CHAPTER 2

Historical Development of Inkblots Techniques:

Historical Development of Inkblots Techniques:

History of Inkblot Procedure

Existing Inkblot Test:

Rorschach Inkblot Test

Holtzman Inkblot Test

Somatic Inkblot Series

History of Inkblot Procedures:

The history of the inkblot procedure is traceable only through Rorschach's own writing, and through the writings of Emil Oberholzer, Walter Morgenthaler and George Roemer. Zubin et al (1965) indicated that the concept of formless stimuli, used in inkblot techniques to stimulate the imagination, could be traced back to Leonardo Da Vinci and Botticelli in the fifteenth century.

Among the present day projective tests, inkblot technique is the oldest one with the earliest published work on inkblot and other vague or formless stimuli for imagination in fifteenth century by da Vinci (1982). In the last decade of the 19th century, Binet & Henry (1895) also followed the suggestions of da Vinci about inkblots. They used this projective technique as a means of tapping imagination as well as assessing intelligence. Such studies were concerned primarily with the traditional subject matter of psychology at that time, rather than their use to describe the personality of the individual (Zubin et al, 1965). Later, inkblots were also used to the study symptom related ‘mental content’.

The concept of projection is generally credited to Freud who used this term as early as 1896 (Freud 1950). He defined it as a defensive process in which impulses, wishes and ideas of aggressive and sexual in nature became externalized. During projective testing, the subject matter serves as a lens of projection and the recorded material of elicited behavior is the screen with the picture projected on it (Rapaport, Gill and Schafer, 1968). Before the publication of Rorschach “Psychodiagnostik’ in 1921, many scientists (Kirkpatrick, 1900; Whipple, 1910; Pyle, 1913; Bartlett, 1916; Parsons, 1917) had used their own versions inkblots in earlier exploration of the mind.

The real beginning of a concept based technique started with Hermann Rorschach when he began to experiment with inkblots as early as in 1911. While he was fully aware of the earlier experiments with inkblots, he was more stimulated by Konard Gehring. As a teacher, Gehring had discovered that certain children gave very similar responses to a variety of inkblots, even though the figures were quite different in their form and /or color. Apparently initially Rorschach had no intention of constructing a psychodiagnostic test (Roemer, 1967). His first purpose was to investigate “reflex hallucinations”. These likely were visual form of hallucination. If this speculation is true he needs to be given credit to studying how Swiss psychotic disturbances may be projected on to inkblots. In any case, it was not until much later when he started collecting material in a systematic manner for diagnostic purposes (Roemer, 1967)

Roemer also indicated that Rorschach discovered the diagnostic possibilities of the inkblot technique somewhat accidentally, while working at Herisau in Switzerland. His interest in inkblots may have also been enhanced by his association with Hens (1917) who published a report concerning the use of inkblots with children, normal adults and mentally ill subjects studied at Bleuler’s clinic. Rorschach criticized Hens’ work because of limited analysis of his results. Probably, the failure of Hens’s approach as perceived by Rorschach stimulated him to deal more directly with the perceptual aspects of the blots.

Rorschach was eagerly gathering material concerning the psychopathological features of certain sects of the Canton of Barn and their founder during 1914-191(Bash, 1965). His Inkblots were being used in contemporary experimentation and he was also encouraged by his friends to experiment. He had a very enquiring mind and consequently was dissatisfied with the contemporary techniques of personality investigations. We now know that he clearly accomplished a major work in a very short time.

Exner (1969) wrote that “during the latter half of the nineteenth century, and the early part of the twentieth century, in Europe, there was much public interest in inkblots, more as a game. It was very common for these to be used in a popular parlor game called "Blotto", where the challenge was to associate an image to a design. The design might well have been created right there, or taken from the many similar designs appearing in contemporary books.

Aside from Rorschach’s studies, Krugman (1942) wrote that Binet and Henri suggested the use of inkblots for studying various personality traits, especially visual imagination in 1985. Dearborn, while working at Harvard University, published an article in 1897 discussed the potentials of employing inkblot techniques in experimental psychology. As Tulchin mentions, in 1848 Dearborn published the results of applying an inkblot technique to a group of sixteen subjects, wherein he used twelve sets of inkblots, each having ten blots similar in nature. Tulchin also cites the pre- Rorschach work of Bartlette, Kirkpatrick, Parsons, Pyle, Sharp and Whipple, all of whom published material between 1900 and 1917 concerning inkblot methodology in the United States and England" (Exner, 1974). Baumgarten-Traumer (1942) mentioned that in 1910 in Moscow, Theodere Rybakow a tutor at Moscow University was using a test consisting of eight inkblots. All of these inkblots were asymmetrical. Rybakow indicated that her husband's decision to work with inkblots was stimulated by the observations of Konard Gehring. Gehring discovered, while using inkblots displayed on very large sheets of paper at the front of the classroom, that certain children gave very similar responses to a variety of inkblots, even though the images were different in their form and color.

Zubin & Eron (1966) described three periods in the history of inkblot’s use in projective testing. The First period started by Artists who painted "indeterminate forms to simulate creative imagination" known as pre-experimental period in the nineteenth century. The second was introduced by Binet known as "psychological experimental period" in 1895 with his assessment techniques, which measured imagination as an index of cognitive ability (Binet & Henry, 1895) and the third period began in 1911 with Herman Rorschach's innovative research on "the interpretation of accidental forms". Roemer (1967) mentioned that Rorschach's first purpose was to investigate the subject's reflex hallucination through viewing inkblots.

Emil Oberholzer was the close associate of Herman through him Rorschach’s ideas and work was made available. He made the test alive after the untimely death of Rorschach. Oberholzer supported Rorschach's work and taught Levy in Switzerland. Levy came to New York with the test. Beck studied under Levy, and then did a dissertation on it, collected norms for children. Hertz in Cleveland did the same, and made different norms. Beck, Klopfer, Piotrowski and Hertz all attributed great significance to Levy’s enthusiasm for the Rorschach. He organized the first Rorschach’s seminar in Chicago in 1925.

Bruno Klopfer was a German psychologist, who stayed in Zurich during the year 1934 and then moved to Columbia (USA) to escape Nazism. He was influenced by Jung and by psychoanalysis and his general approach has been described as "phenomenological" and "qualitative". Samuel Beck, on the contrary, had a more behaviorist training and put more emphasis on quantitative and "objective" data. Beck had also been trained in Rorschach methodology under Oberholzer in Switzerland. Both, Klopfer and Beck did not agree to each other particularly on the scoring of Location, Movement and Colors and the difference brought two prominent Rorschach systems. The Beck´s Rorschach was summarized in Rorschach´s Test (1937) and Klopfer´s system in The Rorschach Technique (Klopfer & Kelley, 1942).

Walter Klopfer continued at Columbia and Beck went to Harvard and they led discussion groups on the Rorschach test. Beck was more faithful to Rorschach's ideas, while Klopfer added more stuff to the scoring system. They started a paper debating the test, its merits and scoring, which turned to be the “Journal of Personality Assessment” in 1936. However, they started showing disagreement on various issues and Hertz tried to bring them together with no results. Klopfer taught Piotrowski in New York, and in 1939 he was separated from others with his own scoring system. Beck and Levy moved to Chicago Michael Reese, and continued for rest of their life. Rapaport made a new scoring system at the Menninger Foundation in Kansas with the help of Gill & Schaefer in 1940. They were interested in using a battery of tests rather a single test. This is how the five distinct Rorschach Scoring systems emerged and none was consistent with the original fifteen main scores of Rorschach.

Exner conducted a survey on Psychologists on the use of Rorschach in 1972 and found “that 3 out of 5 psychologists were trained in Klopfer’s system, 1 out of 2 in Beck’s system, 1 out of 5 in Piotrowski’s system and 1 out of 10 in Hertz or Rapaport’s systems. 22 percent didn't score Rorschach at all and 75 percent didn't stick to a particular system for administration, scoring and norms. Even they do not follow the seating arrangements and the same instructions.

A research publication by Reynolds & Sundberg (1976) ranked the Rorschach test as number one. They based their findings on Buros Mental Measure Year Book. The Rorschach has been the most widely used projective test during 1960s (Chapman & Chapman, 1982). In a national survey in the United States, the Rorschach was ranked eighth among psychological tests used in outpatient mental health facilities (Gacano and Reid Meloy (1994). It is the second most widely used test by members of the Society for Personality Assessment, and it is requested by psychiatrists in 25 percent of cases for forensic assessment, usually in a battery of tests that often include MMPI-2 and MCMI-II (Gacono, et.al, 2007). In surveys, the use of Rorschach ranges from a low of 20% by correctional psychologists (Raynor & Gill, 2008) to a high of 80 percent by clinical psychologists engaged in assessment services, and 80 percent teach it during psychology graduate programs (Weiner, I.B and Greene, R.L. (2007). A survey conducted on the members of The American Psychological Association Division-12, and The Indian Association of Clinical Psychologists showed concern from respondents about the limitations of the test (Dubey, 1982; Manickam & Dubey,2005; Sharma et al, 1975; Wade et al 1978). The most commonly used systems Klopfer and Beck are followed in India. Both the major training institutes NIMHANS, Bangalore and RINPAS, Ranchi are using Klopfer and Beck system respectively.

Campos (2011) opined that we must not forget that the ultimate goal of the testing is to get close to the “psychological truth” of the person who is being assessed, harmonizing and mastering theories and methods. The psychologist should not be merely a test user, but a kind of expert who decides what is needed and should be done in a particular case. Psychological assessment should allow a true interpretation of the data; it is not only a science, but also an art. In this regard, Cates (1999) claims that books and journal articles explore much of the science of psychological assessment. The role of inference and intuition is, at best, approached as something secondary. But the task of interpreting data in a meaningful, accurately and inclusive way, and the "transformation" of the results and their interpretation on something that might be useful to address the issues that triggered the assessment and the client needs, is still an art. In my opinion, no psychological assessment is possible without the use of at least one projective technique.

Piotrowski (2015, 2017, 2017a, 2018, 2018a, 2018b) has evaluated the current status of Rorschach, TAT, SCT and Somatic inkblot tests and emphasized that projective techniques have left an impressive, yet contentious, footprint worldwide (Groth-Marnat, 2009; Handler & Thomas, 2014; Musewicz et al., 2009; Piotrowski, Keller, & Ogawa, 1993; Teglasi, 2010; Wood et al., 2011). Interestingly, survey data from recent ‘test use’ studies point to a rather bleak view regarding the status of projective techniques. Ready and Veague (2014) reported that no projective tests ranked among the top 10 tests being taught in clinical psychology programs. Wright et al. (2016), in a national sample of professional psychologists, found that the Rorschach was the only projective method used frequently (ranked in top 13 tests) among a myriad of psychological assessment domains. But do these reports provide an accurate portrait regarding the extent of clinical emphasis devoted to projective techniques in both training and practice? Undoubtedly, there is a perennial need to empirically address the clinical breadth and status of specific projective methods and their place in contemporary assessment practices.

Bram & Yalof (2018) has compared the two prominent evidence-based systems of the Rorschach currently in practice: the Comprehensive System (Exner, 2003) and Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). The existence of two systems has raised questions and dilemmas for assessment clinicians and educators and suggested a way that is meaningful for practitioners and students involved in clinical personality assessment. Stedman, Essery & McGeary (2018) have summarize the historical use of projective testing (particularly the Rorschach) and emerging research examining the use of projectives in both graduate and internship training programs. The current state of the research suggests a decrease in emphasis in training with projective techniques across both graduate and internship training programs. Dubey,Kumar & Dubey (2018) reviewed the development of inkblot research work and emphasisez that the Somatic Inkblot test has emerged as an extension to the existing inkblot techniques. This unique assessment method relies heavily on content analysis to understand the inner cry of a person and penetrates into deeper layers of unconscious in order to elicit underlying conflicts and intra-psychic processes which contribute to emotional and interpersonal issues in one’s life.

Criticisms of Rorschach Technique:

Although the Rorschach test represented a major step forward in inkblot projective technique, as might be expected, eventually its limitations were gradually exposed. Bartol (1983) commented that "Nobody agrees how to score Rorschach responses objectively. There is nothing to show what any particular response means to the person who gives it. And, there is nothing to show what it means if a number of people give the same response. The inkblots are scientifically useless."

Anastasi (1982) had also made an adverse remark in his book “Psychological Testing: 5th ed” and commented that “Even when objective scoring systems have been developed, the final steps in the evaluation and integration of the raw data usually depend on the skill and clinical experience of the examiner. Such a situation has several implications. … [T]he most disturbing implication is that the interpretation of scores is often as projective of the examiner as the test stimuli are for the examinee. In other words, the final interpretation of projective test responses may reveal more about the theoretical orientation, favorite hypothesis, and personality idiosyncrasies of the examiner than they do about the examinee’s personality dynamics” (Anastasi, 1982, p. 582).

Prof. Eysenck has even criticized his own questionnaires after making a different version of the four questionnaires such as MPI, EPI,EPQ and PEN though almost half of the questions were taken from the earlier version in each questionnaires. In spite of these criticism, Rorschach test remains most popular test internationally (Manickam and Dubey, 2005).

Zubin (1965) has charged seven major failures as follows:

1. Failure to provide an objective system, free of arbitrary conventions, and showing high inter-scorer agreement.

2. Lack of satisfactory internal consistency, or test-retest reliability.

3. Failure to provide cogent evidence for clinical validity.

4. Failure of the individual Rorschach scoring categories to relate to diagnosis.

5. Lack of prognostic or predictive validity with respect to the outcome of treatment, or later behavior.

6. Individual differences between groups of normal subjects.

7. Failure to find any significant relationships between Rorschach scores and intelligence, or creative ability.

Fiske & Baughman (1953) reported that practitioners feel that the variation in the total number of responses is too much to be able to interpret the ratio scores adequately. Also, the meaning of the indices changes depending upon the length of the protocol, because the relationship between Rorschach scores and the total number of responses is complex and curvilinear (1953, Dubey, 1982).Many workers compute percentage ratio in an effort to control the length of the protocol. Holtzman (1956) pointed out that such procedures were very unsatisfactory, not only because of the non-linear relationships between R and other Rorschach's scores, but also because of the crude, unstable and metric qualities of most Rorschach variables.

Dubey (1982), in a study on 300 subjects, found that most of the Rorschach indices are dependent upon the number of responses. When the groups of Normal, Neurotics, and Schizophrenics were divided, on the basis of number of responses, into high productivity and low productivity, many indices, which were found to be significant earlier, lost their significance. It further strengthened the findings of Fiske and Baughman, and supported the intention of Holtzman.

Holtzman et al (1956) pointed out that much of the controversy over the Rorschach arises from the failure to distinguish between the Rorschach as a projective technique in the hands of a skilled clinician, and the Rorschach as a psychometric device, that yields scores having relevance for personality assessment. The analysis of responses to inkblots has ranged all the way from one extreme to the other of the projective psychometric continuum.

History of Holtzman Inkblot Technique:

Wayne Holtzman developed “Holtzman Inkblot Technique” in 1956 to overcome the limitations of the Rorschach test. The main limitation of the Rorschach, as experientially determined, was the problem of variation in the length of the protocol (Fiske & Baughman, 1953; Dubey et al, 1978, 1979, 1989, Holtzman, 1956). Consequently, the usual effect of R linear regression methods for removing the confounding effect of R will generally fail (Fiske & Baughman, 1953, Dubey, 1982).

In development and standardization of his inkblot technique, Holtzman (1988) emphasized that “for many of us, despite these negative finding with the Rorschach, the fundamental idea underlying were still intuitively attractive and could not easily be set aside. I was convinced by my own preliminary research on perception and personality that the major limitation in the Rorschach could best be overcome by developing a completely new technique using more inkblots with simplified procedures for administration. How could one develop psychometrically sound scoring procedures for responses to inkblots while preserving the rich, qualitative projective material of the Rorschach? Blake & Wilson (1950) demonstrated that the first response of a person to each inkblot had all the necessary ingredients for the standard Rorschach scoring system. Why not limit the subject to one response per card and increase the number of inkblots? In spite of ITS cumbersome nature, Zubin’s elaborate rating system demonstrated that a number of variables could be scored for a given inkblot response demonstrated that number of variables could be scored for a given inkblot response. His system required that a simple inquiry be conducted immediately after the response, while it was still fresh in the mind of the subject, rather than going back to it at a later time in the inquiry phase of the standard Rorschach” Keeping these ideas, Holtzman collected data on a small number of cases, asking for a single response and following it with a very simple twofold question: Where was the percept represented in the blot, and what about the blot suggested the percept?

Holtzman was convinced right from the beginning that the new inkblot technique which he has visualized would have several distinct advantages over the standard Rorschach, First the number of response per individual could be held to a relatively constant value, Second, Because each response would be to independent stimulus, the resulting protocol would be much more amenable to psychometric treatment. Third a fresh start in the production of stimulus materials could result in a richer variety of stimuli capable of eliciting far more information than the original 10 Rorschach plates. Forth, two parallel forms of the inkblots to use in the test-retest studies of personality change could be constructed easily from item analysis data in the experimental phase for development. And fifth, adequate estimates of reliability based on internal consistency and parallel test–retest correlations could be obtained independently for each major variable (Holtzman, 1988).

With the help of a professional artist and after preliminary experimentation with many different inks and types of paper, each member of the research group constructed many hundreds of inkblots. Clinical experience with the Rorschach sensitized them to the stimuli properties of color, shading, symmetry, and form that would be most likely to elicit diverse, rich associations useful in qualitative analysis as well as in quantitative ones. Blots were critically judged by a team of clinicians as to their likely value in a new inkblot test. Only 1 inkblot in 50 survived this initial screening. After many months, a sufficient number of promising inkblots had been developed to construct three preliminary forms containing 45 inkblots each, Initial studies were completed using sample drawn from two populations: undergraduate college students and patients in a local mental hospital. The primary purpose of these initial studies was to select the best inkblots for printing and use in two final parallel forms and to develop a comprehensive scoring system. Construction of the final versions of Form A and Form B completed the first stage of long research program aimed at producing a standardized instrument. Holtzman acknowledged the help of his colleagues (Thorpe, Swartz, & Herron) in developing the technique. He further approached a number of friends around the country who collaborated in the project and helped in collecting nearly 2,000 individual protocols on samples ranging from 5-years-old to mature adults and from chronic schizophrenic and psychotic depressed patients to mentally retarded children and adults (Holtzman, Thorpe, Swartz, & Herron, 1961).

The development of the HIT and its standardization lasted from 1955 to 1962. It involved over a dozen well-known collaborators throughout the United States, who collected data on well-defined clinical populations. Containing 45 inkblots in each of two parallel forms, the Holtzman Inkblot Technique (HIT; Holtzman, 1961) was published by the Psychological Corporation. The accompanying book, Inkblot Perception and Personality (Holtzman, Thorpe, Swartz, & Herron, 1961), authored jointly with three of Holtzman’s graduate research assistants, Jon Swartz, Joseph Thorpe, and Wayne Herron, was awarded the Helen D. Sargent Memorial Prize by the Menninger Foundation in 1962 (Holtzman, 1963). Subsequently the HIT was translated into other languages and used as research tool and for clinical assessment in many countries. Suitable versions for group administration using projected images of inkblots were also developed and published (Holtzman & Swartz, 1963; Holtzman, Moseley, Reinehr, & Abbott, 1963).

Donald Gorham, a long-time colleague of Professor Holtzman in the Veterans Administration, developed a computer-based scoring system that was used in cross-culture studies of college students in 17 different countries who were given the group-administrated version of the HIT (Gorham, 1967). The inkblots were displayed on a screen before a group of participants who wrote their responses in spaces provided on the answer sheet, circling the area of the inkblot used on an outline of each blot. Computer-scored group HIT norms for these participants as well as for high school students, U.S. Navy enlistees, schizophrenics, depressives, psychoneurotic, alcoholics, and chronic brain-syndrome patients, a total of over 5,000 participants were published in Gorham, Moseley, & Holtzman (1968). The computer-scored version compared favorably with subsets of hand scored protocols on most of the inkblot scores. Unfortunately, the computer system developed by the Veterans Administration Hospital at Perry Point, Maryland, was written in machine language and did not prove sufficiently popular to justify later conversion for use by modern desk computers. Prof. Holtzman is the pioneer in computer-based scoring and group-administered versions of Inkblot procedure.

In 1988, Dr. Holtzman was honored by the Bruno Klopfer Distinguished Contribution Award by the Society for Personality Assessment in recognition of his work on the HIT that is summarized in an address to the Society (Holtzman, 1988). An annotated bibliography and research guide containing summaries of over 800 articles, books, and reviews of the HIT through 1998 was published by the Hogg Foundation for Mental Health (Swartz, Reinehr & Holtzman, 1999).

It is also mentioned that Holtzman’s interest in cross-cultural studies of personality was sharpened by a year at the Center for Advanced Study in the Behavioral Sciences at Stanford in 1962 to 1963. He was in processes of designing a longitudinal study of personality development among school children supported by the National Institute of Mental Health when Rogelio Diaz-Guerrero visited him at the Center for Advanced Study and suggested to include a similar sample in Mexico. Rogelio Diaz-Guerrero and Holtzman designed a major international project on child development in Mexico and the United States, with a team of psychologists working in Mexico City under Diaz-Guerrero and a similar group in Austin under the direction of Holtzman. Over 800 children were tested annually for 6 years in an overlapping, longitudinal, cross-cultural design, using a variety of personality, cognitive, and perceptual tests, including the Holtzman Inkblot Test. Published simultaneously in both Spanish and English, Personality Development in Two Cultures (Holtzman, Diaz-Guerrero, & Swartz, 1975) contains a wealth of information concerning both similarities and differences in Mexican and North American socio-cultural premises and culturally determined personality characteristics. Several journal articles on various specific findings were also published (Holtzman, 1965, 1982; Holtzman, Diaz-Guerrero, Swartz, & Lara-Tapia, 1968).

History of Somatic Inkblot Series:

In developing the Somatic Inkblot Series, Wilfred A. Cassell had the benefit of insights traceable from the contributions of Hermann Rorschach and Wayne Holtzman. Projective techniques are especially helpful in evaluating those having limited language and verbal skills such as children, foreign born or new immigrants, native peoples, the learning disabled or the mentally sub normal. There is enough structure in many of the SIS inkblots to provide a sense of security and a measure of self-confidence. Those with limited language and verbal skills usually rely more on visualization and adapt better to projective technique than verbal interviews or testing that requires reading or language skills.

Such images use the language of dreams, visual imagery, and symbolic thought, the most basic forms of thinking and expression. It is also the language of repression and brings whatever is buried in the mind closure to consciousness, accessible for processing. Expression stimulated by ambiguous or partially ambiguous visual input can be used in therapy to test insight and to help measure treatment progress.

Wilfred A. Cassell initially recognized in 1959 the need for developing a measure of “Body Image”, as psychiatric resident conducting a collaborative study on hirsutism, with a psychoanalyst Marc Hollender (Hollender & Cassell, 1960). Subsequently Hollender, who was Chairman of the Department of Psychiatry at the Upstate Medical Center in Syracuse, New York, brought Seymour Fisher a colleague of Wayne Holtzman to join the research group.

This enabled Cassell the opportunity to train in projective assessment under the guidance of Fisher. He had constructed two inkblot content scales derived from studying patients suffering from Rheumatoid arthritis: the Barrier and Penetration. The former was based upon a summation of responses depicting the periphery of objects. It was created to assess the degree of definiteness experienced by an individual regarding self- perception of body boundaries. In regard to the latter, this was conceptualized as a mixed measure denoting both the notion of Body Boundary “indefiniteness” (e. g. references to opening such as windows broken containers etc.) and “Interior body awareness”(e.g. responses representing projections of internal organs). It was for this reason that I conceived of an index called the “Body Interior Awareness” measure, which scored only “Internal anatomical responses”. Background work had been presented in a book entitled Body Image and Personality (Fisher & Cleveland, 1958).

Apart from studies involving Rheumatoid Arthritis patients, they extended their investigative research into work with other groups. Their premise was that levels of physiologic reactivity in skin and skeletal muscle would be significantly elevated in individuals with high Barrier scores. Penetration scores were considered to assess indefinite body boundaries in those with high interior reactivity. Their physiological model has not stood up well, but, at the time, provided a stimulating intellectual basis for envisioning the SIS.

After learning Rorschach content analysis theory, Cassell explored the test validity of Fisher and Cleveland’s Penetration index as an operational measure of internal body awareness. He investigated, what in the post World War II period, were classified in a now invalid diagnostic category as “Psychosomatic” conditions. However, no relationship was found between the channeling of stress induced physiologic activity to internal organs, such as heart and stomach, and scores on this index.

This failure led him to next independently reappraise the content constructs underlying the Penetration score. This revealed that regarding somatic orientation within the body gestalt, that this index was spatially mixed and summed separate conceptual categories (e.g. “apples” versus “oranges”). The second scoring category of Fisher and Cleveland included responses theorized to symbolize “indefinite exterior body boundaries”, erroneously added with those concretely depicting internal organs. As a follow-up to this analysis, Cassell constructed a new index based solely upon interior anatomy content. This was called the “Projective index of Body Interior Awareness” (Cassell, 1964)’

As a new theory for guiding further clinical studies (Cassell, 1965), a comparatively simplistic feedback conceptual model was gradually envisioned by Cassell. During this stage in the history of medical knowledge of the SIS, many clinicians believed that each psychologically stressed person had a style for channeling stress-induced arousal to a particular organ system. Chronic psychological stress was then postulated to subsequently stimulate pathological physical processes. In this early speculative period, it was even claimed that these could be reversed by psychoanalysis.

Originally during his residency, Cassell was strongly influenced by such speculative, overly optimistic thinking of his professors. He hoped that designing inkblots with various degrees of resemblance to the human heart might provide an operational measure of “heart awareness”. After field testing the newly designed somatic inkblot series, studies were initiated to assess subjects with medical histories of stress induced somatic symptoms (Cassell, 1965).

Apart from their adaptability to psychophisiological research his selection of cardiac heart like images was also determined by certain personal factors involving his health which augmented his “Death Anxiety”. When an active adolescent boy in Canada, his sport of playing hockey was immediately stopped by an old family physician. During routine chest examination for a “Chest Cold“, the doctor detected a heart murmur and warned him that he would soon die, if I didn’t immediately restrict all active sports. Since he was experiencing no cardiovascular symptoms, he only followed his physician’s ominous advice for a limited period. Yet subsequently when actively competing in various sports, he constantly feared dying of a “heart attack”.

Later during his medical training after volunteering to be a normal control subject in a cardiac function study, the cardiologist reassured him that what the family doctor had made an erroneous diagnosis. While his medical reassurance was helpful, his underlying heart/death related hypochondriacally anxieties were not totally erased. Hence he projected this body image anxiety in designing his initial SIS inkblots.

Ultimately several versions of the SIS were created. These provided a potentially powerful projective electronic system promising to provide new research and clinical diagnostic/therapeutic applications (Cassell, 1977, 1979, 1980) including Behavioral Therapy (Cassell, 1977). The electronic and internet application of SIS-I and SIS-II technique

Features of the Rorschach, Holtzman and Somatic Inkblot Series:

1. Rorschach Inkblot Test:

The pioneer amongst the existing inkblot tests is the Rorschach which was published in 1921. This projective procedure was developed to explore the basic personality structure and psychopathology of the subject. It consists of 10 cards. Five cards are in varying shades of black and gray and known as Achromatic Cards (Card Number I, IV, V, VI, VII). The other five cards are known as Chromatic Card. Two of them are printed in Black and Red (Card Number II, III) and the remaining three are in different colors (Card Number VIII, IX, X). The ten cards are shown in order. The subject is instructed asked to report as many responses as is perceived on each cards. There are five main scoring categories such as Location (W, D, d, S, DS, WS, dd, ds, dr etc), Determinants (Form, Color, Shape, Shading, texture, Movement etc), Contents (Human, Animal, Sex, Anatomical, Natural, Geog etc), Popular/Original and Form Level. Most of Rorschach system (Klopfer, Beck, Piotrowski, Roy Schafer, Hertz and Exner) follow numerical/indices based interpretation. The majority of studies suggest that these scoring systems have high degree of reliability and validity.

A research publication reviewing psychological tests by Reynolds & Sundberg (1976) ranked the Rorschach test as number one. They based their findings on Buros Mental Measure Year Book. The Rorschach test was the most widely used projective test during 1960s (Chapman & Chapman, 1982). In a national survey in the United States, the Rorschach was ranked eighth among psychological tests used in outpatient mental health facilities (Gacano & Reid Meloy (1994). It is the second most widely used test by members of the Society for Personality Assessment. Moreover it is requested by psychiatrists in 25 percent of cases for forensic assessment. Usually it is included in a battery of tests that often include MMPI-2 and MCMI-II (Gacono, et.al, 2007). In surveys, the use of Rorschach ranges from a low of 20% by correctional psychologists (Raynor & Gill, 2008) to a high of 80 percent by clinical psychologists engaged in assessment services. It is also been reported that 80 percent of the time it is included in the curriculum of psychology graduate programs (Weiner & Greene (2007). Yet, over the years, there have been criticism. For example, a survey conducted on the members of The American Psychological Association Division-12, and The Indian Association of Clinical Psychologists showed concern from respondents about the limitations of the test (Wade et al 1978; Sharma et al, 1975; Dubey, 1982). Moreover, in the recent year’s computer scoring system have had disappointing results since these loose the charm of projective testing.

2. Holtzman Inkblot Test:

Development of the Holtzman Inkblot Technique:

Unlike the Rorschach, which has only 10 inkblots in a single form, the Holtzman Inkblot Technique (HIT) consists of two parallel forms, A and B, each of which contains 45 inkblots constituting the test series and two practice blots, X and Y, that are identical in both forms. The inkblots were drawn from a large pool of several thousand, many of which were created by an artist working with special papers and inks that produced brilliant colors and rich shading.

Construction and testing of these initial inkblots was divided into three cycles for purposes of gathering data, each cycle containing a set of 45 untried inkblots. Shading, color, form, the symmetry or asymmetry of the inkblot, and white space for figure-ground reversals were used as the primary characteristics of the blots in the selection process. These stimulus qualities were chosen to ensure sufficient variation of response to yield reliable scores. Earlier work had indicated that somewhere between 40 and 50 inkblots with one response per blot elicited from the subject could be completed in less than an hour by most individuals.

The three experimental sets of blots were given to samples of patients in a mental hospital as well as samples of college students, since these two groups represent opposite extremes on several important variables from earlier Rorschach studies. The main goal was to select from among these 135 inkblots the 90 best ones for the final two forms. Criteria for choosing each blot were based upon analyses of six major scoring variables: Location, Color, Shading, Movement, Form Definiteness, and Form Appropriateness. Of equal importance in this item analysis was a new score called Pathognomic Verbalization, a score designed to capture bizarre and disordered through processes as they are manifest in responding to inkblots.

Other samples in the initial standardization data consisted on 80 firemen representative of lower-middle-class, semiskilled workmen; 140 average adult women obtained by random house-to-house canvassing in two Texas communities; 143 college students from the University of Texas who were given both Form A and Form B with a interval of one week between testing periods; 92 superior students at the University of Texas; 66 freshmen from the Waco VA Hospital; 51 schizophrenics from the Montrose VA Hospital; 50 mentally retarded students from Woodward state school in lowa; 50 mentally retarded adults from Austin State School; and finally, 90 depressed patients from 11 VA Hospital participating in a national chemotherapy project. A total of 1,384 individuals responded to one or both forms of the HIT, providing a firm basis for determining the means, standard deviations, and inter correlations as well as percentile norms for 22 scores that had been developed.

Description of the Test Materials:

Standard materials for the HIT consist of two parallel series, Form A and Form B, the accompanying printed record forms and summary sheets, and the Guide for Administration and Scoring (Holtzman, Thorpe, Swartz, & Herron, 1961). Sets of 35-mm slides are available for use with the group method of administration, as developed by Swartz & Holtzman (1963). A computer-based scoring program scoring program for the group method, as development by Gorham (1967), is also available. A handbook (Hill, 1972) for clinical application of the HIT and a workbook (Hill & Piexotto, 1973) has been published as guides for clinicians. The original monograph and the scoring guide have been translated into a number of different foreign languages. Since 1977, a programmed test and other HIT materials have been available in a multivolume series in German (Hartmann & Rosenstiel, 1977).

The Holtzman Inkblot Test is second in the history of inkblot tests and has attracted many psychologists and researchers in India. It has been taught to Graduate Psychology Students and has made its place in India. The test has only 22 scoring categories and found to have more psychometric value.

The Test-retest stability over time using parallel forms has been found to be high, ranging from a low of 0.36 for Popular to 0.81 for Location. These results are similar to reliability coefficients frequently obtained for subtest scores that measure mental abilities. For most HIT scores, as well as patterns of HIT scores, the reliability of measurement and the stability across time are sufficiently high to justify clinical use in the assessment of individuals. The validity of the HIT for personality assessment is of special interest. Much of the earlier work pertaining to validity and clinical use of the HIT has been compiled in a useful handbook by Hill (1972). A comprehensive annotated bibliography containing over 800 known references to the HIT through 1998 (Swartz, Reinehr, & Holtzman, 1999) contains abstracts of these articles. Several hundred studies have been published bearing on the relationships between scores on HIT variables and independent measures of personality; The HIT was found to be a valid instrument for the assessment of personality.

The scoring system developed for the Holtzman Inkblot Technique (HIT) includes 22 different variables covering many aspects of an individual’s response to an inkblot. These variables were derived from the more important systems for scoring the Rorschach. These are as follows: Reaction time, Rejection, Location, Space, Form Definiteness, Form Appropriateness, Color, Shading, Movement, Pathognomic Verbalization, Integration, Human, Animal, Anatomy, Sex, Abstract, Anxiety, Hostility, Barrier, Penetration, Balance and Popular. When well-trained scorers are employed, inter-scorer agreement is exceptionally high. Only Penetration and Integration fall below correlations of 0.95, and in many cases, the inter-scorer agreement approaches between scores, are also generally high. In the initial standardization work, median values for 50 different samples were generally in the 0.70s and 0.80s. Only Anxiety, Penetration, and Popular fell below this level, whereas Reaction Time, Rejection, and Location had average reliability coefficients above 0.90. These initial results for internal consistency have been repeatedly confirmed in more recent studies both in the United States and elsewhere.

Somatic Inkblot Series:

The initial Somatic Inkblot Series (SIS) was developed as a research projective technique to facilitate the study of stress induced psychophisiological cardiac symptoms. Since envisioned in 1959, the concept has formed the basis of a series of projective procedures having wide range of research and clinical investigation. The SIS-I provided a structured, projective, diagnostic procedure and an adjunct to psychotherapy. It is structured by a sequential presentation of intentionally designed and field-tested inkblot-like images. These stimuli demonstrate typical and atypical response potentials. This technique is based on spontaneous, individually generated responses to semi-ambiguous figures, which elicit intrapsychic associations specific to the person presented with them.

The SIS is a diagnostic procedure as a consequence of the interaction of structure and stimuli. These stimuli evoke symbolism and meanings unique to the responding individual such as present in somatic delusions and affect charged dreams. The test stimuli can be differentiated from typical and atypical peer norms, and can be analyzed according to internationally recognized diagnostic criteria. The procedure is an adjunct to therapy because responses can be further explored to create a more effective treatment plan, and can be re-addressed in later discussions, providing opportunities to elicit deeply defended material. During the administration of the SIS procedure, clients, patients and students may abreact emotional conflict raised to consciousness by the images, which can be a therapeutic experience in itself.

The viewer writes responses on an answer sheet. Most of what is included in the ambiguous structure relates to specific life situations and post-traumatic dream content that has been found to have clinical significance. Viewing the SIS has both diagnostic and therapeutic applications that are far reaching.

The SIS procedures have been used internationally on different normal and clinical population. Various researchers have reported high reliability and validity of the test (Cassell, 1969, 1971, 1972, 1977, 1980, 1988, Cassell & Dubey, 2003, 2009b, Dubey & Cassell 1991, Dubey, et. al. 1995;1993; Goel et.al, 1999; Kaur & Verma, 1998; Kumar,2000,2009,2010; Kumar et al.2004,2005,2008; Nicolini, 2002; Pershad & Dubey, 1994; Rathee et al,1998; Pandey, et.al,1999; Singh & Banerjee, 1996; Verma & Kaur, 1999).

There are Five subtests in Somatic Inkblot Series:

The Somatic Inkblot Series- I consists of 20 inkblot images printed on white cards, each measuring 16.5 X 20.5 cms. The images are printed in black, red, and gray (screened black). Eight of them are black and red (serial numbers 1, 2, 3, 4, 5, 6, 7, and 8); three are exclusively red (serial numbers 10, 11, and 12); and nine are achromatic (serial numbers 9, 13, 14, 15, 16, 17, 18, 19, and 20). Images provide enough obvious anatomical structure to evoke spontaneous verbalization, but not enough to limit the responses solely to the naming of body parts or colors. In this way, obvious anatomical structure provides a feeling of security, which makes deeper and more symbolic repressed material more accessible to the person taking the procedure.

The SIS provides clinicians and researchers with a new diagnostic aid for body percept assessment. It can be used to assess the depth and significance of somatic symptoms, conversion reactions, somatic delusions and sexual dysfunction. Analysis of mutilated or distorted anatomy responses can assess the possibility or level of castration anxiety (Cassell, 1980). Responses depicting themes of body assault may further clarify the extent of aggressive impulses (Cassell, 1977). As a diagnostic tool, the series can help to evaluate undetected affective disorders such as “masked depression” where depressive feelings are denied during the interview and in non-projective psychological tests. The flow of cognition might reveal early defects of schizophrenic disorder. “Death anxiety” in those facing major surgery or those with a terminal illness may be signaled by excessive anatomical responses (Cassell, 1979). The Somatic Inkblot Series can be used to help design a treatment program which might include body awareness exercises, such as physical therapy. It also may be used in other therapies, such as sensory feedback training, behavioral therapy, and desensitization for psycho-physiological symptoms associated with pathological anatomy responses (Cassell, 1977). This technique has been described in the book, “Body Symbolism” (Cassell, 1980), which has been translated into Italian and Russian.

The CD version of the test is designed for supervised self administration. It can also be used as group administered test.

In 1980, after initial success with SIS-I, the development for SIS-II in booklet form was initiated. It consists of A Series and a B Series, each with 31 images, for a combined series total of 62 images. There is also a sample image in the beginning. The stimulus images are printed in rectangles measuring about 5x6 cm, each with a space provided below the image for writing the response. All the images are contained in an eight page booklet. The first seven pages consist of the stimulus images and the space for responses. The last page is printed with instructions for self-administration, and a place for a brief health history and personal data. Unlike SIS-I, it consists of images printed with blue ink on grey paper.

The printed instructions on the back of the book as follows:

“Most people find this test fun and relaxing. First relax, take a few deep breaths, and prepare to enjoy. Please turn this Booklet over and read the sample response. Notice that you may write on the picture or the space below it. Label each in terms of what they resemble or look like to you. Please include everything that you see, even if it reminds you of something, remote, vague, dreamlike, highly personal or even potentially embarrassing. Please include every that you see with as much detail as possible. Also include any outstanding emotional reactions that you might experience in responding to these pictures. Please begin on the first page, study the sample, and continue until completed. Enjoy!”

The SIS-II can be used in a variety of ways, but was designed for self-administration after supervised instruction. Some clinicians use the booklet with the patient or to unobtrusively observe the self- administration to observe reaction times and significant verbal and nonverbal responses for each inkblot (delays, overreaction and content shock). Others prefer to allow the patient to take the booklet home and write in responses whenever they have the time to relax and review the figures (intermittent administration), or if they prefer, at one time (continuous administration). Some have found it useful to have the patient complete the test booklet before going to bed, to stimulate the unconscious to process repressed materials in dream during sleep. None of the existing inkblot tests are designed to be self-administered. Projective testing accesses information about the individual not readily available from history taking, interview, mental status examination or from other forms of testing. It also elicits information, which is not consciously known to the patient, or reported as a problem. Usually, clinically significant, blocked material, will over-ride typical normative responses directly (manifest), or it will appear in symbolized imagery, similar to dream work (latent).

Because there is no time limit, “test anxiety” is reduced, and the individual is free to react in his own time, often exhibiting significant verbal and non-verbal clues to each of the inkblots. Since there is no text to read, the Somatic Inkblot Series does not require a high reading level, therefore, it is applicable to all age groups and a wide variety of cultures. In SIS-II, the subject is asked to rate the three-inkblot images that he “most liked” and the three images that he “least liked.” This inquiry invites positive or negative affectual discharge. The subject’s emotional investment provides valuable diagnostic clues to his/her psychological function. The SIS-II can successfully identify various groups of clinical subjects, and can be used to screen out abnormal subjects from normal subjects.

The SIS-II Electronic version was launched after the success of SIS-II Booklet Form. It is a self-administered test which has also been used as group administered test during personality assessment in business organizations. It is also available in computerized version which has rendered internet application (www.somaticinkblot.com).

It consists of the following five segments:

1. A series of beautiful flowers to reduce test anxiety.

2. An induction period in which semi-hypnotic auditory relaxation suggestions are presented.

3. A section illustrates how to give free associations to the inkblots.

4. A viewing section in which 62 specifically-designed images having color- structured- form and, at times, movement are presented.

5. A recovery portion in which a series of non-threatening nature scenes, combined with upbeat music, bring the viewer back to the time and space reality of the test situation.

The viewer writes responses on an answer sheet. Most of what is included in the ambiguous structure relates to specific life situations (e.g. post-traumatic dream content) that have been found to have clinical significance. Viewing the SIS has both diagnostic and therapeutic applications that are far reaching.

The SIS Video is highly innovative and, in a sense, a "time machine." It takes the viewer away from present reality. If there is unresolved painful material in the past memory storage, through the magic of electronic television, the projected responses will tend to be shaped by this material. What emerges in projective awareness is deep seated material, even though the viewer may have long forgotten the buried traumatic imagery and associated affect. It facilitates the expression of feelings and earlier forgotten life events underlying many forms of mental illness and conversion pain.

When the viewer rates those images, which are the most threatening, the examiner gets a quick psychological overview of the subject’s state of mind. The technique enables the professional to more readily empathize. The hypnotic like administration of the SIS is designed to maximize the pulling power of inkblot projection. The subject is given an answer sheet. The first section includes a health questionnaire. The process of filling out the health questionnaire creates an immediate perceptual set to project images related to medical and psychiatric problems, for themselves or for loved ones. The space/time dimensions of the viewing situation are subtly altered by the video presentation of mesmerizing flowers. These are electronically transformed so the viewer experiences a magical feeling of traveling through a mental garden of beautiful flowers. This draws the subject away from the present reality, back in time, to episodes of previous illness or trauma. Following this sequence, a photograph of a beautiful mountain, followed by an artist's rendition of the same scene, heightens the hypnotic effect.

The example of a person responding to a typical inkblot is cited to show the viewer how to fill out the answer booklet. After this presentation, audio suggestions to relax set the stage for slipping further back in time and re-experiencing images of illness or post-traumatic dreams. During the initial viewing, the subject is entirely alone just as in dreaming. This eliminates the inhibiting effect of another's presence.

By writing responses, rather than verbalizing them, just like in hypnotic writing, the subject may more readily access and release painful material. In addition to the cathartic, therapeutic response, the person may gain some insight and sense of mastery of the traumatic material by the act of drawing and labeling the images. Also, when the procedure is assigned repetitively over time, the experiencing of the healing flowers, in association with the threatening, anxiety-laden images may serve to desensitize the viewer.

In many instances, there is a sufficient richness of material elicited by interviewing the subject concerning the "threatening" images, so that little more history needs to be delved into. In this sense, for the busy clinician or interviewer, the procedure readily serves as what has been referred to as a "quick and dirty" test. Occasionally, an insightful subject may, after having completed the procedure, or having experienced previously repressed post-traumatic dreams, open the interview with a statement about how helpful it was. This person may simply wish to elaborate on memories of past upsetting experiences such as an emotionally unresolved abortion, a miscarriage, past psychological, physical or sexual abuse, or the witnessing of an accident, etc. Given the power of the technique, it is rarely necessary to review associations to the entire 62 images. However, the administrator, who becomes sophisticated concerning content analysis and symbolic interpretation, may glean much additional information from an overall scrutiny of the responses.

Applications of this procedure have proven to be far-reaching and international. The use of graphic images, rather than words, allows the SIS video/computer version to cross both cultural and language boundaries. The number of uses in medical diagnosis, psychological assessment and psychotherapy is rapidly growing. It is anticipated that in the 21st century, all students of the healing arts and psychology, during their training will have the opportunity to be introduced to this technique. Currently, a complete data bank is being developed where individuals from various SIS Centers around the world may submit data and access information via modem or facsimile communication. This could truly be a comprehensive artificial intelligence system to be employed for good in a world beset by evil.

(3) SIS-III Living Images:

SIS Living Images is a replica of SIS-II Electronic Version based upon similar audiovisual presentation principles. It has 40 images some of which detect female anatomy. It was primarily designed for female subjects. It utilizes the ambiguous inkblot creations of female artists to bring into projective awareness feminine PTSD imagery. It initially presents relaxing floral paintings by Sara Steele, a nationally known American artist sympathetic to feminist’s issues. When these are presented in association with a sound track which includes suggestions designed to induce relaxation, the video technology facilitates travel of the psyche back to past traumatic periods. Compared to standard clinical interviews, the hypnotic sensory quality of the video more readily accesses PTSD memories for therapeutic processing.

Since it employs projective principles, it facilitates the communication of recurrent and intrusive recollections of the stressful event, including emotions, thoughts and perceptions. It taps into the same stream of disturbed consciousness, as that of recurrent distressing dreams. For those who have not been able to recall or verbally express the content of traumatic "nightmares" (e.g.: children), it may enable access to this forgotten or repressed imagery.The test has not been used in India so far but getting popular in Alaska and used in PTSD as an aide to therapy.

(4) Game Changer (10 image Version):

The game changer is a web based psychological procedure using projective inkblots images, to assess certain important personality traits, found to be very effective for the success of people in industry. These traits are: (1) Interpersonal Relationship, (2) Team Building and sharing common view of things,(3) Pessimistic Attitude and (4) Aggressive expression. The instrument helps in assessing the traits in high and low scores. The high scores are more desirable in first two traits- Interpersonal Relations and Team Building while low scores are desirable for pessimistic attitude and aggressive expression. It helps to understand if a person can make a good team, will have smooth interpersonal relationship with different sets of people with low pessimistic and aggressive attitude. It is specially designed for business settings. It is a light weight personality assessment tool that can be used by business professionals and managers.

The game changer is a tool rather than a test, more users friendly and is one of the interventions under Dubay Doctorin (2D)(Dubey,2010). This was conceived as an “Agile Service Management philosophy” that blends traditional service management standards with the "human aspect" of the workforce. At the most elemental level 2D is a set of guidelines and tools that provide a nimble and effective implementation of service management. The philosophy covers the entire lifecycle of a service and all crucial aspects of a “service entity" or service provider including the organizational structure.

(5) Somatic Imagery Test (30 images Version):

The 30 Images quick cyber version of the test developed in 2016, is designed for self-administration. The instruction to take the test, Scoring and Interptreatation is similar to SIS 62 images Booklet/Electronic Version. The subject is provided Answer sheet and asked to read the instructions printed on it before taking the test.