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How writing has been and continues to be a relevant clinical tool and potential source of projective material is discussed. Criterion to produce written projective materials is limited to individuals with adequate reading and writing abilities. Clinical tools/approaches noted are: (1) Sentence Completion Method and Incomplete Sentences Test; (2) clients’ writing thoughts and reflections on therapy sessions and how issues are being faced between sessions; and (3) writing as discussing things with oneself—meanings, values, relationships, life, and one’s future. Written projective material from a young woman’s journal expressing suicidal intentions that were eventually fulfilled is also shared.
Projective techniques are regarded as ―clinical tools‖ (Anastasi, 1982, p.590). Among the areas they have assisted clinicians in learning about are ―. . . latent needs, sentiments, feelings, and attitudes which the subject would be unwilling or unable to recognize or to express in direct communication‖ (Rohde, 1946, p. 169). The variety of projective clinical tools have been found to be useful with most client groups. Also, projective techniques as clinical tools ―. . . are especially helpful in evaluating those having limited language and verbal skills such as children, foreign born or new immigrants, native people, the learning disabled or the mentally sub-normal‖ (Dubey, Banerjee, & Dubey, 2019, p. 42). Among the many projective clinical tools there are a select few that involve reading and writing referred to as ―verbal techniques‖ (Anastasi, 1982, p.575). They assume satisfactory reading and writing levels in the language of the clinical tool and beyond. A formal example of such a clinical tool has been labeled variously as the Sentence Completion Method (Holsopple, & Miale, 1954; Payne, 1928; Rohde, 1946) or Incomplete Sentences Test (Rotter & Willerman, 1947).
The instructions on an early version of the Incomplete Sentences Test are as follows:
―Complete these sentences to express your real feeling. Try to do everyone. Be sure to make a complete sentence!‖ (Rotter &
Willerman, 1947, p. 44). Some examples of sentence stems from the Rotter and Willerman (1947) version of the test are: ―2. The happiest time . . . . ; 11. A mother ;
(p.44). Incomplete/sentence completion tests involving writings resulting in projective material have been regarded as helpful and of interest over many years. This is supported in studies that: ―. . . consistently find that sentence completion tests (SCTs) are among the most commonly used personality assessment instruments‖ (Holaday, Smith, & Sherry, 2000, p. 371). Some data confirming this trend are that, ―sentence completion tests were the most widely used projective measures, reportedly used by 26% [342] of [1317] school psychologists‖ (Benson et al., 2019, p.42).
Writings as a source of useful projective material also occurs during treatment. Some clinicians encourage clients to write their thoughts and reflections about their therapy sessions and how they are working at issues between the sessions. A colleague of mine always provided clients with 2-part carbonless lined sheets at the end of each session. The intention was that clients would produce two copies of their reflections in writing with one to be shared to inform the therapy process and then filed by the clinician for consideration in subsequent sessions. In the contexts noted here, writings as projective material are being obtained for caring and therapy.
Writings as projective material was especially recognized by Prescott (1957). He observes that among adolescents, ―Writing is a way of discussing things with themselves, seeking meanings, clarifying values, considering their own relationships with the world, and pondering the meaning of life and its implications for their own future‖ (Prescott, 1957, p. 188). When such writings have been available, they have been studied by psychologists (e.g., Frank, 1953; Haviland & Kramer, 1991). Here we examine the writings from the journal of a young woman, Ashley Smith, incarcerated at the New Brunswick Youth Centre (NBYC) from April 2003 to October 2006 (Ombudsman ..., 2008, p. 17). This excerpt is as it was written by Ashley at age 18 on September 4, 2006 when she was worrying about being transferred to an adult jail:
―Mom, If I die then I will never have to worry about upsetting my Mom again. Itwould have been nice today to stick myhead in the lawn mower blade. F***, I really did have to hold back the urge.Maybe next time I will give it a try.
Most people are scared to die. It can’t be any worse than living a life like mine. Being dead I think would just suit mefine. I wonder when the best time to do itwould be. I’m not going to get locked because then I’m back on checks and theywill expect me to act up then. Iwill call my Mom before bed and have one more chat. Somehow, I have to let herknow that none of this is her fault.I don’t knowwhy I’m like I am but I know she didn’t do it to me. People say there is nothingwrong with me. Honestly, I think they need to f*** off because they don’t knowwhat goes on in my head.
When I use to try to hang myself, I was just messingaround trying to make them care and pay attention. Now it’s different. I wantthem to f*** off and leave me alone. It’s no longer a joke. It’s kind of scares tothink that they might catch me before it’s done and then I will be a vegetable for the rest if my life. That’s why the most importantthing right now is to stayunlocked so they don’t think anything is up. It’s over.
Maybe I will use a brand-new pair of socks. Fresh for me. No I don’t f****ngdeserve a new pair of socks. I will use the old dirty ugly ones. Ha Ha that kind of explains me. Dirty and ugly. Two peas in a pot (sic). F*** THIS WORLD!!! HaHa. When [name omitted] told me she took me off fifteen-minute checks I almosts**t myself. Can she help me anymore. I should ask her for a razor blade. Maybeshe will give me that to. Joke of the day. Ashley Smith is no longer on checks. 1
2 3 4 5 what the f*** is the point of being alive? [Name omitted] said she doesn’t know if I will be allowed to have another apartment visit because I waxed myeyebrow. How about this one. ―I can’t have another apartment visit because I’mf****ng DEAD!‖ I want to die. I went to court yesterday and I thought he wasgoing to send me to adult! Time is running out. My chances are getting fewer andfewer. F***. I give up! I’m done trying‖ (Ombudsman ..., 2008, pp. 23-24).
To appreciate this writing sample as an example of ―projective material‖ it will be helpful to know about Ashley’s mental health and behavior. On March 4, 2003, Ashley was referred for psychological, psychiatric, and educational assessments. At the time of the assessments, Ashley was 15 years old. The diagnostic impression of the psychiatric report indicated ―learning disorder, attention deficit hyperactivity disorder, and borderline personality disorder.‖ ―Depression‖ was ruled out. ―Narcissistic personality traits‖ were added to the psychiatric report in an addendum. What is meaningful about the diagnostic impressions reported is that they were likely based on Ashley’s behaviors and symptoms close to the time she came from the community. The psychology report recommended that Ashley’s parents participate in sessions to deal with an ―oppositional defiant‖ youth. Finally, recommendations were made for ongoing monitoring, evaluation, counseling, and medication.
34: Robert B. Williams
Ashley arrived at NBYC in April 2003 with these diagnoses. Among them, it was borderline personality disorder that was confirmed by her ongoing behavioral symptoms and especially diagnostic criterion 5—recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (American Psychiatric Association, 2000). During her stay at NBYC, Ashley had many and recurring attempts at self-injury. The record documents 168 self-injury attempts—some from very mild to two that were nearly fatal (Ombudsman ..., 2008, p. 35). During September 2006, the month before transfer to an adult facility, there were 16 self-injury attempts by Ashley—a rate higher than at any other time.
Prior to her transfer on October 5, 2006 to a provincial adult facility [St. John Regional Correctional Centre], while still at NBYC, on October 1st, Ashley composed:
My Life
My life I no longer love
I’d rather be set free above
Get it over with while the time is right Late some rainy night
Turn black as the sky and as cold as the sea Say goodbye to Ashley
Miss me but don’t be sad
I’m not sad I’m happy and glad I’m free, where I want to be
No more caged up Ashley Wishing I was free
Free like a bird (Ombudsman . . ., 2008, p. 2).
This poem can be seen as serious projective material in writing.
By October 31, 2006, Ashley was transferred to federal jurisdiction. During 11.5 months of federal incarceration Ashley was segregated/ isolated and instigated approximately 150 security incidents. Many involved self-harm— self-strangulation using ligatures, incidents of head-banging, and superficial cutting of her arms (Sapers, 2008, para. 17). These recurring behavioral incidents ended with Ashley’s self-strangulation death with a ligature on October 19, 2007 at Grand Valley Institution for Women near Kitchener-Waterloo, Ontario, Canada. Regarding
Ashley’s diagnoses, a somewhat recent study reports that individuals manifesting borderline personality disorder with narcissistic personality traits tend to be at increased risk for persistent suicidal behavior (Ansell et al., 2015; Williams, 2018). Finally, in the documentation reviewed it is not clear that any of Ashley Smith’s writings shared here informed the therapy or care she received.
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Anastasi, A. (1982). Psychological testing (5th ed.). New York: Macmillan.
Ansell, E. B., Wright, A. G., Markowitz, J. C., Sanislow, C. A., Hopwood, C. J., Zanarini, M. C., Pinto, A.,
McGlashan, T. H., & Grilo, C. M. (2015). Personality disorder risk factors for suicide attempts over 10 years of follow-up. Personality Disorders, 6, 161-167.
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Benson, N. F., Floyd, R. G., Kranzler, R. G., Eckert, T. L., Fefer, S. A., & Morgan, G. B. (2019). Test use and assessment practices of school psychologists in the United States: Findings from the 2017 National Survey. Journal of School Psychology 72, 29–48.
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Dubey, B. L., Banerjee, P., & Dubey, A. (2019). Inkblot Personality Test: Understanding the unconscious mind. New Delhi, India: Sage Publications India.
Frank, A. (1953). Anne Frank: The diary of a young girl.
New York: Simon and Schuster.
Haviland, J. M., & Kramer, D. A. (1991). Affect-cognition relationships in adolescent diaries: The case of Anne Frank. Human Development, 34, 143-159.
Holaday, M., Smith, D. A., and Sherry, A. (2000). Sentence completion tests: A review of the literature and results of a survey of members of the Society for Personality Assessment. Journal of Personality Assessment, 74(3), 371–383. doi: 10.1207/S15327752JPA7403_3.
Holsopple, J. Q., & Miale, F. R. (1954). Sentence completion: A projective method for the study of personality. Springfield, IL: Thomas.
Ombudsman and Child and Youth Advocate (2008, June). Ashley Smith: A Report of the New Brunswick Ombudsman and Child and Youth Advocate on the services provided to a youth involved in the youth criminal justice system. Fredericton, NB: Author. Available at: https://www.cyanb.ca/images/AshleySmith-e.pdf
Payne, A. F. (1928). Sentence completions. New York Guidance Clinic.
Prescott, D. H. (1957). The child in the educative process.
New York: McGraw-Hill Book Co.
Rohde, A. R. (1946). Explorations in personality by the sentence completions method. Journal of Applied Psychology, 30, 169-181.
Rotter, J. B., & Willerman, B. (1947). The Incomplete Sentences Test as a method of studying personality. Journal of Consulting Psychology, 11(1), 43-48.
Sapers, H. 2008. A Preventable Death. Ottawa, Ontario: Correctional Services of Canada. Available at: https://www.oci-bec.gc.ca/cnt/rpt/pdf/oth-aut/oth-aut20080620-eng.pdf
Williams, R. B. (2018). A possible preventable death: If the lethality of the diagnosis known now was known then. 29th International Congress of Applied Psychology (ICAP2018), June 28th, 2018, Montreal, Canada. Page 238, Poster
Session I, Listing #70 38014.
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