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Journal of Projective Psychology and Mental Health: Volume 25, Number 2, July 2018 Editorial

1. Editorial: Marital & Family Therapy: Which Are the Prominent Assessment Instruments in Research Studies in the Field? Chris Piotrowski (Email: cpiotrowski@uwf.edu), pages 102-104.

Over the past 30 years, there has been increasing clinical interest regarding the issue of assessment and use of specific mental health measures in the field of marital and family therapy (MFT) (Carlson et al., 2013; Fredman & Sherman, 1987; Nurse 1999). Yet, diagnostic testing in the MFT field has been critiqued as a “neglected competency” among practitioners (Bagarozzi, 1989). In fact, in a survey of MFT therapists in Israel, Lavee and Avisar (2006) reported that only 28% of their sample used ‘standardized’ instruments for assessment in couple therapy, and even the most popular measures were used rather sparsely, i.e., ENRICH, 14%; MMPI-2, 9%; Marital Satisfaction Inventory, 9%; Family Adaptability and Cohesion Evaluation Scale (FACES), 7%; Dyadic Adjustment Scale, 7%. These findings were similar to an earlier survey study on assessment practices of MFT practitioners (Boughner et al., 1994). Due to the complexity in elucidating the underlying dynamics of marital and family processes, many professionals are rather skeptical that comprehensive evaluation via assessment instruments can significantly contribute to therapeutic outcome. One major reason for such pessimistic views toward mental health testing is that graduate training in assessment methods has been largely disparaged and neglected in MFT programs (Bray, 1995), and, in recent years, in the majority of clinical/professional training programs in the United States (Piotrowski, 2015; Stedman et al., 2018).

Despite this rather gloomy portrayal of assessment practice, mental health clinicians frequently encounter the necessity to conduct a formal assessment to address salient issues within a couple, marital, or family framework. Hence, most practitioners will probably need to consult the research literature to identify the most prominent assessment measures and tests that target dysfunctions that are prevalent in MFT. Some 20 years ago, Piotrowski (1999), via a keyword search of the database PsycINFO, identified the most researched MFT-related instruments in the literature from 1974-1997; (in rank order), the Family Environment Scale, the Dyadic Adjustment Scale, FACES, FIRO-B, Conflict Tactics Scales, McMaster Family Assessment Device, Marital Adjustment Test, Marital Satisfaction Scale, and the Marital Satisfaction Inventory.

In a more recent systematic analysis, where the focus was on psychometric credibility and clinical utility, Hamilton and Carr (2016) touted high marks for the McMaster Family Assessment Device, FACES, Beavers Systems Model Self-Report Family Inventory, the Family Assessment Measure III, and the Systemic Clinical Outcome Routine Evaluation (SCORE); and failing grades for the Family Environment Scale and the Family Relations Scale. Due to the lack of consensus regarding assessment approaches in the MFT field, I thought it would be informative to examine the mental health literature to determine which MFT-related tests/measures have received the most research coverage and attention in scholarly journals during the time frame 2000-2018. In effect, this exercise is a partial replication of my earlier 1974-1997 bibliometric analysis (Piotrowski, 1999).

2. Inaugural Address: Future Direction of Somatic Inkblot Test as a Projective Psychotherapeutic Technique, delivered by Bankey L. Dubey, President Somatic Inkblot Society, at 8th International Conference of SIS, Panjab University, Chandigarh (India) on April 27-29, 2018, pages 105-107.

Respected Chief Guest, dignitaries on the dais, distinguished delegates, friends, students, ladies and gentlemen!

On behalf of the members of the Somatic Inkblot Society, and on my own behalf, I express deep sense of gratitude to the organizing team of this Conference. It is customary that the President of the Association delivers an address on such an occasion. Accordingly, I have the privilege of addressing this august body. The theme of the conference is Personality Assessment and Psychotherapeutic Intervention through Projective Inkblots Procedure in Clinical and Organizational settings.

This conference is indeed a special occasion as it is being held at the completion of 25 productive and engaging years of the Somatic Inkblots Society and its flagship Journal “ SIS Journal of Projective Psychology & Mental Health”. The SIS Society and the SIS Journal had their seminal beginnings at the University Business School, of this university in 1993, and the Silver Jubilee Conference is also celebrated here.

The concept of projection, as used in the administration of projective tests in contemporary settings, is generally credited to Freud who had referred to this clinical term as early as 1896 (Freud, 1950). He defined ‘projection’ as a defensive process in which impulses, wishes, and ideas of an aggressive and sexual nature are internalized since their conscious recognition would be too painful to acknowledge to the ego. The subject matter used in this procedure serves as a lens of projection, and the recorded material of elicited behavior is the screen with the picture projected on it (Rapaport, Gill, & Schafer, 1968).

I sincerely hope that the beneficial effects of SIS would be available to the patients residing anywhere on the planet earth. A therapist while sitting in his clinic in another part of the world can still provide therapeutic aid to clients through the venue of modern technology. The ultimate vision is to provide competent mental health care through the creative use and ease-of-availability of the Somatic imagery procedure.

3 Anatomical Rorschach Responses and Death Symbolism, Wilfred A. Cassell and B. L. Dubey, pages 108-118.

Three case histories involving individuals suffering from existential death anxiety were administered the Rorschach Inkblot Test to illustrate the responses indicating symbolic death content and death anxiety. The over emphasis on somatic content (many ‘Anatomical’ responses) on Inkblot tests, might reflected the presence of unconscious anxiety and anticipated decay of one’s physical body, may be the plausible symbolic interpretation and indicator of death anxiety. This is not possible if the responses are interpreted using quantitative analysis. In addition, the somatic content demonstrates the healing power of spiritual symbols. The paper will motivate young clinicians and clinical psychologists to use content interpretation to understand the power of projection and take advantage of spiritual symbolism during therapy.

4. Assessment Measures in Research on Eating Disorders: Most Prominent Evaluation Methods Spanning the Scholarly Literature, Chris Piotrowski, pages 119-126.

Eating Disorders (ED) have attracted extensive clinical and research attention, manifested by the exponential growth of articles and book chapters on ED conditions indexed in the scholarly literature. Yet most mental health practitioners only occasionally treat ED patients and tend to be less informed about specific tests and measures used in the assessment process involving this unique clinical group. Thus, the aim of the current article is to provide a referral guide for the general practitioner on the most relied upon measures, scales, inventories, and tests in the study of ED populations. To that end, a triangulated, bibliometric procedure compiled a listing of more than 100 instruments reported in ED research. Based on this pool of measures, a keyword search (All Fields) on each instrument was conducted in the database PsycINFO to determine the number of ‘Hits’ generated by the online search. Since primary research studies were of interest, only the search results for journal articles were tabulated. This first analysis produced a ranking of the most frequently used assessment instruments (n=84) in ED-related research. As this search option depicts comprehensive (overly inclusive) parameters for test inclusion, it was decided to subject the pool of 84 instruments to an online search in the database ProQuest, with the restriction to ‘Abstract only’ inclusion. Based on both analyses, the most prominent and visible measures specific to ED, evident in the research literature were: the Eating Disorder Inventory, Eating Attitudes Test, Three-Factor Eating Questionnaire, Eating Disorder Examination (EDE-Q), Body Shape Questionnaire, Multidimensional Body-Self Relations Questionnaire, Binge Eating Scale, and the Restraint Scale. Several measures of general health status or mental health (e.g., Beck Depression Inventory, SF-36, General Health Questionnaire, Hospital Anxiety & Depression Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, MMPI) were also frequently included in research studies of ED populations. This listing provides a handy referral guide to the major assessment instruments encountered in ED research. On a cautionary note, these findings illustrate that while there are copious evaluation tools available when treating ED patients, research findings in the field are subject to a lack cohesion and generalizability due to the vast breadth of assessment instruments that serve as the basis for data collection and analysis in ED studies.

5. Psychological Identification with Parents: Implications for Late Adolescent Psychological Adjustment, Phebe Cramer, pages 127-136.

Late adolescence is a time during which change often occurs in the relationship between adolescent and parent. In particular, the identification of the adolescent with the parent – the taking on of values, opinions, and mores of the parents -- may change, and these modifications may have important consequences for psychological development. To study this, the parent identification of 160 late adolescents (age 17-20 years) was determined by comparing the adolescents’ description of their parent’s characteristics with those that described their own ideal self. Similarity in these two descriptions was taken as a measure of parental identification. For males, only strong identification with father was found to be related to more potent use of the defense mechanism of identification and lesser degrees of anxiety. In addition, for both males and females, weak identification with the opposite-sex parent was related to stronger anxiety.

6. Comparison of Male and Female Psychopaths on Select CS Rorschach Variables, Jason M. Smith, Carl B. Gacono and Ted B. Cunliffe, pages 137-154.

Psychopathy is considered an essential construct in forensic work (Gacono, 2016). Most methodologically sound studies have involved males rather than females (Smith et al., 2014). Gender differences have been found to be and continue to be considered important in the assessment and management of forensic populations (Cunliffe et al., 2016). Male psychopaths present as pathologically narcissistic whereas female psychopaths manifest a malignant form of hysteria. Both are pathologically self-focused; however, the grandiosity in males is contrasted by women’s negative self-view. In the current study, male and female psychopaths (males = N = 44; PCL-R M = 33.13; females = N = 46; PCL-R M = 32.93) were compared using select Comprehensive System Rorschach variables. Female psychopaths produced more painful rumination (SumV), helplessness (SumY), and poor self-regard (EGOI ≥ .44 & Fr + rF = 0) than the males. Males were more detached (SumT) than females. Implications for future research, recommendations for these populations, and suggestions for using the PCL-R to assess female offenders are discussed.

7. Risk Assessment in the Forensic Evaluation of Child Sexual Offenders: A Diagnostic Framework based on 5 Case Reports, John E. Bingham and Chris Piotrowski, pages 155-164.

In professional mental health, requests from the legal community for determination of ‘risk assessment’ in the adjudication of child sexual offenders are a popular and cardinal feature in forensic practice. In the contemporary milieu, a central concentration of both clinical and research interest is the efficacy and validity of expert predictions of recidivism based on data from specific risk assessment instruments, within the purview of the overall mental health evaluation. With the advent of the Internet and availability of modern communication technology, legal cases involving child pornography, sexting, pedophilia, child-contact offenses, and ‘sex stings’ are escalating at an unprecedented rate. This paper reflects the forensic work of 2 forensic professionals with copious experience in the research and evaluation of child sexual offenders. To illustrate the nature and process of conducting legal requests for determination of recidivism/re-offense potential in child sexual offender cases, the authors elucidate the overall evaluation process and outcome by presenting 5 recent cases where the focus was on risk assessment. In addition, the authors caution that while expert evaluations can contribute to accurate predictions of sexual dangerousness, findings from research investigations have not yet confirmed the efficacy of risk assessment instruments in determining when child sex offenders are no longer a public threat following incarceration and/or treatment. Undoubtedly, the contemporary forensic examiner needs to be cognizant of these limitations and strive to be strictly objective, candid, and mindful of current research findings when expert testimony is at issue.

8. Psychological Testing and Psychoanalysis: Fixable Gap or Great Divide? 8. Anthony D. Bram, Jed Yalof and Kiley A. Gottschalk, pages 165-171.

Although personality assessment has its roots in psychoanalytic psychology, its relationship to psychoanalysis in contemporary practice remains vague. Yet, an assessment that utilizes performance-based measures that provide an analog of sorts to the psychoanalytic situation can support treatment planning, including decisions about whether to convert a psychotherapy patient to psychoanalysis and the training of psychoanalytic candidates. Two possible resistances that might work against the integration of psychoanalytic assessment with psychoanalysis are: (1) the strongly held views that psychoanalytically informed assessment may have little to offer the experienced analyst, and (2) the notion that assessment is a perceived intrusion in the analytic process. The current paper discusses these salient clinical issues. Alternative perspectives are discussed to counter potential resistances to psychoanalytically based assessment. In addition, suggestions for increasing awareness of these issues within the analytic community are noted. Finally, a model for formally studying what psychoanalysts know and how they utilize assessment is suggested.

9. Impact of Childhood Sexual Abuse on Female Sexuality, Shweta Sharma, pages 172-176.

Victims of childhood sexual abuse often have associations, flashbacks, and memories related to the specific aspects of the sexual abuse. This can be reflected in both psychological and physiological responses. Difficulties can range from psychological abhorrence or fear of any intimacy associated with the sexual activity to physiological symptomatology such as veganism and orgasmic disorders. These sexual difficulties can have a severe impact on the woman’s ability to sustain long-term or interpersonal relationships. There is some evidence for greater difficulties in interpersonal and particularly intimate relationships among female adults who were sexually abused in childhood. There will be four different psychological case studies reviewed to analyze long-term impact of childhood sexual abuse, which is different in terms of age, educational and social-economic background.

10. Intervention through Somatic Inkblot Series and CBT in a case of Gender Identity Disorder, Satyadhar Dwivedi and Richa Verma, pages 177-180.

This case demonstrates the use of cognitive behavioral therapy in the treatment of gender identity disorder. An 18-year-old male presented with complaint of feeling of discomfort with his sex organ for several years. He had taken treatment for it with no relief. The Somatic Inkblot Series was administered to understand the underlying psychopathology and conflict of his gender dystopia. The Cognitive Behaviour Therapy was administered in 12 sessions along with pharmacological treatment. The periodic assessments including follow ups indicated substantial change and improvement in his condition which is being maintained even after six months of follow up. The case is presented to highlight the effectiveness of CBT.

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