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Journal of Projective Psychology and Mental Health: Volume 16, Number 1, Jan 2009 Editorial

1. Editorial: SIS Portraits of the Inner Mental World Painted by Blog Pooling of Interpretations, Wilfred A. Cassell, pages 1-2.

SIS projective technology harnesses the projective pulling power of hypnotically presented ambiguous visual color-form stimuli. The viewer is uninhibited by social acceptability restrictions of the test administrator’s presence. What is projected onto the SIS answer sheet flows from mental depths. The released responses represent recollections of the real outer world subjectively blended with hidden inner world imaginations, fantasies, dreams and psychophysiologic based body percepts.

The severely mentally disturbed may protectively reveal in direct or symbolic form residual pathological material from dissociated flashbacks, hallucinations, somatic delusions etc. In this group as well, clinicians may first detect otherwise unreported aggressive impulses projected symbolically in SIS scenes depicting weapons and/or acts of violence.

For those inkblots having minimal structure, the imagery that spontaneously emerges typically reflects the responder’s idiosyncratic mental symptoms and “Inner cry“. The pathological responses evoked by more structured SIS inkblots reflect an interaction between the optics and neurophysiology of visual perception with that of traumatic memory storage and projection imagination.A feature of this edition of our journal involves a revisiting of SIS content validity. Two of the studies dating back to 1978 and 1988 are primarily of historical interest. One of these outlines the original conceptual background for designing B19. The third is a recent study demonstrating the consistency of projective profiles between the Rorschach and the SIS.

Such validity work is essential for establishing a solid numerical foundation for future statistically based investigations. Yet they need replication with more rigorous methods of projective research design. Issues pertaining to SIS validity and reliability need further examination by behavioral scientists and clinical investigators independent from our society. These need to be planned in association with modern techniques for concurrently monitoring neurophysiologic correlates of projective awareness.

For many experienced SIS clinicians such additional body-mind research may seem unnecessary. Interpreting the projected symbolic material in psychotherapy may be quite straightforward. While interpretatively helpful tables of normative responses are being catalogued in a SIS data bank, classifying culturally colored symbolic responses sometimes introduces a degree of ambiguity. Such therapeutic interpretative ambiguities are analogous to those encountered in analyzing dreams.

With regard to inkblot analysis, Wayne Holtzman attempted to improve on the Rorschach by limiting “one” response to “one” inkblot. While this approach may make mathematical sense to ivory tower statisticians, the scoring system frequently breaks down in clinical practice. There are inherent difficulties in defining the limits of a series of word pictures evoked by any one particular blot.

For example, a Bipolar patient in a hypomanic phase may be capable of rapidly flooding multiple images onto any particular Holtzman card. In such an example, it often becomes unclear where the descriptive phrase describing the first response worthy of symbolic scoring ends. Like in dream sequences, the flow of inkblot projected imagery may be rapidly changing. Consequently, in clinical settings, the notion of quantifying “one” response for “one” Holtzman inkblot often proves numerically invalid.

With the SIS scoring system, the administrator has an theoretically important additional opportunity for assessing the validity of projected symbols. This is derived from the responder’s subjective affect rating of the 62 SIS stimuli on the “Three Most Liked” to “The Three Least Liked” scale. Beginning the detailed inquiry with the favorite ones can reduce the responder’s anxiety while concurrently providing informative data. This can set a therapeutic stage for processing highly relevant memories historically traceable to triggering stressful events related to the mental condition’s onset. If these events have led to recurrent stressful dreams, this provides an additional interview opportunity to review, cognitively correct and emotional reprocess pathological memories.

Some therapists may elect to employ an additional technique for identifying the SIS stimulus with the most therapeutic potential. This is done by having the subject view the electronic series just prior to bedtime. It capitalizes on the well known fact that affect laden day residual is ordinarily reprocessed in subsequent dreaming. When this additional therapeutic strategy is incorporated into a SIS guided treatment plan, in the instance of long forgotten severely stressful events, pathologic material may be released from long term memory. When this technique is used, it is essential for the therapist to have an after hours emergency call system as well as to schedule a therapy session for the following morning.

Another interpretative issue concerns the fundamental fact that the professional examiner is also a human being- albeit intelligent and professionally trained in projective principles. Yet most of us wear emotionally colored glasses which sometimes can impair symbol interpretation. Even a therapist efficient in dream interpretation needs another professional opinion in interpreting his/her own dreams. Self analysis of dream material is only effective up to the point of the professional’s own blocking defense mechanisms.

Just as a therapeutically operating group may often be better in analyzing any one member’s dreams, multiple independent SIS trained male and female reviewers are more likely to squeeze the least culturally biased meaning from word pictures on a SIS answer sheet. Hence the need to develop and refine a clarifying Blog-like interpretative approach in our internet connected SIS society.

My hope is to develop this Blog consistent with the philosophy espoused at this editorial’s beginning by the Canadian singer-songwriter Bruce Cockburn song “Gifts”. This song was inspired by the poet, philosopher, translator and scholar Lewis Hyde, in Hyde’s 1983 book entitled the same. Hyde’s original thinking subsequently served as a stimulus for the examination of issues related to ownership, copyrights, and intellectual properties in a market economy.

Wilfred A. Cassell, MD, FAPA, APC, Director, SIS Center, Anchorage, Alaska

2. Dependency, Narcissism and Rorschach: A Discussion Based on the Results of an Empirical Study, Rui C. Campos, pages 3-7.

The present exploratory study evaluates the presence of dependent characteristics of personality (a low value of the Egocentricity Index (Ego Index), a high value of the Sum of texture responses (Sum T), a number of passive movement responses higher than the number of active movement responses plus one (p>a+1), the presence of food content responses (Fd>0) and a high number of popular responses (P)), reflect the presence of the dependent personality style defined and studied by Sidney Blatt (1974, 1990, 2004; Blatt, DÁfflitti and Quinlan, 1976; Blatt & Zuroff, 1992) on a small non clinical sample as considered by Exner and Sendin (1998).. The Rorschach Test was administered to 20 participants, 10 with a dependent style and 10 without a dependent style, defined by the results on the Portuguese version (Campos, 2000a, 2000b) of Blatt et al, (1976, 1979) Depressive Experiences Questionnaire. The Rorschach was administered and coded according to Rorschach Comprehensive System guidelines (Exner, 2003). Only the Egocentricity Index correlated positively and significantly with the presence of dependent style, contrary to what would be expected following the reference of Exner that is, a low value of this index that is characteristic of the presence of dependent characteristics. On the basis of this result the author discusses the relationship between dependency and narcissism and also discusses the mental functioning of the dependent individual.

3. Rorschach Thought Disorders in Various Psychiatric Conditions, Deapti Mishra and Ranjeet Kumar, pages, 8-12.

Various Rorschach researchers have identified unusual ways of formulating responses that appear to be due to disordered thinking. Some of these such as Contamination, fabulized combination, and autistic logic are found to distinguish schizophrenic patients from non clinical individuals. From the literature it appears that study of special scores would be useful in aiding the diagnostic decision and will help us to differentiate various clinical conditions effectively. Keeping this in view, the present study investigated the presentation of Rorschach special scores in various clinical conditions by using Exner’s Comprehensive system. Patients aged 18-55 years, with the ICD-10 (World Health Organization, 1992) diagnosis of Bipolar Affective disorder, current episode mania with psychotic features (n- 30), Schizophrenia (n- 30), Schizoaffective disorder (n-30), Depression (n-30) and 30 normal subjects from the general population were included in the study. Results indicated that although thought disturbances are present in almost all psychotic conditions, they can be differentiated from each other on careful examination of special scores. Schizophrenia patients have the severest type of thought disorder followed by mania and schizoaffective disorders.

4. Depression among Adolescents: Role of Self Efficacy and Parenting Style, Hardeep Lal Joshi, Mandeep Sharma and Rajesh Kumar Mehra, pages, 13-17.

The present study was planned to find out the relationship between parenting style, self efficacy and depression among adolescents. The sample of the study involved 185 adolescents in the age range of 14 to 16 years along with their parents. The adolescents were assessed with Self Efficacy Questionnaire (Muris, 2000), Children Depression Inventory (Kovacs, 1981) whereas parents were administered with Parenting Authority Questionnaire-R (Ritman, 2002).The data were analyzed by using Pearson’s Product Moment method of correlation and stepwise regression analysis. The results showed that (i) all the measures of self efficacy have significant negative correlation with the measure of depression, (ii) Authoritarian Parenting Style has significant positive correlation with measure of depression, (iii) Authoritative Parents have significantly negative correlation with depression,(iv) The stepwise regression analysis found three pertinent predictors of depression i.e. Emotional self-efficacy, Permissive and Authoritarian parenting style among adolescents.

5. Psychological distress associated with Fractures of Upper and Lower Limbs, Suprakash Chaudhury, P.S. Murthy, Indrajeet Banerjee, Shantana Kumari, Sowmya. K. Sukumaran and Rohita Vikash, pages 18-23.

It is hypothesized that a substantial number of patients who sustain severe limb injury will report serious psychological distress. However, little is known about psychological distress and psychiatric morbidity associated with limb fractures. The aim of the present study was to evaluate psychological distress and psychiatric morbidity in patients with fractures of the upper and lower limb. The study included 100 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal control subjects. All the subjects were screened using General Health Questionnaire (GHQ), Michigan Alcoholism Screening Test (MAST), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Multidimensional Fatigue Inventory (MFI) and Perceived Stress Questionnaire (PSQ). Probable "psychiatric cases" identified by the questionnaires underwent diagnostic psychiatric evaluation. As compared to normal controls the limb fracture patients obtained significantly higher scores on the GHQ, MAST, CRSD, IES & MFI but not on the STAI & PSQ. Psychiatric evaluation revealed significantly higher prevalence of psychiatric disorders in lower limb fracture patients (n=37) as compared to upper limb fracture patients (n=20) and control subjects (n=7). Limb fracture patients had a high prevalence of alcohol dependence/abuse (18%) and adjustment disorders (12%). The results indicate that psychological intervention would greatly facilitate the management of these patients.

6. SIS Detection of Invisible Imagery in Bipolar Depression, Radhey Shyam, Wilfred A. Cassell and Bankey L.Dubey, pages 24-31.

Mental disorders are less tangible than medical conditions that ordinarily have more objective diagnostic determinants. For the former, objectivity in interviewing may be enhanced by the clinical application of the SIS projective technique. This semi structured series of semi structured "inkblots" provide a symbolic source of data which can enrich traditional diagnostic/treatment processes. The projected symbolism can tap into rich healing streams of natural spirituality not reachable by non-projective techniques. This approach’s clinical application will be illustrated in a twenty one year old female medical student suffering from Bipolar Depression (BD).

7. Comparison of Psychometric Characteristics of Rorschach and Cassell's Projective Techniques.Anatoly, B. Khromov, pages 32-36.

This article is devoted to the comparative study of the psychometric characteristics of three projective techniques of Rorschach, SIS-I and SIS-II correlated with 12 standard tests: MMPI, 5FPQ, MBTI, BDHI, Raven’s Matrices, , 16FP, POI, Leongard’s, Jenkins’s, Learie’s, Rotter’s, Thomas’s scales. The new original statistic method, based on the comparison of Pearson’s average coefficients of correlation is applied that permits the performance of comparative study of projective techniques. It was reduced, that degree of correlation, expressed through the average correlation coefficients gradually raises from Rorschach to SIS-I and from SIS-I to SIS-II, that indicates the increment of stimulus structure from Rorschach tests to Cassell’s tests, where SIS-II reveals the highest psychometric characteristics , as it has been expected.

8. Rorschach Profile of Schizophrenia and Depression. Richa Priyamvada, Sapna Kumari, R. Ranjan, Jai Prakash, Amool R. Singh, S. Chaudhury, pages 37-40.

Projective techniques have been used in clinical populations for the assessment of perception and psychopathology. The Rorschach test is one of the earliest personality tests and has been in vogue for the last many decades especially for psychodiagnostic purposes. It has been used with varied populations such as epilepsy, mental retardation, children and adolescents and different mental disorders. The present study has been carried out with the aim to compare the profiles of schizophrenia and depression on the Rorschach test. The study sample comprised of 30 schizophrenic and 30 depressive patients, in age range of 20-55 year of either sex. The tools Brief Psychiatric Rating scale, Beck Depression Inventory and Rorschach test were used. Findings of the study reveal that both the groups (schizophrenia and depression) differ significantly on reaction time, major details, minor details, poor form level, movement response, shading response, vista response, human response, and popular response.

9. Emotional Intelligence and Personality Pathology of Adolescents affected with Internalizing Symptoms. Anupama Shrivastava and Anjana Mukhopadhyay, pages 41-45.

Present study aims to explore the in-depth defenses of adolescents behind the internalizing symptoms with the help of SIS-I projective technique and also assessed the level of emotional intelligence of adolescents with internalizing symptoms. The Multidimensional Assessment of Personality (form-t) test was used as a screening tool in the first phase. Total 510 adolescents in the age group of 14-18 years studying in various schools of Varanasi were studied to assess the level of their internalizing symptoms. Those who scored above the cut-off point were identified as the affected group (N=15) and the sample without internalizing symptoms was identified as the normal group (N=10). Somatic Inkblot Series-I and Mangal Emotional Intelligence Inventory were then administered on both samples for final study. The results revealed that the affected group is significantly lower in emotional intelligence than their normal counterparts. Qualitative components of normative responses like human response and typical response were reported to be significantly low in affected groups. Animal response and atypical responses have reported significantly high scores in the affected group. Quantitative pathological contents reported significantly higher HAS factor among the adolescents with internalizing symptoms.

10. Adoption of Cognitive Behavior Therapy in probing of Unconscious Dynamics: A case report. Moon Moon Dutta and Nilanjana Sanyal, pages 46-50.

Psychotherapy is a road to increase individual sense of well-being and to reduce subjective discomfort. Although there are a number of psychotherapeutic approaches available now we are in the era of integrative psychotherapy. In this case report an attempt has been made to understand the client's depth psychology using psychodynamic orientation and then replacing dysfunctional cognitions with adaptive one using cognitive-behavior stratagems.

11. SIS- II Profile of Mentally Retarded Children. Sarika Alreja, Deepak K. Mishra, Mittu M.Varghese, K. S. Sengar and A. R. Singh. Pages 51-54.

Projective techniques particularly inkblot tests are especially helpful in evaluating patients with limited language and verbal skills such as children, foreign born or new immigrants, native people, the learning disabled and mentally subnormal. The Somatic Inkblot Series (SIS) has become an effective projective tool for the assessment of patients suffering from various mental health problems. Mental Retardation is one of the major problems which have drawn the attention of society and mental health professionals all over the world. The present study aims to assess the profile of mentally retarded children using SIS-II. Thirty (30) mentally retarded children attending OPD of Ranchi Institute of Neuropsychiatry and Allied Science (RINPAS), Ranchi, India, were administered the Somatic Inkblot Series Booklet Version (SIS-II) and compared with 30 normal controls. The results reveal significant differences in total number of responses, human, animal, anatomical, movement, most typical, typical, atypical, rejection of images, depression, and pathological anatomy.

12. Correlation between Rorschach and SIS-I Indices in a Normal Group. D. Kumar and R. Kumar, pages 55-57.

Both Rorschach and SIS-I are based on the principles of projection and use inkblots to interpret the responses given by an individual. This interpretation of inkblots is further used to map personality and psychodynamics. Proponents of SIS-I repeatedly affirm that the Somatic Inkblot Series are not incompatible with the Rorschach. In fact they contend that it is a continuation of the Rorschach concept. If it is truly so then common indices across tests should be correlated significantly. To empirically examine this hypothesis, we administered Rorschach and SIS-I on a group of 50 normal subjects drawn from the general population after screening the PGI Health Questionnaire. The scores on common indices were converted into percent scores taking the total number of responses as denominator and product moment correlations were computed on these transformed scores. Of eight analyzed common indices, the correlation coefficients were significant on all indices except for anatomical responses. The detailed results are presented.

13. Content Validity of SIS-I and SIS-II Booklet Version, Wilfred A. Cassell and Bankey L. Dubey, pages 58-59.

This report presents two previously unpublished early statistical studies on SIS content validity. The first was completed in 1978 with the SIS-I. It used a content analysis scoring system to quantify projective responses in a group of 13 women suffering from Premenstrual Dysphoric Syndrome (PMDD). As compared to a control group of 37 women these subjects projected significantly more responses depicting reproductive and sexual symbols. Based upon chi squared analysis, statistically significant differences were found for such sexual-related anatomical responses, but not for unrelated body parts such as heart and lungs. The second study was completed in 1988 with the SIS-II Booklet Version. The data were analyzed for 37 of the 62 SIS stimuli. In the comparison 28 pregnant women were compared with 27 non-pregnant controls. A Chi squared analysis revealed that pregnant women projected more responses related to reproduction and/or pregnancy.

14. Living Images and Psychotherapy: A Case Study. Wilfred A. Cassell, Padma Dwivedi and B.L. Dubey, pages 60-61.

Living Images is a structured video and/or computer monitor projective technique. It incorporates many of the self administration and the mesmerizing oral imagery concepts of the SIS-II system. All of the specifically structured visual stimuli were created by female artists. It is a powerful video/computer electronic procedure for releasing unique stressful memories in females. It has five series of ambiguous human/anatomical stimuli separated by calming representations of beautiful flowers. Once a formal initial examination is completed to establish a working diagnosis, this projective procedure can facilitate psychotherapeutic treatment planning. A previous report in this journal illustrated its application in a case of sexual assault (Cassell,M.et al 1999).

15. Quality of Life in Schizophrenia and its Relationship with Age of onset and Duration of illness. Arif Ali, N.Kujur, Masroor Jahan, A. N. Verma and Amool R. Singh, pages 62-65.

The study aimed at assessing quality of life in schizophrenic patients and to see the relationship between quality of life, duration of illness and age of onset. The sample included 60 schizophrenic patients from Ranchi Institute of Neuron-Psychiatry and Allied Sciences, Ranchi (India). The World Health Organization Quality of life Scale (WHOQOL –BREF) was administered to find out the Quality of life. Results show that the majority of the patients were neither satisfied nor dissatisfied in all domains of quality of life. The findings further reveal that the age of onset has a negative correlation with the environment domain (WHOQOL –BREF) and duration of illness has a negative correlation with the psychological domain (WHOQOL –BREF).

16. SIS Portraits for Interpretative Blog Input. Wilfred A. Cassell, pages 66-67.

Welcome to this new consulting educational exercise. You are invited to review the brief outline of the outlined case history and the SIS-II Video answer Booklet. Please email to me before March 31, 2009 (siscassell2@yahoo.com) all the projective information that you have obtained. In case you do not have a SIS-II booklet to see the images, please write to Dr. Bankey L. Dubey (bldubey@gmail.com). Imagine that you are preparing a formal consultation report for the hospital treatment team.

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