a ‘content based analysis’ which can be done easily to decipher psychological meaning of various projected responses which in turn significantly facilitate psychotherapeutic communication with a client. The SIS responses provide reasonable freedom to clinicians to use both quantitative and qualitative interpretation in understanding the ‘psyche’ of the client. The SIS practitioner with a microscopic view can quickly pick up highly relevant projected responses and open a gateway to the ‘inner cry’ of the client which acts as striking emotionally charged cord to initiate the process of catharsis, reinterpretation and healing. This strength of SIS has been demonstrated in the published case studies (Cassell, 2007; Dubey and Cassell, 2000, Shyam, 2007). In addition to its qualitative analysis power in the hand of an informed clinician; enough empirical data have been generated to demonstrate that SIS can discriminate groups based upon quantitative indices too (Srivastava, 2002; Sunita Kandhari, Ph.D., Assistant Professor, International College for Girls, Jaipur; Jyotsna Sharma, Ph.D. Head, Dept. of Psychology, D.J.College, Baraut, Deepak Kumar, Ph D, Assistant Professor, Kanpur Institute of Technology, Kanpur, Neetu Kandhari, Research Scholar, University of Rajasthan, and Rakesh Kumar, Ph.D. Coordinator, Dept. of Psychology, Institute of Mental Health and Hospital, Agra,. Correspondence Email: jain.imhh@gmail.com Key Words: SIS Scoring, Comprehensive Scoring System of SIS. Kumar, 2000). The Series-I of SIS consists of inkblot images on 20 Cards. It is more similar to Rorschach and Holtzman Inkblot tests and has been used widely by various researchers on Coronary patients (Rathee et al 1994), Drug addicts (Mukhopadhyay, et al. 1996; Mitra and Mukhopadhyay,1996), Normals (Rathee et. al., 1996), Obese patients (Cinzia and Roberto, 1998), Chronic schizophrenics (Kumar et. al. 2001), Achondroplasia and shortened extremities (Khromov, 2001), and Militants (Saldanha, 2002). SIS-I has also been effectively used on Manic and Depressive patients (Kumar, 2010), Schizophrenics (Mohapatra et.al, 2009) and Bipolar depression (Shyam et. al, 2009). A systematic review of the literature available on SIS-I indicated that the test has been extensively used on a variety of population. It has also been said that SIS is a continuation of Rorschach’s concept and both the tools go hand in hand without any contradiction. One of the major merits of SIS has been its potentials for therapeutic uses and reflection of changes over the course of therapy. To further strengthen the potentials of SIS, it was felt that apart from the established ‘content based analysis’; possibility for inclusion of additional indices may also be explored to incorporate the Blot Areas

36 Kandhari et al. and Colors in the framework of quantitative analysis (Kumar et.al, 2005; Jain et al, 2005). A systematic review of Rorschach revealed that multiple scoring systems have been developed for Rorschach and three of the most popular systems (Exner,1974; Klopfer et.al. 1954 and Beck,1961. These scoring systems capitalize on various dimensions of the inkblots e.g. Blot Areas; Attributes like Shape, Movement, Colors, Shading, Special scores, Popular and Content. Exner’s system has maximum number of quantitative indices. The use of large number and variety of indices makes it possible to discriminate groups across several indices. The limited number and variety of indices on the other hand may narrow down the range of indices in discriminating groups. In view of this, the initial attempt was made by Kumar (2005) by extending the quantitative analysis of SIS-I. Following the lead, a Comprehensive Scoring System (CSS) for SIS-I was developed which appeared in 2010 issue of this journal (Kandhari et.al, 2010). In this background, the present study was designed to empirically demonstrate the discriminating power of CSS in major psychiatric disorders. Objectives: To estimate group differences on Somatic Inkblot Series-I through Comprehensive Scoring System in Normal, Schizophrenic, Manic and Depressive patients. Method: The sample consisted of 200 normal persons drawn from general population. The normal subjects with positive history of major psychiatric or physical illness were not included. The screening of normal subjects was done through PGI Health Questionnaire N-1 (Verma et al., 1985). The clinical groups were drawn from psychiatric facilities in Agra and consisted of 90 subjects in three groups: Schizophrenia (n=30); Mania (n=30) and Depression (n=30) diagnosed by consultant psychiatrists as per ICD-10. SIS-I was individually administered on each participants. The scoring of SIS-I protocols was done according to the Comprehensive Scoring System (Kumar 2005, Kandhari et.al, 2010). The characteristics of the sample are listed in Table 1. Table 1 Sample Characteristics Characteristics Normal (N=200) Depressives(n=30) Schizoph. (n=30) Manics (n=30) Age in years (Mean & S.D.) 32.74 ± 8.23 32.57 ± 7.54 31.78 ± 8.71 33.68 ± 7.26 Education Literate 21% 80% 73% 87% Illiterate 79% 20% 27% 13% Occupation Business 40% 10% 7% 13% Service 30% 33% 13% 43% Others 30% 57% 80% 43% Family Type Joint 54% 67% 73% 50% Nuclear 46% 33% 60% 50% Marital Status Married 66% 73% 60% 77% Unmarried 34% 27% 40% 23% Domicile Rural 46% 60% 53% 43% Urban 54% 40% 47% 57%

Efficacy of SIS-I in Discriminating Mania 37 Results and Discussion: To compare the CSS indices in normal, manic, depressive and schizophrenic patients, Kruskal-Wallis test was run on SPSS 11.5 version. H0 were tested against a minimum alpha level of .05. The results are presented in following tables: Table 2 revealed that following indices statistically discriminated the normal and clinical groups - Total Number of Responses, Total Blot Area, Common Blot Area, Uncommon Blot Area, White Background Area, Shape Appropriate, Shape Inappropriate, Human Action, Color Chromatic, 3-Dimension, Animal Part, Most Common Responses and Rejection of Images. Table 2 Results of Kruskal-Wallis Test across Groups Indices Normal Mania Depression Schizophrenia Chi Sq Sig. Mean Rank Mean Rank Mean Rank Mean Rank Total Number of Responses 81.0 186.0 43.8 41.4 154.78 .01 Total Blot Area 162.4 221.1 143.2 131.9 30.85 .01 Common Blot Area 143.4 94.7 173.5 182.2 20.23 .01 Uncommon Blot Area 102.5 73.5 111.1 167.8 49.37 .01 White Background Area 72.0 144.6 125.6 159.6 34.55 .01 Shape Appropriate 198.8 85.3 162.5 38.5 84.67 .01 Shape Inappropriate 91.5 229.6 123.9 259.0 111.46 .01 Human Action 140.7 153.9 110.8 128.8 8.74 .03 Color Chromatic 139.2 176.1 139.1 163.7 12.24 .01 Color Achromatic 140.7 130.5 149.1 140.9 5.44 .014 3-Dimen 78.4 69.8 166.7 146.4 62.07 .01 Human Complete 154.3 154.5 143.3 142.2 .86 .83 Human Part 145.9 147.5 143.7 142.5 .07 .99 Animal Complete 135.7 117.2 150.5 150.4 4.61 .20 Animal Part 101.4 92.6 151.4 159.1 26.46 .01 Internal Organs 142.1 153.8 175.1 129.9 5.41 .14 Most Common Responses 216.7 154.6 96.4 62.5 63.70 .01 Image Rejection 190.7 113.2 221.9 238.8 147.23 .01

38 Kandhari et al. Table 3 Mean Rank Differences and Significance of CSS Indices across Groups CSS Indices Normal Vs Mania Normal Vs Depression Normal Vs Schizophrenia Total Number of Responses -105* 37.2 39.6* Total Blot Area -58.7* 19.2 30.5 Common Blot Area 48.7* -30.1 -38.8 Uncommon Blot Area -8.6 -65.3* White Background Area -72.6* -53.6* -87.6* Shape Appropriate 113.5* 36.3 160.3* Shape Inappropriate -138.1* -32.4 -167.5* Human Action -13.2 29.9 11.9 Color Chromatic -36.9 0.1 -24.5 Color Achromatic 10.2 -8.4 -0.2 3-Dimensional 8.6 -88.3* -68* Human Complete -0.2 12.1 Human Part -1.6 2.2 3.4 Animal Complete 18.5 -14.8 -14.7 Animal Part 8.8 -50* -57.7* Internal Organs -11.7 -33 12.2 Most Common Responses 62.1* 120.3* 154.2* Rejection of Images 77.5* -31.2 -48.1* Total Number of Responses (TR): The productivity on SIS-I is one important variable which also reflects the intellectual endowment of the individual. Results indicate that TR can clearly discriminate the normal group from manic and schizophrenic patients. The Manic group gave more number of TR followed by normal group. Kumar (1968) and Pratap and Kapur (1984) also reported high TR in manic patients on Rorschach. TR reflects scored productivity. Manic patients due to elevated mood, flight of ideas, increased psychomotor activities and distractibility are expected to give more than average number of Responses as compared to normal subjects. Depression is primarily characterized by depressed mood, decreased psychomotor activities, slowed thought process and loss of pleasure. Due to these characteristics the depressive patients give low number of TR in comparison to the normal group. The Total number of Responses has been found diagnostic indicators in this study, as well as in other studies (Pershad and Parekh, 2001; Bohm, 1958; Schafer, 1948). The depressive patients in the index study produced lowest R in comparison to both normal and manic groups which is in the expected direction. Schizophrenics due to paucity of ideas, impaired cognitive functions, and lack of initiative; shallow affect and thought disorder produce significantly lower TR. Total Blot Area (TBA): Rorschach (1921) originally believed that the Whole responses reflect the ability to organize, analyze, synthesize and integrate the environment. The results suggest that TBA can be an important diagnostic indicator for mania. Maniacs produced gave significantly more TBA responses in comparison to normal subjects. At emotional level TBA reflects an exaggerated perception of oneself (Beck, 1952). This inflated self esteem is the characteristic of mania which is responsible for above average

Efficacy of SIS-I in Discriminating Mania 39 TBA on inkblots in this group. TBA is also a measure of conceptual activity (Beck, 1952). Since schizophrenics show gross impairment in reality testing, their TBA evokes more of shape inappropriate responses. Moreover, there is a loss of abstract attitude in schizophrenia. Because of these features, schizophrenics gave lesser TBA. Common Blot Area (CBA): Normal subjects gave significantly more CBA responses as compared to maniacs, and this index can serve as a diagnostic indicator. Generally, the common blot area responses are easier to give than total blot area responses because they represent the easiest perceptual cognitive mode to act when faced with ambiguity (Beck, 1952). In all the blot areas, this one is found to be the highest in a protocol. Since, maniacs accentuate TBA because of their characteristic psychopathology; it leads to proportionate reduction in CBA responses among them. However, this index does not clearly discriminate the depressives and the schizophrenics. Uncommon Blot Area (UBA): The schizophrenic patients are known to have thinking disturbances (Bohm, 1958), therefore their imagination for SIS images is likely to differ greatly with normal subjects. The UBA responses discriminated the normal group from schizophrenics. Uncommon Blot Areas are the least frequent areas selected by the subjects for their associations on inkblots. The schizophrenics are known to attend unusual TBAs on inkblots. These are the areas which are not attended by normal subjects and do not find their place in the listings of UBAs. In schizophrenics, these unusual UBAs indicate their emphasis on absolutely unnecessary aspects of the environment. Over emphasis on UBAs is also suggestive of thinking disturbances, loss of contact with reality and impairment of selective attention, which is common in schizophrenia. White Blot Area (WBA): The clinical sample scored significantly higher on WBA as compared to the normal sample. In the framework of the laws of perception, the blots are considered as figures and the remaining portion of the card as background. When presented for association, healthy subjects mostly respond to figures. There is a very small segment of normal population which selects background as stimulus for their associations. When a specific group of subjects primarily attend white background for their associations, it has got tremendous implications in reflecting their negative, oppositional and suspicious attitudes (Rorschach, 1942; Beck, 1945). The primary significance of the white background area responses has been that of some form of oppositional behavior emerging in a variety of symptom patterns: constrainers, negativism and hostility. Clinically, this suspicious behavior is found in all the major categories of psychiatric illness – schizophrenia, mania, depression and organic psychosis. The negativistic, oppositional and suspicious behavior is responsible for higher WBA in clinical groups. Shape Appropriate (SA): The normal sample scored significantly higher on SA as compared to manic and schizophrenic patients. The shape appropriate responses are indicative of the ability of a subject to direct his ideation with conscious attention, control, discriminating judgment and regard for the environment (Rorschach, 1942). A response indicating an appropriate shape reflects that the subject has respect for the reality of the environment (Beck 1945). The maximum impairment in reality orientation is found in schizophrenic patients hence they are known to produce lowest SA responses on inkblots. Pratap and Kapur (1984) also found lower F+% in manic patients. Bohm (1958) reported poor form perception in manic patients as one of the diagnostic indices. Depressives as a group do not show such impairment (Schafer, 1948)

40 Kandhari et al. hence their SA remains within normal range. Because maniacs have poor concentration, they fail to produce average SA. Depressives indeed show an improved perception of Form (Bohm, 1958). This index is considered as one of the most powerful indicators in discriminating major psychiatric disorders. Shape Inappropriate (SI): The three clinical groups gave more SI responses as compared to the normal group, however, this index successfully discriminated maniacs and schizophrenics from the normal group. According to Cassell (2002), SI responses are those of poor quality and with vague percept either in structure or verbalization. SI is inversely proportional to SA responses. Schizophrenics and maniacs, with their distorted view of reality produce high SI responses. Human Action (HA): HA failed to discriminate the normal group from the clinical group. Human action is associated with fantasy and imagination (Cocking,et al, 1969). Maniacs in general produce a little higher HA reflecting their rapid thought processes. In schizophrenia it is an indication of fantasy life because quality of their HA responses are generally poor. Depressives because of slowed thought processes lack the production of HA responses. 3 Dimensions (3D): 3D discriminated the normal group from the depressives and maniacs. The normal group scored significantly lower than the depressives, and significantly higher than the maniacs. The 3D responses are based on dimensionality, and are indicative of a sense of inner incompleteness (Rorschach, 1942). The Depressive patients have higher degree of sense of personal inadequacy hence they score highest on this index. Since mania is a polar contrast of depression they produce lowest 3D percepts. Some schizophrenics also have awareness of their difficulties which creates this sense of inferiority among them. Animal Part (AP): The results suggest that AP can successfully discriminate the depressives and the schizophrenics. This category of response includes external parts of the animals such as wings, legs, claws beak etc. In general an excess of animal content indicates intellectual constriction and/or emotional disturbance. The person recognizes chiefly the more mundane stimuli and fails to venture in novelty. Because of their characteristic symptom patterns schizophrenics and depressives perceive more parts of Animals on inkblots images. Most Common (MC): Beck (1952) emphasized that the popular response is the basic index for understanding the obvious aspect of adaptive thinking and reality testing. The findings show a significant difference in the magnitude of MC responses produced by the normal group and the clinical groups. The most common responses reflect an ability to participate in popular thinking within a specific culture or the conformity of the individual thinking to that of the group (Beck, 1945). The maximum departure from group thinking is clinically found in schizophrenic patients. Hence, they perceived lowest number of MC responses. Apart from socio-cultural conformity, MC responses are indicative of withdrawal (Beck, 1952). Depressives have characteristic of withdrawal from the society. They tend to withdraw from human environment. Because of this, they perceive lower number of MC responses on inkblots. Image Rejection: Image Rejection is a reliable indicator for maniacs and schizophrenics. According to Cassell (1980), rejection of images shows thought blockage and an inability

Efficacy of SIS-I in Discriminating Mania 41 to think properly. Rejection is also a shock phenomenon in some cases and offers an index to neurosis or psychopathology (Bohm, 1958). Schizophrenics do reject maximum inkblots. In some cases extreme rejection in the form of complete rejection of each and every image is a strong indication of schizophrenic pathology (Beck, 1952). Bohm (1958) reported that spontaneously or with a little persuasion depressive tend to associate with Rorschach images. The true rejection is usually seen in schizophrenics and organics. Depressives, because of their impaired concentration and slowed thought processes fail to associate with inkblots. However, many depressives’ come out with good number of responses on inkblots after persuasion. Maniacs remain too involved in environmental stimuli; any change in the immediate environment catches their attention. On successive presentation of inkblots, they keep on producing associations. Rejection is rarely noticed in manic patients.. Conclusion: The additional scoring of comprehensive scoring system of SIS-I were able to discriminate normal subjects from manic, depressive and schizophrenic groups. The Total Number of Responses, Total Blot Area, Common Blot Area, White Background Area, Shape Appropriate, Shape Inappropriate, Most Common Responses and Rejection of Cards were found to discriminate between Normal and Manic patients and the White Background Area, 3-Dimenension, Animal Part and Most Common Responses were able to discriminate between Normal and Depressive patients. The Total Number of Responses, Uncommon Blot Area, Whole Blot Area, Shape Appropriate, Shape Inappropriate, 3-Dimenension, Animal Part, Most Common Responses and Rejection of Cards were able to discriminate Normal subjects from Schizophrenic patients. The indices such as Color Chromatic, Color Achromatic, Human Complete, Human Part, Animal Complete and Internal Organs failed to discriminate the index groups. Acknowledgement: We are grateful to Prof. B.L.Dubey, Ph.D., Director SIS Centre, Anchorage (USA) for his guidance, expert suggestions and support for CSS of SIS-I. Declaration: This paper is a part of Ph.D thesis of first author awarded by Ch. Charan Singh University, Meerut(India) in 2008. References: Beck, S.J. (1952) Rorschach test, Vol, III. Advances in interpretation. New York : Grune & Stratton. Beck, S.J. (1945) Rorschach’s test vol II. A variety of personality pictures. New York : Grune & Stratton. Beck, S.J., Beck, A.G., Levitt, E.E., and Molish, H.B. (1961) Rorschach’s Test Basic Processes. New York : Gurne & Strattons. Bohm, E. (1958) A textbook in Rorschach test diagnosis (Tr. by A. Beck & S.J. Beck) New York : Grune & Stratton. Cassell, W.A. (1980) Body symbolism and the somatic inkblot series. Alaska, Aurora Publication. Cassell, W.A. (2002) Intellectual struggle in advancing SIS knowledge. SIS Journal of Projective Psychology & Mental Health,9.1. Cassell, W.A. (2007) Body consciousness in exhibitionism. SIS Journal of Projective Psychology & Mental Health,14, 3-13. Cinzia, S., and Roberto Ferro. (1998) The SIS I and body image evaluation in subjects suffering from serious obesity. SIS Journal of Projective Psychologyh & Mental Health, 5, 105-113. Cocking R.R., Dana, J.M., and Dana, R.H. (1969) Six constructs to define Rorschach M : A response . Journal of Projective Techniques and personality Assessment, 33, 322-323. Dubey, B.L. and Cassell, W.A. (2000) Inkblot responses as an aid to therapy. SIS Journal of Proj. Psychology & Mental Health, 7, 3-10 Exner, John E., Jr. (1974) The Rorschach: A Comprehensive System. New York: John Wiley. Jain R., Singh, B., Mohanty, S. and Kumar, R. (2005) SIS-I and Rorschach Diagnostic Indicators of Attention Deficit and Hyperactivity Disorder. SIS Journal of Projective Psychology & Mental Health, 12: 2, 141-152. Kandhari, S., Sharma, J., and Kumar, R. (2010) Development of a Comprehensive Scoring System for SIS-I. SIS Journal of Projective Psychology & Mental Health, 17, 120-125.

42 Kandhari et al. Khromov, A. (2001) Psychological characteristics of subjects with Achondroplasia and traumatically shortened extremities. SIS Journal of Projective Psychololgy & Mental Health, 8, 53-64. Kolpfer, B., Anisworth, M.D., Klopfer, W.G. and Holt. R.R. (1954) Developments in the Rorschach Technique. Vol. 1. Technique and Theory. World Book Coy, New York. 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, 53-60. Kumar, P. (1968). The Rorschach test in manic and normal group. Indian Jr. of Psychology, 35, 35-38. Kumar, R. (2000) Meta analysis of the findings on SIS-II. SIS Journal of Projective Psychology & Mental Health, 7, 141-147. Kumar, R. (2005) An extended scoring system of SIS-I. SIS Journal of Projective Psychology & Mental Health, 12, 123-128. Kumar, S., Singh, R., and Mohanty, S. (2001). A study of Somatic Inkblot Series-I in hospitalized male chronic schizophrenics. SIS Journal of Projective Psychology & Mental Health, 8, 31-37. Mahapatra, J., Sahoo, D., Mishra, P. K., and Kumar R.(2009). SIS-I Indices as a Measure of Ego Strength in Schizophrenia. SIS Journal of Projective Psychology & Mental Health, 16,152-154. Mitra, G., and Mukhopadhyay, A. (1996) SIS and social anxiety - An assessment of personality factors of drug addicts. SIS Journal of Projective Psychology & Mental Health, 3,63-68. Mukhopadhyay, A., Banerjee, S., and Mitra, G. (1996). A comprehensive profile of personality characteristics of male drug addicts. SIS Journal of Projective Psychology & Mental Health, 3, 33-41. Pershad, D. and Pareekh, S.C. (2001) A Protocol Manual for the Rorschach Test: Agra: HD Bhargava Book House, Agra. Pratap, S. and Kapur, M. (1984). Rorschach study of literate manics. Indian Journal of Clinical Psychology, 12, 29-34 Rathee, S.P., Goel, D.S., Chawla, M.L., Saldanha, D., and Dubey, B.L. (1994). A study of Somatic Inkblot Series-I in Coronary Cases. SIS Journal of Projective Psychology & Mental Health, 1: 51-64. Rathee, S.P., and Singh, A. (1996). A comparative study of male and female on Somatic Inkblot Series-I. SIS Journal of Projective Psychology & Mental Health, 3: 43-49. Rorschach, H. (1921) Psychodiagnostic. Ernst Bircher, Bern, 1921. Rorschach, H. (1942) Psychodiagnostic, New York : Grune & Stratton. Saldanha, D. (2002). Profile of militants : An attempt to study the mind of militants. SIS Journal of Projective Psychology & Mental Health, 9: 23-32. Schafer, R. (1948) The clinical application of psychological tests. New York : International Universities Press. Shyam, R. (2007) SIS in paranoid ideation: A case study. SIS Journal of Projective Psychology & Mental Health,14: 145-149. Shyam, R. Cassell, W.A., and Dubey B.L. (2009). SIS Detection of Invisible Imagery in Bipolar Depression. SIS Journal of Projective Psychology & Mental Health, 16, 24-31 Srivastava, A.K. (2002) Somatic Inkblot Series-I; A meta analysis. SIS Journal of Projective Psychology & Mental Health, 9, 33-37. Verma, S. K. and Pershad, D. (1985) PGI Health Questionnaire, Agra, National Psychological Corporation.

Application of SIS in Business Organization Anand Dubey and Bankey L. Dubey The Somatic Inkblot test has been used in industry during selection and employees counseling. It has been found as an effective tool to ascertain if the new incumbents possess certain personality traits such as team building, interpersonal relationship and intra-psychic balance. The present paper will provide SIS Norms and indices for successful executive in business world and the services provided by Dubay Doctorin (2D). The 2D enables organizations to transform into learning organizations to effectively compete in the marketplace. It is very simplistic and pragmatic approach that attempts to understand and capitalize on “the people”, “processes”, assets and technologies” in a service delivery environment focused on specific business outcomes. It can be applied in any service industries including Government Services, Hospitality Services, Transportation and Logistics Services. One of the authors (BLD) used The Rorschach and Somatic Inkblot Series (SIS) for teaching graduate students about 40 years and administered SIS for personality assessment during selection for about 20 years in various private and public sector organizations in India. The findings have been very encouraging. The SIS was found to be a dependable test in assessing certain very important traits such as “Team Building, Inter Personal Relationship, Healthy Mind-Body Imagery”, much required in successful business executives. The profile of executives has been prepared to help organizational/industrial psychologist and human resource personnel working in various organizations as norms/indices. Various areas being assessed by different images of Somatic Inkblots Series-II are depicted in table 1. Anand Dubey, B.E.,MBA, Managing Director, Rights Group, Anchorage, Email:anand.dubey@gmail.com and Bankey L. Dubey, Ph.D., DPM, Director, SIS Center, 4406 Forest Road, Anchorage, AK 99507(USA) Email: bldubey@gmail.com Key Words: Dubay Doctorin(2D). SIS in Industry Table 1 SIS Images Assessing Different Areas

Area Images Interpersonal Relationship A: 9, 21, 24, 31, B: 4, 5, 28, 31 Ego/Self Image A:- 5, 6, 7, B: 22, 27, 28, 29 Healthy Body Imagery A:- 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 23, B: 9,11,16,17, 20, 30 Erotic Imagery A: 4, 8, 22, 25, 27, B: 18, 25 Hostility / Aggression B: 15, 21 Insecurity A: 13, 24, 26, B: 19, 22 Thinking in Group Conformity A: 7, 9, 12, 13, 20, 27, 30, 31, B: 4, 5, 9, 22, 27, 28, 29, 30, 31 Dubey (1975, 1976, 1980, 1989, and 2003) administered inkblot tests (Rorschach and SIS) to executives in different situations. As expected, the data revealed several higher mental functions. These were as follows: productivity, imaginative ability, controlled emotionality, good adjustment and group conformity. In regard to leadership skills,

44 Dubey and Dubey their scores were elevated on team building. Regarding their personality profile, they gave more number of total Responses, Most Typical and Human responses. In contrast they scored low with regard to Animal, Anatomical and Sex responses. The Rejection of images and Pathological responses were almost absent. In another study Dubey et al (2001, 2003) administered SIS Test to 90 executives of a private organization. The SIS profile reveals that they were supported by good ego strength, healthy interpersonal relationship, no erotic disturbances, controlled hostility and aggression, high on team building concept, good human relationship, and keeping touch with reality. The personality profile data of the executive groups is shown in Table 2. Table 2 SIS-II Profile of Executives in Public & Private Sector Organizations and Indicators of Successful Executives Indices Dubey et al, 1995, Pvt. Sector Exe. (n=300) MF Dubey,2001 Tele. Cables (Pvt) (n=90) MF Dubey, 2003 Pub Sec Exe. (n=400) MF Dubey et al 2010, Exec. (n=892) MF Indicators of Successful Executives Total number of Response 70.25 65.57 66.50 68. 00 61-75 (>62) Human Responses 14.20 (20) 19.21(30.96) 20.30 (30) 18. 20 20-25% Animal Responses 8.45 (12) 7.31(12.75) 10.65 (16 ) 8.60 <11% Anatomical Responses 11.40 16 12.38 19.97) 11.80 (16 ) 12.80 <15% Sex Responses 4. 20 (6) 2.24 (3.62) 3.30 (4 ) 3.15 About 6% Movement Responses 8.35 6.31 (10.18) 8. 35 6.30 <13 Most Typical Responses 14.55 15.24 (85) 14.55 14.80 >13 Typical Responses NR NR 40.00 32.00 >50% Atypical Responses NR NR 9.00 9.00 <12% Rejection of Images 0.75 (1.00) 0.35 (0.20) 0.85 (1.00) 0.60 (0.85) <1 Image Pathological Anatomy Scale PAS) 0.6 Almost Nil 0.4 0.5 Almost Nil Depression Scale 0.4 Almost Nil 0.6 0.6 Almost Nil Hostility Aggression Scale 0.5 Almost Nil 0.5 0.4 Almost Nil Paranoia Scale 0.02 Almost Nil 0.3 0.3 Almost Nil Percentage is shown in parenthesis Next the data will be presented illustrating using the SIS as screening test during the selection procedure. The subjects, who did not reject any images, gave more than 13 Most Typical responses (out of 18), more than 20 percent of Human responses, less than 15 percent of Animal and Anatomical responses and gave no pathological responses, were recommended for inclusion in regard to possible employment. However, there were other criteria for acceptance or elimination and none were rejected solely on the basis of psychological test performance. Indices found successful are shown in Table 3.

Application of SIS in Business Organization 45 Table 3 Hard Core SIS Indices of Executives Indices Scores Rejection of Images Less Than 1 Percent Most Typical Responses More Than 13 (out of 18) Human Responses More Than 20 Percent Animal Responses Less Than 15 Percent Anatomical Responses Less Than 15 Percent Pathological Responses Almost Absent Currently ongoing research is enabling us to explore the use of the SIS in “Cyber Space”. The procedure is available on http://psyche. dubay.bz/ under the name “Game Changer”. In this settings comparing the tool to a game rather than a test which has many advantages such as making it seem more users friendly. The game Changer is one of the interventions under Dubay Doctorin (2D) (Dubey, 2010). This was conceived as an “Agile Service Management philosophy” that blends traditional service management standards with the “human aspect” of the workforce. At the most elemental level 2D is a set of guidelines and tools that provide a nimble and effective implementation of service management. The philosophy covers the entire lifecycle of a service and all crucial aspects of a “service entity” or service provider including the organizational structure. Business leaders have a long history of questioning the business value of expensive information technology; yet, this skepticism often is justified given the intangible benefits and long implementation projects. To overcome these problems and break the barriers of implementation, the Dubay Doctorin maintains rapid deployment capability and state of the art of internet based assessment technology. Information informing decision makers is quickly available allowing operational leaders the tools required. The 2D enables organizations to transform into learning organizations to effectively compete in the marketplace. Raising the productivity levels of employees whose job cannot be automated is the next great challenge of information technologies. Supervisors and managers supporting a business process redesign to appropriately enhance the environment. It is very simplistic and pragmatic approach that attempts to understand and capitalize on “the people”, “processes”, assets and technologies” in a service delivery environment focused on specific business outcomes. It can be applied in any service industries including Government Services, Hospitality Services, Transportation and Logistics Services. The Game Changer: It is a web based psychological procedure using projective inkblots images called the “SIS” to assess certain important personality traits, found to be very effective for the success of people in industry. These traits are:

1. Interpersonal Relationship,

2. Team Building and sharing common view of things,

3. Pessimistic Attitude and

4. Aggressive expression. The instrument helps in assessing the traits in high and low scores. The high scores are more desirable in first two traits- Interpersonal Relations and Team Building while low scores are desirable for pessimistic attitude and aggressive expression. It helps to understand if a person can make a good team, will have smooth interpersonal relationship with different sets of people with low pessimistic and

46 Dubey and Dubey aggressive attitude. It is specially designed for business settings. It is a light weight personality assessment tool that can be used by business professionals and managers. It consists of a slideshow of 20 inkblot images. The responders are asked to select a likely “inner projections” from four available preset options or the option to pen their thought as a fifth option. All impressions and emotions are encouraged. At the end the responder is asked to select the “most liked” and the “least liked” images including reasons for the selection. The results are interpreted by software and a report that draws a “personality profile” of the responder is generated. The report has been used by practitioners in the following: 1) Conflict resolution for teams, 2) Productivity management for teams, 3) Team Selection, 4) Cost reduction exercises, 5) Stress management, and 6) Employee morale management. Like other psychological instruments, Inkblot techniques have its critics as well as proponents. The 2D practitioners have used multiple tests in business settings including the MBTI, 16 PF, TAT, this tool fits well with “inexpensive, agile mind set” of 2D practitioners. After understanding the personality profile of existing personnel, training programs are organized to align the team with the following: 1. Are people aware with company’s Mission, Vision and Objectives (MVO)? 2. Do people keep GOAL while engaged in different activities? 3. Are people aware with cost effectiveness? 4. W3 and SPOT analysis. 5. What obstacles hindered in achieving the MVO? The above programs will further help in understanding Strength, Problems, level of Motivation and future planning of goal achievement. A sizable group of people from all strategic departments (30 to 40) can be taken to a Forest Resort amidst natural environment for two days. They will get opportunity to share their experiences and express their feelings. The exercise brings them closer than earlier. The program is particularly designed to achieve the following objectives: a) Cohesive team. b) Effective communication. c) Interpersonal relationship. d) Self confidence. e) Target setting by self The group will be further divided into various teams and asked to choose their own leader and many outdoor exercises will be performed. Later Heads of Department along with their work team were asked to prepare short targets for the next 3 months and long targets for the next 12 Months. This will make them to feel important and give confidence to the entire team that they can work on their own as well be interdependent on others. The group leaders will be responsible to check the short and long term goals achievement, setting next target if earlier set goals are achieved. Daily activities will include checking the cost of each activities, cost reduction, implementation of team goals and team morale. The outcome of such intervention has been reported earlier (Dubey, et al 2002, 2003, 2005) with success stories. Finally because basic human characteristics exist throughout the world, apart from culture, therefore, although the normative data has been established in Indian industry, it is likely that these data may have general applicability to industrial settings worldwide. Conclusion: The SIS has a more technologically advanced projective instrument with multiple industrial

Application of SIS in Business Organization 47 applications. The instrument helps in assessing the basic personality traits such as “Team Building” and “Interpersonal Relationship” needed for the success of the organization. The application of Dubay Doctorin (2D) in effective implementation of service management is also discussed in the paper. References: Cassell, W. A. (1969) Responses to Inkblot Configurations Resembling the Heart. Journal of Projective Techniques and Personality Assessment, 3: 123-126. Cassell, W. A. (1971) Body Consciousness in Exhibitionism. British Journal of Projective Technique, 16:21-31. Cassell, W. A. (1972) Individual Differences in Somatic Perception. Advances in Psychosomatic Medicine, 8: 86 -104. Cassell, W.A. (1977) Aggressive Imagery and Clinical Symptoms in Schizophrenia. British Journal of Projective Technique, 16: 21-23. Cassell, W.A. (1977) SIS-I. Eighth Mental Measurements Handbook. Ed. Oscar K. Buros, The Gryphan Press. Highland Park, New Jersey. Cassell, W. A. (1977) Desensitization Therapy for Body Image Anxiety. Canadian Psychiatric Association Journal, 22: 239-242. Cassell, W. A. (1979) Anatomical Rorschach Responses and Death Symbolism. British Journal of Projective Technique and Personality Study, 24: 7-16. Cassell, W. A. (1980) Body Awareness and Somatic Delusions Involving Sexual Organs. American Journal of Psychoanalysis, 40: 125-135. Cassell, W. A. (1980) Body Symbolism and the Somatic Inkblot Series. Anchorage, Alaska. Aurora Publishing. Cassell, W. A. (1984) Computerized Projective Testing as an Aid in Medical Diagnosis. Alaska Medicine, 26:1, 1-9. Cassell, W. A. (1984) Somatic Inkblot Series Video, SIS Center. Anchorage, Alaska (USA). Cassell, W. A. (1990) Somatic Inkblot Series Manual. SIS Center, Anchorage, Alaska (USA). Cassell, W. A. and Dubey, B. L. (2002) Application of Somatic Inkblot Series-I: New Scoring System. SIS Journal of Projective Psychology & Mental Health, 9: 5-22. Cassell, W, A. and Dubey, B. L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. Anchorage (USA): SIS Center. Cassell, W.A., Dubey, B.L., Dwivedi, P. and Singh, A.R. (2009) How to Delete Viruses and Reconfigure the Brain’s Hard Drive, SIS Journal of Projective Psychology & Mental Health, 16: 91-116. Dubey, Anand (2010) Rethinking Enterprise Resource Planning (ERP), Government Technology, 23:10, 14-19 and page 49. Dubey, B. L. (1975a) Personality Profile of DPM Students, Prabandhak, Journal of Management, 15-22 Dubey, B. L. (1976) A Comparative Study of Personality, Intelligence and Performance of Neurotics and Psychotics, Indian Journal of Clinical Psychology, 3:153-156 Dubey, B.L. (1980) A Personality Study of Business Executive, P U Management Review, 3:37-43 Dubey, B.L. (1989) Rorschach Profile of Indian Executives. Indian Journal of Clinical Psychology, 16: 74-77 Dubey, B.L., Agrawal, A. and Palia, R.S. (2001) Personality Profile and HRD Intervention in a Telephone Cables Company, SIS Journal of Projective Psychology & Mental. Health, 8: 127-134. Dubey, B.L. and Cassell, W.A. (1993) Some Experiences with Somatic Inkblot Series. British Journal of Projective Psychology, 38: 1: 19-41. Dubey, B.L., Cassell, W.A., Pershad, D. and Dwivedi, P. (1995) Diagnostic Utility of Somatic Inkblot Series, SIS Journal of Projective Psychology & Mental Health, 2: 77-84.. Dubey, B. L. and Cassell, W.A. (2000) Inkblot responses as an aid to Therapy, SIS Journal of Projective Psychology & Mental Health, 7:3-10 Dubey, B. L. Cassell, W.A. and Dubey, Anand (2005) Impact of Number of Responses on the Interpretation of Rorschach Indices, SIS Journal of Projective Psychology & Mental. Health, 12: 27-48. Dubey, B. L., Cassell, W.A., Singh, A.R. and Dubey, Anand (2010) A Handbook of Inkblot Technique: Rorschach, Holtzman and SIS. SIS Center, Anchorage, AK. Dubey, S.N. and Dubey, B.L. (2005) Effect of Psychological Intervention through SIS-I Images on Police Personnel. SIS Journal of Projective Psychology & Mental. Health, 12:2,153-158.

SIS- II Profile of Depressive Patients Ajay Tiwari, Preeti Pandey, Nalini Mishra and Anand Dubey The present study intended to investigate the SIS profile of patients suffering from depression. 100 depressive patients attending OPD and community outreach programs of Nai Subah psychotherapy counseling Centre Varanasi, and 100 normal participants were administered the SIS –II Booklet Form of the test. The results revealed significant difference between Depressive patients and Normal participants on most of the SIS indices. Human, Animal, Anatomical, Sex, Most Typical, Typical, Atypical and Depression scales were able to discriminate both the groups significantly. The SIS responses were also able to bring out aggressive contents and disturbed interpersonal relationships of a particular case with his wife whose profile has been cited for validation of projective imagery as offered by SIS-II. The patient was found to improve after 15 sessions of psychotherapy. Depression may be defined as “a disorder involving specific alternation in mood (sadness, loneliness), negative self-concept associated with self-reproaches, and self-blame with regressive and self-punitive wishes (desire to escape, hide or die)” (Beck and Alford, 2009). The probability of developing major depression during one’s life time has been reported to be 5 to 12 percent among males and 10-25 percent among females (DSM-IV, 2004). Kline (1974) has reported that depression is the second most prevalent psychiatric disorder following schizophrenia which ranks first in the United States. While everyone occasionally feels sad, these feelings tend to typically pass within a few days. When a person has major depressive disorder, they experience severely depressed mood and lowered activity levels that persist for two weeks or more. Their symptoms tend to interfere with their daily functioning, and cause distress for both individuals with the disorder and those who care about them (NIMH, 2009). Major depressive disorder is one of the most common mental disorders in the United States. Depression does not affect all demographic groups equally. Data from SAMHSA’s National Survey on Drug Use and Health (NSDUH) show that the prevalence of depression for women is Ajay Tiwari, Ph.D.,Director, Nai Subah Counseling center, Jawahar Bhavan, Sankat Mochan (Turn), Lanka Area, Varanasi-221005 Email: naisubahvaranasi@yahoo.com, Cell: 91-9415302922, Preeti Pandey, Counselor, Neurology Centre, Varanasi, Email: kajaljya@gmail.com, Nalini Mishra, Ph.D. Principal, Dhirendra Mahila P.G.College, Sunderpur, Varanas and Anand Dubey, M.D. Rights Group, 4406 Forest Road, Anchorage, AK 99517, Email: anand.dubey@gmail.com Key words: SIS in Depression roughly twice than that for men. NSDUH’s most recent data for 2008 shows that the prevalence of depression among adults in the United States is 6.4 percent. Women are 70 percent more likely than men to experience depression during their life time. Non-Hispanic blacks are 40 percent less likely than Non-Hispanic whites to experience depression during their life time. Compared to adults over the age of 60 years, 18-29 year olds are 70 percent more likely to have experienced depression over their lifetime. 30-44 year olds are 12 percent more likely, and 45-59 year olds are 100 percent more likely. Over a twelve-months prevalence, 18-29 year olds are 200 percent more likely to have experienced depression than those aged 60+ yrs. while 30-44 year olds are 80 percent more likely to develop depression (Byers et al, 2010, NIMH, 2009). Worldwide estimates of the proportion of people who are likely to suffer from depression in their lifetime vary widely between studies and settings but the best estimate lies between about 4% and 10% for major depression and between 2.5% and 5% for dysthymia (low grade chronic depressive symptoms). Prevalence rates consistently were found to be about 1.5

SIS- II Profile of Depressive Patients 49 and 2.5 times higher in women than men and also to be fairly stable over the age range of 18 to 64 years (Waraich et al, 2004). There have been various studies describing the personality profiles of depressive patients with the help of Rorschach and Somatic Inkblots Tests (Cassell and Dubey, 2003, Dubey, et. al. 1993, 2005, Dwivedi, et al. 1995, Kumar, et.al. 2005, Manickam, et.al. 2003, 2005, Shyam et. al., 2009, Tewari and Dwivedi, 1999). The present study is a modest attempt to compare the profiles of Normal subjects and Depressive patients and advocating clinical significance of SIS responses in a case of Depression. Methodology: The sample consisted of two groups of participants, adults suffering from depression and 100 normal adults. Both the groups belonged to the age range of 21 to 45 years. The depressive patients were diagnosed using the ICD 10 criteria. The Somatic Inkblot Series-II (SIS-II) was administered individually to all subjects after taking their consent. Standard procedure of administration, scoring and interpretation was followed as advised by Cassell and Dubey (2003). Mean and Chi-square were used to analyze the data. Since no parametric tests have been advised to treat inkblot responses, Chi-square test was used to compare the two groups of subjects (Cronbach, 1949, Dubey, 1982). Results and Discussion: The responses of both the groups were compared using Mean and Chi-square test. The results are presented in Table 1. Table 1 Comparison of SIS II Responses of Depressive Patients and Normal Subjects SIS II Indices Depressive (n=100) Normal Group (n=100) P value Mean Mean Mean Total no. of Responses (R) 64.6 64.3 NS Human Responses (R) 16.5 23.8 <0.05 Animal Responses (A) 10.9 7.2 <0.05 Anatomical Responses (At) 13.4 9.5 <0.05 Sex Responses (Sex) 2.7 6.0 <0.05 Movement Responses(M) 8.2 7.3 NS Most Typical Responses(MT) 10.5 13.1 0.05 Typical Responses(T) 18.9 25.4 <0.05 Atypical Responses(T) 17.3 13.8 <0.05 Rejection of Images (Rej) 0.6 0.4 NS Pathological Anat. Scale (PAS) 0.5 0.3 NS Depression(D) 0.7 0.1 <0.05 Hostility Aggression Scale (HAS) 0.5 0.4 NS Paranoia (P) 0.2 0.1 NS NS: not significant.

50 Tiwari, et al The findings of Table 1 reveals that the number of Responses of both the groups were almost equal (Depressive Patients Mean = 64.6, and Normal Subjects Mean= 64.3) unlike the findings of other studies to be more than average (Cassell and Dubey, 2003). The higher number of total responses indicates fair imaginative capacity and functioning of intelligence in both the groups. The total number of responses was not able to discriminate the groups. The findings of the present study are in agreement with those of Ranjan et al (2008) but not with Singh and Dubey (1997) which has shown more responses among normal subjects. The human responses indicate focus on interpersonal relationships and concern for others. The obtained scores revealed that depressive patients have significantly less human responses (M=16.5) than the normal controls (M =23.8) which suggest disturbed interpersonal relationships and a tendency to remain away from others on the part of depressive patients. Animal responses were significantly high among depressive patients (M=10.9) as compared to normal subjects (M=7.2) indicating psychological immaturity, frustration, and impulsive attitude among depressive clients. Depressive patients were also found to score low on Self and Ego strength. They tend to be more anxious about their physical health and tend to remain preoccupied with internal body organs. Consequently preponderance of anatomical responses, (M= 13.4) as compared to the normal subjects (M= 9.5) is significantly different among the two groups, which in turn serves as a diagnostic indicator. Significantly lower number of sex responses among depressive patients (M=2.7) as compared to normal counterparts (M=6.0) show low interest in opposite sex, low sexual desire, and even withdrawal from opposite sex relationships. Findings revealed no significant difference on Movement responses in both the groups though low M (Human Movement) have been reported by many studies (Kumar, 2010, Dubey,1982). The average Movement responses among Depressive clients might indicate that they are yet quite active. Such patients respond well to therapy and generally have good prognosis. The Low number of total Responses, delayed Reaction time, Low W, High Black and White responses, High anatomical responses, Low human Movement (M), High Animal responses (A %), high extent of rejection of inkblots have been reported as indicators of Depression by various studies (Cassell and Dubey,2003, Dubey,1979,1982, Kumar, 2010). The Normal group of subjects in comparison to depressive clients (M=10.5) scored significantly more as far as Most typical responses (M=13.1) are concerned. Higher number of Most Typical responses among normal subjects is suggestive of coherent, logical thinking, and an ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept. Depressive subjects have been found to show poor ego strength, and to an extent exhibit withdrawal from the demands of society. The Low MT responses are also a strong indication of neurotic constrictions of personality. The present finding is consistent with the findings of the other studies (Cassell and Dubey, 2003, Kumar, 2010). The results also revealed that depressive patients have significantly low Typical responses (M=18.9) and high Atypical responses (M=17.3) in comparison to normal counterparts, suggesting deviation from normal view of thinking, low frustration-tolerance, being psychologically immature coupled with aggressive attitude. Rejection of images was low in both the groups which has been obtained along the expected direction among Normal subjects and indicates no serious psychiatric disturbances among Depressive patients. On the pathological scales both the groups scored low on Hostility and Aggression Scale, Pathological Anatomy Scale and Paranoia. However depressive patients scored significantly high on Depression (M=0.7) as compared to normal subjects (M=0.1), suggesting dysphoric emotions. Other studies

SIS- II Profile of Depressive Patients 51 have also found high scores on Depression (Cassell and Dubey, 2003, Kumar, et.al.2005). On the whole, Depressive patients scored high on Animal responses, Anatomical responses, Atypical responses and Depression scales; and low on Human responses, Most Typical responses and Typical responses as compared to Normal Subjects. SIS intervention: The SIS-II Booklet was administered to uncover psychopathology and the basis for developing a language for more effective psychotherapy. The following section would highlight the SIS responses of an interesting client whose responses on the SIS-II appeared to shed enriched information along dynamic perspectives. During the interview sessions, the client appeared quite cooperative and communicative. The profile of the case is described below in brief: Case The case illustration involves a 30 years male, Chartered Accountant, severely depressed with multiple somatic symptoms. He started having complaints of a sensation of heaviness in his head with headache, low mood, hinging sensation, hyperventilation, often weeping, lack of interest in any work, clenching of teeth, at times chest pain and feelings of heaviness in the whole body. His psychosocial history revealed a significant stressor. The onset of his complaints started 4 months after the marriage with a girl belonging to another caste though of the same religion. She has learned Indian Classical Dance (Kathak) and wanted to make dancing as her professional career. However the family never liked the idea and they did not accept the girl. They wanted to see her as a house wife and home maker because the family was well to do economically. The patient reported to be very close to his father, with the mother being critical at times, though supportive in general. Any arguments between his wife and his mother annoyed the patient and made him sad. Whenever he tried to persuade his wife, she misunderstood him and passed critical remarks that he was favoring his mother. She became uncooperative and withdrew her emotional support from her husband. She left her in-laws’ home and started staying separately. She stopped talking to her in-laws and even to her husband over the telephone. He became depressed due to the changing attitude of his wife and his family members and started thinking that his familylife will be ruined. Family counseling was provided to help them to understand the problems of each-other. The wife realized after 10 sessions that her attitude to go against the feelings of her family, particularly the husband and her mother-in-law, had distressed her husband significantly. She started helping her mother-in-law in regular domestic chores. The changing situation and positive attitude helped in improving the condition of the patient. He showed significant improvement and is expected to be symptom-free soon. Content analyses and psychoanalytical explanations of a few responses which were found to be significant have been analyzed and discussed ahead: A1. He perceived “A beheaded king holding two crows upside down, crows are talking among themselves. The legs of king are tied with chains.” The beheaded king connotes his low self-headless image, being unable to exercise his power in family matters and consequently indicates insecurity on the part of the client. The head may be the sign of power and domination which seems remarkable in this case. A2. He saw “Round Earth which is being held by some people”. This may indicate his inability to exercise his rights and feelings of helplessness as he is being

52 Tiwari, et al controlled by someone, possibly by his wife. A3. He perceived “Black Crow,” which in Indian mythology is a sign of Evil Spirit and to some extent “unwanted creature” might symbolically represent his wife who has created problems in the family. A4. He perceived “A man chanting Hare Krishna and Hare Rama by standing on one leg.” This may indicate a kind of withdrawal from the reality by taking the shelter of religion and God. When people have no options left, they often surrender to God and spirituality and accept whatever is the outcome. A5. He saw “Flower and its petal” and “a goat”. “The flower and its petal” may indicate happiness and hope for a better future. This is a healthy response with a positive emotional content. A6. “Teddy bear” is a healthy response which indicates his healthy childhood and smooth relationship with his parents. The teddy indicates his fond childhood memories and experiences. A7. “A dancing lady and an upside-down apple” is a healthy response with a positive emotional content. Dancing lady and Apple further indicate his contact with reality and good signs of prognosis. A8. He perceived “An eye full of tears” which is indicative of depressive contents and low self-image. A9. He saw “Two Ants” instead of perceiving two human beings which may indicate his disturbed interpersonal relationships with his wife. A10. “A gloomy woman - very much similar to my wife” may again indicate depressive contents and poor interpersonal relationship with his wife. A12.“Ear” is a normal healthy response on this image. A13. “Hand in fire, the person is shouting for help- ‘save me I am burning’ ” appears to be the direct expression of his sufferings and desire to seek help from others particularly from his family members. A15. “A man wearing black coat, holding a knife in his hand and has intention to murder someone.” The response is indicative of homicidal tendency and the therapist must take a note of this by advising the family of the patient to be extra careful and to keep a watch on him. The patient needs to be given antidepressive drugs and constant support to keep the aggressive contents of his personality within control. A16. “Two birds loving each other (Looking nice)” is a healthy response and may also indicate his wishful thinking to have his loving relations again. This further indicates his positive attitude and sign of good prognosis. A18. “A sitting Rabbit, a Lion having a heart and Lion is very sad”. Sad lion may indicate his own depressive mood. A19. “The picture at the time of pregnancy and womb” may indicate his regression to infancy and feelings that he was quite secure with no problems while he was a small child. The therapist must take this into account while interacting with him so that he can accept the reality and try to resolve the problems. A20. “Left and right lungs” is a normal, healthy response with a positive emotional content. A21. “A man wearing coat with stretched hands” may suggest his desire to seek help from others. A22. “Spinal Cord”. This is a healthy response which does not require explanation. A23. “Spinal cord” a healthy response which does not require any explanation. A24. “Intestine” is a healthy response but preponderance of many anatomical responses in a sequence, might indicate preoccupation with body imagery, a sign of tension and anxiety.

SIS- II Profile of Depressive Patients 53 A25. “Petals of Rose” is a beautiful response on this image. Generally people perceive female genitalia on this image and the petals of rose symbolically connote the same response. This further indicates his liking towards his wife and joint counseling of both (wife and husband) may help in resolving his interpersonal problems. A26. He perceived “A crying baby in mother’s womb.” This indicates his inner cry and his regressive features to escape from his present problems temporarily to an extent. A27. He saw “The arms of a girl having a lizard on her arm.” Though female torso is the most common response on this image, avoiding female breast may indicate his conflicting relationship with his mother or mother figure. In this case, he has poor relationship with his mother and conflicts with his wife, which has probably led him to avoid the normal response. Furthermore, “Lizard on her arm” may connote symbolically male organs which indicates his desire to be in touch with the arms of the girl (symbolically indicating his wife). The patient can be advised during psychotherapy session to handle his conflicts in personal and erotic areas. A28. “A man wearing gloves in the operation theatre” is a normal response. A29. “A mouse” is a normal response on this image. A30. “Skull” is a most common response on this image, which indicates his common view of things and touch with reality. A31. He perceived “Faces of two men, among them one is frightened”. Though “two faces - one male and another female” is a common response, avoiding female responses may indicate his conflict with his wife and seeing the other man’s face as frightened might indicate his own frightened self image. B1. He saw “Eye of a Vulture glaring at the eyes of a Hawk - both looked to be cruel birds.” The birds may indicate the patient and his wife and ‘glaring at the eyes’ may indicate their oppositional aggressive attitude towards each other. ‘Glaring at the eyes’ may even indicate paranoid tendency but in the absence of other indications, such interpretation does not warrant. B2. “A hanging monkey without legs” may indicate his feeling of helplessness. His psychotherapist must take note of this response during psychotherapy sessions to bring out his depressive mood and the patient needs to be encouraged learning the techniques to handle stress-creating situations. B3. “A woman - between two men - holding a handkerchief in her hand” may indicate the effect of therapeutic sessions when she has learned to face the situation by having a handkerchief in her hand. The two men might be her therapist and Husband or her husband and Father-inlaw who like both the patient and his wife. Images B1,B2 and B3 are unstructured and pure projective, and the responses on these three images have high clinical relevance. B4. “Two faces, two eyes among which one is small and is having marks of wounds, bleeding from the mouth” is a highly aggressive response. The therapist must take a note of such responses during therapy sessions to control his aggression and its outburst. In such situations, anti depressant drugs have significant role to play. Besides, psychotherapeutic explanations of his causes of aggressive outburst along dynamic lines may be effective in moulding his overall personality. B5 “Two men are sitting and talking together with plate in between”. This is a healthy response with a positive emotional

54 Tiwari, et al content. It may also indicate his desire to be with his wife and sharing nice moments of life. B7 “Face of one deer, and a Jacket hanged on stand” is a normal response. B8 “An earth, a nose from other side and a woman” is a good response. B9 “Lungs”. This is a healthy response with a positive emotional content. B11 “ Lungs” is a healthy response, does not need any explanation. B12 “A frightening face suppressing something” may indicate some kind of guilt feelings and something significant which has not been shared probably between the couple. B14 “An apple and lungs” is a healthy response with a positive emotional content. B15 “Hill with lots of bushes and inside the bushes, an arrow, a knife and a saw is hidden”. This is a highly aggressive response. This may also suggest homicidal tendency which calls for the need to have close observation of the patient. The therapist must talk to the patient about how to manage violent situations and how to control his aggression. B16 “Spinal Cord” is a healthy normal response. B17 “Face of a Chimpanzee” is a normal response on this image. B18 “A lizard is lying upside down”. It has sexual connotation and lying upside down may suggest passive desire and, to an extent, feeling of frustration due to disturbed relationship with his wife. B19 “An earth.” He has avoided viewing two hearts which is perceived by most of people on this image. Not viewing two hearts may indicate his disturbed relationships with his wife who had left his home and was staying separately. B20 “A woman is hiding behind the face of a man. This may suggest his guilt feelings of marrying without the consent of the family and consequently feelings of guilt because things were not moving the way he planned before marriage. B21 ”Attack with gun is taking place and cracker” The aggressive theme which was shown on some of the earlier images has come back on this image again. This may suggest homicidal tendency and hints at the need of medication and close observation of the patient. B22 “A resting boy” is a good and normal response on this image. B24 “Lungs” is a normal response. B25 “Earthen pot between two hands or an apple” is normal response. B26 “A Knife” is an aggressive response which needs to be addressed during psychotherapy session. B27 “Two small children” is a most common response seen by normal persons. B28 “A child is sitting in the lap of a man and man is protecting the child” is a normal response but often people perceive a child with a woman than with a man. Avoiding Woman might indicate his disturbed relationship with female figures, particularly with his mother (most probably) or the wife. B29 “A man without a leg” indicates his low self and depressive contents. B30 “Two Ears and an apple” is a normal response. B31 He perceived “A loving couple: both are holding each other with love” indicates his wishful thinking to have loving relations with his wife again. This further indicates his good ego strength, and sign of good prognosis.

SIS- II Profile of Depressive Patients 55 Conclusion: Somatic Inkblot Series-II Booklet version was administered to 100 patients suffering from depression and 100 normal subjects. The results revealed that Human, Animal, Anatomical, Sex, Most Typical, Typical, Atypical and Depression scales were able to discriminate both the groups significantly. The content analyses of SIS responses were able to bring out aggressive contents and disturbed interpersonal relationship of a particular client with his wife. The responses also helped in therapeutic planning and the patient was found to improve remarkably after 15 sessions of re-educative psychotherapy. He is showing interest in his work and getting symptoms free. References: Beck A.T. and Alford, B.A. (2009) Depression causes and treatment, University of Pennsylvania Press, Philadelphia, Pa 2nd Ed. Byers AL, Yaffe, K., Covinsky, K.E., Friedman, M.B. and Bruce, M.L. (2010) High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Arch Gen Psychiatry, 67:489--96. Cassell, W. A. and Dubey, B. L. (2003) interpreting inner world through somatic imagery: manual of the somatic ink blot series. Anchorage: SIS Centre. Cronbach, L.J. (1949). Statistical Method Applied to Rorschach Scores: A Review. Psychological Bulletin, 46: 393-429 Diagnostic and Statistical Manual of Mental Disorders (1994) 4th ed.(Revised 2004) American Psychiatric Association. Washington, DC: Dubey, B.L. (1979) Rorschach Indices of Psychiatric Patients in Army. Indian Journal of Clinical Psychology, 6: 175-179. Dubey, B.L. (1982) A Pragmatic View of Rorschach Inkblot Technique, National Psychological Corporation, Agra. Dubey, B.L. and Cassell, W.A. (1993) Some Experiences with Somatic Inkblot Series. British Journal of Projective Psychology, 38: 1: 19-41. Dubey, B. L. Cassell, W.A. and Dubey, Anand (2005) Impact of Number of Responses on the Interpretation of Rorschach Indices, SIS Journal of Projective Psychology & Mental. Health, 12: 27-48. 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: 165-170. Johns, L.C., Cannon, Singleton, N.,Murray,R.M. and Farrell,M., Brugha, T.,Bebbington,P., Jenkins, R. and Meltzer, H. (2004) Prevalence and correlates of selfreported psychotic symptoms in the British population, British Journal of Psychiatry,185: 298-305 Kline,N.S.(1974) From Sad to Glad: Kline on Depression, Putnam Publishing Group. 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, 12:53-60. Kumar, R. (2010) SIS Imagery in Depression with Somatization – Therapeutic Intervention, SIS Journal of Projective Psychology & Mental Health, 17: 69-72. Kumar, R. (2011) Rorschach Inkblot Test:A Guide to Modified Scoring System, Prasad Psycho Corpora, Agra. 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, 12:53-60. Manickam, L.S.S. and Dubey, B.L. (2005) Rorschach Inkblot Test in India: Historical Review and Perspectives for Future Action, SIS Journal of Projective Psychology & Mental Health, 11:61-78. Manickam, L.S.S. and Suhani B.T. (2003) Psychotherapeutic Usefulness of SIS-II in a Male Client with Somatoform Disorder: Case Illustration. SIS Journal of Projective Psychology & Mental Health, 10:209-218. National Institute of Mental Health (2009) Women and Depression: Discovering hope. Bethesda, MD: US Department of Health and Human Services, (http:// www.nimh.nih.gov/health/publications/women-anddepression-discovering-hope/index.shtml ). Ranjan, J.K., Kumari, A., Kumari, D., Prakash, J. and Sengar, K.S. (2008) SIS–II Profile of Alcohol Dependence Patients, SIS Journal of Projective Psychology & Mental Health, 15:157-162. Shyam, R., Cassell, W.A. and Dubey, B.L. (2009) SIS Detection of Invisible Imagery in Bipolar Depression, SIS J. Proj. Psy. & Mental Health, 16:24-31. Singh, A.R. and Dubey, B.L.(1997) Profile of Drug and Alcohol Dependent Cases. SIS Journal of Projective Psychology & Mental Health, 4:69-74. Tewari, M. K. and Dwivedi, P. (1999) SIS Video in a Case of Depression. SIS Journal of Proj. Psychology & Mental Health, 6: 47-49. Waraich, P. ,Goldner, E.M., Somers, J.M. and Hsu, L. (2004) Prevalence and incidence studies of mood disorders: a systematic review of the literature. Canadian Journal of Psychiatry, 49:124-138.

Effect of Psychotherapy on Pathological Gamblers M.G. Sharma and Vandana Sharma The present study examines the effect of psychotherapy on pathological gamblers. Ninety five (95) treated and 95 non-treated pathological gamblers were evaluated at SIMPHS Varanasi (India). The two groups were matched with respect to age (ranging from 23 to 61 years with a mean age of 41.2 years and mean length of uncontrollable gambling of 10.3 years). Indian adaptation of T.A.T. (Seven cards: 1, 3B, 4, 6BM, 7BM, 13MF, and 16) and Middlesex Hospital Questionnaire were administered to ascertain personality and mental health characteristics on ten selected dimensions viz: need, press, interpersonal relations, outcome, anxiety, obsession, phobia, somatization, depression, and hysteria. Mean scores obtained on different variables were analyzed using t-test of significance. Results indicated that the characteristics associated with treated pathological gamblers were cognizance, dominance, autonomy, achievement, counteraction, affiliation, sex capacity, interpersonal relations and outcome whereas the characteristics associated with non-treated pathological gamblers were aggression, rejection, passivity, acquisition, anxiety, obsession, somatization, depression, and press Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large scale studies and statistical methods for the DSM-IV. As defined by American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental sickness. The observation suggested that the motivation to gamble differed between various forms of gambling. In addition to or because of the excitement of gambling, poker machine players reported secondary rewards in the form of “psychic or emotional escape” from stress. They become totally oblivious to their daily problems. Horse race addicts on the other hand more frequently reported that gambling served to reduce dysphoric mood states. Often they would delay the receipt of race results to prolong anticipatory excitement and arousal. Expectations of large wins which may lead to improved financial and socio-economic status may also provide current and anticipatory reinforcement value despite continued losses (Tec, 1964). Anderson and Brown (1984) and Brown (1984) postulated a model of gambling based on individual differences in autonomic and cortical arousal which, in interactions with M.G.Sharma, Ph.D., Lecturer Dept of Psychology, Sri Agrasen Kanya P.G.College, Parmanandpur, Varanasi-221003, Cell: 91-9415448519, Email:gopal.simphs@gmail.com and Vandana Sharma Ph.D. Psychologist, SIMPHS, Varanasi- 221002(India). Key Words: Pathological Gambling irregular reinforcement schedules, led to the development of pathological gambling. Anderson and Brown (1984) 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) shows 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 size. Increased subjective ratings of anxiety as measured by a shorted from of the Speilberger’s State-anxiety Inventory paralleled heart rate increases. Custer and Custer (1978) surveyed 150 Gamblers Anonymous members attending a conference and found only five percent had reported early, pre-morbid sociopath behaviors. McCormic, et al (1984) reported 76 percent of a sample of 50 gamblers seeking treatment to

Effect of Psychotherapy on Pathological Gamblers 57 meet Research Diagnostic Criteria for major depressive disorder. Fourteen of their subjects reported that their 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 Questionnaire and revealed that treated pathological gamblers had significantly higher scores on extraversion and lower on neuroticism, psychoticism and lie scales, and group therapy is more effective for the treatment of pathological gamblers as compared to individual counseling (Sharma and Sharma,2008) . Sharma and Sharma (2009, 2011) used Vipassana meditation, psychotherapy and Astrotherapy in treating pathological gamblers and found the efficacy of these techniques with encouraging results. There are a number of therapeutic techniques available for the treatments of pathological gamblers. Psychodynamic psychotherapy attempts to uncover any underlying psychological factor that trigger gambling. For people who can gamble to escape, such as those who are depressed, this approach may be successful. Treating any substance abuse problems that may exist with pathological gambling can also be helpful. Other types of treatments involve behavioral techniques used to teach relaxation and avoidance of stimuli associated with gambling. Aversion therapy appears to be successful in treating pathological gambling disorder in highly motivated patients with some insight into the problems, but is not helpful for patients who are less educated or resistant to behavioral methods or treatments. 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 patient with the object of (1) removing modifying or retarding existing symptoms, (2) mediating disturbed patterns of Behavior and (3) promoting positive personality growth and development. Psychotherapy involves the use of certain therapeutic interventions in which persons with mental disorder interact with a trained psychotherapist who helps them change certain behaviors, thoughts or emotions so that they feel and function better. Group psychotherapy is also a type of procedure in which several people discuss their problems with one another under the guidance of a trained therapist. Thus, the need was felt to see the effect of psychotherapy on pathological gamblers which was compared on the Projective Test by Chowdhury (1967) and Middlesex Hospital Questionnaire by Bhat and Srivastava (1973). Materials and Method: The study was carried out at S.I. Mental and Physical Health Society’s Clinic (SIMPHS), Varanasi, India. The sample consisted of 95 treated and 95 un-treated pathological gamblers in the age ranges of 23 to 61 years with a mean age of 41.2 years. Both the groups were matched on socio- economic status. All the subjects had gambled for several years and were gambling about half of their weekly income. After individual counseling, they attended one hour group therapy for 6 months. The group therapy was administered 4 times weekly in the first month, 3 times weekly in the 2nd month, 2 times weekly in the 3rd month, once weekly in 4th months, once in 10 days in 5th months and once in 2 weeks in 6th months. Tools: TAT (Chowdhury, 1967) and Middlesex Hospital Questionnaire (Bhat and Srivastava, 1973) was administered to assess certain personality characteristics and mental health of treated and untreated gamblers. Statistical Analysis: The data thus obtained were analyzed using Mean, S.D. and ‘t’-test.

58 Sharma & Sharma Results and Discussion: The mean scores of treated and un-treated pathological gamblers on need, press, interpersonal relations, outcome, anxiety, obsession, phobia, somatization, depression, and hysteria was compared using ‘t’-test of significance. Results are shown in table 1 to 3. Table 1 compares the treated and un-treated pathological gamblers on need variables. It was found that the two groups differ significantly on cognizance, aggression, dominance, rejection, autonomy, achievement, passivity, counteraction, affiliation, acquisition, and sex. The treated gamblers obtained higher mean scores on harm-avoidance needs of which treated pathological gamblers do have higher mean scores on cognizance, dominance, autonomy, achievement, counteraction, and sex needs, and lower on aggression, rejection, passivity, and acquisition. The treated pathological gamblers have higher harmavoidance. It indicates that treated pathological gamblers had better cognizance, dominance in nature and autonomy in behavior. They always think about their achievement; counteraction, affiliation, and sex were the main needs. Untreated pathological gamblers were more aggressive, rejecting reality with low passivity. In another study Sharma and Sharma (2008) revealed that non treated pathological gamblers were found to be aggressive in nature, tough minded with dominating personality. Sharma and Sharma (2009) further reported that treated pathological gamblers were found to have dominance, autonomy, achievement, harm-avoidance and counteraction affiliation. The findings of the present study support the findings of Sharma and Sharma, (2008, 2009). Table 1 Comparison of Treated and UN -treated Pathological Gamblers on Need Variable Variables Treated Gamblers Un-treated Gamblers ‘t’ value df. p M SD M SD Cognizance 4.03 2.19 3.06 2.51 2.88 .01 Aggression 7.38 2.08 6.03 2.80 3.79 .01 Dominance 12.98 3.16 9.86 2.08 7.93 .01 Rejection 2.70 1.04 3.99 1.99 5.66 .01 Autonomy 6.91 2.67 4.32 2.68 6.69 .01 Achievement 10.28 2.97 7.16 3.16 7.01 .01 Passivity 2.69 1.86 3.91 1.93 4.45 .01 Harm- avoidance 3.62 2.97 2.16 2.73 3.53 .01 Counteraction 6.92 2.87 4.02 2.96 6.83 .01 Affiliat 7.18 3.06 5.67 2.94 3.48 .01 Acquisition 4.86 2.09 5.99 2.87 3.11 .01 Sex 8.06 2.63 6.91 2.67 9.50 .01 The two groups were compared on press, interpersonal relations and outcome variables using ‘t’- test of significance and the results are given in Table 2.

Effect of Psychotherapy on Pathological Gamblers 59 Table 2 Comparison of Treated and Un-treated Gamblers on Press, Interpersonal Relations and Outcome Variables Variables Treated Pathological gamblers Un-treated Pathological gamblers ‘t’ value df. p. M SD M DS Press 2.69 1.20 3.65 1.09 5.85 .01 Interpersonal relations 4.17 2.06 2.99 1.62 4.42 .01 Outcome 2.63 1.01 1.69 1.67 4.70 .01 It is clear from Table 2 that the two groups i.e., treated and un-treated pathological gamblers differ significantly on press, interpersonal relations and outcome variables. The treated pathological gamblers do have higher mean values on interpersonal relations and lower on press variables. This means that their interpersonal relations were relatively better than un-treated pathological gamblers. Besides, they were more likely to adjust in social situations. In a recent study by Sharma and Sharma (2009) that used T.A.T., it was revealed that characteristics associated with treated pathological gamblers are press and interpersonal relations. This finding of the study is quite similar to the present finding. Scores obtained by the two groups on anxiety, obsession, phobia, somatization, depression, and hysteria variables were analyzed using ‘t’- test of significance and results are presented in Table 3. It is evident from the Table 3 that treated and un-treated pathological gamblers differ significantly on six variables i.e. anxiety, obsession, phobia, somatization, depression and hysteria. The treated group of pathological gamblers has higher mean values on hysteria and lower mean scores on anxiety, obsession, somatization, depression, and phobia. This means anxiety might be a cause of regular gambling. Obsessive traits and phobic neurotic symptoms were also seen in the gambling group, and somatic and depressive symptoms were found in un-treated pathological gamblers. Sharma and Sharma (2009) however, in a study found that non-treated pathological gamblers had higher range of anxiety in comparison to treated pathological gamblers. Table 3 Comparison of Treated and Un-treated Pathological Gamblers on M.H.Q. Variables Treated Gamblers Un-treated Gamblers ‘t’ value df. p. M SD M DS Anxiety 2.69 1.31 4.96 1.13 12.8 .01 Obsession 3.36 1.16 4.41 0.93 3.24 .01 Phobia 4.06 1.11 4.99 0.98 6.15 .01 Somatization 4.00 1.03 4.94 0.92 2.97 .01 Depression 3.61 1.03 5.06 1.08 9.57 .01 Hysteria 4.33 0.96 3.93 1.19 1.20 N.S.

60 Sharma & Sharma Conclusion: It can be concluded that the characteristics associated with treated pathological gamblers are cognizance, dominance, autonomy, achievement, counteraction, affiliation, sex capacity, interpersonal relations and outcome whereas characteristics associated with untreated pathological gamblers are, aggression, rejection, passivity, acquisition, anxiety, obsession, phobia, somatization, depression, and press. References: Anderson, G., and Brown, F. (1984) Real and Laboratory Gambling, Sensation seeking and arousal. The British Journal of Psychology, 75, 401-410. Bhat, V.K. and Srivastava, O.N. (1973). Manual of the Hindi version of the Middlesex Hospital Questionnaire, B.H.U. I.M.S. 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. Chowdhury, Uma. (1967). Manual of the Indian adaptation of the T.A.T. Published by J. N. Basu, 1 Sanker Ghose Lane, Calcutta -700006. 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. Ferrioli, M. and Ciminero, A.R. (1981). The treatment of pathological gambling as an addictive behavior, 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. Leary, K. and Dickerson, M.G. (1984). Levels of arousal in high and low frequency gamblers. Unpublished Manuscript. Mc Cormick, R.A., Russo, A.M., Ramirez, L.F. & Taber, J.I. (1984). Affective-disorders among pathological gamblers seeking treatment. American Journal of Psychiatry, 141, 215-218. Sharma, M. G. and Sharma, V (2008). Treatment of pathological gamblers with counseling and group therapy compared on the MMHSI and TDAS, Psycho- Lingua. 38,152-156. 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. (2009). Effect of psychotherapy and vipassana meditation on pathological gamblers, S.I.S. Journal of Projective Psychology & Mental Health. 16, 147-151. Sharma, M.G. and Sharma, V. (2011). Astropsychotherapeutic effect on pathological gamblers. Journal of the Indian Academy of Applied Psychology.37,145-150. Tec, N. (1964). Gambling in Sweden, Bedminster Press, and Towong, N.J.

Somatic Inkblots imagery in Transsexual: A Case study Tirthanker Dasgupta, Rituparna Dasgupta and Padma Dwivedi The Somatic Inkblot Series-II (SIS-II) Booklet version was administered to a 30 years male, Transsexual to understand his personality and inner cry if any. The inkblots images were helpful to bring out poor interpersonal relationship with others, homosexual behavior, severe depression and suicidal tendency, with lots of unprocessed unconscious material that needed to be looked into during therapeutic intervention. The responses were analyzed using content analysis and psychoanalytical interpretation. Transgender is a general term applied to a variety of individuals, behaviors, and groups involving tendencies to vary from culturally conventional gender roles. Transgender is the state of one’s “gender identity (self-identification as woman, man, neither or both) not matching one’s “assigned sex” (identification by others as male, female or intersex based on physical/genetic sex).”Transgender” does not imply any specific form of sexual orientation; transgender people may identify as heterosexual, homosexual, bisexual, pansexual, or asexual. A transgender individual may have characteristics that are normally associated with a particular gender but identify elsewhere on the traditional gender continuum. Transgender people may also identify as bi-gender, or along several places on either the traditional transgender continuum, or the more encompassing continuums which have been developed in response to the significantly more detailed studies done in recent years (Layton, 1996). Transgender vs. transsexual: The word transsexual, unlike the word transgender, is defined by Benjamin in his book “The Transsexual Phenomenon,” on a scale called the “Benjamin Scale” which defines different levels of intensity of transsexualism, namely, “Transsexual (nonsurgical)”, “True Transsexual (moderate intensity)”, and “True Transsexual (high intensity)” (Benjamin, 1966). Tirthankar Dasgupta, MBBS,DPM, Consultant Psychiatrist, Rituparna Dasgupta, MA, PGDPC, Consultant Psychologist, “Moner Alo”, Nabapally, Barasat, Kolkata -700126, Email: moneralo0809@gmail.com and and Padma Dwivedi, M.A., Consultant Family Therapist, 4406 Forest Road, Anchorage, AK 99517(USA)Email: bldubey@gmail.com Key words: Transsexual , SIS in Transsexual, Many transsexuals believe that to be a true transsexual, a person needs to have a desire for surgery, however, it is notable that Benjamin’s moderate intensity “true transsexual” needs either estrogen or testosterone medication as a “substitute for or preliminary to operation (Benjamin, 1966). In addition to the larger categories of transgender and transsexual, there is a wide range of gender expressions and identities which are contrary to the mainstream malefemale binary. These include cross dressers, transvestites etc. The current definitions of transgender include all transsexual people, although this has been criticized. Intersex people have genitalia and other physical characteristics that do not conform to strict definitions of male and/or female, but intersex people are not necessarily transgender, since they do not disagree with their assigned sex at birth. Physical healthcare: Medical and surgical procedures exist for transsexual and some transgender people. Hormone replacement therapy for transmen induces beard growth and masculine skin, hair, voice and fat distribution. Hormone replacement therapy for trans-women results in feminine fat distribution and breasts. Laser hair removal or electrolysis removes excess

62 Dasgupta, et al hair for trans-women. Surgical procedures for trans-women feminize the voice, skin, face, breasts, waist, buttocks and genitals. Surgical procedures for trans-men masculine the chest and genitals and remove the womb and ovaries and fallopian tubes. The acronyms “GRS” and “SRS” refer to genital surgery. The Somatic Inkblot Series (SIS) is a structured, projective, diagnostic procedure and is an adjunct to psychotherapy. The technique is based on spontaneous, individually generated responses to inkblots, which elicit intra-psychic associations specific to the person taking the test. These stimuli evoke symbolism and meanings unique to the responding individuals. The procedure is an adjunct to therapy because responses can be further explored to create a more effective psychotherapeutic treatment plan. Somatic Inkblot Series have been found very helpful in understanding the personality profiles of patients of different clinical groups (Cassell and Dubey, 2003, Cassell et al, 1996, 1999, 2000, Dubey, 1981, 1982, Dubey et. al.,1994, Kumar, 2010). Sahay and Srivastava, (1994) used SIS in two male transsexuals and found the test useful in establishing psychopathology of the cases. The present case study analyses the responses of a transsexual patient on Somatic Inkblots images to find out the inner cry and unprocessed unconscious material having clinical significance during psychotherapy. Case Mr. X: Mr. X, 30 yrs, male, unmarried, Bengali speaking was referred by a physician to a private psychiatric hospital in Calcutta for multiple symptoms. The main complaints of the patient was gender identity crisis, too much interest in sex-changing surgeries, feelings of being harassed by teasing of peers in childhood, attempted suicide (thrice), unpleasant past experiences, disturbed sleep, distress in working condition, poor job satisfaction, lack of peace/low mood, anger/irritation, worry about future and low self-esteem. He has severe depression, hopelessness and frustration towards future life. His father died in early childhood and he was brought up by his mother in his maternal uncle’s house. He is the only child and has good relationship with his mother. Her mother is a working woman and is unable to spend enough time with him. Others in the family are not that much co-operative. Most of the people use to tease him for his sexual orientation by telling him that he looks more like a girl than a boy. He was also teased by his school teachers and friends on his sexual orientation. He was abused sexually by a few known friends initially but later on he had consensual passive homosexual involvement with them several times. His friendship breaks up easily causing him to often have relationship crisis. The Somatic Inkblot Series-II (SIS-II) was administered to him following the standard procedure (Cassell and Dubey, 2003), for understanding his personality profile and unprocessed unconscious material needs to be addressed during psychotherapy. He was motivated and cooperative during testing. The clinically significant responses on SIS-II are discussed ahead: A1: He perceived “butterfly” on this image which is not a common response. The butterfly may indicate feminine outlook and interest in feminine objects. A2: He saw “Heart” on this image which is a atypical response that may depict body imagery and to some extent signs of tension and anxiety. A3: “Cloud” may indicate his free-floating anxiety on this image. A4: Perceiving “Chocolate” on this image may suggest regression to childhood and feministic attitude. A5: He has viewed “Birds” where as human figure is the most common response

Somatic Inkblots imagery in Transsexual: A Case study 63 which he has avoided. This probably indicates his disturbed interpersonal relationship with others. A6: Perceiving “Toy” may again bring the theme of image A4 and his regression to childhood to avoid problems as an adult.

A7: “Apple” is a normal response, A8: He has perceived “Planet” though male sex organ is the most common response on this image. Avoiding male sex organ may indicate his deep rooted sexual conflict which could be due to faulty gender perception or disturbed sexual role as passive homosexuals. A9: He viewed “two Insects” where as two human beings - a male and a female - is the common response on this image. Avoiding two persons may again indicate disturbed interpersonal relationships particularly between male and female. A10: “Eyes” is generally perceived normal response on this image. A11: “Meat (chicken)”is a passive, aggressive response which may indicate helplessness, frustration and depression. The dead chicken (meat) may also be taken as strong indication of suicidal tendency, which the patient has already tried thrice. A12: Perceiving “Eyes” on this image may indicate his suspicious attitude toward others which needs to be addressed during his therapy sessions to explore the possibilities of paranoid tendency if any at this stage. He is unable to continue friendship with anyone which might be an early indication of some serious pathology. A13: “Palm” is a normal response on this image. A14: “Pancreas” is a normal response on this image. A15: “Kidney” is a normal response on this image. A16: “Small Sparrows” is a beautiful response though most people perceive it as two birds. “Small sparrows” may again indicate his regression to childhood where he feels comparatively more secure. A17: “Cage” may indicate his feeling of helplessness and inability to come out of his present situations. A18: “Brain” is a normal response on this image. A19; ”Colon” is a normal response on this image. A20: “Kidney” is a normal response on this image. A21: He perceived it to be a “Star fish.” Though a tortoise / a big man with two babies are the common responses on this image, avoiding two babies and big man may indicate his perpetuator who had forced sexual abuse during childhood. A22: “Star Fish, Sea Fish” might indicate his conflicts with gender role as the common response on this image is Spinal Colum which represents male phallic organ - a conflicting area of the patient. A23: He perceived “Scorpio” which is considered to be a painful insect though Spinal Colum is a common response and avoiding this response indicates his conflicts regarding male sexuality which is the main problem of the patient. A24: “Leg Joint” is the normal response on this image.

64 Dasgupta, et al A25: “Female sex organ” is a normal response on this image. Perceiving female sex organ might indicate his wishful thinking to identify this image as his own body part by taking help of surgery. A26 “Babies in pregnancy” is a normal response on this image. A27 “Female Breast” is a normal response on this image. It may indicate his good interpersonal relationship and closeness with his mother. A30: “Skull” is a normal response on this image. A31: “Two faces” is a normal response on this image though a male and a female have been a better response. Avoiding male and female may also indicate his gender role conflict. B3: He has perceived “Clouds” on this image though people talking are the common perception. The cloud may indicate his tension and free floating anxiety. B4: “Two Faces” is a normal response on this image. B5: ”Discussion between two persons” is a normal response. B8: He has perceived “Nose” on this image which may be an indicator of homosexuality. B9: “Kidney” is a normal response on this image. B14: He has perceived “Water” on this image though this is a rare response which may represent anxiety and insecurity.

B15: “Paper airplanes” is a normal response on this image. B16: He viewed “Scorpion” on this image which may repeat the theme of his perception on image A23. The spinal cord is a common response on this image and avoiding this probably indicates his conflicts regarding male sexuality. B17: “Love sign” is a normal response on this image. B18: He has perceived “Insect” instead of a “male phallic organ” which is most common response on this image. Avoiding perceiving the male sex organ and perceiving it as an insect may indicate his conflict in the male phallic region. B19: “Sun” is a normal response on this image but avoiding two hearts (either side of the sun) may indicate frustration and his conflicts in interpersonal relationship. B20: “Brain” is a normal response on this image. B21: “Hammer” is a normal response on this image. B22: He perceived “Frozen Man” which is a very depressive response. The therapist must take note of this during therapy session to address severe depressive contents with the help of antidepressant drugs and psychotherapy. This may also indicate severe suicidal ideation. B27: “Twins” is a normal response on this image. B28: “Mother with a baby” is a normal response on this image. It further indicates his close relationship with his mother. B29: “Boy” is a normal response on this image. B30: “Ears” is a normal response on this image.

Somatic Inkblots imagery in Transsexual: A Case study 65 B31: “Family” is a normal response on this image. Conclusion: As a whole he has given 14 Most Typical responses which indicate that he has contact with reality, has moderate ego strength and is free from psychotic ailments (no psychotic features). However, he has shown severe suicidal tendency, poor interpersonal relationships, conflict in the sexual area and gender role with marked depression and frustration. He is being treated with the help of drugs and psychotherapy and the improvement is expected to be reported in due course. References: Benjamin, H. (1966). The Transsexual Phenomenon. New York: Julian Press, page 23. Cassell, M. A., Cassell, W. A. Dubey, B. L., Dwivedi, P., Molchanov, E, O’Roark, A.M. and Routh, L.C. (1999) A Video Projective Technique for PTSD in Women. SIS Journal of Projective Psychology & Mental Health, 6:3- 28. Cassell, W. A., Dubey, Asheem and Dubey, B. L. (2000) SIS Projective Responses in PTSD and Dissociative Disorder. SIS Journal of Projective Psychology & Mental Health, 7: -93-108. Cassell, W. A. and Dubey, B. L. (1996) The Use of the Rorschach and SIS in Releasing Somatized Grief. SIS Journal of Projective Psychology & Mental Health, 3: 3-32. Cassell, W, A. and Dubey, B. L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. Anchorage (USA): SIS Center. Dubey, B.L. (1981) Rorschach Indicators in Normal and Clinical Groups in Military Population. ISPT J. of Res. 5: 54-56. Dubey, B. L. (1982) A Pragmatic View of Rorschach Ink Blot Technique. National Psychological Corporation, Agra. Dubey, B.L., Mishra, M., Dwivedi, C.B. and Mishra, N. (1994) Diagnostic and Therapeutic Utility of SIS-II and Rorschach. SIS Journal of Projective Psychology & Mental Health, 1:18-25. Hines, S. (2007) Transforming Gender: Transgender Practices of Identity, Intimacy and Care, The Policy Press. Kumar, R. (2010) SIS Imagery in Depression with Somatization – Therapeutic Intervention, SIS Journal of Projective Psychology & Mental Health, 17: 69-72. Layton, L. (1996) In Defense of Gender Ambiguity: Jessica Benjamin. Gender and Psychoanalysis. 1:27–43. Sahay, M. and Srivastava, P. K. (1994) Somatic Inkblot Series-II in Male Transexuals. SIS Journal of Projective Psychology & Mental Health, 1: 73-78.

Performance of Schizophrenic and Manic Patients on Human Figure Drawing : A Comparative Study Priyanka Shukla, D.Ram and K.S. Sengar The purpose of this study was to compare the performance on Human figure drawing test (HFDT) between schizophrenic and manic patients. The sample consists of 60 patients (30 each schizophrenia and mania). Two intelligence tests were administered to rule out the possibility of mental retardation. The subjects having IQ above 70 were included in the study and the Human Figure Drawing Test was administered individually. The results indicate significant difference on quantitative and qualitative scoring between the performance of schizophrenic and manic groups. Drawing has been used as a method of expression from very beginning of the civilization. Even during Stone Age people tried to express their feelings through paintings on the walls of caves. Even small children are found interested in making sketches and accordingly projecting their inner worlds. In the area of projective testing, the Draw-A- Person Test (Machover, 1949) is well known and is the first test used to study unconscious feelings of individuals (from children to older age). The DAP test requires the subject to make a picture of a person. The technique is based on the assumption that the individual will project his/ her self-image and inner feelings through drawings. The drawing of human figure is an ideal vehicle for self-expression (Machover, 1949). Initially, interpretation of Human Figure Drawing Test was based on characteristics of the figure, such as size, placement on the page, apparent rigidity of the drawn figure, drawing proportion, aesthetic appearance, line quality, gender issues, clothing and omission, etc (Machover,1949; Urban ,1963; and Handler and Reyher, 1985). Mitchell et al. (1993) used human figures to assess cognitive level of patients. Initially the interpretation of the test was restricted to intellectual aspect of the person but continuous research in projective psychology made this test popular. Priyanka Shukla, M.Phil. (M and S.P.), Research Officer, Email: priyankaaravpadhi@gmail.com, and K.S. Sengar, Asso. Prof. Clinical Psychology, RINPAS, Ranchi-834006 and D. Ram, Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi- 834006. Key Words: Human figure drawing test, Schizophrenia, Mania. Comparatively the Drawing test requires less time in administration. The present study is a modest attempt to compare the performance of Human Figure Drawing among schizophrenic and manic patients. Methodology: Sample: The sample consisted of 60 patients (30 patients each suffering from mania and schizophrenia), diagnosed as per ICD-10, (WHO 1993), falling in the age range of 20 to 50 years (Mean age of schizophrenia group and mania group was30.30+7.39 and 29.50+ 63 years respectively), taken from Central Institute of Psychiatry, Ranchi. There were 15 Male and 15 female patients in each groups with minimum education of VIth standard and IQ 70 and more. Procedure: The subjects fulfilling the inclusion criteria were explained the purpose of the study. The socio-demographic data such as age, duration of illness, age of onset, relevant family history, premorbid personality and treatment were recorded. The WAIS (Performance Scale) and Verbal Test of Intelligence (Pershad et al,1984) were administered to rule out the possibility of mental retardation. The subjects

Human Figure Drawing in Schizophrenia and Mania 67 having IQ above 70 were included in study. The Human Figure Drawing Test was administered individually to all subjects. Wechsler Adult Intelligence Scale (Performance Scale): It is the Indian adaptation of WAIS-Performance scale by Ramalingaswami, (1974). It includes five subscales: Picture completion, Digit symbols, Block design, Picture arrangement and Object assembly. Verbal Adult Intelligence Scale: The scale was developed by Pershad, et al (1984) and includes 4 sub tests: Information, Digit span, Arithmetic and Comprehension. The items were taken from the WAIS and standardized on Indian population. Human Figure Drawing Test: The HFDT is designed to support both quantitative and qualitative clinical interpretation of human figure drawings (Mitchell et al., 1993). The individual is asked to draw two human figures (one of each gender). The scoring includes an overall impairment score, distortion and simplification scores, and an organic factor index. The qualitative analysis assesses the cognitive and personality pattern of the individual on the basis of 74 drawing features, some of them are: Extreme Asymmetry, Unequal Arm, Light Lines, Shading (other than hair), Large Size, Addition of extraneous objects, Small Size, Stick figure, Blank, Teeth showing, Spiked fingers, Nostrils showing, Bare feet on clothed figure, Bizarre hair, Disheveled hair, Primitive appearance, Genderless, Childlike, Developmentally Indistinguishable, Naked without Genitalia, Chicken feet, Eyes omitted, Top placement, Bottom placement, Gross disproportion, Internal organ shown, Very large ears, etc. Results: The quantitative scoring of HFDT was subdivided into four sub scores- impairment raw scores, simplification raw scores, distortion raw scores and organic index. Table 1 shows the comparison of quantitative analysis of performance on human figure drawing test between the schizophrenic and manic groups. Table 1 Quantitative Analysis of Performance

variables Schizophrenia (N=30) Mean ± SD Mania (N=30) Mean ± SD Mann Whitney U Test U value z-score Impairment scores 7.76 ± 2.56 5.43 ± 3.14 2.99* Simplification scores 1.46 ± 1.77 .566 ± 1.10 2.41* Distortion scores 1.20 ± 1.37 .96 ± 1.35 .784 Organic index -.66 ± 3.70 .40 ± 1.10 .417 * p<.05, There is significant difference on impairment scores and simplification scores. Impairment scores and simplification scores are found higher in schizophrenia group in comparison to mania group whereas on distortion scores and on organic index no significant differences were found. Table 2 explores the comparison of quantitative performance of schizophrenia and mania patients on their drawing patterns. The response was obtained in terms of frequency and finally chi-square was computed to compare the difference. The table depicts significant difference between the two groups.

68 Shukla, et al Table 2 Qualitative Analysis of Performance Drawing features Schizophrenia (N=30) n (%) Mania (N=30) n (%) c2 Large Size 2 (7.4) 25 (92.6) 35.62** Addition of extraneous objects 0(0) 20 (100) 30.00** Small Size 25 (92.6) 2 (7.4) 35.62** Blank 9(100) 0(0) 10.58** Spiked fingers 24 (75) 8 (25) 17.14** Bizarre hair 17 (94.4) 1 (5.6) 20.13** Genderless 16(100) 0(0) 21.81** Chicken feet 11 (91.7) 1(8.3) 10.41** Arms omitted 0(0) 13(100) 16.59** Hand omitted 0(0) 12(100) 15.00** Fingers omitted 0(0) 13(100) 16.59** Top placement 13 (35.1) 24 (64.9) 8.53** Left placement 3(14.3) 18 (85.7) 16.48** Arms folded 13 (92.9) 1 (7.1) 13.41** Gross disproportion 21(100) 0(0) 18.26** Confused profile 14 (93.3) 1 (6.7) 15.02** Very large ears 24(77.4) 7 (22.6) 19.28** Boots on feet 6 (21.4) 22(78.6) 17.14** Bizarre drawing 21 (87.5) 3 (12.5) 22.50** Internal organ shown 9 (90) 1 (10) 7.86** Leg press 14 (100) 0 (0) 18.26** Hand Back 11 (100) 0 (0) 13.46** Heavy Line 2 (7.7) 24 (92.3) 32.85** Opposite Sex 7 (29.2) 17 (70.8) 6.94** Child 0(0) 8 (100) 9.23** Shading 17 (100) 0 (0) 23.72** * p<.05, **p<.01, Discussion: The overall result of the study reveals significant difference between the performance of schizophrenic and manic groups of patients. The review of literature showed that a few drawing patterns are found as indicators of schizophrenia such as omission, bizarre drawing additions, grossly exaggerated size, front view profile, confusion and tiny empty drawing (Machover,1949; Buck, 1950; McElhaney, 1969; Urban, 1963). In the present study 94.4% features of bizarre hair was drawn by schizophrenic patients in comparison to manic patients (5.6%). 87.5 % bizarre drawing was drawn by the schizophrenic group while it was 12.5% by the manic group. 93.3% Schizophrenics gave confused profiles in comparison of 6.7% by the manic group. These findings of the present study collaborate with the results of previous studies.

Human Figure Drawing in Schizophrenia and Mania 69 Omissions in the drawings have been were suggested as indicators of schizophrenia in earlier studies but no omission was seen among schizophrenics in the present study, though manic patients omitted figures (such as arms, hands, fingers). Omission is reported as a strong indicator of Schizophrenia in western studies but it was not observed among Indian schizophrenic clients. This may be because of the too small sample size of the present study which bars the researchers to draw any conclusive inferences regarding the same. Machover (1949) developed a number of hypotheses based on clinical observations and initiative judgment. She speculated that the size of the drawing related to the level of self esteem and that placement on the page reflects the subject’s mood and social orientation. The present study revealed that 64.9% of manic patients drew features of top-placement who had inflated self esteem, whereas in the schizophrenic group, this feature was drawn only by 35.1% of patients, and the difference between the schizophrenic group and the manic group is statistically significant. 7.4 percent schizophrenic patients made large size drawings whereas 92.6% large size drawings of the human figure were observed in the manic group. In a study Cramer and Ferm (1956) also found that size of figures increased with the degree of euphoria. The findings of present study are also supported by other studies (McElhaney, 1969; Viney, et. al, 1974; Hayes and Hallman, 1976; Ottenbacher, 1981; Handler and Reyher, 1985). A few signs derived from the DAP are associated with specific personality characteristics, for example, the presence of large ears are linked to suspiciousness and auditory hallucinations (Machover, 1949 and Jolles, 1971).In the present study 74.4% schizophrenia patients drew large ears whereas 22.6% were drawn by the manic group of patients. Mitchell et al. (1993) in their study revealed that more number of schizophrenic patients had drawn figure of inappropriate size and their figures were not centrally aligned. It lacked spontaneity, aesthetic appearance, and their figures were not age appropriate. These drawing patterns efficiently predict the personality pattern such as small figures often drawn by schizophrenic patients represent inferiority and inadequacy (Mc Elhaney, 1969; Urban, 1963). These findings are supported by the present study, in which 92.6% human figures of small size was drawn by the schizophrenic group whereas 7.4% figures of small size was drawn by the manic group. Harris (1969) reported shading as an indicator of anxiety but Handler and Reyher (1985) contradicted this finding on the basis of their study. The present study supported the findings of Harris (1969). In the present study, schizophrenic patients who were anxious frequently drew shading features (100%) but the shading features was absent among mania patients. Hands behind back were drawn by 100% schizophrenic patients, which indicate the presence of evasiveness in their personality profiles, which is a characteristic of schizophrenia (Machover, 1949; Urban, 1963). Internal organs were shown by 90% schizophrenic patients which indicates the presence of extreme pathology (Machover, 1949; Urban, 1963; Buck, 1963; Hammer, 1958). 92.3% figures in heavy lines were drawn by the manic group which indicates mood volatility (Urban, 1963; Buck, 1963) whereas only 7.7% was drawn by the schizophrenic group. 70.8 percent manic patients drew figures of opposite sex first in comparison to schizophrenic group (29.2%), which is an indicator of strong emotional attachment to a member of the opposite gender (Machover, 1949). Figure with shoes was most frequently drawn by the manic group (78.6%) which indicates autonomy (Urban, 1963) whereas shoes were drawn only by 21.4 percent schizophrenics.

70 Shukla, et al Conclusion: It can be concluded that there is significant difference between the performance of schizophrenic and manic groups of patients on Human Figure Drawing Test (HFDT). The impairment raw scores and simplification raw scores were found to be higher in the schizophrenic group than in the manic group. The qualitative scoring of HFDT, suggested highly significant differences between the performance of schizophrenic and manic groups of clients. References: Buck, J. N. (1950) The H-T-P technique, a qualitative and quantitative scoring manual. Journal of Clinical Psychology, 4, 317-396. Buck, J.N. (1969) The house tree person technique: Revised Manual. Los Angeles: Western Psychological Services. Cramer, A. and Ferm, J. (1956) “Personality Changes and Figure Drawing test,” A case treated with ACTH. Journal of Clinical Psychology, 21, 20-28. Gurvitz, M. (1967) The Dynamics of Psychological Testing. New York: Rune and Stratton. Hammer, E.F. (1958) The Clinical Application of Projective Drawing. Springfield, 111: Charles C.Thomas. Handler, L. and Reyher, J. (1985) Figure drawing anxiety indices: A review of the literature. Journal of Projective Techniques, 29, 305–313. Harris, D.B. (1969) Children’s drawing as the measure of intellectual maturity. New York: Harcourt, Brace & World. Hayes, J.R. and Hallman, J.L. (1976) Performance under health-endangering and health-depressing conditions. Journal of Psychology, 93, 261-268. Jolles, I. (1971) A catalogue for the quantitative interpretation of the H-T-P. (Revised).Los Angeles: Western Psychological Services. Machover, K. (1949) Personality Projection in the Drawing of the Human Figure: A Method of Personality Investigation. Springfield, IL: Thomas. Mc Lachlan, J.F.C. and Head, V.B. (1974) An impairment rating scale for human figure drawings. Journal of Clinical Psychology, 30, 405-407. McElhaney, M. (1969) Clinical psychological assessment of the human figure drawing. Sprinfield, IL; Thomas. Mitchell, J., Trent, R., and McArthur, R. (1993) Human Figure Drawing Test. Western Psychological Services, California. Ottenbacher, K. (1981) An investigation of self-concept and body image in the mentally retarded. Journal of Clinical Psychology, 37, 415-418. Pershad, D., Verma, S.K., Shukla, T.R., Khorana, S., Misra, M.N., Ojha, K.N., and Gupta, L.N. (1984) Some experience with WAIS-R Hindi verbal section with aged subjects. Indian Journal of Applied Psychology, 21, (2) 47-54. Ramalingaswami, P. (1974) The Measurement of intelligence among Adult Indians. New Delhi: NCERT. Urban, W.H. (1963) The draw-a-person catalogue for interpretative analysis. Los Angeles: Western Psychological Services. Viney, L. L., Aitkin, M. and Floyd, J. (1974) Self-regard and size of human figure drawings: An interpretative analysis. Journal of Clinical Psychology, 30,581-586. World Health Organisation (1991) The ICD-10, Classification of Mental and Behavioural Disorder, clinical presentation and diagnostic guideline, WHO.

program can help ensure a safe, secure and productive workplace, while finalizing their selection process. Some personality inventories such as 16 PF, MBTI, and MMPI have been employed by various companies with encouraging results. These are found helpful to determine the psychological attributes of an individual on job. These are also used for diagnostic and therapeutic purposes for the employees having problems during their work tenure. The personality inventories are convenient in administration and scoring and easier in interpretation but an intelligent subject can understand what part of his/her personality is being assessed through these questionnaires and they can easily manipulate the answers. However, many of these questionnaires have “lie-scales” built in, which allow such response patterns to be detected. Many of these questionnaires are also available in computer software helping the subject to take the test from any place and get its computerized results. Though the personality inventories have their own merits, these have been criticized for yielding right personality characteristics (Cassell and Dubey, 2003, Dubey et al. 2010). A few personality questionnaires are not specifically designed to measure job-related personality dimensions, though are used during selection. The projective approach arose as protest against the rigid frame of personality inventories. In viewing semi ambiguous stimuli, the subject is free to give as many responses as (s)he likes. In this setting, deep seated material may be brought into awareness that previously long forgotten. For example, if the individual had traumatic earlier life experiences with individuals from the past, this unresolved memory could distort and emotionally color their perception of situation at work. The “Thematic Apperception test” and “Word Association test” are still included in the Armed forces Selection Board in India. The Holtzman Inkblot Technique and The Somatic Inkblot Series have been used successfully as “Group Administered” test on general population and in industry (Cassell and Dubey, 2003, Dubey et al, 1993, 2001). In its electronic form the SIS procedure with accompanying software programs facilitates scoring for easy and quick interpretation (http:// psyche.dubay.bz). The Somatic Inkblot Series is a well known projective test and has been used in various business organizations for assessment and behavior modification. The test was found to be a dependable instrument in assessing certain

72 Gupta and Singh very important traits such as “Team Building, Inter Personal Relationship, Healthy Mind- Body Imagery”, much required in successful business executives (Cassell and Dubey, 2003, Dubey, 1993). Somatic Inkblot Series test (SIS) was administered on two females teaching professionals belonging to high strata of the society. Looking at them from organization’s view, it was quite difficult to identify their problems and pains. However, with the administration of SIS, it was possible to identify their problems, difficulties and stress in life. Cognitive psychotherapy was administered to both for understanding and resolving their psychological issues. Clinically significant responses on Somatic Inkblot Test (SIS-II) are discussed ahead: Case 1: Ms. X., 37 years, Ph.D., MBA, married, working as Faculty in a Management Institution, having a daughter of 8 years old with main complaints of adjustment problems and non cooperation from her subordinates. She had past history of physical abuse several times from her husband and never had very smooth relationship. She started staying with her parents after his death 4 years after the marriage. She has been an intelligent person with good professional record. The noncooperation from subordinates was due to the feeling that she got the position which was denied to one of the subordinates. Her problems aggravated because of her own unresolved personal issues. She was administered SIS-II Video test and clinically significant responses were

interpreted following therapeutic intervention: A3: She perceived “X ray of fractured bone” on this image, which may have indicated her own physical pain and injuries that she had suffered during physical abuse from her husband. A4: She saw “Small stream struggling with sea both sides green area” which may indicate her struggle for freedom and independence. The “small stream” connotes her own helpless self image and the green area symbolizes her positive attitude towards future with high ego strength. It is also a sign of good prognosis. A8: She viewed this image as “Shield” though female genitalia are the common response on this image. The shield may indicate her unconscious desire to protect herself from others, particularly males. A13: “A hand surrounded by fire” indicates her suffering and adverse situation which she feels has not yet improved. A27: She perceived “A man’s operated tummy” though “breast” is the most typical response on this image. Avoiding seeing breast may indicate her poor interpersonal relationship with mother or mother figure. In this case, she did not get any protection from her mother-in-law while her husband was misbehaving and physically abusing her. The other plausible explanation could be her unconscious rejection of her daughter and her wishful thinking to see her husband suffering (tummy operated) in pain. The client further disclosed that she has undeveloped breast and feels bad about it which might be another reason to avoid viewing breast on this image. B1: She viewed it as “A dead dog and blood” which may indicate her depressive and highly aggressive response. This may also indicate her hatred towards her husband and finally towards others who created hurdles in her ways. B21: She saw “Blasting gun” on this image which is a highly aggressive response. Keeping her aggressive attitude in view on images A3, A13 and B1, her therapist must take a note of her psychological

reaction to educate her in handling aggressive attitude and behavior. B23: She viewed “Cancer” on this image which might reflect her feelings towards her mother who died of cancer after prolonged sufferings. On further exploration, she revealed that her father is also a cancer patient and taking treatment. During the therapeutic sessions she came out with more information about her husband who was living with another married lady before the marriage. The fact was concealed from the client. Her husband died after two years in an accident. Her aggressive attitude towards her husband is projected on image B1 “A dead dog and blood”. Seeing cancer on image B23 reflects her concern about her father who is the only person protecting and taking care of her and her daughter. Rejection of breast on image A27 may indicate her inferiority feelings towards her own outlook (as a less attractive woman) without developed breast, which is considered to be a sign of femininity. The Cognitive psychotherapy was administered to enhance her positive strength. She was made to realize that she was very good in teaching, a very good in communication, very caring teacher and as a whole good human being. Her difficult relationship with a few male colleagues was not a true reflection of her personality. She started changing her attitude towards her colleagues and concentrated more on academic activities. She is a changed person now with more positive attitude after 3 months of therapeutic intervention.Case 2: Ms. Y, 25 years, MBA, married and working as faculty in a management institution. She has lived hardly one year of married life and after that had poor interpersonal relationship with her husband. He belonged to a rich family and was an adopted child of his aunt. She had lots of complaints against him who has had very unpredictable behavior. His sexual behavior was also very strange and unusual. He had lots of pervasive behavior and at time looked a psychologically sick person. Her husband is staying away and in a way separated though not legally. She is now staying with her parents and having problems of adjustment with her colleagues. She feels depressed most of the time and taking less interest in teaching work. She was administered SIS-II Video test and clinically significant responses on various images are interpreted ahead: A4: She perceived “ Smoke is coming out from a burning thing” indicating her tension and free floating anxiety. “Burning” may connotes her severe problems which is burning her internally. This might be an indication of depressive features A13: She viewed this image as “Some body’s hand asking to save her from fire” which may indicate the severity of her situation and the kind of help she needs from others around her (might be the significant family members), to support her in managing the crisis she is facing from the cruelty of her husband. A16: She viewed this image as “Two dead fishes and one skeleton of fish” which may indicate her disgusted feelings of how the two persons (she and her husband) are dead for each other though alive. Normally “two birds singing/loving each other” is the common perception of people on this image. A25: “Not identified”. She could not perceive anything on this image though “female genitalia” is the most common response. Rejection may work as defense mechanism to avoid severe conflict in the area personal /sexual relationship with her husband. A27: She viewed it as “Dead body of a deer” though female breast is a most common response. Avoiding perceiving torso may indicate conflict with mother or mother figure and her personal relationship with her husband.

74 Gupta and Singh B17: “Not identified” Normally people perceive “Heart” on this image. Rejection of heart may connote her traumatic love relationship with her husband and craving for affection. B 18: “Not identified”, though male genitalia is the most common response on this image. Avoiding perceiving male genitalia may indicate severe conflict with her husband who is staying away and planning to break the relationship. Rejection of both images A25 and B18, may suggest frustrating physical relationship with her husband. B28: “Someone is in agony and thinking” may again indicate her depressive and aggressive mood. The SIS responses indicated her disturbed marital relationship and conflict with her husband. Her disturbed personal relationship is quite evident as she failed to identify image A25 and B18 both representing female and male genitalia respectively. She is tensed and having severe depression. Her therapist must take note of her severe depressive mood which may lead to suicidal behavior. The case history as reported by the subject indicates that her husband might be suffering from psychotic disorder as “once he asked her to jump from the roof to express her love for him”. Such behavior one can expect from a schizoid personality. Beside this, her feeling of being trapped and craving for help is again a sign of depression. Discussion: Every organization hires a competent employee during initial induction. He is also rated as very good performer during initial years. No one tries to understand why his performance has gone down after years of good performance? Asking him to put down his papers and resign is not the solution of problems in every case. One needs to understand why the performance of a good employee has got deteriorated. Is it the situation of the person on job that is responsible to this change or the personal situation is forcing him to behave otherwise? The standard Human Resource Management practices are not effective in every situation. The most effective intervention is professional counseling and the role of psychological intervention start at this place. In almost every case, when there is a disturbed employee, one should take help of an outside professional with both clinical and organizational experience to provide complete assessment. There are many reasons as to why the organizations are taking help of counselors in shaping the organization and improving the “Organizational Culture”. It is the long standing employees who shape the organizational culture and help in developing the effective teams. Though it is also known that the organizational culture is set by the top man of the organization and it flows from top to bottom, but it is also true that every employee contributes their values to shape and reshape the culture. A healthy culture can create a winning environment and success stories. Counseling can help in enhancing psychological as well as emotional health of employees in the organization. The health of employees could be disturbed due to various reasons - professional or personal. Counseling can be a way of supporting employees to enhance the organizational values and ethics. It can make them to understand their strength and their potentials. It will enhance their understanding of what they are capable of doing in the changing scenario? It can also empower them to fight and manage the crisis in personal and organizational lives. Both the cases were assessed by an outside professional who prepared the profile of the subjects and the intervening factors were discussed with internal professionals. The subjects were administered cognitive psychotherapy and were advised related readings to enhance their knowledge “how to help yourself”. They discussed their

family problems and disturbed interpersonal relationship. The significance of Somatic Inkblot images was also discussed to understand the impact of situations on their behavior and personality. Both the cases have shown improvement in behavior with their colleagues. The home situation still remained unchanged having its impact on their behavior, though they were conscious of it. Conclusion: The SIS-II DVD version was administered to two female faculties in a professional institution. Both had adjustment problems and poor interpersonal relationship with their colleagues. Their traumatic marital relationship and depressive mood is projected through SIS responses. They were administered cognitive psychotherapy which helped in improving their symptoms. Changes of responses on readministration of SIS will be reported after completion of therapeutic intervention. References: Cassell, W, A. and Dubey, B. L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. Anchorage (USA): SIS Center. Dubey, B.L. (1993) Personality Assessment through Inkblot Techniques in Management and Business Education. (Ed). J. L. Rastogi et al. Rawat Publications, New Delhi, pp 297-306. Dubey, B.L., Agrawal, A. and Palia, R.S. (2001) Personality Profile and HRD Intervention in a Telephone Cables Company, SIS Journal of Projective Psychology & Mental. Health, 8: 127-134. Dubey, B.L. and Cassell, W.A. (1993) Some Experiences with Somatic Inkblot Series. British Journal of Projective Psychology, 38: 1: 19-41. Dubey, B. L., Cassell, W.A., Singh, A.R. and Dubey, Anand (2010) A Handbook of Inkblot Technique: Rorschach, Holtzman and SIS. SIS Center, Anchorage, AK.

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 35 issues in 18 years. The Journal is available on Society’s Web Site at http: //www.somaticinkblots.com The Journal from Volume 1-18 is available in C D(Acrobat ) 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, DM&SP, Editor Emeritus, SIS J. of Proj. Psy. & Mental Health, E-mail : bldubey@gmail.com Web Site at http: //www.somaticinkblots.com OR Prof. Amool R. Singh, Ph.D.,DM & SP, Director, RINPAS, Ranchi, Editor in Chief, SIS J. of Proj. Psy. & Mental Health, Email:sisamool@yahoo.com OR Rakesh Pandey, Ph.D.,FSIS, Prof. Dept of Psychology, BHU, Varanasi Editor, SIS J. of Proj. Psy. & Mental Health E-Mail: rpan_in@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., Director, RINPAS, 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 throughout station cheque.

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-34006. 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 Gautam Printers, Jagatganj, Varanasi, M. 09415201718 Editor-in-Chief : Amool Ranjan Singh

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH: ACHIEVEMENTS Journal in WHO Listing Members of Somatic Inkblot Society will be glad to know that SIS Jr. of Projective Psychology and Mental Health has been listed by World Health Organization (Global Forum for Health Research) among 25 indexed journals thai have published the highest number of articles on mental health from l MICs in Latin America, Africa and Asia (Medline and PsyclNFO). 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 Eng., Spani., Portuguese, Arquivos de Neuro-psiquiatria Brazil Portuguese Acta Psiquiatrica y psicologica deAmercia Laina Argentina Spanish Journal of the Medical Association of Thailand Thailand English, Thai British Journal of Psychiatry UK 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 U. K. English Psychiatry Research Ireland English Social Science & Medicine U. K. English Revista De Saude Publica Brazil Portuguese International Journal of Geriatric Psychiatry U. K. English SIS Jr. of Projective Psychology & Mental Health India English Journal Brasilerio de Psiquiatria Brazil Portuguese Psychiatry and Clinical Neurosciences Australia English Journal in Pro Quest Listing: We are glad 10 infonn 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 wond including some of the most prestigious higher education insUtutions such as Harvard. Yale, Princeton, Oxford ect. ProQuest provides abstracts and indexing for more than 640 titles, with over 540tities available in full text. Users get access to charts, diagrams, graphs. tables, photos, and other graphical elements essential to psychological research.

Abstracted in ~APA's Psyc INFO" Regd. No. 71632199, RNI Delhi SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & M ENTAL HEALTH EDITORS EMERITUS WilfredA. Cassell, MD, Director, SIS Center, 4501E.104thAvenue, Anchorage,AK.99516 (USA). E-Mail: siscasseIl2@yahoo.com Bankey L. Dubey, Ph.D., Director SIS Centre, 4406 Forest Rd, Anchorage,AK 99517 Cell : 907-250-8834, E-mail: bldubey@gmail.com EDITOR-tN-CHIEF Amool R. Singh, Ph.D., Director, RINPAS and Prof. Clin. Psychology, RINPAS,Kanke, Ranchi-834006 Cel.:91·9431592734, E-mail:sisamool@yahoo.com EXECUTIVE EDITOR Rakesh Pandey, PhD. Professor. Dept. of Psychology. Banaras Hindu University, Varanasi·221005 Cell:91-9415812329, E-Mail: rpanJn@yahoo.com EDITOR Anand Dubey. B£., MBA, SIS Centre, 4406 Forrest Road, Anchorage, AK 99517 E-Mail: anand.dubey@gmail.com EDITORIAL CONSULTANTS KristianAleman. Ph.D., Sweden Yogesh KArya. Ph.D., India K.R.Bane~ee . MRCP India Jayanti Basu, Ph.D. India Saugata Basu, Ph.D" India Suprakash Chaudhury. M.D., Ph.D. India Alfred Collins, Ph.D. USA Carina Coulacoglou, Ph.D" Greece Silvia Daini, M.D. Italy Manisha Dasgupta, Ph.D. India Padma Dwivedi, MA, USA Philip Greenway, Ph.D,Australia M. Jahan, Ph.D., lndia Anatoly B. Khromov, Ph.D., Russia H. Kumar, Ph.D., USA R. Kumar, Ph.D., India A. S. Kundu, Ph.D., lndia Ramjee Lal, Ph.D., India Lisa Milne, Ph.D.,Australia Nalini Mishra, Ph.D., India Ashok KumarNag, M.D., India Paola Nicolini, M.A., Italy Edward M. Petrosky. Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy Jai Prakash. Ph.D.lndia Stefano Reschini, M.A, ltaly BarryA. Ritzier. PhD" U.S.A. D. Saldanha, M. 0 " India Nilanjana Sanyal, Ph.D" India Radhe Shyam. PhD. India Archana Singh. Ph.D., India Umed Singh, Ph.D. India V. K. Sinha, M.D" India TrayambakTiwari, Ph.D., India AiloUhinki. Ps.D., Finland A. N. Verma, Ph.D., India Yasho V. Verma, Ph.D., India Robert B. Williams, Ph.D., Canada