Case 1. Somatic Imagery Test (SIT) as a Measure of Trauma Resolution in a Case of Abortion

Nicole Compagnoni & Bankey L. Dubey

(SIS Journal of Projective Psychology & Mental Health, (2020):27:2, 107-111).

The case:

Ms. X is a 27-year-old female, working as an attorney in Italy. She is currently living with her boyfriend in a comfortable apartment. She never had any problems during childhood and grew up in a healthy family atmosphere. As she described, she had a bad period in her life during late adolescence, in which the bond with her mother deteriorated, due to continuous misunderstandings. During this period, she chose to contact a psychotherapist to resolve the problems. After advice, she noticed improvement in her relationship with her mother. 

Recently, she had to face another problem related to motherhood. She suffered an abortion. The abortion was consciously chosen by her and her partner, who scrupulously evaluated all the alternatives; however, for her, this was a very difficult choice to overcome. A few months later, she was administered Somatic Imagery Test (SIT), in which she projected disturbed physical and psychological discomfort. Overall, she managed to live a happy life.

After a year, I decided to administer the Somatic Imagery test to understand the changes and personal growth that the client had claimed during her journey to overcome the abortion trauma and to monitor the progress of psychotherapy. In the second administration, the patient had overcome most of the difficulties and showed improvement in her relationship with her mother, though the pain of the trauma which she had undergone after abortion was yet to be resolved.

The clinically significant SIT responses on pre and post administration are shown in Table 1 and interpreted using content analysis and psychoanalytic interpretation.

Table 1 shows clinically significant responses on Pre and Post administration

SIT Images	Pre-therapy Responses SIT Administered on May 4, 2018	Post-Therapy Responses SIT Re-administered on May 16, 2019
4	Happy child, clown, atomic bomb.	Happy person, teddy bear, ball, clown.
5	Woman, (bandaged face, dancing) and apple.	Smiling woman (black hair, shapely woman, dancing, sincerity) and Apple.
6	Two dancers	Two people are dancing together, tow hearts, two kisses, holding hands, happiness, moving coordinated
7	A fetus, a pregnant woman’s belly	Ear
8	One hand in bush	Many hands, asking for help, suffering, flames, a big hand at the center, burn.
9	Pods, rain, small plant that sprouts	Two pigeons kissing, a heart, two tongues, love, the fruit hanging from above on a branch- an apple.
12	Lungs	internal organs- lungs
13	Turtle, two children, a bird seen from above	Turtle, two children, a bird seen flying from below.
14	Fish bone, spiral, spine	Spine, straight, erect, stable, support, totem, mask, eyes.
15	Cell, vagina, mollusk	Vagina, depth, cross, concentric, mussel, pendant, jewel
16	A face, hourglass, an alien	Fetus, curled up, wadding, ultrasound
17	Animal lying with horns (suffering)	Breast, fingers, torn dress, naked
18	A sad man and a sad woman.	Two faces, two brains, a sad and worried face or rather angry, whisper, reassure.
19	A woman and a child (she is in the picture and the child with head only)	Two people, two faces, one mask, remove the mask, eyes, black, heads
20	Two seated people looking at each other and playing	Dialogue, two people chatting, confrontation, elderly people sitting
21	Paper planes, scribbles, triangles, geometric drawings.	Knives, point blades, scribbles, grater, erasures, throwing.
22	A heart, halo, an apple, a sun in the background.	Heart inside a heart with round background, crystal, spotted heart.
23	A fish, a jellyfish between two rocky walls	Penis, fish, nemo and dori reef, stings upwards"
24	A sun, two hearts, a broken ball with cracks.	Heart cracked, tentacles, card of hearts behind, sun, rays, heart at the center, world shattered, brightness, luminosity
25	A battle, an explosion, a clipping	Bottle of sparkling wine bang, New Year’s Eve, burst, crop, gun, pistol, trigger.
26	Un person supine down the road	Person on the road, in the middle of the lanes, tracks, rest, waiting.
27	A fetus, a baby, a chick	A fetus, two children, a chick, look at each other.
28	Lady with shawl, makeup, hair up	Mom welcoming baby, hug, baby who wants to go up on his mom’s lap
29	Fear, man running away	Man running, leg down, fear, face anguished
30	Family, children, trees	Family, holding hands, mother, father, two children, going together, loving

Image 4: “happy child, clown, atomic bomb" during first administration. Happy child and Clown are the normal response whereas atomic bomb indicates aggression. The happy child reflects her happy childhood and lots of fun and enjoyment like a clown. She confirms that as a child she felt very happy, full of ideas, cheerful and funny like a clown. Atomic bomb may indicate her active involvement with full of energy and vitality during childhood. She further confirms the fact that as a child she was very active and full of vitality. The atomic bomb may also indicate aggression which can be explored during therapy session. In the second test she perceived “Happy person, teddy bear, ball, clown”. Perception of Teddy bears is a very normal response which may also indicate that the feeling of aggression is processed after and during therapy. 

Image 5: “Woman, (bandaged face, dancing woman and flessible) and apple” on first testing. Both are normal responses. However, “bandaged face” may indicate physical injury/trauma. Probably this might be the trauma of abortion which she felt later on. She gave a normal response “Smiling woman (black hair, shapely woman, dancing, sincerity), and Apple” after psychotherapy. The quality of responses also improved after therapeutic intervention. 

Image 6: “Two dancers” in this image though two persons (male and female) would have been a better response. Not perceiving “Male and Female or Couples” may indicate conflicting relations with her boyfriend. However, her response “Two people are dancing together, two hearts, two kisses, holding hands, happiness, moving coordinated” on second administration improved significantly, indicating better loving relationship, togetherness and bond of love and happiness. 

Image 7: “Fetus” in this image indicates her mental preoccupation with her pregnancy and trauma. After psychotherapy she perceived “Ear” - a normal response. 

Image 8: “one hand in the bush” on the first testing which may indicate known issues/problems which she is trying to resolve. On the second testing “Many hands, asking for help, suffering, flames, a big hand at the center, burn bandaged face” may indicate support and help and desire to run away from something that makes her suffer. This may also indicate her known problems for which she is trying to seek help and support. “The Big hand at the center” may indicate desire to get support from superpower/God. Often people having faith in God may give responses having spiritual symbols. This is also a sign of a prognostic indicator. 

Image 9: “Pods, rain, small plant that sprouts" on this image may indicate her ongoing still immature love, which is slowly growing. It shows that the relationship with her partner is young, like a bud that needs rain to become a strong and stable plant. On second testing she perceived “Two pigeons kissing, a heart, two tongues, love, the fruit hanging from above on a branch - an apple” indicates togetherness, intimate relationship and love with her partner. No longer does she speak of a plant that is sprouting, but of fruit, that is something ripe and ready. Moreover, she identifies the figure with “love”, with the kiss and with “passion” (tongues). This further indicates that the relationship with her partner is becoming more mature, adult and happy. The client confirms an improved relationship with her partner. 

Image 12: "Lungs” on both testing sessions – which is a normal response and indicates her healthy body imagery.

Image 13: “Turtle, two children, a bird seen from above” on first testing and “Turtle, two children, a bird seen flying from below” on second testing. As such responses on both tests look normal, indicating a good interpersonal relationship with her parents during childhood. What is interesting to note is that she perceived the bird from above in first testing and bird from below in second testing. This makes me think of Freud's dream theory, which states that flight is an effect of sexual desire and orgasm, or even of life in the womb. Seeing a bird from above may indicate the desire to escape from something or from someone, while a bird seen from below can symbolize the desire to be free or to reach an important goal. Also, the word "protection" is added. Perhaps, the client is looking for support. 

Image 14: “Fish bone, spiral, spine” on this image, which is a normal response. On the second testing, she vied this as “Spine, straight, erect, stable, point of support, totem, mask, eyes”. Projection of eyes on this image may indicate her suspicious attitude towards her partner.

Image 15: “Cell, vagina, mollusc” – which is a normal response. Even on the second testing she projected “Vagina, depth, cross, concentric, mussel, pendant, jewel” - which is a normal response. The perception of “CROSS” is a spiritual symbol indicating her faith and wish to get support / help from GOD. 

Image 16: "A face, hourglass, an alien". Fetus is normal perception on this image. The hourglass may indicate, the time that passes, just like in the case of an adult woman who feels ready to become a mother, but for some reason renounces this condition. Perhaps it is precisely this renouncement that worries the client. In simpler words, the girl's unconscious desire seems to tell us "I am giving up pregnancy even though I am the right age and even though I am afraid that one day it will be too late". Moreover, the word "hourglass" could also refer to something that empties. In fact, the “alien” may be the feeling of situational rejection of FETUS and nonacceptance of pregnancy leading to abortion.

Image 17: “Animal lying with horns (suffering)" on this image. It is interesting to note that she did not perceive the most common response “breast” on this image. Avoiding perception of breast may serves as defense mechanism to protect her maternal instinct because of the kind of forced decision of abortion. It may also indicate emotional conflict with the mother figure (herself as mother). The animal lying with horns indicates her aggression and hostility towards her partner (destructors) and suffering as symbolic representation of her inner cry. Also, the words "horns" and "suffers” may indicate a sense of danger, pain and insecurity. She wanted support from her mother during such stressful situation but due to difficult relationship she failed to get emotional support. After therapy sessions her responses “Breast, fingers, torn dress, naked” improved to some extent and she perceived breast which is a normal response. However, “torn dress, and naked” still indicates a kind of physical assault, hostility and aggression which must be addressed during therapy session.

Image 18: “A sad man and a sad woman” in the forst testing session. It may indicate pensive mood of her and her partner. However, her responses after therapy changed and she perceived “Two faces, two brains, a sad and worried face or rather angry, whisper, reassure”. The “reassurance” may indicate her desire to get reassurance from her partner towards life in future. It is a good prognostic indicator. 

Image 19: “A woman and a child (she is in the picture and the child with head only) - undeveloped child may indicate her trauma of abortion in the form of immature pregnancy. Though her responses on second testing “Two people, two faces, one mask, remove the mask, eyes, black, heads” improved to some extent after therapy, yet she needs support and assurance towards happy motherhood. 

Image 20: “Two seated people looking at each other and playing.” In the first testing session which is a normal response. However, on the second testing she viewed “Dialogue, two people chatting, confrontation, elderly people sitting” may indicate unpleasant dialogue/conversation with her partner before abortion. 

Image 21: “Paper planes, scribbles, triangles, geometric drawings” on the first testing session which is a normal response. However, the suppresed anger came out after therapy and she projected “Knives, pointed blades, scribbles, grater, erasures, throwing”. Knives and pointed blades may indicate flared up hostility. The psychotherapist must help the client to release her aggression during therapy session.

Image 23: “A fish, a jellyfish between two rocky walls" is projected on first testing. Normally people see male sex organ on this image. Fish is the symbolic representation of male sex organ. “A jelly fish between two rocky walls” may indicate her desire to see his partner having hard time in relationship. This may also indicate her hatred towards his partner. She further expressed that she has lost sexual interest and did not have satisfactory relationships with his partner. However, the responses on second testing “Penis, fish" look improved response and an indicator of maturity to deal with her partner.

Image 24: “A sun, two hearts, a broken ball with cracks” on first testing. The broken ball may indicate a kind of broken relationship with her partner because of forced abortion. The theme continued on the second testing as she perceived ““Heart cracked, tentacles, card of hearts behind, sun, rays”. The “heart cracked” and “world shattered” may indicate her pensive and aggressive mood with feelings of disturbed, shocked, devastated, traumatized sufferings as she expressed during therapy session that she has had the right age to become mother and she was never ready for abortion. 

Image 25: "A battle, an explosion, a clipping" - she perceived on first testing which may symbolize uncontrolled aggression. Similar theme is projected on image 21. However, the aggression reduced to some extent after psychotherapy and she projected “Bottle of sparkling wine bang, New Year’s Eve, burst, crop, gun, pistol, trigger” on second testing. This shows the effect of psychotherapy and the power of Somatic Inkblot test in pulling out the suppressed unconscious material. 

Image 26: In the first testing she saw “A person supine down the road." This may indicate her injured ego and depressive mood. On the second testing she perceived “person on the road, in the middle of the lanes, tracks, rest, waiting." It may indicate that she is taking rest and waiting for her loved one to support her. This is a positive response and looks as if psychotherapy has improved her mental condition. 

Image 27: “A fetus, a baby, a chick” on first testing and “A fetus, two children, a chick, look at each other” on second testing, which are normal perception. “Look at each other” may indicate care, expectation and hope towards life.

Image 28: “Lady with shawl, makeup, hair up” but avoided to perceive “mother holding her child” which is most common response on this image. Avoiding to perceive “Baby/Child” may indicate her trauma of abortion. It may also indicate her “conflict with mother”. A person who has lost her child may often avoid baby on this image. However, on the second testing, she perceived “Mom welcoming baby, hug, baby who wants to go up on his mom’s lap” is normal response. Positive effect of psychotherapy is visible on various images of Somatic inkblot test. “Mom welcoming baby, hug, baby who wants to go up on his mom’s lap” may also indicate that she is eager to become mother again. 

Image 29: “Fear, man running away” on first testing and almost similar response “Man running, leg down, fear, face anguished” on second testing may indicate a kind of uncertainty, anxiety and fear towards life. This must be addressed during therapy session.

Card 30: “Family, children, trees” on first testing and "Family, holding hands, mother, father, two children, going together, loving" on second testing. After psychotherapy her response improved significantly and showed concern of family, togetherness, mutual support and love. Here she specified the concept of family and added love and mutual support that is desired within each family. 

Quantitative Analysis:

On both administration of SIT she gave high number of responses which indicates that she has high productivity, high creative ability, and high functional intelligence. She has given high percentage of human responses indicating stable relationships and good interpersonal skills. The "animal" responses are low indicating latent aggression that is often not listened to, but all in all, they are negatively related to "human" responses. The anatomical responses are low and indicate no pathology in healthy body imagery, though there is partial anxiety towards one's body image. The protocol shows depressive content but is not alarming. A higher number of Most Typical responses (MT) are suggestive of coherent, logical thinking, and ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept. It may also indicate negotiation skills and confidence in words to resolve issues. There is no denying the existence of an issue in sexual conflict which can be addressed during therapy session. It also indicates good prognosis.

On second administration of SIT she gave almost more than the double of the answers than pre-test administration. The indices further indicate high creativity and functioning intelligence. Human responses are still very high, while animal responses have increased slightly, indicating her good socio-emotional competence and her propensity towards people. The anatomical score still shows a slight concern towards the body, but sexual responses have increased, indicating an improvement in intimate relationship with her partner. Finally, there are many movements, which make us think of the fact that she has regained her vitality and is active as before the onset of her symptoms. 

The client has projected responses such as "marrowbone", "baobab", "erect, totem", "vagina, depth, mussel", "trigger, bat" that clearly represent sexuality (Image 9,14,15,17). In the first administration, she perceived only one sexual response (female genitalia), while on second administration she perceived both male and female genitals. Her interpersonal relationship with her partner has improved and she feels happy with her boyfriend.

Conclusion: 

It can be concluded that the client is a very strong and emotionally stable person and is able to face the obstacles of life. A year before, she had some depressive thoughts and some relationship issues, while at present, there is an improvement in the tone of expression and overall, her mood. Her relationship with her partner has improved and they communicate with each other comfortably. She has regained her vitality and desire to do, though the road to complete resolution of her trauma is yet to complete. However, the prognosis is that she will be able to overcome this obstacle without taking so many painful residues. It is also interesting to note how the phallic and pelvic symbols are reported so intensively in the second testing. The findings clearly indicate the rejuvenating power and healing effect of somatic images.