Scoring and Charting
Definitions of Scoring Indices
Mental health professionals with training and experience in projective techniques will
have little difficulty integrating the scoring and charting conventions used with the
Somatic Inkblot Series. “Body Symbolism” (Cassell, 1980), can be a resource for
increasing one’s skill in the interpretation of the original 20 cards SIS responses.
Since the procedure conceptually taps into the same stream of imagery as seen in
dreams, daytime fantasies and visual hallucinations, a background in interpreting
such content, either in a direct or latent symbolic way, is helpful. Clinicians experienced
in art psychotherapy will readily adapt to this technique (Kwiatkowska, 1978; Ulman,
1965). They will find the SIS a useful aid, especially for people who cannot draw. In a
sense, the SIS employs 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.
There are variations in test-taking, with important clinical applications. People who
have difficulty in completing the test and who do not respond to a number of video
images may be exhibiting denial, avoidance, blocking or repression. Excessively
detailed responses suggest obsessive-compulsive traits. Exaggerated verbal
responses, while discussing inkblots least liked, suggest affect-laden content. This
should be further explored for relevance and meaning to the individual. In some cases,
repressed material can burst into conscious awareness, triggered by the semiambiguous inkblots. The underlying dynamics of many somatic complaints and
personality traits can become accessible with this technique.
The eleven categories found to be important in understanding and interpreting protocols
are:
1. Total Number of Responses 8. Typical Responses
2. Human Responses 9. Atypical Responses
3. Animal Responses 10. Rejection of Images
4. Anatomical Responses 11. Pathological Responses
5. Sex Responses a. Pathological Anatomy (PAS)
6. Movement Responses b. Depression (D)
7. Most Typical Responses c. Hostility and Aggression (HAS)
d. Paranoia (P)
Each category is designed to stimulate consistency among the raters, and to afford
commonality in acquiring information for research and normative data collection. The
Somatic Inkblot Series has a very simple scoring system. It is less complicated than
existing inkblot tests, since it emphasizes content analysis. The scoring categories
have been descrived as follows :
1. Total Number of Responses ( R )
The total number of responses is arrived at by counting all the responses given by the
subject on the 62 images of the SIS-II / Video. This number suggests imaginative
capacity and functioning intelligence of the subject. Psychiatrically ill patients will have
a poor imaginative capacity and poor functional intelligence.
2. Human Responses ( H )
Human responses include the whole human body, or external parts of the human body
like face, ear, nose, legs, etc. The category does not include mutilated forms of the
whole body or parts of it, such as crushed human being, broken legs or smashed face.
These mutilated responses are included in the Anatomical responses. The number of
Human responses suggests subject's interpersonal relationship with human beings.
When responses are low, it might be indicative of a desire to be away from others and
indicative of schizoid or social isolation tendencies.
3. Animal Responses ( A )
Animal responses include living or dead animals such as wild and pet animals, reptiles,
birds and sea animals. This category also includes external parts of the animals such
as wings, legs, claws, beak, etc., but it does not include mutilated parts of the whole
animal such as crushed birds or animals, pulled out wings, etc. Whenever a large
number of animal responses are given, interpretation should be that the respondent is
more comfortable with animals than people or psychologically immature.
4. Anatomical Responses ( At )
Anatomical responses pertain to internal parts of living beings and their mutilated
forms, both of humans and animals. These responses are consistently high in those
who have a poor self image and who are preoccupied with internal body organs.
5. Sex Responses ( Sex )
Sex responses pertain to the internal or external reproductive system and to sensuous
parts of the body. These responses include thighs, buttocks, breasts, fallopian tubes,
ovaries, etc. Heightened anxiety and pathology may be associated with either
heightened projections or impaired recognition of imbedded sexual structure. These
may signify sexual anxiety and/or dysfunction.
6. Movement Responses ( M )
Movement responses indicate movement in human beings or animals. Examples
include “talking human being,” “flying bird” or “running tiger.”
7. Most Typical Responses ( MT )
Most Typical responses are those which are given by more than 75 percent of normal
subjects on a particular image (Dubey and Cassell, 1993). The total number of such
responses are limited to 18. A higher number of Most Typical responses is 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.The following is
the list of Most Typical responses along with the images eliciting them:
SIS-II A:
Image Responses
A7 Apple/fruit
A7 Dancing lady
A9 Two human beings/ladies
A12 Ear
A13 Raised hand
A20 Kidney/lungs
A27 Breast
A30 Skull
A31 Two faces of persons
SIS-II B:
Image Responses
B4 Two faces of persons
B5 Two persons talking
B9 Kidney/lungs
B22 Man/boy sleeping or resting/
dreaming and soul going up
B27 Child/children
B28 Mother and child/standing lady
B29 Running man
B30 Ears
B31 Family-father, mother and two
children
8. Typical Responses ( T )
Typical responses are those which are commonly seen by healthy people on a particular
image.
9. Atypical Responses ( AT )
Atypical responses are those of poor quality and with vague percept, either in structure
or verbalization. A response that markedly departs from the category of Typical responses
is also scored under Atypical category. For example, if the viewer gives the response
“flower” on image A20 it should be considered as atypical because this image should elicit body anatomy such as kidney/lungs. The number of Atypical responses is proportionate to the degree of psychological or psychiatric disturbance. Perseveration may be a sign of neuropsychological impairment, and is usually absent in normal people.
Below is a list of Typical and Atypical responses on each image:
Typical and Atypical Responses (SIS-II A):
Plate SIT-1
Typical: Two people; two animals
Atypical: Lungs; diseased lungs; ovaries and fallopian tubes;
woman’s breast; x-ray of pelvis
Plate SIT-2
Typical: Floral arrangement; people
Atypical: Heart, eye
Plate SIT-3
Typical: Space needle; cross; tree
Atypical: Bleeding body part; vagina
(libidinal cathexis in lesbian women)
Plate SIT-4
Typical: A horse’s face; abstract art
Atypical: A mask, an eye looking at me; the Devil; a person
(mother grieving loss of son)
Plate SIT-5
Typical: Clown; happy person
Atypical: Woman; heart; mouth
Plate SIT-6
Typical: Person and teddy bear
Atypical: Egg and teddy bear; two chromosomes;
legs; lines and teddy bear (lack of
gestalt in concrete thought disorder)
Plate SIT-7
Typical: Woman dancing; Eve and apple; seductive woman; apple
Atypical: Male; pregnant woman; heart; rivers and island; snakes
Plate SIT-8
Typical: Man; man showing male parts
Atypical: Woman’s vulva; egg and sperm; fat body or face;
baby; lines
Plate SIT-9
Typical: Man and woman dancing; hearts; two men or
two women dancing
Atypical: Two sets of lines; face; eyes; two ants; two animals
Plate SIT-10
Typical: Eyes; eyes out of focus; woman’s face in
rear view mirror
Atypical: Hazy face; crying
Plate SIT-11
Typical: Nose; auto; person sitting; leaning forward; the
Thinker; runner waiting for starting gun
Atypical: Person doubled over in severe pain; person doubled
over all the way with head between legs; kidney
excreting waste (GI problems)
Plate SIT-12
Typical: Ear
Atypical: Embryo
Plate SIT-13
Typical: An upraised hand; a hand reaching for help; palm
Atypical: Suffering, pleading, helpless, desperate, or attacking
hand; hand in flames or reaching out of concealment
to grab someone (rape victim)
Plate SIT-14
Typical: Esophagus and stomach; Olympic torch
carrier; airport tower
Atypical: Fetus; miscarriage; sacred heart; kidney
Plate SIT-15
Typical: Stomach; bird; fetus
Atypical: Kidney; dead baby
Plate SIT-16
Typical: Two love birds; heart
Atypical: Two (starving) birds fighting for food;
lungs; x-ray of chest; leaves
Plate SIT-17
Typical: Chest; ribs; heart; lungs
Atypical: Ugly dog; monster looking out at you; gaping open mouth;
two catfish looking at evil; sea horses; heart (afraid it
will stop) (death anxiety in an eight year old)
Plate SIT-18
Typical: Heart; female genitalia; uterus; animal coming out of heart
Atypical: Creature from outer space; atomic bomb exploding;
X-ray of brain
Plate SIT-19
Typical: Intestines; colon
Atypical: Human penis; woman forming fetus
Plate SIT-20
Typical: Kidneys; lungs; thorax
Atypical: Weight lifter (back pain detail); a bush with a spear
for roots; brain; ovaries; testicles; eyes; ears
Plate SIT-21
Typical: Turtle; flying bird; babies on sides
Atypical: Stretched animal skin; man flashing two children;
smashed animal showing entrails; spinal disc
Plate SIT-22
Typical: Spinal column; chest; rib cage; pelvis; phallus
Atypical: Male genitals burrowing; funny face with low
forehead (lower part); man-eating plant (upper part)
Plate SIT-23
Typical: Spinal column
Atypical: “Mind block” (rape victim repressing male genital
symbolism); pots, pans, or plates stacked on each
other (neutralizing defense against phallic symbol
by rape victim)
Plate SIT-24
Typical: Female pelvis; people
Atypical: Demons or devils
Plate SIT-25
Typical: Vagina
Atypical: Stained glass window; crucifix (substituting religious
symbolism); cave or tunnel; beetle; Indian oil lamp; eyes
Plate SIT-26
Typical: Fetus; embryo
Atypical: Face; reflecting repugnant emotion (pregnant
woman unhappy with pregnancy)
Plate SIT-27
Typical: Human female breast; baby sucking at breast; deer’s head
Atypical: Female arm being injured; marked decapitated woman
Plate SIT-28
Typical: Leg; thigh; wrist and hand
Atypical: Hand from horror film
Plate SIT-29
Typical: None typical, all are “projective”
Atypical: Scary face; person running; shadow of a gun
Plate SIT-30
Typical: Face; skull; Neanderthal man; monkey’s face
Atypical: The rapist’s face; evil surrounded by evil; the Devil
Plate SIT-31
Typical: Two human faces, man and woman, or adult
and child whispering secrets
Atypical: Man and woman arguing; sad faces
Typical and Atypical Responses (SIS-II B):
Plate SIT-1
Typical: Camp fire; melting ice cream
Atypical: Rotting tooth; amniotic sac with embryo; heart bleeding
Plate SIT-2
Typical: Fire spreading in forest; rag doll on a stick
Atypical: Ovaries; fallopian tubes and uterus; attacking
animal; monster; ultrasound of vagina
Plate SIT-3
Typical: People talking
Atypical: Throat and tonsils; vagina; rectum;
pelvic bones; Darth Vader’s head
Plate SIT-4
Typical: Two human faces; adult and child
Atypical: A person projecting an alter personality
(multiple personality disorder); mummies;
person threatening someone
Plate SIT-5
Typical: Two seated human figures throwing balls; people conversing
Atypical: Man and woman arguing; me (referring to self)
not able to communicate with Doctor.
Plate SIT-6
Typical: Upper thighs and lower abdomen; pair of pants
Atypical: Fat thighs; penis in vagina; stomach x-ray;
woman’s lace panties (eroticism,
typical in lesbian woman)
Plate SIT-7
Typical: Ribs; upper chest; hot water bottle
Atypical: Brain; painful back; heart with arrow in or through it ; pelvis
Plate SIT-8
Typical: Nose; a man’s profile; earth
Atypical: Pregnant woman; cocoon
Plate SIT-9
Typical: Lungs; kidney; penis and testicles
Atypical: Woman’s reproductive organs; liver and
spinal cord; gall bladder
Plate SIT-10
Typical: Bear’s face; dog; seeds
Atypical: Sad dog; pregnancy; female; female
reproductive organs; ears
Plate SIT-11
Typical: Lungs; two birds; flowers
Atypical: Lungs distorted fighting for breath; smoker’s lungs
Plate SIT-12
Typical: Face; man squinting hard
Atypical: Evil face; expression of pain; angry face; crying face
Plate SIT-13
Typical: Colon; intestines, a question mark
Atypical: Peep hole
Plate SIT-14
Typical: Pure projection, lower back; pelvis; apple
Atypical: Heart; trachea and lungs
Plate SIT-15
Typical: Broken glass; paper airplanes; knives
Atypical: Knives to kill someone; suicidal or homicidal imagery
Plate SIT-16
Typical: Spine; spinal cord; vertebrae
Atypical: Tool for drilling; hypodermic needle; painful vertebrae
Plate SIT-17
Typical: Heart; smoking
Atypical: Open vagina receptive to intercourse; a dark hole
Plate SIT-18
Typical: Spinal cord; penis in vagina
Atypical: Sperm going through tunnel; two
people talking; snake in a pipe
Plate SIT-19
Typical: Cell; ovum; egg; sun, heart
Atypical: Broken heart (post-trauma response
of rape victim); egg being fertilized
(pregnancy wish); ugly spider
Plate SIT-20
Typical: Brain; exposed brain
Atypical: Fetus; diseased or troubled brain
Plate SIT-21
Typical: A gun; exploding cork; firecracker
Atypical: A gun shooting someone; penis with a
band around it (impotence)
Plate SIT-22
Typical: Body resting; soul leaving body; dead person
Atypical: Blood spurting from chest; crime victim bleeding to death
Plate SIT-23
Typical: Spider; rib cage; heart; lung; crab
Atypical: Rib cage with cancer
Plate SIT-24
Typical: Kidneys; hanging lamps
Atypical: Twins (pregnancy wish); sperm; testicles; ovaries
Plate SIT-25
Typical: Pelvis of woman; hands holding glass circle
Atypical: Apple; koala bear; pelvis with fire inside; desire
Plate SIT-26
Typical: Female sex organs (cervix, ovaries, uterus, vagina)
Atypical: Skull; top of hammer; dog with large ears
Plate SIT-27
Typical: Fetus; embryo; child
Atypical: Diseased fetus; dead baby
Plate SIT-28
Typical: Mother and child
Atypical Woman holding baby close and running away;
person in despair hugging ‘ self; father and child;
Jesus holding and comforting someone
Plate SIT-29
Typical: Running human figure; lame
Atypical: Human figure with one leg running in fear
Plate SIT-30
Typical: Two ears, Fetus
Atypical: Split brain (multiple personality disorder); lungs
Plate SIT-31
Typical: A family of two adults and two children standing together;
Father Mother and two Children.
Atypical: A family disintegrating; people with penises
for head; four children
10. Rejection of Images ( Rej )
If the subject is unable to give any response on any of the 62 images, the response is considered
as rejected. Verbalizations like spot or inkblot are not considered as responses, and are treated
as Rejections. To determine the percentage of Rejection of Responses, 62 (total number of
images shown) divides the total number of rejected images, then that product is multiplied by one
hundred. Rejection of images shows thought blockage and an inability to think properly.
11. Pathological Scales
Four pathological scales have been used (Cassell, 1980) for the evaluation of individuals. They
are a) Pathologic Anatomy Scale (PAS); b) Depression (D); c) Hostility and Aggression Scale
(HAS), and d) Paranoia Scale (P). Some of them are based on the work of Wayne Holtzman
(1956). The scales are as follows:
a) Pathological Anatomy Scale (PAS).
Subjects who have personal health concerns, or who are pathologically identified with the health
of others, may project responses in which the body is seen as diseased. These responses are
usually related to specific regions involved in the subject’s body image, and can be appraised by
evaluating the qualitative nature of the somatic material projected. The anatomical imagery is
similar to that described by De Vos (1952) in Rorschach responses involving “diseased anatomy.”
Body parts might be reported as red, inflamed, infected or cancerous. Organs may be sore,
painful or hurting. Passages may be blocked or obstructed. Bones may be out of place or broken.
It is possible to assess pathologic anatomy by summing up all such responses. All of these
responses are scored under PAS.
Individuals who project these responses should be further evaluated for either hypochondriacal
or excessive concern about physical health. This material should be explored, clarified and
assessed in the detailed inquiry and follow-up interview, since the subject may still have unresolved
| anxiety about this alteration in body concept. The | total number of such responses is counted to |
|---|
form a score for PAS.
b) Depression Scale (D)
A depressed subject’s emotional state can be viewed as either overt or covert. Subjects
with overt feelings of depression readily admit them, and are good reporters of their
own mental state. They usually exhibit nonverbal behaviors, such as sighing, weeping,
downcast eyes, etc., which are consistent with the experienced affect. Subjects in a
state of masked depression often conceal or deny their feelings. Frequently, they are
preoccupied with their bodies hypochondriacally, and project anatomical responses,
which are likely to be pathological. A depressed mood can be assessed by inkblot
responses with high morbid or depressive content. The severity of these thoughts and
feelings can be assessed by a study of their frequency and content quality.
A four-point scale can be used to score the depressive content of inkblot imagery:
Score 0: No depressive content
Score 1: Slight or mild depressive content in the face of humans or animals (i.e. a sad
face)
Score 2: Moderate depression associated with the “inkblot’s” expression. An expression
with a marked, or strong affect (e.g. a weeping person, a grief-stricken person)
Score 3: Sadness or depressed affect associated with an anatomical response. For
example a heavy heart, a breaking heart, or a heart with a clamp on it.
Something that is suicidal, or hanging from roof, or a dead man.
Individuals who are clinically depressed, but fail to recognize it, may have similar
difficulty recognizing content in the SIS. In the absence of neurological disorder, a high
number of Rejection responses may signify masked depression.
c) Hostility and Aggression Scale ( HAS )
Hostility and Aggression can be reflected in projective responses involving physical
assault or body injury (Cassell, 1977) and are scored as follows:
Score 1: Animals that are predatory or hostile to humans; an implement of aggression
in a dormant state; a human or an animal that is seen as fierce, aggressive, or
dangerous; a hostile attitude seen in humans or animals; references to bowel
function or defecation with hostile content; a knife or a snake.
Score 2: Animals or humans seen as angry or in aggressive struggle, either verbal or
physical; furious snakes; or abstract expressions of direct conflict or oral
aggression.
Score3: Homicidal scenes and/or anatomical responses involving body destruction.
Subjects with histories of acting out hostile impulses have been found to
project anatomical responses with murderous themes.
d) Paranoia Scale (P)
A cardinal projective feature of paranoid ideation involves a heightened awareness of
threatening faces that are “looking” at the individual. This may be experienced as an
exaggerated sense of self-consciousness in social situations. An emphasis on the
eyes” of people or animals may be present in anxiety-laden dreams. It may be clinically
indicated in art therapy, with figure drawings emphasizing “eyes.” The patient may
hallucinate images of such staring faces. The paranoid scale quantifies such responses.
Charting of Responses - an Illustration
Background Notes on Mr. X:
Mr. X is 35 years old, and holds a post-graduate degree in English. He is married and
the father of two children; a 4 year old daughter and a 6 month old son. He is an
executive for an advertising company. He has earnings from service and agriculture,
and he lives in his own house, with his family, and his parents. He belongs to the upper
socio-economic class.
His main complaint was of poor interpersonal relationships in the family, particularly
with his mother. He has not talked with her for the last 10 years even though they are
both living in the same house. He also reported having disturbed sleep, irritability and
a feeling of uneasiness being indoors. In due course of time, he developed stuttering,
and started keeping himself aloof from friends and relatives.
During hypnotic session, he could remember when he was 10 years old. His mother
and his father’s sister beat him while he was sleeping with her daughter, his cousin. His
mother and aunt incorrectly suspected of sex play, which was not even in the mind of
| Mr. X at that age. Since then, he has developed hatred towards his | mother and his |
|---|
aunt. He reports smooth relationships with his wife and children.
Mr. X was treated for his symptoms, particularly the stuttering, in a prestigious medical
institute, but could not correct his problem. The treating physician referred him for a
personality assessment and hypnotic session. Mr. X was administered SIS-Video. His
responses on SIS-Video are charted and shown as illustration.
Charting of Responses:
Each of the images has some significance; therefore, all of the responses on these
images are of clinical value for qualitative content analysis. The structural meaning of
each image in series A and B is given in the table of Typical and Atypical responses.
The abbreviated meaning of each image is also given in the Response Profile chart
below.
If responses are appropriate for the images, it may be inferred that the individual has a
high awareness for the region shown in the image. If the response to a particular image
is not commensurate with the meaning of the image as given in the profile, it is considered
as a pathological response. Such pathological responses are indicated by a check
mark, or darkening of the space.
Some responses are considered to be pathological when a pathological or abnormal
adjective is attached to an appropriate response. For example, on image A13, a “raised
hand” is an appropriate response, but “helpless hand under distress” is a pathological
response. On image B5, “two persons” in any form is an appropriate response, but “two
persons involved in an argument” is a pathological percept and is marked accordingly
on the Response Profile.
On image A20, a “kidney” is an appropriate response, whereas “diseased kidney” is
indicative of pathology, and is indicated as such in the Profile Chart. “A family consisting
of father, mother and two children on image B31 is a normal response, whereas “four
persons/four children/two ladies and two children fighting together, in distress or in
search of some help” is indicative of some abnormality. Any response, which is clearly
atypical as per the list for Typical, and Atypical responses is to be charted as such on
the Response Profile.
There are eleven main scoring categories for the evaluation of the protocol. These
categories are more for descriptive analysis of the protocol. The first category in the
evaluation of the protocol is the Total number of responses. This figure can be obtained
by counting all the responses on all 62 images. In the present protocol, the Total
number of responses is 59. Fifty-seven images elicited one response each, and one
image, A22, elicited two responses. Images A3, A29, B1, and B14 could not stimulate
any response. The total responses added to 59.
Images eliciting Human responses were categorized as H, and all the H’s were counted.
The response of “Ghost” on B3 was also considered as H, but since it was a deviant
response, it was labeled as P. On image B6, his response was “seems like a woman
suffering from venereal disease.” This response was also categorized as H, because
woman is the primary response. If this response was something like, private part with
venereal disease, then it could be classified as Anatomy, not even sex, but in such
cases dual content is recommended. On image B22, his response was “dead woman
lying on the floor.” This was also counted, as H because the woman is only dead, not
mutilated. It would have been classified as anatomy if the response was “dead man
mutilated.”
In the present protocol, there were four responses categorized as Animal responses.
These were on images A16, B10, B19, and B24. Image B24 had a response of “A
strange snake-like creature with two heads, and large bulging eyes.” It was categorized
as A. If the whole response was devoid of the two words snake-like, then the response
would be considered as a Mythological or primitive human being and then could be
categorized as H. In the present instance, the creature is snake-like, and therefore,
Animal content is the safest category.
Response Profile for Quick Look
Image Area of Normal Patho Image Area of Normal Patho
Projection logical Projection logical
A1 Pure Projection B1 Pure Projection
A2 Pure Projection B2 Pure Projection
A3 Pure Projection B3 Pure Projection
A4 Human Body B4 Man & Woman,
Two Persons
A5 Human Gestalt B5 Two persons talking
A6 Human/Animal B6 Lower
Whole/part Gestalt abdomen/intestine
A7 Women & Apple B7 Chest/internal Body
A8 Male/Female B8 Nose/Earth
body/Sex
A9 Two persons/Man & Woman B9 Lungs/Kidney
A10 Man/Woman face B10 Animals/Animal’s Face
A11 Nose B11 Two Birds/Lungs
A12 Ear/Fetus B12 Face
A13 Hand B13 Intestine
A14 Fetus B14 Apple/Pelvis
A15 Stomach/Fetus/Bird B15 Knives/Broken Glass
A16 Birds and Heart/Stomach B16 Spinal Cord/Vertebrae
A17 Heart/Chest B17 Heart/Mouth
A18 Inner body part/ B18 Penis in Vagina/Spinal
Heart/Uterus Cord
A19 Intestine B19 Heart/Lungs
A20 Lungs/Kidney B20 Brain
A21 Turtle/Bird/Babies on Side B21 A gun fired of
A22 Rib cage and spine B22 Body resting/Soul
leaving body/Death
A23 Spinal column B23 Rib cage/Spider
A24 Female pelvis/People B24 Kidney/Testicles
A25 Vagina/Eye B25 Pelvis of woman
A26 Fetus, Embryo B26 Female sex organ
A27 Breast/Baby sucking Breast B27 Fetus, Embryo, child
A28 Leg, Thigh, Limb B28 Mother and child/ Lady
A29 Projection/Human Body part B29 Running man/Boy
A30 Human skull, Death Symbol B30 Two ears
A31 Man & woman, Two Persons B31 A family parents & children
Mr. X’s Responses to SIS-II A
Responses C ontentMost Typical Atypical
Pathological
Typical
A1 Looking like an Arab in bed H T D-1
A2 It reminds me of a heart with all At AT PAS-1
arteries and veins cut
A3 Rejection Rej.
A4 A funny looking flower (unremarkable) T
A5 A very happy, ugly person H T
A6 A woman in her child’s room H T
A7 Eve looking at the apple (2 response) H MT/MT
A8 A naked man with a crooked smile H/M T
A9 Man & woman exchanging sweet H/M MT
nothings
A10 A woman in the front seat of a car H/M AT D-2
and a man in the back seat.
The woman is crying.
A11 A couple making love H/M AT
A12 An ear lobe H MT
A13 Someone is asking for help with H/M MT D-1
his hand
A14 A Child is sleeping on the floor on H AT
a side of a statue
A15 A kidney; could also be a fetus At T
A16 Two fish caught on the same hook A HAS-1
A17 A woman looking at herself in the H/M T
mirror, she has a big heart
A18 Female genitalia Sex T
A19 A diagrammatic view of the human At T
body with intestines seen clearly
A20 Human kidney, bladder, penis- At MT
excretory system
A21 A large man dancing on one foot H/M T
with his children
A22 1. Trachea and lungs, or At T
2. Man with a very long nose H AT
A23 A vertebral column or a millipede At T
A24 A monster kidnapping two children, H AT HAS-2
someone is having a bad dream
A25 Vagina Sex T
A26 An unborn baby curled up At T
A27 Woman’s breast swollen with milk, H MT
whom she feeding is not known
A28 A shapely woman trapped in a H AT HAS-2
test tube (projection)
A29 Rejection Rej.
A30 A skeletal skull At MT
A31 A boy and girl talking to each other- H/M MT
something serious is the matter
Mr. X’s Responses to SIS-II B
Responses C ontentMost Typical Atypical Pathological
Typical
B1 Rejection Rej
B2 Top view of a man lying on his H AT
stomach
B3 A ghostly face seen through a H AT P
broken window
B4 Husband and wife looking closely H MT
at something-perhaps their child
B5 Very happy scene - domestic bliss H MT
between couple
B6 Seems like a woman suffering H AT P AS-2
from venereal disease
B7 A fly spot with a crushed insect At AT HAS-2
stuck to its side
B8 A full moon and it reminds me of H T
a lady wearing a funny hat holding
something in her hand
B9 Kidneys At MT
B10 A very strange looking dog A T
B11 A funny looking blouse or a jacket AT
B12 A man in great anguish H AT HAS-2
B13 Looks like a cottage by the moonlight AT
B14 Rejection Rej
B15 Mountains being spoiled by pollution AT
B16 A pregnant molecule trapped in At T
a test tube
B17 Dark in a power outage T
B18 The penis in vagina Sex/M T
B19 One of those creatures found at A T
the bottom of the sea
B20 Human brain At T
B21 A pistol. Its barrel has burst T HAS-1
B22 A dead woman lying on the floor H T D-1
B23 Cancer At T
B24 A strange snake like creature with A AT HAS-1
two heads and a large bulging eye
B25 A naked woman with thighs spread H/Sex AT
wide apart
B26 Female genitals Sex AT
B27 Embryos. One black and the other At T
white
B28 A very evil looking thing seems like H AT HAS-3
a cross between a man and a dog
B29 Child coming home from school H/M MT
B30 Two ear lobes H MT
B31 A happy family H MT
CONTENT PATHOLOGICAL SCALES
H = Human response PAS = Pathological Anatomy
A = Animal Response D = Depression with degree
At = Anatomical Response HAS = Hostility and Aggression with
degree
Sex = Sex Response P = Paranoid
M = Movement response
MT = Most Typical response
T = Typical response
AT = Atypical response
Rej = Rejection of Images
Summary of Mr. X’s Protocol:
Total number of responses: 59 Pathological Scale
Human responses: 31 PAS = 2
Animal responses: 4 D = 4
Anatomical responses: 14 HAS = 7
| Sex responses: | 5 P = 1 |
|---|
Movement responses: 10
Most typical responses: 15
Typical responses: 25
Atypical responses: 19 Rejection of images: 4
Foot note: Most Typical, Typical, and Atypical are the form level of the responses. A response cannot be
categorized as Most Typical and Atypical as well. These 3 categories are in hierarchical order, as far as the
quality of form is concerned. The sum total of these responses should always be equal to Total number of
responses.
All the responses of the internal body parts, or mutilated whole or parts of the body
were considered under the content category of Anatomy. The response on image A26,
was “An unborn baby curled up” and is classified as an Anatomy response. If the
response was “born baby” or only “baby” then the response category would have been
H. The response on image B23 “cancer” was categorized as At (Anatomical) because
it implies a diseased organ. The total number of Anatomy responses in the present
protocol is 14.
All the responses with explicit or implicit sexual parts of living beings, dead or alive,
were categorized as Sex responses. In the present case, the total number of Sex
responses was five: Images A18, A25, B18, B25, and B26. On image B25, his response
was “a naked woman with thighs spread wide apart.” This response was categorized in
both Human and Sex responses.
All the responses indicating movement in humans or animals are counted in the
Movement category. In the present protocol, the total number of Movement responses
was 10: Images A8, A9, A10, A11, A13, A17, A21, A31, B18, and B29. All of the responses
in Movement category are basically scored as Human, with movement as a secondary
category. The response of “crying” on card A10, “a smile” on A8, “looking at herself” on
A17, and “intercourse” on B18, were all considered as Movement responses.
The Most Typical responses are those given by more than 75 percent of healthy subjects
on a particular image. The total number of such images is limited to 18 and is given in
the text. The number of Most Typical responses in the present protocol is 15. His response
on image A9 of “a man and a woman exchanging sweet nothings” is a Most Typical
response, and very similar to, “two human beings/ladies” mentioned in the list of Most
Typical responses. On A13 his response of, “Someone asking for help with his hand” is
a Most Typical response.
When a response matches qualitatively in its character and content with the response
mentioned in the list of Typical responses, it is considered as a Typical response. In the
present protocol the total of Typical responses is 25.
Atypical responses are those of poor quality and marked by a departure from the
content category of typical responses. In the present case the total number of Atypical
responses are 19. On image A28 his response of, “A shapely woman trapped in a test
tube” was considered as Atypical, because under Typical responses only upper or
lower limbs are included. Image B11 elicited “A funny looking blouse or jacket.” It was
considered as Atypical, because it markedly departed from the listed Typical response
On the Pathological Scale, a response is indicative of pathological anatomy, or it is not.
There are no degrees. In the present example, only two responses are indicative of
pathological anatomy: eg.on A2, “...arteries and veins cut” and on B6, “Seems like a
woman suffering from Venereal Disease.” The total number scored in the PAS is 2.
On the Hostility and Aggression Scale, the responses judged to be indicative of hostility/
aggression are measured on 3-point scale, based on the severity of the response. In
the example using the case of Mr. X, a number of responses are rated as indicative of
hostility and aggression. These responses are; A16, A24, A28, B12, B21, B24 and B28.
Number A8, “A naked man with a crooked smile” was not rated as HAS. Number A16,
“Two fish caught on the same hook” is an idiomatic phrase indicative of aggression, but of a mild degree; therefore it is scored as HAS-1. On image A24, the response of “A monster kidnapping two children” indicates a moderate degree of hostility and aggression and was scored as HAS-2. His response for A28, “A woman trapped in a test tube” indicates a moderate degree of hostility towards women and was scored as HAS-2. Number B12, “A man in great anguish” indicates a moderate degree of aggression and was scored as HAS-2. The responses on number B21 of “A pistol” and “A snake” on B24 are of harmful objects and scored as HAS-1. Images A1, A10, A13 and B22 were scored as Depressed. The rating of the severity of the content of the responses was marked in the sample scoring protocol. The response for A1, “looking like a Arab lying on bed” was marked as D1 (the lowest degree of severity of depression). Lying in bed indicates passivity. On image A10, the response of “A woman is crying” was rated as D-2 (the moderate degree of helplessness and depression). The response for A13 “Someone asking for help with his hand” was scored
as D-1 (a lower degree of helplessness). The sum on the Depression scale is 4.
On the Paranoia Scale responses are not rated in degrees. A response shows paranoia
or it does not. Any response that is suggestive of suspicion is categorized as paranoid.
In the present case, only one response, number B4 “Ghostly face seen through a
broken window” is indicative of paranoia. Thus, on paranoia scale, the score is one.
Clinical Considerations
Attention should be given to signs of somatic repression. This is reflected when images
with high anatomical structure are left blank or when symbolic responses are projected,
disguising the somatic content. A good example is “Chinese pagoda” instead of a
spinal cord on A23. Another example would be seeing a bush instead of kidneys or
lungs on A20. Individuals suffering from psychogenic pain in a conversion disorder are
examples of this group of respondents.
In the detailed inquiry, depending on the clinical indications, specific questions may be
asked to explore certain areas pertaining to the patient. For example, if the examiner
wishes to explore the subject’s perception of communication with the therapist (i.e.
transference material), further responses may be obtained on image B5 with this
question: “If this picture represents a doctor-patient/client relationship, what do you
think of their communication?”
What may at first seem an abnormal image pattern may prove to be a normal variant
under the added scrutiny of detailed inquiry. The response may be a defense against
painful reality, a temporarily focused but generalized anxiety or an acquired or learned
response from family, job, school, life experience or long-term chronic medical problems.
The therapist should withhold judgment and not share it with the patient until the
dynamics are clear. In classical analytic therapy, this delay is intentional and is an
integral part of the treatment plan. The therapist waits until the patient has the insight,
awareness and coping skills, and thus is ready to understand and process these new
learning. A subject’s therapeutic readiness involves the ability to process affect-laden,
repressed material, and unrealistic expectations of him/herself and others. Choosing
this moment of truth, i.e. the time to share judgment, is a test of the therapist’s knowledge,
understanding and judgment.
Another line of inquiry concerning the determinants of SIS responses involves
determining if the subject’s projected material reflects inner psychological experiences
not directly recorded from past visual experience. These responses may relate to
nighttime dreams, daytime fantasies, or, in psychotic individuals, visual hallucinations.
For example, a woman lived in a psychologically and physically abusive marriage for
years, and suffered from a post-traumatic stress disorder had responded reflecting
input from her past visual reality. On A8 she saw “A man, a mean man” (depicting her
ex-husband); A9 was seen as “being chased by a man”; B10 was seem as a “bruised
body” (her own); and B15 was seen as “a fight with knives (her ex- husband had
threatened her repeatedly with knives).”
In contrast, her response to A13 did not directly relate to her past visual reality. She saw
this as a “Hand in water reaching for ground.” When her associations to this were
explored in the detailed inquiry, she recalled a recent nightmare as follows: “My exhusband came and called me a mother-fucking bitch. He stabbed me in the back, over
and over. Next, he took me to the water and held my head underneath. He left, but only
after he thought I had drowned. After that, in the dream, I reached for the ground and
pulled myself out.”
SIS images are similar to images used in art therapy, in that they enable the individual
to see them as an expression of externalization of the self, or the self as perceived by
others. For example, there can be a perceived fusion between a child, or the self as
child, and an abusive or controlling parent or authority figure.
A number of artists have been interested in dreams and have attempted to represent
dream imagery in their art. Leonardo Da Vinci sometimes slept holding a billiard ball in
his hand, poised over metal pail. As he slept, his grasp on the ball weakened and it
would fall into the pail, awakening him. Then, he would sketch what he saw in his
dream. This method was used by Da Vinci to stimulate and channel his creativity. If a
subject does not perceive an anatomical structure on an image, which generally elicits
one (see response profile), it may be interpreted that the patient is denying physical
discomfort and has low awareness. He might be having deep-rooted problems with
that part of the body or organ.
Emphasis or sexual avoidance of a structure may suggest conflict in that area. Emphasis
on eyes, ears, or hair may suggest paranoid ideation. A higher conformity to Most
Typical responses may suggest that the patient or client have group conformity in his/
her thought process. High scores on the four Pathological Scales may suggest pathology
in the respective area. The greater the percentage of Atypical responses, the deeper
the pathology.
Rejection of Images
It is equally important to understand why a person is unable to perceive on a particular
image. Each image is created to depict a particular area, hence rejection of such
images have lot of clinical significance. Interpretation in detail is given in chapter-7.
Since these inkblots are highly structured - in the absence of any organic pathologyinability to perceive a particular blot can be highly clinically significant. It may help, in
understanding his reactions to different situations presented through inkblot imagery.
The avoidance of such images may further be probed to understand the unconscious
process. Though responses to different images are quite relevant to understand the
personality of the subject but the rejection of images may be equally relevant and may
help in peeping through the inner self of the subject. Because of such relevance
rejection of images have been given much importance while interpreting SIS protocol
of a subject.
When a person is unable to perceive images in a concrete form, it can be taken as
rejection. It has been noticed that people reject images, which depict certain precept
related to their traumatised experience or underlying painful memory. For example a
person having poor interpersonal relationship may reject images A7, A9, A31, B4, B5,
B31, because these images project human content. Poor interpersonal relationship
with spouse may also lead to rejection of images A7, A25, A27, & B18. Images like A25,
A27, & B18 project more of erotic content. Since this area is disturbed because of poor
relationship, people (he/she) may not feel like responding anything on these images.
Similarly, it has been noticed on clinical sample of cardiac cases that persons suffering
from heart problems rejects images depicting a heart - for example images A5, A18,
B17, & B19. A few patients who have recovered and have accepted their clinical
problems bravely do perceive ‘a heart’ on these images. It suggests that they have no
fear regarding their heart as they have been properly counselled. Persons suffering
from body ailments, for example Kidney problems generally reject images A20 & B9,
which depict Kidneys. It has also been noticed that females traumatised sexually find it
difficult to perceive image A22, A23, & B18, which generally project spinal column and
male genitalia. The symbolic meaning of these images may relate to male sex organs.
Since these persons have undergone traumatising experience and have unpleasant
memories of the precept, they may find it difficult to see anything on these images. Even
if they perceive something, often they give poor quality responses and attach a special
meaning to it. For example: an educated female patient responded to images B18 as
“ejaculating penis which I do not like” suggests her own suffering due to the unfortunate incident of rape and the trauma which she had for two months particularly the fear of getting pregnant. Another patient who experienced an unpleasant sexual harassment perceived “A deadly android more like a creepy insect.”
The person with a broken heart (broken love affair) may see image B19 as two hearts
of two persons particularly male & female are separated by social forces/ pressure.
Such people may perceive two arguing male & female on A31 or a sad crying person
on image A10 or B28.
People in need of help from others may perceive a “helping hand” on image A13.
Difficult childhood and a feeling of separation may be projected by rejection of image
A6 or the inability to perceive a “teddy bear”. A feeling of separation from the mother
may lead to rejection of image “B28”.
It should be kept in mind that the material, which follows need to be, assimilated by the
experienced clinician with the overall medical and psychiatric history data. Even certain
contents from dreams and visual hallucinations may be included.
There are two types of interpretation of SIS responses - Clinical and Research. Whenever
a protocol is to be interpreted for clinical purposes, interpretation of the images is
essential. Whenever interpretation is required for research purposes, the total number
of responses, percentages for Movement responses, Animal responses, Anatomical
responses, Sex responses and Rejection of images need to be determined. The number
of Atypical responses, Most Typical responses and Pathological responses is equally
essential.