CHAPTER 4

Studies on Rorschach, Holtzman and SIS:

Studies on Rorschach, Holtzman and Somatic Inkblot Series (SIS):

Inkblot Test in India:

The Rorschach Inkblot test:

The Rorschach is the oldest and popular projective test, which still is widely used in clinical setting (Dubey, 1981; 1982). Diagnostic testing based upon this instrument remains the most requested function of clinical psychologists (Verma, 1980; Dubey, et. al., 1981, 1982; Arora, 1982; and Verma & Misra, 2002).

Manickam and Dubey (2005) reviewed the hystorical development of Rorschach and included the available research papers, a good source for research scholars. Initially during the fifties and sixties, research papers related to Rorschach test were published mainly in Indian Journal of Psychology and Indian Journal of Psychiatry. At present, there are three journals published from India: Indian Journal of Clinical Psychology, (1974), Journal of Personality and Clinical Studies (1985) and SIS Journal of Projective Psychology and Mental Health (1994) that published articles related to Rorschach test and projective psychology. In these three Journals, the number of articles published using Rorschach test as a research tool showed a decreasing trend in the last decade of publication. After the introduction of the Somatic Inkblot Series (Cassell, 1980, 1984, 1990; Cassell & Dubey, 2003; Dubey, 2003) and the publication of the SIS Journal of Projective Psychology and Mental Health from 1994, publication of research related to projective psychology increased significantly in India. Although still widely used, like internationally, in India the Rorschach appears to be diminishing based on the percentage of published articles on Rorschach test over the last ten years.

Though publication in these three journals can be considered as a pointer to the trend in research with the Rorschach test, there are a number of research studies that are conducted in different centers of training that go unpublished. This could be due to the paucity of the appropriate journals, accessibility of the journals and/or the lack of enthusiasm on the part of the concerned research student to complete the process of publication. Moreover, in India there is no funding agency, that promotes the research exclusively in the areas of clinical psychology or psychology and lack of financial funding has thwarted the publication zeal of researchers (Manickam, 2003).

The earliest published work in India on Rorschach can be traced in 1947 by Prasad and Asthana in which they looked into the signs of meaning on Rorschach test. H.S. Asthana continued his research on Rorschach test and published papers in scientific Journals and presented papers in India and abroad for 30 years (1950, 1956, 1963, 1965, 1966, 1971, and 1977). He administered the test to diverse groups, developed norms for Indian population (Asthana 1950a, 1950b and 1971) and described the personality of social organization of Indians (Asthana, 1956). His work on the perceptual development of children (Asthana, 1965, 1966, 1977) led to the publication of the report that looked into the scope of the Rorschach test as a research tool to study the perceptual framework of children (Asthana & Mohan 1977). Ray (1955) used Rorschach test on tribal population. Bagh (1955), Dosajh (1956) and Jain (1956) had also used Rorschach test with adolescent school children. Dubey (1972, 1975, 1976, 1977a, 1977b) used Rorschach to study hearing problems, tuberculosis patients and management students. The other earlier publications include that of Gupta, (1959), Julka (1963), Raychaudhari & Maitra (1965a) and all the studies were conducted on diverse student population (Manickam & Dubey,2005)

Asthana (1963) was probably the first Indian researcher to use the Rorschach test for research in clinical settings and brought out its clinical utility in assessing different aspects of personality (Bhargava & Saxena, 1995). Since then, clinicians in hospitals and clinical settings had been using the test. With the introduction of the Diploma in Medical Psychology (DMP; later titled as D.M. &S.P. and M.M & S.P, currently M. Phil in Clinical Psychology) at the All India Institute of Mental Health (presently National Institute of Mental Health and Neuro Sciences, NIMHANS), Bangalore, India in 1955, and later on at Ranchi Institute of Neuro Psychiatry and Applied Sciences (RINPAS), Kanke, Ranchi, Rorschach was introduced to the students of clinical psychology. And now the test forms part of the curriculum of the clinical psychology trainees at the major training centers in India. Moreover, the master level students who select a course in clinical psychology are also given training on the application of Rorschach test.

In the history of the use of the test in India, at different periods of time one or two researchers continued with their interest in Rorschach test as a research tool. While H.S. Asthana from the start in 1947 led the scene in fifties, sixties and seventies, Raychaudhari and Kumar carried the baton in sixties and early seventies and it was taken over by B.L.Dubey in the seventies and continued for over 4 decades (1972,1973,1975, 1976,1977,1978,…2008,2009,2010,2011, 2015, 2016, 2017, 2018). S.K. Verma and D. Pershad contributed in keeping the test active in research for more than three decades (1977, 1979, 1994, 1995, 1997, 1999, 2000, 2001) However, in the late nineties and in the beginning of the twenty first century, the research interest appeared to have decreased though a number of clinicians continue to use the tool for the purpose of assessment and psychotherapy (Dubey et al, 2001, 2002…2009, 2010, 2011,…2015, 2016, 2017,2018). Shukla (1977) reviewed the test from a wider perspective of the projective techniques in India and Dubey (1977, 1978, 1981 and 1982) appraised the status of the test in the eighties in an earlier review. Manickam et al (2003, 2004 and 2005) is doing excellent work and has reviewed in detail the work on Rorschach in India. Sanyal et al (2005) has reviewed theoretical evidence in the Indian scenario and pinpointed to a peculiar and alarming trend of Rorschach avoidance.

Manickam & Dubey (2005) reviewed that the Rorschach test has been in use in India since 1947 on diverse population, there was no major and in-depth study undertaken on its adaptation or improvising the scoring pattern, or comparison of different scoring methods. With the introduction of the Somatic Inkblot Series, there is increased research on SIS compared to Rorschach test. There is more Doctoral Research work leading to Ph.D. on Somatic Inkblots Test than Rorschach in India. The decline of interest in Rorschach might be due to poor training at premier institute and more emphasis on numerical interpretation of Rorschach responses which has reduced its value as a projective test.

The Holtzman Inkblot Test:

The Holtzman Inkblot Technique (HIT) was developed to partially overcome psychometric limitations of the Rorschach by constructing completely new sets of inkblots. During the 10-years period following World War II, major interest in the Rorschach was expressed by graduate students, many of whom had learned a little about the Rorschach while serving in the armed services. Hundreds of studies during this period piled up a wave of criticism from which the Rorschach movement never fully recovered. While much of this early research was either irrelevant or poorly conceived, an impressive number of well-designed validity studies generally yielded negative results. The growing realization that the Rorschach had inherent psychometric weakness came to a head in a symposium on failures of the Rorschach that was sponsored by the Society for Projective Techniques (Zubin, 1954).

Studies on Holtzman Technique in India:

Darolia & Joshi (2004) tried to find the empirical evidence for the effectiveness of Herron’s short (30-inkblot) form of Holtzman Inkblot Technique. The data demonstrated fairly high internal consistency and temporal stability of most of the HIT variables. The internal consistency and temporal stability coefficient for most of the HIT indices were found to be larger than .60 and .70, respectively. Factor analysis of the 22 HIT variables yielded eight significant factors (Eigen-values >1). The observed factor-structure replicated five of the Holtzman’s second-order factors with some minor variations. Overall, the findings suggest that short form of HIT has psychometric invariance with the standard 45-inkblot form of HIT as far as the factor structure of the two forms is concerned. However, in view of the fact that the 45-inkblot form of the HIT has not been used in the present study, further empirical evidences are needed to demonstrate the psychometric compatibility of the two forms of the HIT.

Singh (2006) examined the relationship between two contexts of creativity i.e. novelty and meaning. Psychometric measures of creativity are considered to index novelty context whereas projective tests, particularly inkblot tests are considered to tap meaning context. To realize the main objective of the study 202 high school male students were randomly drawn from various school of Kurukshetra District, Haryana. The selected subjects were administered with Holtzman Inkblot technique and Torrance tests of creative thinking (both verbal and figural). Obtained data were analyzed by applying Pearson’s Method of Product Moment Correlation, and Inter-battery Factor Analysis. Both the co-relational analyses have clearly revealed the strong positive overlap between verbal and figural measures of creativity assumed to be indexing novelty context. Analyses have demonstrated weak association between psychometric and projective indices of creativity. Projective tests like HIT are taken as indexing meaning context of creativity.

Singh (2006a) further studied the relationship of novelty and meaning contexts of creativity with Jensen’s Level I and Level II. Psychometric measures of creativity like Torrance Tests of Creative Thinking are considered to measure novelty context of creativity, whereas projective indices, particularly inkblot techniques are taken to index the meaning context of creativity. Likewise measures of learning/memory viz. Forward Digit Span, Backward Digit Span, and Serial Rote Learning are the indices of level I ability; and Raven’s Progressive Matrices and Verbal measures of general mental ability like Hundal’s General Mental Ability Test are considered to tap Jensen’s level II ability. To realize the main objective of the study 202 high school male students were randomly drawn from Kurukshetra District of Haryana. The selected subjects were administered Holtzman Inkblot Technique (HIT), Torrance Tests of Creative Thinking (both verbal and figural), Forward Digit Span, Backward Digit Span, Serial Rote Learning, Raven’s Progressive Matrices, and Hundal’s General Mental Ability Test. The obtained data were analyzed by applying descriptive statistics, Pearson’s Correlations, and Principal Component Factor Analysis. Analyses have clearly established the two contexts of creativity i.e. novelty and meaning, and differential relationships with Jensen’s level I and level II abilities. Analysis also supports Jensen’s hypothesis of factorial distinction between level I and level II abilities. Weak associations have been obtained between psychometric measures of creativity (novelty context) and the indices of level II ability. Overall, findings of the present study highlight the complexity of relationship between creativity and intelligence. Thus, clear-cut distinction has been found between two contexts.

Kamlesh (1979) in her study on projective (HIT) and psychometric measures of creativity, found verbal originality having positive relationship with Location, Movement and Anxiety variables of HIT; Fluency with Location, Movement, and Penetration; and Elaboration with Penetration. Results showed that projective and nonverbal measures of creativity were sharing only a small portion of their variance. The projective and verbal measures of creativity were found to be independent entity with negligible overlap. This shows clearly that novelty and meaning contexts of creativity are conceptuality different.

Sharma & Singh (1990) investigated the projective and psychometric personality correlates of attribution styles on a sample of 200 male students ranging in age from 16 to 18 years. They were administered HSPQ, HIT and Attribution styles questionnaire. The data were analyzed with Pearson’s Correlations and Principal component Factor Analysis. Factor analysis yielded 14 rotated factors above 1.00 Eigen value, accounting for 78.48% of total variance. Of these 14 factors, five mainly loaded on HIT variables which were almost in agreement with the orthogonal factors reported by Holtzman et al. (1961).

Suman Lata & Singh (1990) administered HSPQ, Torrance Test of Creative Thinking (Verbal) and Holtzman Inkblot Technique on 200 female subjects ranging in age between 14 and 16 years for the exploration of projective and psychometric personality correlates of creativity. Obtained data were analysed by applying Product Moment Method of correlation and Principal Component Factor Analysis. In total 14 factors were extracted greater than Eigen value of 1.00 accounting for 65.73% of total variance. Four of HIT factors (Holtzman et al., 1961) were replicated. The first factor had significant loadings on Hostility, Anxiety, Barrier, Reaction Time, Anatomy, Sex, Space and Integration depicting psycho-pathology of thoughts and emotional disturbances similar to factor III of Holtzman et.al. (1961). Factor II named as Verbal Creativity had significant loadings on all the four variables of creativity (originality, fluency, flexibility, elaboration) plus some HIT variables viz Popular, Penetration, Human, and Movement depicting some overlap between verbal creativity and projective creativity. Third factor bear significant loadings on Form Appropriateness. Form Definiteness, Space, Animal and Human interpreted as factor of Perceptual Maturity almost comparable with one located and reported by Holtzman et al. (1961). Fourth factor mainly loaded on HIT variables i.e. Animal, Human, Sex, Anatomy, and Popular along with Factor B of HSPQ labeled as Mental Capacity depicted some structured overlap between above mentioned HIT variables and crystallized Intelligence. Another factor which brought together HIT variables of location, shade and space depicting some structured comparability with factor IV of six orthogonal factors located by Holtzman et al (1961). One more factors emerged loading significantly on Color, Sex, and Animal depicting the chromatic sensitivity in fantasy production did not match structurally with any of the factors reported by Holtzman et al (1961) may be because of cultural differences.

Rishi (1995) investigated hostility in relation to personality and motivation. For this, a sample of 170 female college students was administered 16 PF, HIT, MAT and Hostility Scale. Obtained data were subjected to correlational analysis particularly Pearson’s correlations and Principal component Factor Analysis. Factor Analysis yielded 17 factors accounting for 76.42% of total variance. HIT variables scattered over 10 factors of the present solution. Factor I loading mainly on Integration Balance, Human, Movement and popular replicated one of the six orthogonal factors i.e. Perceptual Maturity reported by Holtzman et al. (1961). Factor IV mainly loaded on Anxiety, Hostility along with factors G and M of 16 PF depicting the fantasized anxious hostility. Factor VI was defined as depicting chromatic sensitivity in terms of positive loadings of Color and Shading and negative of FD, FA, and Animal. It almost replicated one of the six factors reported by Holtzman et al. (1961). Factor VII being loaded on Barrier, Human, & Animal variables along with Factor F and Q of 16 PF depicts the index of body boundary and ego identity. Factor XI bearing high loadings on Pathognomic verbalization and sex along with Mating and Home parental sentiment of MAT and factor I and Q4 of 16 PF depict psychopathology and sexual disturbances. It is also somewhat comparable to one of the factors (iii) reported by Holtzman et al. (1961).Factor XIII of this solution depicted the emotional immaturity being loaded significantly on Anatomy, sex, Hostility and RT along with factor M of 16 PF and Fear of MAT. It also resembles with one of the factors reported by Holtzman et al. (1961). The specific finding of this study is the construct differentiation of the conscious hostility (indexed by HIT) and self-attributed hostility (indexed by questionnaire).

Singh (1995) administered a large battery of tests consisting of GMAT, Raven’s Standard Progressive Matrices, and Memory for Numbers Test, Holtzman Inkblot Technique and Torrance Tests of Creative Thinking on 202 male school students. The study was conducted to investigate the relationship between intelligence and creativity by taking HIT variables as projective measures of creativity. Two factors of projective creativity were located which resembled with those reported by Clark et al. (1965). First factor has higher loadings on variables of Hostility, Anxiety and Movement. Second factor has loadings on variables of color and locations.

Renu & Singh (1996) investigated the projective and psychometric personality correlates of altruism. For this 100 adult married females ranging in age between 40 to 70 years were administered 16PF, HIT, and Altruism scale. Obtained data were analyzed with Product Moment Method of correlation and Principal component Factor Analysis. Factor Analysis yielded 14 varimaxely rotated factors greater than Eigen value of 1.00 accounting for 72.22% of total variance. HIT variables scattered over ten factors depicting structured overlap with psychometric measures of personality and altruism. Six factors were mainly defined by HIT variables. Factor I of the present solution mainly loaded on Abstract, Pathognomic verbalization, Anxiety, Barrier, Hostility, and Animal depicting distorted thinking and almost replicates one of the six orthogonal factors (Factor III) reported by Holtzman et al. (1961). Factor II of this solution loaded significantly on Balance, Integration, Form Definiteness, Animal, Movement, and space was named as Perceptual Maturity which resembles substantially with one of the factors (I) located and reported by Holtzman et al. (1961). This factor is indicative of organized and balanced perception, ideational activity, good imaginative capacity, differentiated ego boundaries and perceptual maturity. Factor IV of this solution has depicted Popular, Reaction Time and Color as significant HIT correlates of altruism. Factor V has brought together four HIT variables viz Shading, Color, Form Definiteness, and animal, and Factors E and Q2 of 16PF depicting Chromatic Perceptual Sensitivity. It has, to some extent, replicated one of the factors (II) reported by Holtzman et al. (1961). Factor VIII of the present solution emerged as bipolar factor loading negatively on location, Rejection, Reaction Time, and positively on Form Definiteness and space depicting the organized perception. It, to some extent, resembles with factor IV of solution reported by Holtzman et al. (1961). Factor IX mainly defined by Anatomy and Penetration with factor B of 16 PF depicts emotional immaturity and hypochondriatic sensitivity. Factor XIII brought together hostility, movement, Penetration, Form Appropriateness, Barrier, Animal and Rejection, all with negative loadings depicting affective disturbance.

Kaur & Singh (1998) conducted a study on novelty and meaning contexts of creativity in relation to fluid and crystallized intelligence. For this a sample of 100 male school students of 9th & 10th grades was administered with Hundal General Mental Ability Test, Raven’s standardized Progressive Matrices, HIT and Torrance Test of Creative Thinking with Pictures. HGMAT and RPM were used to index gc and gf respectively. HIT and TTCT were used to represent meaning and novelty contexts of creativity. HIT was scored only for six variables viz. location, color, movement, anxiety, hostility and penetration which are considered as the indices of projective creativity (meaning context). Obtained data were factor analyzed which yielded five factors. Factor I was labeled as crystallized intelligence on which none of the HIT variables marked significant loading. Factor II was of figural creativity (Novelty context) on which HIT variables did not load significantly depicting the construct independence between meaning and novelty contexts of creativity; Five of HIT variables appeared on Factor III i.e. Hostility, Anxiety, Movement, Location and Penetration that was labeled as Projective Creativity (Meaning Context). Penetration, Location, and color have marked some structured association with RPM, a measure of fluid intelligence.

Kumar & Darolia (2003) examined the compatibility of full and short versions of HIT. For this both the full and short versions of HIT were administered on 175 postgraduate students of K.U. Kurukshetra with age ranging from 20 to 27 years. Principal Component Factor Analysis was applied on both the data. Eight factors were extracted in data from full scale named as Hostile Fantasy, Perceptual Maturity, Creative Thinking, Conventional Percepts, Body Image Boundaries, and Unnamed. In case of short version also eight factors were obtained labeled as Perceptual Differentiation, Perceptual Maturity, Unconscious Anxiety, Creative Thinking, Conventional Percepts, and unnamed. Obtained factor patterns from full scale and short version were found to be in agreement with each other to some extent. Obtained factors in both also replicated some of the orthogonal factors reported by Holtzman et al. (1961). Thus, full and short form of HIT did not differ much in terms of psychometric properties.

Joshi & Darolia (2004) developed norms of Holtzman Inkblot Technique (HIT) for Indian High School students. The standard 45 cards HIT was administered to 372 male students of 9th to 12th grade drawn from various schools of Haryana in the age range of 13 to 18.5 years. The results indicated that inter-scorer reliability co-efficients ranged between .68 and .98; most of the split-half reliability coefficients ranged between .55 and .93 except the variables of Anxiety, Barrier, Abstract, Popular, and Pathognomic verbalization, which had relatively lower estimates. The percentile norms were developed for all the 22 HIT variables. Seven orthogonal factors were extracted. Three of the rotated factors proved to be good match for Holtzman’s factors I, III, and V whereas factors II and VI were replicated with little variations. Seven factors were extracted. The first factor showed high loadings on Hostility, Animal, Anxiety, Barrier and Human. Higher loadings on variables of Popular, Location, Balance, Human, Form Definiteness and Anatomy constituted the second factor. Third factor had high loadings on Rejection, Reaction Time and Form Appropriateness and Form Definiteness (Reverse). The fourth factor comprised of variables of Integration, Movement and Penetration along with negative loadings on Reaction Time, Space and Form Definiteness. Fifth factor had high loadings on Shading, Space and Form Appropriateness with negative loading on color. Factor VI had high loadings on Pathognomic verbalization, Color, Abstract and Penetration. Seventh factors comprised of sex, Anatomy, FA, and Human variables.

Darolia & Joshi (2004) conducted a study to present empirical evidence for the effectiveness of Herron’s short form (30-inkblot) of Holtzman Inkblot Technique (HIT). The data demonstrated fairly high internal consistency and temporal stability of most of the HIT variables. The internal consistency and temporal stability coefficient for most of the HIT indices were found to be higher than .60 and .70, respectively. Factor analysis of the 22 HIT variables yielded eight significant factors (Eigen values >1.00). The observed factor structure replicated five of the Holtzman’s second-order factors with some variations. Overall the findings suggest that the short form of HIT has psychometric invariance with the standard 45-inkblot form of HIT as far as the factor structures of the two forms are concerned. However, in view of the fact that the 45-inkblot form of the HIT has not been used in the present study, further empirical evidences are needed to demonstrate the psychometric compatibility of the two form of the HIT.

Urmila (2005) examined relationship between indices of Holtzman Inkblot Technique and their psychometric measures. Holtzman Inkblot Technique along with psychometric tests tapping 21 normal and pathological traits of which, eight derived from NEO-I scales, two from 16PF scales, four from CAQ scales, two from MAT scales, trait-state Anxiety Inventory, Hostility scale, Empathy Scale, and Aggression Scale were administered to a randomly drawn sample of 218 adult females. HIT Anxiety correlated significantly with psychometric measures of trait anxiety, state anxiety, fantasy, depression and pathognomic deviation. HIT variable of Hostility was found to be significantly correlated with psychometric measure of hostility, trait anxiety, state anxiety impulsiveness and aggression. Sex of HIT shown positive correlation with MAT subtest sex/mating. Color correlated with trait Anxiety, Paranoia and Impulsiveness. Three of the six Holtzman’s factors were replicated. One factor yielded high loading on Anxiety, Hostility, Abstract and Penetration along with psychometric measure of Trait and State Anxiety. Second factor had high loadings on Location, Color, Integration and Reaction Time along with psychometric measure of empathy and hostility. Third factor had loadings on Movement, Anatomy, Integration and Penetration. Other factor had significant loadings on form definiteness, Animal, Balance and Form appropriateness. One more factor having loadings on Human, Popular, Animal (Reverse) and Form Appropriateness also emerged.

Kanupriya & Singh (2005) studied projective and psychometric personality correlates of emotional intelligence on 106 female students with age ranging from 16 to 18 years. The selected students were administered with 16PF, HIT and Multi-Dimensional Emotional Intelligence Scale. Obtained data were analyzed with Pearson’s Correlations and Principal Component Factor Analysis. Factor Analysis with built-in-Eigen values criterion yielded 16 factors accounting for 70.34% of total variance. HIT variables loadings scattered over seven factors. Factor I of present solution mainly loaded on some HIT variables viz Space, Rejection, Sex, Location, Form Appropriateness, and Shading depicting perceptual immaturity, almost replicating one of six orthogonal factors (Factor-I) located and reported by Holtzman et al. (1961). Factor III being defined mainly by Barrier, Balance, Form Definiteness, Movement, Form Appropriateness and RT was labeled as factor of Balanced Ego Identity. Factor IV borne out significant or near significant loadings on Pathognomic verbalization, Abstract, Anxiety, RT and Movement providing the caricature of cautious thinking person. Factor V depicted bodily preoccupation in terms of significant loadings on Penetration, Anatomy, Hostility and Anxiety and substantial replication of one of the six orthogonal factors reported by Holtzman et al. (1961). Factor VI loaded mainly on Hostility, Anxiety, Animal, FD, RT, - Location and Color, so defined as factor of Anxious Fantasized Hostility. It resembled, to some extent, with factor III of solution reported by Holtzman et al. (1961). Factor VIII of the present solution loaded significantly on Integration, Shading, RT, Location and Hostility depicting the perceptual maturity substantially resembled with one of the factors reported by Holtzman et al. (1961). Factor IX of the present study marked significant loadings on Popular, Color, FD, and Anxiety coupled with factors Q1, E, & O of 16 PF depicted the conventional awareness in inkblot percepts. Meenakshi (2011) studied “Compatibility of SIS -II and Holtzman Inkblot Technique in terms of single response method and multiple response method” for her doctoral work on 400 college male and female students.

The Somatic Inkblot Series:

The SIS is an addition to the family of inkblot tests. The SIS has adopted individual and group administration and used video/computer technology in testing. It has attracted researchers world vide but it is becoming popular in India, Italy, South Africa and Russia. The Somatic Inkblot Series (SIS) is a structured, projective, diagnostic procedure and is an adjunct to psychotherapy. The SIS is structured by a sequential presentation of intentionally designed and field-tested inkblot-like images. These images demonstrate typical and atypical response potentials. The SIS procedure is projective because it is based on spontaneous, individually generated responses to semi-ambiguous figures, which elicit intra-psychic associations specific to the person presented with them. The SIS was originally conceived in 1959 as a projective test for assessing the significance of physiologic heart symptoms. After years of research and field-testing in 1980, a book on 20 card version of the projective procedure called SIS-I was published. The SIS-II (62 image Booklet Form) was developed in 1984. Encouraged by the tremendous success of the booklet form, the SIS - Video (video version of 62 images booklet Form) was also launched. It provides diagnostic and therapeutic aid. The SIS-II and SIS Video is a self-administered as well as group administered test.

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. These 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 test, clients may abreact emotional conflict raised to consciousness by the images, which can be a therapeutic experience in itself.

Subsequent volumes of the “SIS Journal of Projective Psychology & mental Health” (1994-to date) have continued covering a wide range of clinical, industrial, educational and research applications. Thanks to the technical contributions of Anand Dubey and Rakesh Jain, abstracts and all volumes (1994-2017) are available on http://www.somaticinkblots.com, as a free contribution to worldwide mind-body-spirit knowledge. We expect this to grow in the future as those Indian students who have obtained doctorate degrees continue in their efforts to advance SIS knowledge. The Manual of SIS –II/Video “Interpreting Inner world Through Somatic Imagery” (Cassell & Dubey, 2003) have also cited research contribution of several clinicians.

Singh (2007) emphasized the journey of Somatic Inkblots test from assessment to treatment. The SIS has both diagnostic and therapeutic properties. Besides diagnostics, it provides a useful aide to therapy which has been proved by a number of innovative clinicians and researchers. As more clinicians avail themselves of the SIS technology, they will be more effective at developing in depth and sophisticated treatment plans. One can envision and apply optimal blending of information from the medical and psychological aspects of human existence for the purpose of therapeutic strategy. Cassell (2009) emphasized that SIS projective technology harnesses the projective pulling power of hypnotically presented ambiguous visual color-form stimuli. The viewer is uninhibited by social acceptability restrictions of the test administrator’s presence. What is projected onto the SIS answer sheet flows from mental depths? The released responses represent recollections of the real outer world subjectively blended with hidden inner world imaginations, fantasies, dreams and psychophysiologic based body percepts.

Cassell (2010) emphasized “the pulling power of SIS Test and how it is facilitated by SIS memory releasing electronic viewing technology. This evolving psychological testing system and structured interview aide has far reaching applications in the 21st century. These extend far beyond mind/body research and clinical diagnostic/treatment into the spiritual realm of existence. Inkblot projective procedures, such as the Rorschach were originally conceived for traditional applications by clinicians. Subsequently their use was extended to other populations, such as testing applicants for military service or roles in industry. Unfortunately, sometimes such extension disregarded basic standards of validity and reliability, resulting in flagrant abuses. As an extreme example, at one time in California, the Rorschach results sometimes determined a prisoner’s fate in regard to execution! We need to be careful not to repeat such overly optimistic expectations in extending SIS assessment work, and the evolving technologies therapeutic applications. Cautions are indicated in an age when basic brain research points out the important role of genetic factors as well as the importance of psychopharmacological based treatments. To date all positive therapeutic claims have been based upon individual case history studies. It is humbling to realize, that as yet, not even one statistically based outcome study has been attempted. I challenge dedicated SIS workers to contemplate this important line of future therapeutic investigation. Moreover, it may prove to be worthwhile, when recognized treatments fail to relieve suffering, that SIS therapists create new ways to more effectively communicate utilizing the language of spiritual symbols that are consistent with the sufferers own religious doctrine”.

“We now have a growing body of evidence permitting investigation into the mental mechanisms by means of which imagery projected onto such spiritually charged SIS stimuli can mentally displace PTSD memories and relieve discomforting emotions. Focusing on these conjured up visions readily displaces pathological material that would otherwise flood conscious awareness dragging along discomforting affect. This reflects the brain’s basic biological neural inhibiting mechanisms that normally (unless there is a Dissociative splitting) only allow only one stimulus to peak into consciousness at a time. This principle is utilized in Yoga. Focusing on specific body regions can obliterate negative memories and affect. In some yet inexplicable psycho-soma manner, this can establish optimal neurophysiologic conditions for the body’s natural healing processes.

Clinicians treating individuals suffering from definable mental conditions are encouraged to first introduce SIS evoked imagery consistent with guidelines established by traditional scientifically based professional disciplines within this society. Yet standard present day therapies take time. Frankly, for many victims of PTSD they are sometimes not always as effective as their adherents claim. Moreover many clinical research studies suggest that the “personality” of the therapist is more important than the technique. In any case, when these do not entirely resolve symptoms, it is reasonable to envision supplementing them by scientifically exploring concepts and symbolic language in therapy related to spirituality. Eventually as SIS color/form/movement stimuli are created with content related to other religions than Christianity, they will have a wider range of spiritual releasing power to augment existing PTSD treatment methods.

Investigators exploring the boundaries of our scientific knowledge in a relatively intangible spiritual realm are advised to keep in mind a sound scientific basis in reality for their pioneering endeavors. None of what has been discussed above need be based upon accepting or adhering to the alleged validity of a particular religious doctrine. We are mere mortals functioning as mind-body scientists in envisioning new techniques for healing - without subscribing to any particular religious belief system which purports to explain the multiple mysteries of cosmic reality (Cassell, 2010, Cassell et al, 2012, 2016)”.

Reliability and Validity:

Mathur & Pais (1963) correlated the ‘extratensive’ and ‘introversive balance experience’ as measured by Rorschach test with that of the scores on Sack’s Sentence Completion Test. Raychaudhuri & Maitra (1965b) attempted to validate the test using the development stages and Rorschach indices. Raychaudhuri & Mukherjee (1969) also tried to validate movement responses based on expression of agitated impulsivity. Mukherjee & Raychaudhuri (1970) evaluated the correlation between the Rorschach indices and structured measures of personality with the clinical rating. Pratap & Filella (1966) in an early attempt explored the correlation between the test indices and the scores on manifest anxiety scale. Dubey, et. al. (1994) administered the Rorschach test to a client before and after 6 months period and reported consistency of 4 responses on two cards, card IV and VI, and slight change in two other cards. Banerjee, et. al. (1998) investigated the significance of the salient features of SIS measure with that of the subtle and common indices of the Rorschach test. Pasari & Paul (2005) administered Rorschach and 16 PF on 30 patients of CIP, Ranchi. Results indicated that ten traits of 16PF were correlated with 22 variables of Rorschach. Thus both the tests validated each other. Manickam (2013) also established the reliability of Rorschach test. Dewangan et al, (2015) studied the effect of Social desirability on the Rorschach test.

Extensive work was done to establish the reliability and validity of SIS-II Test. The correlation for the content categories over a period of four weeks, on repeat testing was found to be in the range of .69 to .88. The split-half reliability of SIS-II and SIS-Video was established by splitting the test into two equal halves. These equal halves are the natural divisions of the test that consists of two series, A and B. Therefore, it can be assumed that it is possible that Cassell might have something in mind to develop two parallel forms. However, in view of rigorous field testing, he chose to combine both sets "A" and "B" into one single test. Except MT and Human Responses, correlation for R, Animal, Anatomical, Sex, Movement and Rejection of images was found to be in the range of .66 to .89. Inter-scorer reliability for the indices was scored separately by a trained and experienced clinical psychologist, having experience with the SIS, and by a fresh psychologist who was provided with a set of definitions for the variables. It was discovered that there was no difference between their two independent scorings. It can be argued that it was not a scoring, but merely a counting of the responses under different categories (Total number of Responses: Human responses, Animal responses, Anatomical responses, Sex responses, Movement responses, Most Typical responses and Rejection of images).

“The validity of a psychological test is an essential characteristic that must be demonstrated beyond any doubt. Its validity can be based on theoretical assumptions, clinical experiences and its utility in the field. The division of tests into objective and projective requires different standards for measuring validity. The projective tests, such as the SIS, cannot be tested for validity, like objective tests. The SIS is a method of observation and appraisal. With regards to a test that measures some aspects of personality, it is legitimate to ask, "Is it valid?" However, in regard to a method of observation, the appropriate questions are: "Is it useful?", "Is it productive?", and “Does it conform to some construct?"

The SIS is an objective procedure for observation; therefore validity in psychometric terms cannot be determined. The question then arises; can we still call it a valid procedure? The clinical interview and the diagnostic procedures are based on the information elicited from the patient/client and his observations. Has anyone doubted the validity of such clinical interviews and diagnostic procedures? If not, the validity of the projective test, the SIS in particular, must be recognized since its utility would appear to be established at a clinical case history level. It is therefore, necessary to demonstrate empirically the content and construct validity of the SIS. The other types of validity generally given in textbooks cannot be determined (Cassell & Dubey, 2009b)”.

The content validity of the test can be demonstrated if the patient/client suffering from focal somatic symptoms project altered patterns of anatomical responses. In a number of studies, it has been found that relationships exist between an individual's physical disturbances and his/her projected anatomical responses (Cassell, 1969, 1971, 1972, 1977, 1980, 1990; Dubey & Cassell, 1993, and Green Grass & Adamson, 1977). In a study on heart patient in India, results suggested that the somatic preoccupation was not verbalized any more than compared with a healthy control. It was interpreted that the body disturbances were consciously denied (Goel et. al, 1990).

To have construct validity on the basis of existing literature on inkblot technique, it can be assumed that Most Typical responses and Atypical responses have to be different in broad psychiatric diagnostic categories compared to healthy controls. This hypothesis was tested on Neurotics, Schizophrenics, and healthy Normal subjects. The Atypical responses were found to be significantly higher in Psychotics than Neurotics and Normal. Likewise, Most Typical responses were significantly higher in normal subjects compared to psychiatric patients (Cassell, 1988, Cassell & Dubey, 2003, Dubey & Cassell 1991, 1993). Several researchers have found SIS test as highly reliable and valid instrument (Kaur & Verma, 1998, Nicolini, 2002: Pershad & Dubey, 1994; Singh & Banerjee, 1996; Verma & Kaur, 1999).

Rathee et. al. (1998) administered Somatic Inkblot Series-II (SIS-II) on 200 psycho-pathological cases of Armed Forces to find out its diagnostic validity. Results revealed that out of 10 common indices of both tests, five variables in schizophrenia, four in affective psychosis, seven in unspecified psychosis, five in Anxiety, four in Depression and seven in Hysteria, showed high and positive correlations. The findings indicate the high diagnostic validity of SIS-II indices against those of Rorschach's among six psycho-pathological groups of armed forces.

Pandey et al. (1999) examined the stability of SIS-II response contents on a sample of 30 subjects over time in two ways, i.e., it analyses the consistency of responses evolved by individual images in a number of people, as well as it measures an individual’s consistency in responding to all the 62 images of SIS-II. Besides this, it also attempts to present an appraisal of the test-retest reliability of some commonly used SIS-II quantitative indices and response consistency of personality dimension related SIS-II image clusters as proposed by Dubey and associates (Dubey et al., 1995). Separate analyses of response consistency for unstructured and semi-structured images have also been done to substantiate the speculation regarding unstructured images yielding lower response consistency as compared to semi-structured images.

The Meta- Analysis of the findings of the studies on SIS-II was carried out to provide combined mean and standard deviation of various groups and to see if SIS-II indices could differentiate the groups statistically. All the studies appeared in SIS Journal of Projective Psychology and Mental Health 1994-2000 were considered for the purpose. The studies were combined into five groups based on specified criteria: Normal, Neurotics, Psychotics, Substance Dependents and Murderers. Critical Ratio were computed on combined mean and standard deviation for inter group comparisons. Results indicate that SIS-II indices do differentiate the comparison groups (Kumar, 2000).

Srivastava (2002) concluded the findings of the studies on SIS-I with the aim to provide normative data by combining mean and standard deviations of existing studies and to see if SIS-I indices can differentiate various groups. All the studies published in SIS Journal of Projective Psychology and Mental Health from 1994-2001 (January) were considered for the study. The studies were pulled into four groups on specific inclusion criteria: Normal, Coronary Heart Disease, Generalized Anxiety Disorder and Schizophrenia. Critical ratio was computed on combined mean and standard deviation for intergroup comparison. The results revealed that the SIS-I indices significantly differentiate the comparison groups.

In the Unites States Panek et al (2002) has established that when significant differences exist among the total number of responses (R) in comparing groups on data obtained from projective techniques (PTs), it is advisable to also compute comparisons based on percentages obtained by dividing individual variable scores by their respective Rs. The purpose of this study was to determine whether different results would be observed on the projective Hand Test (HT) when comparing raw scores versus percentages, even when the Rs do not significantly differ. The HT was administered to 90 individuals seeking treatment at a pain clinic for three distinct physical maladies, arthritis, fibromyalgia, and migraine headaches. Results indicated that there were no significant differences among the three groups for Rs. A 2 (Gender) X 3 (Pain Groups) ANOVA, with age as a covariate, yielded interpretable groups and two gender effects derived from raw scores. The same results were obtained for percentage comparisons with the exception of one-non significant finding for the repetition (REP) variable. REP is a reliable indicator of an organic brain syndrome and, therefore, it was important to authenticate the significance of this variable. The lack of corroborative support for the percentage comparison suggested caution in over interpreting the differences among the raw scores, especially in an exploratory investigation utilizing small samples.

Cassell & Dubey (2009) presented two previously unpublished early statistical studies on SIS content validity. The first was completed in 1978 with the SIS-I. It used a content analysis scoring system to quantify projective responses in a group of 13 women suffering from Premenstrual Dysphoric Syndrome (PMDD). As compared to a control group of 37 women these subjects projected significantly more responses depicting reproductive and sexual symbols. Based upon chi squared analysis, statistically significant differences were found for such sex related anatomical responses, but not for unrelated body parts such as heart and lungs. The second study was completed in 1988 with the SIS-II Booklet Version. The data were analyzed for 37 of the 62 SIS stimuli. In the comparison 28 pregnant women were compared with 27 non-pregnant controls. A Chi square analysis revealed that pregnant women projected more response related to reproduction and/or pregnancy.

Kumar (2009) studied factor structure of SIS-I quantitative indices on 100 normal adults. Principal Component Analysis identified four components with Eigen value greater than one. However, only three components were rotated subsequently as only one index loaded significantly on the fourth factor. The first factor loaded significantly on Typical, Most Typical (positive) and Atypical responses and was labeled as ‘objective thinking’. The second factor loaded positively on Movement, Human and Anatomy responses and negatively on Animal responses and this factor was labeled as ‘emotional maturity’. The third factor loaded significantly on Total Number of Responses (positive loading) and Rejection of Images (negative loading) was labeled as ‘reaction to stress’.

Cassell & Dubey (2010) pointed out that some psychologists question the validity of projective test as they do with Questionnaires. They forget that the projective tests cannot be verified on the same parameters as questionnaires. We put our perception and feelings in to the mind of subject by asking them to choose their answers as “Yes” or “No”, “True” or “False” “Agree” or “Disagree” etc. The true validity of a test should be decided “if it measures for what it was made”. An Inkblot test is a powerful instrument. It brings unprocessed symbolic material through projection which cannot be measured /assessed through so called objective questionnaires.

Basu (2014) critically relocates the debate concerning the validity and utility of projective tests within multiple interpretative and process oriented approaches. Some scholars opine that there could be alternate ways of looking at projective tests, for example using it as a technique to elicit cognitive and emotional states or as behaviour samples. Supporting, modifying or denigrating the use of projective tests may reflect different underlying attitudes toward ambiguity and multiple interpretation of a situation. Thus it represents either of two different traditions of psychology: one, aspiring to attain a structured and organized view of human behavior facilitating prediction, and the other, an acceptance and appreciation of idiographic and divergent responses that may not necessarily be predictive, but informative about the multiple possibilities of human thought process. This latter approach would be more concerned with the process of experiencing rather than with obtaining a relatively final and fixed answer to the dilemmas of existential conditions. The possibility of such approach was always present in the history of projective tests, but has been subdued under the hegemonic pressure of diagnostic utility. The author argues that a process oriented view of responses to ambiguous situations, along with a sensitivity to human diversity and multiple interpretations rather than emphasizing commonality, may open up a fresh relocation of projective technique within psychology. Training of projective technique may incorporate this consideration for future researchers.

Sanyal, et al (2011) highlighted the clinical probing of a case, aged 8 years, first born, and belonging to a middle socio-economic strata, living with maternal grandparents, and having adjustment problems. She was administered with the CAT, Fairy Tale Test, and Somatic Inkblot Series -II. The three different projective tests were administered for cross-verification of the findings. Results revealed striking congruence of the signs of the searches in relation to the clinical delving of the interview and the projective probing of the case, reflecting the clinical efficacy of projective tests in general. Cervigni (2013) administered SIS-I (Card form) to two cases for diagnostic formulation and therapeutic intervention in Ialy. The test was found valid in assessing personality and diagnostic evaluation and the test must be included in every clinic as a therapeutic procedure. It helped in therapeutic planning and trapping unprocessed unconscious material.

Dewangan & Roy (2015) studied Social Desirability Biasness in Rorschach Inkblot and found that many psychologists rely more on projective psychological assessment to identify any personality pathology or clinical symptoms with the believe that projective tools are protected from social desirability biasness.

Khromov & Dubey (2016) measured the correlation of Rorschach, SIS-I and SIS-II inkblot tests to find out the mutual empirical validity with MMPI test. The three tests were administered to 98 subjects. The results were ciphered on identical forms containing 54 categories which were correlated with MMPI test. The structure of correlation in each pair matrix of three inkblot tests was calculated and has been compared. Сronbach has commented that projective techniques give wider strip of information and lower reliability in comparison with objective psychometric tests whereas Cassell (1980) emphasized that increased structure of projective stimulus have raised level of reliability of projective tests. The findings of present research revealed, that psychometric properties of inkblots tests increased after increasing the stimulus from Rorschach to SIS-I 20 images and from SIS-I to SIS-II (62 images). However, it was not able to increase the ability to differentiate subjects’ specific mental disorders. Correlation between ambiguity and projection of properties of the person has nonlinear character, and the moderate level of ambiguity gives an optimum variant at displaying.

Jain et al (2016) administered SIS-II (Booklet form) and Hypnova Suggestibility Questionnaire on 18 adults in the age range of 18-35 years, to see if any of SIS-II indices are linked with suggestibility of the respondents. The non-parametric correlation coefficients were significant for Total Responses Vs. Physicla Suggestibility and Most Typical Responses Vs. Emotional Suggestibility. These results suggest that suggestibility can have some influence on SIS-II indices.

Different groups:

Normal Population:

Kumar (1962c), Prabhu (1967), Asthana (1971) and Somasundaram, et. al., (1971b) found that the average number of responses for the normal population was in the range of 18-33. Singh (1975) also found that the number of responses given by tribal population that had more ‘culture contact’ and ‘less culture contact’ was below the normal range reported from abroad. Singh (1975) opined that the group he studied were “not perceptually responsive and not receptive” to the world outside and gave less number of popular responses. Human responses (H) accounted for 9.66 percent (Singh 1975) and it was contradictory to the findings reported by Prabhu (1967) and Kumar (1962c), but was in agreement with Asthana (1971) and Somasundaram, et al. (1971b),who reported Human responses in the range of 7 to 10 percent.

Dubey & Dosajh (1979) administered Rorschach test and found that the average number of response was 14 (13.76) among army personnel serving in other ranks. Dubey (1979, 1981) conducted several research studies using Rorschach on military personnel both clinical and normal population (Dubey 1979, 1982, 2005) and reported low number of responses. 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 into high productivity and low productivity, on the basis of number of responses, many indices, which were found to be significant, lost their significance. It further strengthened the findings of Fiske and Baughman (1953), and supported the intention of Holtzman (1956). Ramachandra & Chaturvedi (1995) used Rorschach to study body imagery. Mohn (2002) has emphasized the application of SIS images on patients.

The Rorschach test and the SIS were compared on nine common indices such as R, H, A, M, FM, Anatomical, Sex, Rejection, and Most Typical/ Popular and found compatible. The SIS appraises the same construct as the Rorschach test. However, due to the use of self-administration and video technology it reaches beyond the Rorschach test (Dubey et al 1994, Cassell, 1994, Cassell et al 1996, Cassell and Dubey, 1998, 2002, Rathee et al, 1998).

Dubey et al (1995) administered Somatic Inkblot Series on 500 subjects including 300 normal and 200 psychiatric patients (Neurosis and schizophrenia) and analyzed SIS protocols to find out (1) whether the pattern of responses in two forms (SIS-II and SIS-Video) are different, (2) to demonstrate whether series A and series B of SIS-Video can be used independently to curtail the testing time and (3) to find out whether some of the objective scoring criteria be formulated to differentiate the patients of major psychiatric diagnostic categories. Results suggest that the SIS-II and SIS-Video can be divided into two short test consisting of series A and series B separately. The normal and the clinical groups differed on various scoring categories adopted here. SIS can help during selection as screening instruments. These scoring categories, however, are less informative as far as general psychology of individual patient is concerned. The profile of anticipated and given responses for the image are more important for thorough understanding of the patient.

Bailey & Murstein (1996) tried to find out relationship between the Somatic Inkblot Series-II and a self-reported Paranoia Scale on college-age student sample (N=60). The content of written responses to the Somatic Inkblot Series II were Analyzed for paranoid content. Based on past research with other projective devices, a content analysis of Somatic Inkblot Series responses featuring eye references, facial references, atypical references, and paranoid ideation was conducted. The result indicated that two of the scoring methods, those for eye content and paranoid ideation, were positively associated (p< .05) with self-reported Paranoia Scale score. The findings lend support to the Cassell (1990) eye paranoia scale for the Somatic Inkblot Series II, and extend these findings to a nonclinical sample. Cassell and Dubey (2002) prepared new manual for SIS-I (Card form of the test). Separate norms are also available on Russian and Italian population. The new scoring system along with interpretation of SIS responses with case studies are presented in the manual.

Mishra & Dwivedi (1997) administered SIS-II and Rorschach to compare the common diagnostic indices in Normal, Neurotic and schizophrenics. The sample comprised of 50 each, normal, neurotics and schizophrenics. The results suggest that the diagnostic confidence certainly, which is achieved by the SIS-II and the Rorschach in diagnosing schizophrenics compares well. The study further suggests that both the tests provide ample support to the theory that SIS-II provides certain additional diagnostic information’s which are not available through the Rorschach. The results also suggest that the SIS-II indices as compared with the Rorschach indices, discriminate better the normal subjects and paranoid schizophrenics whereas the Rorschach indices discriminate better the depressive neurotics and undifferentiated schizophrenics.

Cassell & Dubey (1998) tried Somatic Inkblot Series on different groups of clinical and normal subjects and found high discriminating ability of the test. It was also found to be a successful screening tool during selection in industry. Its reliability, validity, discriminating diagnostic ability and screening value have been emphasized in various issues of SIS Journal by many researchers. The test has attracted researchers and clinicians in different parts of the world.

Singh et al (1999) administered SIS-II on 480 subjects, half of them male and half female in four categories (Adolescents and Adults, Later Adults and Old). It aimed to find out the effect of age and sex on the projection of total number of Responses i.e. Human responses, Animal responses, Anatomical responses, Sex responses, Movement responses, Most-typical responses and Rejection of images. The Total number of responses was found to be within the normal range of 61 to 65. Significant differences on R, Most-Typical and Rejection of images were also found in normal range. Males and females of this study show high human responses which indicates their healthy inter personal relationship. Animal responses were found to be higher in males and females of adolescent and adult age as compared to later adult and old age persons. It is also observed that females give higher animal responses than males. As has been observed in the Rorschach, the Anatomical responses were higher in later adult and old age group; it may be due to the increased body consciousness in this age. Male subjects gave more sex responses than female subjects. Similarly, later adult and old age subjects showed higher sex responses as compared to adolescents and adults. Females showed higher movement responses than males. Pathological responses were almost negligible in all the age groups of males and females. All the SIS-II indices were found to be positively correlated except the Rejection of images. The most liked and the least liked images were found to be 31B and 29A respectively.

Pandey et al (2001) examined the effect of age on SIS-II response contents. Three groups of subjects belonging to rural area of Gopalganj district, in the age range of 6-12 (children) 13-20 (adults) and 21-40 years (adults) were individually administered the SIS-II. The responses were scored for 9 indices. Analysis of the data revealed an age related increasing trend for various categories of sex responses as well as for movement, most typical, atypical and rejection responses. A reverse trend (i.e. decrease in score with increasing age) was obtained for human responses. Age specific changes in other SIS-II indices were also observed. Contrary to earlier findings, subjects of the present study across all age groups showed slightly elevated score on atypical response index of SIS-II. This observation therefore put a need to develop norms for rural population. Dubey & Singh (2002) tried to find out the inter correlation among eight SIS indices i.e. total number of Responses (R), Human responses (H), Animal responses (A), Anatomical responses (At), Sex responses (Sex), Movement responses (M), Most Typical responses (MT) and Rejection of Images (Rej.) on 480 male and female of four categories (Adolescents13 to 15 years, Adult 20 to 22 years, Later Adults 50 to 52 years and Aged 60 to 62 Years). All the eight subgroups consisted of 60 subjects. High and positive correlation was observed among various indices of SIS -II.

Khromov et al (2004) studied problems of students (both conscious and unconscious) related to their various interpersonal and intra-personal domains of life. Twenty-two university students (18 females and 4 males) were assessed on two projective measures (the SIS-I and the SSCT) and one questionnaire measuring student’s attitude and problems. Finding suggests that greater number of animal and movement responses is associated with little concern for one’s health, and activity/ passivity. High anxiety over one’s own infantilism was found to be related with more Typical, Human, and Heart responses. The atypical visual images were more frequently seen on the SIS-I protocols of those who were anxious with their emotional life. The research finding reveals that the SIS-I can be used successfully to reveal the psychosomatic symptoms, interpersonal problems and broken interpersonal relationship. Khromov (2009) further compared the psychometric characteristics of three projective techniques (Rorschach, SIS-I and SIS-II) and correlated with 12 standard tests: MMPI, 5FPQ, MBTI, BDHI, Raven’s Matrices, 16FP, POI, Leongard’s, Jenkins’s, Learie’s, Rotter’s, Thomas’s scales. From the psychometric point of view SIS - II has emerged as the advance version of the Rorschach inkblot test and proved to be a successful diagnostic instrument.

Singh et al (2005) administered Rorschach test following Beck’s method to 100 normal subjects in the age range of 18-50 years; both male and female with minimum education up to 12th standard were taken for the study. The findings of Rorschach do not match with Beck’s norm. It further emphasizes the need of Indian Norms on larger population. Chaudhury et al (2007) administered Rorschach test using Klopfer’s method to 442 older Indians aged 65 years or more, comprising of normal subjects and patient groups. The normal sample consisted of 282 subjects. The patient sample consisted of 160 patients with the diagnosis of dementia (n=66), alcohol dependence syndrome (n=8), schizophrenia (n=16), mania (n=5), depression (n=50) and anxiety disorders (n=15). The Rorschach protocols of normal older Indians at different age groups showed significant differences from each other and also from the Western norms. The Rorschach profiles of the various groups of patients also showed significant differences between them, from normal older Indian subjects and also from the Western norms. Interpretation of the Rorschach protocols of normal older Indian and also patients using the Western norms would be fallacious and misleading. The use of the Rorschach test to study the aging trends of normal older adults as well as an aid to clinical diagnosis was strongly supported.

Singh et al (2008) intended to determine whether there are significant differences in personality style, as measured by 16 PF Form-B (Hindi Adaptation), between people who give an adult female as a response to card VII of Rorschach and those who do not. One hundred (N=100) normal subjects, in the age range of 21-45 yrs of either sex, with minimum education up to 10th class were included in the study. General Health Questionnaire-12 items, Rorschach Inkblot Test (Beck’s system) and 16 PF, were administered individually. Findings of the study showed that both groups differed significantly on four factors (Factor –A, H, N and Q3). It is apparent from the result that the subjects who perceived female content were warm hearted, participating, socially bold, spontaneous, shrewd, calculating, controlled, socially precise and following self image. Present research findings also reveal that inability to report female content on card VII seems to be related to social discomfort, dependency needs, passivity, introversion and social anxiety.

Kumar, et al, (2007) tried to find out the inter-correlations in nine indices of the SIS-I. The test was administered to 50 subjects and the product moment was computed to see the correlations. Results revealed positive correlations in seven indices of SIS-I except Rejection of Images and Most Typical Responses No significant correlations were found with Most Typical Responses and other indices. Positive correlations were observed between Total numbers of Responses, Human Responses, Animal Responses, Anatomical Responses, Movement responses, Typical Responses and Atypical Responses.

Kandhari, et al (2010) administered SIS-I and developed Comprehensive Scoring System (CSS) for SIS-I on 200 normal subjects. The CSS indices were enumerated and defined operationally for objective scoring. The SIS-I protocols of the sample were scored as per the developed CSS. Mean and S.D. of each scoring indices of Comprehensive Scoring System were computed. The results are presented in details. Kandhari et al (2010) further tried to find out the norm of SIS-I Comprehensive Scoring System on 200 normal subjects drawn from the general population. The study aimed at delineating the pattern of responses on SIS-I in normal population. Kandhari, et al (2011) studied the pattern of responses on SIS-I in 200 normal males and females. The SIS-I was administered individually and the data was analyzed through Mann Whiteny U-test. The results indicate that males and females differ significantly only on a few indices of SIS-I. Highly significant difference was found only on TR and CBA. Mahapatra, et al (2011) administered SIS-I on 50 Normal and 50 Depressive patients to measure the ego strength in depressive patients. The findings indicated that the Number of Responses (R), Human Responses (H), Movement Responses (M), Most Typical Responses (MT), Typical Responses (T) and Atypical Responses (AT) measured ego strength. The Total Number of Responses, Movement Responses and Typical Responses were found significantly lesser, and Most Typical Responses and Atypical Responses were significantly higher in the depressive group than the Normal group.

Singh (2007) investigated the pattern of responses on SIS-II in normal high school male and female students. The sample comprised of 100 male and 100 female high school students. SIS-II was administered individually. The mean, SD, and t-ratio were computed to compare the two groups. Principal Component Factor Analysis was carried out to understand the factor structure of SIS responses in two groups. T-test and factor structures have revealed significant gender differences in some SIS-response patterns. Females have been found scoring significantly high on SIS-II scales of Animal responses, Pathological Anatomy and Depression, and low on Anatomy and Sex than their counterpart males. Five principal components each have been located in the two data, which also differentiate the SIS response patterns of male and female subjects.

Alreja et al (2009) administered The SIS-II to 30 medical practitioners in the age range of 25-45 years. The profile has revealed that the medical practitioners have fair imaginative capacity, functioning intelligence, good interpersonal relationship, psychological maturity, fair ego strength, adaptability Kumar & Kumar (2009) compared common indices of SIS-I and Rorschach on a group of 50 normal subjects drawn from general population. The scores on common indices were converted into percent scores taking total number of responses as denominator and product moment correlations were computed on these transformed scores. Of eight analyzed common indices, the correlation coefficients were significant on Total Number of Reponses, Human, Animal, Sex, Movement, Most Typical/Popular, Typical/Good Form, Atypical, and Rejection and fair social conformity.

Shweta et al (2010) administered the Rorschach test following Beck’s method on 238 subjects, consisting of 130 male and 108 females. Chi-square, t-test and U-test were computed to compare the Rorschach variables. Result does not show significant difference between Male and females except on two variables-Dd and Sex. The findings are in contrast with western norm and to some extent with Indian studies also. In addition, religious responses on Rorschach test focus new dimension of further research.

Verma & Singh (2014) indicated the potential of SIS-II to index the differential effect of age and education on the thinking, imagination, and perception of adolescents and young adults. Overall, findings of the present study depict young adults to be more characterized by cortical inhibition, zoo fears, body image dysphoria, appearance anxiety, sexual anxiety, psychodynamic energy, social conformity, healthy perception, creative imagination, low stress tolerance, hypochondriatic tendency, over health concern, depressed mood, hostile & aggressive impulses & conflicts, and exaggerated sense of self –consciousness. The results of this study though reflect significant age and educational differences in SIS-II percepts yet can’t be generalized until studied on large sample. Kruthi, et al (2015) administered SIS-II test to 10 Iranian couples, studying in Mysore and living together, having no history of marital discord. The mean age of the male was 42 years and female was 35.5 years. The mean scores on the eleven indices were almost similar to the scores reported by earlier studies. No cultural variation was noticed in their responses.

Executives in Industry:

Dubey studied, executives in different set ups (Dubey, 1975, 1976, 1980, 1988, 1989, 2003) and found that they were having high productivity, high imaginative ability, controlled emotionality, high adjustment and high on group conformity. They were also found high on team building. They gave more number of total Responses, Most Typical and Human responses with low number of Animal, Anatomical Sex responses. The Rejection of images and Pathological responses were almost absent.

Singh & Dwivedi (1998) administered SIS-II procedure to study 50 managers and 100 students. Findings showed significant differences in total number of responses, animal responses and sex responses; whereas no significant differences were found in other response categories. Pathological responses were negligible in both the groups.

Dubey et al (2001) administered SIS procedure to evaluate 90 Executives of a private organization. The SIS profile reveals that they were supported by good ego strength, healthy interpersonal relationship, no erotic disturbances, controlled hostility and aggression, high team building concept, good human relationship, and keeping touch with reality. Two executives showed unhealthy profile suggesting disturbed sexual relations, poor ego strength and to an extent neurotic profiles.

Dubey & Dubey (2012) used SIS test in industry during selection and employees counseling. It has been found as an effective tool to ascertain if the new incumbents possess certain personality traits such as team building, interpersonal relationship and intra-psychic balance. The test provided Norms and indices for successful executive in business world. The services provided by Dubay Doctorin (2D)is also described. The 2D enables organizations to transform into learning organizations to effectively compete in the marketplace. It is very simplistic and pragmatic approach that attempts to understand and capitalize on "the people", "processes", assets and technologies" in a service delivery environment focused on specific business outcomes. It can be applied in any service industries including Government Services, Hospitality Services, Transportation and Logistics Services.

Creativity:

Creativity is another significant area that has been studied. Raychaudhuri & Maitra (1968) examined the level of creativity using the movement responses of Rorschach and found significant association. Raychaudhuri (1971) in another study explored the correlation of creativity and gender.

Ramachandra (1994) studied 30 creative artists, and equal number of neurotics and non-creative group, using Klopfer’s method. The creative group had average number of responses, quick reaction time, and healthy emotional relationship with others and good ego strength. The experimental group of creative artists had the ability to view their problems objectively and incisively as evidenced by the indices. However the quality of responses suggested a keen perception and disposition to do things differently from that of the other two groups. Interestingly even at the beginning phase of introduction of the test, Raychaudhuri (1963) studied the responses of the Indian musicians.

Singh et al, (2007) administered Rorschach Inkblot test to examine creativity on 100 normal subjects, in the age range of 18-20 years, of either sex, educated up to 12th standard. As a tool, General Health Questionnaire (Shamsunder et al., 1986), Verbal test of creative thinking and Rorschach test (Beck System), were used. Findings of this study show that both the groups (High Vs low creativity) differ significantly on total number of Response (R), Whole response (W) and Popular response (P).

Singh et al (2009) tried to explore indicators of creativity and administered SIS-II and Torrance Test of Creative Thinking with Words, on 100 male students of 11th and 12th grade, randomly selected from Senior Secondary Schools of Kurukshetra District of Haryana. Obtained data were analyzed by applying descriptive statistics, Product Moment Method of Correlation and Principal Component Factor Analysis. Obtained inter-correlations and factor structure have depicted some structured overlap between two types of measures. Six of SIS-II scales i.e. Typical, Most Typical, Human, Movement, and Depression have emerged significant projective indicants of creativity.

Kaslow et al (2014) studied structured and qualitative look at changes in Rorschach Inkblot Test responses for two creative writers over the courses of their psychoanalyses. Attention was paid to capacity to preserve transitional space between reality and fantasy using the Reality-Fantasy Scale, which was applied to responses, coded using Exner’s Comprehensive System. Based upon empirically coded responses using the Reality-Fantasy Scale, over the course of their psychoanalyses, they demonstrated greater reliance on fantasy and more extreme reality-fantasy alterations. Psychodynamically-informed clinical interpretations of the Rorschach responses that showed shifts in creativity are offered. Results reveal that the Rorschach is a valuable projective tool for examining creativity in individuals undergoing psychoanalysis, engagement in a psychoanalytic process enables analysands to more readily share their fantasy-based perception, and it is optimal to use both the formal Reality-Fantasy scale and clinical interpretations for garnering a comprehensive understanding of shifts in creative processes secondary to psychoanalysis.

Children and Adolescents:

Bagh (1955) was probably among the earliest researchers using Rorschach test on adolescent school children. Asthana, (1965; 1966) evaluated the perceptual development of children and Julka (1962) also conducted research with child population. Using the Rorschach indices of aggression and maladjustment Raychaudhuri, et al. (1969) compared the normal boys and boys with behavioral problems. Dixit (1964) conducted a developmental study of the response pattern of children and adolescents. Joseph and Pillai (1986) differentiated the creative students into high and low creative group using certain Rorschach indices. Prakash (1977) reported the profile of institutionalized orphan children. Shankar (1956) and Raychaudhuri & Maitra (1965a) also examined the Rorschach responses of the young offenders. Shanmugam (1959) correlated yet another interesting variable, the lunar signs (stars) and the responses of adolescents. Though there were diverse and exciting experiments with the test on children in the initial phase, there were not many innovative attempts in the later period.

Sanyal (2013) used Somatic Inkblot Series–II to verify the therapeutic bearing of the test as a “lens” or “window” in offering light to the unconscious in a non-threatening way. The responses to the SIS-II seemed to verify the assumption that it serves as a “therapeutic template” on the basis of which the next line of treatment in terms of psychotherapy may be designed in future.

Based on the experience of using the test with different groups of children, Asthana & Mohan (1977) recommended the scope of the Rorschach test as a research tool to study the percept of children more than three decades ago; but there were not many takers for it. Using the hostility measure on Rorschach test, Singh & Kapur (1984) administered 150 school children in the age group of 11-14 years and found association with locus of control, intelligence and PEN scores. Bhargava & Saxena (1995) examined the profile of deprived group of adolescents and found that the group differed from the control group on longer RT, RT chromatic and achromatic cards.

Cassell & Dubey (1998) used the SIS procedure to study two adults who were severely disturbed by the media effects of addictive-type playing of violent electronic games and the third a 14 year old male admitted to a psychiatric hospital for highly dangerous and threatening behavior. SIS images helped in understanding their aggressive and violent behavior. Cassell & Dubey (2012) presented four case studies designed for training students to illustrate how SIS technique brings to the surface unprocessed painful material of real life, leading to violent behavior. It is hoped that some of such violent behavior might have been prevented if the victim’s care providers had included in their initial diagnostic workup a version of the Somatic Inkblot Series (SIS). When assessing dangerousness, SIS projective testing enables the examiner to bypass psychological denial defenses.

Savage (2003) administered the SIS-I to find out the traumatic effect of parental divorce on children. In many cases the children are not aware of the intention of the parents to dissolve the marriage. Once the decision to divorce is made most couples find it difficult to approach life in a positive and constructive way. They experience a range of emotional and psychological consequences and many are very vague about their future. Communication between the couples can range from talking about the impending events to complete non-communication. The self-esteem of both or one parent is negatively affected and they may loose their sense of priority and tend to be problem and circumstance driven (Hoffman & Pincus, 1989). The case is presented in details in this case study.

Jain et al (2005) tried to find out the diagnostic indicators of ADHD on the Rorschach and SIS-I tests. The study was conducted on a sample of 224 children in the age range of 6-11 years drawn from various schools of Baraut near New Delhi. Participants were categorized into two groups - ADHD (n=111) and control (n=113). Rorschach and SIS-I were individually administered on each participant and the response pattern of ADHD and normal children on two projective measures was compared. Frequency data of scored indices were transformed into percent scores (taking total number of responses as denominator) and total and transformed scores of the ADHD and Control groups were compared (using t-test) for identifying the discriminating indices. The sensitivity of both tests in identifying patients of ADHD was also compared. Several Rorschach indices such as, M, D, FC, F+, and A, were found significant in differentiating normal children from ADHD. The SIS-I Results revealed that both the tests are sensitive in discriminating the ADHD children from normal controls. Findings have been discussed in the light of available research evidences. Kumar & Singh (2007) studied the changes in the quantum at different age levels by administering Somatic Inkblot series (SIS-I). The test was administered on 100 children and 100 adults. The results revealed significant differences on six out of nine variables: Movement, Typical, Atypical, Anatomy, Most Typical and Rejection of Images which confirmed the hypothesis. Sharma et al (2013) administered Rorschach in Delinquents and Bhogta, et al (2013) used SIS-II in Thalassemia patients.

Chaudhury et al (2007) administered the Rorschach test using Klopfer’s method to 313 children and adolescent patients with psychiatric disorders viz. schizophrenia (n=66) mania (n=10) depression (n=33), anxiety state (n=24) hysteria (n=45) nocturnal enuresis (n=48) head injury (n=16) epilepsy (n=32) and mental retardation (n=39). The Rorschach profiles of the various groups of patients showed significant differences among the groups and from normal Indian subjects and the Western norms. Interpretation of the Rorschach protocols of Indian children and adolescent with psychiatric disorders using the Western norms would be fallacious and misleading.

Kumar et al (2008) administered SIS-I to find out the quantum of the contribution of gender in the productivity. Two hundred (n=200) adults from general population were administered SIS-I individually. The sample consisted of 82 male and 118 female participants. After exploring the fulfillment of the assumptions of parametric statistics, the regression analysis was performed to analyze the quantum of gender contribution. The results indicated significant contribution of gender in productivity with a small effect size.

Singh & Singh (2008) examined the impact of environment on the responses of SIS-II Images of two different school systems: the Government Schools and Gurukuls system in Haryana state (India). Two hundred male students (100 from government school and 100 from Gurukul System), matched with academic grade were randomly selected for the study. They were administered Somatic Inkblot Series (SIS-II) Booklet Form individually. The means, standard deviations and t-ratios were computed to compare the two groups. Obtained t-ratios have revealed significant mean differences in some of the SIS-II response patterns. Gurukul students obtained significantly high score on Movement responses, Atypical responses, Rejection of images, Pathological Anatomy scale, Depression scale, and Paranoia scale and low on Typical responses than the students of Government Schools. Similarly Verma & Singh (2013) found the effect of age and education on the responses of Somatic inkblot test (SIS-II).

Sharma et al (2013) administered Rorschach test to find out the personality characteristics of juvenile delinquents (N=30) as compared to non-delinquents (N=30). The findings revealed that both the groups differed significantly on W, Dd, FQ-, DQ+, DQV, M, Passive Movement p, Human Movement Passive, H, Hd, Ad, Hh, Experience Stimulation (es), Adjusted es, X-%, X+%, Zf, Interpersonal interest- Human content, and Total number of blends on Rorschach test.

Sanyal (2013) opined that projections of varied kinds are part and parcel of daily emotional exchanges with the environment. They give vent to the unconscious realm of the mind that tends to threat the ego-system. Resistance and consequently repression are resultant effects. Projective techniques come at the aid at this juncture to penetrate deeper into the unconscious folds in a non-threatening way, thereby offering space for clients to open up their inner veils on a face-to face basis. The Somatic Inkblot Series–II (SIS-II) is one such projective assessment tool that is apt enough to provide therapeutic elements to unravel the unknown contents of one’s personality. The present theoretical discourse plunges into the attempt to verify the therapeutic bearing of SIS-II as a “lens” or “window” in offering light to the unconscious in a non-threatening way with the help of eight selected case studies in the form of child cases, whose responses to the same test provided dynamic meaning, in terms of their emotionality. The responses to the SIS-II seemed to verify the assumption that it serves as a “therapeutic template” on the basis of which the next line of treatment in terms of psychotherapy may be designed in future.

Army Population:

Dubey et al (1982, 2005) administered Rorschach test to 200 psychiatric patients admitted in a military hospital and 100 normal subjects, all male, in the age range of 20-40 years. A number for scoring indices of Rorschach protocol is said to be dependent on the number of responses given by the subjects. Therefore, a procedure for controlling the protocol for the productivity was warranted. Accordingly, all the 300 protocols were divided on the basis of their number of responses into two groups taking the combined median as the cut-off point. The above median group is called “High Productivity Group (HPG)” and below median group as “Low Productivity Group (LPG)”. Each of these groups was separately analyzed by chi-square test for each of the Rorschach indices. The mean values for the profiles of normal, schizophrenia and neurosis were calculated for various indices separately for HPG and LPG groups to facilitate comparison with other studies.

Rathee and Singh (1996) administered Somatic Inkblot Series-I to 75 Normal Army Subjects (35 Male and 40 Female), and found that female subjects gave more number of responses and male subjects rejected more cards. Female subjects gave more of Animal responses and male subjects gave more sexual responses.

Rathee (2002) further assessed diagnostic value of Somatic Inkblot Series-II (SIS-II) among sub groups of psychotic and neurotic patients. The SIS-II was administered on each patient individually, following the standard procedures (Cassell & Dubey, 1997). The findings reveal that total number of Responses; Atypical and Pathological responses were able to discriminate among subgroups of Psychotics. Likewise, R, MT, Atypical, Movement, Rejection of Images Human, Animal and Sex responses were able to discriminate among subgroups of Neurotics. The Test Comments of both groups of psychotics and neurotics proved to be more useful to understand their underlying psychopathology. The patients with less disturbances liked the test and felt comfortable while reacting upon its images, as compared to patients with more disturbances. The SIS Profile can provide a lot of help in diagnosis of various categories of psychosis and neurosis.

Saldanha (2002) studied 31 militants through Somatic Inkblot Tests (Cassell, 1980; 1984) and personalized interviews and divided them into hard core (67.74%) moderate core (22.58%) and soft core (19.68%) types. They were drawn from 8 recognized militant groups operating in the valley. 74.19% were below 30 years. 61.29% showed hostile and aggressive responses on SIS Test. Concordance rates between psychological (SIS) and intelligence reports were as high as 77.77%. Psychological stress was revealed only in 3.22 %. 67.74% were unlikely to benefit from rehabilitative measures. The usefulness of Somatic Inkblot Test in understanding militant psychology is discussed.

Roopa & Joseph (2004) used Rorschach Inkblot Test, at IAM as a part of routine psychological evaluation for aircrew. This test supplements information gained from objective questionnaires. Previous studies in other countries have shown that subgroups of aircrew can be differentiated on the basis of Rorschach indices. 61aircrew were studied in three groups; non clinical, medical and psychiatry. All underwent a clinical interview and were administered the Rorschach test individually with no testing of limits by one of two trained psychologists. Responses were scored following Rapaport’s (1970) method in terms of location, determinants and content. “t” test was used and results indicated significant differences between the groups in content responses and non-significant differences in location and determinant indices.

Mixed Group:

Hussain, et al (1976) appraised the profile of unwed mothers and Kumar & Patel (1990) compared the profile of marital high and low adjusted women. Hostility and aggression as measured through the Rorschach test was also reported by various researchers (Shivadasani, 1971; Rangaswami, 1982; Gupta, et. al., 1989).

Shanker (1968) explored the caste factor and investigated the correlation between the educational level and the affective factors on Rorschach among Dalits (Harijans). Julka (1962), Kundu (1969) and Singh (1975) appraised the profile of tribal population. Kundu (1969) described the response pattern of tribal young offenders and Singh (1975) studied the effect of modernization on the response pattern of the tribal population. Chakraborty, et al (2015) administered SIS-II on 60 Orphans and 60 normal Children and found that Orphans Children gave significantly more number of R, Animal and Anatomical responses than the Normal Children.

Psychiatric Disorders:

Though the Rorschach test was used initially in India with non clinical population, later a greater number of studies emerged involving hospitalized psychiatric patients (Mishra & Dwivedi, 1997). It has also been widely used in India for clarifying diagnostic issues in OPD patients’ settings (Kohli & Kaur, 2002). Historically Pramod Kumar (1960, 1961, 1962, 1963, 1965) was one of the early clinical investigators have done extensive work with this procedure in clinical populations. Kumar evaluated the profile of those with different psychiatric disorders, and compared it with the normal control group. Among psychotic disorders, Kumar (1961b) investigated the profile of patients with schizophrenia, and verified the differences with that of a normal control group (Kumar, 1963). Bagadia, et. al., (1971) on a large sample analyzed the responses of patients with schizophrenia disorder. Dubey (1977) and Dubey, et. al., (1977) studied the psychiatric population, focusing on schizophrenia and compared it with other disorders. Mujtaba & Mujtaba (1985) and Prasad, et. al., (1987) also evaluated the groups of patients with schizophrenia and other disorders. Deviating from the common trend, Malaviya (1973) studied the Rorschach signs of suicide on a group of schizophrenic patients who had attempted suicide.

Exclusive research on patients with affective disorder was undertaken by Kumar (1960b) and provided Rorschach profile of the patients with mania, and compared it with a control group (Kumar, 1965). Similarly he analyzed the profile of patients with depressive disorder (Kumar, 1962b) and compared it with a normal control group (Kumar, 1962a). Almost a decade later, Bagadia, et. al .(1973) on a large sample described the profile of patients with depressive disorder. Pratap & Kapur (1984) studied patients with mania and more recently Kumar, et. al., (2003) compared the Rorschach test and SIS-I indices of the manic patients. Kumar (1960a) studied the response profile of the test of patients with different neurotic disorders and compared it with general population (Kumar, 1961a). While Dubey, et al. (1979) studied the patients with neurotic disorder, Akhtar, et al. (1975) studied the patients with obsessive-compulsive disorder. Ramachandra (1994) used Rorschach to compare the profile of a group of patients with neurotic disorder with that of creative artists and non-creative group.

Kumar & Patel (1990) found that the Rorschach test differentiated high marital adjusted and low adjusted women. The highly adjusted group gave more average number of response (28.73), whereas the lower group gave only 18.60. The RT as well as TR was less for highly adjusted group. Kaur & Verma (1998) administered Rorschach test and SIS-II to 32 psychiatric patients in order to assess the inter-relations on selected variables. Both the scales showed some degree of overlap with significant correlation between the two scales on Movement, Human, Animal and Popular responses (r= ranging from .42 to.58) but insignificant correlations for Anatomy, sex, F+ and Total response. Mishra et al (2008, 2009) administered Rorschach and found varying pattern in various Psychiatric Conditions. Verma et al (1996) compared PEN and SIS-II on 32 psychiatric patients, in order to find dependence of SIS variables on certain personality dimensions. The result shoes that (a) the number of “Most Popular” responses depend upon the education of the subject (b) Psychotics scores tended to influence Atypical and pathological responses, (c) Neuroticism scores influence number of Typical responses, (d) The lie score was found inversely related to perception of Human, Movement and Pathological response (e) Extraversion was not related to any of the SIS variables.

Pandey et al, (1996) analyzed three most liked and three least like images on SIS-II given by neurotics, Schizophrenics and normal controls (n=50 in each group). A differential pattern of preferences emerged such as normal controls showed positive affect for healthy body imagery (Image 5 A and 13A), whereas neurotics, and schizophrenics had poor concept (image 31A and 5B). Image 31B was most liked by all subjects which supports the contention of Dr. Cassell to carry pleasant feelings way back home by the subject at the end of the test. Analysis of disliked images revealed that images pertaining to erotic/ sex and insecurity were more disliked by the clinical subjects, while the normal controls showed no such pattern.

Pershad et al (1997) used SIS-II on 50 Normal, 57 Neurotic and 70 psychotic patients to find out the extent and type of body images disturbances in psychiatric patients. He compared the body image disturbances in patients with different type of psychiatric illnesses. It was observed that Most Typical responses and Sex responses were lowest in the psychotic group, as compared to normal subjects. This indicated that psychotics tended to deny anatomical structure and their perception was not in conformity with the typical responses. Movement responses and projection of images were high in pathological groups. In the normal group, 26 percent of the subjects gave their responses similar to structural theme of the image. In the neurotic group this number was reduced similar to structural theme of the image. In the neurotic group this number was reduced to 23 percent and in psychotics it was only 18 percent. However, a significantly high correlation was observed between Normal and Neurotics, Normal and Psychotics and Neurotics and Psychotics in their perceptual and structural theme on 16 images. The highest concordance was the thematic structure of kidney, spine and fetus.

Kohli & Kaur (2002) administered Rorschach and PEN to 125 patients attending Psychiatric OPD of PGI Chandigarh (India). Cases were referred to Psychology Unit for ruling out psychotic illness. The questionnaire variables did not show significant correlation with Rorschach. The Rorschach profile shows signs of general disturbance and propensity to psychosis rather than clear-cut pathognomic signs.

Cassell et al (2002) administered the Somatic Inkblot Series Video, Rorschach Inkblot Test and Figure Drawing tests in a case study of a 15-year-old girl who was admitted to a psychiatric hospital in Boston for treatment of Major Depression and Dissociative Reaction. She had history of suicidal ideation and self-mutilation of her left wrist and forearm. The relaxing instructions in the video and the hypnotically present healing flowers may have facilitated neural extinction of the terrifying hallucinations intruding upon her consciousness. The Figure Drawing and Content Analysis of SIS and Rorschach may provide useful aides to supplement standardized clinical interviewing techniques.

Mishra et al, (2009) investigated the presentation of Rorschach special scores in various clinical conditions by using Exner’s Comprehensive system. Patients aged 18-55 years, with the ICD-10 (World Health Organization, 1992) diagnoses of Bipolar Affective disorder, current episode mania with psychotic features (n- 30), Schizophrenia (n- 30), Schizoaffective disorder (n-30), Depression (n-30) and 30 normal subjects from the general population were included in the study. Results indicated that although thought disturbances are present in almost all psychotic conditions, they can be differentiated from each other on careful examination of special scores. Schizophrenia patients have severest type of thought disorder followed by mania and schizoaffective disorders.

Schizophrenic Disorder:

In a study on 25 active schizophrenics and 25 recovered cases, Sandhu (1978) observed that the recovered schizophrenics showed improvement in the form level, reality orientation, emotional control and decline in anatomy content. Pershad et. al. (1979) evaluated the profile of ‘the difficult to diagnose cases’ and found that 26.5% gave at least one of the pathognomic signs that Brar (1970) suggested-namely, loosening of association, tendency to over-generalize, lack of reality contact and pursuit of one’s or personal meaning to common symbols. When taken separately 20% of the protocols had one or more responses of confabulation, 11% had contamination and 6% had position responses.

Dubey (1977) also found signs on Rorschach that differentiated patients with schizophrenic disorder, neurotic disorder normal group. Dubey, et al.(1977) compared the over inclusive thinking patients with different psychiatric disorders. Prasad, et al. (1987) compared patients with obsessive-compulsive disorder with that of schizophrenics. Mujtaba & Mujtaba (1985) studied 20 Wheeler’s signs of homosexuality of paranoid and non-paranoid schizophrenic patients. Though both the groups had the homosexuality signs, the paranoid group had significantly more signs. While the paranoid group had 9.4 signs, the non-paranoid had only 4.15, as listed by Wheeler. But the presence of homosexuality signs, they suggested, may not be taken as the ‘sign’ to diagnosis individual cases. Prasad Rao, et al. (1987) compared obsessive compulsive disorder and schizophrenia and signs that differentiated the group were W%; D%; P; F+%; R; Anatomy; Sex and M: C. Similar findings were reported on Homosexual subjects by Chaudhury and Jyothi (1996). Dwivedi, et. al. (1995) administered Rorschach and found that schizophrenics gave less number of total responses (R) and more responses with anatomy and sex content.

Chaudhury et al (1996, 1996a, 1998, 1999) administered Rorschach on Homosexuality and Schizophrenia and validated Thiesen’s Pattern, Alfa Index and Weiner’s signs. Chaudhury & Sundari (1996) administered Rorschach to 44 adolescent schizophrenics and an equal number of age and sex matched normal adolescents to analyze Thiesen’s Patterns. Only three of the five Thiesen’s patterns associated with schizophrenia, namely patterns A, C and D occurred significantly more frequently in the Rorschach records of adolescent schizophrenic as compared to the normal controls. Dubey et al (2012) administered SIS-II in homosexual.

Chaudhary & Jyothi (1997) administered Rorschach test to 100 Schizophrenic patients and 100 Neurotic patients. The records of 54 Schizophrenics and 41 neurotics fulfilled the two requirements for application of Piotrowski’s Alpha Index. The Alpha index correctly classified 46 Schizophrenics and 29 neurotics. The Alpha index had a sensitivity of 85.2% and a specificity of 70.7%, which compares favorably with other diagnostic tests in clinical medicine. Chaudhary & Jyothi (1998) administered Rorschach test on three groups of 20 schizophrenics, each with mean length of hospitalization 3.2 years, 3.7 years and 11.2 years. Rorschach test was scored following Klopfer’s method. The conditions for applying Piotrowski’s alpha index were present in 29 schizophrenics out of whom 28 (96.6%) were correctly diagnosed. The alpha index was equally valid for all the three groups of schizophrenics.

Chaudhury et al (1999) administered Rorschach test on 50 schizophrenia patients and an equal number of age and sex matched neurosis patients and normal control subjects. Color stress sign was present in 30 schizophrenia patients, five neurosis patients and five normal controls. Deviant tempo sign was positive in 24 schizophrenia patients, nine neurosis patients and seven normal control subjects. The differences were highly statistically significant. Wiener's signs were found a valid diagnostic aid for the diagnosis of schizophrenia. Among the two signs the color stress sign was comparatively more useful as compared to the deviant tempo sign for the diagnosis of schizophrenia. SIS was used to study schizophrenics with positive results (Saldanha et al, 2013, Singh et al, 2011).

Kumar et al (2001) administered SIS-I to identify the prominent indices among 32 hospitalized male chronic schizophrenics in Institute of Mental Health, Agra and 32 normal participants. The analysis of results indicated that the schizophrenic group scored lower on total number of responses, animal responses, anatomical responses, sex responses, most typical responses and typical responses.

Kumar & Khess (2004) studied Exner’s Schizophrenia Index (SCZI) to capture the thought disorder and inaccurate perception thereby aiding the diagnosis of schizophrenia. However, earlier studies had pointed the need to analyze the sensitivity and specificity of these six special scores of the CS in various psychotic conditions to overcome diagnostic problems. The specificity of SCZI for the diagnosis of schizophrenia needs further exploration in as much as thought disorder and inaccurate perception are also found in other psychotic disorders especially, mania. Taking these lacunae into account the present study examined the differential sensitivity of the special scores of SCZI in discriminating schizophrenia and mania. Patients with the diagnosis of schizophrenia and mania (N=30 in each diagnostic group) as per the ICD-10 criteria were assessed on Rorschach for the six SCZI indices. Results indicated that deviant responses were highly pathognomic of mania, whereas contamination and incongruous responses were found more in schizophrenic patients. Dwivedi (2015) used Exner system on Psychotic patients.

Kumar (2005) tried to extend the scoring system of SIS-I and developed “Extended Scoring System (ESS)” in four categories. (1) Blot area (2) attributes (3) response category and (4) most common responses. To assess the discrimination power of Extended Scoring System (ESS) three groups of subjects were drawn - schizophrenics (n=30), manics (n=30) and normal (n=30). The patient groups were drawn from Institute of Mental Health and Hospital, Agra. SIS-I was individually administered. The analysis of results through one-way analysis of variance with Scheffe’s post- hoc comparisons revealed that the added indices discriminate the groups. Singh et al (2011) administered SIS-I to 50 non-paranoid Schizophrenic patients and 50 normal subjects to identify the diagnostic indicators of non paranoid schizophrenics. The results indicated that the patient group scored lower on total Response, Animal response, Sex, Human, Movement, Most Typical and Typical response.

Kumar et al (2006) compared the response pattern of SIS-I and Rorschach in schizophrenic patients. The sample comprised of 30 schizophrenic patients drawn from the inpatients of Institute of Mental Health and Hospital, Agra and 30 normal subjects. They were administered SIS-I and the Rorschach test individually and the Mean, SD, t-test and correlation were calculated on percent scores. The schizophrenic patients obtained significantly low scores on total number of responses, anatomical responses, movement responses, and typical responses as compared to normal subjects. The schizophrenics scored significantly higher on human and atypical responses. The findings also revealed significant and positive correlation between SIS-I and Rorschach scores on total number of responses, rejection of images, most typical responses, and sex responses.

Singh et al, (2008) studied the pattern of changes in Rorschach indices after treatment in a four month follow up study based on pre and post-test design. Fifty patients (Schizophrenia and Mania), admitted in RINPAS, Ranchi, in the age range of 21-45 yrs, were taken for the study. Findings showed that after treatment, information processing capacity (W, D, F) as well as ideational aspects of personality (P, F, M) were significantly improved. Findings also revealed that features related to self-perception and interpersonal relationships are less susceptible to change as compared to affective, cognitive and coping features.

Priyamvada et al (2009) compared the profiles of schizophrenia and depression on Rorschach test. The study was carried out on 30 schizophrenic and 30 depressive patients, in age range of 20-55 year of either sex. The findings reveal that both the groups (schizophrenia and depression) differ significantly on reaction time, major details, minor details, poor form level, movement response, shading response, vista response, Human response, and popular response.

Mahapatra (2009) administered SIS-I to explore if it can also effectively gauge ego strength in schizophrenic patients. SIS-I was individually administered to 50 schizophrenic patients drawn from Psychiatry OPD of VSS Medical College, Burla, Sambalpur. A matched control group of 50 normal participants was also drawn from general population. Consistent with the hypotheses of projective techniques, following SIS-I indices were identified as measures of ego-strength – Total Number of Responses (R), Most Typical Responses (MT), Typical Responses (T) and Atypical Responses (AT). The results clearly indicated that like other projective tools, SIS-I indices successfully measures ego-strength in schizophrenic patients.

Mahapatra et al (2010) further administered Rorschach test to explore if it can effectively gauge ego strength in schizophrenic patients. The Rorschach test was individually administered to 50 schizophrenic patients drawn from Psychiatry OPD of VSS Medical College, Burla, Sambalpur. A matched control group of 50 normal participants was also drawn from general population. The following indices of Rorschach inkblot test were identified as measures of ego-strength: Total number of responses (R), Whole responses (W), Rare detail (Dd), White Space (S), Good Form (F+), Human Movement (M) and Popularity (P). It was found that R, F+, M and P responses were significantly lower, and W, Dd and S responses were significantly higher in the schizophrenic group. These results suggest that Rorschach indices may successfully measure ego-strength in schizophrenic patients.

Kandhari et al (2010) developed a “Comprehensive Scoring System (CSS)” for SIS-I on the basis of Beck’s scoring system for Rorschach. The CSS indices for SIS-I were compared in manic, depressive and schizophrenic patients. A sample of 90 patients in three groups: mania (n=30), depression (n=30) and schizophrenia (n=30) were drawn from a psychiatric institute. SIS-I was administered individually to each patients and scoring was done according to the CSS. The Kruskal Wallis test revealed significant difference amongst various indices of CSS.

Saldanha, et al (2013) studied the effect of medical intervention on the responses of Rorschach Test and Somatic Inkblot Series-II in a case of Schizophrenia. The study shows how clinicians can effectively supplement Rorschach data utilizing SIS - II images to monitor the progress of the treatment. In this instance the chief symptoms of hyper sexuality was dramatically reduced. The addition of the SIS data facilitates understanding the significance of hidden desires of the psychotic patient which otherwise would have not been revealed.

Dwivedi (2015) studied sensitivity of Exner’s Comprehensive Scoring System in detecting specific delusions in psychotic patients and found that none of the scoring variables of Exner scoring system could differentiate the groups. Vishwakarma et al (2016) studied the associations among emotional intelligence and Rorschach’s special indices in patients with schizophrenia on a sample of 30 male patients, in the age range of 18-45 years. MSREIS-R test and Rorschach inkblot test (Exner system) were administered to assess different components of emotional intelligence and the special indices respectively. The results revealed that two components of emotional intelligence (a) ability to utilize emotions and (b) to manage emotions in self were significantly reflected on Exner’s indices (i) Suicide constellation (ii) Depression Index and (iii) Coping Deficits index.

Kumar et al (2016) administered SIS-II (booklet form) to compare the profile of non-chronic and chronic schizophrenia patient. Results indicated that non-chronic schizophrenia and chronic schizophrenia patients differed significantly on Human (H) and Sex indices of SIS-II. The non-chronic schizophrenia patients have psychologically more social isolation tendencies and have higher sexual anxiety in comparison to chronic schizophrenia patients.

Affective Disorder:

Pratap & Kapur (1984) studied hospitalized patients with manic disorder and found that the group had increased indices like -total number of responses, responses on cards VIII, IX and X, reaction time to achromatic cards, average response time, location details and determinants compared to a control group of normal subjects. Content responses and popular responses as well as F+ and F- Form level ratings differed significantly in the two groups.

Kumar et al (2003) administered SIS-l and Rorschach on a group of 30 male manic patients drawn from Institute of Mental Health & Hospital, Agra. Raw scores on common indices of the tests were converted into percentages. Percent scores of the indices on SIS-I for normal subjects were taken from a previous study (Kumar et.al.2001). The critical ratios were computed on SIS-l scores of Manic and Normal subjects. The results revealed that Anatomy, Typical and Atypical responses were able to differentiate the groups. Pearson’s product moment correlation was calculated on the percent scores of Rorschach and SIS-I on common indices in manic patients. The obtained co-efficient of correlations were significant on all the indices except for Most Typical responses. Both the tests, Rorschach and SIS-I are in card forms with chromatic and achromatic colors. Both the tests bear more similarities than the booklet form of SIS-II which is in single color and designed for self-administration. This may imply that SIS-I has potential for use as a parallel form of Rorschach test. The index based present study explored the correlations in one diagnostic entity only. Similar studies are required on normal and other clinical population to delineate a pattern of correlation between the tests.

Kumar et al (2004) further used SIS-I to study 30 Schizophrenics, 30 Manic and a matched 30 normal subjects. One-way ANOVA was computed with post hoc comparisons. However, no difference was found in total number of responses in manic and control groups. Human responses are significantly higher in schizophrenics. The animal responses failed to differentiate the groups. The comparison of anatomical responses across the groups revealed that schizophrenics have given significantly lower anatomy content than the manic and control groups. The manic group did not differ from control group on anatomical responses. Similarly movement responses are lesser in schizophrenic group than the other two groups. No difference was found on movement responses in manic and control groups. Most typical indices were able to differentiate Manic and Schizophrenic groups. The Typical responses turned to be powerful indicators and could differentiate all the three groups. The Rejection of images was also turned to be a discriminator in schizophrenia and mania. The results indicated statistically significant differences across the groups.

Kumar et al (2005) tried to find the Rorschach and SIS-I diagnostic indicators of manic and depressive disorders and the diagnostic compatibility of the two tests. Two clinical groups: Manic (N=50) and Depressive (N=50) along with a normal control group (n=50) were administered Rorschach and SIS-I individually. The individual protocols on these tests were scored on several common indices and between group comparisons was done using t-test. Findings revealed that the SIS-I provided important diagnostic information not only for differentiating clinical cases from normal healthy subjects but also for differentiating Manic patients from Depressives. It was also observed that the diagnostic efficacy of the SIS-I was comparable to that of the Rorschach. Kumar et al (2006) further used SIS-I on 50 Manic Patients (25 Male and 25 Female) and 50 Normal Subjects (25 male and 25 Female).The Manic Male patients scored significantly higher number of Animal responses and lower number of Most Typical responses than Female Manic patient. Except slightly higher Rejection of images by normal female subjects, no significant gender differences were noticed in normal group. SIS was found to be an effective diagnostic instrument in suicidal patients (Singh et al, 2014, 2014a) and therapeutic procedure in Depressive patients (Tiwari et al, 2012).

Kumar & Khess (2005) used Exner’s method to study Schizophrenia Index (SCZI) and Perceptual-Thinking Index (PTI) in differentiating schizophrenia from Mania. 30 actively psychotic patients from each group fulfilling the ICD-10 Diagnostic Criteria were included in the study. Results revealed significant correlation between the indices (r= .97; P= .01; d=7.99). SCZI revealed a hit rate of 73% and 83% with cutoff 4 and 5, respectively. And, PTI showed a hit rate of 83% with cutoff 4. Overall performance of the indices and the individual criteria indicate that the PTI is marginally better than SCZI in differentiating schizophrenia from mania.

Kumar et al (2006) studied the pattern of responses on SIS-I in Manic male and female patients. The sample comprised of 50 Manic Patients (25 Male and 25 Female) and 50 Normal Subjects (25 male and 25 Female). The Somatic Inkblot Series-I Card form was administered individually. The Manic Male patients scored significantly higher number of Animal responses and lower number of Most Typical responses than Female Manic patient. Except slightly higher Rejection of images by normal female subjects, no significant gender differences were noticed in normal population. George & Kumar (2008) used Comprehensive System of the Rorschach to (Exner) to identify Depression Index (DEPI). Thirty patients (n=30) with the diagnosis of recurrent depression as per the ICD-10 criteria and 30 normal healthy controls from general population were assessed on Rorschach. Results indicate that patients with depression scored more on Depression Index with high specificity and low sensitivity.Kandhari et al(2012) used SIS-I on Manic patients.

Kumari et al (2009) compared the responses of schizophrenia and BAD currently manic patients on somatic Inkblot Series-II. The sample consisted of 30 schizophrenia and 30 BAD currently manic in patients drawn from Ranchi Institute of Neuro-Psychiatry and Allied Science, (RINPAS), Ranchi. India. 15 male and 15 female were included in each group. The results reveal that schizophrenia and BAD mania patients obtained significantly different scores on Total number of responses, Human responses, Sex responses, Movement responses, Typical responses, Atypical responses and, Rejection of images.

Mishra et al (2010) used Rorschach following Exner’s method to find the response pattern of manic patients. Main objective of the study was to develop a profile of mania patients on Rorschach variables. 120 Bipolar Affective disorders patients having psychotic features, ranging from 18-55 years of age, diagnosed as per ICD-10, and 50 randomly selected normal subjects from the general population, matched with respect to age and sex with mania group were included. Findings of the study indicate that mania patients differ significantly from normal control on several Rorschach variables

Neurosis (Anxiety Disorders and Depression):

Kaur & Kapur (1983) administered Rorschach test, following Klopfer’s method, to normal and patients with conversion and dissociative disorder. The patients with ‘dissociative disorder’ gave fewer responses, took more time, and gave more d and less S responses. The percentage of Fc, FC’, C’F and FC were low compared to the normal group. The content analysis showed that the group gave more responses with mythological human responses, animals, nature, clouds, sex and unusual responses than the normal group.

Gupta (1977) used Rorschach ranking conformity test and found no correlation between normal subjects and a group of patients with neurotic disorder. But the study had a small sample size of 25 in each group. Probably, Malaviya’s (1973) research is the only contribution towards understanding the signs of suicide on the Rorschach test. Akhtar et al (1975) administered Rorschach test using Klopfer’s method to 50 patients of Obsessive neurosis and found that they were high on movement, animal and human responses, often selection of unusual areas, with lower number of color, shading and anatomical response.

Mishra & Gupta (2008) administered Rorschach test to 71 Neurotic cases taken from a private psychiatric hospital in Lucknow. They gave low R (between11 to 20), more F and low number of C, M and Shading responses. Gender has no bearing on the Rorschach psychogram). Dubey & Dwivedi (2015) administered SIS-II to an 18 years old girl, diagnosed as a case of “Dissociative Convulsion Disorder, studying in 12th class with complaints of fits (fainting attacks), headache and nausea. The SIS responses projected her poor interpersonal relationship, pent up aggression and abusive childhood. The SIS imagery was used as therapeutic intervention tool with positive results and relief from symptoms. Gupta et al (2015) administered SIS-II in treating a female patient with attempted suicide with encouraging results. The SIS images helped in therapeutic intervention.

Dubey & Cassell (2014) reported a case history study examining the concomitant protracted Bereavement associated with loss triggered Mental Disorders of her daughter and husband. It reviews both the symbolic imagery in their dreams as well as that reflected in their projective responses to SIS-II Video. Cassell (2016) in his Editorial described the effect of “Nuclear Anxiety” on human either in full conscious awareness consciously or out of it. Such fear/aggression has been projected on some inkblots. Perceiving “An atomic Bomb explosion” can be the projection of such explosive imagery may symbolize deep seated fears of ultimately dying from a future nuclear war. This is a very complex psychophysiological area where there exist many more fundamental questions related to violent imagery than answers.

Cassell & Dubey (2016) reported a case history illustrating the psychological defense system of a 100 year old woman who at assessment was “Happy and Healthy” while “Never Thinking about Her Own Death”. People worldwide face their own ultimate mortality with a wide range of culturally/emotionally colored reactions. Yet ultimately as one grow older, Death Dysphoria tends to surface in daytime conscious awareness, as well as sometimes directly or symbolically in affect charged dreams directly. A central portion of the dogma proposed by theologians of the world’s great religions consist of “so-called reality” historical facts. For true believers, these may provide emotional comfort by claiming death overcoming miracles that purport to overcome “The sting of death”! Similar death anxiety has been reported in other studies (Cassell, 2011, 2014, Cassell et al, 2013).

Sharma et al (2013) studied the effect of systematic desensitization and group therapy on different type of 110 phobic patients, in the age range of 12 to 19 years (Mean age of 16.7 years) with mean length of abnormal fear for about three years. The Rorschach test was administered using Beck’s method. Results indicated that the two groups (treatd with psychotherapy and untreated with psychotherapy) differ significantly on total Responses, Whole responses, obvious details, rare details, Movement, CSum, Vista, Human, Human detail, Good form, Animal, Popular, Lambda, T/IR and Rejection of cards. After 7 months of psychotherapy most of the patients became symptom free.

Sachacher & Jahan (2014) administered SIS-II to a 30 years male, diagnosed as “Body Dysmorphic Disorder”.as per DSM-IV. The SIS helped in expressing his preoccupied thoughts of being ugly and anxiety about body image.

Singh, U. & Rani, K. (2014) conducted a study to examine the SIS-II correlates of suicide ideation, on 480 Secondary School students (186 females and 294 males) drawn from 11th & 12th grade students of various Senior Secondary Schools of Gurgaon and Delhi, using SIS –II and Beck's Scale for Suicide Ideation. The t-ratios revealed that the female students scored high on Suicide Ideation, Human, Animal, Movement and Most Typical Reponses; and low on Anatomy than male students. Both inter-correlations and factor analyses have depicted structured overlap between some SIS-II scales and suicide ideation. Movement, Depression, and Hostility and Aggression Scales of SIS-II have emerged significant correlates of suicide ideation depicting SIS-II Suicide Ideation Constellation Index (M+, D+, HAS+). Singh and Rani (2014a) further used Beck Scale for Suicide Ideation, SIS-II and Neo-FFI on 300 Senior Secondary School students (150 females & 150 males) of Gurgaon and Delhi to find out gender-specific projective and psychometric personality indicators of suicide ideation. The findings revealed female students scored significantly high on Suicide Ideation, Human, Animal, Movement, Most Typical, Neuroticism, and low on Anatomy, Extraversion, and Conscientiousness.

Psychosomatic and Dissociative Disorder:

Devi & Kaliappan (1997) administered SIS-II to find out the improvement in the inner life of 19 Tension Headache subjects from the Banking Industry. Multimode behavior therapy was applied for treating the tension headache subjects. Findings showed a significant reduction in the Atypical responses and an increase in the Typical and Most Typical responses among the tension headache subjects. Sharma et al (1997) used SIS-II to find out psychological profile of 22 patients suffering from alopecia areata. Psychological disturbances were found in 55 percent of cases.

Nicolini (2000) used SIS-I to examine corporeal perception in subjects with Migraine, under treatment in an outpatient Center for Psychosomatic Medicine. The SIS-I Test is known to be a suitable test for assessing somatic perceptions and mental processes that form the base of the psychosomatic disorder. A control group of 16 subjects and two groups of subjects with psychosomatic pathology, matched in respect of age, number of subjects (16), level of education and professional activity was taken for study. The SIS-I test helped in getting important information required for establishing the psychopathology of the patients and the relation existing between each subject under treatment in the Center and his own body, proving to be a useful diagnostic help.

Chaudhury et al (2001) studied 50 consecutive patients with Alopecia Areata (AA) and an equal number of age and sex matched control subjects without any physical or psychiatric disorders were evaluated with psychiatric interview and mental status examination, Sinha’s Anxiety Scale, Carroll Rating scale for Depression Toronto Alexithymia Scale, the Presumptive Stressful Life Events Scale and the SIS-II. Analysis revealed that patients with AA were significantly more anxious and depressed, obtained significantly higher Alexithymia scores and reported significantly more Stressful Life Events as compared to controls. The Somatic Inkblot Series-II test revealed psychological disturbances in 52% patients.

Kumar (2010) administered SIS-I to a 28 year Engineering graduate woman severely depressed with multiple somatic symptoms. It is evident that many of her SIS responses reflected the severe extent of her depression. SIS responses also projected her poor relationship with her mother-in-law. The therapeutic intervention had begun to restorer self-image as being a competent mother to care for her child. The rich and graphic SIS symbols were discussed in the case study.

Mishra et al (2010) used SIS-II to study a 12 years old girl of 7th grade with complaints of nervousness, headache and low mood, stiffness in upper limbs and body and fits of occasional unconsciousness. She was diagnosed as a case of “Dissociative Convulsion Disorder” as per ICD-10. The SIS responses projected her poor interpersonal relationship, pent-up aggression, physical abuse and disturbed family functioning. The SIS imagery projected traumatic feelings which formed the basis for effective therapeutic intervention. SIS was tried by many researchers to treat Dissociative Disorder patients (Manickam et al, 2013, Sachacher & Jahan, 2014, Sengupta et al, 2012, Dewangan et al, 2014). Pandey et al (2011) administered SIS-II to a 16 years old girl, studying 10th grade with complaints of fits of unconsciousness, severe headache, low mood and nausea. She was diagnosed as a case of “Dissociative Convulsion Disorder” as per ICD-10. The SIS response projected her poor interpersonal relationship, pent up aggression, physical abuse and disturbed family functioning. The SIS imagery was used as therapeutic intervention tool with positive change in her condition.

Cassell, et al (2013) administered SIS-II to a 17 years old girl of 12th grade, suffering from tension headache for last 2 years. Her other complaints were feeling heaviness and tightness in head, nausea, muscular stress, tingling sensations, numbness, feeling tiredness and physical weakness. The SIS responses projected her intra psychic conflict, poor interpersonal relationships, pent up aggression, inferiority complex and disturbed family functioning. The SIS images were used as therapeutic intervention tool with positive outcome.

Dasgupta (2013) used SIS-II on a clinical case having emotional problems to verify the efficacy of Dance Movement Therapy (DMT). The SIS was administered thrice (Pre-testing session, 2nd testing after 8 sessions of DMT and 3rd testing two weeks after termination of DMT), as a measure to determine any significant change(s) through the projective mode. Both quantitative as well as qualitative analyses were done to unfurl the efficacy of the therapeutic intervention, if any, on the client’s personality profile and profile of mood states. DMT was found to have a substantial qualitative effect in molding the personality profile along with mood state as revealed through qualitative improvement in the nature of responses on the SIS-II. The case manifested specific trend of “inner growth” in personality make-up in the post-test sessions. This effect was also found to persist even after the termination of DMT. The SIS responses showed positive change with overall improvement. It indicates the effect of Dance Movement Therapy, which relies on the search for one’s “authentic movements”, to bring about gradual somatic transformations and consequent psychic modifications.

Manickam, et al (2013) used SIS in a case of 26 year old married male from Afghanistan, who was having cough for one year duration, diagnosed as psychogenic headache. He avoided perceiving sexual responses on images generally depicting sexual imagery, may indicate deep rooted sexual conflict. The SIS responses further helped in planning and providing integrative psychotherapy to him. Follow up of the client after one year showed that he is free of symptoms, has legally migrated to one of the European countries and is effectively engaged in work.

Dewangan, et al (2014) used Rorschach test as early detection of somatization problem in general population. In a two phase cross-sectional study, 400 college students of Kolkata, India were given Symptom Assessment-45 questionnaire to screen psychiatric morbidity. 15 students were selected as high risk for somatization and 15 as low-risk for somatization based on the screening. The Rorschach test following Klopfer system (1956) was individually administered to them. Findings could identify only few Rorschach variables like Animal Detail and Nature content in association with somatization.

Dubey & Dwivedi (2015) administered SIS -II to an 18 years old girl, studying in 12th class with complaints of fits (fainting attacks), headache and nausea, diagnosed as a case of “Dissociative Convulsion Disorder. The SIS responses projected her poor interpersonal relationship, pent up aggression and abusive childhood. The SIS imagery was used as therapeutic intervention tool with positive results and relief from symptoms.

Post –Traumatic Stress disorder (PTSD):

As might be expected, the majority of projective studies have been based upon the Rorschach. Most of these have been conducted with veterans traumatized by war (Frueh & Kinder, 1994). A few have examined nonmilitary victims of trauma (Levin, 1993; Saunders, 1991). Strictly speaking, just because the studies employ the Rorschach does not mean that their scores were based upon the assessment of projected traumatic imagery. For example, if the numerical data employs scales such as those derived by Exner's scoring system, it would be erroneous to categorize them as derived from “projective" testing.

Two other promising projective test are, first the Hand Test (Wagner, 1983) and the second the Childhood Hand that Disturbs Projective Test. The former has been used in studying PTSD in veterans (Walter, et al, 1998) and noncombat traumatized individuals (Rasch & Wagner, 1989). The later has been used in the therapeutic resolution of sexually related trauma (Davido et al, 1994).

Cassell (2008) published the psycho-biographical study which used the power of SIS projective technique to access adolescent PTSD Holocaust memories of a psychologist. Traditional interviews reveal only what a person is able to recall and then chooses to reveal. While these may be supplemented by information from tone of voice, body posture etc., such nonverbal sources have limitations. In many stressful situations, the mind can play tricks by defensively hiding relevant material. Moreover verbal communication is limited by the number of words to communicate emotionally colored perceptions. The SIS-II video initially uses beautiful floral scenes to artificially induce a trance like state facilitating the release of memories. In viewing semi-structured, yet ambiguous “Inkblots”, the released imagery is then projected. What is seen and felt can represent a rich supplemental source of information in a psychobiological study. Cassell & Dubey (2008) administered the Somatic Inkblot Series-II to an OCD patient as an aide in cognitive behavioral psychotherapy. Content analysis of SIS projected symbolic imagery was able to bring to the surface long forgotten, unresolved stressors. The SIS could stimulate in memory long forgotten posttraumatic dreams and providing clinically relevant information for treatment plan. The SIS therapeutic intervention can be implemented to undermine affect linked irrational obsessions and thereby reduce compulsive behaviors. SIS was also used in several cases of PTSD (Cassell et al, 2014, Brock et al, 2015) with positive findings. Cassell & Dubey (2010) administered the SIS-II Video to an American Vietnam veteran suffering from PTSD and the SIS images helped in reprocessing combat related long term traumatic material.

Cassell & Dubey (2014) reported a case history study examining the concomitant protracted Bereavement associated with loss triggered Mental Disorders of her daughter and husband. It reviews both the symbolic imagery in their dreams as well as that reflected in their projective responses to SIS-II Video. Cassell et al (2014) reported a case study involving a fatal Alaskan Brown bear attack experienced in 2013 by a Vietnam veteran, who had been severely stressed on two separate combat occasions during Vietnam War. These occurred when the helicopter in which he was riding shot down. While he survived two of his colleagues crashed near death. He also experienced the combat death of comrades which ultimately led to developed deep seated PTSD suffering. Gradually (without therapy) over the years, his subjective awareness of such discomfort faded in intensity. Eventually after the war, he was able to work as a mechanic, got married and relocated to Anchorage Alaska. In December 2013, he shared a near fatal Alaskan Brown bear attack experienced the previous September when hunting alone in a remote region. The SIS helped him in reliving combat trauma in PTSD dreams.

Brock et al (2015) studied SIS Symbols of PTSD and the Need for Empathy in Therapy in a case history study of a victim of PTSD who was traumatized by severe stress throughout childhood and adolescence. A major underlying aspect of all medical therapies involves the degree of positive empathetic linkage extending from the clinician to the sufferer. This is especially applies for those tormented by recurrent intrusive childhood traumatic memories - the basis of Posttruamatic Stress Disorder (PTSD). In such situations, the clinician created supportive empathic bond provides an essential foundation of psychotherapy. Moreover when the treatment plan encompasses “Body-Mind-Spirit” theoretical principles, the resultant empathetic bridge optimizes the prognosis. Yet such occupational exposure over time, in vulnerable care providers may induce empathetic “Secondary Traumatization”. This article illustrates typical professional risk factors by presenting a case history study of a victim of PTSD who was traumatized by severe stress throughout childhood and adolescence.

Case & Dubey (2011) reported “Emotionally Unstable Personality Disorder”and presented clinical case history involving an adult male, with a childhood background of PTSD and ADHD. His personality problems became apparent in late adolescence. As an adult, he self medicated with alcohol and street drugs for handling bouts of severe depression. When this failed, he sought treatment and revealed his inner tormented world through symbolic dreams and SIS imagery. These presented time capsule “pictures” of his “borderline” life style traceable to trauma in a dysfunctional family. Cassell & Dubey (2017) studied another case of PTSD using SIS technique. The case study involves a technician working on the oil field. There was an explosion, while he was in the tank to repair it. He has been in treatment a few weeks, for the major trauma he had just over a year ago. SIS images helped as therapeutic aid and he showed fast improvement

Organic Disorder:

D’Netto & Kishore (1976) administered Bender Gestalt Test, Raven’s Progressive Matrices, Drew-a-man Test, Memory Scale and Rorschach Ink Blot Test to 40 brain injury cases. All these tests detected abnormalities from 65% to 75%.

Vagrecha & Senmajumdar (1974) administered Rorschach and Alexander’s Pass Along Tests and tried to find the difference in IQ and Piotrowski Signs in epileptic patients as compared to normal subjects. They found the use of 5 or more signs on Rorschach test to be of lesser relevance for organic group than the Piotrowski’s findings The findings also revealed significant reduction in IQ of the epileptics, but no such differences were found on Rorschach signs.

Mishra (2010) administered SIS-II to 50 epileptic patients attending OPD and community outreach program of Ranchi Institute of Neuropsychiatry and Allied Science (RINPAS), Ranchi, India and 50 normal participants. Results reveal significant differences between the two groups on most of the SIS indices.. Most Typical response, Depression and Rejection of images were found as most discriminating diagnostic indicators.

Subnormal Group:

Upadhyaya & Sinha, (1974) and Ojha, (1975) administered the test to mentally retarded adults with high and low intelligence (IQ above and below 40). The lower IQ group showed more descriptive themes, poor verbal productivity, less interaction, perceived environment as more threatening, gave less shading and color responses, had lower mean range of content and less popular responses on Rorschach. Ojha (1975) administered Godard Form Board, Draw-a-Man Test, Shukla’s Test of Intelligence, Bender Gestalt Test, CAT and Rorschach to 25 delinquent children in the age range of 5-14 yrs. The results showed that the delinquents had short span of attention, poor comprehensive ability with low Motor, speech, and language development. Vashistha & Bhardwaj (2007) prepared personality profiles of Mentally Challenged and Severely Hearing Impaired children through Rorschach Inkblot Test. The findings reveal that mentally challenged children have extroversive personality, while severely hearing impaired children have introversive personality structure.

Alreja et al (2009) administered SIS-II to 30 subnormal Children attending OPD of RINPAS, Ranchi, and 30 Normal Children. The results revealed significant difference in total number of Responses, Human responses, Animal responses, Anatomical responses, Movement responses, Most Typical responses, Typical responses, Atypical responses, Rejection of images, Depression Scale, and Pathological Anatomy Scale.

Alcohol, Drugs and Substance Abuse:

Rorschach test could differentiate alcoholics from non-alcoholics. Arora, (1982) observed that on 6 categories, namely +C >3, M<C, Water responses, Fabulized responses >1, F% <65% and W % <20, differentiated alcoholics from non-alcoholics. Similarly, Banerjee et al. (1998) examined seven indices of the test- Human, Animal (A), Anatomical, Atypical, Popular (P), Rejection (R) and Sex (S) responses of heroin addicts using Klopfer’s method. Out of that, four indices namely, A, P, R and S significantly discriminated the heroin addicts from the control group. Verma & Misra (2002) studied Rorschach’s Response Patterns of Drug Addicts. Giovanna Gaetani et al (1995) studied corporal perception in HIV Positive and Negative Heroin-Addicts using Somatic Inkblot Series-I and found positive correlation. Mukhopadhya et al (1996) used SIS-I in preparing the comprehensive profile of personality characteristics of male drug addicts.

Mitra & Mukhopadhyay (1996) administered SIS-I to Forty adult male opiate drug addicts (Heroin (N=19), Brown Sugar (N=12), Tidigesic (N=9). The social anxiety level of the clinical samples was measured in terms of social avoidance and distress (SAD) and fear of negative evaluation (FNE). SIS-I measured the pathological personality components of the drug addicts. Rest of the qualitative components analyzed the significance of the result obtained by objective measure. Results revealed that the three groups significantly differ in SAD (p<. 01) and FNE (p<. 05) of social anxiety scale. Tidgesic group reported highest score in social anxiety and distress and lowest score in fear of negative evaluative and the lowest in social avoidance and distress. SIS pathological indices do not differentiate the groups. Qualitative components are also reporting a predominance of specified components such as anatomical responses (At), atypical responses (At) and human responses (HR). This suggests uniformity in personality components among opiate addicts which may be termed as the drug dependency traits.

Singh & Banerjee (1996) administered SIS-II on 38 O.C.D. patients in order to study the response patterns on chosen variables. The results suggested that SIS-II could be a useful psychodiagnostic tool in clinical set up. Singh & Dubey (1997) administered SIS-II to 50 drug dependent and 50 alcohol dependent cases. The SIS protocols were compared on R, MT, H, A, At, Sex and Rejection. Drug dependents scored low on R and MT responses. The SIS- II can be used as a powerful psycho diagnostic tool for discriminating drug and alcohol dependent groups from normal subjects.

Banerjee et al (1998) administered SIS-I and the Rorschach Inkblot Test on 15 heroin addicts and 15-matched normal subjects. Four indices each were proved to be successful discrimination index between heroin addicts and normal. Ambiguity in Rorschach image reported higher number of responses in MT, AT, Rejection, Animal and Sex indices. Verma & Mishra (2002) administered Rorschach test on drug addicts and found that the drug addicts were anxious, had poor control over emotional situations and lack of contact with reality.

Mitra & Mukhopadhyay (2000) administered SIS-I and compared three drug abuser groups namely, heroin (N=98), brown sugar (n=79) and tidigesic (N=70) and matched normal subjects (N=48) in terms of level of depression, social anxiety and social motive components as well as the differences in pathological contents and indices of personality. The follow-up groups i.e. rehabilitated (N=6) and the relapsed (N=35) were also assessed to search out support for the outcome. BDI, SIS I Social Evaluative Anxiety Scale (SAD and FNE) and AMS were used to explore the socio-psychological differences among the groups. Besides the investigation has also taken an account of the follow-up data compared the results with their aboriginal data of the same subjects. F-ratio used for the inference of the results obtained through questionnaires on t-applied to compare the percentage of the pathological contents and SIS indices. Mann –Whitney U-test explored the authenticity of acceptance and rejection of null hypotheses and subsequently the directional hypothesis. Level of depression and social anxiety (SAD & FINE) were reported to be significantly high among drug addicts and follow-up relapsed group with low social approval motive when compared with the normal and follow-up rehabs groups. A pathological component i.e. high PAS, D and P, low HAS along with atypical, anatomy, sex and human responses were able to discriminate the clinical groups.

Basu & Nandi (2004) compared 30 male Ganja (cannabis) dependent, 30 tobacco dependent and 30 non-smoker adults of Kolkata. They were individually administered the General Health Questionnaire – 28 and SIS-I. Results indicated that the non-smokers had the least general mental distress as well as the highest scores on the positive indices on SIS-I. Among the negative indices however, the non-smoker group also scored high in Animal, Anatomy and Sex responses. They scored the lowest in two negative indices of mental health, namely, Atypical responses and Rejection of images. The Ganja and tobacco smokers shared some of the somatization responses. However the tobacco smoking group could utilize the social resources to a greater extent than the Ganja smokers. The results have been explained in terms of the intrinsic nature of the two drugs as well as with reference to the legal and social acceptability status of Ganja and tobacco as agents of dependence.

Ranjan et al (2008) tried to assess the profile of alcohol dependents. Thirty (n=30) male alcohol dependent inpatients from RINPAS, Ranchi, and 30 normal subjects were administered SIS-II. Result reveals significant differences in Atypical, Most Typical, Typical, Sex, Anatomy, Depression and Movement responses of the alcohol dependents and normal subjects. The Alcoholic group gave significantly higher Anatomy (At), Sex and Atypical Responses (AT), and significantly low on Most Typical Responses (MT) and Typical Responses (T). Overall SIS-II profile of alcohol dependent patients indicates that they are having somatic preoccupation, anxiety regarding sexual dysfunction and low ability to keep up with the demands of society.

Chaudhury et al (2010) studied 100 male patients with alcohol dependence and an equal number of age, sex, occupation and regional background matched controls with the help of State Trait Anxiety inventory, Carroll Rating Scale for Depression, The Multiphasic Questionnaire, Maudsley Personality Inventory, Toronto Alexithymia Scale, AFMC life events scale, Self-esteem inventory and the Somatic Inkblot Series- II. Analysis of the results showed that alcoholics obtained higher scores on state and trait anxiety, depression, mania scale, paranoia scale, schizophrenia scale, psychopathic deviance, neuroticism, extroversion, and AFMC life events scale. Alcohol dependent individuals had significantly lower self-esteem as compared to control subjects. As compared to normal controls significantly more alcoholics were identified as alexithymic. The SIS profile of the alcohol dependence patients indicated that they vary on Human response, Animal response, Anatomy responses, Sex responses, Most Typical responses, Typical responses, Atypical responses and Depression, from the normal population.

Cassell & Dubey (2010) administered the Somatic Inkblots Video to a person who has been abusing Alcohol and other drugs for the last 25 years. The SIS images helped in planning therapeutic intervention leading to positive attitude towards life. This individual shared emotional pain which he has felt during years which had impaired his occupational functioning on his job. To facilitate such treatment, Cassell designed an advanced electronic series as an adjunct to therapy. This updated system, like the SIS, initially induces hypnotic conditions to facilitate the release of stressful memories. Then the viewer visualizes ambigous pictures of stressful scenes which predispose to mind altering substance abuse. This artificial intelligence procedure was created solely as an adjunct technique for use by licensed addiction counselors during individual and group psychotherapy. It does not require the sophisticated training or understanding of statistical normative data expected of that a psychologist formally trained in psychometrics.

Bala, et al. (2010) used SIS in a case of 20 years old male, educated up to ninth standard, taking alcohol, ganja, brown sugar (smack), cigarette, and tobacco from last 5 yrs. According to ICD-10 he was diagnosed as a case of Mental and Behavioral Disorder. On psychological evaluation he was guarded and nothing could be elicited except inadequate parenting and family problems. However, on SIS images he could not conceal his personality and antisocial traits. The diagnostic /treatment applications of this projective interview aide are the main objective of this case history presentation.

Sexual Disorders/Marital Problems:

Kapur & Kapur (1967) was among the early researcher studying the profile of patients with sexual disorder. Raychaudhuri & Mukherjee (1970) explored the Wheeler and Shafer signs of homosexuality in male prisoners. Dubey (1977) has used Rorschach to assess the personality of impotency cases and therapeutic management. Basu & De (1997) used Rorschach test on Transsexuals and found rejection of the male body, glorification of the female features and difficulty in adequate human relationship.

As indicated in this book’s foreword by Wayne Holtzman, the HIT is well suited for the projective assessment of an individual’s evolving sexuality. Unlike the Rorschach, it presents a great number of ambiguous inkblots. These obviously provide the test administrator a much wider range of sexually suggestive stimuli. In fact, in his book, the clinical case which was selected for illustration purposes involved a male college student in psychotherapy, whose projective responses did not lead to a clear cut formal psychiatric diagnosis. Rather, the extreme number of sexual responses apparently reflected a previously unrecognized sexual role confusion, which eventually over time demonstrated a surfacing homosexual preference. Sometimes imagery projected onto inkblot stimuli such as the hit can tap into the same stream of sexual images flowing in dreams which shape sexual orientation. The test - retest capabilities with a second series of 45 cards is a further methodological plus for choosing Holtzman’s instrument for possible sexual issues unreported in face to face interviews. It might be noted that the pulling power of both the Rorschach and HIT may be enhanced by pretest establishment of artificial intelligence relaxation through initial electronic administration of the SIS hypnotic introduction program.

Ordinarily, the HIT administrator is not subjected to the same degree the likelihood of erroneous criticism; being accused of administering “pornographic material disguised as scientific technique”. This erroneous criticism is a potential professional role hazard to SIS professionals, especially by bigoted publically celibate but privately sexually active religious repressive authorities. On the other hand those, who confine their testing to the more ambiguous blots, can never really detect somatic repression an important pathological defense mechanisms in the conversion disorders. Also, the HIT does not so readily lend itself to behavioral therapy treatment programs involving gradually increasing exposure to conditioning like higher affect intensities of SIS activated sexual imagery.

Because the SIS has a degree of non-pornographic sexual structure, the procedure facilitates sexual studies. Sahay & Srivastava (1994) used SIS to study Male Transsexuals. Dwivedi et al. (1998) used Somatic Inkblot Series-Video in a 22 years old young, unmarried, graduate lady who had reported history of sexual abuse. The SIS responses revealed her traumatic experiences. Her hatred and aggression along with feeling of helplessness and craving for protection were brought out. The SIS procedure worked as a time machine and took her back in time, helping in processing unprocessed painful material. After therapeutic intervention she reflected a lot of positive changes in her total outlook. SIS was also found successful trerapeutic tool in treating a homosexual case (Dubey et al, 2012).

Pandey et al (2003) reported the diagnostic utility of sex responses with extended quantitative scoring criteria. Three groups of psychiatric patients viz, anxiety neurosis, paranoid schizophrenics and undifferentiated schizophrenics (N=25 in each group) and a group of age matched normal control (N=25) were individually tested on SIS-II. The obtained protocols were scored for 1) Sex responses on sex-images, 2) Sex responses on non-sex images and 3) Non-sex responses on sex images. Analysis revealed that partitioning of sex responses on sex and non-sex images provided diagnostically more rich information compared to the conventional scoring of total sex responses on all the 62 SIS-II images. 'Sex responses on non-sex images was found to be diagnostically redundant component and responsible for lowering the diagnostic efficacy of total sex responses.

Dubey, et al (2004) used Somatic Inkblot Series –II Booklet form to assess 30 cases of Psycho Sexual Disorder. SIS images proved to have pulling power to bring out the inner cry of suffering patients, which they were not interested in sharing with others. The PSD subjects have shown normal productivity, keeping contact with reality, preoccupation with sexual imagery and more concern with body imagery. Psychotherapy along with sex education and medical intervention helped the patient to lead normal lives again.

Saldanha et al (2011) administered SIS-I on 40 patients with sexual problems i.e. inadequate penile erection for a satisfactory sexual interaction with females and premature ejaculation and compared the data with 40 normal individuals. SIS-I provides valuable insights to a clinician to understand the underlying anxiety status of an individual suffering from sexual dysfunction which can be effectively addressed with psychotherapy and medication.

Manickam, (2013) described the importance of content analysis and the penetrative power of sexual and anatomical responses in diagnosis on the Rorschach Inkblot test through a longitudinal case study of 14 years in a case of marital maladjustment. He further highlighted the use of the test is decreasing day by day because of poor training on the application of Rorschach test to clinical psychology students. Manickam & Suhani (2014) administered SIS-II to six couples who were referred for psychological evaluation for marital problem, sexual dissatisfaction and physical abuse. The female partners did not have psychiatric disorders and reported that their partners have either low sexual desire or sexual dysfunction. The findings showed that there was significant agreement in the scores of the couples except on Sex scores.

Cassell (2013b) reported a clinical case that examines the marital stressors activated when a husband develops paranoid delusions with dangerous suicidal/ homicidal impulses. He falsely portrayed that his wife is sexually unfaithful to him. The SIS-II booklet form of the test was administered to him and his wife. The SIS responses were able to bring out physical and sexual abuse during his childhood. The SIS responses also projected his wife’s fear of being murdered. The SIS responses further helped in therapeutic intervention. Cassell et al (2015) interpreted three dreams “where women viewed having male sex organ in their dreams” and interpreted as “It’s time to get to know your man side intimately. Explore it and get familiar with it in your daily life. No need to be scared or confused. You will only learn how to harness your power if you learn how to use it and make it part of your life.”

Prison Population:

As early as in 1956 Shanker (1956) appraised the profile of juvenile delinquents. Raychaudhuri & Maitra (1965a) compared normal convicted and incipient delinquent adolescents. Mukherjee, (1965, 1966, 1968) conducted a series of studies on different groups of prison population. Majumdar & Mukherjee (1969) examined some of the ratios of the Rorschach test profile of the convicted prisoners and Sharma, (1969) compared the color pyramid and responses on Rorschach test. Sethi, et al. (1971) appraised the psychopathology of murderers using the test.

Yadav (1977) observed that the Rorschach protocol of criminals convicted for rape, robbery and murder showed low productivity (low R), low intellectual efficacy, rejected more cards, showed casual interest to test situation and gave a few movement, W and P responses. Rangaswami (1982) studied the hostility measure of the test on three groups of prison population and found that the hostility measure on Rorschach was positively correlated to the hostility measure of the Hospital Hostility Questionnaire. The test could differentiate the three groups of convicts who were diagnosed to be schizophrenics, non-convicts who were schizophrenics and control group that consisted of persons with no psychiatric disorder.

Singh et al (2001) administered the Somatic Inkblot Series-II test to 30 professional murderers and the result was compared with normal subjects. The findings suggest that the SIS-II is a powerful psychological test to discriminate murderers from normal population.

Physical Illness:

Though the test was used with people with different physical illness in the initial period, it was not used later with the physically or psycho somatically ill population for research. This could be due to the fact that the clinicians who worked in the medical or general hospital setting were less in number. Even the low number of professionals who worked in medical set ups might have other professional functions as their priority that dissuaded them from exploring the worth of the test. Moreover, psychological intervention for patients with different physical illnesses are not given due importance in the medical setting by other specialists. Therefore, there might have been less referral to the psychologists for evaluation that led to the less output in research with the test from medical setting. Ardhapurkar, et al. (1967) evaluated the profile of patients with ischemic heart disease. Ardhapurkar, et al. (1974) in another study appraised the Rorschach test responses of patients with bronchial asthma and Dutta, et al. (1976) investigated patients with peptic ulcer. Pandey (1995) used SIS to study Alexithymia and found it an excellent projective measure.

Nehra et al (1997) administered SIS-II to find out the personality and inner cry of patients suffering from speech defects. 18 cases having speech problem, in the age range of 15 years to 64 years with the mean age of 27.44 years were administered SIS-II individually. The results showed greater number of R, low rejection of images, disturbed interpersonal relations with somatic preoccupation (higher anatomical, but lower sex responses with moderate human and most typical responses). The cases that rejected more images were also found to give low number of responses and most typical Reponses.

Cinzia & Ferro (1998) used SIS-I card form and Cognitive Behavioral Assessment on 30 hospitalized female obese patients, in the age group of 20-59 years. Results suggest that (a) Subjects with high scores of psycho-physiological activation, depression and anxiety gave greater number of anatomical content and typical responses. (b) Higher scores on neuroticism and psychoticism were associated with lower number of dehumanized content. (c) Anxiety and fear contents responses were associated with sexual content. (d) Lie scores were associated with lower pathological emotional content. Verma et al (2000) studied body distortion reflected through the perception on projective techniques like inkblot test and human figure drawings.

Khromov (2001) compared aggressiveness (Buss and Durkee), emotional state (SUPOS-8, Miksic),and projective body images (SIS-I, Cassell) on 19 subjects with Achondroplasia, 18 with traumatically shortened extremities, and 95 healthy subjects in the age range of 17 - 20 years old. The data was analyzed contextually and statistically. The most valuable information was discovered from the projected responses of SIS-I technique, which represents the ego-body-image. No other technique was able to get this. The subjects with Achondroplasia gave fewer movement responses. Some responses were replaced by an image that suggested, “I’m small” (i.e. pussy cat). The correlation of such images was 17- 6 - 3 for each group of 10 subjects. The body image for such subjects was evident only at the subconscious level, which allows them to keep a good self-esteem. The main psychological features of dwarves were superseeding somatic images, inadequacy and infantilism, increased sensitivity and an attachment to other people. Subjects with an acquired orthopedic defect have clear images of the deformed body at the conscious level, causing frustration, a high level of physical and verbal aggression, negativism and an extra-punitive reaction.

Nicolini (2002) studied corporeal perception in 41 obese female subjects, under diet therapy. A possible organic cause of the weight increase has been excluded. The projective SIS-I and EDI-2 Tests have been administered to have a psycho diagnostic evaluation. The main objective of the presentation is to compare the results of the two tests and carrying out the thorough qualitative and quantitative analysis of the SIS-I protocols. At the end a case of 37 years old female subject using SIS-I and EDI-2 is discussed for the better understanding of the tests. It may be concluded that the dissatisfaction of the Obeys subjects for their own body can be seen both by EDI-2 and the qualitative and quantitative analyses of responses of SIS-I test. As a matter of fact obese women of the present study find difficulties to integrate parts of their own body and particularly to assimilate female traits in a gestalt form. It may be further brought out that the obese women perceive a disharmony between the experience of their real body and their ideal body. The low level of impulsiveness that is noticed on EDI-2 is supported by low affective interpersonal relationship indicated on SIS-I test and in the clinical interview. The particular case study in question indicates her body anxiety, aggressive attitude, sexual conflict and disturbed interpersonal relationship. It further validates the efficacy of Somatic Inkblot Series and it’s pulling power to bring out on the surface deep-rooted problems, needs therapeutic intervention.

Cassell & Dubey (2004) studied three cases using the SIS Card form. The first case explored the notion that when the cardiovascular system is activated by exercise or emotional stress, the resultant sensory feedback lowers the perceptual threshold for visualizing SIS cardiac content. The second case introduced the potentially new diagnostic category “Body Phobia” and illustrates how during deep relaxation, SIS stimulated imagery can provide an effective Cognitive Behavioral treatment aide. The third case examined the relationship of body consciousness, and heart rate in newly hospitalized patients who experience Schizophrenic Disorder. It reveals how psychotic patients experiencing high sensory feedback from tachycardia can become unduly conscious of the heart and develop related somatic delusions.

Cassell & Dubey (2004a) further emphasized that a SIS consultant can provide rapid and comprehensive diagnostic/therapeutic consultation to clinicians in various parts of the world. Relatively immediate consultative aide is readily available through modern electronic communication technology (e.g. FAX, e-mail etc.). This article outlines certain underlying neural mechanisms underlying inkblot projection in SIS consultation. For illustration purposes, it assesses the SIS-II Booklet responses of a 47-year-old man in treatment at the University Psychosomatic Clinic in Ulm, Germany. The projective assessment was done “Blind” with no direct access to the overall clinical records. When done in this manner, the interpretations and management recommendations are essentially unbiased. This gives a measure of additional validity to the SIS consultant’s “second opinion”. The man was free of cardiac illness, yet was unduly concerned about his heart. In completing the brief health questionnaire on the last page of the Booklet, he indicated that his main concern was “heart trouble and pain.” In regard to the enquiry about mental problems in the questionnaire, he noted “depression and thoughts of suicide.”

Lal (2004) used SIS-II to explore the differences in personality characteristics of a group of 25 physically disabled and 25 normal adolescents drawn from a Rehabilitation Center for Disabled at Jaunpur. Analysis of data revealed that disabled adolescents have poor interpersonal relationships, feels socially isolated, psychologically immature, poor self- image, poor ego strength, thought blockage and inability to think properly. The responses given by disabled on pathological scale reveal excessive concern about physical health, depressed emotional state, more hostility and aggression. They also experience exaggerated sense of self- consciousness in social situations.

Chaudhury et al (2009) administered SIS-II to evaluate psychological distress and psychiatric morbidity in patients with fractures of upper and lower limb. The study included 100 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal subjects. The analysis of the SIS II profiles indicates that the limb fracture patients and normal controls did not differ significantly on R. The groups were also found to be similar on animal responses, anatomical responses, and movement responses. However, significant differences were found on H responses. Sex responses and Atypical responses were more in the patient population than the normal subjects.

Bhogta et al (2014) investigated the personality profile of 30 patients suffering from thalassemia and 30 normal using SIS-II. The findings reveal significant differences between Thalassemia and Normal groups on Total number of responses, Human (H), Animal (A), Sex, Movement, Most Typical, Typical, Pathological Anatomy Scale, Depression and Hostile & aggression responses. Singh & Mukhopadhyay (2018) administered SIS Card form to 20 parents of diagnosed children with ADHD symptoms (5-12years) The findinds indicated high animal and anatomical response indicating lack of socialization, frustration and preoccupation to inner body parts thereby projecting somatic anxiety. Higher percentage of typical responses and human response denotes a balance between the personality and family pathology of parents of ADHD children.

Therapeutic Intervention and Dreams:

There are not many studies that looked into the therapeutic usefulness of the Rorschach test, though clinicians tend to make use of symbolic Content Analysis in psychotherapy. Consistent with this approach, the Somatic Inkblot Series has been extensively used as an aide to psychotherapy with encouraging results. Rating the projected responses on an anxiety threat hierarchy has been found to facilitate the early exploration of the most clinically relevant stressors. In addition, exploring the symbolism, permits the therapeutic processing of deep seated distorted dream for cognitive correction and realty testing (Cassell 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003,) Dosajh, 1995, 1996, 1997, 1998; 1999, 1999a, 1999b, Dosajh & Dosajh, 1999) Cassell & Dubey, 1996, 1997a, 1997b 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2014).Cassell reported in many instances that those so helped spontaneously, responded that “I guess you have made this test particularly for me” (Cassell, 2004, 2005, 2006, 2007, 2008, 2009, 2010). Other therapists have observed similar promising results (Dubey, 1977, 1983, 1986, 1992, 1993, 1996, 1997, 2000, Kumar, 2010, Singh, et al, 2010). It has been observed in grief work that the procedure opens up for expression the individual’s previously inhibited “inner cry”(Cassell et al, 1996, 1997, 1998, 2003).

At this stage the plan is to investigate with controlled statistical based studies. Reviewing the studies conducted on different groups it appeared that some of the research was conducted due to the easy accessibility of the sample rather than answering or exploring a pertinent research question. However SIS and Rorschach test continues to be used as a tool for personality assessment and diagnosis of different types of mental disorders (Verma & Misra, (2002). Dosajh (1995, 1996, 1997, 1998) used SIS-II to study the efficacy of the test in the treatment of schizophrenics and found it to be a very sensitive instrument for psycho diagnosis and psychotherapy.

Singh & Dwivedi (1997) administered Somatic Inkblot Series-II (SIS) to a 35 years old, educated, married lady who was suffering from ulcer. SIS brought out her cold feelings for her husband, conflicting family life, broken love affair, affectional deprivation and suicidal ideation. SIS worked as a time machine and helped her in processing a lot of unprocessed unconscious material.

Cassell & Dubey (1997) used Somatic Inkblot Series-II video to an adult woman who was suffering from depression. After viewing the SIS-Video she dreamt about an early life traumatic experience in which she witnessed her 18 months old brother being killed by sled dog. Due to her limited verbal skill at the age of 3 years and the emotional unavailability of her parents, who themselves were grief stricken; she could never share this experience with anybody before the administration of this test. This suggests the power of somatic inkblot images not only as a diagnostic tool but also a therapeutic aid and a remarkable time machine.

Cassell (1998) has emphasized the pulling power of SIS images. SIS enables clinicians to release the “inner cry” of suffering individuals. Unlike most other projective tests, the SIS asks the subject to rate responses on an anxiety – threat subjective retag scale. It specifically determines in order, the three inkblots considered to be most disturbing. The one ranked highest has subsequent post –traumatic dreams of such events. Using that SIS inkblot on the answer sheet as a stimulus object for projective perception, the therapist has the capability to retest situations of activating post traumatic imagery for therapeutic reprocessing. Television viewing prior to sleep can be particularly effective in stimulating the emergence in full consciousness of long forgotten posttraumatic dreams (Cassell & Dubey, 1997). The latter may then become available for subsequent therapeutic analysis and resolution with the assistance of a trained therapist. Further the SIS Video was used to stimulate clinically effective psyche beacons for therapeutically guiding meditation. Some of the theoretical background for this approach has been outlined in SIS Journal (Cassell et al, 1997). Cassell et al (2000) used the SIS-Video to study the effects of psychological trauma in two adolescent females. The first was an adolescent Jewish girl who was traumatized in a German concentration camp at Aushwitz and interviewed as an adult survivor. The second involved studying a hospitalized adolescent girl suffering from Dissociative Disorder. In both instances, the SIS technology provided a type of "time machine" for releasing long forgotten emotionally painful feelings and memories.

Savage (2001) administered Somatic Inkblot Series-I to three patients who were not responding with medical treatment. The SIS was able to identify deep seated conflicts which patients were unable to uncover through conventional therapy. The usefulness of therapeutic tool of reframing along with hypnotic relaxation is also demonstrated with the help of case studies. Savage (2003) further administered SIS and Hypnotic relaxation in a case of Child after the traumatic experience of the divorce of his parents. This case history illustrated that the SIS is a very effective as a psychodiagnostic tool and therapeutic aid. The therapist was able to help the patient to resolve his underlying conflict of his perceived rejection by father.

Mishra & Mishra (2001) administered SIS-II to 18 years female college student who had lost her mother in the early childhood and was staying with her uncle who had no children. She had difficult relationship with her stepmother. Her responses to SIS images were able to bring out her inner cry and depressed feelings.

Cassell et al (2001) demonstrates the application of Somatic Inkblot Series (SIS-II Booklet). The test Image A3 is in a monochromatic bluish gray color and the form is suggestive of a cross. For many devoted Christians this can stimulate spiritual imagery and affect in consciousness, activating healing. The image significantly contrasts with many traditional artistic representations of Christ‘s crucifixion, which are highly structured and leave little to the imagination. With abstract symbols, such as this SIS inkblot, there is an enhanced potential for the external visual stimulus to tap into the Dreamer’s deep inner well of divine spirituality. In employing this approach it must be remembered that different religions have their own unique symbols and rituals. SIS therapists must be open minded and unbiased in order to employ these for spiritual healing. It is not our role to change or convert any suffering individual’s religious orientation. Rather, we need to foster healing by optimally activating the person’s religious symbols in the therapy process. Those suffering should be encouraged to have reverence for spirituality arising spontaneously through dream imagery for themselves and their loved ones.

Singh & Mishra (2001) administered the Somatic Inkblot Series-II to a 20-year-old male student of graduate level who had a history of masturbation for last 3 years. Because of this habit he developed guilt feeling and had a fear of failure. He got familiar with a female classmate but never had physical relation with her. He developed symptoms of withdrawal, avoiding meeting people, lack of interest in study, feeling of insecurity and odd thinking to commit suicide. He was given re-educative psychotherapy to channel his energy to academic activities. The result was very positive and the subject showed significant improvement. His suicidal ideation has gone and he has developed positive attitude towards life.

Cassell et al (2002) used Somatic Inkblot Series Video, Rorschach Inkblot Test and Figure Drawing tests to a 15-year-old girl who was admitted for treatment of Major Depression and Dissociative Reaction. She had history of suicidal ideation and self-mutilation of her left wrist and forearm. The relaxing instructions in the video and the hypnotically present healing flowers may have facilitated neural extinction of the terrifying hallucinations intruding upon her consciousness. The Figure Drawing and Content Analysis of SIS and Rorschach may provide useful aides to supplement standardized clinical interviewing techniques. Dubey (2003) emphasized the application of SIS as an electronic aide to assessment and therapeutic intervention.

Cassell et al (2003) used SIS in interpreting symbolism in dream and emphasized that every night we spend several hours in the mysterious inner world of our dreams. Those with an innate sense of curiosity have long been fascinated with the meaning of the images and affect experienced during this altered state of consciousness. The present case study explores symbolism in a devil dream of a severely depressed adolescent girl hospitalized after experiencing suicidal and homicidal ideation. She was interviewed using the Rorschach and SIS stimuli as sources for visual stimulation of daytime imagery. In the present study it may be inferred that “Lucifer” embodies both her mother’s abusive nature and that part of the adolescent’s personality identified with the mother. Her extreme hatred and homicidal ideation was also symbolized through SIS responses.

Manickam & Suhani (2003) administered SIS–II to 41 years male client who had the diagnosis of somatoform disorder. SIS -II protocol showed repression of sexual responses and rejection of several images. Giving feedback about his responses helped in breaking the resistance and bring out repressed unconscious material. In the following session he revealed his incestuous sexual experiences and the repressed guilt about it. Resolving the conflicts helped the patient to be free from the symptoms over a short-term integrative psychotherapy. Manickam et al (2004) used SIS Booklet form for assessment and therapeutic intervention of a Dissociative Convulsive Disorder patient of 24-years male, who was successfully treated in three sessions. SIS showed severe repression of sexual impulses by rejecting all the images, which are likely to evoke a sexual response. A conscious denial of sexual responses prompted to challenge the patient at the initial and early phase of the therapy without threatening the ego functions. Further interview helped the patient to disclose his unprotected homosexual and heterosexual relationships and his anxiety related to sexually transmitted infections including HIV. A dramatic cessation of the pseudo seizures following the session prompts to make use of the SIS technique at the appropriate time in psychotherapy, in order to reduce the cost of treatment and care of psychological disorders.

Vimal & Mishra (2003) administered SIS-II to a 44 years male contractor, who was having uncomfortable and peculiar sensations in stomach, chest, head and heart. He was found normal on different investigations. Responses on SIS revealed his disturbed relationship with his father, maternal deprivations and preoccupation with physical symptoms. Significant responses on SIS are discussed in the case study. Vimal (2004) administered SIS-II to a 19 years college student. He had complaints of feelings of sadness, excessive crying, dejection, hopelessness and lethargic behavior. SIS responses were able to bring out his aggressive attitude towards parents, suicidal ideation and low self. Therapeutic intervention helped him in developing positive attitude and hope for better future.

Cassell & Dubey (2004) summarized three cases using the original 12-card form of the SIS. The first case explored the notion that when the cardiovascular system is activated by exercise or emotional stress, the resultant sensory feedback lowers the perceptual threshold for visualizing SIS cardiac content. The second case introduced the potentially new diagnostic category “Body Phobia” and illustrates how during deep relaxation, SIS stimulated imagery can provide an effective Cognitive Behavioral treatment aide. The third case examined the relationship of body consciousness, and heart rate in newly hospitalized patients who experience Schizophrenic Disorder. It reveals how psychotic patients experiencing high sensory feedback from tachycardia can become unduly conscious of the heart and develop related somatic delusions. Cassell (2005) studied four case histories to illustrate how the SIS can provide important information regarding violent fantasies (Cassell & Dubey, 1998, Cassell, et al, 2002). The direct and symbolic imagery projected can provide new insights enriching those obtained with standard clinical interviews. We also must learn how to more effectively incorporate its spiritual applications into clinical practice.

Dubey & Dubey (2005) administered SIS test along with Progressive Muscular Relaxation (PMR), Shav Asana and GSR Bio-feedback for 10 days. The results suggest significant increase in Most Typical (MT) and Human responses (H) and decrease in Rejection of images (Rej), Atypical (AT) and Pathological (PAS and HAS) responses. The SIS-I profile is shown and the effect of Progressive Muscular Relaxation and Shav Asana is discussed.

Cassell (2006) used Somatic Inkblot Series-II Vide to examine two clinical case histories of individuals whose erroneous premarital perceptions made them vulnerable to unsuspectingly entering a highly traumatic marriage. Eventually each experienced psychiatric and medical problems. The first case involves a woman who married a sociopath, who intentionally presented a false positive social image of himself. Ultimately he became homicidal and she was fortunate to survive with her life. The second involves a successful business man who married a woman who appeared normal. Unbeknown to him, she had Borderline Personality Disorder (BPD). His marriage took him to the edge of bankruptcy and for a while shattered his mental health. The SIS images were helpful in processing the traumatic memory and accepting the reality of life. Cassell and Dubey (2006) administered SIS Video to two cases: The first study examines the case history of a severely traumatized 17 years girl whose homicidal behavior led to psychiatric hospitalization. The second case was a fourteen-year-old Black youth with history of violent behavior. The Somatic images were able to bring out aggressive imagery and relevant unprocessed repressed material helpful during therapeutic intervention. The interview with patients and significance of somatic images are discussed in the paper.

Cassell (2007a) presented a case history of a man suffering from Exhibitionism illustrating his phobic like avoidance of somatic-inkblot structure suggestive of sexual content. A follow up interview using intravenous barbiturate induced sedation combining psychotherapy and behavioral therapy is described in the paper. Cassell (2007b) further administered the SIS to activate projective awareness and regionally specific anatomical imagery underlying psychophysiologic symptoms. A case history-involving premature ejaculation using Jacobson-deep muscle relaxation to facilitate-desensitization therapy was described. Results suggest that a combination of cognitive and behavior therapy in association with the use of pharmacologic relaxation was helpful. Cassell & Dubey (2007a) studied a case after administering SIS and Sand Tray technique for an educational television interview with a practicing child psychiatrist and Jungian trained analyst.

Radheshyam (2007) administered SIS-II to a 26 year old medical practitioner. His presenting symptoms at initial psychological evaluation were insomnia, loss of appetite, excessive sweating, restlessness, difficulty in concentration and lack of interest in self and work. The responses on SIS projected his aggression and inner cry. SIS further helped in expressing himself, and in recovering from the financial and emotional trauma. The treatment plan involved eight sessions of Rational Emotive Therapy supplemented by introducing SIS symbolism in the therapeutic process. This combination appeared to have marked therapeutic effects. He reported considerable improvement in mood, cognition and a significant reduction in depressive symptoms. Radheshyam et al (2009) further administered SIS-II to a 21 year old female medical student, initially diagnosed with BD in her early teenage. At that time she was initiated on mood stabilizing medication which enabled her to continue her studies. During later adolescence there was one stressful episode worthy of comment. During a depressive phase because of poor motivation, she received an unusually low grade in class 5 on a term examination. With the prompting of a boy in her class and to avoid her family discovering it, she tore up the report. After learning about this incident, her teacher ordered her to inform her parents. Fearing their angry response, she stayed away from classes for a month in a stressful state of “terror”. This SIS Images helped in tapping into rich healing streams of natural spirituality not reachable by non-projective techniques (Cassell, 2012, 2012a, 2013, 2013a, 2013b, 2014, 2014a, 2015, 2015a, Cassell & Dubey, 2012, 2012a, Cassell et al, 2013, 2013a).

Cassell et al, (2009) administered SIS Living Images Test to a severely depressed woman who was admitted to a psychiatric hospital because of serious suicidal ideation. On the day of admission a standard psychiatric interview established an initial diagnosis of Major Depression. The following day new information was obtained with regard to the release of traumatic memories. The SIS Images helped in processing the traumatic material and therapeutic planning. Cassell et al (2009) demonstrated “How to Delete Viruses and Reconfigure the Brain's Hard Drive”. In an analogous fashion to computer viruses, these are verbal messages and externally implanted cognitive/emotional/behavioral codes of a negative nature. The SIS web site capitalizes on the power of ambiguous pictures to stimulate imagery ranging from the positive to the negative. The SIS Center has a video illustrating the former entitled “Poppa”. This was designed to program positive paternal dreams at bedtime. If abused, physically, psychologically or spiritually, the child may incorporate this negative input into the self-image. Later in life, a trauma victim may be prone to acting out this implanted code on immature subjects or vulnerable adults.

Cassell & Dubey (2010) administered the SIS-II Video to an American Vietnam veteran suffering from PTSD. Like many such military veterans, he had never sought treatment for his own mental symptoms. He had been deeply depressed and suicidal. The SIS images helped as a psychotherapeutic aide in reprocessing combat related long term traumatic material.

Mitra & Sanyal (2010) tried to provide an integrated understanding of different theories while understanding the psychopathology of a single case. It is argued that such an understanding can help in effective treatment process as the therapist can be more flexible, empowered by a more in-depth understanding of the phenomena that arise during the process of psychotherapy. The SIS test was used to tap the unprocessed unconscious material in treating patients (Gupta & Singh, 2012; Manickam & Suhani, 2014; Cervigni, 2013; Dasgupta, 2013; Dasgupta et al, 2012) with encouraging results. Mitra & Sanyal (2015) highlighted the role of cultural basis of psychopathology and modified therapeutic stances with the help of case studies. People from different cultural contexts are expected to define and experience reality in different ways. The views of therapies developed in the western individualistic culture and Indian collectivistic culture are strikingly different. Therefore, to successfully treat the patients reared up in Indian culture, the therapist – mostly trained in therapies developed in the west – must remain aware of these influences and approach them in a way that is congruent to their belief system. The case presentations illustrate religious and cultural factors markedly influenced the therapeutic intervention.

Cassell & Dubey (2012) studied “spiritual warfare” - a symbolically deceptive religious practice that can rob primitive people of their historical culture/dream based positive spiritual symbols. Throughout recorded history, powerful authoritarian leaders have either openly, or deceptively, inflicted their religious/political views on the minds of weaker subjects – especially those of vulnerable children. Inkblot evoked images can highlight otherwise hidden aspects of the inner emotional world of humans. These may reveal to the professional, past traumatic events and unexpressed distressing emotions which might, otherwise, only surface in disguised symbolic dreams. A clinically effective variation of the SIS procedures involves administering these, at bedtime, to stimulate dreams revealing material otherwise unreported in traditional clinical interviews. Thankfully, such innovative work has flourished in India. This country has long been revered for its rich contributions to depth psychology, meditation and healing. People from around the world have traditionally traveled there to acquire skills as practitioners of Yoga. Image focusing exercises have long been effectively taught by the Indian experts. Practicing the traditional techniques eventually can lead to positive health effects.

Cassell (2014) in his Editorial expressed “seemingly boundary less body-mind spiritual field having Cosmic time, energy and space dimensions has a very long history. Historically, it is traceable to my deceased anthropological professor Ernest Becker theoretical views published in his 1973 Pulitzer Prize winning book “Denial of Death.” He brilliantly described how humans utilize the psychological defense mechanism of denial to avoid such futuristic focused morbid somatic introspection. As a follow-up introspective illustration, I will now share a vivid “Death Dream” that strongly suggested to me viewing an “Afterlife” mystical continent. The dream emerged in nocturnal consciousness beginning with the following visual imagery and feelings: My body seemed to be moving magically through the air at a high elevation over an ocean like body of water. I was amazed to observe young people floating in spiritual space above it …then on an emerging island-like configuration below, I witnessed the figures of two adults, as though their bodies we defining a gate-like entrance to the space below… they were observing my floatation through psychic dream space…then a manuscript appeared documenting my many published insights into the clear relationship between nighttime dream imagery and inkblot projective responses… next my theoretical writings in a magical like fashion floated up in psychic space…these appeared to be permanently documented on what resembled an ancient stone tablet form…I held this in my hand to for viewing by onlookers whom I did not see, but somehow sensed to be watching …the words were clearly written…they documented certain specific projected symbols, that I had previously in the reality of the planet earth had written for SIS scientists to understand my previously published work documenting SIS body-mind-spirit theory. Next my mood changed from positive feelings to one of mild frustration/irritability and sadness… I became saddened observing that most viewers floating by in the dream’s spiritual dimensions seemed somewhat detached and unappreciative of the diagnostic/ healing power of SIS symbolism.

Cassell et al (2015) used SIS in interpreting three dreams. The images brought the suppressed unprocessed unconscious material hidden in the store house of unconscious mind. Its symbolic interpretation helps in understanding the inner world of the dreamer. Symbolic interpretation may further help as an aide in therapeutic management of the patients

Sanyal (2016) emphasized the power of projective procedure and wrote that the world of projection radiates the internal elements in the subjective coloration of one’s own schema. Schema-content is once again the product of sensorium-transmitted external objects. The frames and fringes of projection need tender care to understand one’s internal contents and dynamics of personality. Such understanding differentiates between healthy and pathological frames of personalities. Assessment of mental health offers beads of comfort and, in their integration, a productive person for the society. Pathology, detected through projective techniques, opens up the gates of connection to initiate productivity in a person. …Psychology as science offers the avenues to accept traumas with grace, to attain and maintain stability in life. It also helps us to fathom the deep layers of hidden mind through projective assessment techniques. These are doors of self-knowledge that need to be kept open to usher in positive approaches to embroider the soothing fringes of personal experiences. We blame others in our frustrations without realizing this may be one’s unrealistic expectations that are getting baffled in the process or else, this is the blamer’s own projection in the form of projective identification on to someone else. True logical perspective developed within oneself is the “mantra” of attaining peace and escaping the clutches of mis-readings leading to pains. Projective techniques are just not to know “others” in totality, but also to peep into one’s own world, develop self-knowledge to adopt right cleansers, to attain a crystal-clear mind. Kumar and his associates used Cognitive Drill Therapyand SIS images to treat various forms of phobia, anxiety and other problems and reported satisfactory results (Dwivedi & Kumar, 2015; Kumar,2010; Kumar & Dubey, 2016; Shabina et al. 2018, Verma et al. 2017, 2018).

Norms:

Several researchers have attempted to develop “Indian” norms of Rorschach responses. The earliest attempt was by Asthana (1950b) and he also (Asthana, 1950a; 1963; 1971) provided norms for groups of population. Somasundaram, (1964) attempted to develop norms for the population in Kerala. Prabhu (1967) also provided norms of some of the indices for the adult population. Jain & Prakash (1967) explored the linear correlation between Sum R and other indices in order to establish norms and Kumar (1962c) listed the popular responses on Rorschach for different groups of population. Though Rorschach test stimulus can be considered culture free, the response pattern is influenced by culture. Singh (1975) reported the difference in the responses of tribal population from two types of culture contact area. He administered Rorschach test to 100 tribal population of Gadeba living at Karapat, in Orissa State to two groups, one with more culture contact and the other with least culture contact, the number of responses given by both the groups was observed to be below the average. The content of the responses also showed significant diversity. Hence there is a need for developing norms for different population (Manickam, 2004). D’Netto, et al. (1974) and Dubey (1978, 1982) found the average response of the army personnel to be 16± 6.5 and it is significantly lower than Klopfer (R 20-45) and that of Prabhu (1967) (28.5 ± 9.71). Singh et al (2005) established Beck’s Norm of Rorschach on Indian Population. They administered Rorschach on 100 normal subjects in the age range of 18-50 years; both male and female with minimum education up to 12th standard. Results suggest that the findings of Indian studies do not match with the norms suggested by Samuel Beck. It further emphasizes the need of Indian Norms on larger population.

Chaudhury et al (2005) administered Rorschach test following Klopfer’s method to 450 children and adolescents in the age group of two and half to 16 years. Rorschach protocols of normal Indian children and adolescents at different age groups showed significant differences for each other and also for the western norms. Interpretation of Rorschach protocols of normal Indian children and adolescents using the western norms would be fallacious and misleading. Use of the Rorschach test to study developmental trends of normal children and adolescents were strongly supported.

Chaudhury et al (2006) further administered the Rorschach test following Klopfer’s method to 1256 subjects consisting of 300 normal army personnel, 300 normal civilians, 250 schizophrenics, 300 neurotics and 106 patients with organic disorders. The Rorschach protocols of normal Indian army personnel and normal civilians showed significant differences from one another and also from the western norms. These differences are culturally determined and are not indicative of low intelligence or psychopathology. Patients with schizophrenia, neurosis, head injury and epilepsy show significant differences from the records of normal subjects. The protocols of army schizophrenics show significant deviations from those of normal army personnel and these changes revert to normal with clinical recovery. The Rorschach test is not a culture fee test as claimed earlier. In view of the differences from Western norms, Rorschach protocols of Indians should be interpreted using the norms for Indians. In case of army personnel, the norms on army personnel should be used (Dubey, 1978, 1977, 1982).

Singh (2007) investigated the pattern of responses on SIS-II in normal high school male and female students. The sample comprised of 100 male and 100 female high school students. SIS-II was administered individually. The mean, SD, and t-ratio were computed to compare the two groups. The Mean profile of Male subjects was found to be total Responses: 59.73, Human Responses: 12.91, Animal Responses: 5.63, Anatomy: 18.48, Sex responses: 1.73, Movement Responses: 1.42, Most Typical Responses: 11.15, Typical Responses: 22.99, Atypical Responses: 2.28, Rejection of Images: 2.19, PAS: .53, Depression: .17, HAS: .92 and Paranoia: .01. The Mean profile of Female subjects was found to be total Responses: Mean= 59.89, Human Responses: 12.15, Animal Responses: 7.15, Anatomy: 10.52, Sex responses: .75, Movement Responses: 1.87, Most Typical Responses: 11.55, Typical Responses: 21.71, Atypical Responses: 1.91, Rejection of Images: 2.05, PAS: 72, Depression: .56, HAS: 1.13 and Paranoia: .01. However, the Most Typical Responses was slightly lower than Cassell and Dubey (2003) who reported a mean of MT as 12+.

Content Analysis:

Though different authors studied the response patterns, indices and the profile, systematic research on Rorschach’s content analyses is yet to be undertaken. Content wise, D’Netto et. al., (1974) observed that military personnel gave responses related to military environment. In clinical situation, the ‘content’ of the responses do influence in formulating the differential diagnosis and is of much assistance to predict the outcome of psychotherapy and its prognosis. Noble Laureate Prof. Erik Kendel (2005) has mentioned “psychoanalysis still remains the most intellectually satisfying theory of human mind”. In this contention we need to follow Eagle’s (2007) view that, Psychoanalysis cannot be a self contained discipline but instead must open to influence from integration with findings and theory from other disciplines. The responses given on various images should be analyzed content wise and symbolically (psychoanalysis) to understand the personality and psychopathology of the case.

Most of clinicians in India depend on the content analysis provided by the researchers from western countries. Responses like Xmas father (Card II), Xmas tree Card VIII, cross, (Card VI) vampire (Card I, IV, V) court of alms (Card VIII) ‘after math of September 11’ (Card IX) responses are given by subjects who are Hindus by faith and hailed from urban, multi religious background. Subjects from Christian and Islamic faith orientation also gave responses like ‘temple tower’ (Card II) and ‘lamp that is used in temples’ (Card II, Card VII). With computerized scoring system and analysis, it might be much easier to conduct studies on content analysis. A multi-centered study to elicit the content profile of both clinical and non-clinical Indian population may be initiated (Manickam, 2004). Cassell & Dubey have published about 50 cases (in SIS Journal of Projective Psychology and Mental Health, 1994-2017) using content analysis of Rorschach and SIS responses. They have emphasized that content analysis helps in peeping through the inner deep of unconscious and hear the inner cry of suffering individuals. Without content analysis Inkblot responses carry no meaning.

It may appear paradoxical to observe that the research related to the test flourished until clinical psychologists “took over” it and after that it showed a declining trend. One of the factors for this phenomenon may be the attraction of young clinical psychologists towards the emerging science of neuro-psychology and behavioral intervention strategies within the ambit of clinical psychology in India. This led to side lining of psychodynamic psychology and to the “unconscious” rejection of the psychodynamic process of the clients. With that the projective tests altogether and Rorschach test in particular slipped into a dormant phase (Manickam, 2004). It is also likely that with the introduction of Somatic Inkblot Series (SIS), clinicians and researchers prefer to use SIS, which is less complicated and found more useful than the Rorschach test particularly for personality assessment and therapeutic intervention (Cassell & Dubey, 1994, 2003).

Test Improving:

Research on improving the scoring methods has not been much attention. Pershad & Dubey (1977, Dubey, 1982) criticized the scoring method of Rorschach and suggested that the interpretation should be based upon the number of Responses. In order to study the productivity on Rorschach protocol, they suggested the need to differentiate between low, medium and high number of responses than focusing on low and high number of responses. Dubey (1985, 2005) analyzed the discriminating capacity of the test regulating the number of responses and Dubey & Pershad (1978b) controlled the responses of the test to observe the shift in clinical significance.

Apart from these, Dr. Cassell has suggested an additional approach for clinical use with the Rorschach Test. Initially the 10 Rorschach plates are administered in traditional order. However to establish anxiety threat hierarchy prior to the detailed enquiry, all 10 plates are placed face up on a table. The subject then is asked to select 3 most liked plates. Starting then with most liked the examiner request the subject to report everything seen and felt emotionally in relationship to the card. After wards this favored card is placed face down by the examiner on the table. This process is then repeated for the next favored card and then afterward for the third card which he selected as “liked”. This initial enquiry serves to reduce test anxiety.

Next the examiner asked the subject to select the card which seems “most disliked”. This enables the examiner to explore the responders’ imagination, memories and threatening dreams along with their negative affect valance. Then the examiner placed the card face down on the table. Next the response to the two remaining disliked Rorschach cards is similarly treated. Afterward, the remaining 4 cards are reviewed in detailed enquiry.

The same approach to content analysis may be used with the Holtzman Inkblot test. In fact, it is much more likely to elicit clinically relevant imagery and an affect. Ninety as oppose to ten incorporates many more stimuli which are more likely to trigger the release of responses idiosyncratic to the individual.

Future Perspectives:

Manickam & Dubey (2005) have suggested that keeping the diversity of Indian population, separate norms will be more helpful for different groups. The Indian population is too complex and cumbersome for a psychologist to work with (Manickam, 2004). Though many researchers studied the response patterns, indices and the profile, the systematic research on Rorschach’s content analyses is yet to be undertaken. Responses like Xmas father (Card II), Xmas tree Card VIII, cross, (Card VI) vampire (Card I, IV, V) court of alms (Card VIII) ‘aftermath of September 11’ (Card IX) responses are given by subjects who are Hindus by faith and hailed from urban, multi religious background. Subjects from Christian and Islamic faith also gave responses like ‘temple tower’ (Card II) and ‘lamp that is used in temples’ (Card II, Card VII).

Schulmeyer & Piotrowski (2017) interviewed 44 psychologists in Bolivia (South America) regarding tests used in the areas of projective, objective (self-report) personality, and behavioral assessment. The findings indicated Drawing techniques, TAT, Rorschach, MMPI, and Beck Inventories as top instruments used by them. In addition, there was strong emphasis on assessment using DSM diagnostic criteria. These findings corroborate scholarly reports on the continued reliance on both projective and self-report assessment practices worldwide (Piotrowski, 2015). Piotrowski (2017) reviewed the Rorschach research published in journal during 2000-2016 from the database of PsycINFO. The search identified a total of 838 peer-reviewed articles, of these, 747 were determined to be mostly ‘primary’ articles and served as the data-set for the analysis. The most prevalent researched topics were (in rank order): Norms, psychotic states, eating disorders, historical aspects, psychosomatic factors, treatment planning/outcome, aggression/hostility, personality, psychodynamic issues, depression, and personality disorders. Neglected areas of research were noted such as, assessment training, differential diagnosis, anxiety states, racial/ethnic differences, and social desirability. Despite an extensive repository of literature, the Rorschach remains an emerging area of study with an opaque sense of direction for future research.

Martin & Frackowiak (2017) have found that Psychological assessment and projective/performance-based assessment in particular, has seen a decline in recent years, both in training and clinical use. This trend is alarming and raises concerns about the loss of important clinical tools and its effect on the field of psychological assessment as a whole. Piotrowski (2017a) reviewed the literature regarding practice settings and indicated that, projective methods/techniques (PT) have been popular clinical tests and relied upon assessment tools in the mental health field in the USA. There is very recent evidence that projective assessment is currently a rather neglected evaluation approach by professional psychologists, with the exception of the Rorschach. At the same time, survey data from South America, point to the central role of PT in the assessment process in Brazil and Bolivia. The same can be said for Japan, but not Australia. Interestingly, despite a strong psychoanalytic bent, PT are rather ignored in most European countries.

Cassell & Dubey have published about 70 cases (in SIS Journal of Projective Psychology and Mental Health, 1994-2017) using content analysis of Rorschach and SIS responses. They have emphasized that content analysis helps in peeping through the inner deep and hear the inner cry of suffering individuals. Without content analysis Inkblot responses carry no meaning. Kumar (2015) has suggested different areas of research by clinical psychologists working on projective inkblot tests. However, there is need to establish department of training in existing pioneer institute of Mental Health / Clinical Psychology, to impart extensive training to students on the application of Rorschach test.