CHAPTER 7
Administration and Scoring of Somatic Inkblot Series:
Administration and Scoring of Somatic Inkblot Series (SIS):
Administration:
Procedure and Instructions:
Over the years the Somatic Inkblot Series has evolved in to five Formats. Although the method of their administration varies, they have a common conceptual basis in Scoring and Interpretation.
The Scoring Sheet serves to collect personal information, such as age, gender, education and other relevant health data separated from the pages for personal responses to the images. The reason the subject is asked to complete the health questionnaire immediately before viewing the Booklet or Electronic version is to bring to mind any physical problems. This momentarily creates a perceptual set for projecting clinically relevant material. As appropriate or necessary, the (response) Answer Booklet from the inkblots can be used by itself, independent from the electronic application. A unique advantage of the SIS procedure is that it can be “self-administering” should the therapist, counselor, psychologist, physician, research scientist, or educator find it appropriate to application circumstances and goals. The procedure can also be used as “Group Administration” during selection in various organizations.
CD/DVD/Video Procedure:
When the SIS video is to be presented in the professional’s office, the assessment room needs to be equipped with suitable electronic equipment (TV/VCR/Computer). In addition to comfortable seating for two or more persons, it is best to provide a small table or desk to facilitate the writing of observations and responses in the answer booklet. Adequate and adjustable lighting and privacy from interruption and extraneous sounds will enhance the experience of the procedure.
The initial instructions and assistance provided by the professional will induce the relaxed mood intentionally cultivated. This is accomplished through the use of pictures of flowers, peaceful scenes of natural environments and musical interludes. A calm mind and semi-hypnotic state will serve to promote the release of deeply repressed and/or painful material that otherwise might never have been recalled. Ordinarily, traumatic material is less likely to be verbalized directly in an interview situation or through non-projective psychometric tests.
The professional will provide full disclosure of potential benefits and risks associated with each procedure administered. This assures fully conscious and voluntary willingness to enter into the experience. Risks include the potential of bringing previously repressed or controlled post-traumatic experience and feelings into full awareness. In most instances, similar to a subject’s experiencing dreams or “nightmares,” the SIS viewer is able to reconstitute psychological defenses immediately afterwards. In rare instances, the professional needs to be available to assist. Fortunately, there has been no reported instance of major or lasting adverse effects.
For children and adolescents, appropriate informed consent must be obtained from a parent or legal guardian. If, for any reason, the examiner is concerned about the potentially disruptive impact of the colored stimuli in an unstable viewer (e.g. Psychotics, Borderline personality etc.), the procedure is available in a black and white version. This can elicits clinically relevant content without affect intensive “color shock”. Often, a salient and dramatic benefit is the identification of forgotten, traumatic experiences. In certain cases, when the victim is given the opportunity to reprocess these, away from the original stressors, a type of insight /emotional healing results independent of the therapist.
When the video tape version of the SIS-II was designed, it was intended primarily for supervised administration by a professional in an office or hospital setting. Subsequently, it has been demonstrated to be useful in group situations. In addition, it can help large populations, (to) cope with major disasters such as a tornado, or other major natural events (tsunami, flood , earthquake etc,) the procedure could be shown on public television.
With relatively psychologically intact subjects, the administrator may choose to give the SIS as a “take-home” assignment. The subject is instructed to complete the procedure while relaxing in the evening. The viewing of the affect charged inkblots immediately prior to sleep may serve to stimulate dreams of a clinically relevant nature. The individual is instructed to record any such material and bring it to the follow-up interview for detailed inquiry the following morning. Then, the examiner starts by exploring associations to, and feelings about, the responses which were originally rated as the three most-liked when the answer booklet was completed. If more rigorous documentation is required, the follow-up interview may be recorded on audiocassette or videotape, depending on the interviewer’s preference. The review of this material is designed to relax the subject and open the session for the subsequent exploration of more painful material, often elicited from those that are rated as “Least liked”. Rarely, it may be necessary for the examiner to return to a discussion of the “most liked” inkblots if the emotional exploring of the affect impact of discussing the “least liked” inkblots becomes too threatening.
The electronic versions are primarily intended for supervised administration by a trained professional as an adjunct to individual counseling, therapy or industrial consultations. When asked to give an opinion about the SIS video procedure in 1990, Prof. Wayne Holtzman, internationally respected developer of the Holtzman Inkblot Series (Holtzman et al, 1956), said, “Unlike many other methods, it is particularly appealing when used by the clinician and subject in an interactive, interpretive mode as part of the total diagnostic-treatment process. The dynamic nature of the stimulus, when presented electronically in full color, reaches well beyond the limitations of traditional projective techniques.”
Examination Instructions:
This viewing procedure is to be administered under the direct supervision of a trained professional who has explained its risks/benefits, clinical relevance and value in better understanding your problems. If, at any time, questions or difficulties should arise during or after this procedure, please feel free to contact your clinician who will be pleased to assist.
Before the clinician administers the SIS procedure, it is important that a reasonable comfort level is established with the person who is to view the SIS images. The professional may begin by going over the instructions listed on the back page of the answer booklet. First, have the subject fill in the brief health history. Explain that a series of flowers will be shown to help the person relax. Next, indicate that there will be video instructions on how to fill in the answer booklet. Turn the booklet over and observe how the illustrated inkblot was labeled at the top of the first page. Then write down whatever comes to your mind. Include any emotions that relate to each image. When you have completed the procedure, please note the instructions on the back page regarding rating of inkblots which you “Liked the Most” and which you “Liked the Least”. Remember to include why you choose those particular images.
SIS-II Booklet Procedure:
The booklet version of the Somatic Inkblot Series (SIS-II) can be used in a variety of ways but was designed for self-administration after supervised instruction. The subject is provided eight pages booklet consisting 62 images in two series A and B each with 31 images and asked to read the instructions printed on last page of the booklet. “Most people find this test fun and interesting. First, please relax, take a few deep breaths, and prepare to enjoy. Please turn this booklet over, and study the sample response. Notice that you may write on the picture or in the space below it. Label each in terms of what they resemble or look like to you. Please include everything you see even if it reminds you of something remote, vague, dreamlike, highly personal or even potentially embarrassing. Please include everything you see with as much detail as possible. Also include any outstanding emotional reaction that you might feel occur in responding to these images.
Please begin on the first page study the sample, and continue until completed.” The subject is asked to complete the identification data and the brief health history as instructed in video procedure. Reassure the subject that:
There are no rights or wrong answers. Different people see different things in the inkblots. It is important to write whatever the inkblot looks like regardless of whether or not it makes sense or how it might seem to others. And the test may take about one hour to complete.
Like video procedure, the subject is asked to select three image which (s) he/she liked the most and three images which he/she liked the least.
After the completion of the procedure (test), the clinician will quickly go through the responses and will decide if a specific response needs further exploration. This helps particularly in understanding the psychopathology behind an “Atypical response” or a response helping in hearing the inner cry of the individual. Except the procedure of presentation (Card/ Booklet/CD/DVD or Videotape), procedures follow the same administration.
Scoring:
There are only 11 scoring indices common in all Forms of SIS (Card / Booklet/ CD/ DVD or Videotape).
Definitions of Scoring Indices:
Mental health professionals with training and experience in projective techniques will have little difficulty integrating the scoring and charting conventions used with the Somatic Inkblot Series. “Body Symbolism” (Cassell, 1980), can be a resource for increasing one’s skill in the interpretation of the original 20 cards SIS responses. Since the procedure conceptually taps into the same stream of imagery as seen in dreams, daytime fantasies and visual hallucinations, a background in the interpretation (interpreting) of such content, either in a direct or latent symbolic way, is helpful. Clinicians experienced in art psychotherapy will readily adapt to this technique (Kwiatkowski, 1978; Unman, 1965). They will find the SIS a useful aid, especially for people who cannot draw,. In a sense, the SIS (employs) uses art as a diagnostic and therapeutic approach for those who cannot engage in traditional art procedures. Other clinicians with experience in dream interpretation, visualization techniques, guided imagery, active imagination therapies and hypnotherapy will also readily adapt to this procedure.
There are variations in test-taking, with important clinical applications. People who have difficulty in completing the test and who do not respond to a number of CD/DVD images may be exhibiting denial, avoidance, blocking or repression. Excessively detailed responses suggest obsessive-compulsive traits. Exaggerated verbal responses, while discussing inkblots least liked, suggest affect-laden content. This should be further explored for relevance and meaning to the individual. In some cases, repressed material can burst into conscious awareness, triggered by the semi ambiguous inkblots. The underlying dynamics of many somatic complaints and personality traits can become accessible with this technique. The eleven categories found to be important in understanding and interpreting protocols are:
| 1. | Total Number of Responses |
|---|---|
| 2. | Human Responses |
| 3. | Animal Responses |
| 4. | Anatomical Responses |
| 5. | Sex Responses |
| 6. | Movement Responses |
| 7. | Most Typical Responses |
| 8. | Typical Responses |
| 9. | Atypical Responses |
| 10. | Rejection of Images |
| 11. | Pathological Responses |
| a. | Pathological Anatomy Scale (PAS) |
| b. | Depression (D) |
| c. | Hostility and Aggression Scale (HAS) |
| d. | Paranoia (P) |
Each category is designed to stimulate consistency among the raters, and to afford commonality in acquiring information for research and normative data collection. The Somatic Inkblot Series has a very simple scoring system. It is less complicated than existing inkblot tests, since it emphasizes content analysis. The scoring categories have been described as follows:
1. Total Number of Responses (R):
The total number of responses is arrived at by counting all the responses given by the subject on the 62 images of the SIS-II Booklet/ DVD/Video. This number suggests imaginative capacity and functioning intelligence of the subject. Psychiatrically ill patients will have a poor imaginative capacity and poor functional intelligence.
2. Human Responses (H):
Human responses include the whole human body, or external parts of the human body like face, ear, nose, legs, etc. The category does not include mutilated forms of the whole body or parts of it, such as crushed human being, broken legs or smashed face. These mutilated responses are included in the Anatomical responses. The number of Human responses suggests subject's projection of own self, interpersonal relationship with other human beings. When responses are low, it might be indicative of a desire to be away from others and indicative of schizoid or social isolation tendencies.
3. Animal Responses (A):
Animal responses include living or dead animals such as wild and pet animals, reptiles, birds and sea animals. This category also includes external parts of the animals such as wings, legs, claws, beak, etc., but it does not include mutilated parts of the whole animal such as crushed birds or animals, pulled out wings, etc. Whenever a large number of animal responses are given, interpretation should be that the respondent is
more comfortable with animals than people or psychologically immature.
4. Anatomical Responses (At):
Anatomical responses pertain to internal parts of living beings and their mutilated forms, both of humans and animals. These responses are consistently high in those who have a poor self image, preoccupation with somatic symptoms in the region focused on.
5. Sex Responses (Sex):
Sex responses pertain to the internal or external reproductive system and to sensuous parts of the body. These responses include thighs, buttocks, breasts, fallopian tubes, ovaries, etc. Heightened anxiety and pathology may be associated with either heightened projections or impaired recognition of imbedded sexual structure. These may signify sexual anxiety and/or dysfunction.
6. Movement Responses (M):
Movement responses indicate activity and kinesthetic motor impulses. Examples include “talking human being,” “flying bird” or “running tiger.” Dancing and joyful movement may reflect a positive mood and Low movement may indicate depression.
7. Most Typical Responses (MT):
Most Typical responses are those which are given by more than 75 percent of normal subjects on a particular image (Dubey and Cassell, 1993). The total numbers of such responses are limited to 18. A higher number of Most Typical responses are suggestive of coherent, logical thinking, and ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept. The following is the list of Most Typical responses along with the images eliciting them:
SIS-II A Series (Responses on a particular Images):
A7 Apple/fruit
| A7 | Dancing lady |
|---|---|
| A9 | Two human beings/ladies |
A12 Ear
| A13 | Raised hand |
|---|---|
| A20 | Kidney/lungs |
A27 Breast
A30 Skull
| A31 | Two faces of persons |
|---|
SIS-II B Series (Image Responses on particular Images):
| B4 | Two faces of persons |
|---|---|
| B5 | Two persons talking |
| B9 | Kidney/lungs |
| B22 | Man/boy sleeping or resting/ dreaming and soul going up |
| B27 | Child/children |
| B28 | Mother and child/standing lady |
| B29 | Running man |
B30 Ears
| B31 | Family-father, mother and two children |
|---|
8. Typical Responses (T):
Typical responses are those which are commonly seen by healthy people on a particular image.
9. Atypical Responses (AT):
Atypical responses are those of poor quality and with vague percept, either in structure or verbalization. A response that markedly departs from the category of Typical responses is also scored under Atypical category. For example, if the viewer gives the response “flower” on image A20 it should be considered as atypical because this image should elicit body anatomy such as kidney/lungs. The number of Atypical responses is proportionate to the degree of psychological or psychiatric disturbance. Perseveration may be a sign of neuropsychological impairment, and is usually absent in normal people.
Below is a list of Typical and Atypical responses on each image:
Typical and Atypical Responses (SIS-II A):
Need inkblot representations: Please put images A1-A31 and B1-B31 with each image either before or towards the Right side Or at the end of B31)
Image A 1
Typical: Two people; two animals
Atypical: Lungs; diseased lungs; ovaries and fallopian tubes; woman’s breast; x-ray of pelvis
Image A 2
Typical: Floral arrangement; people
Atypical: Heart, eye
Image A 3
Typical: Space needle; cross; tree
Atypical: Bleeding body part; vagina (libidinal cathexis in lesbian women)
Image A 4
Typical: A horse’s face; abstract art
Atypical: A mask, an eye looking at me; the Devil; a person (mother grieving loss of son)
Image A 5
Typical: Clown; happy person
Atypical: Woman; heart; mouth
Image A 6
Typical: Person and teddy bear
Atypical: Egg and teddy bear; two chromosomes; legs; lines and teddy bear (lack of gestalt in concrete thought disorder)
Image A 7
Typical: Woman dancing; Eve and apple; seductive woman; apple
Atypical: Male; pregnant woman; heart; rivers and island; snakes
Image A 8
Typical: Man; man showing male parts
Atypical: Woman’s vulva; egg and sperm; fat body or face; baby; lines
Image A 9
Typical: Man and woman dancing; hearts; two men or two women dancing
Atypical: Two sets of lines; face; eyes; two ants; two animals
Image A 10
Typical: Eyes; eyes out of focus; woman’s face in rear view mirror
Atypical: Hazy face; crying
Image A 11
Typical: Nose; auto; person sitting; leaning forward; the Thinker; runner waiting for starting gun
Atypical: Person doubled over in severe pain; person doubled over all the way with head between legs; Kidney excreting waste (GI problems)
Image A 12
Typical: Ear
Atypical: Embryo
Image A 13
Typical: An upraised hand; a hand reaching for help; palm
Atypical: Suffering, pleading, helpless, desperate, or attacking hand; hand in flames or reaching out of concealment to grab someone (rape victim)
Image A14
Typical: Esophagus and stomach; Olympic torch carrier; airport tower
Atypical: Fetus; miscarriage; sacred heart; kidney
Image A 15
Typical: Stomach; bird; fetus
Atypical: Kidney; dead baby
Image A 16
Typical: Two love birds; heart
Atypical: Two (starving) birds fighting for food; lungs; x-ray of chest; leaves
Image A 17
Typical: Chest; ribs; heart; lungs
Atypical: Ugly dog; monster looking out at you; gaping open mouth; two catfish looking at evil; sea horses; heart (afraid it will stop) (death anxiety in an eight year old)
Image A18
Typical: Heart; female genitalia; uterus; animal coming out of heart
Atypical: Creature from outer space; atomic bomb exploding; X-ray of brain
Image A19
Typical: Intestines; colon
Atypical: Human penis; woman forming fetus
Image A 20
Typical: Kidneys; lungs; thorax
Atypical: Weight lifter (back pain detail); a bush with a spear for roots; brain; ovaries; testicles; eyes; ears
Image A 21
Typical: Turtle; flying bird; babies on sides
Atypical: Stretched animal skin; man flashing two children; smashed animal showing entrails; spinal disc
Image A 22
Typical: Spinal column; chest; rib cage; pelvis; phallus
Atypical: Male genitals burrowing; funny face with low forehead (lower part); man-eating plant (upper part)
Image A 23
Typical: Spinal column
Atypical: “Mind block” (rape victim repressing male genital symbolism); pots, pans, or plates stacked on each
other (neutralizing defense against phallic symbol by rape victim)
Image A 24
Typical: Female pelvis; people
Atypical: Demons or devils
Image A 25
Typical: Vagina
Atypical: Stained glass window; crucifix (substituting religious symbolism); cave or tunnel; beetle; Indian oil lamp; eyes
Image A 26
Typical: Fetus; embryo
Atypical: Face; reflecting repugnant emotion (pregnant woman unhappy with pregnancy)
Image A 27
Typical: Human female breast; baby sucking at breast; deer’s head
Atypical: Female arm being injured; marked decapitated woman
Image A 28
Typical: Leg; thigh; wrist and hand
Atypical: Hand from horror film
Image A 29
Typical: None typical, all are “projective”
Atypical: Scary face; person running; shadow of a gun
Image A 30
Typical: Face; skull; Neanderthal man; monkey’s face
Atypical: The rapist’s face; evil surrounded by evil; the Devil
Image A 31
Typical: Two human faces, man and woman, or adult and child whispering secrets
Atypical: Man and woman arguing; sad faces
Typical and Atypical Responses (SIS-II B):
Image B 1
Typical: Camp fire; melting ice cream
Atypical: Rotting tooth; amniotic sac with embryo; heart bleeding
Image B 2
Typical: Fire spreading in forest; rag doll on a stick
Atypical: Ovaries; fallopian tubes and uterus; attacking animal; monster; ultrasound of vagina
Image B 3
Typical: People talking
Atypical: Throat and tonsils; vagina; rectum; pelvic bones; Darth Vader’s head
Image B 4
Typical: Two human faces; adult and child
Atypical: A person projecting an alter personality (multiple personality disorder); mummies; person threatening someone
Image B 5
Typical: Two seated human figures throwing balls; people conversing
Atypical: Man and woman arguing; me (referring to self) not able to communicate with Doctor.
Image B 6
Typical: Upper thighs and lower abdomen; pair of pants
Atypical: Fat thighs; penis in vagina; stomach x-ray; woman’s lace panties (eroticism, typical in lesbian woman)
Image B 7
Typical: Ribs; upper chest; hot water bottle
Atypical: Brain; painful back; heart with arrow in or through it; pelvis
Image B 8
Typical: Nose; a man’s profile; earth
Atypical: Pregnant woman; cocoon
Image B 9
Typical: Lungs; kidney; penis and testicles
Atypical: Woman’s reproductive organs; liver and spinal cord; gall bladder
Image B 10
Typical: Bear’s face; dog; seeds
Atypical: Sad dog; pregnancy; female; female reproductive organs; ears
Image B 11
Typical: Lungs; two birds; flowers
Atypical: Lungs distorted fighting for breath; smoker’s lungs
Image B 12
Typical: Face; man squinting hard
Atypical: Evil face; expression of pain; angry face; crying face
Image B 13
Typical: Colon; intestines, a question mark
Atypical: Peep hole
Image B 14
Typical: Pure projection, lower back; pelvis; apple
Atypical: Heart; trachea and lungs
Image B 15
Typical: Broken glass; paper airplanes; knives
Atypical: Knives to kill someone; suicidal or homicidal imagery
Image B 16
Typical: Spine; spinal cord; vertebrae
Atypical: Tool for drilling; hypodermic needle; painful vertebrae
Image B 17
Typical: Heart; smoking
Atypical: Open vagina receptive to intercourse; a dark hole
Image B 18
Typical: Spinal cord; penis in vagina
Atypical: Sperm going through tunnel; two people talking; snake in a pipe
Image B 19
Typical: Cell; ovum; egg; sun, heart
Atypical: Broken heart (post-trauma response of rape victim); egg being fertilized (pregnancy wish); ugly spider
Image B 20
Typical: Brain; exposed brain
Atypical: Fetus; diseased or troubled brain
Image B 21
Typical: A gun; exploding cork; firecracker
Atypical: A gun shooting someone; penis with a band around it (impotence)
Image B 22
Typical: Body resting; soul leaving body; dead person
Atypical: Blood spurting from chest; crime victim bleeding to death
Image B 23
Typical: Spider; rib cage; heart; lung; crab
Atypical: Rib cage with cancer
Image B 24
Typical: Kidneys; hanging lamps
Atypical: Twins (pregnancy wish); sperm; testicles; ovaries
Image B 25
Typical: Pelvis of woman; hands holding glass circle
Atypical: Apple; koala bear; pelvis with fire inside; desire
Image B 26
Typical: Female sex organs (cervix, ovaries, uterus, vagina)
Atypical: Skull; top of hammer; dog with large ears
Image B 27
Typical: Fetus; embryo; child
Atypical: Diseased fetus; dead baby
Image B 28
Typical: Mother and child
Atypical: Woman holding baby close and running away; person in despair hugging ‘ self; father and child;
Jesus holding and comforting someone
Image B 29
Typical: Running human figure; lame
Atypical: Human figure with one leg running in fear
Image B 30
Typical: Two ears, Fetus
Atypical: Split brain (multiple personality disorder); lungs
Image B 31
Typical: A family of two adults and two children standing together; Father Mother and two Children.
Atypical: A family disintegrating; people with penises for head; four children
10. Rejection of Images (Rej ):
If the subject is unable to give any response on any of the 62 images, the image is considered as rejected. Verbalizations like spot or inkblot are not considered as a response, and are scored as Rejections. To determine the percentage of Rejection of Responses, the total number of rejected images are divided by the total number of images and multiplied by 100. Rejection of images may show low intelligence, thought blockage from psychological inhibition or organic brain involvement.
11. Pathological Scales:
Four pathological scales have been used (Cassell, 1980) for the evaluation of individuals. They are:
a) Pathologic Anatomy Scale (PAS);
b) Depression (D);
c) Hostility and Aggression Scale (HAS), and
d) Paranoia Scale (P).
Some of them are based on the work of Wayne Holtzman (1956). The scales are as follows:
a) Pathological Anatomy Scale (PAS):
Subjects who have personal health concerns, or who are pathologically identified with the health of others, may project responses in which the body is seen as diseased. These responses are usually related to specific regions involved in the subject’s body image, and can be appraised by evaluating the qualitative nature of the somatic material projected. The anatomical imagery is similar to that described by De Vos (1952) in Rorschach responses involving “diseased anatomy.” Body parts might be reported as red, inflamed, infected or cancerous. Organs may be sore, painful or hurting. Passages may be blocked or obstructed. Bones may be out of place or broken. It is possible to assess pathologic anatomy by summing up all such responses. All of these responses are scored under PAS. Individuals who project these responses should be further evaluated for either hypochondriacal or excessive concern about physical health. This material should be explored, clarified and assessed in the detailed inquiry and follow-up interview, since the subject may still have unresolved anxiety about this alteration in body concept. The total number of such responses is counted to form a score for PAS.
b) Depression Scale (D):
A depressed subject’s emotional state can be viewed as either overt or covert. Subjects with overt feelings of depression readily admit them, and are good reporters of their own mental state. They usually exhibit nonverbal behaviors, such as sighing, weeping, downcast eyes, etc., which are consistent with the experienced affect. Subjects in a state of masked depression often conceal or deny their feelings. Frequently, they are preoccupied with their bodies hypochondriacally, and project anatomical responses, which are likely to be pathological. A depressed mood can be assessed by inkblot responses with high morbid or depressive content. The severity of these thoughts and feelings can be assessed by a study of their frequency and content quality.
A four-point scale can be used to score the depressive content of inkblot imagery:
Score 0: No depressive content
Score 1: Slight or mild depressive content in the face of humans or animals (i.e. a sad face)
Score 2: Moderate depression associated with the “inkblot’s” expression. An expression with a marked, or strong affect (e.g. a weeping person, a grief-stricken person)
Score 3: Sadness or depressed affect associated with an anatomical response. For example a heavy heart, a breaking heart, or a heart with a clamp on it. Something that is suicidal, or hanging from roof, or a dead man.
Individuals who are clinically depressed, but fail to recognize it, may have similar difficulty recognizing content in the SIS. In the absence of neurological disorder, a high number of Rejection responses may signify masked depression.
c) Hostility and Aggression Scale (HAS):
Hostility and Aggression can be reflected in projective responses involving physical assault or body injury (Cassell, 1977) and are scored as follows:
Score 1: Animals that are predatory or hostile to humans; an implement of aggression in a dormant state; a human or an animal that is seen as fierce, aggressive, or dangerous; a hostile attitude seen in humans or animals; references to bowel function or defecation with hostile content; a knife or a snake.
Score 2: Animals or humans seen as angry or in aggressive struggle, either verbal or physical; furious snakes; or abstract expressions of direct conflict or oral aggression.
Score3: Homicidal scenes and/or anatomical responses involving body destruction. Subjects with histories of acting out hostile impulses have been found to project anatomical responses with murderous themes.
d) Paranoia Scale (P):
A cardinal projective feature of paranoid ideation involves a heightened awareness of threatening faces that are “looking” at the individual. This may be experienced as an exaggerated sense of self-consciousness in social situations. An emphasis on the eyes” of people or animals may be present in anxiety-laden dreams. It may be clinically indicated in art therapy, with figure drawings emphasizing “eyes.” The patient may have hallucinating images of such staring faces. The paranoid scale quantifies such responses.
Administration and Scoring of SIS -I (20 cards/ DVD Set):
Method of Presentation:
As the SIS Booklet/ DVD Form
Scoring:
Scoring of Responses is common in DVD/Video/Booklet and Card Forms except the Most Typical, Typical and Atypical Responses on SIS-I 20 cards which is given below:
7. Most Typical Responses (MT):
Most Typical responses are those, which are given by, more than 75 percent of normal subjects on a particular image (Dubey and Cassell, 1993).The total number of such responses is limited to 9. A higher number of Most Typical responses are suggestive of coherent, logical thinking, and ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept.
The following is the list of Most Typical responses along with the images eliciting them:
| Card | Responses |
|---|
| Card I | Two Birds |
|---|---|
| Card II | Heart |
Card II Bird
| Card III | Two human beings/ladies |
|---|---|
| Card IV | Apple/fruit |
| Card IV | Dancing Lady |
| Card IX | Kidney/Lungs |
| Card XV | Spinal Column/Rib Cage |
| Card XVII | Spinal Column/Pelvis |
8. Typical Responses (T):
Typical responses are those, which are commonly seen by healthy people on a particular image.
9. Atypical Responses (AT):
Atypical responses are those of poor quality and with vague percept, either in structure or verbalization. A response that markedly departs from the category of typical responses is also scored under Atypical category. For example, if the viewer gives the response "flower" on image 9 it should be considered as atypical because this image should elicit body anatomy such as kidney/lungs. The number of Atypical responses is proportionate to the degree of psychological or psychiatric disturbance. Perseveration may be a sign of neuropsychological impairment, and is usually absent in normal people. Below is a list of Typical and Atypical responses on each image:
Typical and Atypical Responses:
Inkblot representations: Please put images 1-20 with each Card either before or at the Right sideor after Card 20)
Plate SIT-1
| Typical: | Two persons |
|---|
Atypical: Lungs
Plate SIT-2
Typical: Clown; happy person
Atypical: Woman; heart; mouth
Plate SIT-3
Typical: Man and woman dancing; hearts; two men or two women dancing
Atypical: Two sets of lines; face; eyes; two ants; two animals
Plate SIT-4
| Typical: | Woman dancing; Eve and apple; seductive woman; apple |
|---|
Atypical: Male; pregnant woman; heart; rivers and island; snakes
Plate SIT-5
Typical: Turtle; flying bird; babies on sides
Atypical: Stretched animal skin; man flashing two children; smashed animal showing entrails; spinal disc
Plate SIT-6
Typical: Two lovebirds; heart
Atypical: Two (starving) birds fighting for food; lungs; x-ray of chest; leaves
Plate SIT-7
Typical: Heart; female genitalia; uterus; animal coming out of heart
Atypical: Creature from outer space; atomic bomb exploding; x-ray of brain
Plate SIT-8
Typical: Chest; ribs; heart; lungs
Atypical: Ugly dog; monster looking out at you; gaping open mouth; two catfish looking at evil;
Plate SIT-9
Typical: Kidneys; lungs; thorax
Atypical: Weight lifter (back pain detail); a bush with a spear for roots; brain; ovaries; Testicles; eyes; ears
Plate SIT-10
Typical: Lips, mouth (upper area) and Stomach (lower area)
Atypical: Non anatomical, Animal
Plate SIT-11
Typical: Intestine
Atypical: An animal
Plate SIT-12
Typical: Female sex organs (cervix, ovaries, uterus, vagina)
Atypical: Skull; top of hammer; dog with large ears
Plate SIT-13
Typical: Female genitalia, perineal area, buttocks, and heart
Atypical: An animal, creature from other space, leaf
Plate SIT-14
Typical: Vagina
Atypical: Stained glass window; crucifix (substituting religious symbolism); cave or tunnel; beetle; Indian oil lamp; eyes
Plate SIT-15
Typical: Spinal column
Atypical: "Mind block" (rape victim repressing male genital symbolism); pots, pans, or plates stacked on each other (neutralizing defense against phallic symbol by rape victim)
Plate SIT-16
Typical: Eyes, head, tongue, nose
Atypical: Bushy plant, Flower
Plate SIT-17
Typical: Spinal column, Rib cage, Pelvis, Phallus
Atypical: Indian lamp, big hammer
Plate SIT-18
Typical: Oral or Facial region, Crown
Atypical: Gate of Hell, Castle
Plate SIT-19
Typical: Two birds, Hands
Atypical: Butchered Animal, Dressed Chicken
Plate SIT-20
Typical: Face or part of face, Eyes
Atypical: Ghost, Fearful face
Overall Clinical Considerations:
Attention should be given to signs of somatic repression. This is reflected when images with high anatomical structure are left blank or when symbolic responses are projected, disguising the somatic content. An example is the response "Chinese pagoda" instead of structure suggestive of spinal cord. Another would be seeing a bush instead of kidneys or lungs on Card 9. Individuals suffering from psychogenic pain in a conversion disorder are examples of this group of respondents. In the detailed inquiry, depending on the clinical indications, specific questions may be asked to explore certain areas pertaining to the patient. For example, if the examiner wishes to explore the subject's perception of communication with the therapist (i.e. transference material), further responses may be obtained after enquiries.
What may at first seem an abnormal image pattern may prove to be a normal variant under the added scrutiny of detailed inquiry? The response may be a defense against painful reality, a temporarily focused but generalized anxiety or an acquired or learned response from family, job, school, life experience or long-term, chronic medical problems. The therapist should withhold judgment and not share it with the patient until the dynamics are clear. In classical analytic therapy, this delay is intentional and is an integral part of the treatment plan. The therapist waits until the patient has the insight, awareness and coping skills, and thus is ready to understand and process these new leanings. A subject's therapeutic readiness involves the ability to process affect-laden, repressed material, and unrealistic expectations of him/herself and others. Choosing this moment of truth, i.e. the time to share judgment is a test of the therapist's knowledge, understanding and judgment.
Another line of psychotherapeutic line of inquiry concerning the determinants of SIS responses involves determining if the subject's projected material reflects inner psychological experiences not directly recorded from past visual experience. These responses may relate to nighttime dreams, daytime fantasies, or, in psychotic individuals, visual hallucinations. SIS images are similar to images used in art therapy, in that they enable the individual to see them as an expression of externalization of the self, or the self as perceived by others. For example, there can be a perceived fusion between a child, or the self as child, and an abusive or controlling parent or authority figure.
A number of artists have been interested in dreams and have attempted to represent dream imagery in their art. Leonardo Da Vinci sometimes slept holding a billiard ball in his hand, poised over metal pail. As he slept, his grasp on the ball weakened and it would fall into the pail, awakening him. Then, he would sketch what he saw in his dream. This method was used by Da Vinci to stimulate and channel his creativity. If a subject does not perceive an anatomical structure on an image, which generally elicits one (see response profile), it may be interpreted that the patient is denying physical discomfort and has low awareness. He might be having deep-rooted problems with that part of the body or organ.
Emphasis or sexual avoidance of a structure may suggest conflict in that area. Emphasis on eyes, ears, or hair may suggest paranoid ideation. A higher conformity to Most Typical responses may suggest that the patient or client have group conformity in his/her thought process. High scores on the four Pathological Scales may suggest pathology in the respective area. The greater the percentage of Atypical responses with poor quality, may indicate deeper pathology.
Rejection of Images:
It is equally important to understand why a person is unable to perceive on a particular image. Each image is created to depict a particular area, hence rejection of such images have lot of clinical significance. Since these inkblots are highly structured - in the absence of any organic pathology- inability to perceive a particular blot can be highly clinically significant. It may help, in understanding his reactions to different situations presented through inkblot imagery. The avoidance of such images may further be probed to understand the unconscious process. Though responses to different images are quite relevant to understand the personality of the subject but the rejection of images may be equally relevant and may help in peeping through the inner self of the subject. Because of such relevance, rejection of images has been given much importance while interpreting SIS protocol of a subject.
When a person is unable to perceive images in a concrete form, it can be taken as rejection. It has been noticed that people reject images, which depict certain precept related to their traumatized experience or underlying painful memory. For example a person having poor interpersonal relationship may reject SIS I Card 3 and 4, because these images project human content. Poor interpersonal relationship with spouse may also lead to rejection of Card 3, 4 and 14. Images like 14 projects more of erotic content. Since this area is disturbed because of poor relationship, people (he/she) may not feel like responding anything on this card. Similarly, it has been noticed on clinical sample of cardiac cases that persons suffering from heart problems rejects images depicting a heart - for example Card 2,7,and 9. A few patients who have recovered and have accepted their clinical problems bravely do perceive 'a heart' on these images. It suggests that they have no fear regarding their heart as they have been properly counseled. Persons suffering from body ailments, for example Kidney problems generally reject Card 9, which depict Kidneys. It has also been noticed that females traumatized sexually find it difficult to perceive Card 15 and 17, which generally project spinal column. The symbolic meaning of these images may relate to male sex organs. Since these persons have undergone traumatizing experience and have unpleasant memories of the precept, they may find it difficult to see anything on these images. Even if they perceive something, often they give poor quality responses and attach a special meaning to it. For example a patient who experienced an unpleasant sexual harassment perceived “A deadly android more like a creepy insect" on Card 15.
It should be kept in mind that the material, which follows need to be, assimilated by the experienced clinician with the overall medical and psychiatric history data. Even certain contents from dreams and visual hallucinations may be included.
| (3) | Administration and Scoring of Living Images: |
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Living Images is self administered test with no scoring. The responses are interpreted following Content analysis and Symbolic interpretation.
| (4) | Administration and Scoring of Game Changer: |
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The Game Changer is a web version of the test and consists of a slideshow of 10 inkblot images. The responders are asked to select a likely "inner projections" from four available preset options or the option to pen their thought as a fifth option. All impressions and emotions are encouraged. At the end the responder is asked to select the "most liked" and the "least liked" images including reasons for the selection.
The instrument helps in assessing the four traits such as: (1) Interpersonal Relationship, (2) Team Building and sharing common view of things, (3) Pessimistic Attitude and (4) Aggressive expression in high and low scores. The high scores are more desirable in Interpersonal Relationship and Team Building whereas 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 and can channelize pessimistic and aggressive attitude.
Based on the responses chosen by the participant (subject), report is generated and communicated after completion of the test. The test is specially designed for business settings and helps as screening tool particularly during selection interviews.
| (5) | Administration and Scoring of Somatic Imagery Test (30 images Version): |
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The 30 Images quick cyber version was developed in 2016, is designed for self-administration. The instruction to take the test is similar to SIS 62 images Booklet/Electronic Version. The subject is provided Answer sheet and asked to read the instructions printed on first page, before taking the test.
The Scoring is done after completion of the test. It follows Quantitative as well as Qualitative/Psychoanalytic Interptreatation.