Interpretation and Application of SIS Responses

The SIS employs mainly two methods of interpretation:

1. Quantitative Analysis

2. Content Analysis

1. Quantitative Analysis: Analysis of various indices, such as total number of responses

to images, number of human, anatomical, sex, and animal content; most typical, typical,

atypical responses, movement and four categories of pathological responses have

been created. These were established for evaluating a series of mental constructs in

various normal and clinical groups. If the number of atypical responses and the rejection

index, along with the total pathological score becomes elevated, then the prognosis is

estimated to be more guarded.

2. Content Analysis: Content analysis is given more emphasis in interpretation since

it frequently helps to bring out the unprocessed unconscious material. What is seen

through the response profile, along with the affect linkage, may have direct or symbolic

significance either in the present or in the viewer’s past. It is quite analogous to assessing

such material as the in-depth study of dreams. While the professional’s own theoretical

frame of reference will strongly influence the interpretative process, it is the authors,

viewpoint that in most clinical therapeutic situations, content analysis for any given

individual is a richer approach. This manual combines Medical, Psychological and

Spiritual Application of SIS Images and Psychoanalytic Interpretation/ Content

analysis of responses for clinical case illustrations.

Medical, Psychological and Spiritual Application of the SIS Inkblots :

Health professionals interested in training need not have formal credentials in

psychology. While a background with any of the existing projective therapies facilitates

the learning process, it is not essential. The SIS represents structured interviewing with

what were originally referred to as somatic inkblots because of their high degree of

anatomical resemblance. With the addition of new stimuli and modern forms of electronic

presentation, these now range from those comparable in their vagueness to the

Rorschach at one extreme to those at the opposite pole resembling pictures in the

Thematic Apperception Test.

The SIS was originally conceived in 1959 in a medical research setting at the upstate

Medical Center in Syracuse, New York during a study of body image disturbances of

women with hirsutism. This led to the investigation of how physical symptoms were

subjectively experienced (Hollender & Cassell, 1972). To more effectively study body

awareness, inkblots with a high degree of somatic structure were designed. Pathological,

anatomical responses provided a scientific method for understanding the subjective

experience of illness. (Cassell, 1965, 1972, 1980; Adamson et al, 1977). A number of

investigators have employed the SIS in evaluating patients with medical conditions

e.g. coronary artery disease (Cassell, 1984, Rathee et al, 1994) and AIDS (Gaetani et

al, 1995).

This projective procedure has also been employed in a number of psychiatric studies

(Gaetani et al, 1995, Rathee et al, 1995, Mishra, 1996, Dwivedi et al, 1994, Cassell et

al, 1996), including one involving the use of sodium pentothal (Saldanha & Dubey,

1995). It has also been shown to be useful in assessing the personality profiles of those

suffering from chemical dependency problems (Singh et al, 1996,1997, Mukhopadhyay

et al, 1996). A recently developed version of the SIS includes inkblots with structure

resembling the traumatic events experienced by such addicted patients and their

families.

Apart from the above applications, there are also a number of psychological uses. After

much field testing of new stimuli, non-anatomical ambiguous structure was added to

the inkblot series in order to assess other issues of clinical and developmental

significance. Examples follow: Image B5 depicts two people sitting down talking to

each other. Much can be learned about how the patient views treatment - when for

example it is suggested that the scene depict a doctor explaining about the use of

antidepressant medication. Issues of future non-compliance may be identified, that

may not have been evident through direct questioning.(e.g. “the man in the video

would not follow the doctor’s advice”).

In regard to the stimulation of images having spiritual connotations, there are also a

number of applications. For example, in working with Christians, Image A3 can evoke

imagery of Jesus on the cross. In terms of negative spirituality, which has been shown

to be detrimental to health, other inkblots can stimulate awareness of satanic imagery.

An example of one inkblot that can evoke trust and the ability to engage in psychological

intimacy during nurturing medical and nursing care is image B28, which portrays “a

loving mother hugging a child”. A patient, who fails to detect this embedded material,

may be highly dependent and difficult to manage in a treatment setting. There may be

an unconscious desire to retain the sick role in order to obtain nurturing which was

never received in childhood. There are many other applications, which will be

subsequently reviewed.

Professionals with a variety of theoretical backgrounds have been trained in this

approach. In analysing responses, while psychometric indices are available,

interpretation in most clinical setting largely relies on content analysis. The diagnostician

can learn much by assuming that the projected material relates either directly or

symbolically to the viewer or a loved one. Sometimes what is not seen in the embedded

structure for a particular inkblot may have more clinical significance than that which is

actually reported. Responders suffering from conversion disorder characteristically

avoid reference to anatomical structure depicting the painful region and this has been

referred to as “somatic repression” (Cassell, 1980). Work with severely traumatised

68 Interpretation

individuals suggests that the self-administered video version of the SIS can function as

a type of electronic time machine. It employs beautiful mountains, mesmerising flowers

and a sound track with instructions to relax so-like in hypnotherapy - the viewer may go

back in time to earlier stressful periods. In these conditions the flow of projected

responses may approximate imagery originally present in long forgotten nightmares.

This pictorial stream provides the disturbing material in consciousness, which is

eventually projected as SIS responses. At times, the viewing procedure gives much

cathartic relief - a form of therapy in itself (Cassell, 1995, 1996, 2001,2002).

Certain responses have special significance to physicians working with patients

experiencing death anxiety (Cassell, 1979). It is also useful as a releasing trigger in

the management of delayed grief reactions (Cassell and Dubey, 1996). Therapists with

a religious orientation are much more effective in comforting such people than those

who avoid the discussion of spirituality or who are atheists. The latter need to refer such

patients to those who are experienced in working therapeutically within the systems of

religious beliefs. Otherwise, it represents a form of spiritual malpractice. It is imperative

to support and not undermine the faith of an individual. For example, in treating

Christians, it is essential to reinforce the Easter message of hope.

Because of the common use of symbolism, training with SIS can provide insights into

dream interpretation. In regard to significance of dreams, Barrett (l996) summarised

the diverse literature as follows: According to the poet Elias Canetti, “All the things one

has forgotten scream for help in dreams.” To the ancient Egyptians they were prophecies,

and in world folklore they have often marked visitations from the dead. For Freud they

were expressions of “wishfulfilment” and for Jung, symbolic representations of mythical

archetypes. Although there is still much disagreement about the significance and

function of dreams, they seem to serve as a barometer of current mind and body

states”.

This latter statement has particular relevance in understanding the striking parallel

between post-traumatic dreams, visual hallucinations and SIS responses. It is

hypothesised that the visual cortex is episodically excited with neural impulses during

sleep - much the way a computer monitor screen saver program functions. Certain of

these are derived from peripheral body sensations; others from memory storage sites.

The individual senses these as cerebral excitations having the vague color - movement

- form characteristics of the electronic versions of the SIS inkblots. The dreamer’s

psyche then projects images onto these brain sensory patterns. Many of these simply

reflect residual from the stimulation received earlier in the day. What is seen has little

meaning except according to Crick and Mitchison (1983) as “reverse learning” designed

to remove the overloads of “neural garbage” from the brain.

However, others may have considerable proprioceptive emotional and cognitive

significance. For examples, when the dreamer envisions a personal scene of urinating

the imagery reflects accentuated proprioceptive stimulation from a full bladder, which

then may be interpreted consciously as a warning to get up and go to the bathroom.

When the dreamer’s mind attempts to interpret the brain’s neural excitations, scenes of

a recent stressful life event-for example having been injured in an accident-the subjective

interpretation of the cerebral sensory input continues to be strongly influenced by

processes of psyche projection and a number of additional factors. These include

perseverating recent memory engrams of visual, auditory and pain sensations

experienced at the time of the trauma. When these are correlated in time and space- by

Pavlovian conditioning-with the traumatic events of a particular day in the year, the

neural memory basis are laid down for subsequent anniversary reactions. Research

measuring relative regional blood flow during activation of traumatic imagery suggests

that the ventral anterior cingulate gyrus and right amygdala may be brain sites for such

memory storage (Shin et al, 1997).

For those suffering from post-traumatic stress disorder, in sleep a type of behavioural

therapy induces homeostatic healing naturally in the central nervous system by the

association of the traumatic imagery with a state of relaxation. With the SIS a similar

desensitisation (Cassell, 1977) occurs when the stressful images are immediately

followed by flowers and nature scenes designed to reduce anxiety.

Guidelines for interpretation of SIS responses

Anatomy responses depicting pathology may reflect fears of imaginary illness or

represent subjective perceptions of actual physical disease (Adamson, Greengrass

and Martin 1977, Brady, 1995). An example of the former is an apparently healthy

individual who smokes heavily and consequently projects fears of developing cancer

in envisioning A20 as “cancerous lungs”. Eventually, that individual might succumb to

the carcinogenic effects of tobacco and then perceive “a tumour blocking breathing”.

Questioning about the significance of the latter response could lead to a therapeutically

meaningful exploration of the physical pain, subjective suffering and concerns about

dying.

Projected anatomy responses depicting “a broken heart” or “a sad face ”may symbolically

signify depression and underlying suicidal ideation even though the responder may

avoid reference to such painful affect upon direct questioning. The psychological

defence mechanism of denial is commonly employed when the individual fears body

disintegration or realises that a loved one is dying. The SIS was originally proven to be

an aid in getting around denial in order to release grief in therapy. Older individuals

may deny that they are preoccupied with imminent death yet project anatomical

responses symbolising this anxiety (Cassell, 1980). Because of the all-pervasive nature

of such concerns in the seriously ill, a number of SIS inkblots were specifically designed

to facilitate therapeutic exploration of death concerns.

70 Interpretation

Another way the SIS explores this area involves the use of cards having embedded

structure capable of evoking highly threatening imagery. Certain of the blots resemble

what children perceive in their dreams as “ monsters”. For example, Card 18 may

suggest a demon- like monster with sharp teeth. While some clinicians may choose to

ignore childhood nightmares- because they are so common - the projective use of the

SIS can uncover areas of undetected trauma crying out for therapeutic processing.

Rejection of SIS Images

In evaluating prognosis, one of the most important SIS indices quantifies the number of

rejections. Since these inkblots are highly structured- in the absence of organic brain

disease- failure to respond to a particular blot can be quite revealing. It can be helpful

to understand the viewer’s interpersonal interactions to observe the interaction of the

human figures that are perceived in the inkblots (Lerner, 1991). The avoidance of

human content may reflect a lack of interest or discomfort in relating to people.

Difficulty in detecting the anatomical structure may suggest a detachment from body

experiences and reduced awareness of emotionally cued body sensations. Individuals

with a high somatic rejection index may manifest an inability to introspect. In regard to

perceiving others they may lack empathy. Such people have considerable difficulty in

focusing in on their own internal sensations associated with increase in heart rate and

changes in gastric motility at times of intimate arousal. These mind- body connections

begin to be laid down early in life when the infant associates the warm gastrointestinal

sensations of feeding with images of the mother’s body. Failure to experience nurturing

from parental figures in childhood leads to developmentally impoverished people. Just

like animals that are reared without maternal contact, these fail to develop neural

connections to their peripheral autonomic system. As adults they are resistant to

entering close loving human relationships. Sadly enough, such concrete thinking

individuals are unable to accept or express love. Sensing their lack of internal

physiologic reactivity, they may report feeling, “empty or hollow inside.”

Just like their inability to respond to the SIS inkblots maturely , they have great difficulty

projecting positive feelings onto images of spirituality. For example, in the Christian

religion , a central concept involves the trinity of the Holy Spirit, God and Jesus Christ.

The first two refer to loving spirituality in the absence of visual imagery. When people

think about God, they usually project human characteristics and ordinarily consider

him to have a masculine sexual identity. While no one has seen Jesus in our century,

there are a number of artistic representations on his physical appearance. In addition,

there are religious symbols depicting his life and crucifixion (i.e., the communion bread

representing his body and wine symbolising his blood). All of these images are

experienced with psychological principles of projection operating. Consequently, they

lend themselves to assessment with the SIS.

A case history will be outlined to illustrate the emptiness within the body image that

such a spiritually impoverished individual experiences. The patient came to therapy

because of a life long history of severe panic attacks and depression. He had

experienced his first panic attack in adolescence after waking from a dream with

terrifying death images. He was highly anxious experiencing psychophysiologic cardiac

symptoms (i.e. heart palpitations). These had been triggered by the nightmare and the

subsequent thought that someday he would die. Since he had no belief in God, he

commented, “it would be all over-there would be nothing more”. His panic attacks were

mentally associated with the obsessive phase going through his mind “0h!!!no!!!no!!!no!!!”.

To understand him better, certain observations about him might be helpful. He had

been raised in an alcoholic dysfunctional family. Only rarely had he experienced love

and then mainly at an oral phase of psychosexual development. Consistent with this

he was able to identify the breast anatomical content in Image A27. However, his

mother had not been especially nurturing beyond infancy, so he was unable to perceive

Image B28 as “a mother hugging a child”. Consequently as he matured he distanced

himself in interpersonal relationships. He also isolated himself from all internal body

sensations associated with the psychophysiology of mature love.

With regard to spirituality, as a youth he learned intellectually about the Christian

concepts of love. However, he blocked the positive affective component from his own

heart sensations. As a psychological defensive measure to isolate religious teaching,

he exaggerated the human frailties of various churches. With a cynical humour he cited

repeated instances of self righteous clergy claiming their members were “holy” while

labelling other congregations in the community as “evil”. He took particular glee in

describing his memories of “Holy Rollers” involving Christian sects that he had witnessed

rolling about the floor of a tent. The notion that religious services could evoke feeling of

ecstasy was beyond his scope of body consciousness.

When he was in his early twenties, he married. Eventually his wife gave birth to a

daughter. However, his emotional isolation continued and he was aloof from both. To

fill the emptiness in the vessel image of his body, he turned to the false sense of warmth

derived from psychophysiological stimulation with nicotine and alcohol. Ultimately, he

became divorced. Although his daughter tried unsuccessfully to emotionally reach out

to him, he defended against her attempts at intimacy by directing sarcastic humour at

her. Consequently, he remained essentially alone.

Later in life, as a result of heavy smoking, he developed emphysema. He also suffered

from “Essential Hypertension”. As his breathing became laboured, he became more

and more obsessed in the day time with ever more intense death fears. At night, more

terrifying symbols threatened him in dreams. Eventually he became angry at his family

physician and sought help elsewhere. When his health began to seriously deteriorate,

his daughter developed a psychotic depression. She could not deal with the imminent

loss of a father who was so emotionally remote. Both were atheists and resisted attempts

72 Interpretation

to discuss spiritual concepts or referral to a pastoral counsellor.

In responding to the 62-item SIS booklet, the lonely old man rejected 40 images. He

avoided reference to the human and anatomical content. This paralleled his subjective

blindness to positive affectual body sensations of love. For image A3 he projected his

own emptiness within the body gestalt with the response “A wolf peering out of a

hollow log from a fallen tree”. The symbolism is noteworthy in that in his social isolation

he identifies with the cultural myth of the lone wolf. The “hollow log” symbolises how he

perceives his own body with diminished positive affectual psychophysiologic sensations.

The response “fallen tree” denotes his fear of his body’s imminent death. Another

response symbolised how he masked his true feelings: Image A19 “It looks like a

human face with a mask”. Lastly, his anger about dying was directly projected in the

response for Image B10 as “an angry dog!”. No doubt his affectual disturbance played

both a role in his hypertension. Apart from his pulmonary problems, he was also at

higher risk for dying, in view of recent research indicating that coronary patients who

survive a myocardial infarction but who are depressed, are more prone to die than non

depressed ones.

SIS- II/Video Death Scene

When the 62 item SIS-II/Video was created, previous experience had indicated the

importance of having specific inkblot structure to symbolise death and dying. Image

B22 illustrated was specifically designed with this in mind. It depicts a dying person

lying down having ambiguous age, sex and race characteristics. In the video version,

the objects over the abdominal area move upward signifying to some “the spirit leaving

the dying person’s body”.

Certain clinical case studies might be of value. The first was a middle-aged woman

who was in long term treatment for affective illness. During the course of this, her

mother developed cerebral vascular disease and suffered from multiple strokes.

Eventually she lost all her faculties including bowel control. Not only was this highly

stressful to the daughter, it required extensive nursing care, since she cared for her at

home without professional help. When the mother eventually died, it was a blessing

but the grieving was difficult.

When the SIS was administered, Image B22 was seen to represent her mother’s dying

body with her spirit ascending. Afterwards, she had a healing spiritual dream: she

witnessed her mother getting out of bed wearing a beautiful nightgown. Her mother

expressed love and appreciation for all the care that she had received. She danced in

joy showing her restored health. It was interpreted as a reassuring spiritual visitation

from the mother. To interpret it as “wish fulfilment” would have totally undermined the

grieving process. The dream signalled the resolution of her depression. After this

message, during the day she was able to experience special psychic moments, the

loving spiritual presence of her mother.

Another clinically depressed Christian woman, with comparable response to Image

B22 and a history of also having lost her mother to chronic illness (cancer), experienced

an analogous series of healing images. These appeared during meditation when she

closed her eyes in communion at church. Her experience follows: “I saw heaven-a

place of gold, shimmering lights and “light”... lots of lights. I saw a banquet table

surrounded with lots of food and happy people. In the midst of this joyous scene sat my

mother. She was smiling and laughing with her new friends. Then I saw my mother and

me both clothed in white gowns as we danced with Jesus. What was my mother

saying? I believe that she wanted me to know that she’ll be there to greet me with open

arms when the gates of pearl open for me one day.” After this vision, her depression

rapidly resolved and she once more could feel joy.

A few additional case histories might be helpful. The first concerns a teen-age youth

that had been admitted to a psychiatric hospital for severe depression and suicidal

behaviour. In viewing the booklet, he envisioned Image B22 as the body of his father

who had shot himself five years earlier. His father had been a Vietnam veteran who had

suffered from post traumatic stress disorder and alcoholism after the war. He had been

highly abusive and the boy had never been able to effectively express his grief. Another

example was a woman who had found her husband’s body after he had shot himself.

The terrible traumatic imagery from eighteen months earlier had made her

psychologically numb. In the detailed inquiry, this numbness was dissolved and she

was able to process the trauma more emotionally and cognitively. Following this, she

became less depressed and more in touch with her emotions. Also, themes of her

deceased husband’s bleeding body faded from her post-traumatic dreams.

Sometimes, in highly resistant cases, a therapist may elect to use hypnotherapy to

release deeply buried or repressed grief. An example from South Africa involves a 31

year old widow who had not been able to grieve, following the murder of her husband

(Savage, 1995). Traditional psychotherapies failed. Ultimately, a treatment plan was

developed in which a hypnotic trance was induced during which she viewed the

booklet form of the 62 Image SIS. When she viewed Image B22, she was able to

release her pent-up emotions for the first time, as follows: “It is a graveyard. It lets me

think of my husband’s death. It is not right that he should be there! He did not die as he

should have - he was murdered and that is not right! It brings many questions to my

mind: Why him? Where was God? Why did God allow it? It is only people whom I love

that die!” This began the grieving process and opened the way for cognitive therapy to

correct her illogical thinking.

Hallucinations and Delayed Grief Reactions

In certain native-American cultures-especially for males-it is not socially acceptable to

show feelings of grief. These individuals are extremely reluctant to seek professional

help and are ordinarily not suitable candidates for traditional therapy procedures.

Adolescent natives have the highest rate of suicide in the United States. When these

74 Interpretation

present in severe states of depression with psychotic features such as hallucinations,

the beautiful nature scenes in the video version of SIS-II may be particularly useful.

One Alaska native teenage youth that required psychiatric hospitalisation illustrates

this phenomenon. He had been seriously playing Russian roulette with a revolver and

then tried to jump off the school’s roof. In responding to Image B22, he saw his uncle’s

body after it had been pulled from the river eight years earlier. The cause of the drowning

was unclear. It may have been an accident related to the consumption of alcohol, or it

could have been suicide.

For Image B18, he saw a graveyard scene of his uncle’s body being lowered into the

ground. With the emergence of this childhood death imagery into full conscious

awareness, he began to cry for the first time. It also provided insights into why, in his

psychotic depression, he had hallucinated his uncle calling him to join him in death.

Because he projected the graveyard scene over an SIS image with phallic content, for

the first time it alerted the treatment team to the possibility that his uncle had perpetrated

sexual abuse.

The second case to be reviewed involving hallucinations was a teen-aged girl who

was admitted to a psychiatric hospital with a psychotic depression with paranoid

ideation. She suffered from both suicidal and homicidal ideation. Several months earlier,

a younger sister who had a series of birth defects had died at surgery. She had suffered

extensively and her older sister was enraged at the surgeons and also irrationally

blamed herself. She was tormented by recurring nightmares. In these, a “shadow man”

threatened to kill her as punishment for allowing her little sister to die. During the day,

she was also terrified by similar images of him in the form of hallucinations. In both the

dreams and hallucinations, he was always dressed in black with penetrating green

eyes. Emphasis on eyes has been found with the SIS to relate to paranoid tendencies

(Bailey and Murstein, 1996, Savage, 1995).

After viewing the 62 image SIS II, she selected Image A17 as the most threatening. She

saw it to represent “two smiling fishes with a stolen heart. In the detailed inquiry, she

said that the “fish” were “hurting someone just for pleasure-like the shadow man in my

dream”. The parallel between her hallucinatory experiences and the SIS response

continued, when she described the second most threatening image, which was A30. It

resembled “a human skull waved by black”. This had a dual meaning. In the first

instance, it looked like the feared “shadow man”. Secondly, it was seen to depict her

sister’s “rotting head after death”.

In terms of spirituality, she felt that she was beyond hope because of not saving her

sister from the “evil murderous surgeons” towards whom she had homicidal thoughts.

Consistent with her hopelessness, image A21 was seen as “a raven with a heart so

heavy, it can not be thrown up to fly-even by angels”. Other responses relating to her

clinical state follow: Image A22 “A face with a screwdriver coming out of the skull-it

reminds me of killing my sister. I want to hurt or kill people just to make them feel pain

and suffer the way my sister did”, Image A23 “An angry groundhog looking for revengeit brings to mind the shadow man”, Image B12 “A muscle caught by a metal clamp like

the one they took from my sister’s leg”, Image B15 “Shards of glass and knives flying

out of fire- I hate the doctors”, Image B16 “a tarantula pulling it prey”. In obtaining

associations to this, she indicated that it reminded her of the “shadow man who is like

a tarantula jerking me around... he talks to me when I am awake... he tells me that I am

a murderer and killer... I need to die... I should put a knife through my heart... he wants

me to leave the knife there while my body rots... he calls me by my sister’s name... he

wants me to be her and to be like her in heaven, where I can have a life too”. These

responses were then used as a basis for the cognitive therapy to correct her delusional

thinking and to establish more appropriate reality testing.

Dream Programming

Another application of the video version of the SIS-II involves showing the video version

at night-time prior to sleep. This can stimulate therapeutic dreams in individuals suffering

from chronic depression illness dating back to losses sustained many years earlier

(Cassell and Dubey, 1997, 2000, 2001). One example involves a forty-year-old woman

who at age three witnessed her eighteen months old brother torn apart by an attacking

pack of dogs. As a child, she was never able to process this terrible trauma. In viewing

the video, for the first time in adult life she recalled long forgotten nightmares depicting

the horrible traumatic memories. When this material was subsequently reported, her

therapist first became aware of the need to therapeutically assist her with the loss.

Releasing Repressed Satanic Memories

Physicians and counsellors sometimes have to evaluate patients with histories of

physical, psychological and sexual abuse. In many areas of the United States with the

breakdown in the family and the high rates of drug related crimes this may involve

disturbed adolescents who become attracted to satanic cults. Their memories are

readily available for therapeutic processing.

By contrast, it may be adults who have no conscious recollection of childhood trauma,

which can in rare instances, involve organised cult activity. In extreme instances, such

individuals may suffer from serious dissociative disorders such as multiple personality.

Two examples will be reviewed of women who had features of this condition. Both

initially came for treatment when conversion pains syndromes led to drug seeking

behaviour with many doctors resulting in addiction to prescription medication. Each

had repeated psychiatric hospitalisations for dangerous suicidal and homicidal ideation.

There multiple personalities manifested themselves through different handwriting and

strange negative behaviours for which there was total amnesia.

The first case involved a middle age black woman. When she viewed the SIS video

76 Interpretation

images, she was highly threatened by Image A10 envisioned as “Satan looking back

at you through the mirror”. This projective response reflected her projecting her bad

personalities on to the inkblot’s human facial structure. These personalities

encompassed both threatening suicidal thoughts of self-destruction and homicidal

impulses towards her husband. These had never been verbalised directly to him but

revealed through the handwriting of her satanic personalities. Naturally, the notes he

found got his attention, making him aware of the serious implications of her illness.

The next most threatening projection was in relation to Image B19 seen to depict “the

end of the world”. This is consistent with the dire predictions of many fundamental

religious groups who are always predicting doomsday. She verbalised positive

attributes to this vision saying that at the end “Christ would come”. Another response,

which carried a high degree of disturbing affect, was given in relation to Image B15

“knives flying against someone up against the wall”. Detailed inquiry led to repressed childhood memories. When no adults were home, her older brother had chased her with a long meat knife and gestured at cutting her throat. Relating to her flashbacks and nightmares of past sexual abuse by her father, and marital rape type sex, many responses symbolised such horrible memories: Image A22 “A man’s hard penis ready to enter”, Image A24 “A vagina red and sore” image A28, “A naked man pulling off his shirt”, Image B18 “A man’s penis that wants action”, B24 “Man’s testicles”, Image A7 “Eve enticing Adam to eat the apple”. Finally, a series of responses related to the conflict in her personalities between good and evil: Image A2 “A creature from the War of The Worlds”, A18 “A heart of life surrounding an angel”, Image A31 “A man and woman yelling at each other!”, B2 “Two furry angels coming up from Hell”, Image B4 “A ghost with hollow eyes”, B12 “Someone hanging on a cross with life coming out of them”. In her intense suffering, she had the good aspects of her personalities positively identified with Jesus on the cross; Image B22 “A dead man’s soul rising to Heaven” and Image B25 “The angel of death”. With a version of the SIS called Living Images made by women artists to focus on feminine issues, certain of her responses denoted the splitting in her personality were projected as follows: “Two people becoming one trying to separate to get control again”

and “Tired of the battle to separate-getting weaker”. Others picked up the pain and

demonic imagery as follows: “A person being blown away-needless pain”, “the penis

of the devil” and “ Satan looking into my soul”.

The second woman had a similar history of incestuous trauma eventually acknowledged

by her father. What she did not report was that his own father had been trained in

satanic cult rituals prior to immigrating to this country from Eastern Europe. Initially,

when the granddaughter viewed the video version of the SIS, many responses related

to the past sexual trauma. However, one response was at the time unexplainable.

Image B24 was envisioned as “a burning baby”. Two years later after hypnotherapy

memories returned of participating in ritual sacrifice. The use of this SIS video facilitated

the evaluation process and the ultimate therapeutic reduction in her dissociative

symptoms.

Stimulating Christian Imagery

When the twenty card form of the SIS was first used in field trials, there was an unexpected

finding concerning the projection of Christian imagery in relation to one of the SIS

Inkblots. This was a card, which has anatomical content, which some responders see

as depicting the female genitalia. Remarkably enough, others who avoided the sexual

material saw religious symbols such as a “crucifix”, “a stained glass window” etc. One

interpretation was that they employed these symbols in defending against the sexual

material. This is analogous to how Christian teaching about morality may assist in

preventing the acting out of socially unacceptable sexual impulses.

In any case, when the new series of SIS inkblots were field tested on the Internet,

another inkblot was found to evoke Christian imagery (Image A3). These were not

considered to be defensive in nature, but rather a direct projection of what the inkblot

actually represents. Examples follow: “Christ ascendant”, “I see Christ on the cross

with his purple representing his royalty”, “Jesus Christ on the cross”, “A cross with rays

coming from the point where it crosses. It’s planted in the ground. See the roots? It

reminded me of Jesus’ death. I’m sad now”, “A bloodied cross such as the one that

Jesus was crucified on. It is wet and dripping and it is backgrounded by the lights of

Heaven”, “I see pain and suffering, but it is Jesus who is suffering for the great good of

many”, “Jesus dying on the cross”, “I see the crucifixion, the roots symbolise the tree of

eternal life and the yellow is the light of God shining down upon Christ” and “A cross,

the blood remains, but around it are vivid colours and light-perhaps symbolic of the

light offered by Christ’s sacrifice!” Other example of religious symbolism - some good

and others evil - follows. “Someone just died and their soul is just emerging from their

bloody body as an angel”, and “it looks like a cross with its roots in front of a stained

glass window”, “An errant angel ascending to Heaven”. This looks like an angel, maybe

it comes from deeper religious belief”. “A bleeding cross on a stained glass window”,

“A holy woman in front of a great light who is beckoning to me with either great sadness or great joy”, “A vagina or a cross” and “an angel trying to fly through a gap”. These responses show you how some of these inkblots may be used for stimulation purposes. Examples of satanic imagery follow: “l see Satan going up to take over heaven”, “Satan: he’s eating your soul raw with a sprinkle of garlic and a dab of honey. Hmm honey, I’m only three and half years old” and “If you look at it upside down it appears to be an ugly reindeer, covered in the blood of slaughtered elves, exploding from the bowels of Hell from whence Satan has expelled him for only wounding that pesky Santa, instead of bringing back his dismembered disloyal body to the Hell he(Santa) once called 78 Interpretation

home...(Satan speaking)” “Rudolph, how dare you offer me these petty corpses of

pathetic elves. Bring me Malladeigo... I mean, Santa Clause!!”.

Finally it might be of interest to note one Internet responder’s summary comments as

follows: “l have read a lot of very strange ideas here. Blood and gore seems to hold a

fascination for many. Flowers, birds and religion seem to be the lead. Initially I could

see about nine splotches of colour smeared about in a vague symmetrical layout.

Second impression was that of Christ hanging on the cross with a stained glass window

effect in the background. “As far as some body’s privates, you gotta be sick!”

The use of the SIS to stimulate religious imagery is a fascinating new area of

investigation. Research on this could have much relevance for learning about spiritual

imagery. Interested readers may review the overall responses evoked on the Internet

by visiting SIS web site at http: //www.somaticinkblots.com.

As another example, therapists can better learn to interpret the language of body

symbolism during grieving (Cassell and Dubey, 1996, 2000). When the grief stricken

individual complains about a heavy sensation in the chest (e.g. “a broken heart”), the

empathetic listener may interpret this for the sadness that it represents, rather than as

a symptom of physical illness. The trained listener will be able to understand it as the

symbolic communication of emptiness-resulting from a loss of the joyful

psychophysiologic sensations stimulated by imagery of a loved one. Given this insight,

they will then be more knowledgeable about how to therapeutically introduce loving

spirituality to fill the inner void in the body gestalt. For Christians, actively imaging

Jesus through visual aids and meditation can effectively restore sensations of love and

fill the empty heart. Adherents of other religions will achieve similar health benefits,

although the imagery will necessarily be different. For example Hindus can visualise

Krishna or Shiva, Buddhists the goddess Kuan Yin, Muslims the Holy city of Mecca etc.

These changes in body awareness can reduce somatic suffering until imagery from

dreams meditation and other spiritual experiences restore the broken love bond. This

is highly important during the early stages of grieving. It is also critical at anniversaries

of times of loss. (Cassell et al, 1999, 2001, 2002).

Another application of the SIS involves educating trainees concerning the many

parallels between what a particular individual envisions in an inkblot and what that

same person projects onto spirituality. Courses can include studies using the inkblots

to educate about how subjective perception operates under a variety of circumstances.

For example, this can apply to understanding how different readers perceive scripture

differently. They may acquire better insights into conflicts concerning the meaning of

ambiguous religious writings. Those clinicians and clergy who become educated may

be more adept at bringing cult members who have been brainwashed by a demonic

leader back to reality. At the time of writing, the news media are currently flooded with

reports about the “Heavens Gate Cult” in California. As an extreme response to celibacy,

one third of the men were castrated. These fanatics committed mass suicide because

their deluded leader convinced them that the Hale-Bopp comet was being followed by

a space ship which would take them to heaven.

Those entering the healing fields need guidance on how God gives guidance and

healing through the media of dreams. When a grieving person has dream imagery of

a diseased loved one appearing healthy, the therapist needs to support the faithful’s

belief that this is a spiritual visitation. It is abusive for an atheist analyst to interpret this

in some analytic jargon such as “wish fulfilment”. For Christians, there is also the

central need to identify with imagery of Jesus, which can be stimulated by SIS viewing.

Another application involves the use of the SIS as a screening procedure in assessing

applicants for the health sciences and clergy. It also can be used to assist in the study

of occupational stress or burnout in these highly stressful vocations. In an earlier

section, it was observed that the responses given by the volunteers revealed a modest

level of psychological distress. These fields require individuals who can be earthly

transmitters of loving spirituality, yet they must empathetically bear the heavy burden of

suffering. They need to realise their own human limitations in order to retain realistic

sized egos, even when placed upon pedestals. Many of the inkblots with human

characteristics can access this level of functioning. Similarly, the anatomical structure

can evaluate sexuality. Prospective trainees who are vulnerable to boundary or counter

transference issues can be identified early in their careers. They may be referred for

personal therapy prior to acting out their problems. Boundary issues will always require

special attention. Unfortunately, in some religious settings there has been much

confusion between sexuality and interpersonal spiritual intimacy. Whatever one’s

personal views about celibacy, prospective clerics in the Roman Catholic church have

to struggle with this issue. Given rare but highly publicised sexual abuse tragedies, it

would seem that traditional methods of assessment have not been especially effective

in screening out perpetrators (i.e. pedophiliacs).

Certain of the inkblots access erotically perverse satanic forces. This area of assessment

has particular clinical relevance in the evaluation of victims of abuse. In the Living

Images Series for women, a few of the inkblots were designed specifically to evaluate

dissociation by presenting outlines of the body, which depict splitting. The cases

reviewed represented examples of this reaction to sexual trauma. It is suggested that

the SIS approaches may be used as a projective technique in association with structured

interviews (Gould et al, 1996, Pelcovitz et al, 1997) to better evaluate at a

multidimensional level, reactions to extreme stress. They also may be effectively

employed to supplement questioned at assessing death anxiety (Cella & Tross, 1987).

Commonly, clinicians encounter patients with a lesser degree of dissociative illness.

These may suffer from pain in the absence of detectable physical illness. The use of the

SIS may enable trained professionals to give projective data- derived consultations

regarding the diagnostic significance of such “hysterical” somatic symptoms. Similarly,

80 Interpretation

the inkblot information may be useful in identifying depressive symptoms, which are

denied but symbolically projected. The latter can be of value the decision whether to

use antidepressant medication. The clergy can acquire skills to better assist suffering

people who withdraw from loving spirituality and destructively project evil onto

themselves, their families, their physicians and other health care providers as well as

religious support systems.

Other applications concern the growing number of healing benefits that can come from

the mesmerising aspects of the SIS video. As previously indicated the mountain and

floral scenes produce an altered state of awareness. This can approximate the trance

experiences that some American native religious leaders induce through religious

rituals incorporating spirituality with all aspects of nature. Alaskan natives now have

incredibly high rates of alcoholism, dysfunctional families and elevated morbidity and

mortality scores. Some native leaders now trace these problems to the decline in their

culture secondary to the deleterious impact of Christian missionaries. These wellmeaning clergy preached that it was a sin for the shamans to pass on ancient myths

and legends. Native dancing was also frowned on. It is entirely possible that in the

absence of their spiritual energy system, the natives may be more vulnerable to their

many health problems.

It is also relevant that investigators and clinicians have provided cross-cultural insights.

In Japan, therapists quickly recognised the therapeutic power of electronically

associating traumatic SIS imagery with natural beauty (Cassell, 1991). The mystical

arts of Shinto and Buddhist religions induce spiritual effects by creating environment

replete with natural and artistic beauty. Consistent with the healing power of flowers

and projective technique, two videotapes have been produced; “A Walk Through the

Garden of Life” and “Fantasy Flowers” to reduce anxiety prior to medical, dental and

surgical procedures.

Research has flourished in India where there is a vast heritage and sophistication

concerning the ability of meditation to positively alter physiologic function. World-wide

experience suggests that a promising area of future investigation concern exploring

how that the SIS approaches can effectively bridge physical-psychological-spiritual

dimensions. When appropriately integrated with modern medical and surgical therapies,

this promises to play a role in enhancing the profound healing powers of spirituality.

Stimulus Plate SIT-12: Visceral Tension / Headache & Autonomic Locus

The case of Mr. X. is described in detail in chapter-6. This detailed interpretation may

help clinicians to learn the system in practice. A much shorter report is sufficient to

understand the psychopathology of the patient and to communicate case information

to any referring agency for their case management.

Mr. X. a 35-year-old man was tested in India on June 5, 1990. He reported that he

recently had a throat infection, but his main problem was stuttering. He denied having

any pain, although he reported that since 1975 he had been feeling sensations of

abnormal pressure in his head.

Least Liked Images

In reviewing his responses to the Somatic Inkblot Series, A24 was found to be the least

liked. Instead of seeing material related to the female pelvis, he saw “a monster

kidnapping two children - someone’s having a bad dream”. Here he avoids reference

to the female pelvis, and substitutes the very threatening image material of the

kidnapping of children. This material shows age regression and trauma, which are

characteristics of children’s dreams. The source of symbolism needs further evaluation.

It might be noted that in Rorschach procedure, he gave several responses depicting

aggression. These responses were consistent with his SIS scores and his long term

conflicting relationship with his mother.

The second least liked image was B10. In B10, he again overlooked an image depicting

female pelvic content and saw “a very strange looking dog - something frightening

about it”. Again the symbolic defense that he uses in defending against the female

pelvic area is highly threatening. Since this time it is a dog. It is consistent with his

perception of women being threatening. Since his relationship with his wife, at least on

the surface, appears relatively normal, it would seem that this reflects some degree of

threat in terms of a woman’s body, which relates to his long-term conflict with his

mother.

The very last image that was threatening was B28. On B28, he saw “a very evil-looking

thing - seems like a cross between a man and a dog”. He said that he found this

threatening because the figure has “a very evil presence”. It may be recalled that the

normal response here is a loving image of a woman holding her child. Again, the

patient cannot see this because of his long-term conflict with his mother. He uses the

symbolic defenses of a man and again, a dog. Unable to see the shape of a woman, he

changes it to a man, and then instead of seeing a child, he sees a dog. The evil

connotation comes through because, at some level, he does recognize the image as

his mother’s. He senses and associates a negative feeling, interpreting the image as

“evil”, because he did not get satisfactory nurturing from her as a child, and because of present, long standing feelings of anger towards her. The Most Liked Images B5 is the image he liked the most. He saw it as a “very happy scene”, reminding him of domestic bliss between a couple. This reflects his own happy marriage. It is remarkable, that in spite of the problems with his mother, and some deep-seated problems he has in the area of sexuality, he reports that his own marriage is okay. One wonders the validity of this report, but certainly his response to B5 is consistent with a happy and 82 Interpretation

harmonious marital relationship.

His second most favorite image was B29. He saw this “as a child coming from school”.

Many individuals see this as a man running, sometimes with a leg off. He sees this in a

regressive way, perhaps wishing for the happy childhood, which he never had. One

does not know from his history whether his early relationship with his mother was

positive or not, but he certainly wishes to regress to what he perceives as a happier

existence.

He saw B31 as “a very happy family”. Many individuals, in fact, do see it in this way.

Perhaps it is of some note that he didn’t refer to children. It may be that his own

childhood experience was not happy.

Description of Images in Order

A1. Was seen as “looks like an Arab lying in bed.” This is unremarkable, except that

a man in bed may be going along with what was noted in the Rorschach, which

was a high degree of sexual preoccupation, and it could have sexual connotations.

A2. He stated, “It reminds me of a heart with all the arteries and veins cut.” This is

somewhat unusual, in that it shows heightened cardiac symptoms. It is possible

that in states of anger and arousal, with his irritation, he was more conscious of

his heart beating.

A3. He could not give a response. This was rejected, which is somewhat unusual.

A4. Was seen as “ a funny-looking flower.” This is remarkable.

A5. Was seen as “a very happy, though ugly person.” This shows a capacity for

gestalt, and the fact that it projects happiness is consistent with his own overall

happiness, in spite of his stammering. The theme of evil and ugliness does project

through. The ugliness reflects his conflict at home with his mother.

A6. Was seen as “a woman in her child’s room.” This is somewhat unusual, and may

reflect a wish for that. It is not consistent with the fact that in B28 he avoided

reference to the maternal-child content. It’s also possible that the woman in the

child’s room could reflect some conflict with his mother on a sexual level, which

may have occurred in childhood. This makes sense. In view of his sexual

preoccupation, he has been threatened by mother-child images.

A7. Was “Eve looking at the apple.” This is unremarkable, although the symbol Eve

does get at the thought of sexuality, which is conflicting and may reflect certain

Oedipal, issues involving himself and his mother.

A8. Was seen as “a naked man with a crooked smile.” This is probably not remarkable.

A9. Was seen as “a man and woman exchanging sweet nothings.” This is a good

response and probably relates to his happy marital situation.

A10. Was seen as “a woman in the front seat of a car, and man in the back seat. The

woman is crying.” Here this is seen as being emotionally upset. It’s interesting

that no further association comes to mind. What he has reported so far has

reflected a happy, harmonious marriage, or it could refer back to his mother’s

troubled mental state.

A11. Was seen as “a couple making love.” Instead of seeing nasal content, he projected

a theme of sexuality and intercourse, which is again consistent with his Rorschach

material. It is not consistent with what he reports in the clinical interview, that all is

well sexually in his marriage. His response shows a heightened preoccupation

with sexuality.

A12. Was seen as “an earlobe.” This is a normal response.

A13. Was seen as “someone asking for the help with his hand.” Assuming that this is

good because he probably identifies with the person asking for help. It also

states his motivation to receive therapy.

A14. Was seen as “a child asleep on the floor by the side of a statue.” Here, instead of

picking up something related to the stomach, he introduces somewhat regressive

material. This again may go back to his need for the nurturing that he never

received from his mother.

A15. Was seen as “a kidney, or it could also be fetus.” Both are unremarkable.

A16. Was seen as “two fish caught in the same hook.” Here he avoids reference to the

anatomical content in the image, and sees fish on a hook. This may be suggestive

of his traumatic experience when his mother, who incorrectly suspected sexual

play, beat him and his cousin.

A17. “A woman looking at herself in the mirror. She has a big heart.” This shows a

heightened awareness of a family image. Also his emphasis on a big heart is

consistent with the heightened cardiac awareness noted in A2. Who the woman

is, needs to be evaluated. Does she represent his wife, his mother, etc.?

A18. “The female genitalia.” This in itself is not a remarkable response, but it is consistent

with his heightened sexual imagery, as noted with the Rorschach.

A19. “A diagrammatic view of the human body with intestines clearly seen.” This is a

normal response.

A20. Was seen as “the kidneys, bladder and penis.” This is a normal response, except

that it looks like the human excretory system, which is an unusual response. It

may reflect a type of perseveration from A19, or some unusual pre-occupation

with his bowels.

84 Interpretation

A21. “It looks like a very large man dancing on one foot with his children.” Probably an

unremarkable response, except that if one is going to see children here, it would

perhaps be more usual to see maternal imagery, but this is equivocal.

A22. Was seen as “trachea and lungs - it could also be a man with a very long nose.”

This is somewhat unusual. He correctly picks up the anatomical structure in the

inkblot, but because the threat of the phallic material comes through displaced in

the safer image of a “very long nose.”

A23. Was seen as “a vertebral column or perhaps a millipede.” This is a normal

response.

A24. Was previously commented on.

A25. Was seen as “a vagina.” A normal response.

A26. Was seen as “an unborn baby curled up.” A normal response.

A27. Was seen as “a woman’s breasts swollen with milk.” Whom she is feeding is not

clear. Here, in a regressive fashion, he wishes for a nurturing relationship with his

mother, which he never had. On Rorschach Card 1, the second response was “a

breast with a nipple.” This again reflects a wish for the nurturing he presumably

never had, or he wants to go back to that stage of his life.

A28. Was seen as “a shapely woman trapped in a test tube.” Here, the return to the

eroticism occurs. He avoids reference to the male thigh. The woman trapped in a

test tube may reflect his being trapped in a test tube, or it may reflect some erotic

relationship between him and his mother, where feelings have not been

expressed.

A29. Was seen as “ looks like an evil thing straight out of a horror film.” He is capable

of having evil and horrifying thoughts and fantasies. These go back to the horror

of his relationship with his mother.

A30. Was seen as “a skeletal skull.” This is not remarkable.

A31. Was seen as “a boy and girl talking to each other. Something serious is the

matter.” In this image, he sees conflict in the relationship. It is interesting that he

sees a boy and girl, instead of a man and woman. This has regressive connotations

and shows his projection of conflict between males and females.

B1. Was rejected.

B2. Was seen as “ a top view of a man lying on his stomach.” This is unusual. The

image of a man lying on stomach is seen in A20, the human excretory system.

This may indicate some sexual trauma he had experienced at some time.

B3. Was seen as “a ghostly face seen through a broken window.” Again, this reflects

some material from the past that’s threatening to him. It may elicit some paranoid

feeling he has, or he might be concerned about what the SIS is bringing up in his

consciousness, and the fear that the clinician will see some of that material.

B5. Was seen as “a very happy scene.” This reminds me of the domestic bliss between

a couple that was commented on previously.

B6. He stated that “seems like a woman suffering from venereal disease”. It continues

perseveration of the theme of sexuality, through the idea of venereal disease.

Whether he has been faithful to his wife or there are problems or fears in the area

of his sexuality, needs to be explored.

B7. Was seen as “a fly with a crushed insect stuck to his sides.” This response is

consistent with the theme of aggression and violence.

B8. Was seen as “a full moon.” “It reminds me of a lady wearing a funny hat holding

something in her hand. It also looks like the profile of a nose.” This response is

significant, because it look him awhile to ultimately see the nose. Prior to this he

sees the image of a woman. Again, what is accounting for the fact that he

consistently sees the image of females when typical responses are image of

males?

B9. Was seen as “kidneys again.” Unremarkable.

B10. This was previously described.

blouse, or a jacket. He may well have some sort of feminine identification in his

body image. Even though he didn’t get nuturing from his mother, he may have

identified with her in an aggressor type of way.

B12. “A man in anguish,” was his comment. Many people see this as such, but it

certainly fits him. He is stammering because of strong inner conflict and emotional

feelings that he can not express either to himself or to others.

B13. “A cottage by the moonlight,” was his comment. This is unremarkable.

B14. “Dark in a power outage,” was his comment. This is unremarkable.

B15. “Mountains being spoiled by pollution,” was his comment. It is probably

unremarkable. He doesn’t see anything aggressive, such as knives in it. He is not

a person who is aware of strong aggressive feelings. He is not likely to harm

himself or others. Yet, there may be lot of inner aggression that he has repressed

along with his sexuality.

B16. “A pregnant millipede trapped in a test tube,” was his response. This is a most

unusual response. Instead of seeing the spinal content, he sees a female organism

that is pregnant. His Rorschach and SIS responses have previously emphasized

86 Interpretation

both the issue of pregnancy and the female imagery. This is his second reference

to a woman being trapped in a test tube. The first was in A28. It may be that at

some level, the feminine psychology within him is not being expressed. Perhaps

it is trapped inside him, symbolically, in a test tube. It may be part of his stammering

problem. If he could express and deal with his feminine psychology and come to

terms with his mother, he would be able to speak better.

B17. It is remarkable that he rejected the image even though it reflects the heart. It may

be recalled that previously, on A2 and on A17, he shows some heightened

cardiac awareness. Here he viewed as "something that looks like the heart" and

he avoids reference to it, this reflects perceptual inhibition. This may relate to

cardiac anxiety and psycho-physiological heart symptoms. Symbolically, the

mental representation of his heart is associated with anxiety.

B18. Was recognized as “the penis and the vagina.” This is unremarkable.

B19. Was recognized as “those creatures found at the bottom of the sea.” This is

unremarkable.

B20. Was recognized as ”the human brain.” This is unremarkable.

B21. Was recognized as “a pistol and its barrel has burst.” Seeing a pistol is a usual

response. Seeing a pistol with a broken barrel picks up some concern about the

effects of expressing aggressive feelings. It may be that, years earlier, he did

verbalize aggressive feeling to his mother, and as a result she stopped talking to

him, and this has been a major trauma to him. We also know that he was traumatized

when his mother falsely accused him of early sexual behavior with a female

relative. This probably was done in a very aggressive way.

B22. Was recognized as “a dead woman lying on the floor.” This is a most unusual

response. He may be projecting his feminine body image, or in a deeper way, it

may reflect repressed homicidal feelings towards his mother.

B23. He saw “ cancer.” Here, again, it is remarkable that he avoided any reference to

the chest content and simply saw “cancer.” This is a pathological anatomical

response. At this instance, it is not venereal disease, but cancer. He may have

some feelings of depression and sadness, or hypochondriacal concerns, which

are translated into fear of cancer. Of course, it may simply be that some relative

may have cancer, and that is his concern.

B24. He saw “a strange snake-like creature with two heads and a large bulging eye.”

Here, the emphasis on eyes is quite unusual, and shows a heightened awareness

of the eye. It reflects a paranoid feeling of being observed. It may be his sexual

conflicts coming to the surface, as shown from his response to B2, heightened

bowel awareness and a man lying on his stomach. There may also be some

latent homosexual issues related to the paranoia.

B25. He saw “a naked woman with thighs spread wide apart.” This continues the

theme of sexuality.

B26. His response “reminds me of female genitals.” This is a normal response.

B27. His response “embryos. One black and the other white.” This is a normal response.

B28. He viewed “A very evil looking thing, seems like a cross between a man and a

dog.” This suggests his aggression towards his mother. Psychoanalytically it

reveals hatred and aggression towards a woman, as generally people see “a

mother with a child” on this image.

B29. He saw “a child coming home from school.” This is again somewhat regressive.

B30. He saw “two earlobes.” This is unremarkable.

B31. He saw “a family.” This is a normal response.

Interpretation of SIS Responses on Re-Administration (After 10 sessions of

Hypnotherapy) :

His experience of chronic pressure in the head started with a conflict with his mother.

The pressure in his head reflects his own inner anguish and pain all of his built-up

feelings of aggression, hurt, and sexuality in regards to his mother; all that have been

in conscious awareness as a result the therapy provided by one of the author (Dubey),

he became more conscious of his inner feelings and eventually his physical symptoms

became less painful.

Those responses, which appear to be clinically relevant, in terms of, change after 2 nd

testing will be noted. After 10 sessions of psychotherapy, image A4 was seen as “a

woman about to hit some giant creature on the head”. Now he feels safe enough to

allow himself to see an image of a woman being aggressive and safe enough to allow

it to come into a higher level of consciousness. This shows that he is now handling the

abusive relationship involving conflict with his mother in a more acceptable way. It is

also consistent with his marked improvement.

The next image shows a change in response is A10. In the re-test situation, he sees it

as “a woman confessing before a priest”. The confessing woman is of interest, because

it may be an expression of working through of the mother son conflict. It’s as though a

type of confession has occurred between him and the therapist. Another interpretation

is that if this is his mother, there has been some confession or admission to him of guilt

on her part. Since therapy began, there has been minimal communication with his

mother. The mother and son are now somewhat closer.

A16 On re-administration was seen as “two birds singing a song“ rather than “two fish

caught in the same hook”. He was able to process his traumatic experience of

88 Interpretation

childhood, and now had normal perception on this image.

A17 was seen more appropriately as “a couple of sea-horses face to face” rather than

“a woman holding herself in the mirror with a big heart“. The reduction in the emphasis on the woman reflects a restoration of, and returns to, a more normal perception. As his relationship with his mother improves, he is less preoccupied with female imagery. A24 The next response, which is dramatically better, is A24. In this, he sees “three children sleeping together”. It is no longer like a bad dream. Through therapy he was able to process some of his trauma. The result is that he is less child-like and is not so pre-occupied with that type of trauma. A27 He sees “a child breast feeding”, which has helped him to come closer to his mother. A28 was seen as “a distorted female figure without head and legs”. There is still a persistence of female imagery, which is most unusual. This time, the female is no longer seen as “trapped”. The female part of him has been expressed in therapy, and he has also had a chance to talk about his conflict with his mother. The feelings are no longer trapped in a test tube. His speech is better because he doesn’t have to stammer in holding back this type of material. B1 it is interesting that for B1 he is able to give a response. Previously he was unable to do so. The response that has emerged is “a blood stain on a white handkerchief”. This is a pathological response, and it may reflect a theme of violence and aggression, but now he is more comfortable talking about them and his aggressive feelings. Previously, he was inhibited and felt like he had to repress those feelings. This is consistent with his improvement and reduction in stammering. One would also expect from his response that the feeling of pressure in his head would lessen. Clinically, this was the case. B2 Was seen as “a very untidily made keyhole”. The response here is much healthier than his original response of “a top view of a man lying on his stomach”. This second response does not have homosexual connotations. It does, however, continue the theme of paranoia, which may appear to him as “looking through a keyhole”. B3 His response to B3 is also less threatening. Instead of seeing it as “a ghostly face”, he see it as “two persons standing in a forest fire at night”. B6 Was seen as “mother and child“. This is a much healthier response than seeing “a woman with venereal disease”. Again, there has been significant improvement. B8 Was seen as “a spotlight illuminating the nose and cheeks of a man”. This is a very appropriate, sexual response. Now, he is identifying more with a masculine

role, and his therapist, in a positive way. The female aspect of him has been

expressed, so the preoccupation with maternal imagery is fading. The therapy

has been helpful.

B15 He recognized as “reminds me of war and disorder with bombers flying”. This is a

reflection of his increased awareness of his aggressive impulses and feelings.

This is a healthy response because he is now conscious of his feelings and

verbalized some of them in therapy. This has been good.

B17 This is the most interesting response. This time it reflects the pubic region of a

woman. No doubt, at some level of consciousness, this was what he saw in the

first viewing, but it was too threatening. Therapy has allowed this threatening

material of a sexual nature to come into full conscious awareness. Of course, the

response is still pathological, and still avoids reference to the heart. But, at least

he is dealing with this, and is feeling more comfortable.

B21 It is noteworthy that the pistol is still seen as having burst with B21. This shows

consistency with the first response.

B22 There is consistency in seeing a woman in B22, but this time it becomes “a

woman meditating”, rather than “a dead woman lying on the floor”. He no longer

has homicidal feelings towards his mother. These feelings have been resolved,

and the communication is now better.

B23 Was “reminds me of a crab”. This response is much more normal. He is not seeing

“cancer”, because he is feeling clinically better. Some of his bad feelings have been “gotten out”, and he is no longer hypochondriacal. B26 This is seen as “a leopard or a dog belching on the back of a chair”. For a man, this is a more normal response. Not seeing the female genitals here shows that he is working through his conflict with his mother, and therefore he is less preoccupied with sexuality. B27 This was interesting. He saw “the good and evil aspects of a person”. Here he is beginning to come to grips with the good and evil within himself and his mother. He is able to love, yet see the relation as problematic. This is a good prognosis for therapy. B28 This was seen as ”a very evil looking person-more of an animal”. His aggression towards his mother has reduced considerably. B29 This was seen as “an athlete finishing in a race”. He has moved from an aggressive childlike position to one of victory in an adult. He is certainly not as regressed now. The therapy has helped him. B31 He doesn’t see a “happy family”, but he sees “a father, mother and two children”. 90 Interpretation

He is happier with his own past, and this has been integrated as a result of

therapy.

Interpretation of SIS Responses on 3rd Administration (after 6 months of termination

of psychotherapy)

The Somatic Inkblot test was again administered (3rd time) after 6 months of termination

of psychotherapy. His responses at this time were almost normal. The patient improved

significantly and became symptom free. His relationship with his mother not only

improved but also became very cordial and he started talking to her after many years.

A few clinically significant responses are discussed below.

A6 This was seen as “Playing football with Teddy.”. This is a typical response

suggesting that he has resolved his childhood traumatic experiences.

A8 This was viewed as “A smiling man”, symbolizing his happy mood.

A12 This is seen as “waving good-bye or trying to attract attention”. This again suggests

his improved interpersonal relationship, particularly with his mother.

A16 This was seen as “Two birds on a branch singing a love song”. Once again the

happy mood concept is projected.

A24 This was perceived as “a nude female though not very clear”. This suggests a

love-hate relationship, maybe with his mother, though in a very mild form.

A27 This was seen as “a baby holding his mother’s breast”. This shows that

psychologically he is back to his mother and is resolving the love-hate relationship.

B22 This was seen as “a sleeping woman”. He has resolved his aggression and

instead of seeing a dead woman, he has seen a sleeping woman.

B28 This was viewed as “a mother and a daughter in tender embrace”. This suggests

that he is emotionally closer to his mother. Mother and child is the most common

response on this image.

Clinically significant responses given by the patient at each administration are

shown below to highlight the improvement in the quality of responses on the SIS

images.

Comparison of SIS Responses on 1st, 2nd and 3rd Testing for Quick View

First testing : When sick

Second testing : After 10 sessions of Hypnotherapy

Third testing : Six months after termination of Psychotherapy

A6 1 A fat woman in her child’s room.

2 A woman in her child’s room.

3 Playing football with Teddy.

A8 1 A naked man with a crooked smile.

2 A happy person.

3 A smiling man.

A10 1 A woman in the front seat of the car and a man in

the back seat ( woman is crying )

2 A woman confessing before a priest. Also looks

like a half veiled face.

3 Funny looking birds perched on paper.

A13 1 Someone asking for help with his hand.

2 A hand asking for help. Person seems under great

stress.

3 Waving good-bye or trying to attract attention.

A16 1 Two fish caught on the same hook.

2 Two birds in a tree singing a song.

3 Two birds on a branch singing a love song.

A24 1 A monster kidnapping two children. Someone

having abad dream.

2 Three children sleeping together.

3 Nude female though not very clear.

A27 1 Woman’s breast swollen with milk. Whom she is

feeding is not known.

2 Child breast feeding.

3 A baby holding his mother’s breast.

A28 1 A shapely woman trapped in a test tube.

2 Distorted female figure without head and legs.

3 A female with sagging breast.

B6 1 Seems like a woman suffering from venereal

disease.

2 Mother and child.

92 Interpretation

3 An owl, one eye open and the other shut.

B22 1 A dead woman lying on the floor.

2 A woman meditating.

3 A sleeping woman.

B28 1 A very evil looking thing, seems like a cross

between a man and a dog.

2 A very evil looking person-more of an animal.

3 A mother and a daughter in tender embrace.

The case analysis suggests that Somatic Inkblot Series is a powerful projective

diagnostic instrument. It works as a time machine and helps in processing repressed

material. It works like a thermometer and helps in detecting the severity of emotional

problems.

Stimulus Plate SIT-20: Aggressive Confrontation / Police Combat Threat

This case involves a 34 years year old, highly intelligent man, who in his early twenties

was a state trooper. While he was driving his police car alone in a very remote area,

three men ambushed him. There was an extensive gun battle, during which he killed

two of his attackers. However, he was wounded before back up was able to arrive and

rescue him. While he was treated medically, he never had the opportunity for formal

psychological treatment.

Eventually, his physical wounds healed and for medical reasons he retired. Ultimately,

he went to a university for training in a new field. However, for many months following

recovery, he had recurrent anxiety-laden dreams, reliving the gunfight and other

symptoms of Post-traumatic Stress Disorder. Eventually, many of these largely

disappeared and he had only some minor physical pain periodically to remind him of

his injuries. During this period, he developed classic symptoms of Panic Disorder. He

experienced sudden bursts of high anxiety associated with heart pounding and the

belief that he was going to die of a “heart attack”. Sometimes he had nightmares where

he woke-up in terror with his heart pounding, but he could never recall the content of

his most recent dreams.

This is the example of how the SIS Video represents a “time machine“ by taking him

back to his original trauma. When he viewed the SIS Video, he projected responses

consistent with his long-forgotten “nightmares” of the shooting incident. For example,

he stated that A30 represented a highly threatening image. He visualized an X-ray of

the head, re-experiencing images of the forgotten trauma. The second most threatening

image was B15. Here he saw “sharp thing that hurt”, replicating the bullets that had

been fired through the windshield of his police car during the ambush years ago. The

third most upsetting image was A3. For this he saw “a blast-hole in a police car.” He

stated “I can see blood splattered on the window.” The processing of this repressed

trauma represented the first step in resolving this old psychological injury. While it is

better for victims of traumatic life events to process their emotional pain in the immediate

hours after the trauma, there may still be powerful therapeutic value years later. The SIS

Video can do much to alleviate deeply imbedded and forgotten traumatic material.

Stimulus Plate SIT-2: Accident Trauma / Kinesthetic Shock Matrix

This second case involves psychological trauma that the subject was never able to

process. The subject was a State Trooper, in a remote area, who responded to an

accident scene. It involved a family of four whose car was struck head on by vehicles

driven by a drunk driver. This case was published in the Japanese Bulletin of Arts

Therapy, (Vol. 22 No. 1, 1991). Portions of the article follows :

An individual’s inner suffering can be healed by the appreciation of beauty in nature. In

Alaska, it is easily possible to experience the therapeutic power of a natural setting,

with no human being present for miles around. On a clear day, the sight of Mount

McKinley can release intense emotions. One can sense the grandeur of the mountain

and can attain perspective with regard to nature. The original native people had a more

appropriate sense of values. They did not assign a mortal’s name to this magnificent

mountain. With a sense of reverence, they named it Denali-meaning “the Great One.”

Their medicine men incorporated nature’s healing aspects in visual art and symbolic

dance rituals. Their efforts represented a primitive form of art therapy.

There are many parallels between what one can experience in the great outdoors in

Alaska and the healing forces stimulated by art natural setting in Japan. Japanese

children are taught at an early age to appreciate the beauty of nature. They are

encouraged to reproduce their visual and psychological response in a variety of art

forms. One can enhance the quality of life by standing under the cherry tree, inhaling

the fragrance and gazing at the blossoms. Many photographs and other works of art

have been created which serve to reactivate sensory memories of such events. In

some mystical way, they too can provide a revitalizing effect. Bonsai and lkebana can

stimulate the senses in a similar fashion. Such work can enhance the life of the viewer,

both mentally and physically. Shinto shrines provide natural settings within the urban

environment, enabling one to get back in touch with healing forces. The Bhuddist

religion recognizes the positive effect of flowers on the human psychic state. The lotus

is a symbol of the spiritual purity. In Japanese culture, social traditions, such as bowing,

ascribe deference to the spirituality of the person, who is viewed as a type of “beautiful

flower,” deserving respect.

In the SIS-II, we have attempted to recreate the healing power of nature as an electronic

form of art therapy. Most individuals are comfortable with viewing television, and many

spend considerable time watching it. In a recent book, “Television and the Quality of

94 Interpretation

life: How Viewing shapes Everyday Experiences,” Robert Kubey and Mihaly

Csikszentmihalyi (1990) reported that there is an altered state of consciousness with

reduced concentration and heightened passivity. Consequently, it makes sense to

employ this modern technology in the design of diagnostic and therapeutic procedures.

Since the instruction are on the video tape, and the viewer is provided with a booklet

containing illustration of the images under which responses may be written and the

figures labeled, the examiner need not be present during the test procedures. This

serves two purposes: to free up the clinician’s time, making testing more cost-effective,

and to provide a viewing situation, which is analogous to dreaming in total privacy. In

this solo situation, the contaminating and potentially inhibiting effect of an examiner’s

presence is minimized. An additional, and clinically important, advantage is that verbal

communication is totally eliminated at this stage. Pathological images, with their

associated disturbing affects, will more readily emerge from repressed memories when

the viewer does not have to verbalize them at the time of their return to consciousness.

This manner of recording projective responses to the 62 test images of the SIS-II

employs principles that experienced hypnotists have known for years. When the inhibited

individual is in a hypnotic trance, if so instructed, he may be able to write answers to the

hypnotist’s question that, on times, he cannot express verbally.

Another approach with the SIS-II uses special video technology, whereby the television

screen is embedded in a table. Using partially transparent art paper, the viewer can

reproduce in color what he sees, and then label the drawing. For those in pain, this is

a way to gain control over threatening imagery. The application of labels to such material

can introduce intellectual defenses, which can further reduce the threat.

The patient policeman was administered SIS-Video. His responses revealed that he

was also suffering from a form of Post-traumatic Stress Disorder. Image A2 activated

repressed, painful memories of an event that had taken place 13 years before a terrible

accident. The image reminded him of a badly injured father, trapped in the wreckage,

desperately trying to reach a bleeding, screaming child, who had been thrown out at

the time of a head-on collision. During the detailed inquiry, his defenses collapsed, and

he wept. He vividly recalled the horrible details as follows: “when I close my eyes, I can

smell the heat of the pavement, and blood. Blood has a special smell!” For the first time,

he was able to express his emotional anguish as a cathartic, therapeutic experience.

Immediately after this was expressed, his consciousness was flooded with an additional

series of memories. These concerned scenes of injured and dying children that he had

witnessed when he was working with native Alaskans. There is a high rate of alcoholism

among the Alaskan natives. Accidents, homicides, suicides and other acts of violence

are all too common.

An example of one of his painful memories is as follows: “there was this little girl lying

on the table-the kitchen table. She was small-just a little thing, and she was so quietshe wasn’t moving. I had to take her from the father. He didn’t want to let her go. I had to

have an autopsy. Finally, I had to pull, and say “I’m sorry!, I’m sorry!” (Expressing

profound guilt and sorrow).” In follow-up psychotherapy, he recalled a series of forgotten,

emotionally charged dreams dealing with trauma to children. Eventually, he acquired

insight into his own background. He realized that the abandonment that he had

experienced as a child by his alcoholic father had made him especially vulnerable to

such traumatic events.

Policeman is more likely to witness accidents exposing them to psychological trauma.

Physicians and surgeons are also high risk. Those of the medical profession who tend

to project high numbers of anatomical responses to the Rorschach may not just be

reflecting their training and heightened familiarity with human anatomy. (Ames, Metrouz

& Rodell, 1973). In addition, they may be expressing the integration of repressed

pathologic anatomical images from repeated occupation of exterior. Many in such

circumstances are not able to express their empathetic reactions and may tend to

numb out their pain with alcohol and/or drugs. Later in life, they, like this policeman, are

especially vulnerable to develop depressive symptoms. All therapists who treat

traumatized victims, using art therapy techniques, should be cautioned that they should

share their feeling with a colleague if their own thought content unduly reflects the

visual trauma of such individuals.

A potentially worthwhile therapeutic application for the SIS-II exists for art therapists

who use group techniques. Individuals in distress may view the image in a group

setting. The group therapist will then have the opportunity to review their pathologic

responses. Sometimes it is more important clinically, in assessing the projective

responses of group members suffering from hysterical conversion reaction and

psychosomatic pain, for the group therapist to interpret the significance of repressed

anatomical images.

Another advantage of this procedure is that the use of graphic, rather than verbal

techniques facilitates the crossing of language barriers. A therapist in one culture can

more readily understand what is represented pictorially in another. It has been said that

a picture is worth a thousand words. Also, from a therapeutic standpoint, the act of

drawing and labeling images gives the troubled person a sense of mastery over the

threatening material. In addition, in re-test situations, the repetitive drawing of the

traumatic symbols, or the exposure to the video stimulus, in association with the healing

picture of a flower after each image, can help to reduce the individual’s suffering.

Certainly, this outcome occurred in the above case. The policeman reported that the

repeated viewing of the SIS-II was helpful in alleviating his inner pain.

Stimulus Plate SIT-11: Alopecia Areata / Somatosensory Boundary Disruption

Mr. X, 29 years old, Ph. D. student, presented in July 1992 with recurrent loss of hair

over scalp, arms, legs and torso for the last 13 years. His mother had a history of

alopecia areata and bronchial asthma. In view of alopecia totalis, he was treated with

96 Interpretation

prednisolone plus 300 mg once a month for four months, and had complete regrowth

of hair (Sharma, 1996). Subsequently, he presented with relapse of alopecia totalis in

July 1994 and gave history of stress due to conflict with Ph. D. thesis guide. He was

treated with topical sensitizer diphencyprone and had complete regrowth of hair at six

months and is on maintenance therapy for almost 3 years.

As he narrates, his father to the extent of being physically abused frequently gave him

severe beating. He perceives his father to be very authoritarian, aggressive and

dominant, therefore leading to frequent quarrels between his parents, and he feels that

most families in India are like his family. He is aggressive towards his brothers and

sisters. He finds it to be a broken family.

He has few friends and very limited contacts. He got familiar with a female university

student and soon married her. It is a sort of arranged marriage by his friends, though his

parents gave their consent in the end. Initially he was withdrawn from his wife as he

was feeling sexually weak. There was a problem of erection, which improved to some

extent after medication. Medical treatment and supportive psychotherapy helped in

improving his symptoms.

A few significant responses on Somatic Inkblot Test with content analysis are given

below:

A3: He saw “The hand/palm of a person caught in a fire as if crying out for help.” Once

again his inner cry has come out on the surface that he needs help from others.

This may also be indicative of his wishful thinking to get support and help from his

physician/therapist for his physical symptoms in the form of alopecia or even

sexual inadequacy.

A5: He perceived this image as “A man crying for freedom with his body torn apart.” It

brings out his inner cry and desire to get away from his broken home/family. He

further confirmed this feeling during the interview and therapy session. He finds

his home not worth living and wants to flee.

A10: He viewed this image as “The face of gloomy woman marred by distressful life.”

It may depict his projection towards his mother who often received physical

assault from his father and is depressed. The patient projects that most of the

Indian families have such bad atmosphere. This may also bring out his sympathy

towards his mother and his inability to help her because of the dominant father.

A15: He has seen “An infant pierced/stabbed by a long knife in the womb itself.” This

may be indicative of his regressive phenomenon, which takes the person back in

time and he feels it could have been better if he had died as a fetus. It suggests

his depressive mood and that the person wants to bring out unprocessed painful

situations during childhood. Imagination of stabbing in the womb itself may also

be indicative of severe pain inflicted by his father during his early childhood.

Such information is very important for a therapist as it helps him in therapeutic

intervention.

A22: He viewed it as a “scorpion” rather than seeing it as a backbone or male genital

organ. The plausible explanation could be that because of his “impotence” he

has avoided seeing backbone/male sex organ even on suggestion. Since it is

painful to think of impotence to a newly married person, he has projected it as a

‘scorpion’ - a pain-inducing insect. A23: He has seen “A baby scorpion.” Once again the imagery of male genital organ has been suppressed and painful imagination in form of a scorpion is brought out on the surface. The other possible explanation could be his injured ‘tailbone’, a few years before for which he had a lot of pain and sufferings. A31: He perceived “a couple sharing their common woes” on this image seeing a couple is the most typical response but “common woes” may bring out his inner cry particularly because of his sexual weakness and inability to perform the role of a husband. B4: He viewed on this image “A happy man but a woeful woman”, suggesting his projection of seeing his wife under woeful imagery. This may also be the projection of his mother whom he always finds in a miserable situation. Once again the theme of disturbed family life and his own withdrawal from reality as a defense mechanism has been brought out. B11: He has seen “a wig kept on the head of a person.” This may suggest his fear of becoming “bald”. The loss of hair due to alopecia areata has created in him a lot of tension and he is worried to the extent of becoming bald. Such anxiety is quite expected in a young man. B20: He viewed “the rear view of a head with long hair”, which suggests his wishful thinking to have long hair. He further elaborates that he has seen his own photograph with long hair and wishes to have long hair once again. B28: He has seen “a distressful passionate person” on this image, which people generally see as a ‘lady with her child’. Avoiding seeing a lady may be due to his conflict with his wife and the passionate person could be the projection of himself B31: He has seen “A family with their children knitted together tightly out of some unknown certainty/fear/upheaval or resolution”, on this image. Since it is the last image of the test, the theme of a happy family is projected on this image so that the person could carry positive feeling at the end of the test. Instead of seeing a happy family, he has seen a family with their children knitted together tightly - a painful projection. The test has worked as a time machine and has taken the person back in time to help him process the painful memories of childhood. Physical abuse, lot of uncertainty and strict discipline might be a few reasons for 98 Interpretation

such an imagination.

As a whole it can be concluded that the Somatic Inkblot Test has helped the patient in

projecting the painful childhood experiences, disturbed family relationship, fear of

being bald and disturbed physical/emotional relationship with his wife. The test has

further helped in establishing the psychopathology leading to psychosomatic

disturbances (alopecia areata) and the need for counseling.

Alopecia areata is known to be associated with emotional factors (Dubey and Das,

1977). In a recent study from India emotional factors were blamed in unto 7 percent, in

including or perpetuating alopecia (Sharma, Dawn and Kumar, 1996). These figures of

5 to 7 percent emotional factors in alopecia areata suggests patients own view point,

but when a projective inkblot test like the Rorschach or the Somatic Inkblot Series was

administered, altogether a different picture emerged as discussed in the case of Mr. X.

It is painful to accept and reveal one’s own sufferings in front of a physician, but the

patient feels comfortable to project his sufferings through the inkblot images and accepts

this during interview and analysis. 55 percent patients revealed psychological

disturbances through projection on inkblot imagery and later on owned the sufferings.

Stimulus Plate SIT-1: Bereavement & Grief / Central Somatosensory Void

Case History:

A patient whose eleven-month history of depression followed the murder of her husband

on his way back from work is described. A characteristic of her symptom pattern was

depression, an unwillingness to talk in the group therapy sessions and an overwhelming

anxiety to the extent that she would run out of the group therapy session. She experienced

persistent and disturbing nightmares but refused to discuss the content of the dreams.

Four months of conventional treatment in a specialized unit did not reduce the intensity

of frequency of the symptoms or suicidal ideation. In the fourth month of her admission

hypnotherapy was done with dramatic results.

Mrs. H. a 31-year-old widow was referred for admission to specialized unit for the

treatment of depression following the murder of her husband during November 1990.

She gave a four-month history of depression, loss of appetite, episodes of weeping

and disturbing nightmares. She was socially withdrawn and became anxious whenever

she left the house. Four months of outpatient treatment before admission did not result

in any symptom relief. There was psychomotor retardation, frequent crying and suicidal

ideation for three months preceding admission. One week after her husbands funeral

she tried to run in front of a car in a suicide attempt but was prevented from doing so by

by-standers. One week before admission she took an overdose of tablets.

Mrs. H. had a sense of husband’s presence, and experienced auditory hallucinations.

She would hear her husband calling her name. Her husband’s clothes were still in his

cupboard and at 1700 hrs. in the evening she went to the window to wait for him to

return home from work. She was intensely angry at the unknown murderers but refused

to elaborate. She said their seven-year marriage was a happy one. Two children were

born to the couple.

Progress Notes

Week One

Patient refused to talk in group therapy sessions was tearful and uncooperative. At on

time she mentioned that whenever she loved some one, she loses them, but refused to

elaborate.

Weeks Two To Five

Patient remained tearful and uncooperative refused to talk in group therapy sessions.

She remained actively suicidal and was not allowed to go home for weekend leave.

Nightmares disturbed her sleep but the patient refused to discuss the contents of these

disturbing dreams. During the fourth week, she attempted to abscond from the unit and

was brought back to the ward by the nursing staff. In week five she again attempted to

abscond.

Week Six

After six weeks hospitalization there was no reduction of symptoms. The patient was

actively suicidal and refused to participate in the group therapy discussions. It was

clear from the few words that she did say that Mrs. H. was intensely angry with the

unknown perpetrators of her husband’s murder. Mrs. H. was placed in a grief group

together with three fellow patients who had suffered losses through death. The groups

were run by the author with the social worker of the unit as co-therapist. The object of

the group was to provide an opportunity for mutual sharing, support and expression of

anger while working towards acceptance of the loss.

Week Nine

After seven group therapy sessions Mrs. H. was still unable to express any anger. She

did speak briefly about her difficulty at looking at her husband’s clothes. After the

seventh group therapy session she took an overdose of tablets. By session ten, no

reduction in the intensity of her symptoms was apparent. She was uncooperative and

made another bid to abscond from the unit. The patient complained of feeling confused,

helpless and had a fear of losing control. Two of the four group patients were ready for

discharge and the group was disbanded. At that point on her therapy the author went

on a three-week vacation.

Weeks Eleven To Fifteen

During this period Mrs. H. remained suicidal and very uncooperative. She refused to

talk about her or the disturbing dreams. She was frequently tearful and expressed

100 Interpretation

feelings of hopelessness. She was certified in terms of section 9 of the Mental Health

Act (No. 18 of 1973, Amended Act No. 3 of 1984). Certification was necessary as Mrs. H.

was actively suicidal, demanded her discharge, was verbally aggressive, very tearful

and attempted to abscond.

Week Sixteen

The author returned from leave. There was no reduction in the frequency and intensity

of Mrs. H’s symptoms. A reappraisal of the situation was made.

(i) The disturbing nightmares suggested repressed material that the patient found

was overwhelming.

(ii) The intensity and persistence of anger was a further indication of repressed

material the patient had difficulty with.

(iii) The fear of losing control prevented her from adequately dealing with her

emotions.

Intervention through Somatic Inkblot Series

A decision was made to conduct hypnotherapy. Using the Somatic Inkblot Series II

(SIS-II) designed by Dr. Wilfred Cassell (1980) did the initial assessment. The blot

consists of 62 semi ambiguous visual stimuli in booklet form, based on specific

anatomical structures. The SIS-II can be used in a variety of ways but was designed for

self administration after supervised instruction. One advantage of self-administration is

that it saves therapy time, reduces possibility of inhibiting responses due to presence

of the therapist and serves to reduce test anxiety. The booklet can be taken home by the

patient and completed in privacy in a relaxed atmosphere. Mental health professionals

with training in the use of projective techniques such as human figure drawing, thematic

apperception test, word association or sentence completion test will have no difficulty

adapting the SIS-II to their work. The patient is requested to identify three “most liked”

responses. This serves to reduce anxiety. The three “least liked” responses are examined

next in the detailed inquiry. The entire series of 62 images are then scrutinized for

psychopathological material or themes. The test has been found successful as

therapeutic and diagnostic measure (Cassell, 1994; Dubey et. al 1993, 1994).

The night after the administration of the SIS-II Mrs. H. had one of her nightmares. When

she woke, she broke the frame containing the photograph of her husband and threw

the furniture around in her room.

Mrs. H. identified images A23, A20 and A5 as the “most liked” and images B13 and B22

as the “least liked”. The detailed inquiry was done in hypnosis.

Session One

The patient was introduced to the experience of hypnosis in the first session. Induction

was by systematic relaxation and deepening by counting backwards from 10 to 1 with

suggestion that relaxation will increase with each successive number. Mrs. H. proved to

be an excellent subject and induction and deepening were readily achieved. No post

hypnotic suggestion was given and no exploration was done as the patient was

promised that the first session would only be used for relaxation and to allow her to

experience what hypnotic induction felt like. She could decide to continue after the first

session. The patient agreed to continue with the sessions.

Session Two

The second session was held on the following day as the patient became distressed

and tearful during the night. Induction was by systematic relaxation and deepening by

counting backwards from 10 to 1. The patient was then “awakened by reversing the

induction procedure with the post hypnotic suggestion that she would still feel completely

relaxed and calm. She was asked to focus on the first of the “least liked” images B4 and

to concentrate on it. A second induction was done with deepening. She was instructed

to visualize the images and to say whatever it made her feel. The following is a translation

and summary of her responses.

Murderers,

They killed my husband.

I hate them, they made me feel like this.

I want to get a gun and shoot them. I am entitled to feel like this.

She refused to say more even when encouraged to do so. The same procedure was

followed with second “least liked” image, B13. The following is a summary and translation

of her responses.

It is a graveyard.

It lets me think of my husband’s grave.

It is not right that he should be here.

He did not die as he should have, he was murdered and that is not right.

It brings many questions to my mind.

Why him, where was God, why did he allow it, it’s not human.

If he did not love me, he would not have died.

We married because we loved each other.

It is only people whom I love that die.

Mrs. H. then went on to give a detailed account of three major losses she had experienced

that made her feel guilty. At the age of 14, a car killed her pet dog when it followed her

to the shop. Family and friends could not understand her grief and told her it was only

102 Interpretation

a dog. Mrs. H. felt responsible for the dog’s death. “If it had not followed me to the shop,

it would not have died.”

The second loss was her boyfriend who died in a car accident on his way home after

visiting her. She again felt responsible by saying that if he had not been in love with her

and visited her he would have died. She did not view the body and has still not visited

his grave. She was 16 years old at that time. The third loss was a girl friend that died of

cancer when Mrs. H was 18 years old. “If she was not my friend she would not have

died.” She did attend the funeral but did not view the body. Mrs. H was given the

opportunity to “speak” to her husband and tell him how she felt and how desperately

she wanted to have helped him if she could. Mrs. H was taught a self-hypnotic technique

(visualization in a safe place) at the end of the session. The session lasted about one

and half-hours.

Session Three

One week after the second session the third session was given, the same induction

procedure was followed. Patient was noticeably anxious at the start of the session and

10 minutes were necessary to help her to relax. The following is a translation and

summary of her responses to the third “least liked” Image B22.

It is a picture of a person lying on the ground….it makes me think of something I don’t

want to think about.

I feel the pain … I want to forget about it.

I don’t want to talk about it.

It reminds me of what happened to my husband.

It reminds me of my nightmares…what happened to my husband … I don’t want to talk

about my nightmares.

At this point Mrs. H. cried uncontrollably for about 15 to 20 minutes. At the end of that

period she repeated that she did not want to see that scene again. Mrs. H. was formally

given the opportunity to say “goodbye” to him.

Four days after the third session she again had a nightmare, but fell asleep again after

doing self-hypnosis.

Behavior in the Ward after hypnosis

There was an immediate change in the patient’s behavior after the third session. Her

mood had lifted; she was co-operative and became a full participating member of the

group. Following the third session, the patient reported that she had accepted her

husband’s death and was able to give support to fellow patients in the group. Two

weeks after the third hypnosis session she was discharged from the unit. She was

almost completely symptom free and not suicidal. At her one-week follow up appointment

she was still symptom free and reported feeling sad about her husband’s death. She

had not looked at his clothes but said she knew she had to do it.

Discussion

The dramatic response after only three hypnotherapy sessions is consistent with reports

in the literature (Fromm and Eisen , 1982; Handelman, 1984; Manthorpe, 1990). It must

be clearly stated that in complicated bereavement it is not the depression but the

repressed material that is treated. There are definite contradictions for the use of hypnosis

for the treatment of depression and this is not recommended as a treatment for this

condition.

Mrs. H’s symptoms can be understood in psychodynamic terms as her struggle to

relinquish or to preserve the lost object. The reality of her actual loss is greatly increased

by an unconscious fantasy of having lost her internal good objects as well. Her internal

world was predominated by bad objects and was in danger disintegration (Klein, 1975;

Segal, 1978). The patient is unable to grieve normally because of an obstacle in

normal grieving. She is unable to move in therapy because of her guilt and self blame.

She believed her husband died because she loved him. An unconscious sense of guilt

or a need for punishment operated to prevent relief from her suffering. Once she is

freed from her self-punishment and guilt, through the use of hypnosis, she was able to

take control of her life (Brabant, 1990; Epston, 1991).

The use of hypnotherapy and the SIS-II enabled the therapist and the patient to identify

repressed material that caused her distress. This case demonstrates the usefulness of

the SIS-II and that rapid symptomatic relief in complicated bereavement can be achieved

through hypnosis.

Stimulus Plate SIT-17: Somatoform Pain / Pelvic & Spinal Somatization

Mrs. P is a 35 years old lady, educated unto M.Phil., married to a practicing physician

and having an eight years old son. She belongs to a middle class family. She had

complained of frequent burning sensation in the stomach and was getting irritated

quite often. She was diagnosed a case of peptic ulcer for which she was undergoing

treatment. She was interested in understanding her own personality and approached

the physician for help. SIS-II, booklet form, was administered and a few clinically

significant responses are analyzed here for understanding how SIS Images help in

processing the underlying unconscious phenomenon.

A2: She has viewed this image as ‘Sita’ sharing her suffering with ‘Kush’ and

facing the ‘Agni Pariksha’ (In Hindu mythology Sita is the wife of Lord Rama,

who conveys her suffering to her son Kush and faces the test of fire to prove

her purity to the society). This indicates her guilt feeling and unshared sufferings.

She wanted to open herself to some person in her immediate vicinity, may be

even the therapist. It may further indicate her poor interpersonal relationship

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and disturbed family life, which she wanted to share with her eight years old

son, as he is closest to her.

A3: “Christ being crucified”, indicates her sad feeling and suicidal ideation. It

suggests that she has a lot of depressive contents inside.

A4: The feeling of her suffering and inner cry has come more directly through her

response to this image, “Chekhov’s horse listening to its master’s grief, when

he fails to find a human as his companion”. Where master is getting none

other than a pet animal with whom he can share his grief. This projects her

own sufferings and grief ridden unconscious material.

A5: She has viewed this image as “Man’s effort to steal fire from the sun like

‘Prometheus’,” indicates a myth where God provided fire to man which gives light and energy. Here her response signifies that she once again wants to be warm and energetic. A6 Her response to this image “Suddenly, one day, one feels that childhood is far away and one has to complete the journey of life barefooted”, suggests her regression and takes her back in time when once again she wants to be a child, free from problems and sufferings. A8: In this image she could see, “A man in search of his identity” as she has lost her own identity. A9: Her response, “Chalte-Chalte younhee koi mil gaya tha”, (By chance someone met me on the way), takes her back in time and she remembers the time she spent with the person she had a love affair with. On interview she came out with her own story of a love affair with someone whom she wanted to marry but her family didn’t allow and unwillingly she got married to the present husband. She admits that she could not develop an internal liking for this man. They do not speak to each other frequently and to the extent of not having physical relationship for months. The same feeling has been brought by her on Image A10 also. A10 She viewed “two newly born chicken feel it’s better not to speak“. It proves that SIS images work as a time machine and takes the person back in time helping in processing the painful experiences of the past. A13: She perceived, “Remember, the icy hand of death is approaching!” Her cold feeling and suicidal ideation has been brought out. A14: She has viewed “The candle of light is burning but fails to remove the shadow of memories.” It suggests her pensive feeling towards life with a lot of uncertainty and insecurity. She is not able to ride over the unpleasant memories, which she wanted to control and remove forever.

A16: She has responded, “Two birds consulting each other, where to make their

nest?”. This response once again brings back the feeling of insecurity and

search for a place called “home“ where she can live peacefully. The present

home seems to be a broken one where she finds herself to be alone.

A17: She has responded, “Two unlucky fish that have no brains yet existing”,

indicates her own disturbed family life. This image generally brings out beautiful

imagery of two loving birds/fishes. Instead of seeing them together she is

finding them as existing without any interest. It projects her own life with her

husband.

A18: She has viewed, “How painful the art of creativeness is !”. She avoided seeing

the commonly perceived response “heart”. She is feeling hurt and insecure in

her relationship with her husband.

A23: She has avoided seeing the commonly perceived response “Backbone” and

has viewed “fear of breast cancer” on this image. Avoiding backbone on this

image may indicate her disturbed sex life. During interview she has accepted

her hatred towards her husband. “Fear of breast cancer“ may further indicate

her wishful thinking to avoid physical contact with her husband by developing

dreaded disease such as cancer.

A25: She has viewed “An effort to provide more light as darkness prevails all over!”

Avoiding seeing the female genital organ in this image has further brought

out her sexual conflict.

A31: She has avoided seeing male and female in this image and has responded,

“Do not open your eyes. Otherwise your dreams will be shattered.” It suggests her flight from reality and adoption of life in non-realistic state. She is unable to face the reality and to manage the situation in her favor. B3: She has responded, “Hearts once broken, never heal.” Once again the broken heart concept has come back suggesting her depressive content and broken love affair. B4: Once again the depressive content is brought back by her response, “No one gets all his/her desires fulfilled.” She is not satisfied with what is provided to her, particularly the family. B5: The wishful thinking of being fortunate and having a nice time has been depicted by her response in this image, “Lucky ones! Having their full moons!”

She feels, as she has not enjoyed ‘full moon’ reason being her disturbed

relations with her husband. On interview, she accepted that her moon is always

in cloud and she cannot imagine the pleasant feeling of a full moon.

B7: She has viewed this image as, “The dancing peacock.” It suggests her ego

strength and wish to lead a happy life.

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B8: She has perceived “The moon during eclipse.“ This image brings back the

depressive contents. Similar contents have been depicted in image B5 also.

The concept of moon during eclipse, in Indian mythology suggests that the

demon ‘Rahu’ is torturing the moon to take his revenge. The patient is comparing

herself to the moon and perceives as if she was under the clutches of her

unmanageable husband. This brings out her sufferings through her projection

of the lunar eclipse.

B11: She has rejected this image and could not perceive anything. Generally people

perceive, lungs, two birds or flowers. She has been unable to view the

commonly perceived response because of her poor interpersonal relationship

with her husband.

B14: She has viewed, “Let us wait for the dawn.” This indicates her ego strength

and positive attitude towards the future. She is definitely hopeful of a bright

future. Waiting for the dawn indicates symbolically that good time (dawn) will

come after bad time (night). Such responses indicate good prognosis.

B15: Her response, “Stop this violence, please“, suggests that she is not interested

in violence anymore. This reflects the bad she has had in her life.

B16: She has rejected this image. People generally perceive spine or vertebrae,

which connote the imagery of the male sex organ. Denial of this imagery may

indicate her conflicting sexual relations, which have been confirmed by the

subjects. She has also avoided perceiving the common response, the spinal

cord in image A23 earlier.

B19: She has perceived, “When the sun begins to burn you, no shade will give you

protection.” This suggests her broken home situation. She feels that outsiders

can’t help if your family does not help you. Her depression has come up on the

surface through this image.

B22: She has responded, “Let me take rest. I have endured a lot and feel a little bit

tired”, suggests her helplessness and feeling of being tired with her own

family life.

B31: She has perceived, “We won’t be able to grow properly if we are too many!”

Being the last image of the test, it has been created in such a way that people

should carry on the way back home the concept of a happy family. Since the

subject is not having a happy family life, she has failed to perceive a happy

family.

Somatic Inkblot Series is a powerful projective instrument. It worked as a time machine

and took the patient back in time where she started projecting her broken love affair.

She is passing through deprived family life, constant stress, deprivation of affection

with a lot of hostility and insecurity. The patient is still having a good ego strength, which

has protected her from complete breakdown. She is hopeful towards a good future,

which is a positive strength. SIS worked as a therapeutic tool and she was quite

cheerful at the end of the test.

Stimulus Plate SIT-18: Therapeutic Dream Stimulation / Unconscious Imagery

It is generally recognized that when individuals view television programs containing

violence, this can have a profound mental effect. One involves the incorporation of

violent images in their nighttime dreams. In a similar fashion, the viewing of SIS Video

can give rise to threatening images, which stimulate dreams related to previously

experienced trauma.

A case example follows to show how this had a positive emotionally cathartic effect. In

addition, it had important cognitive therapeutic effects since the person relived the

trauma through the eyes of an adult and could come to understand, as a result, that the

previously held childhood guilt was irrational. The person in question is a 41-year-old

woman who was referred by her psychotherapist for anti-depressant medication. She

had significant neurovegative symptoms of depression. Since she was relatively stable,

she was sent home with the SIS-Video and answer sheet. The instructions were to view

the video before going to sleep, then the following morning, to record nighttime dreams

in the answer booklet. Her next appointment was scheduled a week later.

Remarkably enough, the night after she viewed the video, she reported having a

significant dream. She viewed an early life trauma that had been previously totally

blocked from her memory. She recounted, at age three while looking out of her window,

seeing her 18-month-old brother walking over to a neighbor’s sled dog team. She then

witnessed the dogs viciously attack him. Because of her limited verbal skills at this age

and emotional unavailability of her parents, who were grief stricken, she never had the

opportunity to share this terrible experience with anyone. After viewing the SIS-Video,

she, for the first time as an adult, remembered her horror. She experienced the repressed

anger, guilt and grief about his tragic death.

The dream imagery involved visualizing her brother’s head and facial features in

consciousness, with the horribly wounded body obscured in clouds. This information

was communicated to her therapist.

When the results of the video were reviewed, she labeled the following three as the

“Least Liked”: A30: Was seen as the most threatening image. She saw “an evil skull in a cloud.”

This response may be interpreted to directly reflect her dead brother. The fact

that his body was not present in the initial dream reflected that the over all

wounds were too painful for her to initially accept. It might be noted as time

went on with therapy, a more complete image sequence of her brother’s death

emerged. She was then able to grieve successfully and with cognitive therapy,

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correct her childhood erroneous belief of blaming herself.

B28: Was seen as the second most threatening image. She saw this as “A ghostspooky.” It may be recalled that this image depicts a mother holding an infant.

This was too threatening for her to accept in full conscious awareness. It may

have reflected memories of seeing her mother holding her baby brother and

childhood feelings experienced from also holding him.

B1: This was the third most threatening image. She saw this as “A fist.” She said

that this made her feel even angrier. Therapeutic exploration of this took her

back to long forgotten angry feelings about his death. In an irrational fashion,

she had blamed herself for the terrible tragedy. Frequently, when something

tragic happens in a family, children irrationally blame themselves.

Dr. C: We appreciate you coming here tonight Sherry, and giving our time and a little

bit about yourself. We encourage facing the inner pain. We hope this will help

others understand some of the processes of grieving and what is required. Do

you feel okay?

Sherry: Yes I do. I feel good about it

Dr. C: How did you feel about taking the Somatic Video Procedure? Can you share

that?

Sherry: I feel good about it. I feel open about it. I didn’t know what to expect when I fell

asleep last night. I saw my little Jimmy.

Dr. C: Yes, yes. Let’s start with some of the images you found most favorable. B17

were the one you found as your favorite. You saw it as “a glowing heart.” Would

you care to say more about this?

Sherry: It struck me as being something with “a lot of warmth and a lot of love”, and it

really hit me that way when I saw it, and I really felt good about it.

Dr. C: Yes, yes. Do you feel that you are now beginning to feel some grief and freeing

up pain and allowing you to love with a lot more energy?

Sherry: Yes, a lot!

Dr. C: Could you please tell us about that?

Sherry: Well, when I mentioned it before, I talked to you last; it is like I felt a lot of

warmth and a lot of love for my husband. He probably feels a little overwhelmed

by it all, but he’s handling it very well. He has been real supportive about it all,

but as I get rid of the pain and grieve and understand, its just in everyday life

you feel a lot of love for people and what’s going on around you, you just feel

really good about it.

Dr. C: Before you did not feel you had the energy to love the way as you do now

since you’ve been in treatment?

Sherry: Not at all.

Dr. C: And B31. Can you tell us what you see there and what it brings to mind?

Sherry: A family. It’s like togetherness. And I just see a lot of happiness and a lot of love

there. It just struck me at that instant it just came to mind.

Dr. C: What was your family like when you were a little girl and all, before the terrible

loss of your brother?

Sherry: We had a lot of fun, from sledding to floating down rivers and looking at little

baby ducks, everything you could possibly imagine, we did as a group, and it

was really, really enjoyable. And after my little bother passed away, I sort of

became my dad’s little girl. My sister became my mom’s little girl. And we kind

of did things separate then.

Dr. C: Do you wish, or did you ever wish while you were growing up for that nostalgic

time that your family was complete and all?

Sherry: Yeah. Yes I did, and um —, I really, um —I really did want that. And I think I really

felt it when I was showing horse and I did it on my own, where they wouldn’t

come to shows to watch me. And I wish they had been there as a group.

Dr. C: Yes, yes. There was one more image that I wanted you to look at. It is B29. What

so you see there, please?

Sherry: Oh, a person jogging, that’s just, um — that’s just how it struck me right away

anyway. It almost looks like the person has a smile on his face. And that they’re

real happy about it.

Dr. C: And what does that bring to mind?

Sherry: Um —, good health. Happiness. And probably getting out and doing something.

Dr. C: So that we know that fun in Alaska and exercise is a part of the treatment of

depression.

Sherry: Yes that is exactly correct.

Dr. C: Now, the images that really bothered you. You mentioned that A30 were highly

threatening for you. Could you please tell us what you saw in A30?

Sherry: In A30, to me, it was just a real, real evil skull in a cloud. And it represented

death or the devil, and I didn’t like it at all. And it is something that we probably

have to face.

Dr. C: And when we talked about this earlier, you told me some other things that

110 Interpretation

were brought to mind, the devil and the pain.

Sherry: With the experience I had been through before.

Dr. C: Yes, could you tell us about that please?

Sherry: I had a friend who had died during childbirth, who was my closest friend. After

she passed away, I felt like a separate entity was trying to take me over and

where I lived and I went through a real battle in fighting this bad entity off and

that I finally won.

Dr. C: What was her name?

Sherry: Molly.

Dr. C: What was she like?

Sherry: She was a real kind hearted and gentleperson. A very loving person. We were

born three months apart and grew up together.

Dr. C: So you were probably real close.

Sherry: Probably closer to her than my own sister. We moved in together when we

were single, after high school. We were always together. Almost — a real

bond between us.

Dr. C: And what happened?

Sherry: She got something like a hemorrhage, I believe. Her blood pressure shot up

real high and she started bleeding in the head and they couldn’t stop the

bleeding and she passed away.

Dr. C: Do you remember how you felt when you first heard about it.

Sherry: Um, devastated. When I first heard the news, it was like took an inflated

balloon and filled it with air and someone took out all the air at once. It was

terrible-just a horrible feeling. Then I could also remember laying in bed that

night and thinking of Molly and at the same time I was crying and crying about

her and all of a sudden my tears stopped and I really, really felt that God was

there holding and comforting me for a while. And I never felt such peace or

comfort in my whole life. It was wonderful.

Dr. C: Did you have images of her in your dreams for a while during that period of

time?

Sherry: A long time.

Dr. C: What were they like?

Sherry: She would come to me and she was still on the pregnant side and she would

say, “Sherry, I’m okay! Not to worry, but I’m fine.” She did that several times.

Dr. C: And how did you feel when you saw her in your dreams, were you sharing…?

Sherry: Happy that I saw her. But her death affected me so much that for years afterwards

if I was driving down the road and I thought about Molly, tears would come to

my eyes. But it wasn’t until when Maureen (her psychotherapist) had me write

a goodbye letter to her I as able to… I felt then may be I could let go of her.

Dr. C: So when you were in therapy with Maureen and wrote this, what were some

of the feelings you wrote in the letter?

Sherry: I remembered all the fun times we had together, and how close we were

together, and how we enjoyed and that I knew it was time for me to let go off

her, but I would always love her.

Dr. C: Did that affect your own feelings about pregnancy or having babies?

Sherry: Yes it did. At that time I didn’t understand it, but it made…having a tubular

(where you have the tubes tied). I had that done and I thought I was having

some problems — birth control pills that I’ve been on for quite a few years and

the doctor thought I was having problems with them. So we decided to do this.

But later, since I had it done about four months after she passed away and I

had surgery to have the reversal done. And it wasn’t until this year that I

actually realized that probably the real reason was because of Molly’s death.

Dr. C: Can you share the real reason?

Sherry: Probably the fear of maybe because of Molly died in child birth and that it was

so sudden — maybe,— maybe it was my own fear of it happening to me or

maybe it was — maybe because I didn’t think it was fair that she should die

during child birth.

Dr. C: And you’ve been trying to have children since then?

Sherry: Yes.

Dr. C: And what’s your emotional reaction, still not successful?

Sherry: I’ve decided, naturally, both my husband and I talked about it, and we have

come to terms with that, should it happen, that if we were blessed with it, it was

meant to be. Because as far being checked, everything is in working order.

Dr. C: You should realize that as you process grief and so on, that it is not just a

central thing, but that it could affect the reproductive functioning, that you

might be more receptive now, and you might connect, who knows. It’s a

wonderful thought because I think you would make a great mom!

Sherry: Yeah.

112 Interpretation

Dr. C: The second image that you found quite frightening were B28. Would you tell

us what you see there, please?

Sherry: A ghost. And it struck me as not being as being good. It struck me as being

more on the bad side.

Dr. C: Think of this ghost, what bad things of this ghost?

Sherry: I think of Jimmy’s death and I think of Molly’s death.

Dr. C: And what emotions are evoked?

Sherry: Depression, everything being more on the gray side.

Dr. C: And the image B1, you rated as the third most threatening image. What do you

see this as?

Sherry: Um — which one? Oh, anger. And I think I felt angry at Jimmy for leaving us

like that. And maybe — and maybe blaming myself.

Dr. C: What sense of anger did you have as a little girl for Jimmy — for his leaving

you — at wandering over to the dogs, and getting killed and all?

Sherry: I couldn’t understand why they had attacked him. I could never understand

that.

Dr. C: Could you tell us what you remember that day when you were three years

old?

Sherry: I remember my mother finding Jimmy and he was still alive and she picked

him up and put him in the car. And I went to the driver’s side of the door and I

asked if I could go. She said “No!” She was frantic — I mean she was absolutely

frantic! But I couldn’t — I couldn’t tell you what I saw on the seat. Even though

Jimmy was lying there on the seat I couldn’t tell you what I saw.

Dr. C: So that — you always blocked out those horrible images?

Sherry: Yeah. Yes, that’s for sure. And I definitely… but after my dream last night and

actually seeing Jimmy with blonde hair and blue eyes — and actually seeing

him, I feel relieved — real relieved about it.

Dr. C: Perhaps you could tell us about the dream at this point?

Sherry: Well, I dreamt that, my dream started off with men and women in a kind of

army/military type situation and then I, um, dreamed of a scalpel (which Jimmy

did have surgery on him before he passed away — before he died they did

perform surgery on him). And then it was kind of cloudy and foggy and then

the clouds parted, and there was Jimmy and he was lying on his stomach. I

wouldn’t say he was smiling, but he wasn’t sad. He just looked content. And

he was just looking at me, and I felt very frightened if what I saw, I didn’t expect

that to happen. It woke me up and I can remember looking at the clock and it

was 2:05 A.M. and I was really, really startled by it. Um.

Dr. C: What frightened you about this imagery in your dream?

Sherry: Because I actually saw him. It was seeing Jimmy. And maybe because I didn’t

see beyond the head and shoulders, I didn’t see the rest of the body.

Dr. C: And why do you suppose that was terrifying?

Sherry: Because that is the part of the body that was injured. I think that was what it

was. I think that was why I probably woke myself up.

Dr. C: Because you didn’t want to see the horror, which you saw as a little girl, and

this represses that.

Sherry: Right, exactly.

Dr. C: What were your emotions that followed then last night?

Sherry: I got up and I went to bed. And I felt really… I cried for a little bit, but I didn’t cry

hard, but I did cry for a while about it and thinking about seeing Jimmy. And I

felt the best thing for me to do is I sat down and I prayed to God. And I asked

God, what do you want me to see or what do you want me to feel? I will leave

it in your hands and then I will see it. And I left it up to Him. I then went back to

sleep and I had two dreams after that. One was of a floatplane taking off a lake,

but the floats fell off the plane and it was so it was no big deal to anybody and

the other one was of … (interrupted).

Dr. C: Um, can we talk about that one for a moment? What does that bring to mind,

that the floats fell off.

Sherry: It brought back that the plane could not land; it could not land again when the

floats fell off.

Dr. C: What does that make you think of?

Sherry: That it could not come back to Earth.

Dr. C: And what does that bring to mind?

Sherry: Jimmy.

Dr. C: In what ways?

Sherry: That he cannot come back to Earth! That he is gone forever.

Dr. C: That is in the physical way, but not in the spiritual way — um, what is your

feeling?

Sherry: Um, that it is God’s way of telling me that he was probably fine.

114 Interpretation

Dr. C: Do you feel that you will see him again?

Sherry: Yes I do.

Dr. C: Could you share that thought?

Sherry: I really do feel that I will see Jimmy again, and my friend Molly.

Dr. C: That is a very comforting thought, isn’t it?

Sherry: Yes.

Dr. C: And there was a third dream?

Sherry: There was a little choo choo train with an old steam engine that came flying

through the air over the lake after the plane. And — and it was a bright gold

train, a little choo choo train, with a green trim. And I was looking, and nobody

thought it was a big deal. It was okay that it was flying through the air.

Dr. C: How did you feel when this train came zippin’ through the air?

Sherry: It was kind of funny. I thought it must not be a big deal if no one else thought it

was a big deal, but it was just okay.

Dr. C: Trains are neat. What do you think your dream is trying to do with this third

dream?

Sherry: That again — that it was okay, and, um, no matter how odd something is,

sometimes it is all right, or the circumstances — that we just have to realize

that. So, it is hard.

Dr. C: Yes, it is hard. Yes, it is hard. It has a wonderful that you are getting in touch with

some of these feelings and freeing yourself up for love now. That it would be

even more of a wonderful miracle if you and your husband could connect with

a baby.

Sherry: Yes.

Dr. C: I was wondering if we take a few moments now and go through the whole

series of images. I do not want to tire you out, but if you could just look at each

image and tell us what you see, starting with image A1 and go right through it,

please.

Sherry: A1 hit me as two bunny rabbits. And they look like happy bunny rabbits.

Dr. C: And does that bring anything to mind?

Sherry: Um — other than that we had little rabbits when I was growing up. We usually

had rabbits running and they were just pets. And I really enjoyed them.

Dr. C: So this goes back to a happy childhood theme.

Sherry: Yeah, oh yeah.

Dr. C: Okay, A2.

Sherry: Is a squirrel with a tail which… when I looked at this image on paper it looked

a little different than it did on film. It reminded me of a squirrel, then again,

there were lots of squirrels running around. And there used to be lots of them

and they were fun to watch.

A3: Flowers floating on a pond. That reminded me of a lot of Lily pads and stuff

floating around on the pond. I always thought that they were really pretty and

I enjoyed them.

Dr. C: Yes, Alaska is really beautiful.

Sherry: Oh yeah. And image A4. It was a person on the left with his hands up and on

the right it looked like a bus: part of a bus. And, — um, I’m not sure why I saw

that, but it was what came to mind when I saw this particular image.

A5: I thought it was kind of comical. It was kind of cute. It had a Moose’s head at the

top, a heart in the middle, and a person’s body at the bottom. And I thought that

was some kind of comical thing.

A6: Was a pumpkin that had two legs and a little teddy bear I saw — just sitting

there.

A7: Looked like a tomato and then a dancing person.

Dr. C: And the sex of the person?

Sherry: Ah, I never really thought of it. I would have to say a boy!

Dr. C: Okay.

A9: Two people. To me it looked like they were dancing a square dance and then,

when you look at it again it could be two duck heads.

Dr. C: It’s interesting how we see images, isn’t it?

Sherry: Yes it is.

A10: Reminded me of, when I first looked at it, like parts of two pansies of the flower

petals.

A11: I couldn’t come up with anything. Nothing came to my mind at all.

A12: A clown face with a hat on. And to me, the face was in the middle with the hat

coming over the top.

A13: A hand and then with people around it. It looked like little people to me — here.

And there were people around the hand.

116 Interpretation

A14: Was smoke coming out of a hole, is what it reminded me of.

A15: Was a pelican in a dive. It looked like a pelican doing a dive.

A16: Were two birds kissing.

A17: Was a heart inside a rib cage, is what it looked like to me. Or it looked like it

could be two horses’ heads and a heart.

A18: Was a heart with a bunny rabbit and it looked like the back of a bunny rabbit

with his ears up.

A19: Was an intestine, is what it looked like.

A20: Looked like two kidneys.

A21: Looked like a bird. Because the colors in the picture it brought forms to, it

looked like two little pigs with a bird. It was kind of cute.

A22: That just hit me as a lobster because of the shape of it.

A23: Was a candlestick holder.

A24: That reminded me of people in the forest — probably because of the darkness

of the image.

A25: Was a mask.

A26: Reminded me of a womb, of a baby in a womb.

Dr. C: How do you feel seeing a baby in the womb?

Sherry: I felt good and I felt a little sad.

Dr. C: What’s the good part?

Sherry: Birth. Um — something new happening inside a person.

Dr. C: And the sad part?

Sherry: Is that I do not have one.

Dr. C: Yet.

Sherry: Yet (laughs - anticipation, hope).

A27: Reminded me of a little yellow chicken in the film. I’m not sure how I came up

with that after looking at it here (laughs).

A28: Reminded me of a person’s torso.

A29: Looked like a volcano eruption to me.

Dr. C: Well, we did have a volcano eruption going off here recently (laughs).

Sherry: Yeah, we sure did.

Dr. C: Did that depress you?

Sherry: Yeah it did.

Dr. C: W hat was your reaction to it?

Sherry: I was wondering if it was going to go really hard this time. You probably

remembered when it erupted, in probably the fifties. And we were covered

with dust and we had to stay in our houses.

Dr. C: Gets your attention quick, doesn’t it?

Sherry: Yes, real quick (smiling).

A30: Was a “Skull. An evil skull in a cloud.” I just didn’t feel good about this picture

at all.

Dr. C: Yes, we talked about that.

A31: Was “two people faces with their brains –“ because in the film it looked to me

like their face and brain were bright colors in the film.

B1: Was a “fist” we talked about.

B2: I could not come up with anything on that at all.

B3: Reminded me of a “cow’s skull—” of the old skull as you would see in the

desert.

B4: “A side view and front view of a face—kind of together.”

B5: Was “two people sitting down and they looked like they were throwing bottles

between each other.” Which to me was that they were having fun.

Dr. C: You’re going to have more fun as you process this grief.

Sherry: Oh yeah, a lot more fun (smiles).

Dr. C: Yes.

B6: Reminded me of a “flower or a sea anemone”, which I think were real pretty

floating around.

B7: “A sting ray fish.” That could be because when I was in Florida I got to pet one

as it swam by (laughs).

B8: Reminded me of a marble in the film and here it looks like part of a person’s

face or nose.

B9: It looked like two kidneys with a hand holding them at the top.

118 Interpretation

B10: Reminded me of an owl.

B11: Looked like flags waving in the wind.

B12: Was a tree.

B13: I could not come up with anything on that one at all.

B14: It looked a face in a bottle, and it was very faint.

B15: Was a child’s finger-painting.

Dr. C: The face in the bottle, does that bring anything to mind?

Sherry: It was like something was trying to appear, but it was not quite clear. Which

would bring to mind the image of Jimmy, but not quite clear.

Dr. C: Yes, previously viewing the SIS, did you have many dreams about him?

Sherry: No, not that I could remember. B16 reminded me of an African with a mask on.

B17: Which was my favorite, was the glowing heart.

B18: Was the back of a person. Looked like a person just standing there.

B19: A starfish with a couple of hearts in it, or a jellyfish.

B20: A half moon with a cloud.

B21: Reminded me of Mr. Potato Head which was the game we used to play when

we were kids (laughs). And you got to detach all the parts.

Dr. C: It sounds like you had a lot of fun when you were a little girl.

Sherry: Oh yes, we did.

B22 : Reminded me of a person lying down with bubbles coming out of him.

Dr. C: We had talked about that one a little bit ago. Would you like to expand on that

image a little more?

Sherry: Yes, that one was like the life leaving a person I think. It’s…

Dr. C: What does that bring to mind?

Sherry: Yes, of Jimmy dying, is what it brings to mind.

Dr. C: How does that make you feel when you think of that?

Sherry: Sad, very sad about it.

Dr. C: It sounds like you had a good cry last night?

Sherry: I did (laughs).

Dr. C: It helps, doesn’t it?

120 Interpretation

Sherry: I felt really relieved. Its — I don’t know, its funny how you feel healed, or start to

heal.

B23: That reminded me of ribs, of people's ribs.

B24: I couldn’t come up with anything on that.

B25: Looked like hands holding a Christmas ornament.

B26: Was like a shirt and a pair of pants.

B27: Was two people dancing.

B28: Was the Ghost.

B29: Was a person jogging.

B30: Looked like two people’s ears.

B31: The last one was a family, which… that imagery hit me really strong.

Dr. C: What was the emotion?

Sherry: Togetherness and happiness.

Dr. C: Yes.

Sherry: Yes, very, very much so.

Dr. C: Thank you.

Sherry: (Smiles).

It can be concluded that the SIS-Video took the patient back in time and stimulated her

through dreams of her 18 months old brother being killed by a sled dog team. Processing

her grief and anger helped her. SIS-Video has been found to be a powerful test helping

in hearing the inner cry of the patient and relieving trauma.

Stimulus Plate SIT-5: Marital Discord / Relational Dyad Representation

“What is learned and remembered is dependent on one’s psychological state at the time of the experience” (Rossi, 1986, p.47). Accessing the state-bound memory or experience, creates an opportunity for growth through reframing or reorganizing it to facilitate some resolution. This is achieved through the recreation of the emotions, sounds and thoughts related to the repressed event or experience. Accepting the concept of state-bound memory, the therapist strives to create for the patient an opportunity to access the state bound sources of the problem. Hypnosis is one way of helping patients to access state-bound memories. All patients however are able to access these memories. The Case presentation illustrates the use of the SIS as a projective technique and an adjunct to hypnosis, to help patient access the state bound memory, when conventional therapy is unable to achieve the same result. A three-stage administration technique is used. The first step is to administer the SIS

cards and for the patient to identify the three cards they found least disturbing and the

three cards they found most disturbing. The second step is to induce a light trance.

Depending on the severity of the condition, the author would either induce a light trace

or a deep one. The patient is given suggestions of relaxation and the state of relax is

then anchored in the fingers. The third step is to ask the patient to open their eyes, look

and concentrate on the card and close their eyes again. The patient is asked to report

what emotional responses the card evoked or what images came to mind.

Three vignettes describe the use of the SIS to access state bound memory. The patient

described is a woman with marital problems, an anorectic child and a woman with

chronic anxiety. Once the memory was accessed and reframed, she showed a dramatic

improvement in her condition.

Mrs. E.D. is a 38-years-old married woman who was referred by a colleague because

she was not responding to conventional treatment and hypno-therapy for the complaint

of marital and sexual problems. She dated the onset of her problem to nine years prior

to being seen by the author after having had a Pap smear. She reports that she was

embarrassed by the examination and had difficulty opening her legs. The examining

doctor made derogatory remarks about her being sexually active as a single woman.

She is married for two years to her boyfriend of 12 years and has a 2-year-old son. Her

husband had visual problems. After extensive therapy by a colleague, which included

hypno-therapy the patient showed no signs of improving. She was referred to the

author for hypno-therapy.

At the initial interview the SIS-II booklet was administered after taking a partial history.

The following is what the author considered were some of the more significant

responses.

A3 I don’t know.

A4 Left-hand side looks like a rose bud starting to open.

A5 Looks like a small body, length and arms. This is the mouth. Like this person is

confused like me.

A6 Looks like a teddy bear sitting here could either be legs. Also reminds me

almost like sperm going somewhere. Could also be me keeping myself closed.

A7 Someone drawing, could also look like the fruit being hanged, looks like me

moving my body away.

A8 (After a long silence), looks like a figure as well, like a pregnant tummy. Looks

like sperm. Pinokio’s nose growing.

A12 An ear, could be someone is always wanting to listen.

A13 A hand and it looks like some hand of a plant or something. Saying stop right

there. Like its telling you if you go any further it might be dangerous. Could

122 Interpretation

also be a flame or something that is in the sea, something like that?

A22 Looks like a head cut apart, some object, two heads that were put together but

separate.

A26 Looks like a deformed face, I see the eyes, or it could be a scan, a baby, and

development-taking place.

B1 Head of a baby, flames, and picture depicting the moon from space, whirlwind.

B10 Scan of womb showing developing fetus, pregnant stomach.

B15 Confusion, a child’s scribble, danger, dangerous pointing.

B30 Ears, there will always be someone who will listen to you.

By looking at the responses, the author formed the hypothesis that the patient was

feeling confused and was asking for someone to listen to her story. The frequent

references to babies were difficult to interpret. Because hypnosis was the treatment of

choice, the following two sessions were spent clarifying any misconceptions the patient

might have about hypnosis and to let her experience what it feels like to be in a state of

relaxation and to provide her with an anchor for relaxation. This was done with the full

knowledge that the referring colleague had used hypnosis and that the patient was

familiar with the technique. The primary objective was to establish a rapport and to

introduce her to my way of working.

Session 4.

Two options were considered; one was to explore the responses to the booklet in

greater detail or to administer the SIS cards. The second option was decided on as a

further diagnostic tool. The following are her responses to the cards.

Card 1.

Patient Could be a young girl with ponytails. Could be two birds. Young girl’s eye

look a bit sad.

Therapist : What is she sad about ?

Patient : I do not know. May be she wanted something she was not allowed to get.

Therapist : What do you think it could have been ?

Patient : My mind goes back to when I was 10 years old. Mother had cancer; I knew

she was sick when I was nine. I knew she had pain. I did not realize that she

had died. I knew she had to go to a hospital. I knew she was in pain, I

insisted that she plaits my hair. When I left for school she wanted me to kiss

her, I refused to kiss her.

Comment : At this point the patient became very quiet and tears rolled down her face.

Patient : At school the principal called me, I thought it was my uncle who had open

heart surgery, I thought Uncle Bobby had passed away. When I got home

my grandfather told me, my mother was gone. My grandfather was crying. At

the funeral I refused to look at my mother in the coffin. I feel sad. I often think

about her. I am sad; I did not kiss her good bye. My greatest fear is that I lost

my mother; I hope my son does not lose me before he is 18. I think of her

quiet often. My grand father had two daughters.

Comment : On a further questioning patient told the therapist she had two photos of her

mother displayed in her house and that she was sexually active before the

marriage.

Card 2.

Patient : Little boy with a big face, there is a smile on his face. There is a smile but no

eyes I cannot read the expression. I do not know if it is a smile or not or they

are just stretching their lips.

Therapist : What does that make you think of ?

Patient : People not saying her true feelings, just smiling, a smile on her face. I am

always smiling don’t let anyone know.

Therapist : Why did you get married ?

Patient : He insisted. After a year I proposed, maybe it was the sexual thing, after a

few years he wanted to get married. I made up my mind; no I did not want a

big wedding. I never had my parents. I fell pregnant; he said we had to get

married, as his uncle did not want another child out of wedlock. I was 35, I

was single for a long time, I felt free. At 18 my husband started having

problems with his eyes. I have accepted his condition, I am proud of what he

had achieved. I feel it is too much, I feel if I do not help him he will leave me.

I went into this relationship knowing his eyes were bad. He had a drinking

problem. He wants another child.

Card 3.

Patient : Another face, longish hair. Person is contented, could be a little bit (could

not make out what the patient said) I don’t know why I said that. It dawned on

me she is asking me a question, Do you think she did the right thing I want

to say yes, may be I did not forgive XX (She mentioned her own name) for

what she did.

At this point the hour was over and the patient was distressed. The session ended with

the patient being relaxed.

Session 5.

Conclusions drawn from session four were that the patient had some separation anxiety.

There was guilt about her mother’s death and her refusal to kiss her goodbye on the

124 Interpretation

day she died and she had some unresolved conflicts about her premarital sexual

activities. The author decided to use hypnosis to help her to work through these conflicts.

Routine induction was done with systematic relaxation. Using age regression and

visualization the patient was able to “talk” to the 10-year-old girl and reassure her that

young girls react on impulse some times and that she could forgive the 10-year-old girl

for what she did.

Session 6 and 7.

During these sessions hypnosis was used to complete the grief work and help her to

resolve conflicts related to her mother’s death. Some ego strengthening was also

done.

Session 8.

Patient reported that she was feeling relaxed and had visited her mother’s grave and

was able to complete her ritual of separation and felt proud of her achievement. She

reported that she had applied for a promotion post and requested some assertiveness

training to prepare her for the interview. She still had the fear of dying. Basic stress

management techniques were discussed.

Session 9.

She reported that she was able to make decisions with confidence and only spoke very

briefly about her marital problems. She was concerned that her husband was very

friendly with a colleague at his work. She promised to phone to confirm the next

appointment. The patient defaulted and did not return to therapy.

Discussion

The case demonstrates the usefulness of the SIS in identifying deep-seated conflicts

which patient is unable to uncover through conventional therapy. The usefulness of the

therapeutic tool of reframing is also demonstrated. The patient presented with marital

problems but did not respond to conventional therapy aimed at the “problem”. The SIS

helped to identify the underlying unresolved grief. Once this was dealt with and reframed,

the patient was able to continue with her normal duties. Because the patient terminated

therapy no follow-up appointment was given. It is interesting to note that only 3 cards

were used in this case. An unknown factor is the author does not know whether any of

the other cards would have uncovered some

It could be argued that the problems would have eventually been identified but at

considerable emotional cost to the patients. The case history has demonstrated the

usefulness of the SIS images to identifying deep-seated conflicts.

Stimulus Plate SIT-14: Examination Anxiety / Autonomic Hyperarousal

Most clinicians consider the use of inkblot testing such as the Rorschach, primarily for

its diagnostic applications. In recent years, the widespread use of numerical scoring

systems such as those developed by Klopfer and Exner, have tended to bypass the

therapeutic value of Herman’s inkblots in stimulating imagery for free association and

content analysis. This failure partially relates to the fact that most modern therapists are

not adequately trained in this approach for recalling painful memories and PTSD

dreams. In the past psychoanalysts such as Roy Schafer did preliminary explorations

involving Rorschach content analysis as an aide in treatment, Another reason for the

original ten plates becoming relatively unused as an aide to therapy concerns the fact

that the color-form configurations lack sufficient structure to routinely stimulate clinically

relevant interview themes.

As an attempt to create visual stimuli more consistently capable of stimulating imagery

for diagnostic and therapeutic purposes, the Somatic Inkblot Series (SIS) was envisioned

in 1959. Work was initiated designing a new series of ambiguous yet partially structured

designs, whose use been reviewed in SIS journal. This presentation represents a

longitudinal case history study of eight years comparing the diagnostic and therapeutic

utility of inkblot images. [t may also refresh the memories of clinicians concealing how

projective stimuli can facilitate not only diagnosis, but also provide a powerful yet

underutilized tool in the various current day psychological treatments.

A male college student age nineteen was selected for the case history study. He was

referred by a psychiatrist and was plagued by incapacitating examination anxiety,

when interviewed; he had major problems with stammering. Part of his developmental

history, involved his having been placed at age seven by his parents in a boarding

school in another city. At that time he experienced considerable abandonment feelings

and severe homesickness. In addition, it was noted that until age twelve he suffered

from enuresis.

As part of assessment and treatment plan development, he was given the Rorschach,

SIS-I and SIS-video Images These procedures were completed initially in March 1991,

then repeated in October 1991, then the third time in April 1992 and fourthly in February

1999. Repeating the visualization processes facilitated evaluating the clinical progress,

while at the same time providing an aide for stimulating imagery for therapeutic

discussion.

The longitudinal treatment plan involved insight oriented psychotherapy discussing

his abandonment issues, content analysis with him concerning the significance of his

inkblot responses, cognitive therapy and hypnotic relaxation During the initial period

of three months his psychiatrist provided him medication to assist in the control of his

anxiety. Fortunately, he made impressive improvement from the biweekly psychological

intervention.

After six sessions, since he was able to deal with his anxiety more effectively and

consequently he was able to take and successfully pass examinations. The

psychopharmacological approach was no longer necessary. However, therapeutic

work on the stammering and interpersonal conflict issues continued at intervals over

the observation period. These were on an “‘if and when needed basis” for approximately

seventy sessions over the eight years. As will be shown, eventually the latter sessions

began to focus on stressful interpersonal issues not directly related to the original

presenting problems.

Results of Inkblot Interviewing:

At the initial evaluation with the Rorschach, there were signs of both low

productivity(R=12) and imaginative capacity suggestive of his anxiety problem. In spite

of definite improvement in his clinical symptoms, the Rorschach responses did not

reveal much change, nor did they in this instance, stimulate therapeutically relevant

percepts. The total number of Human content responses remained only 2 in all test

sessions. Most Klopfer’s scores were essentially no different with repeat testing. By

contrast the Human content with the SIS-I was observed to increase over time. This

matched his reduced examination anxiety and improved social skills. Initially he gave

five human responses on the twenty inkblots and this number doubled on the last

testing session. The quality of contents during 3 rd and 4th testing improved, which can

be observed in the tables, presented in this report. This was associated with his

improved ability to communicate and interact with people. A few clinically significant

responses on Rorschach, SIS-Video and SIS-I are shown below for understanding the

pulling power of the test.

With the SIS-Video, there was a similar increase in his ability to recognize human

content in the video presentations and their quality improved. For example, initially on

A13 he responded," lt looks like fungi or algae”. Next he saw it as “A hand surrounded

by fire”, denoting the painful grief stemming from his unresolved abandonment issues.

In the third session, he projected a response symbolizing his progress; ‘A hand getting

out, surrounded by plants”. Finally, he saw it as “ A hand of a person clapping!” This

reflected his appreciation for the therapeutic assistance given over the years.

Next consideration will be given to illustrating how the discussion of his SIS-Video

responses facilitated treatment, Firstly, in regard to the early abandonment issues,

exploration with him of the following responses warrant comment:

A3 Initially he saw this as ‘~A human cell or roots of a plant that has been uprooted”.

Here the significance of the projection of the responses “human cell” symbolizes his

traumatic loss at age seven when psychologically uprooted as denoted in the “plant

uprooted”. After his therapist repeatedly processed the family significance of this 518

imagery to him, he gradually began to resolve his abandonment issues. He learned to

126 Interpretation

accept dependency on people as a necessary part of mature life. In working through

his transference to the therapist, he acquired insight into the fact that loss and grief

need not always follow trusting in close human relationships.

It was highly significant that he rated this symbolic material denoting as the “least liked”

or most threatening imagery evoked by the 62 images of SIS-Video presentations. This

demonstrates the critical importance of the therapist knowing developmental history

concerning early losses and not attempting to do “blind interpretations”. Lastly, in the

final retest situation eight years later, he imagined seeing “a lovely flower with colorful

roots”, with growth in his self-confidence and esteem he could readily identify with a

“lovely flower”, the color signified his enhanced emotional state. A14 Initially, he said that this represented “a picture on the wall” The next two responses correctly identified the anatomical structure embedded in the inkblot. This was consistent with his developing a more mature awareness and sensitivity to emotionally tinged body sensations, At the eighth year of therapy, he projected the response “Energy being sent from a person”. This depicted his recognition that he could benefit from establishing interdependency relationships with nurturing people. Since had a religious support system, the additional value of spiritual meditating as a higher source of human “energy” was also discussed. A18 He responded to this in the SIS-Video presentations as follows: “Smoke ring”, “Lava, smoke, volcano, cloud from volcano and finally bright gases and lava ejected by volcano”. His free associations to these responses in therapy immediately led to his emotional pain, low self-esteem, hurt and anger when originally psychologically abandoned in childhood The fact that he visualized the “gases” in brighter colors he realized symbolized his more positive self-image and hope. To complicate interpretation, his therapist realized that some of his angry symbolism was stemming from new conflict with his parents. They recently had proposed a bride for him whom he considered unacceptable. Shortly before the fourth interview he had established a love relationship with a woman of his choice, Consistent with this he imagined SIS-Video Image 31A to represent “Two lovers kissing”. Similarly, he envisioned 17B as “A heart beating on Valentine’s Day”. Previously he had given the following responses: “volcano crater”, ‘heart”, and “Bright flower with pedals”. Also related to his evolving amorous interests, he visualized 22B as “A man sleeping and thinking of a woman he loves”. This illustrates how the SIS may be used to follow maturing as an individual attempts to move beyond childhood fixations through new life passages This longitudinal case history employing the Rorschach and two versions of the SIS perhaps may be best considered from an historical point of view. The use of inkblots in art and psychology predate Herman Rorschach by many years. What is of interest is the fact that even though there have been attempts to develop inkblots such as the work of Holtzman and others, somehow the great creativity inherent in Herman’s blots have been forgotten by modern professionals who over utilize reductionism scoring in cult like training seminars.

Table 24

Comparison of Rorschach Responses on 1st, 2nd, 3rd and 4th Testing:

Card 1st Testing 2nd Testing 3rd Testing 4th Testing

No.

I Bat Bat Bat Bat

II Faces of two persons Two persons Two kids Two persons

clapping like clapping. clapping. clapping like.

III A person Hand of an Animal Frog-head Two ladies

dancing

IV Skin of an Animal Animal like bat Bat Flying Bat

V Two deer’s horns up Bird like vulture flying Bat flying Bat Flying

VI Skin of a lion Skin of a deer Skin of an animal Skin of an animal

VII Squirrel standing Two children playing Two kids standing Two children

on a Rock on something. playing

VIII Two animals climbing Two animals like Two animals on Two animals

wolf going up. wolf going up a rock climbing climbing

IX Arial view of a valley Rejected Web’s type Two animals

X Various animals- Various animals- Various animals- Various animalsSpider, Peacock, Rats Spider, Peacock, Rats Peacock, Spider, Spider, Peacock,

Fish Rats

Table 25

Comparison of a Few Significant SIS-I Responses on 1st, 2nd, 3rd and 4th Testing:

Card 1st Testing 2nd Testing 3rd Testing 4th Testing

No.

1 Two hens sitting 1.Two hens 1. Two hens 1. Two hens

2. head of a person 2. head of a 2. head of

person person

5 1. Bat As some one has Mother & two Mother & two

2. Two children been killed babies babies

playing

6 Two penguin Two children Two children Two children

playing playing joining hands playing

14 Insect with mouth Insect like Clown Clown

beatles

18 Face of ghost 1. Bat Man's face Face of a

2. Eyes, mouth face person

of some one

20 Rejected Face of a person Face of some Face of a

thing person

128 Interpretation

Table 26

Comparison of a Few Significant SIS-Video Responses on 1st, 2nd, 3rd and 4th

Testing:

Card 1st Testing 2nd Testing 3rd Testing 4th Testing

No.

A 3 Plant uprooted. Roots of a plant Roots of a plant Lovely flower with

with branches colored root

A 13 Looking like fungi Hand surrounded Hand surrounded Hand of person

algae by fire by plant clapping

A14 Picture on a wall Liver Human Stomach Energy being sent

from a person

A18 Smoke ring Lava/Smoke Volcano Cloud from Bright gases

Volcano ejected by Vol cano

A 21 Looking like a bat Two small children Two children Hand of a person

with bat playing around who is clapping

their mother

A24 Rejected Forest with tree Pond in a Forest Mother and baby

A31 Faces of man Man and Women Man and women’s Two lovers

and women face kissing

B4 A girl seeing her Two faces Two male and Girl and boy sitting

face in a mirror female faces in a park

B17 Looking like Heart beating Bright flower with Heart beating on

volcano crater petals valentine day

B18 Rocket going up Penis Penis of a person Graphic artist

in war working on

Epic B22 A person sleeping Dead body soul Person laying

Man sleeping and

and thinking of going up down and think- thinking of Shen

some thing ing he is dead & Ming

soul is going up

B23 Depression created Spider with legs Spider with legs Bright color in a

by a bomb shop

B28 A girl embracing her Women embracing A girl clinging her Mother and

mother her child mother daughter

B 31 Couple with children Man women with Couple with their Happy family

their children two children boy

and girl

Most educated people associate the name Rorschach to the notion of inkblot testing.

While scoring Systems have added immeasurably to diagnostic application, their very

use has tended to obscure the clinical merit of using content analysis. Overlooking the

rich symbolism of inkblot responses, such as those illustrated in Body Symbolism

(Cassell,1980), especially as they may readily lend themselves to the therapeutic

approaches does the field of projective testing a great disservice. Although, many

psychologists refer to the Rorschach data as resulting from “projective testing” this is a

misnomer when standard scales are the sole source of data. What is even more of a

tragedy for the field concerns the fact that there has been so little effort to improve in the

design and presentation of the existing inkblots.

In this study it was shown how the rich imagery evoked by the SIS tended to make the

Rorschach percepts pale in comparison. Ordinarily, ten relatively ambiguous blots can

not compare in projective pulling power with the SIS stimuli designed with embedded

clinically relevant material. For example, the SIS is much more able to stimulate human

percepts. In this case illustration, the clinical improvement with treatment over time was

associated with a doubling in the number of human responses observed with the SISI but not the Rorschach

Apart from having 62 more visual stimuli for presentation, the SIS in the video version

has more pulling power as a result of technology. It reduces test anxiety by combining

floral relaxation for inducing hypnotic viewing with the opportunity for the viewer to

write responses. The subject is alone, and like in hypnotic writing, does not have to

hear what is reported Moreover, it is unnecessary to immediately share potentially

threatening imagery with a professional person at the time the projective images and

their disturbing emotions enter consciousness. When the subjects rates responses for

those that are “least liked” the interviewer has an opportunity to evaluate their anxiety

treat A busy clinician may simply get free associations to the most anxiety laden SIS

image, without taking interview time with the others. For the college student under

study, most threatening imagery provided very important information confirming the

therapist’s suspicion that early abandonment was a major stress. Of course, during the

initial assessment, the youth had not yet been provided with this insight It was only after

his therapist made this inkblot interpretation that he was able to begin to resolve this

childhood loss. Giving associations in therapy sessions to the response to M “A human

cell or roots of a plant uprooted” quickly led to the imagery’s affect linkage and his long

forgotten grief.

While longitudinal case histories such as this point the way for clinicians in the new

millennium, it must be recognized that there are many obstacles to be overcome. This

is particularly true in the United States where problems related to professionalism are

formidable Psychoanalysts are rapidly becoming a vanishing breed. Even though they

employ free association in interviews, most do not believe that they should include

inkblot analysis in their treatment. Present day residency training programs for

psychiatrists, since the era of psychopharmacology have become restricted by over

adherence to the medical model. The concept of projection, whether it is onto inkblots,

the individual’s body, the therapist (i.e. transference), fantasy imagery and dream

analysis are often relegated to outdated theoretical models. Many psychologists avoid

130 Interpretation

projective testing because it is not readily quantifiable and to many suggests mysticism.

Also because in the American private economic sector insurance companies are

resisting paying for their work, many are experiencing drastic limitations in their practices.

They are being rapidly replaced by less trained psychotherapeutic practitioners (e.g.

social workers, psychiatric nurses, pastoral counselor’s etc.) in test procedures.

Moreover, psychologists in several states have convinced legislators to pass laws

limiting test procedures only to licensed psychologists. What ever the professional

discipline of the clinician, their should be a rich background of depth psychology,

psychoanalysis and psycho-synthesis in interpreting the direct and symbolic meaning

of projected responses. In fact, symbol interpretation is the basis for deciphering the

language of the unconscious. Although these issues of the therapist’s socioeconomic

status and power go far beyond the scope of this report, they must be considered

challenges to be dealt with in the twenty-first century.

Stimulus Plate SIT-28: Female Sexual Assault / Intrusive Threat Defense

Miss X, 27 years, unmarried, Las Graduate, practicing as attorney, belonging to high

middle class family, has history of sex abuse at the age of 4 years by a 19 years boy,

physical relationship with an aged family friend, history of feeling depressed, wish to

leave the family and conflicting parental relationship was given Somatic Inkblot Series

Video for understanding the personality and therapeutic intervention. Intervention of a

few responses found to be quite relevant has been given for understanding the

psychopathology of the case.

A few responses on SIS-Video given by Miss X is discussed ahead :

A1 On this image she saw “A man who looks healthy and majestic but pretty empty

inside” is a direct projection of how she feels empty inside although she looks

normal and healthy on the outside. The fact is that she conjures up images of a

man rather than of women may reflect her sexual identification partially identified

with that of her perpetuator.

A3 Many people in viewing A3 introduce spiritual connotation with this image.

Here she directly projects her feeling of wanting to be free of her past traumatic

memories and inner trauma by seeing “My soul when will it become free”.

A5 She viewed “A Lady who is all heart celebrating along” on A5 is direct projection

of same sex identification to the human form. She focuses on the heart because

she is introspective and socially withdrawn as a result of her pain and depression.

It may probably also represent a projection of her mother’s image who is critical

and non supporting. Her depression is abnormally high and she has given lot

many responses depicting depression.

A6 “A sad teddy bear” on A6 brings back the theme of sadness or depression

almost in a perseveratory fashion. In addition the response has repressive

features. She totally avoids reference to the human gestalt and focuses instead

in a child like fashion in a teddy bear.

A10 On this image “Blind Woman” is the projection of her psychological blindness

associated with her repressing images of her past sexual abuse. She also

comments that she is getting impatient and needs therapeutic resolution for her

long-standing childhood conflict.

A11 She viewed “A needle through the heart-I want to weep but I won’t” on this

image. This is a direct projection of an emotional pain and depression, the fact

that she conjures up the image of a needle penetrating the heart symbolizes her

past sexual penetration and body boundary violation. In commenting on this

horrible response, she for the first time acknowledge tot he examiner her

depression and need for emotional catharsis as well as her inability to do so as

without therapeutic assessment.

A12 She viewed “can you hear me with your ears and listen with your heart” on A12.

With this question she directly asks the interviewer if she will be heard with

empathy and compassion. Previous attempt to share her pain as a child fell on

the deaf ear of the parents.

A13 She saw “A window hazy with fog with the center clear, a hand out stretched

asking me to wait. May be I should give up". Here she continues she theme of

her own reluctance to weep and share her pain with the therapist. She has

learned from the failure of past attempt to share which were met with frustration

and further hurt that the process of attempting to communicate may itself lead to

further hurt and rejection.

The hand symbolizes that part of herself that “I won’t on A11, will not allow her

self to trust the therapy it would be necessary to interpret the symbolic significance

of this response in terms of transference. Lastly the reference to “giving up”

continues the depressive feelings of her helplessness

A14 She saw “A dry flower” on this image. Here rather than recognizing the anatomical

structure, she projects her self image as being dead inside.

A18 On this image she viewed “A man hanging upside down with smoke bellowing

out of his head and waiting to fall through the dark circle into a hole.” Many

individuals see anatomical contents here such as the heart or image of sexual

intercourse. Because of her sexual trauma and resultant pelvic anxiety she

totally avoided reference of somatic structure in the video image. The defensive

material projected symbolizes of her severe depressive mood and latent death

wishes. At times she fantasize running away from her home and escaping from

her problems.

132 Interpretation

A23 She saw “Looking like a deadly ardroid, resembles a creepy centipede (scary

feeling)” on this image. Here the response is remarkable because of her failure

to correctly identify somatic structure, which is so clearly depicts spinal column.

There are two possible determinants of somatic repression, one relates to her

past medical history fallen 4 years earlier injuring her tail bone and causing

considerable pain. The other relate to phallic connotation of this particular image.

While both hypothesis can lead to heightened body anxiety, symbolic analysis

of her defensive imagery suggests that the later determinant is more noticeable

that she saw a deadly ardroid resembling a creepy centipedes which is highly

threatening to her.

Remember that previously in responding to image the needle had threatening

phallic connotation. A little girl violated by penal penetration will always carry

such negative association to phallic imagery.

A31 On this image she viewed “A beautiful women looking at her hazy reflection.

She is not sad yet contemplative (Feeling confused)”. Here she avoids reference

to central content in A31 which pictorially depicts a man and woman in very

close interaction, because this material is highly threatening to her due to her

past experience with her male perpetuator. The normative content is totally

repressed. She defenses against this structure by substituting image symbolizing

her self in therapy looking at her own self -image. The fact that she sees her

reflection as “not sad” represents the psychological defense mechanism of

denial. The introduction of the idea that the woman is confused symbolizes her

own confusion and cognitive disarray.

B3 “Two people sitting inside a womb overlooking an alter of fire. Here fire signifies

life (feeling of wonder)” was her response on this image. Seeing 2 people inside

the womb continues the regressive theme previously noted on A6, the fire

denotes her emotional pain. In this essence rather than associating depressive

aspects she introduces the concept of life and wonder. This was positive

prognostic implication to therapy and needs to be interpreted to her inner context.

If she is willing to share her pain during therapy, there is hopeful recovery.

B6 She saw “ A half statue girdle downwards with some infection around the girdle

(Feeling of depression)” on this image. Here she partially picks up the correct

anatomical structure referring to the lower abdomen and thigh. However, because

of her content by seeing a more abstract image “i.e. statue girdle’. Here it is

noteworthy that she projects a pathological anatomical response. “Infection”

symbolizes her own injured genitalia. The facts that this image accentuate her

feeling of depression in responding to the image indicates that she is grieving

the loss of her virginity and body boundary intactness. The assault on a child’s

body is not just injurious in a sexual way but when a perpetuator is a close family

friend, the overall ego becomes distorted and confused just like she indicated

on A31. The other explanation could be her repeated infection in her pelvic

region for which she has taken treatment.

B12 On this image she viewed “A parrot hanging upside down trying to fly away”.

Here again she totally represses the real structure of the image, which denotes

some man’s facial area and nose. The fact that the bird is seeing upside down

trying to fly away directly symbolizes the childhood feeling of vulnerability and

helplessness to avoid her perpetuator.

B16 She saw “The centipede is back again. I hate centipede (feeling of filth and

dread”) on this image. The significance of this response is previously reviewed

with A23.

B28 She viewed “A person hugging a white colored pet”. Most individuals who have

had experience of positive nurturing mother will see as a woman holding the

child. Here she defends against by avoiding reference to the maternal and

female connotation of the adult figures seeing only a “Person”. Similarly she

avoids reference of the child introducing the image of a pet. In spite of this, it

should be recognized that on an image which was loving and affectionate.

Frequently when child has not received maternal love, they will turn to pets to

meet the; need for affection. Such individuals with other inkblot test such as the

Rorschach test and the Holtzman Test give higher number of animal response

than the human response.

B30 She saw once again “Two ears-can you here me?” on B30, Here like in A12, she

directly asks the therapist if her inner cry will be heard and responded to

therapeutically. It is important from the point of view of establishing the early

therapeutic alliance and that she is given reassurance that unlike the past when

no one has heard her she will be heard with empathy and compassion now. In

this sense her cry will be heard and she will have the helpful therapeutic

relationship. Many male therapists because of trust issue prefer to refer such

traumatized female patients to a female therapist.

The responses to SIS have been successful in identifying the inner cry of the individual,

which itself is the first step of therapeutic intervention.It is important to remember that

the projective tests do not have so called objective procedure of interpretation. It is the

clinician’s acumen, which is necessary to interpret a protocol. In this case study, it was

the obvious percepts to unstructured stimuli which helped the subject to project her

inner cry.

Stimulus Plate SIT-1: Releasing Somatised Grief / Dual SIS & Rorschach Matrix

Grief

There are many stages in the grief process. One involves the appearance of the

deceased person’s body or aspects of the body in the individual’s dreams (VonFranz,

134 Interpretation

1984). This is one way for the individual to experience spiritual and psychological

contact with that individual and to deny the pain of the loss so that sleep can occur. The

dreamer, when awake, realizes that it is “just a dream”, and will then feel the emotional

discomfort and continue in the normal grieving process. Occasionally, especially at

night, the images of the person will spill over into conscious awareness in the form of

hallucinations when the deceased person will appear as a ghostlike figure and

sometimes talk. The lay public has referred to these hypnogogic phenomena involving

images of the departed loved one as “ghosts”.

Images of the deceased person’s body may be projected onto inkblots (Cassell, 1980)

and video stimuli having human and anatomical content. This process will be illustrated

by presenting the case history of a woman, who had lost her father several years

earlier, resulting in depression and required antidepressant medication earlier .

Psychologically, she closely identified herself with him in her own body gestalt. She

had developed painful somatic symptoms in her chest, mimicking those, which he had

experienced in dying of cancer of the lung.

A transcript of a video interview completed with this grieving person and interview with

the authors follows:

Dr. C: I appreciate your coming here today and could you tell us a little bit about the

extent of your depression and how it relates to your father’s death and so on

?

Mrs X: I miss him. I could always talk to him. He made me feel good. And even now I

sometimes still feel it was my fault that he was sick.

Dr. C: What was his sickness? Could you tell us?

Mrs X: He had cancer and it went into his bones and then he died shortly after we got

back. We were gone when we found out that he had cancer. And we got back

to Alaska in June of 83 and it just wasn’t my father.

Dr. C: Yeah.

Mrs X: He had changed quite a bit from the chemotherapy and that.

Dr. C: What were the changes you saw in your father with this cancer and how did

that impact you at the time?

Mrs X: Well, when I first saw him he was just, he was sitting in the corner of my

mother’s kitchen and he was just little thin old man with hardly any hair. He

couldn’t talk because he’d had a couple strokes and he had a hard time with

that.

Dr. C: How old was he at the time ?

Mrs X: He was 56.

Dr. C: So that must have been hard for you to see that?

Mrs X: Especially when I saw him the summer before and he was. We had gotten

closer and I guess I could just talk to him.

Dr. C: Could you tell us if you had images of your dad in dreams?

Mrs X: Yes, he looked like my father and not like this person that I saw when we came

back.

Dr. C: How would you feel when you saw your father the way he used to be in your

dreams?

Mrs X: Secure.

Dr. C: Yeah, you loved your dad. And then when you’d wake up how would you feel

when you realized it was just a dream?

Mrs X: I would feel very upset, umh some I would really kind of feel like I was, when

I woke up and found that he wasn’t there, that was the dream and that the

dream I have of being with him was real.

Dr. C: Did you ever have visual experiences or sense his presence in the waking

state?

Mrs X: Yes, sometimes I’ve walked through the malls and might have gotten a glimpse

of someone, a gentleman walking or shopping and I would have to look again

because I thought it was my father.

Dr. C: And what emotions would you feel at the time?

Mrs. X: It kind of scared me a little bit but they were high but when I realized it wasn’t

my father they were....I felt very bad.

Dr.C: Yes. I appreciate your sharing. I know it’s very painful. It will help to continue in

getting some of the grief out. One of the things we noticed was when you

looked at these ink blots you saw things resembling your father. And at this

time I was going to have Dr. Dubey go over the results of the Rorschach with

certain of the cards so I’d appreciate if you would share with him as well, O.K.

Thank you.

Dr. D: I would be interested to know a little more about these images that you have

already seen. You have responded on card #2 something like “Cancer cells...”

Mrs. X: It’s just.

Dr. D: Would you tell something more about it?

Mrs. X: It just reminds me of the cancer cells eating him up inside and him having a

hard time not being able to speak because of the strokes.

Dr.D: I am sorry. Can you think of something more on this card?

Mrs. X: Just the cancer and the blood. Wondering where the blood went because my

father was cremated.

136 Interpretation

Dr.D: On card #8 you perceived “there is an arm in the center and there are two

persons grabbing and pulling me down”. Can you tell a little more about this?

Mrs. X: He was my son and my mother, you know it just feels like I try to talk to my

mother and I try to do what she wants me to do and I try to please her and to

please my son too and I can’t do it. I’m having a hard time.

Dr. D: Yes. Of the two persons, one is your mother and the other one your son, is that

so? And are they helping each other?

Mrs. X: Well, my son he tries sometimes. He sticks up for me when he knows I’m being

pushed into a corner. He has this feeling. My mother, I love her, but I have a

hard time getting her to stand by me.

Dr. D: May be it reminds you that at this juncture when you really needed her help

she was not that helpful?

Mrs. X: She thinks it’s all in my head.

Dr. D: Take care. On card #9 your response was “A person hiding behind and feeling

ashamed like me”. What makes you feel like that? What makes you feel

ashamed?

Mrs. X: I’m just ashamed of myself because I can’t seem to do what everybody wants

me to do and like I said before I feel responsible for my father’s death. For

being bad when I was younger. And I just don’t want anybody to see.....

Dr. D: Please take care. It was a painful disease and why you feel responsible for his

death? Why you blame yourself?

Mrs. X: Because I feel if I had been a better daughter. I just feel that they took it out on

him to punish me and uh for being the oldest I just feel like I didn’t set a good

example for the other kids but yet I was treated like the youngest a lot.

Dr. D: So you think yourself as a bad girl and your father was being punished for

your mistake.

Mrs. X: You see I came up here. We were in the States and I came up the summer

before for vacation. I was under a doctor’s care there and I was having some

problems and I didn’t spend the time I wanted to with him then. And we were

getting closer and closer together and I had to leave. It was recommended by

a doctor that I go back to be with my doctor there so I had to cut my trip short

and leave him before we really got a chance to get a lot of things said.

Dr. D: O.K. This is card #10. And you said, “This is an explosion and there is something

coming out of mind.” What makes you to think so?

Mrs. X: It makes me think of me. I keep a lot of things inside. I don’t yell that much at my

son. I just let things that happen to me. I keep inside and then when it reaches

a certain point I just lose it. And I try to talk and explain what’s going on and I

can’t because I’m so nervous and crying and then when it’s over I feel ashamed.

I feel like I’ve done something wrong.

Dr.D: And by seeing “something is coming out” might be giving a sort of release, a

release of tension, how is that?

Mrs. X: By not keeping it in anymore. Finally by saying something to someone. Like I

say I have a hard time because I just start crying and shaking and I can’t get it

out. I just sometimes feel like I want to explode because I can’t take any more.

Dr. D: Is that a feeling of helplessness?

Mrs. X: Yes.

Dr. D: Now let us review your response on the SIS-I. You have selected card #20 as

the most threatening image to you. And here you have given a response, "It’s

like death coming to me. May hurt me". So please elaborate a little more.

Mrs. X: It’s just coming to get me. I think about a lot and I, like I say I’m afraid of dying.

And it’s coming.

Dr. D: Are you still so much afraid that it might come at any time and it may hurt you?

Please tell about this.

Mrs. X: I’m afraid that it’s gonna come very soon and I worry about my son when it

happens and my husband but mainly my son. I don’t feel I have done very well

as far as health goes this year and I’m scared. I don’t want to die right now.

Dr. D: On card #12 you have seen blood. May be the card is of red color and probably

this red color reminds you of blood. Would you say a little more about this?

Mrs. X: It’s mine, my father’s you know everything. All the problems that I’ve had

where i’ve lost blood and my father losing all of his blood somewhere and it’s

just all together.

Dr.D: How that blood has come?

Mrs. X: Through surgery and death.

Dr.D: Surgery! What kind of surgery?

Mrs. X: Surgeries that I’ve had and death of my father.

Dr. D: Please take care. I am going to show you another card, card #18 of SIS. And

here you have said “the gate of hell”. Would you tell about this gate of hell?

Mrs. X: Well, it just looks like the gate of hell. The teeth are the gates that are opening

that you walk through. The eyes are watching you to make sure that you do

come. It’s like it’s waiting for me. That’s where I’m going to go because I wasn’t

good.

138 Interpretation

Dr.D: It’s very painful.

Mrs. X: It’s scary.

Dr.D: Yeah. Is it the whole thing or just the eyes watching you and waiting for you?

Mrs. X: It’s the mouth opening up and as I go through closing in on me.

Dr. D: Does it still remind about your father?

Mrs. X: I’m afraid that’s where my father is.

Dr. D : On card #5, you have said “pain” . What sort of pain is that?

Mrs. X : It’s the pain eating inside. The pain my father had felt. The pain that I feel and

when I need him he is not there.

Dr. D: Can you imagine this red spot inside?

Mrs. X: It’s like a disease.

Dr. D: What sort of disease is that?

Mrs. X: Cancer.

Dr. D: Yeah.

Mrs. X: I’m scared of cancer. I had it once before, got over it but it kind of. It’s like, first

they said the cancer is looking good, that it was getting smaller and then all of

a sudden he started getting bone pain and it was in his bones.

Dr. D: Can you relate these red spots? Do they look like something to you?

Mrs. X: Right now they just look like little people that are trying to take him over. They

want to get in and spread more.

Dr. D: Can you think of who they might be?

Mrs. X: Just a disease.

Dr. D: It’s really very painful to think of your father and his disease. This is card #6 of

SIS. Right here you have said “a child in tension.” Can you tell us more about

this child?

Mrs. X: Well, the child is used to having just a mother around and now he had to learn

that the mother has met someone and that they are going to be husband and

wife and that the mother has to build her life around the husband and the child

does not understand it because he had always had the mother’s attention.

Dr.D: Does this child remind you of anything?

Mrs. X: My son.

Dr.D: Yeah.

Mrs. X: Yeah, it was just him and I for quite a while and then I met my husband and I

tried to please, you know, my son and my husband. It was hard. My son

needed to build his life around us and you know, we had problems because

I would be upset when my husband would punish him. I would say things in

front of my son.

Dr. D: Just to save him?

Mrs. X: Yeah, and I shouldn’t have. I should know. I just wanted Kevin to grow up and

be loved. You know he deserves that.

Dr.D: Yeah, and now the last card. This is #19 of the SIS and here you saw “something

is dying”. What is that? Would you like to elaborate?

Mrs. X: It’s like the slow death my father had. I mean it was fast but yet it was slow

painful. A person or thing is just laying there helpless and not being able to

move, say anything who ever once in a while open his eyes and look around

and see that the family is there with him. And there is nothing he can do and he

tries to speak but he can’t and he just slowly starts dying.

Dr. D: Take care.Now I wish to discuss your responses on a few SIS Video images.

On image A2 you have said “a bad life with lots of uncertainty”. Would you like

to tell about this?

Mrs. X: It does not know what’s going to happen next. And it has been a bad life,

maybe not for me but I have put my husband through an awful lot and my son.

Insecurity had made me afraid that my husband will find some one else.

Dr. D: Oh?

Mrs. X: Someone who is better for him. I give everything I have but I sometimes don’t

feel that it’s enough.

Dr. D: On next image # A3 you have said that it’s beautiful flower but later on you

said that it’s a flower with roots and an insect is eating the roots.

Mrs. X: That’s what it looked like.

Dr. D : Can you elaborate little more?

Mrs. X: It’s just that there is somethings that is beautiful and some people that want to

destroy. My husband is a very good man and sometimes I feel that I am

dragging him down. So I feel like I’m the beetle eating the root because I kind

hurt his career so.

Dr. D: It is very painful. Let’s go ahead on image A13. You have seen “man’s hand

reaching for help”. What’s that?

Mrs. X: My father reaching from the pits of hell. My father wasn’t a bad man but he had

problems and .........

140 Interpretation

Dr. D: Is that his hand in need of help?

Mrs. X: Reaching out for somebody to help him.

Dr. D: Do you think that he got the help he needed?

Mrs. X: Sometimes.

Dr.D: Yeah.

Mrs. X: Then when I think back on some of the things I did, he didn’t.

Dr.D: So the help and support he should have been given, he didn’t. I’m sorry. Let’s

proceed further on image #A21.

Mrs. X: Right here.

Dr.D: On A21 you have seen “a man is being torn apart by sickness”. Who is that

man?

Mrs. X: My father being torn apart by cancer.

Dr. D: Your father?

Mrs. X: Being eaten up with cancer.

Dr.D: You perceived on image A26 “baby” trapped in a ball and that baby is not able

to come out”. Will you describe about this ?

Mrs. X: I had to have a hysterectomy because I had cancer and my sister was pregnant

and she didn’t want to have any more children and she went and had an

abortion.

Dr.D: Oh! I am sorry.

Mrs. X: And to me this child that never had a chance to live and that she could have

more children and I couldn’t.

Dr.D: Take care. On image B2 you have said “cancer eating up all good cells”. So

again you are thinking.....

Mrs. X: My father.

Dr. D: Let’s proceed to image #B3. You perceive people, man and woman sitting in a

house on fire”. How is this?

Mrs. X: It’s, I don’t know it just looked like two people that were sitting there and that

really didn’t realize what’s going on around them.

Dr. D: Don’t they realize?

Mrs. X: What’s going on. It’s like they’re not there.

Dr. D: Um huh. Will they be able to save themselves?

Mrs. X: I feel that way sometimes.

Dr.D: And on image 9B you have seen “bad lungs”. What do you mean by bad

lungs?

Mrs. X: My father had lung cancer and the last chest x-ray that had it didn’t look too

good and it just scares me.

Dr.D: Sorry.

Mrs. X: I don’t want to die of cancer. I don’t want to go like my father did.

Dr. D: Proceed further to image B20. You saw “brain covered by bad cells”. What is

that?

Mrs. X: Cancer cells in the brain.

Dr. D: Last image on SIS video B22, you saw “a man lying down with a bad pain”.

What is that?

Mrs. X: Bad pain. Fire in his stomach. It just looked like there that his stomach was on

fire.

Dr. D: Can you tell more about this?

Mrs.X: It was like fire, you know the smoke and uh the pain and my father got hurt very

badly in the hips and around there.

Dr.D: You have not listed the three images which you liked the least. May be you

weren’t able to select 3 images.

Mrs. X: I wasn’t really able to. It was hard because the cards they really make me

nervous and they’re hard for me and I didn’t like them. Very few did I....I just

didn’t like them. I felt agitated, I mean not agitated but nervous. I just wanted to

forget about them.

Dr.D: But it helped you in releasing lots of emotions, pent up tensions and feelings

making you to feel sad, I guess.

Mrs.X: Well they are.

Dr.D: How do you feel after taking the test?

Mrs. X: Drained. Sometimes better. And then sometimes it just brings up memories of

watching my father die in the hospital. We didn’t leave his side until the end.

Mrs. X: Because my husband was stationed in the states. And I was in and we found

out we were coming back. Just before we left I was in an P I ward in Virginia

and they were trying to help me. They were trying to help me get to, I guess, get

ready for what I was going to see. It was a really big change and

Dr.D: It’s very painful.

Mrs. X: I guess nobody could prepare you for that. But then when he went in the

142 Interpretation

hospital the last time I stayed there day and night, all of his kids did. We slept

on the floor and in the halfway. We all stayed there with my mother until it was

over.

Dr. D: Thank you for sharing your agony with me. We’ll be meeting again.

Dr. C: Dr. Dubey thank you very much for the sensitive and probing interview with

Mrs. X. It seems we have a powerful approach with the combination of the

Rorschach and the SIS (Card Form and then the Video). As I indicated to you,

a sensitive, caring psychologist and a patient with sufficient ego strength that

she can face pain even though the grief goes back a number of years and is

very intense. I wanted to ask you some questions in terms of how you feel the

Rorschach and the SIS helped us clinically especially as it relates to therapy.

As you know I have been very interested in a content analysis approach. I had

the privilege years ago of working with Professor Seymour Fisher on the

Rorschach and SIS anatomical responses presented by people who had

somatic symptoms. Ultimately, I realized that we needed projective stimuli

with more anatomical content and so on and have been stimulated originally

by reviewing some of Dr. Schafer’s work on the psychoanalytic content analysis

and others more recently such as Lerner (1991). It was fascinating for me to

realize that you had met Piotrowski toward the end of his life and that he

himself was interested in psychoanalytic content analysis. Could you share

about that please, especially in terms of Mrs. X's responses?

Dr. D: I use both the tests SIS and Rorschach on clinical cases. The SIS provides

more vital information and it is a quick test for diagnosis and screening. The

SIS is backed by theories of Body Symbolism and Inner Cry (Cassell, 1980).

The theories are very impressive and exciting. About 40 percent of cases in

hospitals particularly in psychiatric set up have somatic manifestation, though

the causes are psychological in nature.

Dr. C: Exactly. A lot of people cannot verbalize their emotional issues and tend to

somatize. In medical and hospital set up, physicians and nurses, who focus

on the physical symptoms, reinforce it. Many either does not have time or the

training to work on the psychological issues is not adequate.

Dr. D: Yeah. And more often I have found that people express their psychological

problems through physical symptoms.

Dr.C: Yes.

Dr.D: So the test is very helpful in detecting the psychological problems, the inner

cry of the patient as in the case of Mrs. X. The medicine (anti-depressant) is not

going to help her much. Her problem is probably because of her psychological/

emotional attachment with her father, which she is unable to resolve after his

death.

Dr.C: The anti-depressant medicine helps her to feel better symptomatically. The

symptoms are removed and so on but it doesn’t get to the core difficulty, the

grieving process and her irrational thoughts.

Dr.D: Exactly. As you have noticed that the SIS-video images have created hypnotic

like effect and she started coming out. It helps in understanding the

psychopathology of the case and releases tensions of the person undergoing

the test. And you could notice her face, she was feeling released and cheerful.

Dr.C: She got relief. As time goes on, in my own career, I have moved from an

interest in the diagnostic aspects really to the therapeutic and I am much more

interested in the techniques that help people, that release feelings and help

them understand themselves.

Dr.D: Many psychologists working in teaching set up and not really trained in

handling patients do not believe much in projective tests and particularly in

inkblot procedure. They believe more in questionnaires because it does not

require any training and sophistication in interpretation.

Dr.C: That’s right. It’s also true in this country that some of the authorities on

Rorschach who give seminars do not see a broad range of patients anymore.

They are so removed that they’re missing some of the richness of clinical

work. I wonder if we could go through at this time and have you comment on

some of the specific color responses. Please begin with her Rorschach

responses and then SIS.

Dr. D: All four cards # 2,8,9 and 10 were very informative and effective in this case.

Dr. C: Yes.

Dr. D: She was very upset on chromatic cards.

Dr.C: They carry the punch in terms of the affect.

Dr.D: She was unable to control her emotions and all through she was sobbing.

She was crying like a child during the interview session.

Dr.C: Yes. So she really went back in time to the original loss of the father. So this

pulled her back and facilitated release of the pent up grief.

Dr.D: Right. And it is really difficult to put such responses under closed scoring

categories. For example, on Card #8 she says “I feel like as I am in the center

and two persons are pulling me from each other. And that one side is my

mother and on the other side my son”. Such responses can be interpreted

only by its content analysis.

Dr.C: Correct and this is how the inner cry can be trapped through content analysis.

Dr. D: What she perceived is her real situation.

144 Interpretation

Dr. C: It makes it more real when you have a stimulus than just talking in generalities

in an interview.

Dr.D: Exactly. And on card #9 again she perceives “a person hiding behind and

feeling ashamed like me”. This is true projection which one can never imagine

on questionnaires.

Dr.C: Yes.

Dr.D : And such feeling that “I have let them down, especially my father”. “I feel like I

am a bad girl and my father is being punished for me”, is common in paranoid

Schizophrenics. However, such responses are possible due to excessive

unreleased grief.

Dr.C: Right.

Dr.D: And on the basis of such responses you cannot put her under schizophrenia.

Dr.C: That’s right.

Dr.D: Such responses can be explained through psychoanalytic interpretation.

Dr.C: Yes.

Dr.D: She is blaming herself because she could not attend to her father when he

needed her. It is her guilt feeling for not attending to her father during distress

though her health did not allow her to attend to her father.

Dr.C: Yes. She was helpless.

Dr. D: She felt that as a child it was her duty to help her father whom she could not do

and because of this she is calling herself a bad child.

Dr.C: So it is very important that the therapist ultimately goes back and makes these

interpretations.

Dr.D: Exactly, this is what Dr. Piotrowski (1985) explained me when I visited him at

his Logan's Square home in Philadelpha in July 1985. He explained that do

not give more emphasis on indices such as M, FM, C, Popular and Form and

try to understand the meaning behind the contents of given responses.

Dr.C: Yes.

Dr.D: Because after all why psychological tests are done? It is only to help in getting

more and more information about the patient.

Dr.C: We want information which is clinically relevant to the therapy process.

Dr.D: Exactly, and that is why out of 62 images on SIS, I was interested only in a few

images giving more clues.

Dr.C: Right. What is your feeling about rating the images for their degree of threat

and then starting with those that are most threatening?

Dr.D: The images rated as most threatening help in understanding the

psychopathology of the subject. Such images depict specific body imagery

and traumatic experiences way back in time. In fact it is not the 20 cards of SISI or 62 images of SIS -II/Video but the three most threatening images which

will provide you signals to peep into the inner self of the subject.

Dr.C: Yes.

Dr. D: And you make depth interview to understand the causes of threat/repression.

Dr.C: And then in instances where there is somatic repression then only those that

are relevant.

Dr.D: Exactly, may be out of 20 you have only five or six cards to go through.

Dr.C: Right.

Dr. C: Other cards you can leave aside.

Dr.C: And with the video technique you are not there so it doesn’t take that long to

process such material.

Dr.D: Exactly. And even on SIS-I card #20 she said, “It is death coming to me, it’s

hurting me. It is about to take me. I am afraid of dying”. Unprocessed grief

comes like this.

Dr.C: Yes.

Dr. D: It is painful to imagine but there are many more such persons facing to cancer

bravely.

Dr.C: Excuse me. In the book “Body Symbolism (Cassell, 1980)” the last chapter

deals with death anxiety. And characteristically, as you know, people deny

death as an issue. And we have a technique here on some of those death

related cards you can introduce it clinically and deal with it.

Dr.D: Yes, she has projected the fear of death by giving responses such as “Gate of

Hell” on card #18. Further she said, “I have to go inside-my father has already

gone inside”. One can see the sort of fear and insecurity in her.

Dr.C: There’s a lot of rage associated with this. Part of the problem with her is that

she hasn’t gotten in grips with her anger for her father for leaving and the way

he died and some of the old childhood problems as well.

Dr. D: And on card #19 she said, “I’m going to die and my father died and may be in

the near future something is going to happen to me”.

Dr.C: Would you be concerned about suicidal ideation with her in view of this death

146 Interpretation

preoccupation?

Dr.D: Well, she has maintained ego strength and attached with her son and husband,

because of this the chances of suicidal is very less.

Dr. C: Yes.

Dr.D: And that is why she is not talking about suicide.

Dr.C: Yes.

Dr.D: She is aware of her medical profile. Her strength is still her consideration and

caring attitude towards her family.

Dr.C: Yes. She has also a positive relationship with her husband and other people

who love her.

Dr. D: And if the person has gone through such traumatic experiences she is bound

to give such responses on SIS images.

Dr.C: Thank you for your most interesting comments. What would you recommend

in terms of someone considering the use of the SIS as opposed to existing

techniques including non projective tests?

Dr.D: What I have noticed that while taking the questionnaire people have to restrict

their choice to yes or no, true or false, agree or disagree. Most of the time

these questionnaires have cultural loading. Contrary to this you are free to

project your feelings and emotions on inkblot tests. Somatic Inkblot Series is

the latest and most powerful amongst the inkblot tests.

Dr.C: Yes.

Dr.D: And in fact, in one of my studies where I tried to find correlation between

Rorschach and SIS, It turned to be quite low, reason being the Rorschach

measures the basic personality and is used as diagnostic test. The SIS is a

diagnostic as well as therapeutic instrument. It helps in understanding the

psychopathology of the case. It further helps to peep into the inner deep and

hearing the inner cry of the suffering individual. So this way you can get more

information which is not possible through tests like the Rorschach and the

Holtzman. This SIS is not against the Rorschach test but it is further extension

of the Rorschach. The SIS was tried in India during selection and was found to

be a successful instrument in getting the right man on job.

Dr.C: Yes.

Dr.D: So the SIS covers both the aspects diagnostic as well as therapeutic. The best

part of SIS-II and video is its self - administration. It can also be administered

in group. It reduces test’s anxiety because the subject is alone while taking the

test. It helps in true projection. The test can be taken even at home or while

waiting for his turn in the clinic. So because of these qualities it is the best

projective test.

Dr. C: And there are variations in the use of SIS test. For example, currently I am

interested in administering the procedure at bedtime and seeking at what

extent some of the images are picked up in the individual’s dreams by doing

the interpretation of dream work the following morning.

Well, thank you very much. Dr. Dubey. Your comments have been most helpful and I

have learned a great deal from you in terms of your own experience with the SIS and

sometimes one can get too close to a procedure but I think it has been very helpful and

thank you.

We’ve had the opportunity to look at an individual who has lost her father and see how

this has affected her responses to the Rorschach and the SIS both in the card form and

the video. Hopefully this material, as time goes on, may be brought up in therapy in

ways that will help her express the inner cry and further move ahead in resolving the

blocked grief. As an experienced clinician might well imagine, it is not just a matter of

prying at the pain to release feelings. In addition, there needs to be definitive cognitive

therapy in terms of helping her deal with some irrational thinking that she has relative

to her pathological guilt. Similarly, she needs further insight into, how the sympathetic

identificaiton with her father’s deteriorating body image contributed to her converting

the diseased anatomicial imagery into repressed affect, leading to physical symptoms

of chest pain and marked cancer phobia.

Copies of the videotape of this interview completed in 1991 may be obtained by writing

to the authors. This may be sent to those interested individuals who might wish to use

it for teaching purposes. Even though Mrs. X signed a statement giving permission for

its educational release, it is not available in the United States or Canada to protect her

confidentiality. The authors apologize for the lack of editing in the transcript, but it is our

belief that if one employs a case history phenomenological approach, accuracy in

reporting is far more valuable to the scientific methodology than grammatical

organization.

Acknowledgement

The authors are grateful to the patients for their cooperation and thanks them for their

permission to use the material in this Manual for educational purpose. The name of the

patients mentioned in the case report is fictitious to hide their identity.

148 Interpretation