Case 2. Therapeutic Intervention through Somatic Imagery Test - A Case Study

Shubhika Singh & Bankey L. Dubey

(SIS Journal of Projective Psychology & Mental Health, (2020):27:2, 112-115).

The Somatic Imagery Test (SIT- online version) was administered to a 54 years old female to understand her personality and inner cry, if any. The inkblot images were helpful to bring out high dissatisfaction and poor interpersonal relationship with her partner, mild depression and suppressed hostility with lots of unprocessed unconscious material that aided the process of therapeutic intervention. The responses were analyzed using content analysis and psychoanalytical interpretation. 

Introduction:

The Somatic Inkblot Series (SIS) is a semi - structured, projective, diagnostic procedure and is an adjunct to psychotherapy. It is structured by a sequential presentation of intentionally designed and field-tested inkblot-like images. These images demonstrate typical and atypical response potentials. The somatic inkblots procedure is projective because it is based on spontaneous, individually generated responses to semi-ambiguous figures, which elicit intra psychic associations specific to the person presented with them. Since its inception, the SIS test has undergone transformation that led to the development of different versions of the test and has now adapted modern technology which helps the clinician to administer and use the test in diverse situations effectively (Dubey and Dubey, 2018, Dubey et al, 2019, Dubey et al., 2005).  

The Somatic Imagery test (SIT) is a short version of 30 somatic images for quick assessment. It is designed for self-administration after supervised instruction. The test is also used as “Group administered test”. The subject is asked to go to http://dubeyhealingcenter.com and follow the instructions “Most people find this test fun and interesting. First, please relax, and prepare to enjoy. Please write each in terms of what they resemble or look like to you. Different people see different things in the inkblots. It is important to write whatever the inkblot looks like to you. Please include everything you see even if it reminds you of something remote, vague, highly personal or even potentially embarrassing. Please include everything you see with as much detail as possible. Also include any outstanding emotional reaction that you might feel in responding to these images”.  The test may take about 30 minutes to complete.  Please be assured that there are no right or wrong answers. 

Mental health professionals with training and experience in projective techniques will have little difficulty integrating the scoring and charting conventions used with the SIT.  Inkblot Personality Test: Understanding the Unconscious Mind (Dubey, et al, 2019, Cassell and Dubey, 2003), can be a resource for increasing one’s skill in the interpretation of responses on Somatic Imagery test. Since the procedure conceptually taps into the same stream of imagery as seen in dreams, daytime fantasies and visual hallucinations, a background in the interpretation of such content, either in a direct or latent symbolic way, is helpful. Clinicians experienced in the art of psychotherapy will readily adapt to this technique (Kwiatkowski,et al, 1978). They will find the SIT an useful aid, especially for people who cannot draw. In a sense, the SIT (employs) uses art as a diagnostic and therapeutic approach for those who cannot engage in traditional art procedures. Other clinicians with experience in dream interpretation, visualization techniques, guided imagery, active imagination therapies and hypnotherapy will also readily adapt to this procedure (Dubey et al, 2019).

The present case study analyses the responses of a female client who approached one of the authors (SS) for psychotherapy. She was administered the Somatic Imagery Test (SIT) - the online version (www.Dubayhealingcenter.com), to find out the unprocessed unconscious material having clinical significance.  

Case X:

The Client X was a 54-year old married female, Hindi speaking, who approached for help. The main complaints of the client were frequent anger outbursts, irritation, hot flashes, general dissatisfaction in life, lack of peace/low mood, unpleasant past experiences, disturbed sleep, worry about future, low self-esteem and overall distress.  

She is an only daughter to her parents in a family of five brothers. She was very close to her father as a child and reported that she was his favorite child. She also reported that her father was a man of ideals and was extremely short tempered. As a child, she wasn’t very close to her mother. She is educated till 11th standard and regrets not being allowed to continue her education. This makes her feel conscious, leading to low self-confidence at times. She got married at the age of 21 years. She feels that she was neglected and never received the love, acceptance and attention that she expected from her husband and in-laws.  

The Somatic Imagery Test (SIT) was administered to her following the standard procedure ((Dubey and Dubey, 2018, Dubey et al, 2019) for understanding her overall personality and unprocessed unconscious material that needed to be addressed during psychotherapy. She was motivated and cooperative during testing. The clinically significant responses were interpreted using content analysis and psychoanalytic interpretation.   

Image 1: “looks like a child holding” indicating her need for support and a kind of insecurity.   On interaction she accepted that she still needed support from her family.

Image 2: “Roots of plant” is a normal response.  

Image 3: “Bat on top. Heart shape in the middle and bat-type figure below too” which are normal responses.  

Image 4: She projected “looks like dog on the side and Face of human - big round”. The dog on the side indicates good interpersonal relationship during childhood. However, the “big human face” may indicate strict discipline and authoritative attitude of parents during childhood. The findings are supported by her case history.

Image 5: “Apple. Lips and snake-like shape below” on this image. Apple is the most common normal response to this image. She had avoided perceiving “dancing lady”, the second most common response on this image. If a female is unable to perceive dancing lady, it may indicate that the happiness from her life has gone away. It is a strong indicator of poor interpersonal relationship with her partner and mild depression, which is supported by her case history. Instead of perceiving dancing lady, she has perceived “a snake” which is symbolic of phallus. She also perceived lips along with the phallus which could be indicative of feelings that may correlate with intimate relationship. “Lips and snake” may further indicate oral-erotic and passive-receptive tendency (Schafer Rorschach). Overall, her response is indicative of poor interpersonal relationship with her partner, which can be discussed during therapeutic session.

Image 6: She did not perceive anything in this image. Projection of “male and female, or any two persons” is a healthy response, suggestive of good interpersonal relationship. Rejection of this image may indicate poor interpersonal relationship with her partner which is also supported by her responses on image 5. 

Image 7: “Ear” on this image - a most typical and normal response. 

Image 8: Seeing “Full palm” is also a most typical normal response on this image. 

Image 9: “Hen (left side) and “Lizard shape” (Right side). Inside both - small birds” Perceiving lizard is a sexual connotation. Hen may symbolize weak, helpless female. The normal response on this image is ‘two birds interacting or making love.’ Avoidance of this is suggestive of frustrated love affair and conflict in love relationship. The Lizard may also indicate negative attitude towards her partner (Phillips and Smith).

 Image 10: “Ribcage; lungs” which is a normal response.  

Image 11: Seeing “Animal in the center – may be a dog and heart shape on the outside” are normal responses. Dog may indicate “Passive - dependency” (Klopfer Davidson).  

Image 12: “Kidney” which is a most typical and normal response.  

Image 13: “human shadow and 2 children on the side” which is a normal response and is indicative of good interpersonal relationship with parents especially with father which corroborates with her case history too.

Image 14: “Backbone” is normal response on this image which is indicative of heathy body imagery.  

Image 15: “Vagina” is a normal response on this image which is indicative of healthy erotic and body imagery.  

Image 16: “Sonography image of a fetus in the womb” which is a normal response.  

Image 17: “Nipple” on this image. Breast is the most common perception and a normal response. Non-perception of breast may indicate deprivation/ conflict with mother during childhood. Those who lost their mother during childhood, lived away from their parents, often reject this image. A female having undeveloped breast, or sexual trauma may also find difficult to perceive this image. It further indicates the client’s craving for affectional need from her mother. She expressed that she was not very close to her mother during childhood and has conflicting relationship with her mother and mother-in-law.  

Image 18: “Face of a Women and man. Women, on the right looking in anger. Man, on the left just looking at her with attention”. The client expressed that this is how her husband looks at her and she reacts in this manner. This response clearly indicates expression of aggressive behavior towards her partner. 

Image 19: “Two skulls - Left one is female, and right is male”. Two faces are the most common response on this image. Avoiding perceiving two faces may indicate poor interpersonal relationship between wife and husband.  

Image 20: “Two people sitting on a chair having conversation - male and female” is normal response. This suggests that the client has a mature approach to handling the situation and is attempting to have a smooth relationship with her husband.   

Image 21: “Looks like lady's half body (in pink). Also, looks like horse's half body too”.  Here, her response “half horse” is a sexual connotation. Generally, half horse is an atypical response and may indicate sexual interaction under pressure or painful situation.  The “horse” also indicates ambivalence towards domineering father/authority (Phillips and Smith) which is supported by her case history. 

Image 22: Normally, people see a heart in this image but, the client has rejected this image, which may indicate conflicting love relationship. It may also indicate cardiac problems of self or of some significant family member(s). 

 Image 23: She could not perceive anything in this image. Malesex organ is the most common response. Female having sexual conflict or sexual trauma may reject this image because it symbolizes male phallic region.

Image 24: “Disease, Cancer cell.” In this image, she avoided perceiving the hearts which is indicative of disturbed interpersonal relationship. And cancer could be indicative of the painful situation which she is perceiving constantly.

Image 25: She did not perceive anything and rejected this image which may suggest suppressed hostility/ aggression. She has expressed aggression on Image 18 also. The psychotherapist must address to manage such aggression during therapy session.  

Image 26: “A Child standing inside a circle” which is a rare response on this image. Most people perceive it as ‘body resting; soul leaving body; person doing yoga, and dead person’. Avoidance of common percept on this image may indicate fear / death anxiety.

Image 27: “Small babies of hen when they come out - Chicken”. Here, in this image, the client avoided to perceive human baby, which may indicate aggressive attitude or feeling of separation from children. 

Image 28: “Mother holding the child in her arms and embracing the child really close to her chest”- This is a normal response indicating affection towards children. She has used the Hindi word “Chipkana” which may further indicate insecurity that her children should not go away and/or leave her.  

Image 29: “Running Man” is a normal response to this image.   

Image 30: “Parents and two kids.” is a most typical normal response.  

Conclusion: 

Overall, the client gave 11 Most Typical responses which indicate that she has contact with reality, has good ego strength and is free from psychotic ailments (no psychotic features). However, she rejected 4 images which indicate that she has high dissatisfaction in her personal intimate relationship, sexual conflict, mild depression and suppressed hostility. All in all, her responses revealed high degree of preoccupation with her strained interpersonal dynamics with her partner. The SIT analysis was shared with the client and she corroborated the results. She is currently undergoing psychotherapy and is being treated for relational and emotional issues. The outcome is encouraging, and the client is feeling better after three sessions. The SIT procedure can be considered an excellent tool to tap into one’s unconscious mechanism and unprocessed painful materials. It gives the therapist a head start into the direction of exploration in therapy. The use of SIT and its findings greatly helped in establishing rapport with the client, eliciting psychopathology and in therapeutic planning.  

References:

Cassell, W, A. and Dubey, B. L. (2003).Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. SIS Center, Anchorage, (USA) (www.somaticinkblots.com),

Dubey B. L., Banerjee P. & Dubey Anand (2019).Inkblot Personality Test: Understanding the Unconscious Mind, SAGE Publication.

Dubey B.L. & Dubey Anand (2018) . Manual of Somatic Imagery test. Dubay Healing Center, 7490 Coon Club Road Medina, OH 44256 (USA)

Dubey, B.L., Cassell, W. A., Manickam, L.S.S. and Singh., A. R. (2005). Efficacy of Somatic Inkblot Test in Personality Assessment, Diagnostic Evaluation and Therapeutic Intervention. Indian Journal of Clinical Psychology, 31, 10 -23. 

Kwiatkowski , J.S., D. Perahia, D. and B. Pullman, B. (1978). Aspects of oxo pyridine‐water interactions, Wiley online Library: https://doi.org/10.1002/qua.560140819