Therapeutic intervention through SIS
in a case of Dissociative Convulsion Disorder
Bankey L. Dubey and Padma Dwivedi
The Somatic Inkblot Series-II (Cassell and Dubey, 2003) was administered to an 18 years old girl, studying in 12th class with complaints of fits (fainting attacks), headache and nausea. She was diagnosed as a case of "Dissociative Convulsion Disorder" as per ICD-10. The SIS responses projected her poor interpersonal relationship, pent up aggression and abusive childhood. The SIS imagery was used as therapeutic intervention tool with positive results and relief from symptoms. Significant responses are interpreted and discussed in the case study.
What is Somatic Inkblot Series?
The Somatic Inkblot Series (SIS) is a structured projective diagnostic procedure and an adjunct to psychotherapy. It is the third inkblot test after Rorschach and Holtzman tests. Unlike the earlier two inkblot tests, it is self-administered and can be taken as group-administered during screening and personality assessment. The series has 5 subtests eg. 20 Cards SIS-I (Like Rorschach), DVD of SIS-I, SIS-II (62 images Booklet), DVD of SIS-II and SIS Living images. The SIS stimuli evoke symbolism and meanings unique to the responding individual such as present in somatic delusions and affect charged dreams. The procedure is an adjunct to therapy because responses can be further explored to create a more effective treatment plan, and can be re-addressed in later discussions, providing opportunities to elicit deeply defended material. During the administration of the SIS procedure, patients may abreact emotional conflict raised to consciousness by the images, which can be a therapeutic experience in itself.
The viewer writes responses on an answer sheet. Most of what is included in the ambiguous structure relates to specific life situations and post-traumatic dream content
that has been found to have clinical significance. Viewing the SIS has both diagnostic and therapeutic applications that are far reaching. The SIS procedure has been used internationally on different samples. Various researchers have reported high reliability and validity of the test (Cassell and Dubey, 1996, 2000, 2003, Cassell et al, 2013,
Cervigni, 2013, Pershad and Dubey, 1994, Pershad and Verma, 1995).
As an aide to psychotherapy, the imagery projected onto inkblots enable the therapist to view stressful events from the subject's past life. The critical images that are projected may reflect, either directly or in disguised symbolic form, real life historical events. In addition to the above, the projected symbolism may be traceable to highly subjective body mind-spirit phenomena such as body imagery, dreams, visual hallucinations etc. By assessing an individual's responses, and associations to them, much can be learned about the person's innermost thoughts and feelings. What is seen or imagined in semi-ambiguous inkblots reveals his deeper layer of self-perception. It is hoped that these evolving technique may be applied by investigators of inner psychic space leading to the creation of new body-mind-spiritual theory.
………………………………………………………………………………………………………………… Bankey L.Dubey, Ph.D., DMSP, Director SIS Center and Padma Dwivedi, M.A. Psychotherapist, SIS Center, N8/187-R-1, Newada, (Maa Shitala Road), Sunderpur, Varanasi-221005 (India). Email: bldubey@gmail.com,
Key words: SIS Therapeutic intervention
At its present stage, the various forms of the SIS have been found helpful as an aid to enable professionals to empathize more sensitively with the suffering individual's "inner cry." Previously, their suffering was more likely to be hidden because of defensive mental mechanisms Dubey et al, 2015). Many existing techniques employed today are highly time consuming, not particularly cost-effective. Perhaps most important of all, they do not readily provide a transparent window into the inner world.
In an analogous fashion, the imagery projected onto inkblots enables the examiner to view more clearly stressful events from the subject's past life. The critical images that are projected may reflect, either directly or in disguised symbolic form, real life historical events. Interpreting these is a much more challenging task than faced by an astronomer whose concepts relate to time, space and energy. In addition to the above, the projected symbolism may be traceable to highly subjective phenomena such as inkblot responses, body imagery, dreams, visual hallucinations etc. (Cassell and Dubey, 2012).
Case Study:
The patient was 18 years girl, studying in 12th class. She had normal milestones with no past history of psychological problems. She had been a good and sincere student, and scored among the top 4 students in the class. Her parents always compelled her to get first position. She tried hard but could not satisfy the desire of her parents and got bad remarks after every examination. She further reported that her father had abusive relationship with her mother and at certain times, ended up with physical assault to the mother and children. Her younger brother always supported her. Her symptoms started when she entered Junior college at age 17. She had fits of
unconsciousness with severe headache. On interrogation she narrated her love relationship with a young man who deserted her. Her problem aggravated to the extent that she had pain in fingers while taking examination.
At this stage she was referred for therapeutic intervention. She was administered SIS -II Booklet (62 images) and a few clinically significant responses are discussed here to show the penetrative power of the SIS images.
SIS Responses:
A6: "A sad teddy bear" may indicate her abusive childhood and pensive mood. She feels neglected from parents, particularly father.
A7: "A dancing girl" is normal response indicating her desire to live happily and enjoy life with positive attitude.
A 9: "A man and a woman seen arguing" may project conflicting relationship between father and mother, who used to quarrel often, ending up in physical abuse of mother.
A 10: Face of a sad woman who is crying". This may reflect her mother's pensive mood and her own sad face after getting scolding from father. Such responses may be indicative of depressive features and suicidal behavior which must be discussed during therapy sessions.
A 13: "hand raised asking for help". This may project her own or her mother's cry for help which she has witnessed several times and feels sad. She is looking for help from significant others. The client has concern about her mother and wishes to help her.
A 31: "A man and woman in serious
discussion. This may project the
disturbed relationship among parents or with her boy-friend.
B 4: "Father and son discussing something". This may indicate her disturbed relationship with her father, who often discussed about her performance in examination and feels he had better suggestions to offer her.
B 18: "A snake is swimming into a tunnel". This may indicate her love relationship and desire for physical contact. Snake and swimming into tunnel has very clear Freudian symbolism which should be addressed during therapeutic intervention sessions. She is a mature person and such response may indicate her normal feeling/desire.
B 19: "Two separated heart" may indicate her broken love affairs. The seriousness of such affairs and its impact on her should be discussed during therapy session. Keeping other responses in view, at least this response does not seem to look to have serious impact.
B 28: "Woman in sad mood thinking of something". This may indicate her mother's sad mood due to broken home environment. Normally people perceive "mother with child" and the avoidance of perceiving child might be her inability to protect her daughter and herself from her husband.
B29: "A running boy" looks normal response with positive attitude even in odd situation. Many people perceive handicapped person running on this image.
B 31: "Four persons, seems two children and two older people". This is the last image of the test and the image is created in such a way that people should carry
"happy family" perception way back home. She has avoided perceiving happy family because of her disturbed family environment. She has avoided perceiving parents but has seen two children which may indicate her loving relationship with her younger brother.
Dream Interpretation:
On the following night after viewing SIS images she saw the following dream:
"I am walking on the bank of a river and it looks as if I am in my city. It is beautiful weather and I noticed a boat sailing in the river. A young couple is sitting and talking. They look very happy. I am also feeling happy to see them. All of sudden I saw an aged man walking towards me. I did not like his appearance and I woke up". It looks a wishful dream with lot of pleasant feelings. The young couple may symbolizes "she with her boyfriend", and "sailing in the river may indicate her erotic desire for physical contact". "They look very happy" may symbolize her wishful thinking to have pleasant days ahead after marriage, particularly when she departs from her parental home. Such dream may also protect her ego from breakdown. The sudden presence of an aged man may be her father's image that she does not like.
Treatment plan:
Initially she was given free verbalization and allowed to express everything she felt bad about during last three years. The significance of SIS responses and its projective interpretation was discussed. She was asked to question anything regarding interpretation. After 3 sessions of initial discussion, she was administered 10 sessions of hypnotic relaxation therapy. She started showing improvement after 5 sessions of therapy. The intensity of headache reduced significantly and she started analyzing the situation around her.
She developed confidence and the frequency of fits reduced. Her relationship with mother improved and she felt cozy to approach her mother. She still hesitates to approach her father and do not like to meet him. She feels everything will be alright in future and she will have a beautiful life.
Conclusion:
The SIS-II test was administered to an 18 years old girl, studying in class 12th with the main complaints of fainting attacks and headache. The SIS response projected her disturbed relationship with father, broken love affairs and pent up aggression. The SIS imagery was used as therapeutic intervention tool with positive results and provided much relief from her symptoms. She is still under observation and taking therapy.
References:
Cassell, W. A. and Dubey, B. L. (1996) The Use of the Rorschach and SIS in Releasing Somatised Grief. SIS Journal of Projective Psychology & Mental Health, 3: 3 -32.
Cassell, W. A. and Dubey, B. L. (2000) Inkblot Responses as an Aid to Therapy. SIS Journal of Projective Psychology & Mental Health, 7:3-10.
Cassell, W.A. and Dubey, B.L.(2003) Interpreting Inner World through Somatic Imagery, SIS Center, 4406, Forest Road, AK 99517(USA).
Cassell, W.A. and Dubey, B.L.(2012) Spiritual Warfare and SIS Spiritual Symbols, SIS Journal of Projective Psychology & Mental Health, 19: 80-90.
Cassell, W.A., Pandey, P., Tiwari, A., Mishra, N. and Dubey, B.L. (2013) SIS Guided Therapy for an Adolescent Girl's Tension Headaches, SIS Journal of Projective Psychology & Mental Health, 20:1, 49-54.
Cervigni, A. (2013) Therapeutic Intervention through SIS Imagery: Two Case Studies, SIS Journal of Projective Psychology & Mental Health, 20:2, 122-127.
Dubey, B.L., Cassell, W.A. and Dubey, A. (2015) Hand Book of Projective Technique (Rorschach, Holtzman and Somatic Inkblot Series), SIS Center, Anchorage, USA.Pershad, D. and Dubey, B.L. (1994) Reliability and Validity of Somatic Inkblot Series in India, SIS Journal of Projective Psychology & Mental Health, 1994 1: 33-38
Pershad, D. and Verma, S. K. (1995) Diagnostic Significance of Content Analysis of SIS-II. SIS Journal of Projective Psychology & Mental Health, 1995, 2: 139-144