Administration

Procedure and Instructions

The objective of this Introduction and Guide is to describe the SIS-II booklet and the

videotape version of the SIS-II, both of which are provided with the basic procedure kit.

The purpose is to present administrative and interpretive guidelines for the professional

use of the procedure. The booklet 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 Videotape 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 form booklet can be used

by itself, independent from the video 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.

Video Procedure

When the SIS video is to be presented in the professional’s office, the assessment

room needs to be equipped with a color television monitor and a videocassette recorder

(VCR). 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 on video. 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 might never be 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 to bring 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,

instance of major or lasting 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 SIS Video (e.g.

psychotics, borderlines, etc.), the procedure is available in a black and white version,

which elicits content without the potentially emotionally disruptive color shock.

A salient and dramatic benefit is the identification of forgotten, traumatic experiences.

In certain cases, the identification of these may serve to inhibit mental mechanisms

and subvert effective coping with present life situations. When the video tape version of

the SIS-II was completed in 1984, it was intended primarily for supervised administration

by a professional in an office or hospital setting. Subsequently, it has proven to be

useful in-group situations.

With certain individuals who are psychologically intact, the administrator may choose

to give the SIS as a “take-home” assignment. The subject is instructed to complete the

procedure in the evening in a relaxed setting, when psychological defenses are lower.

The viewing of the threatening images immediately prior to sleep may serve to stimulate

dreams of a clinically relevant nature. As part of the instructions, the individual is asked

to record any such material and bring it to the follow-up interview for detailed inquiry.

This is normally scheduled for the following morning.

In the interview situation, the administrator starts by exploring associations to, and

feelings about, the images 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 most threatening. Rarely, it may serve as a base to

which the interviewer can return, if the emotional impact of the latter material is too

threatening.

Upsetting life experiences serve to inhibit or subvert effective and satisfying coping

with present life situations. Benefits throughout the history of formless stimuli and

projective instruments trace back to the fifteenth century (Zubin, Eron & Schumer,

1965). They include stimulation of creative imagination and generation of data for

study of thought processes, reflex hallucinations, intelligence, personality and

psychopathology, in addition to the potential for making audible and understandable

“the inner cry.” This is consistent with what the Greeks referred to as emotional catharsis. The videotape version is primarily intended for supervised administration by a trained professional as an adjunct to individual counseling, therapy or industrial consultations. In addition, it has proven useful in-group sessions and as a “take-home” assignment at bedtime to stimulate dream material. When asked to give an opinion about the SIS video procedure in 1990, Wayne Holtzman, Ph.D., 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 40 Administration

of the stimulus, when presented by videotape in full color, reaches well beyond the

limitations of traditional projective techniques.” [For a brief history of projective and

inkblot assessment methods, see Historical Development of Inkblot Technique.]

The SIS-video is unique in the principles it uses to make the individual’s “inner cry”

audible and in the way it uses video technology to access the deeper layers of

consciousness to draw out the response. Television is an almost universal form of

lives and, therefore, non-threatening. In their book, “Television and the Quality of Life:

How viewing Shapes Everyday Experience,” (1990) Robert Kubey and Michaly

Csikszentmihally report that when watching television there is an altered state of

consciousness with reduced concentration and heightened passivity. This makes it

possible to employ principles known by hypnotists. Specifically people under a hypnotic

trance or altered state of consciousness can respond to questions that they might not

be able to in a normal conscious state. Viewing the SIS- video, like dreaming, can be an

emotional and cognitive experience, which has therapeutic value.

Procedure guidance is provided verbally on the videotape and is printed in the

Response Form Booklets. The booklet presents the same sequence of images as the

video; however, booklet images are blue to avoid color shock.

As indicated, initial attention is given to the three images identified as “Most Liked.”

Consideration is given to responses reflecting health, emotional maturity, positive

outlook and other reflections of ego strength. The insight obtained from these responses

is important, since post-procedure inquiry and therapeutic follow-up, ideally, always

begin with the positive responses.

Starting with the positive serves to reduce the subject’s anxiety and reassures him/her

that he is basically okay psychologically. From positive feelings, it is easier to move into

negative areas of imagery. The therapist may choose to return to the positive images for

closing post-procedure inquiry and follow-up therapy sessions to bolster the subject’s

psychological defenses.

The first step for professional analysis and interpretation of responses involves studying

the three responses that the patient considered “least liked,” along with the reason(s)

for their negative impact. Next, the responses for the entire series of 62 images are

conflict or suffering, diseased anatomy responses, symbolic anatomy (e.g. broken

heart as a sign of depression), excessive sexual content, etc. Perseveration of a theme,

from one image to another, may suggest important unresolved material on a constant

issue (i.e. repeatedly seen fetuses in someone who had repeated miscarriages).

neuropsychological impairment.

SIS procedures lend themselves to working with individuals whose first language is

not English, and with those who have different cultural or socialization histories.

Instructions are available in a number of languages. Also, most human figures use a

color/form not specific to a particular race. As with other modes of assessment or

diagnosis, interpretation of responses as typical or atypical is dependent upon

normative comparisons with responses from peers, or their populations of interest,

such as high achievers in the responder’s school system; hospitalized patients; young

mothers; unmarried males; etc. Because of the potential to provide information of

psychological significance and therapeutic value, somatic imagery theory is reviewed

briefly in a following section.

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 point to the

example at the top of the first page. Tell the person that he is to simply label the images,

just like in the example, and to include any emotions that relate to each image. Then

turn to the back page of the booklet and ask the individual, upon completion of the 62

images, to first select the three images that they liked most, and then, the three images

least liked, and the reasons why they chose those particular images.

Finally, ask if there are any questions concerning the procedure. Instruct the subject to

start and inform him where you will be, in case there are any problems. Also indicate

that if more time is needed to look at or write down something concerning an image, the

VCR may be stopped.

The reason for introducing the health history moments before the video procedure is to

bring to mind any present or past health issues. This material in short-term memory

subsequently creates a perceptual set to project clinically relevant responses. The soft

music, in association with repetitive relaxation commands, creates an artificially semihypnotic state. Like the subject in a trance, this electronic technology serves to pull the

subject out of the test reality into the imaginary television world. These initiates a

fantasy voyage, which takes the viewer back to earlier space-time, coordinates when

unresolved traumatic events wounded the ego. To reverse the trip, the video concludes

with relaxing

42 Administration

nature scenes, which serve to return the individual to the present time/space reality of

the clinician’s office.

If the examiner’s previous clinical evaluation indicates that the subject is fairly stable,

the video and booklet can be taken home for viewing at bedtime. This may serve to

stimulate therapeutic dreams and is illustrated in ‘Case-7’.

When the subject indicates that the viewing is complete, it is necessary to conduct a

short debriefing interview. This is to ensure that the procedure was completed according

to the instructions. Reassure the subject that things have gone well. It is very important

to make certain that no special therapy techniques are required to assist the individual

if unduly painful material has been released. The examiner’s detailed inquiry is

scheduled for the next day. The viewer is reminded to record any dreams that may be

event of a delayed emotional response.

The busy clinician may not wish to deal with associations to any other images than the

ones “most-disliked,” because at any one testing time, these three represent the heart

of the procedure. Unlike other inkblot tests, it is not necessary to obsessively review the

responses to all 62 images, unless one is doing a formal psychological report or

conducting research. In the instance of pathological or deviant responses, the inquiry

is aimed at discovering positive or negative cathexis of specific body regions. The

professional might ask, “Has this any relationship with your personal life, or the life of

your loved ones? Have you viewed similar images in your past life, dreams or fantasies?”

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 might occur in responding 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:

1. There are no right or wrong answers.

2. Different people see different thing in the inkblots.

3. 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.

4. The test may take about one hour in its completion.

Like video procedure, the subject is asked to select three image which (s)he liked the

most and three images which (s)he liked the least.

After the completion of the test, the clinician will quickly go through the responses and

will decide if an 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 (Booklet Form or Videotape), both the procedures

follow the same administration.

Benefits

It is readily apparent that the SIS instrument has many applications in traditional medical

and psychiatric populations. When the SIS was first developed its research and

diagnostic uses were given high priority. With time and experience, it became evident

that employing this technology in clinical populations had value as an adjunct to

traditional therapy procedures. In certain instances, the SIS proved to shorten the time

of treatment and to be cost effective.

Because it is a video procedure that is linked to computerized scoring, it has multiple

additional applications, especially in screening candidates for the military and law

enforcement agencies. Why hire an individual who may have long-forgotten, repressed

traumatic life experiences in employment situations where there is a high occupational

risk of further trauma? Such persons have a lower threshold to future job-induced

stress, which could jeopardize the effectiveness of a particular group or company.

The SIS procedure can be employed as a measure of the effectiveness of any treatment

program which deals with traumatized individuals (e.g. soldiers and policemen). If

these people do not have appropriate early identification and active therapy, they will

be at high risk to develop alcohol and drug problems, physical symptoms, mental

disorders and a variety of behavioral difficulties.

44 Administration