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Journal of Projective Psychology and Mental Health: Volume 29, Number 2, July 2022

1. Editorial: Further Evidence that Projective Techniques Continue as Popular Clinical Assessment Tools in Practice Settings: Chris Piotrowski (Senior Editor, University of West Florida, pages 61-63.

Despite continuing criticism regarding the psychometric credibility of projective techniques, evident in the scholarly literature (e.g., Imuta et al., 2013; Lawrence et al., 2021; Ryan et al., 2019), mounting recent evidence indicates that projective tests are considered an integral part of acceptable methods used or applied in research studies (Eby, 2020; Piotrowski, 2022). In fact, a quick perusal of the recent literature shows the presence of projective measures are relied upon and embedded in research studies (e.g., Aoki & Kogayu, 2021; Bram et al. 2018; McGlone & Viglione, 2020; Schapers et al., 2021; Tafti et al., 2021; Toeplitz, 2013; Yuan et al., 2021). Moreover, I note several novel adaptations to drawing tests, which continue to attract research attention over the past decade: ‘Draw-a-Person-in-the- Rain’ test (Willis et al., 2010), ‘Person Picking an Apple from a Tree’ technique (Potchebutzky et al., 2020), and the newly developed ‘House Imagery Test’ (Yuan et al., 2021). Perhaps reflecting the acceptability and relevance of projective assessment, chapter coverage in recent texts on psychological assessment clearly depicts the importance of projective techniques in clinical and child psychology applied to the mental health evaluation process (Saklofske et al., 2013; Sellbom & Suhr, 2020; Verdon & Azoulay, 2020; Weiner & Kleiger, 2021; Wright, 2020; Yalof & Bram, 2021).

All this bodes-well for research, but what about the status of projective testing in practice/applied settings, particularly as a foundation for forming a conceptual therapeutic framework in mental health treatment? Hence, the purpose of this commentary is to address this specific issue by examining recent test usage findings, based on empirical data, as reported by practitioners.

Of particular interest are the findings of 2 recent dissertations regarding the use of projective tests by practicing psychologists. The first study surveyed a sample of 510 members of APA Division 12 (both clinical child and pediatric psychologists) on the use of drawings (H-T-P, DAP, KFDs) in assessment (Longest, 2006). The most interesting observation is that 25% of the practitioners responded to the survey. Such attention to drawings in clinical practice shows a continued professional interest in projective assessment (see Piotrowski, 2016). More recent data on the use of a variety of projective techniques by psychologists were reported in a dissertation on current assessment practices in the context as an aid in therapy (Hanigan, 2021). This study surveyed licensed psychologists in practice across a myriad of applied settings in the USA. Of the 293 respondents, 29% were engaged in assessment for 20+ hours/per week (this is a slight increase from survey data reported over the past 2 decades). In addition, 55% of these practitioners use at least one projective technique (45% don’t use any projective measures). Frequency of projective test usage is of particular interest, and I outline the findings below (% of respondents):

What is particularly noteworthy regarding the findings reported in the Hanigan (2021) study is that use of projective measures was compatible to the extent of reliance on objective tests (e.g., the Millon Inventories, the NEO, and the 16PF) by this national sample of psychologists. Furthermore, this study found nearly equal usage of the Rorschach-Performance Assessment System versus Exner’s Comprehensive System. This latter finding reflects the perennial scholarly debate regarding the relative status of these 2 Rorschach approaches in contemporary personality assessment (see Gacono & Smith, 2022 for a discussion).

Overall, the continued presence of projective measures in the research literature, the introduction of a host of novel projective techniques in recent years, and contemporary survey data on test usage clearly confirm the fact that projective techniques remain a significant part of the assessment armamentarium of mental health professionals. Indeed, this corroborates the conclusions of earlier reviews on psychological testing practices (see Frauenhoffer et al., 1998; Hughes et al., 2007; Piotrowski, 2015). I note one caveat to these general conclusions: The current pandemic has had a very detrimental impact on the assessment enterprise (Gicas et al., 2021; Krach et al., 2020), particularly with regard to the use of the Rorschach. In fact, a recent survey of members of the Society for Personality Assessment (noted in Ales et al., 2022) found that 52% of SPA practitioners have ceased conducting clinical assessment due to the challenges of test administration via tele-health mediums in the context of COVID-19. This disengagement of personality assessment practice has been corroborated in an analysis of the recent mental health literature related to COVID-19 (Piotrowski & Watt, 2021). Hence, we must await the findings of future studies (post-COVID) before an accurate appraisal on the nature and extent of psychological testing (particularly projective techniques) can be determined (Krishnamurthy et al., 2022). But, for now, projective assessment appears alive and (somewhat well) in the field of mental health evaluation.

2. Suicide Risk among Habitual Non-Suicidal Self-Injury Individuals on the Rorschach, Sanae Aoki, Nobuo Kogayu & Satoshi Ono, pages 64-74.

This study examined the characteristics of habitual self-injurers who are at higher risk for suicide by comparing Non-suicidal Self-injury (NSSI) behaviors, clinical history, and psychological characteristics on Rorschach between habitual NSSI individuals who had attempted lethal suicide and those who had not. Individuals (n=45) who attempted suicide used multiple methods of self-injury, and their injuries were more severe. They also had no memory of the self-injurious behavior. On the Rorschach, S-CON≧7 was also more common in those with a history of suicide attempts. Negatively biased cognition (MOR>3) and limited ability to provide ideas and solutions to life problems (P<17) were more common features in habitual NSSI individuals with a history of suicide attempts. Furthermore, more than half of those who experienced suicidal behavior had a history of school absences. Among the habitual NSSI individuals, the high suicide risk group who had attempted suicide showed many behavioral characteristics such as variety and severity of self-injurious behaviors. On the other hand, based on the Rorschach results, psychological characteristics such as negative cognition and inflexibility of thinking were also more common in the high suicide risk group, which may be an important diagnostic marker in the assessment of suicide risk and subsequent treatment.

3. Use of Projective Techniques with the Elderly: An Historical Analysis of Key Research Studies, Chris Piotrowski, pages 75-79.

A review of the mental health literature clearly indicates that both clinicians and researchers have considered various projective measures as suitable and pragmatic assessment instruments in the mental health evaluation of the elderly. The aim of the current study is to present a brief overview of this body of scholarship, based on a bibliographic analysis. To that end, a comprehensive search of the database PsycINFO identified 35 peer-reviewed articles with a focus on projective tests and aged populations. Of these, the author determined that 23 references were either select reviews or empirical studies. Based on an aggregated analysis of this dataset (1954-2016), the author contends that projective techniques have the ability to reveal latent psychodynamics, identify cognitive deficits, and differentiate select diagnostic groups. These attributes of projective measures are a key feature in the assessment of the elderly, where issues such as depression, declining health, and deficits in verbal expression are critical clinical challenges. A select bibliography of key studies is provided.

4. The Use of Virtual Reality in Psychological Research and Therapy: Attributes and imitations, Steven J. Kass, pages 80-86.

Virtual reality (VR) allows users to experience highly immersive, simulated events that would otherwise be too dangerous, expensive, or just impossible to achieve in a real environment. While VR was once only available to a handful of researchers, commercialization and decreased costs have greatly increased its accessibility to all. Because it provides the capability to precisely control the virtual world, VR has become an increasingly popular tool for use by psychological researchers and therapists, alike. The vast growing literature on VR documents how it has been used for such purposes as gaming and entertainment, knowledge elicitation, training and education, exposure therapy, and physical rehabilitation. However, though the use of VR holds great potential, it may not be suitable for everyone. Many factors must be considered before adopting this technology. This article reviews some of the many uses for VR, as well as its strengths and limitations when used for research and therapy.

5. Development and Initial Examination of a Measure of Emotion Regulation Knowledge, Adam P. Natoli & Julie F. Brown, pages 87-96.

Many effective therapies targeting emotion dysregulation employ psychoeducation and skills training interventions, both of which presumably increase a person’s accessible knowledge of processes that potentially facilitate or hinder emotion regulation processes, how different skills can help regulate emotional experiences, at what point emotion regulation strategies should be used, and which emotion regulation strategy would be ideal given the context (i.e., emotion regulation knowledge). Thus, emotion regulation knowledge may play an important role in emotion regulation functioning. Based on a review of the literature, no currently available measure directly assesses emotion regulation knowledge. The aim of the current study was to develop such an instrument. Development and initial validation of the Emotion Regulation Knowledge Scales (ERKS) occurred over two measurement development phases and a subsequent validation phase using two diverse samples. A pool of 77 items was developed and then reduced based on expert appraisals of each item. Exploratory structural equation modeling was used to identify an optimal factor structure of the ERKS and then, using a second sample, confirmatory factor analysis was applied to test whether the identified model would be confirmed. Initial construct validity of the ERKS was then assessed using a latent variables approach. Exploratory structural equation modeling supported a two-factor solution of the ERKS, which was confirmed in a second, independent sample. The two ERKS scales possessed good internal consistency and produced theoretically consistent correlations with measures of psychological distress and emotion dysregulation. The presented findings, combined with the potential utility of the ERKS in research and clinical settings, support early confidence that the ERKS is an internally reliable and valid measure of emotion regulation knowledge. However, future confirmatory research is necessary to support this claim.

6. Application of Somatic Inkblot Test in Personality Assessment, Screening and Therapeutic Intervention, Bankey L. Dubey & Anand Dubey, pages 97-103.

The Somatic Inkblot test (SIT) is highly innovative and, in a sense, a "time machine." The SIT automates the entire “life-cycle of the psychological test” including administration, scoring, interpretation, reporting and diagnostic collaboration. In addition to quantitative analysis, the SIT facilitates and emphasizes content analysis, psychoanalytic interpretation, and symbolic interpretation via a database of research and case studies made available as “hints”. “Facts” and “Artificial Intelligence”. It takes about 30 minutes to complete the test. The SIT was taken by a 40-year female, married, having symptoms of depression, loneliness, and suicidal thoughts for the last 5 years. She was diagnosed as a case of reactive Depression. The SIS responses projected her disturbed erotic relationship, deprivation of affection during childhood from her mother, and nonsupport from her in-laws. The SIT imagery was used as a tool for therapeutic intervention resulting in a positive outcome.

7. Gender Differences in Depression, Anxiety, Stress and Sleep Disturbances among Doctors Combating Covid-19, Shravani Javadekar, Archana Javadekar, Suprakash Chaudhury, Bhushan Chaudhari & Daniel Saldanha, pages 104-110.

COVID-19 has caused havoc in the lives of doctors. The doctors were faced with the Herculean task of managing a variety of patients, dealing with the queries of their loved ones, keeping up with the ever-changing guidelines, while balancing the worries of their own families, and facing the risk of contracting the infection themselves or transmitting it to their loved ones. Bearing this in mind, the present study was undertaken to assess the impact of gender in causing depression, anxiety, stress, and sleep disturbances between male and female doctors during COVID-19 pandemic. This cross-sectional, analytical, web-based study was conducted during September 2020, after obtaining approval of Institutional Ethics Committee. All participants gave informed consent. The participants completed basic socio demographic questionnaire, and two standardized questionnaires- Depression Anxiety Stress Scale 21 (DASS21) and Athens Insomnia Scale. Out of 143 doctors included in the study, 83 were females (58.04%), while 60 were males (41.96%). On DASS-21, depression and stress was significantly higher in female doctors as compared to male doctors. On the Athens Insomnia Scale, more female doctors suffered from insomnia as compared to male doctors, but the difference was not statistically significant. Female doctors have significantly higher depression and stress while dealing with COVID-19 compared to male doctors.

8. Relationship Conflict - A Case study with the help of Somatic Inkblot Test, Nipun Ranga, Sakshi Bhagta & Anand Dubey, pages 111-115,

The Somatic Inkblot Test (Booklet version) was administered to a couple, who were in a relationship for 5 years. Both are employed and financially stable. They are having relationship issues, and the male partner wants to walk out from this relationship. He feels he cannot adjust anymore. The responses given by them on the test indicated intimacy, erotic conflict, and personality issues. The responses were analyzed using psychoanalytical interpretation and content analysis and discussed in the case study.

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