ISSN 0971-6610

SIS Journal of Projective Psychology

& Mental Health
Volume: 24 Number: 01 January 2017
Editorial 1-2
Wilfred A Cassell
Thematic Apperception Techniques (TAT, CAT) in 3-17
Assessment: A Summary Review of 67 Survey-based Studies
of Training and Professional Settings
Chris Piotrowski
Blood Pressure Variations and Emotional Dampening: 18-25
Preliminary Evidence for the Curvilinear Relationship
Dharmendra Jain, Meenakshi Shukla and Rakesh Pandey
Integrative Assessment of Interpersonal Dependency: 26-33
Contrasting Sex Differences in Response Patterns on Self-
Attributed and Implicit Measures
Adam P. Natoli and Robert F. Bornstein
Rorschach Research through the Lens of Bibliometric 34-38
Analysis: Mapping Investigatory Domain
Chris Piotrowski
Fairy tales: The Emotional Processors of Childhood Conflicts 39-47
in Dynamic Interpretative Lens
Nilanjana Sanyal and Manisha Dasgupta
Efficacy of Cognitive Drill Therapy in Treatment of Specific 48-51
Phobia
Bhavana Arya, Sandhya Verma and Rakesh Kumar
Response to the Blank Card of Thematic Apperception Test 52-56
(TAT) and its Correlation with Personality Factors
Anand Manjhi and Sunita Purty
Mindfulness, Emotion Regulation, and Subjective Well-Being: 57-63
Exploring the Link
Satchit P. Mandal, Yogesh K. Arya and Rakesh Pandey
Recovery-Focused Behavior Therapy (RFBT): A Case Study 64-68
Rakesh Kumar and Raj Kumar Sahu
SIS Society Honors Early Adventures into Space and Others 69-70
of Note
Wilfred A. Cassell
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SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is a refereed journal and
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 SIS J. Proj. Psy. & Ment. Health (2017) 24: 1-2

Editorial
In my Jan 2016 editorial I wrote about the time have more relevance to younger members of
limited aspects of the human body and hence our SIS Society than myself.
its occupant’s existence. Since then I have
In my relatively limited time left living on our
turned 82 years old and confess to readers
planet earth, I hope to move my life focus. I
that my psychological defense mechanisms
plan on investigating the relationship between
are weakening which earlier in life enabled me
the acting out of aggressive impulses and
to deny “Somatic Death”. Moreover this
imagery denoting aggression. I hope to
psychic blindness was dramatically weakened
conduct studies to correlate how specific SIS
in April last year, when my dermatologist
stimuli viewed prior to sleep might stimulate
informed me that I had a skin tumor lesion
clinically relevant dreams - especially those of
which was a form of cancer that untreated
a posttraumatic nature. The proposed
could sometimes metastasize. Fortunately a
research subjects will be both perpetrators of
plastic surgeon was able to effectively remove
aggression, as well as their victims.
it.
Human history is too replete with aggression
While this health related incident has led me
and warfare. At times there appears to be a
to focus on issues related to aging, I
strong evidence for relating acts of violence to
frequently tend to avoid this existential issue
sexuality. In animals this relationship is
at night prior to sleep by fantasizing. I imagine
witnessed every fall in Alaska. Then the
waking up in the morning living in a young
previously quiet male moose’s testosterone
man’s body with more time and energy to
surges thereby attracting him to females as
complete SIS studies. Caen Chaffee a movie
well as motivating him to fight off competitors.
producer symbolized this theme in a
production “The Curious Case of Benjamin For humans social norms in world cultures
Button”. In his fantasy film an infant child born, prevent such overt acting out yet, for some
with an aged body, eventually over time men the connection may have some
developed into a normal adult healthy man. theoretical relevance. Sometimes sexual
potency in men has been linked to social
Relative to this fantasy theme, there now are
power and their having access to the “BOMB”.
a number of pharmacological studies in
Historically, in World War II nuclear scientists
experimental animals suggesting that it may
in America built atomic bombs which were
eventually be possible in humans to slow
used to destroy Japanese cities effectively
aging or even reverse the process. For
ending the conflict. Yet they failed to develop
example, a study published in the journal “Cell
international safeguards for the future!
Reports” led by Dr Jorge Ivan Castllo-Quan
found that when fruit flies were given a low Now in 2016 military leaders of little world
dose of Lithium, in adulthood or later in life, power can brag about access to such
they lived an average of 16 to 18% longer weapons of mass destruction. They are fully
than flies who received sodium chloride. This aware that citizens worldwide are anxious
finding was regardless of the insect’s genetic about this dangerous state of affairs
makeup. Another example involves research
This “Nuclear Anxiety” may exist either in full
led by HeikiTanile Professor of Molecular
Biology at the A, I. Virtanen Institute of conscious awareness consciously or out of it.
Eastern Finland. His group found that long- I observed this in the early 1960s when I first
conducted field tests with college students in
term dietary supplement with pyruvate
the normal population. As outlined in my book
increases the energy reserves in the brains of
BODY SYMBOLISM, my intention was to
mice. Hopefully such studies eventually may
develop projective test color-form
be repeated in human subjects that would
configurations with embedded structure
2: Wilfred A Cassell

partially suggestive of the human heart. It was
hoped that these would facilitate
psychophysiological studies of medical
patients suffering from either real or imagined
cardiac pathology.
Eventually with much research this was found
to be a useful projective aide for standard
interviewing. However in addition there was a
totally unexpected but highly interesting
finding as follows in regard to Figure 1:
Many students viewed this as “An atomic
Bomb explosion”. Since then I have learned
that the projection of such explosive imagery
may symbolize deep seated fears of ultimately
dying from a future nuclear war. (Perhaps
symbolically reflecting in the human brain’s
neural “wiring” linking sex imagery with
images of aggression, some subjects
projected the sexual anatomical response
“Female genitalia”.)
This is a very complex psychophysiological
area where there exist many more
fundamental questions related to violent
imagery than answers. I now invite members
of our international SIS Society to
contemplate considering such future
fascinating, and in a nuclear age ESSENTIAL
SIS RESEARCH!
Wilfred A Cassell, M.D., FAPS, APC. Editor Emeritus,
SIS J. of Proj. Psycho.& Mental Health Director, SIS
Center, Anchorage (USA) Email:
siswilfredacassell@yahoo.com

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH

(An Official Publication of Somatic Inkblot Society)
Published Regularly Twice a Year in January and July
First Volume Published in 1994
All Volumes of the SIS Journal are also available in PDF Format
Individuals/Institutions can become Member of Somatic Inkblot Society
by Submitting Membership Application Form Given in the Journal
and Receive Print Version/Soft Copy of the Journal
Published After the Date of Membership
Free of Cost

Bankey L. Dubey, Ph.D., DPM, DM&SP,

Editor Emeritus,
SIS Journal of Projective Psychology and Mental Health,
E-mail : bldubey@gmail.com
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 3-17

Thematic Apperception Techniques (TAT, CAT) in Assessment: A Summary

Review of 67 Survey-based Studies of Training and Professional Settings
Chris Piotrowski
A cursory review of the recent literature in the areas of testing and assessment tends to depict the impression that
Thematic tests have been largely eschewed in professional practice over the past 2 decades. Indeed, this class of
assessment instruments has been the target of extensive criticism based on incisive reviews of the literature (e.g.,
Lilienfeld et al., 2000). The intent of the current study is to determine whether this collective movement, evident in
the scholarly literature since 1990, against Thematic assessment, has had a deleterious impact on the popularity
of these tests in graduate training programs and professional usage worldwide. To that end, the author identified,
through an extensive literature review, published survey research with regard to Thematic instruments that
reported on assessment training and test usage patterns from 1989-2017. The 67 identified survey-based or
records-based studies served as the data pool in the current review (Training=16; Practice=51 settings). The
summary analysis indicated that 43 of the 67 studies (64%) reported that Thematic tests have been relied upon in
assessment training or practice to at least a „moderate‟ degree. This trend was particularly evident in 9 of the 16
surveys (56%) of graduate-level and internship training. However, only 20% (n=10) of the practice-based studies
reported a high level (top 10 ranking) of usage of Thematic techniques. Most of the 67 studies found infrequent
use of children‟s Thematic tests (e.g., CAT). This review revealed that, over the years, Thematic techniques have
been favored by clinical psychologists and professional counselors, but rather neglected in forensic and
neuropsychological assessment. Also, a dramatic decline in usage of both the TAT and CAT was noted in most
samples of school psychologists. Noteworthy, several studies found that coursework and training emphasis with
the TAT was rather cursory and unstructured. On a cautionary note, this review observed a slight diminutive trend
in Thematic methods in both training and practice since 2008. Thus, the future status of Thematic tests in the
assessment armamentarium appears precarious, particularly as competing assessment approaches and novel
testing instruments emerge in the field. Finally, there is a need for additional research regarding the scope of
Thematic assessment in training programs in countries outside the USA (Piotrowski, 2015b), due to the dearth of
studies of academic settings overseas.

Over the past 75 years, Thematic methods,
within the family of projective tests, have been
popular assessment tools (Dana, 1996;
Dupree &Prevatt, 2003; Frank, 1948; Handler
& Hilsenroth, 1998; Handler & Smith, 2013;
Keddy & Piotrowski, 1992; Klopfer & Taulbee,
1976; McGrath & Carroll, 2012; Murstein,
1965; Piotrowski, 2015a; Piotrowski & Keller,
1989, 1992; Wade & Baker, 1977). Despite
their status in the testing community,
projective tests have generated much
scholarly criticism by clinicians and
academicians over the years, even during the
zenith of their popularity (e.g., Butcher, 2006;
Fisher, 1967; Ivnik, 1977; Keiser & Prather,
1990; Retzlaff, 1992; Reynolds, 1979;
Swensen, 1968; Vukovich, 1983). Since this
onslaught of academic critique has been
particularly contentious over the past 25 years
(see Garb et al., 2002; Lilienfeld et al., 2015;
Meyer et al., 2001; Wood et al., 2002), the
aim of the current study is to review the extant
literature, since 1989, on assessment usage
of the most popular thematic tests (i.e., the
TAT and CAT) in both academic training and
applied practice settings. Other Thematic
instruments, like the Roberts Apperception
Test, Make-A-Picture-Story-Test, and the
Children‟s Apperceptive Story-Telling Test
(Schneider &Perney, 1990) have a limited
research base and, thus, are not included in
this analysis.
Proponents of projective assessment contend
that Thematic tests provide rich idiographic
material not only clinically but also as a robust
source of research data in scholarly
investigations (e.g., Basu, 2014; Blatt, 1975).
In support of this view, Dana (1996, p. 203)
concluded “The TAT continues to be used in
assessment practice because of the potential
richness of the protocol data for personality
study.” Moreover, Thematic approaches
seem particularly amenable in the
assessment of children (e.g., Chandler, 2003).
More recently, Weiner and Greene (2008)

Chris Piotrowski, Ph.D. University of West Florida (USA) Email: cpiotrowski@uwf.edu

Keywords: TAT, CAT in Assessment.
 4:Chris Piotrowski
argue that Thematic techniques can serve as
a prodigious precursory tool in screening for
psychological disturbance or maladjustment.
Critics, like Ziskin (1995, pp. 866-870),
counter that “The TAT is an extremely difficult
technique to evaluate empirically.”
Scholarly research on Thematic tests,
particularly the TAT, has been rather robust
over the years. A keyword search (March
2016) of the database PsycINFO produced
930 article references and 200 dissertations.
In an analysis on the prevalence of projective
techniques in published research reported in
key journals from 1947-1965, Crenshaw et al.
(1968) found the TAT to be ranked 2nd in
terms of investigatory interest over time, and
even surpassed the Rorschach in the 1960-
1964 period.
Historical Context:
Graduate-level Training Settings:
From an historical perspective (i.e., prior to
1990), attitudes of mental health practitioners
toward Thematic techniques remained quite
positive; however, views of clinical faculty and
internship directors toward some projective
tests, while positive, have become more tepid
over time (see Kolbe, 1985; Piotrowski 1999,
2015b for review; Rossini & Moretti, 1997).
Early surveys, such as McCully (1965),
reported rather positive attitudes of internship
directors regarding the TAT, with 94% of
respondents considering Thematic techniques
as somewhat or very important. In a survey of
academic clinical psychologists in APA-
approved clinical training programs, Thelen et
al. (1968) found that Thematic tests were
considered the most important of the
projective techniques to master, with 71 of
respondents confirming that coverage of the
TAT should be required coursework. About
this time, Shemberg and Keeley (1970)
detected a slight decrease in training in
projective techniques in PhD clinical training
programs. However, very positive attitudes
toward diagnostic testing was reported by
internship directors (Garfield & Kurtz, 1973);
in fact, 93% of internship centers emphasized
the TAT. During the 1980s, where attitudes of
academic faculty and internship directors
toward projective tests were somewhat
tempered, the TAT was still endorsed as
important by 74% of academic clinical
psychologists (Pruitt et al., 1985). Moreover,
the TAT continued to be emphasized during
internship training (see Durand et al., 1988).
These positive attitudes on the part of faculty
toward Thematic assessment reflected the
importance attributed to diagnostic training at
clinical practicum sites (see Craig & Horowitz,
1990). In support of these findings, in a
national survey of practicing clinical
psychologists, Wade and Baker (1977) found
that nearly 30% recommended that clinical
students learn the TAT. It must be noted,
however, that, during this time, the CAT was
not emphasized in clinical training (e.g.,
Piotrowski & Keller, 1984).
Mental Health Practice Settings:
Early national surveys on clinical test usage in
practice settings found the TAT ranked 4th
and the CAT in 38thplace (Sundberg, 1961).
Hinkle et al. (1968), on data from 247
psychotherapists, found the TAT to be
amongst the top tests used in private practice.
In a nationwide survey of clinical agencies,
Lubin et al. (1971) reported that the TAT
ranked 7th and the CAT 14th. Gendreau
(1975), in a study on psychological test usage
in corrections in Canada, reported the TAT
ranked 9th. Surveys of mental health
practitioners in the 1970s corroborated the
popularity of Thematic instruments with the
TAT and CAT amongst the top 10 and top 15
tests, respectfully (see Brown & McGuire,
1976; Piotrowski & Keller, 1978). Emphasis in
practice with Thematic approaches continued
into the 1980s (Fee, Elkins, & Boyd, 1982;
Harrison et al., 1988; Haynes & Peltier, 1983;
Lubin, Larsen, &Matarazzo, 1984; Sweeney,
Clarkin, &Fitzgiggon, 1987; Tuma& Pratt,
1982; Watkins et al., 1988). In fact, one
survey found that 91% and 23% of
practitioners recommended competency in the
TAT and CAT, respectfully (Piotrowski, 1985).
Quite revealing, surveys of practicing school
psychologists (i.e., Goh et al., 1981) reported
that both the TAT and CAT were frequently

used in the assessment of personality. Even
clinicians with an anathema to projective
techniques, such as behavior therapists, have
been reported to rely on the TAT (Piotrowski
& Keller, 1984). Interestingly, this popularity of
the TAT was also evident overseas. Evers
and Zaal (1982) reported that the TAT ranked
4th in test usage in The Netherlands. Based
on test usage data from 383 Australian
psychologists, Sharpley and Pain (1988)
found the TAT to be the 8th „most valued‟ test
and highly recommended for inclusion in
graduate-level training.
Rationale for Current Study:
Since the early 1990s, the assessment
community has witnessed a steady stream of
rather disparaging commentary directed
largely on the lack of psychometric credibility
of individual projective methods, including
Thematic techniques (see Lilienfeld et al.,
2000; Smith & Dumont, 1995; Ziskin, 1995).
Thus, based on this dramatic shift
(commencing around 25 years ago) to
expunge projective techniques from both
training emphasis and clinical practice, it
would be of interest to a) summarize survey
data regarding coursework and training
emphasis in Thematic tests in
professional/graduate training programs since
1989, and b) examine the extent of
professional usage of Thematic techniques in
applied practice settings during this time
frame.
Investigatory Design:
In order to appreciate historical trends on the
scope of emphasis and usage of Thematic
techniques in graduate-level training and
practice/professional settings, the author
utilized bibliometric analyses of the extant
literature to identify survey-based studies. To
that end, a systematic search of the database
PsycINFO (published by the American
Psychological Association) was conducted, as
this research repository is considered the
leading scholarly file of research in the social
and behavioral sciences worldwide. Table 1
summarizes survey findings of both academic
and applied settings on emphasis and usage
TAT & CAT: 5
of Thematic tests since 1989. This analysis
includes the 67 published studies on test
usage that were identified in journal
publications, based on academic/training and
clinician/practitioner samples worldwide.
Findings:
First, response-rates of the reviewed studies
varied widely; thus, the conclusions of the
current analysis findings must be tempered by
the unknown views of a sizeable percentage
of non-responders from the samples under
study. Thus, with a cautionary stance, the
current analysis showed that, overall, based
on data from both academic and practice
settings over the past 25 years, the TAT has
been emphasized or used to at least a
„moderate‟ degree in 43 of the 67 (64%)
studies in this review. This popularity was
more apparent in training or internship
settings, where the TAT was found to be
highly valued in coverage in 9 of the 16
studies (56%) compared to only 11 of the 51
studies (22%) of practitioners. In fact, 21 of
the 51 studies (41%) of practice settings
indicated sparse usage of the TAT. However,
„moderate‟ levels of TAT use were noted in
38% of the studies involving practitioners.
With regard to the Children‟s Apperception
Test (CAT), reliance on the CAT was rather
absent across all academic and practice
settings. Many studies that found the TAT to
be popular also reported sparse usage or
emphasis on the CAT. This disuse of the CAT
was even evident in surveys of child
practitioners and school psychologists.
Moreover, only a couple studies found
moderate use of the Roberts Apperception
Test. Interestingly, scant discussion on the
neglect of children‟s Thematic tests was
proffered by investigators in the literature
reported in the current analysis.
In addition, this extensive review revealed that
there has been a slight decline in enthusiasm
for Thematic instruments by both graduate
faculty and practitioners in recent years (see
Peterson et al., 2014; Ready &Veague, 2014;
Stedman et al., 2017). Moreover, the latest
evidence (Mihura et al., 2016; Wright et al.,
 6:Chris Piotrowski

2016) points to the fact that although there from mentors. Noteworthy, there is a dearth of
continues to be some reliance on data on the status of Thematic techniques in
performance-based testing, interest in graduate-level educational or training
Thematic tests appears to be waning (see programs in countries outside the USA (see
Rabin et al., 2016; Ready et al., 2016). Piotrowski, 2015b for review). Future research
needs to examine didactic issues and identify
Several other trends in practice or applied
trends regarding assessment training, over
settings were noted. Thematic tests have
time, at universities in nations worldwide (see
been popular with clinical psychologists and
Elosua&Iliescul, 2012; Raez de Ramirez,
professional counselors (e.g., Clark, 1995),
1999).
but less so with forensic psychologists (Neal
&Grisso, 2014), and largely neglected by Conclusion:
neuropsychologists (see Rabin et al., 2005;
These findings, based on extensive survey
Smith, 2010). In fact, studies regarding
data over time, point to the reality that a
forensic mental health assessment, including
sizeable minority of faculty and mental health
survey data from outside the USA (Martin et
professionals have relied on Thematic
al., 2001), indicate that projective tests are not
assessment and have done so based largely
relied upon by practitioners in most legal
on several key attributes of these techniques
settings (McLauglin&Kan, 2014; Ryba et al.,
discussed in the assessment literature:
2003). Furthermore, Thematic tests have,
notably, that Thematic techniques tend to be
historically, had a central role in the
conducive in diagnostic assessment (Dana,
assessment practices of school psychologists
1996; Woolford et al., 2015; Wright et al.,
(e.g., Hughes et al., 2010; Hutton, 1992;
2016), particularly in understanding and
Kennedy et al., 1994); however, recent
addressing stressors, social-emotional needs,
surveys in the school psychology field indicate
and interpersonal challenges. In this context,
a slight de-emphasis on reliance of these
Thematic methods may offer an integrative
evaluation tools, with the CAT showing the
function within the multi-method assessment
most decline in usage (e.g., Hojnoski et al.,
model (Flanagan & Motta, 2007; Hopwood &
2006; Shapiro &Heick, 2004).
Bornstein, 2014; Riccio& Rodriguez, 2007).
Despite the popularity and emphasis with the However, based on recent evidence (since
TAT in academic training settings prior to 2008), there appears to be a diminution of
2008, empirically-based studies have found didactic and practicum offerings in academic
that TAT training in graduate education has and internship programs in projective
been rather cursory and unstructured (Duffy, techniques; hence, the future status of the
1993). It must be noted that in the recent TAT in the assessment armamentarium
Mihura et al. (2016) study, survey objectives appears precarious.
failed to elucidate the extent or depth of
Historically, the current findings regarding
training in specific assessment approaches or
Thematic tests attest to the popularity of and
tests. Moreover, academic coverage in clinical
interest in projective assessment over the
training with the TAT appears to be rather
decades, as evidenced in coverage in
restricted to the seminal models proposed by
scholarly books on psychological tests (e.g.,
Bellak and Murray (see Rossini & Moretti,
Aronow, Weiss, &Reznikoff, 2013; Groth-
1997) and recent data point to a lack of
Marnat, 2009; Harwood, Beutler, &Groth-
instructional emphasis on TAT scoring
Marnat, 2011; Murstein, 1965; Newmark,
protocols (see Mihura et al., 2016). The
1996; Rabin, 1986; Rapaport et al., 1968).
impact of this de-emphasis on future trends is
This scholarship reflects the vast research
uncertain. Hence, interested students may
landscape on projective techniques evident in
need to pursue educational opportunities with
the extant literature. However, future studies
Thematic tests via nontraditional venues such
are needed to determine whether interest in
as workshops and individualized instruction
 TAT & CAT:7

Thematic methods will expand beyond a competing assessment approaches and

narrow circle of enthusiasts, particularly as testing instruments emerge in the field.
Table 1: Emphasis or Use of Thematic Tests in Training/Practice Settings across 67 Studies
(1989-2017)
Study Country Sample Findings
Piotrowski & USA Test usage in 413 mental Amongst the top 30 tests used, the TAT
th th
Keller (1989) health facilities ranked 9 ; the CAT 14 .
th
Tsoi&Sundber Hong Kong Division of Clinical The TAT ranked 4 .
g (1989) Psychology of the Hong
Kong Psychological Society
th
Bubenzer et USA 743 members of the The TAT ranked 7 in terms of usage
al. (1990) American Association for but used only occasionally.
Counseling & Development,
primarily practitioners
*Watkins et al. USA Data based on 56 directors 45% of these programs emphasized the
(1990) of counseling psychology TAT in coursework/training.
training programs
Archer et al. USA 165 respondents who were The TAT ranked very highly for inclusion
(1991) either APA Division 12 in a „Standard‟ test battery, endorsed by
members, Society for 63% of respondents.
Personality Assessment
members, and/or
practitioners with a research
interest in adolescent
assessment
Butler et al. USA 280 members of the 33% of respondents in neuropsychology
(1991) International use the TAT for „personality‟
Neuropsychological Society assessment.
Ogawa & Japan Japanese Clinical Although several projective tests were
Piotrowski psychologists ranked highly, the TAT was not used
(1992) frequently.
Hutton (1992) USA 389 school psychologists For the area of personality assessment,
(members of NASP); update the Roberts Apperception Test ranked
th
on the Goh et al. (1981) #2; the CAT #3; the TAT 12 .
study

*Piotrowski USA A replication of the 80% of the programs suggested

&Zalewski Piotrowski & Keller (1984) competency in the TAT; this was on par
(1993) study; 80 Directors of both (85%) with findings of the 1984 survey.
PhD and PsyD APA clinical Only 10% of programs endorsed the
psychology programs in CAT.
1991
Pinkerman et USA Surveyed 126 psychologists Projective tests were used frequently,
al. (1993) in 37 juvenile/family courts including the TAT.
on scope of testing practices
of children under age 18
Kennedy et al. USA Practicing school Overall, projective tests used frequently;
(1994) psychologists TAT ranked #9; CAT #12.
Stinnett et al. USA Data analysis based on 123 In social-emotional assessment, 29%
th
(1994) members of the National use the TAT (ranked 11 ); 15% use the
th
Association of School CAT (ranked 19 ).
Psychologists (NASP) in
1993
th
Chan & Lee Hong Kong 50 practicing psychologists 56% noted the TAT, ranked 12 ; 38%
8:Chris Piotrowski

th
(1995) in 1993 used the CAT, ranked 18 .
Watkins et al. USA 412 APA members who TAT used by 82% of practicing
th
(1995) were clinical psychologists psychologists & ranked 5 overall; the
th
CAT was used by 42% (ranked 16 );
90% felt that clinical students should
gain competency in the TAT; however,
only 22% endorsed the CAT in training
& only 6% recommended competency in
the Roberts Apperception Test.
Borum&Grisso USA 102 forensic For psychologists, the TAT was relied
(1995) psychologists/psychiatrists upon by only 8% of respondents; for
psychiatrists, 10%; CAT not mentioned.
*Wilson USA Data, obtained in 1992, on For the practitioner sample, Thematic
&Reschly assessment practices from tests were not amongst the top 10
(1996) 251 members of the National instruments; for faculty, the TAT was
Association of School covered by 35% in coursework and by
Psychologists (NASP); and 54% in supervised training.
faculty in school psychology
programs
Lees-Haley et USA Forensic evaluation reports Only 6% of „neuropsychology‟ reports
al. (1996) by 100 forensic included use of TAT (ranked #39 test);
neuropsychology experts CAT not listed.
*Rossini & USA 50 Directors of APA- 30 of these programs provided
Moretti (1997) accredited clinical coverage of the TAT in graduate-level
psychology training courses; Interpretations of TAT
programs shared their views protocols by students were infrequently
on coursework/coverage of required; only about 15 programs
the TAT offered practicum experiences with the
TAT; surprisingly, book chapters on the
TAT and journal articles were rarely
required readings; thus, instruction on
the TAT was found to be unstructured.
*Culross& USA Surveyed 63 instructors The TAT and CAT were taught in 71%
Nelson (1997) listed in NASP-approved and 52% of personality assessment
graduate programs in school courses, respectively.
psychology on tests
emphasized in personality
assessment coursework
Ackermann & USA Practitioners in court-related In a re-analysis of the findings, Hagen
Ackermann custody evaluations &Castagna (2001) found that the TAT
(1997) was used in 16% of assessment reports
of parents; The CAT was used in 17%
of evaluations of children, the Roberts
Apperception Test in 7%.
Frauenhoffer USA Surveyed 487 mental health For psychologists, 50% used the TAT
et al. (1998) practitioners (psychologists, and 26% the CAT; however, thematic
counselors, social workers) tests were not popular with either social
workers nor professional counselors.
Piotrowski et USA 137 practitioners in National Tests considered most important to
al. (1998) Register of Health Service practice: only 15% of psych.
providers in Psychology practitioners noted the TAT; CAT not
recommended.
Muniz et al. Spain, Test use by practicing Overall, projective methods were quite
th
(1999) Portugal, & psychologists popular; The TAT was ranked 10 , but
Latin more emphasized in Argentina than in
 TAT & CAT:9

America Spain.
Boccaccini& USA Diagnostic test usage in Although only 9% used the TAT, 67% of
Brodsky personal injury cases by 80 respondents endorsed the TAT due to
(1999) practicing forensic „acceptance within the field‟; 50% based
psychologists on „research support‟.
*Piotrowski & USA Extent of graduate-level 76% of these internship sites provided
Belter (1999) assessment curriculum was training on TAT; 23% on the Roberts
reported by training directors Apperception Test; however, only 10%
from 84 APA-approved of these directors considered the TAT
internship settings essential for practice.
Camara et al. USA 179 practitioners, mostly Neuropsychologists shunned thematic
(2000) clinical psychologists tests; but clinical psychologists valued
th
regarding test usage the TAT (ranked 6 ) and, to a lesser
th
degree, the CAT (16 ).
Archer & USA 346 psychologists, working The TAT (ranked #4) was used by 63%
Newsom with adolescents of respondents; Roberts Apperception
(2000) Test used by 40% (ranked #19);
Interestingly, CAT not listed amongst
top 30 test.
*Stedman et USA 324 internship directors Directors had favorable attitudes for the
al. (2000) across a variety of mental TAT and picture-story tests to be
health settings included in „integrated‟ assessment.
Boothby & USA Correctional (prison) Thematic tests were not amongst the
Clements psychologists top 20 assessment instruments.
(2000)
*Clemence& USA Surveyed 382 internship Internship directors supported graduate-
Handler (2001) settings on use and training level preparation in projective
of psychological tests assessment; 56% recommended
competency and inclusion for the TAT in
„Testing battery‟.
Muniz et al. European 3,455 professional In 5 of the 6 countries, projective tests
(2001) (Spain, UK, psychologists use of were not popular; in Belgium, the TAT
Holland, psychological tests and CAT were noted by 16%, and 10%
Slovenia, of professionals.
Croatia,
Belgium)
Luiselli et al. USA Assessment for autism 27% of service centers use the TAT in
(2001) reported by 100 practitioners the treatment of autism.
in national service centers
for developmental disabilities
in 30 states
*Belter & USA Survey data on 82 directors Nearly 60% of the programs required a
Piotrowski of APA-approved doctoral specific course on projective testing;
(2001) clinical/professional The TAT was amongst the most
psychology training emphasized (by 70% of directors).
programs on assessment
curriculum
*Childs &Eyde USA Course syllabi data, from 84 71% of programs indicated that the TAT
(2002) APA clinical psychology should be a key component in the
programs, determined assessment curriculum.
coverage of projective
assessment techniques
Cashel (2002) USA 162 child & adolescent 56% of respondents use the TAT
th
practitioners in outpatient, (ranked 19 ) to some degree; 48% use
10:Chris Piotrowski

hospital and school settings
*Stedman et USA Based on survey data from
al. (2002) 334 psychology interns,
determined extent of pre-
internship assessment report
writing experiences
Bow et al. USA 84 psychologists reported on
(2002) assessment practices
regarding sexual abuse in
child custody cases
Demaray et al. USA Surveyed over 316 school
(2003) psychologists on
assessment practices in
ADHD
Lally (2003) USA 64 Diplomate-status forensic
psychologists, test use in
court-related evaluations
the CAT; 34% use the Roberts
Apperception Test.
Results showed that clinical students
met or exceeded most expectations of
internship training directors by
producing a median of 18 integrated
testing reports; however, reports
including the TAT were a few (M=1.5).
The TAT was used in 15% of
assessments of accusing parents and
alleged perpetrators.
Although 30% supported projective
assessment, less than 5% noted the
CAT, TAT, or Roberts test.
TAT was deemed „unacceptable‟ by
77% of sample across several forensic
domains.

Ryba et al. USA Psychologists‟ test usage in Projective tests were infrequently
(2003) juvenile competency to stand employed; only 12% reported using the
trial evaluations TAT.
Shapiro USA Determined assessment The TAT was used occasionally across
&Heick (2004) practices of 648 school recent cases involving psychological
psychologists (NASP assessment issues.
members)
Echemendia& USA Test use practices of 911 No Projective techniques were amongst
Harris (2004) neuropsychologists top tests used.
Anderson USA Diagnostic assessment Although 75% of the respondents rely
&Paulosky practices of 95 „eating on self-report measures, only 10% use
(2004) disorder‟ specialists any projective techniques.
Rabin et al. USA/ Assessment practices of 747 Only the Rorschach was amongst the
(2005) Canada clinical neuropsychologists top 40 tests in neuropsychological
assessment.
de Oliveira et Brazil 35 professional CAT-Human, used by 57%, ranked #1;
al. (2005) psychologists TAT infrequently emphasized.
Hojnoski et al. USA 170 school psychologists TAT used by 31% of respondents,
(2006) reported use of projective mostly for diagnostic purposes &
tests treatment planning; 16% use the CAT.
Archer et al. USA 152 forensic psychologists‟ 54% of respondents (n=54) use the TAT
(2006) use of projective techniques at least „occasionally‟ in forensic
in court-related assessments evaluations of adults; The CAT was not
popular in child forensic assessment.
Koonce (2007) USA 246 NASP members were For direction for selection of ADHD test
surveyed on selection of battery, none of the „thematic‟ tests
tests in ADHD assessment were used.
Herzberg Brazil Clinical psychology faculty TAT ranked #1, used by 73% of faculty;
&Mattar (2008) use of projective tests in the CAT-Human figures by 15%.
practice, University of Sao
Paulo
Madaus et al. USA Assessment practices Apparently, projective techniques are
(2009) reported by 164 „special not used in the assessment of social-
 TAT & CAT:11

education‟ directors in school emotional behavior in „special

districts in 5 northeastern education‟ milieu.
states
Ogawa et al. Japan 237 Japanese psychologists TAT not listed in the top 20 tests used in
(2010) in practice Japan in 2010; in the prior 2004 survey,
TAT used only by 8% of sample.
Smith et al. USA 404 members of the The TAT was occasionally used by
(2010) International about 30% of the sample in personality
Neuropsychological Society assessment, but not highly ranked.
or National Academy of
Neuropsychology surveyed
on personality assessment
practices
Donoso et al. USA 150 professionals who Overall, projective techniques were
(2010) conduct vocational relied upon infrequently; TAT was used
rehabilitation evaluations by 28% of respondents, ranked #18.
Raez (2011) Peru University psychologists in 92% of the sample use projective
Lima, and members of the techniques; 43% rely on TAT; 41% on
Peru Society of Rorschach & CAT.
Projective Methods
Ackermann USA 213 forensic psychologists 29% of the sample use the TAT in
&Pritzl (2011) surveyed on tests used with assessment of parents.
parents in child custody
evaluations
Evers et al. 17 Study conducted in 2009; Projective tests were not ranked highly
(2012) European sample included 12,606 in 6 countries (Netherlands, Norway,
countries professional psychologists Sweden, UK, Croatia, Germany).
regarding testing practices; Turkey was the only European country
data analysis based on 400 with TAT usage, but rather infrequently,
respondents 7%.
*Neukrug et al. USA Based on survey data from 93% of instructors report teaching
(2013) 210 counselor educators emphasis with the TAT, which was
th
across the U.S., this study ranked 12 .
examined graduate-level
coverage of assessment
instruments by instructors
Peterson et al. USA 926 counselors (clinical Amongst a copious set of testing
(2014) mental health, school, instruments, the TAT seems to be used
th
occupational) rated tests of moderately (ranked 40 ); the CAT
th
all types regarding usage occasionally (ranked 70 ).
Neal &Grisso International 434 forensic examiners of Across a variety of forensic/legal
(2014) sample: professional organizations domains, a myriad of testing
USA (45%), instruments was used; however, the
Canada only projective test noted was the
(7%), Rorschach.
Europe
(3%),
Australia-
New
Zealand
(4%)
*Ready USA Compared training in Although the response-rate was rather
&Veague psychological assessment low (33%), no projective tests ranked in
(2014) across 3 training models the top 10; only practitioner-scholar
(Clinical-Science, Scientist- programs offer limited coverage on
 12:Chris Piotrowski

Practitioner, Practitioner- projective techniques; younger faculty

Scholar) in APA-Accredited express little interest or competency in
programs teaching specific projective techniques.
Sotelo- USA Cognitive assessment A variety of IQ, achievement tests, and
Dynega& practices of 323 school educational measures were popular; no
Dixon (2014) psychologists projective tests were noted.
Wechsler et al. Iberian/Latin Test development & usage Projective tests very popular in
(2014) -American in Portugal, Spain, Venezuela; Rorschach somewhat
countries Argentina, Venezuela, and popular in Brazil and Argentina; Spain
Brazil and Portugal indicated low usage of
projective tests. Thematic tests are not
amongst the top tests used by
practitioners in any of these countries.
Rabin et al. USA & Testing practices of 512 Among Top tests for „personality
th
(2016) Canada neuropsychologists; assessment‟; TAT ranked 14 , but used
members of INS and NAN infrequently (1%).
*Ready et al. USA & Views of Directors of Overall, the majority of directors
(2016) Canada internship settings on pre- indicated that professional academic
internship preparation in programs do not adequately prepare
assessment; Data based on students for assessment activities on
236 APPIC sites internship; 28% of sites offer training in
the TAT.
Wright et al. USA 279 members of APA in 49% indicated use of projective
(2016) practice, with an interest in techniques other than the Rorschach
Assessment; Data based on (TAT data not specifically reported);
low response rate (17%) 54% use the Rorschach.
*Mihura et al. USA Of 244 APA-accredited The survey, in a general fashion,
(2016) doctoral clinical psychology inquired about „coverage‟ in assessment
programs, 83 usable surveys courses and practicum;
were analyzed authors concluded that instruction
emphasized “breadth at the expense of
depth”; TAT „covered‟ in 63% of
programs; only 8 programs (15%)
taught formal coding for the TAT.
*Stedman et USA APPIC internship programs 72% of programs (adult focused) desire
al. (2017) reported on „Assessment‟ pre-internship training in assessment; in
training offered and on pre- mixed-programs (adults/children), 35%
internship expectations of offer training in „Story‟ techniques.
testing competency

Note. Studies (n=16) marked with asterisk (*) focused on graduate/internship training.

References:
Ackerman, M.J., & Ackerman, M.C. (1997). Custody
evaluation practices: A survey of experienced
professionals. Professional Psychology:
Research and Practice, 28, 137-145.
Ackerman, M.J., &Pritzl, T.B. (2011). Child custody
evaluation practices: A 20-year follow-up. Family
Court Review, 49(3), 618-628.
Anderson, D.A., &Paulosky, C.A. (2004). A survey of the
use of assessment instruments by eating disorder
professionals in clinical practice. Eating & Weight
Disorders, 9(3), 238-241.
Anderson, T.K., Cancelli, A., &Kratochwill, T.R. (1984).
Self-reported assessment practices of school
psychologists: Implications for training and
practice. Journal of School Psychology, 22, 17-
29.
Archer, R.P., Buffington-Vollum, J.K., Stredny, R.V., &
Handel, R.W. (2006). A survey of psychological
test use patterns among forensic psychologists.
Journal of Personality Assessment, 87, 84-94.
Archer, R.P., Maruish, M., Imhof, E.A., & Piotrowski, C.
(1991). Psychological test usage with adolescent

clients: 1990 survey findings. Professional
Psychology: Research and Practice, 22, 247-252.
Archer, R.P., & Newsom, C.R. (2000). Psychological test
usage with adolescent clients: Survey update.
Assessment, 7(3), 227-235.
Aronow, E., Weiss, K.A., &Reznikoff, M. (2013). A
practical guide to the Thematic Apperception
Test: The TAT in clinical practice. New York:
Bruner-Routledge.
Bartram, D., & Coyne, I. (1998). Variations in national
patterns of testing and test use: The ITC/EFPA
international survey. European Journal of
Psychological Assessment, 14(3), 249-260.
Basu, J. (2014). Psychologists‟ ambivalence toward
ambiguity: Relocating the projective test debate
for multiple interpretative hypotheses. SIS
Journal of Projective Psychology & Mental
Health, 21, 25-36.
Belter, R.W., & Piotrowski, C. (2001).Current status of
doctoral-level training in psychological
testing.Jour. of Clin. Psych., 57, 717-726.
Belter, R.W., Piotrowski, C. (1999). Current status of
master‟s-level training in psychological
assessment. Journal of Psychological Practice,
5(1), 1-5.
Beutler, L.E., Williams, R.E., Wakefield, P.J., &Entwistle,
S.R. (1995).Bridging scientist and practitioner
perspectives in clinical psychology. American
Psychologist, 50, 984-994.
Blatt, S.J. (1975). The validity of projective techniques
and their research and clinical contribution.
Journal of Personality Assessment, 39, 327-343.
Boccaccini, M.T., & Brodsky, S.L. (1999).Diagnostic test
usage by forensic psychologists in emotional
injury cases. Professional Psychology: Research
and Practice, 30, 253-259.
Boothby, J.L., & Clements, C.B. (2000).A national survey
of correctional psychologists. Criminal Justice
and Behavior, 27, 716-732.
Borum, R., &Grisso, T. (1995).Psychological test use in
criminal forensic evaluations. Professional
Psychology: Research and Practice, 26, 465-473.
Bow, J.N., Quinnell, F.A., Zaroff, M., &Assemany, A.
(2002).Assessment of sexual abuse allegations in
child custody cases. Professional Psychology:
Research and Practice, 33, 566-575.
Brown, W.R., & McGuire, J.M. (1976). Current
psychological assessment practices. Professional
Psychology, 7, 475-484.
Bubenzer, D.L., Zimpfer, D.G., &Mahrle, C.L.
(1990).Standardized individual appraisal in
agency and private practice: A survey. Journal of
Mental Health Counseling, 12, 51-66.
Butcher, J.N. (2006). Assessment in clinical psychology:
A perspective on the past, present challenges,
and future prospects. Clinical Psychology:
Science and Practice, 13(3), 205-209.
Butler, M., Retzlaff, P., &Vanderploeg, R.
(1991).Neuropsychological test usage.
TAT & CAT: 13
Professional Psychology: Research and Practice,
22(6), 510-512.
Camara, W.J., Nathan, J.S., & Puente, A.E. (2000).
Psychological test usage: Implications in
professional psychology. Professional
Psychology: Research and Practice, 31, 141-154.
Cashel, M.L. (2002). Child and adolescent psychological
assessment: Current clinical practices and the
impact of managed care. Professional
Psychology: Research and Practice, 33(5), 446-
453.
Chan, D.W., & Lee, H.B. (1995).Patterns of psychological
test usage in Hong Kong in 1993. Professional
Psychology: Research and Practice, 26, 292-297.
Chandler, L.A. (2003). The projective hypothesis and the
development of projective techniques for children.
In C.R. Reynolds & R.W. Kamphaus (Eds.),
Handbook of psychological and educational
assessment of children: Personality, behavior,
and context (2nd ed., pp. 51-65). New York:
Guilford Press.
Childs, R., &Eyde, L. (2002). Assessment training in
clinical psychology doctoral programs: What
should we teach? What do we teach? Journal of
Personality Assessment, 78, 130-144.
Clark, A.J. (1995). Projective techniques in the counseling
process. Journal of Counseling and
Development, 73(3), 311-316.
Clemence, A., & Handler, L. (2001). Psychological
assessment on internship: A survey of training
directors and their expectations for students.
Journal of Personality Assessment, 76, 18-47.
Craig, R.J., & Horowitz, M. (1990).Current utilization of
psychological tests at diagnostic practicum
sites.The Clini.Psychst, 43, 29-36.
Crenshaw, D.A., Bohn, S., Hoffman, M.R., Matheus, J.M.,
& Offenbach, S.G. (1968). The use of projective
methods in research: 1947-1965. Journal of
Projective Techniques & Personality Assessment,
32(1), 3-9.
Culross, R.R., & Nelson, S. (1997). Training in personality
assessment in specialist-level school psychology
programs. Psychological Reports, 81, 119-124.
Dana, R.H. (1996). The Thematic Apperception Test
(TAT). In C.S. Newmark (Ed.), Major
psychological assessment instruments (2nd ed.,
pp. 166-205). Boston, MA: Allyn and Bacon.
Demaray, M.K., Schaefer, K., & Delong, L.K. (2003).
Attention-deficit/hyperactivity disorder (ADHD): A
national survey of training and current
assessment practices in the schools. Psychology
in the Schools, 40(6), 583-597.
de Oliveira, K.L., Noronha, A.P., Dantas, M.A., &
Santarem, E.M. (2005). The use of psychological
techniques and instruments for behavioral
psychologists.PsicologiaemEstido, Maringa,
10(1), 127-135.
Donoso, O.A., Hernandez, B., &Horin, E.V. (2010).Use of
psychological tests within vocational
rehabilitation. Journal of Vocational
Rehabilitation, 32, 191-200.
 14:Chris Piotrowski
Duffy, J.N. (1993). Utility of the Thematic Apperception
Test as an aid to personality
assessment.Dissertation Abstracts International,
54, 1711.
Dupree, J.L., &Prevatt, F. (2003).Projective storytelling
techniques. In C.R. Reynolds & R.W. Kamphaus
(Eds.), Handbook of psychological and
educational assessment of children: Personality,
behavior, and context (2nd ed., pp. 66-90). NY:
Guilford Press.
Durand, V., Blanchard, E., & Mindell, J. (1988). Training
in projective testing: Survey of clinical training
directors and internship directors. Professional
Psychology: Research and Practice, 19, 236-238.
Echemendia, R.J., & Harris, J.G. (2004).
Neuropsychological test use with Hispanic/Latino
populations in the U.S.: Part II of a national
survey. Applied Neuropsychology, 11, 4-12.
Elosua, P., & Iliescu, D. (2012). Tests in Europe: Where
we are and where we should go. International
Journal of Testing, 12, 157-175.
Evers, A., Muniz, J., Bartram, D., et al. (2012). Testing
practices in the 21st century: Developments and
European psychologists‟ opinions. European
Psychologist, 17(4), 300-319.
Evers, A., &Zaal, J.N. (1982).Trends in test use in The
Netherlands. International Review of Applied
Psychology, 31, 35-53.
Fee, A.F., Elkins, G.R., & Boyd, L. (1982). Testing and
counseling psychologists: Current practices and
implications for training. Journal of Personality
Assessment, 46, 116-118.
Fisher, S. (1967). Projective methodologies. Annual
Review of Psychology, 18, 165-191.
Flanagan, R., & Motta, R.W. (2007). Figure drawings: A
popular method. Psychology in the Schools,
44(3), 257-270.
Frank, L. (1948). Projective methods. Springfield, IL: C.C.
Thomas.
Frauenhoffer, D., Ross, M.J., Gfeller, J., Searight, H.R., &
Piotrowski, C. (1998). Psychological test usage
among licensed mental health practitioners: A
multidisciplinary survey. Journal of Psychological
Practice, 4, 28-33.
Garb, H.N., Wood, J.M., Lilienfeld, S.O., &Nezworski,
M.T. (2002). Effective use of projective
techniques in clinical practice: Let the data help
with selection and interpretation. Professional
Psychology: Research and Practice, 33, 454-463.
Garfield, S.L., & Kurtz, R.M. (1973). Attitudes toward
training in diagnostic testing: A survey of directors
of internship training. Journal of Consulting and
Clinical Psychology, 40, 350-355.
Gendreau, P. (1975). Psychological test usage in
corrections. Canadian Journal of Criminology and
Corrections, 17(3), 215-220.
Goh, D.S., Teslow, C.J., & Fuller, G.B. (1981).The
practice of psychological assessment among
school psychologists. Professional Psychology,
12, 696-706.
Groth-Marnat, G. (2009). Handbook of personality
assessment (5thed.). Hoboken, NJ: Wiley.
Hagen, M.A., &Castagna, N. (2001). The real numbers:
Psychological testing in custody evaluations.
Professional Psychology: Research and Practice,
32, 269-271.
Handler, L., &Hilsenroth, M. (Eds.).(1998). Teaching and
learning personality assessment. Mahwah, NJ:
Erlbaum.
Handler, L., & Smith, J.D. (2013). Education and training
in psychology assessment. In J.R. Graham, J.A.
Naglieri, & I.B. Weiner (Eds.), Handbook of
psychology, Vol. 10: Assessment psychology
(2nd ed., 211-238). Hoboken, NJ: Wiley.
Harrison, P.L., Kaufman, A.S., Hickman, J.A., & Kaufman,
N.L. (1988). A survey of tests used for adult
assessment. Journal of Psychoeducational
Assessment, 6, 188-198.
Harwood, T.M., Beutler, L.E., &Groth-Marnat, G. (2011).
Integrative assessment of adult personality
(3rded.). New York: Guilford Press.
Haynes, J.P., & Peltier, J. (1983). Psychological
assessment practices in juvenile forensic
settings. Psychological Reports, 52, 759-762.
Herzberg, E., &Mattar, A. (2008). Clinical instruments
used in the department of clinical psychology of
USP: 10 years later. Boletim de Psicologia, 58, 1-
11.
Hinkle, J.E., Nelson, S.E., & Miller, D.
(1968).Psychological test usage by psychologist
psychotherapists in private practice.
Psychotherapy: Theory, Research, and Practice,
5(4), 210-213.
Hopwood, C.J., & Bornstein, R.F. (Eds.).(2014).
Multimethod clinical assessment. New York:
Guilford Press.
Hojnoski, R.L., Morrison, R., Brown, M., & Matthews, W.J.
(2006). Projective test use among school
psychologists: A survey and critique. Journal of
Psychoeducational Assessment, 24, 145-159.
Hughes, T.L., McGoey, K.E., & Owen, P. (2010).The
importance of personality assessment in school
psychology training programs. In E. Garcia-
Vasquez, T.D. Crespi, & C.A. Riccio (Eds.),
Handbook of education, training, and supervision
of school psychologists in school and community,
Vol. 1: Foundations of professional practice (pp.
185-211). New York: Routledge.
Hutton, J.B., Dubes, R., Muir, S. (1992). Assessment
practices of school psychologists: Ten years
later. School Psychology Review, 21, 271-284.
Ivnik, R.J. (1977). Uncertain status of psychological tests
in clinical psychology. Professional Psychology,
8(2), 206-213.
Keddy, P., & Piotrowski, C. (1992).Testing in
psychotherapy practice: Literature review survey,
and commentary. Journal of Training & Practice
in Professional Psychology, 6(1), 30-39.

Keiser, R.E., & Prather, E.N. (1990). What is the TAT? A
review of ten years of research. Jr. of Personality
Assessment, 55, 800-803.
Kennedy, M.L., Faust, D., Willis, W.G., & Piotrowski, C.
(1994). Social-emotional assessment practices in
school psychology. Journal of Psychoeducational
Assessment, 12, 228-240.
Klopfer, W.G., &Taulbee, E.S. (1976).Projective tests.
Annual Review of Psychology, 27, 543-567.
Kolbe, K., Shemberg, K., & Leventhal, D.
(1985).University training in psychodiagnostics
and psychotherapy.The Clini.Psyst, 38, 59-61.
Koonce, D.A. (2007). Attention deficit hyperactivity
disorder assessment practices by practicing
school psychologists. Journal of
Psychoeducational Assessment, 25(4), 319-333.
Lally, S.J. (2003). What tests are acceptable for use in
forensic evaluations? A survey of experts.
Professional Psychology: Research and Practice,
34, 491-498.
Lees-Haley, P.R., Smith, H., Williams, C.W., & Dunn, J.T.
(1996). Forensic neuropsychological test usage:
An empirical survey. Archives of Clinical
Neuropsychology, 11(1), 45-51.
Lilienfeld, S.O., Lynn, S.J., &Lohr, J.M. (2015). Science
and pseudoscience in clinical psychology
(2nded.). New York: Guilford Press.
Lilienfeld, S.O., Wood, J.M., & Garb, H.N. (2000).The
scientific status of projective techniques.
Psychological Science in the Public Interest, 1(2),
27-66.
Lubin, B., Larsen, R.M., &Matarazzo, J.D. (1984),
Patterns of psychological test usage in the United
States: 1935-1982. American Psychologist, 39,
451-454.
Lubin, B., Wallace & Payne (1971). Patterns of
psychological test use in the United States: 1935-
1969. Profesal. Psychology, 2, 70-74.
Luiselli, J.K., Campbell, S., Cannon, B., et al. (2001).
Assessment instruments used in the education
and treatment of persons with autism: Brief report
of a survey of national service centers. Research
in Developmental Disabilities, 22, 389-398.
Madaus, J., Rinaldi, C., Bigaj, S., &Chafouleas, S.M.
(2009). An examination of current assessment
practices in northeastern school districts.
Assessment for Effective Intervention, 34(2), 86-
93.
Martin, M., Allan, A., & Allan, M.M. (2001).The use of
psychological tests by Australian psychologists
who do assessments for the courts. Australian
Journal of Psychology, 53(2), 77-82.
McCully, R.S. (1965). Current attitudes about projective
techniques in APA-approved internship training
centers. Journal of Projective Techniques and
Personality Assessment, 29(3), 271-280.
McGrath, R.E., & Carroll, E.J. (2012).The current status
of “projective tests”. In H. Cooper et al. (Eds.),
APA handbook of research methods in
psychology, Vol. 1: Foundations, planning,
TAT & CAT:15
measures, and psychometrics (pp. 329-348).
Washington, DC: American Psychological
Association.
McLaughlin, J.L., &Kan, L.Y. (2014). Test usage in four
common types of forensic mental health
assessment. Professional Psychology: Research
and Practice, 45(2), 128-135.
Meyer. G.J., Finn, S.E., Eyde, L.D, et al. (2001).
Psychological testing and psychological
assessment: A review of evidence and issues.
American Psychologist, 56(2), 128-165.
Mihura, J.L., Roy, M., &Graceffo, R.A.
(2016).Psychological assessment training in
clinical psychology doctoral programs. Journal of
Personality Assessment, 98(6), 745-754.
Miller, D.N., & Nickerson, A.B. (2007).Projective
techniques and the school-based assessment of
childhood internalizing disorders. SIS Journal of
Projective Psychology & Mental Health, 14, 48-
58.
Muniz, J., Bartram, D., Evers, A., et al. (2001). Testing
practices in European countries. European J. of
Psychological Assessment, 17(3), 201-211.
Muniz, J., Prieto, G., Almeida, L., & Bartram, D. (1999).
Test use in Spain, Portugal and Latin American
countries. European Journal of Psychological
Assessment, 15(2), 151-157.
Murstein, B.I. (1965). Handbook of projective techniques.
Oxford, UK: Basic Books.
Neal, T., &Grisso, T. (2014). Assessment practices and
expert judgment methods in forensic psychology
and psychiatry: An international snapshot.
Criminal Justice and Behavior, 41, 1406-1421.
Neukrug, E., Peterson, C.H., Bonner, M., & Lomas, G.
(2013).A national survey of assessment
instruments taught by counselor educators.
Counselor Education & Supervision, 52, 207-219.
Newmark, C.S. (1996). Major psychological assessment
instruments (2nded.). Boston, MA: Allyn and
Bacon.
Ogawa, T., et al. (2010). Psychological testing practices
in Japan: Comparisons between 2010, 2004, and
1986. Paper presented at the Japanese
Psychological Association meeting (for full report
contact: ogawa.toshiki.ke@u.tsukuba.ac.jp).
Ogawa, T., & Piotrowski, C. (1992). Clinical psychological
test usage in Japan: A comparative study with a
survey in the U.S.A. Tsukuba Psychological
Research, 14, 151-158.
Peterson, C.H., Lomas, G.I., Neukrug, E.S., & Bonner,
M.W. (2014). Assessment use by counselors in
the United States: Implications for policy and
practice. Journal of Counseling & Development,
92, 90-99.
Pinkerman, J.E., Haynes, J.P., & Keiser, T.
(1993).Characteristics of psychological practice in
juvenile court clinics. American Journal of
Forensic Psychology, 11(2), 3-12.
Piotrowski, C. (2016). Bender-Gestalt Test usage
worldwide: A review of 30 practice-based studies.
 16:Chris Piotrowski
SIS Journal of Projective Psychology & Mental
Health, 23(2), 73-81.
Piotrowski, C. (2015a). Projective techniques usage
worldwide: A review of applied settings 1995-
2015. Journal of the Indian Academy of Applied
Psychology, 41(3), 9-19.
Piotrowski, C. (2015b). Clinical instruction on projective
techniques in the USA: A review of academic
training settings 1995-2014. Journal of Projective
Psychology & Mental Health, 22(2), 83-92.
Piotrowski, C. (2015c). On the decline of projective
techniques in professional psychology training.
North American Journal of Psychology, 17(2),
259-265.
Piotrowski, C. (2007). Forensic psychological testing as a
function of affiliation and organizational setting.
Organization Development Journal, 25(1), 94-98.
Piotrowski, C. (1999). Assessment practices in the era of
managed care: Current status and future
directions. Journal of Clinical Psychology, 55,
787-796.
Piotrowski, C. (1985). Clinical assessment: Attitudes of
the Society for Personality Assessment
membership. Southern Psychologist, 2(4), 80-83.
Piotrowski, C. (1984). The status of projective techniques.
Journal of Clinical Psychology, 40, 1495-1502.
Piotrowski, C., & Belter, R.W. (1999). Internship training
in psychological assessment: Has managed care
had an impact? Assessment, 6(4), 381-389.
Piotrowski, C., Belter, R.W., & Keller, J.W. (1998). The
impact of “Managed Care” on the practice of
psychological testing: Preliminary findings.
Journal of Personality Assessment, 70, 441-447.
Piotrowski, C., & Keller, J.W. (1992). Psychological
testing in applied settings: A literature review
from 1982-1992. Journal of Training & Practice in
Professional Psychology, 6(2), 74-82.
Piotrowski, C., & Keller, J.W. (1989). Psychological
testing in outpatient mental health facilities: A
national survey. Professional Psychology:
Research and Practice, 20, 423-425.
Piotrowski, C., & Keller, J.W. (1989).Use of assessment
in mental health clinics and
services.Psychological Reports, 64, 1298.
Piotrowski, C., & Keller, J.W. (1984).Psychodiagnostic
testing in APA-approved clinical psychology
programs. Professional Psychology: Research
and Practice, 15, 450-456.
Piotrowski, C., & Keller, J.W. (1984).Attitudes toward
clinical assessment by members of the AABT.
Psychological Reports, 55, 831-838.
Piotrowski, C., & Keller, J.W. (1978).Psychological test
usage in southeastern outpatient mental health
facilities in 1975. Professional Psychology, 9, 63-
67.
Piotrowski, C., Keller, J.W., & Ogawa, T. (1993).
Projective techniques: An international
perspective. Psychological Reports, 72, 179-182.
Piotrowski, C., &Zalewski, C. (1993).Training in
psychodiagnostic testing in APA-Approved PsyD
and PhD clinical psychology programs. Journal of
Personality Assessment, 61(2), 394-405.
Pruitt, J.A., Smith, M., Thelen, M.H., &Lubin, B. (1985).
Attitudes of academic clinical psychologists
toward projective techniques: 1968-1983.
Professional Psychology: Research and Practice,
16, 781-788.
Rabin, L.A. (1986). Projective techniques for adolescents
and children. New York: Springer.
Rabin, L.A., Paolillo, E., & Barr, W.B. (2016). Stability in
test-usage practices of clinical
neuropsychologists in the U.S. and Canada over
a 10-year period. Archives of Clinical
Neuropsychology, 31, 206-230.
Rabin, L., Barr, W.B., & Burton, M. (2005). Assessment
practices of clinical neuropsychologists in the
United States and Canada: A survey of INS,
NAN, and APA Division 40 members. Archives of
Clinical Neuropsychology, 20, 33-65.
Raez de Ramirez, M. (2011).Latin-American perspectives
on projective techniques, Rorschach diagnostics,
and evaluation of personality. Data based on
Symposium presented by the author: Lima, Peru.
Raez de Ramirez, M. (1999).The present situation about
the teaching of the Rorschach and other
projective tests in Peru.Revista de Psicologia,
17(2), 147-167.
Rapaport, D., Gill, M.M., & Schafer, R. (1968). Diagnostic
psychological testing (rev. ed.). New York:
International Universities Press.
Ready, R.E., Santorelli, G.D., Lundquist, T.S., & Romano,
F.M. (2016).Psychology internship directors‟
perceptions of pre-internship training preparation
in assessment. North American Journal of
Psychology, 18(2), 317-334.
Ready, R.E., &Veague, H.B. (2014). Training in
psychological assessment: Current practices of
clinical psychology programs. Professional
Psychology: Research and Practice, 45, 278-282.
Retzlaff, P. (1992). Professional training in psychological
testing: New teachers and new tests. Journal of
Training & Practice in Professional Psychology,
6(1), 45-50.
Reynolds, W.M. (1979). Psychological tests: Clinical
usage versus psychometric quality. Professional
Psychology, 10, 324-329.
Riccio, C.A., & Rodriguez, O.L. (2007). Integration of
psychological assessment approaches in school
psychology. Psychology in the Schools, 44(3),
243-255.
Rossini, E.D., & Moretti, R.J. (1997). Thematic
Apperception Test (TAT) interpretation: Practice
recommendations from a survey of clinical
psychology doctoral programs accredited by the
APA. Professional Psychology: Research and
Practice, 28, 393-398.
Ryba, N.L., Cooper, V.G., & Zapf, P.A. (2003). Juvenile
competence to stand trial evaluations: A survey
of current practices and test usage among
psychologists. Professional Psychology:
Research and Practice, 34(5), 499-507.

Schneider, M.F., &Perney, J. (1990).Development of the
Children‟s Apperceptive Story-Telling Test.
Psychcal Assent, 2(2), 179-185.
Shapiro, E.S., &Heick, P.F. (2004). School psychologist
assessment practices in the evaluation of
students referred for social/behavioral/emotional
problems. Psychology in the Schools, 41(5), 551-
561.
Sharpley, C.F., & Pain, M.D. (1988).Psychological test
usage in Australia. Australian Psychologist, 23(3),
361-369.
Shemberg, K., & Keeley, S. (1970). Psychodiagnostic
training in the academic setting: Past and
present. Journal of Consulting and Clinical
Psychology, 34, 205-211.
Smith, D., & Dumont, F. (1995). A cautionary study:
Unwarranted interpretations of the Draw-A-
Person test. Professional Psychology: Research
and Practice, 26, 298-303.
Smith, S.R., Gorske, T., Wiggins, C., & Little, J.A.
(2010).Personality assessment use by clinical
neuropsychologists. International Journal of
Testing, 10, 6-20.
Sotelo-Dynega, M., & Dixon, S.G. (2014). Cognitive
assessment practices: A survey of school
psychologists. Psychology in the Schools, 51(10),
1031-1045.
Stedman, J.M., et al. (2017). Availability of training in
psychological assessment at internship
sites.Journal of Training and Education in
Professional Psychology, in press.
Stedman, J.M., Hatch, J.P., &Schoenfeld, L.S. (2002).
Pre-internship preparation of clinical and
counseling students in psychological testing,
psychotherapy, and supervision: Their readiness
for medical school and non-medical school
internships. Journal of Clinical Psychology in
Medical Settings, 9, 267-271.
Stedman, J.M., Hatch, J.P., &Schoenfeld, L.S. (2000).
Pre-internship preparation in psychological
testing and psychotherapy: What internship
directors say they expect. Professional
Psychology: Research and Practice, 31, 321-326.
Stinnett, T.A., Havey, J.M., &Oehler-Stinnett, J. (1994).
Current test usage by practicing school
psychologists: A national survey. Journal of
Psychoeducational Assessment, 12, 331-350.
Sundberg, N. (1961). The practice of psychological
testing in clinical services in the United States.
American Psychologist, 16, 79-83.
Sweeney, J.A., Clarkin, J.F., & Fitzgibbon, M.L.
(1987).Current practice of psychological
assessment. Professional Psychology: Research
and Practice, 18, 377-380.
Swensen, C. (1968). Empirical evaluations of human
figure drawings: 1957-1966. Psychological
Bulletin, 70, 20-44.
Thelen, M.H., Varble, D.L., & Johnson, J. (1968).Attitudes
of academic clinical psychologists toward
TAT & CAT:17
projective techniques. American Psychologist, 23,
517-521.
Tsoi, M.M., &Sundberg, N.D. (1989).Patterns of
psychological test use in Hong Kong.
Professional Psychology: Research and Practice,
20, 248-250.
Tuma, J.M., & Pratt, J. (1982). Clinical child psychology
practice and training: A survey. Journal of Clinical
Child Psychology, 11, 27-34.
Vukovich, D.H. (1983). The use of projective assessment
by school psychologists. School Psychology
Review, 12, 358-364.
Wade, T.C., & Baker, T.B. (1977). Opinions and use of
psychological tests: A survey of clinical
psychologists. American Psychologist, 32, 874-
882.
Watkins, C.E., Campbell, V.L., & Manus, M.
(1990).Personality assessment training in
counseling psychology programs. Journal of
Personality Assessment, 55, 380-383.
Watkins, C.E., Campbell, V.L., & McGregor, P. (1988).
Counseling psychologists‟ use of and opinions
about psychological tests: A contemporary
perspective. The Counseling Psychologist, 16,
476-486.
Watkins, C.E., Campbell, V.L., Nieberding, R., &
Hallmark, R. (1995).Contemporary practice of
psychological assessment by clinical
psychologists. Professional Psychology:
Research and Practice, 26, 54-60.
Wechsler, S.M., Oakland, T., Leon, C., et al. (2014). Test
development and use in five Iberian Latin
American countries. International Journal of
Psychology, 49(4), 233-239.
Weiner, I.B., & Greene, R.L. (2008).Handbook of
personality assessment. New York: Wiley.
Wilson, M.S., &Reschly, D.J. (1996).Assessment in
school psychology training and practice. School
Psychology Review, 25(1), 9-23.
Wood, J.M., Garb, H.N., Lilienfeld, S.O., &Nezworski,
M.T. (2002).Clinical assessment. Annual Review
of Psychology, 53, 519-543.
Woolford, J., Patterson, T., Macleod, E., Hobbs, L., &
Hayne, H. (2015). Drawing helps children to talk
about their presenting problems during a mental
health assessment. Clinical Child Psychology and
Psychiatry, 20, 68-83.
Wright, C.V., Beattie, S.G., Galper, D.I., et al. (2016).
Assessment practices of professional
psychologists: Results of a national survey.
Professional Psychology: Research and Practice,
47, 236-249.
Ziskin, J. (1995). Coping with psychiatric and
psychological testimony, Vol. 2 (5th ed.,
Challenging personality testing: The Rorschach &
other projective methods, pp. 866-870). Los
Angeles, CA: Law and Psychology Press.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 18-25

Blood Pressure Variations and Emotional Dampening:

Preliminary Evidence for the Curvilinear Relationship
Dharmendra Jain, Meenakshi Shukla and Rakesh Pandey
The present study attempts to validate and extend the earlier findings linking blood pressure (BP) and reduced
emotion recognition ability i.e., emotional dampening (ED). Twenty normotensive participants had their BP
readings taken via an automated BP monitor and were subsequently assessed on a task of Facial Emotion
Recognition. Bivariate linear correlations revealed that both SBP and DBP were associated with poor emotion
recognition (i.e., ED). Partial Least Square Modelling showed that ED was also linked with a single latent measure
of BP and BP related emotional dampening occurs more for positive and negative non-aroused emotions as
compared to negative aroused emotions. Further, when the link of ED and BP was tested under the assumption
of non-linearity (quadratic), the correlation of emotion recognition accuracy with SBP and DBP not only increased
substantially in magnitude but some of the previously non-significant correlations became significant. This
observation provides support for a quadratic relationship between BP and ED and implies that ED occurs for both
higher and lower levels of BP.
Researchers have recognized for a long time however, do not provide evidence for the
that emotional factors, particularly negative possibility that hypertension and/or elevation
emotional states and psychological stress, in blood pressure may dampen the emotional
may lead to development of hypertension responding for positive emotional valence too.
(Somova, et al., 1995; Everson,et al., 1998; Pury and colleagues (Pury, et al., 2004)
Rutledge & Hogan, 2002; Player, et al., 2007). empirically tested whether the emotional
However, the observation that elevation in dampening in response to elevated blood
blood pressure (BP) and hypertension may pressure is generalized across emotional
lead to emotional impairment is relatively a valence or not. They tested three predictive
recent one. During the beginning of the 21st models of the emotional impact of elevated
century a number of researchers observed blood pressure viz., the ameliorative model,
that individuals with hypertension showed a the positivity bias model, and the emotional
reduction in pain sensitivity and an increase in dampening model. The ameliorative model
pain threshold (e.g., Bruehl& Chung, 2004) assumes that elevations in BP result in less
whereas individuals with low blood pressure negative appraisal of negative emotional
showed an opposite pattern i.e., enhanced stimuli but the appraisal of positive stimuli will
pain sensitivity (Duschek, et al., 2009; not be altered. However, the positivity bias
Duschek, et al., 2008). Similarly, some studies model proposes that elevation in BP is
reported that patients with hypertension associated with a less negative appraisal of
perceived their negative emotional states negative stimuli and at the same time
and/or psychological stress/distress as less increased positive appraisal of positive
aversive (Nyklíˇcek, et al., 1996, 1998, 1999). emotional stimuli. The third model i.e., the
These observations suggest that hypertension emotional dampening model holds that
is associated with reduced emotional appraisal of both negative and positive
responsivity (i.e., emotional dampening) for emotional stimuli is reduced in individuals with
aversive and negative emotional states such higher resting blood pressure (see Pury et al.,
as pain, stress, distress etc. (Bruehl& Chung, 2004 for details). Pury and colleagues (2004)
2004; Duschek et al., 2008, 2009; Nyklíˇcek, obtained support only for the emotional
et al., 1996, 1998, 1999). dampening model of hypertension suggesting
The studies linking hypertension with that elevation in blood pressure impairs the
enhanced pain threshold and/or reduced appraisal of emotional stimuli irrespective of
aversiveness of negative emotional states, the emotional valence.

Dharmendra Jain, D.M. Asst. Professor in Cardiology, Institute of Medical Sciences, Banaras Hindu University,
Varanasi, Email: djaincard@gmail.com, Meenakshi Shukla, M.A.(Psy) Research Scholarand Rakesh Pandey,
Ph.D., Professor & Head, (Corresponding author) Dept.of Psychology, Banaras Hindu University, Varanasi-221005
(India), Email: rpan.in@yahoo.com.
Keywords: Emotional dampening, blood pressure, hypertension, facial emotion recognition

Subsequent researches supported the
emotional dampening-elevated blood
pressure relationship using a wide variety of
emotion perception tasks (e.g., McCubbin,et
al., 2011, 2013; Wilkinson & France, 2009).
Further, emotional dampening has also been
reported in aged individuals who were at high
risk for developing hypertension (McCubbin,
et al., 2011) as well as in individuals with
parental history of hypertension (Wilkinson &
France, 2009).
The empirical evidence accumulated so far;
thus, provide support for the relationship of
blood pressure elevation with emotional
dampening. However, the observed mild to
moderate magnitude of relationship
[correlations ranged from -0.19/-0.22 to -0.35/-
0.36 in some studies (Pury et al., 2004;
McCubbin et al.,2011), while in others it
ranged from -0.360 to -0.581 (McCubbin, et
al, 2013)] suggest other possibilities and
explanations. For instance, the obtained mild
to moderate correlations suggest that the
relationship of BP with emotional dampening
is either inherently weak, or the said
relationship may be strong but might not have
been captured by the statistical methods
used. Close examination of the said studies
revealed that the correlation between BP and
emotional dampening was computed using a
statistical method that assumes the
relationship between them to be linear. Thus,
it is likely that the inherently strong but
curvilinear relationship between BP and
emotional dampening might have been
underestimated.
To the best of our knowledge, none of the
studies conducted till date have empirically
tested and compared the relationship between
blood pressure elevation and emotional
dampening under the assumption of linearity
as well as non-linearity. Almost all the studies
examining emotional dampening in relation to
blood pressure have assumed the relationship
to be a linear one. However, some indirect
evidences do point towards the possibility that
the emotional dampening – blood pressure
relationship may be curvilinear in nature. For
example, the observation that low blood
pressure is strongly associated with
Blood Pressure & Emotional Dampening:19
decreased recognition of positive affect (Jorm,
2001) suggests the possibility that reduction in
blood pressure may also be associated with
emotional dampening. This finding coupled
with the observation that emotional
dampening occurs in response to elevation in
blood pressure (Pury et al., 2004; McCubbin,
et al., 2011, 2013) suggests the possibility
that emotional dampening may occur at both
lower and higher levels of the BP range and
the emotional responsiveness may remain
intact in between. The observation of
‘‘inverted U-shaped’’ relationship between BP
and cognitive performance (e.g., Morris et al.,
2002) suggest the possibility that such
curvilinear relationship might hold true for
performance involving affective domain.
However, empirical test of the proposed
‘‘inverted U-shaped’’ relationship between BP
and emotional dampening is a striking gap in
the existing literature.
Moreover, the aforesaid studies
demonstrating association between emotional
dampening and elevated blood pressure have
not presented consistent findings in relation to
elevation in Systolic Blood and Diastolic Blood
Pressure (SBP & DBP, respectively). For
instance, some studies noted a significant
relationship of emotional dampening with SBP
but not with DBP (e.g., Pury et al., 2004) while
others observed the reverse pattern (e.g.,
McCubbin, et al., 2013). Still others noted that
both SBP and DBP correlated significantly
with emotional dampening (e.g., McCubbin, et
al., 2011). The observed variation in findings
questions the validity of conclusion that
elevation in BP is associated with emotional
dampening and suggests the need to re-
investigate this relationship. Further, the
reported variations in findings in relation to
SBP and DBP also necessitate exploration of
emotional dampening in relation to a
composite measure of BP. Given the
difference in the biological mechanisms of the
SBP and DBP, the sum or average of SBP
and DBP would not be an appropriate
composite index of BP. However, BP may be
modelled as a latent reflective construct with
SBP and DBP as indicators. Following this
approach, the present study also attempts to
20:Jain, Shukla & Pandey
examine the relationship of emotional
dampening with a single latent measure of BP
reflected in SBP and DBP.
Considering the said gaps, the present study
attempts to examine the relationship between
blood pressure and emotional dampening
under the assumption of both linear and
curvilinear (Quadratic) relationship. Further,
attempt has also been made to test the
relationship of various discrete emotion
categories (viz., positive, negative aroused
and negative non-aroused emotions) with the
reflective latent construct of blood pressure
using partial least square regression. The
effort to examine the link of emotional
dampening with a single index of blood
pressure would not only help to reconcile the
observed inconsistency in findings but also to
generalize the findings of blood pressure
related emotional dampening.
Methods:
Participants: Participants were 30 adults (15
male, 15 female) in the age range of 19-50
years (average= 28.31 ± 8.95 years). The
ethnic background of all the participants was
Asian and they belonged to middle class
socio-economic status. To achieve
comparability of the findings with previous
studies (Pury et al., 2004; McCubbin, et al.,
2011, 2013) those participants were excluded
whose blood pressure was in the hypertensive
range as per the criteria laid down by the
Seventh Report of the Joint National
Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure (JNC-7, 2003; Chobanian, et al.,
2003). Thus, individuals with a Systolic Blood
Pressure (SBP) ≥ 140mmHg and/or Diastolic
Blood Pressure (DBP) ≥ 90mmHg were
excluded from the present study. Further,
individuals having BP in normotensive range
but taking anti-hypertensive medication were
also excluded. Since a single latent construct
of BP (based on SBP and DBP) was to be
created in the present study, individuals with
atypical BP variations (e.g., high SBP and low
DBP or vice-versa) were identified and
excluded from the analysis. For this purpose,
median split was performed on SBP and DBP
measures to form high and low SBP and DBP
groups. The participants falling in high SBP
and low DBP group or vice-versa (N=8) were
excluded from the analysis. Further, two
participants (having higher age as compared
to others) were also excluded as their
inclusion led to unnecessary inflation of the
age range. Thus, the final sample comprised
of 20 participants (10 male, 10 female) in the
age range of 21-44 years (average= 27.85 ±
7.55 years).
Materials and Experimental Task: The
Facial Emotion Recognition Task comprised
of 18 black & white photographs of human
faces expressing the six basic emotions of
happiness, sadness, fear, anger, surprise,
and disgust. The photographs were chosen
from a standardized set of photographs
displaying posed facial expressions of male
and female Indian adult subjects (Mandal &
Rai, 1987). These photographs were correctly
recognized for the emotion expressed by 70%
of the observers and rated on a 7-point scale
for distinctiveness of the expressed facial
emotion. The stimuli consisted of 3
photographs each for the said emotion
categories and an equal number of male and
female faces were included.
The task (designed in Super Lab 4.0)
consisted of 18 trials (3 photographs x 6 basic
emotions). In each trial, a facial emotion
photograph was presented on the computer
screen along with six five-point rating scales
(one for each of the six basic emotions).
Participants were required to indicate the
presence of each of the six emotions in a
given facial affect photograph on the five-point
rating scale (ranging from ‘1-Not At All
Present’ to ‘5-Completely Present’) by
encircling an appropriate number of the scale.
Procedure: The participants of the study had
been asked to refrain from consuming
caffeine, alcohol, or performing strenuous
exercise for about 2 hours before the
experiment. Immediately upon their arrival to
the laboratory, participants were requested to
sit on a comfortable chair and relax for about
10-15 minutes. Meanwhile, demographic
information was collected from them.
Following this, three BP (SBP and DBP)
measurements were taken from the non-

dominant arm of the participants using
OMRON SEM-1 Automated Blood Pressure
Monitor, allowing 2 minutes gap between the
readings. The readings were then averaged to
determine the final blood pressure reading.
Participants were then requested to sit in a
chair facing the computer monitor to complete
the facial emotion recognition task. Apart from
giving verbal instructions about how to
complete the task, instructions were also
presented on-screen. After ensuring that
participants have clarity about how to perform
the task, they were given a small practice
session with three trials. If any difficulty was
noted in the practice session, it was resolved
with another practice session. After practice
session, the final task was administered.
After completion of the task, the recognition
accuracy score for each emotion photograph
was calculated using the following formula:
[(rating on the target emotion/ sum of ratings
on all the remaining emotions) x100]. The
recognition accuracy score for each discrete
emotion was calculated by averaging the
scores obtained on the three photographs of
that emotion. Further, an average score of all
the six emotions was also computed as an
index of overall emotion recognition accuracy
(irrespective of valence). Based on the
empirical observation that for medium and
high-intensity facial expressions, fear is
consistently confused for surprise but not
vice-versa (e.g., Guo, 2012), overall emotion
recognition accuracy score excluding the
emotions of fear and surprise (i.e. average
score of happiness, sadness, anger, and
disgust) was also calculated. Further, the
emotion recognition accuracy was also scored
in accordance with valence and arousal of the
emotions. The average scores for ‘happy’
and ‘surprise’ was used as an index of
recognition accuracy of Positive Emotions.
Similarly, the average scores of ‘anger’ and
‘fear’ represented Negative Aroused Emotions
while the average scores of ‘sadness’ and
‘disgust’ were clubbed as negative Non-
Aroused Emotions.
Results and Discussion:
The average resting SBP of the participants
ranged from 100-139 mmHg (M= 123.30 ±
Blood Pressure & Emotional Dampening:21
9.56 mmHg), while the average resting DBP
ranged from 63-88 mmHg (78.25 ± 7.30
mmHg) across the entire sample. The SBP of
men ranged from 106-139 mmHg and that of
women from 100-127 mmHg. The range of
DBP of men was 64-88 mmHg and that of
women was 66-88 mmHg. This finding
suggests that all the participants were having
their BP in the normotensive range and thus
the findings of the study would have
implications for the emotional correlates of
resting state BP variations in the normal
range.
The link of the BP with emotional dampening
(i.e. reduced emotion recognition accuracy)
was first tested under the linearity
assumption. Findings revealed that the resting
SBP and DBP were negatively correlated with
the recognition accuracy of various emotions
supporting the notion of blood pressure
related emotional dampening. However,
correlation of none of the emotions with either
SBP or DBP reached conventional level of
statistical significance except happiness which
correlated significantly with both SBP (r= -
0.468, p= 0.037) and DBP (r= - 0.452, p=
0.045). The observed negative correlation of
overall emotion recognition accuracy was
marginally significant with SBP (r= - 0.418, p=
.067) but not with DBP (r= - 0.272, p= .245).
The correlation of overall emotion accuracy,
obtained for four emotions (i.e., happy, anger,
sad, and disgust) after excluding the often
confused emotions of fear and surprise, with
SBP and DBP resulted in a slight increase in
the magnitude of correlation. The pooled
emotion recognition accuracy correlated
significantly with SBP (r= - 0.454, p= 0.044)
but not with DBP (r= - 0.318, p= 0.172).
The said pattern of correlation between
emotion recognition accuracy and BP clearly
indicates that elevation of blood pressure
even in the normotensive range is associated
with dampened emotional responding as
reflected by reduced accuracy in recognizing
facial expressions of emotions. Further, these
findings corroborate earlier findings that blood
pressure related emotional dampening
involves both positive and negative emotions
and is not limited to any specific emotional
22:Jain, Shukla & Pandey
valence (Pury et al., 2004; McCubbin, et al,
2011, 2013).
However, unlike the earlier studies, the
present study examined the emotional
dampening for each of the six basic emotions
and it was observed that emotional
dampening occurred for all the six basic
emotion categories except fear and surprise.
One reason for non-observance of emotional
dampening for the said two emotions may be
the restricted range of scores resulting from
confusion of these emotions with each other
in their recognition (e.g., Guo, 2012). Here it
is worth mentioning that the effect size of the
emotional dampening observed for various
emotions was though comparable with the
correlations observed in earlier studies (Pury
et al., 2004; McCubbin, et al., 2011, 2013),
none of the correlations were found significant
except the correlation of the accuracy of
recognition of facial expressions of happiness
with BP. Thus, statistically reliable dampening
in relation to elevated blood pressure was
noted for recognition of happiness only.
Another analysis examining the link of
recognition accuracy of positive, negative
aroused and negative non-aroused emotions
with SBP and DBP revealed that both SBP
and DBP were correlated negatively with
recognition accuracy of positive emotions (r =
-.430 & -.414 respectively), negative non-
aroused emotions (r = -.406 & -.322
respectively), and negative aroused emotions
(r = -.276 & -.025 respectively). However,
none of the said correlations were found
significant (p>.05) though the magnitude of
relationship (effect size) was moderately
strong for each of the said relationships
except for negative aroused emotions.
The said pattern of relationship noted in the
present study suggests that emotional
dampening though involved all the emotion
categories, the dampening was noted more
for positive and negative non-aroused
emotions and less for negative aroused
emotions. This observation is a significant
addition to the existing literature dealing with
blood pressure related emotional dampening.
The observed lower dampening of negative
aroused emotions may be explained in terms
of the hypersensitivity of hypertensive for such
emotions. It has been noted that hypertensive
individuals experience and express negative
aroused emotions such as anger, hostility etc.
more frequently as compared to others
(Helmers, et al, 2000; Hosseini,et al, 2011;
Guyll & Contrada, 1998; Yan, et al., 2003).
This sensitivity to and frequent experience of
negative aroused emotions among
hypertensives may intrinsically prime them for
these emotions which in turn may result in
enhanced recognition accuracy (i.e., reduced
emotional dampening). The said explanation,
however, is fraught with the danger of
overgeneralization inasmuch as the present
study was conducted on normotensives and
not on hypertensive individuals.
The relationship of the emotion recognition
accuracy with a single latent measure of blood
pressure was also examined in the present
study using Partial Least Squares (PLS)
based structural equation modelling. This
analysis was not only helpful to model and
test the relationship of a single index of BP
with recognition of latent emotion categories
but is also more appropriate statistical tool for
small sample data. Two structural
relationship models were tested – one relating
the latent emotional categories of positive,
negative aroused and negative non-aroused
emotions with the latent construct of BP and
the other linking aroused and non-aroused
emotions (irrespective of valence) with blood
pressure. Findings revealed that the latent
construct of blood pressure significantly
predicted dampening of positive and negative
non-aroused emotions but not the negative
aroused emotions (Fig.1). Moreover, when
emotions were grouped based on arousal
alone (disregarding valence and excluding the
emotions of fear and surprise that were often
confused by the participants), both aroused
and non-aroused emotions were found be
equally dampened by BP (Fig. 2).

Figure1:The relationship of latent construct of blood
pressure with recognition accuracy of Positive,
Negative Aroused, and Negative Non-Aroused
Emotions (* p< .05)
The findings of the PLS based modelling
provides further support to our correlation
based findings that elevated blood pressure is
associated with dampened responding for
positive and negative non-aroused emotions
but not for negative aroused emotions.
However, it brings to fore some newer insight
into the relationship of BP and emotional
dampening. For instance, it suggests that
elevated blood pressure is linked with
dampening of both aroused (happy and
anger) and non-aroused (sad and disgust)
emotions when emotional valence is
disregarded. However, if valence and arousal
both are considered simultaneously then
emotional dampening in response to elevated
blood pressure occurs for negative non-
aroused emotions but not for negative
aroused emotions. These observations
indicate that arousal and valence interact with
each other in determining the emotional
dampening impact of BP. However, this
speculation needs to be tested in future
research using emotional stimuli with
calibrated valence and arousal ratings. The
findings of the PLS based modelling further
add to the existing literature by demonstrating
that BP modelled as a single latent construct
(reflected in the variations in the SBP and
DBP) is associated with emotionally
dampened responding particularly for positive
and negative non-aroused emotions. Despite
the fact that the observed correlations and
Blood Pressure & Emotional Dampening:23
Figure 2: The relationship of latent construct of blood
pressure with recognition accuracy of Aroused and
Non-Aroused Emotions (*p<.05)
effect sizes in the present study were as
strong as reported in earlier studies (Pury et
al., 2004; McCubbin, et al., 2011; 2013), the
correlations were not found statistically
significant in the present study. One obvious
reason for this is the small sample size
(N=20) of the study as compared to earlier
ones (Pury et al, 2004; N = 65; McCubbin et
al., 2013; N = 96; McCubbin et al., 2011; N =
106). The power analysis using a two-tailed
alpha value of 0.05, a power of 0.95, and an
effect size of 0.3 showed that the correlations
would have been significant on a sample size
of 115. Another reason for the lower level
effect size of non-significant correlations may
be the fact that the relationship tested
between the given variables may not be
genuinely linear. It is well known that
computation of linear correlation between
curvilinear related variables often results in
zero order or lower magnitude of correlation.
To test the said possibility the present study
re-examined the relationship of SBP and DBP
with emotion recognition accuracy under the
assumption of non-linearity (quadratic) of
relationship. Compared to linear relationship,
quadratic relationship with SBP was found to
be significant for Anger (r= 0.635, p= 0.012),
All Emotions (r= 0.607, p= 0.020), Four
Emotions (r= 0.654, p= 0.009), Negative
Aroused Emotions (r= 0.572, p= 0.034) and
Negative Non-Aroused Emotions (r= 0.581,
p= 0.030). Significant quadratic relationship
24:Jain, Shukla & Pandey

was also noted between DBP and the emotion the variance explained by blood pressure in
Happy (r= 0.554, p= 0.044). Table-1 shows linear and quadratic models.
Table 1: Variance explained by SBP & DBP for individual and composite emotions
in linear and quadratic models
Emotion SBP DBP
Linear Quadratic Linear Quadratic Linear Quadratic
2 2 2 2
R R R R
* * *
Happy .219 247(p=.089) .204 .307
Sad .150 .220 .077 .240(p=.097)
Fear .014 .017 .035 .083
*
Anger .113 .403 .012 .117
Surprise .005 .018 .005 .014
Disgust .097 .268(p=.071) .072 .087
*
All emotions .175 .368 .074 .168
* **
Four Emotions .207 .428 .101 .225
Positive .184 .200 .171 .249(p=.088)
*
Negative Aroused .076 .327 .001 .049
*
Negative non-aroused .165 .338 .104 .185
(*p<.05, **p<.01)
It is evident from Table-1 that both systolic response to reduction in blood pressure.
and diastolic blood pressure explained a However, the small sample size undermines
larger amount of variance under the the validity of such conclusions and
assumption of quadratic relationship than necessitates future study using large sample.
linear relationship. Further, some of the Conclusion:
relationships that were non-significant under The findings of the present study corroborate
the assumptions of linearity became the earlier observation that elevation in resting
significant when a curvilinear relationship was state blood pressure even in normotensive
assumed. Taken together, these range is associated with emotional dampening
observations suggest the possibility that the as reflected by reduced emotion recognition
relationship between emotional dampening accuracy. However, the lower sample size
and BP is curvilinear (quadratic). Here it is and lack of statistical significance of the
worth noting that though the magnitude of findings limit the generalization of the findings
correlation under curvilinear relationship and necessitate future research. The present
assumption has increased substantially and study extends the earlier observations by
some of the previously reported non- suggesting the possibility that the relationship
significant correlations became significant, a between BP and emotional dampening may
number of correlations are still non-significant. be curvilinear (quadratic) and thus both
Thus, it is likely that the same effect sizes elevation and depression in BP can dampen
might have been found significant if a larger the emotional responding. This hypothesis is
sample would have been used as indicated by supported by the observation that compared
the power analysis. to linearity assumption, under the assumption
The analysis of the scatterplot with quadratic of curvilinear relationship the previously non-
curve fitted in the data revealed that wherever significant relations became significant and
the quadratic relationship was found the magnitude of correlations increased
significant (see Table – 1) the nature of substantially. Another major observation of
relationship was best modelled by an inverted the present study was that BP as a single
U shape. Thus, the observation of inverted U latent variable (indexed jointly by SBP and
shape relationship suggests that emotional DBP) is also associated with emotional
dampening may occur not only in association dampening. However, the most important
with elevated blood pressure but also in contribution of the present study is the

observation that emotional dampening though
involves both positive and negative emotional
valence, the magnitude of dampening may
vary depending on the valence and level of
arousal of the emotions. The elevation in BP
results in greater dampening of positive and
negative non-aroused emotions but not of
negative aroused emotions. However, if
emotions are categorised with respect to
arousal (disregarding valence) the emotional
dampening in association with elevated BP
was noted for both aroused and non-aroused
emotions. The observation that even minor
alterations on either side of the resting BP can
influence the accuracy of emotion perception
has significant implications not only for
researches dealing with hypertension and
other cardiovascular disorders but also for
emotion processing.
References:
Bruehl, S., & Chung, O. (2004). Interactions between the
cardiovascular and pain regulatory systems: An
updated review of mechanisms and possible
alterations in chronic pain. Neuroscience and
Biobehavioral Reviews, 28, 395–414.
Chobanian, A.V., Bakris, G.L., Black, H.R., et al. (2003).
The Seventh Report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure: The Journal of the American
Medical Association, 290(10):1312.
Doi:10.1001/jama.290.10.1312-a.
Duschek, S., Dietel, A., Schandry, R., & Reyes del Paso,
G. A. (2009). Increased sensitivity to heat pain in
chronic low blood pressure.European Journal of Pain,
13, 28–34.
Duschek, S.,Schwarzkopf, W., &Schandry, R.
(2008).Increased pain sensitivity in low blood
pressure.Journal of Psychophysiology, 22, 20–7.
Everson, S. A., Goldberg, D. E., Kaplan, G. A., Julkunen,
J., and Salonen, J. T. (1998). Anger expression and
incident hypertension.Psychosomatic Medicine,60,
730–735.
Guo, K. (2012). Holistic Gaze Strategy to Categorize
Facial Expression of Varying Intensities.PLoS ONE,
7(8): e4258. doi:10.1371/journal.pone. 0042585.
Guyll, M., &Contrada, R. J. (1998). Trait hostility and
ambulatory cardiovascular activity: Responses to social
interaction. Health Psychology, 17, 30– 39.
Helmers, K.F., Baker, B., O'Kelly, B., Tobe, S.W.
(2000).Anger expression, gender, and ambulatory
blood pressure in mild, unmedicated adults with
hypertension.Annals of Behavioral Medicine, 22, 60-64.
Hosseini, S.H., Mokhberi, V., Mohammadpour, R.A.,
Mehrabianfard, M., Lashak, N.B. (2011). Anger
expression and suppression among patients with
essential hypertension.International Journal of
Psychiatry in Clinical Practice, 15,214-218.
Blood Pressure & Emotional Dampening:25
Jorm, A.F. (2001). Association of hypotension with
positive and negative affect and depressive symptoms
in the elderly.The British Journal of Psychiatry,
178:553-555.
Mandal, M.K., & Rai, A. (1987).Responses to facial
emotion and psychopathology. Psychiatry Research,
20, 317-324.
McCubbin, J.A., Loveless, J.P., Graham, J.G., Hall, G.A.,
Bart, R.M., Moore, D.D., Merritt, M.M., Lane, M.D.,
Thayer, J.F. (2013). Emotional Dampening in Persons
with Elevated Blood Pressure: Affect Dysregulation and
Risk for Hypertension. Annals of Behavioral Medicine,
DOI: 10.1007/s12160-013-9526-2.
McCubbin, J.A., Merritt, M.M., Sollers, J.J. 3rd, et al.
(2011). Cardiovascular emotional dampening: the
relationship between blood pressure and recognition of
emotion. Psychosomatic Medicine, 73: 743-750.
Morris, M.C., Scherr, P.A., Hebert, L.E., Bennett, D.A.,
Wilson, R.S., Glynn, R.J., Evans, D.A. (2002).
Association between blood pressure and
cognitive function in a biracial community population of
older persons. Neuroepidemiology, 21(3):123–30.
Nyklíˇcek, I., Vingerhoets, A. J., & Van Heck, G. L.
(1996). Hypertension and objective and self-reported
stressor exposure: A review. Journal of Psychosomatic
Research, 40, 585–601.
Nyklíˇcek, I., Vingerhoets, A.J., Van Heck, G.L. (1998).
The under reporting tendency of hypertensives: an
analysis of potential psychological and physiological
mechanisms. Psychology Health; 13:1–21.
Nyklíˇcek, I., Vingerhoets, A. J., & Van Heck, G. L.
(1999).Elevated blood pressure and self-reported
symptom complaints, daily hassles and
defensiveness.International Journal of Behavioral
Medicine, 6, 177–189.
Player, M. S, King, D. E., Mainous, A. G., &Geesey, M. E.
(2007).Psychosocial factors and progression from
prehypertension to hypertension or coronary heart
disease.TheAnnals of Family Medicine, 5, 403-411.
Pury, C.L.S., McCubbin, J.A., Helfer, S.G., Galloway, C.,
McMullen, L.J. (2004). Elevated resting blood pressure
and dampened emotional response. Psychosomatic
Medicine, 66:583–587.
Rutledge, T., & Hogan, B.E. (2002).A quantitative review
of prospective evidence linking psychological factors
with hypertension development. Psychosomatic
Medicine, 64, 758–766.
Somova, L. I., Connolly, C., & Diara, K.
(1995).Psychosocial predictors of hypertension in black
and white Africans. Journal of Hypertension, 13, 193–
199.
Wilkinson, D.Z., & France, C.R. (2009). Attenuation of
positive and negative affect in men and women at
increased risk for hypertension: a function of
endogenous barostimulation? Psychophysiology. Jan;
46(1):114-21. DOI: 10.1111/j.1469-8986.2008.00757.x.
Yan, L. L., Liu, K., Matthews, K. A., Daviglus, M. L.,
Ferguson, T. F., & Kiefe, C. I. (2003). Psychosocial risk
of hypertension: The Coronary Artery Risk
Development in Young Adults (CARDIA) Study. The
Journal of the American Medical Association, 16,
2138–2148.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 26-33

Integrative Assessment of Interpersonal Dependency: Contrasting Sex

Differences in Response Patterns on Self-Attributed and Implicit Measures
Adam P. Natoli and Robert F. Bornstein
Numerous clinical and experimental studies have reported that women are more dependent than men. These
conclusions are based primarily on self-reported (or ―self-attributed‖) dependency scores, where women almost
invariably obtain higher scores than men. However, this has not been true when implicit dependency scores
(typically obtained via performance-based or projective tests) are examined. These patterns suggest that
implicit—self-attributed test score discontinuities may differ across sex; it is therefore of interest to contrast the
direction and magnitude of dependency test score discontinuities in women and men. Self-attributed scores of
interpersonal dependency were obtained from the Interpersonal Dependency Inventory and Relationship Profile
Test, while dependency was measured implicitly by the Rorschach Oral dependency Scale. Analyses of
implicit—self-attributed test score discontinuities across sex in a sample of 1,508 undergraduates yielded a
number of significant differences in direction confirming that women obtain higher self-attributed dependency
scores than implicit dependency scores, whereas this pattern is reversed in men. Analyses comparing the
magnitude of implicit—self-attributed test score discontinuities across sex yielded only one significant difference:
Discontinuity between self-attributed scores of dysfunctional detachment and scores on an implicit measure of
dependency was larger among women than among men. Findings are discussed within the frameworks of
gender schema theory and social role theory. These results have implications for methodologies used in
contemporary personality assessment; suggestions for continued research are offered.

Dependency is characterized by a tendency to characteristics or traits. In these

look to others for advice, support, and
reassurance, behave in a compliant and
cooperative manner, and be passive and
acquiescent in interpersonal relationships.
Numerous clinical and experimental studies
have found women to appear more dependent
than men (Ainsworth, 1969; Alonso-Arbiol,
Shaver, & Yárnoz, 2002; Maccoby & Masters,
1970; Masling, 1986; Millon, 1981; Mischel,
1970; Parens & Saul, 1971; Walters & Parke,
1964). Indeed, sex differences in self-
reported (or ―self-attributed‖) dependency
scores are the norm in clinical and research
settings, but this has not been true when
implicit dependency scores (typically obtained
via performance-based tests) are examined
(Bornstein, 1995; Bornstein, Manning,
Krukonis, Rossner, & Mastrosimone, 1993).
Scores derived from self-report measures of
dependency reflect the degree to which an
individual attributes traits, feelings, thought
patterns, motives, behaviors, and experiences
that are associated with dependency to him-
or herself. Performance-based measures of
dependency, particularly those identified as
stimulus attribution tests (e.g., the Rorschach
Inkblot Method [RIM]), evaluate implicit
performance-based measures individuals are
presented with ambiguous stimuli to which
they are asked to attribute meaning or
interpret (e.g., create a story). The
individual’s attributions are determined in part
by the characteristics of the stimulus and in
part by the individual’s cognitive style,
emotions, motives, perception, and need
states. Scores on these measures are
typically obtained through the use of
standardized scoring and interpretation
systems that quantify the participant’s
responses and his or her approach to the
task. Moreover, performance-based
measures continue to be popular clinical
instruments worldwide, based on an extensive
review of the literature (see Piotrowski, 2015,
2017).
Despite the ability to evaluate the same
construct using these two different methods,
in the study of dependency as well as in other
areas, there has developed a strong reliance
on the use of self-report measures in
personality and personality disorder (PD)
research. In fact, Bornstein (2003) found 81%
of published studies of personality pathology
between 1991 and 2000 relied exclusively on

Adam P. Natoli (Corresponding author Email: adamnatoli@mail.adelphi.edu, Voice 609-933-0747) and Robert F.
Bornstein, Derner Institute of Advanced Psychological Studies, Adelphi University, 1 South Avenue, Garden City,
NY 11530
Keywords: Dependency, Sex Differences, Personality Assessment, Multimethod Assessment, Test Score
Discontinuity

self-report data. More recent studies (e.g.,
Bornstein, 2011; Cizek, Rosenberg, &Koons,
2008; Hogan &Agnello, 2004) have found
similar trends and it is generally agreed that
self-report methods have dominated the past
several decades of personality and PD
research (Rogers, 2003; Widiger & Samuel,
2005). This would not be noteworthy if
different methods of assessing the same
construct yielded similar scores. Yet, this is
not always the case and many studies show
only small to moderate associations (typically
in the r = .20 - .30 range) between self-report
and performance-based scores of analogous
constructs related to personality and other
individual difference variables (see Bornstein,
2002; Meyer et al., 2001; Mihura, Meyer,
Dumitrascu, & Bombel, 2013; Zeigler-Hill et
al., 2012).
A number of researchers have argued that
precision and depth of conceptualization can
be improved through the use of multimethod
assessment (Bornstein, 2015; Ganellen,
2007; Meyer et al., 2001) and that divergence
between scores obtained using different
methods can be used advantageously when
understood within an appropriate context
(Bornstein, 2002, 2009). Though there is
often some convergence across dissimilar
methods for assessing dependency, there are
many instances in which studies of
dependency have shown sex, or sex role
orientation, to partially explain score
differences between men and women
(Bornstein et al., 1993; Bornstein, Bowers, &
Bonner, 1996). Moreover, evidence suggests
that implicit-self-attributed test score
discontinuities may differ in women and men
(see Bornstein, 1995, 2012); as a result, it is
of interest to contrast the direction and
magnitude of dependency test score
discontinuities in women and men to better
comprehend the role that respondent sex may
play with respect to dependency assessment
and test score discontinuity.
The present study sought to evaluate intra-
individual convergences and divergences
between scores derived from two different
methods (i.e., self-report and performance-
based) for measuring interpersonal
Sex differences in independency:27
dependency, and investigate whether the
direction and magnitude of dependency test
score discontinuities differed between women
and men. Specifically, we hypothesized
that—consistent with extant research in this
area—we would find higher self-attributed
dependency scores than implicit dependency
scores in women, but higher implicit
dependency scores than self-attributed
dependency scores in men. As a secondary,
exploratory aim of this investigation we
determined whether there were differences
between men and women with regard to the
magnitude of test score discontinuity
regardless of direction.
Method:
Participants: As part of an ongoing program of
research examining the antecedents and
dynamics of interpersonal dependency, 1,508
undergraduate participants (1,158 women and
350 men) completed two self-report measures
of dependency and one performance-based
measure of dependency between 2006 and
2015. Their age range was 16-59 years-old,
with a mean age of 19.11 (M = 19.06, SD =
3.30 for women and M = 19.29, SD = 2.12 for
men). The breakdown of race/ethnicity of the
sample is as follows: 60.2% Caucasian-
American/White, 16.6% Hispanic-American,
10.5% Asian/Pacific-Islander, 10.3% African-
American/Black, 2.2% Multi-Cultural, and
0.1% Native American; 4.1% of the students
are from outside the United States.
Measures:
Interpersonal Dependency Inventory (IDI;
Hirschfeld, Klerman, Gough, Barrett, Korchin,
& Chodoff, 1977): The IDI is a 48-item
questionnaire that asks participants to rate the
degree to which each of a series of
dependency-related self-statements is
characteristic of his or her attitudes, feelings,
or behavior using a 4-point Likert scale,
ranging between 1 (not characteristic of me)
and 4 (very characteristic of me). The IDI is
comprised of three subscales: Emotional
reliance on others (ER), Lack of social self-
confidence (LS), and Assertion of autonomy
(AA). In addition to scores on these three
subscales, a total IDI score is derived by
subtracting the individual’s AA subscale score
28:Natoli & Bornstein
from the sum of his or her scores on the ER
and LS subscales. Accordingly, high IDI total
scores reflect high levels of dependency.
Internal consistency of the IDI subscales has
been investigated in multiple subject samples
with reliability coefficients ranging between
.72 and .91 (Hirschfeld et al., 1977). The IDI
subscales have also demonstrated temporal
stability over a 17-week period, obtaining test-
retest correlations between .61 and .85 for the
three IDI subscales (Frank, Kupfer, Jacob, &
Jarrett, 1987). Additional information
regarding the construct validity of the IDI is
provided by Bornstein (1994, 2005).
Relationship Profile Test (RPT; Bornstein
&Languirand, 2003): The RPT is a rationally
derived 30-item questionnaire that asks
participants to rate a series of self-statements
using a 5-point Likert scale, ranging between
1 (not at all true of me) and 5 (very much true
of me). These statements were derived from
the theoretical and empirical literature on
dependency, detachment, and healthy
dependency. The statements were written to
tap the four components of each personality
style (i.e., cognitive, emotional, motivational,
behavioral) and other core features of
dependency, detachment, and healthy
dependency. The RPT generates three
subscale scores: Destructive overdependence
(DO), Dysfunctional detachment (DD), and
Healthy dependency (HD). Scores on each
subscale are calculated by summing scores
on 10 individual items that comprise that
subscale. Thus, scores can range from 10 to
50 for each subscale, with higher scores
reflecting higher levels of DO, DD, or HD.
Acceptable internal consistencies of the
RPT’s subscales have been reported, with
coefficient alpha levels ranging from .68 to .83
(Bornstein et al., 2003). In the same study,
Bornstein et al. (2003) found, as predicted, a
significant inverse relationship between HD
scores and both DO and DD scores. With the
exception of HD scores in men (r = .27), 3-
year reliability coefficients ranged from .49
and .64 and were comparable across gender
(Bornstein &Huprich, 2006). Further
information regarding the construct validity of
the RPT is provided by Bornstein et al. (2003).
Rorschach Oral Dependency Scale (ROD;
Masling, Rabie, &Blondheim, 1967): The
ROD scale is used to derive a score of
dependency from the content of Rorschach
responses, administered either in standard or
group format. Each response is assessed for
the presence of oral dependent content; a
response is defined as oral dependent if it
falls into any one of the following categories:
(a) foods and drinks, (b) food sources, (c)
food objects, (d) food providers, (e) passive
food receivers, (f) food organs, (g)
supplicants, (h) nurturers, (i) gifts and gift
givers, (j) good luck symbols, (k) oral activity,
(l) passivity and helplessness, (m) pregnancy
and reproductive anatomy, and (n) negations
of oral percepts. One point is assigned for
each oral-dependent Rorschach response.
The number of oral-dependent responses is
divided by the total number of responses to
control for variations in response productivity.
However, this study utilized the group
Rorschach administration procedure to obtain
a standardized number of responses (see
Bornstein & Masling, 2005; Masling, 1986,
2002, for descriptions of this procedure).
Thus, a greater number of oral-dependent
responses reflect a higher level of
dependency. Studies have reported interrater
reliability to be quite high, with Pearson
correlations generally above .90 when using
either clinical or nonclinical data (Bornstein,
1996). Bornstein, Rossner, and Hill (1994)
found ROD retest reliability coefficients for 16,
28, and 60 weeks to be .67, .48, and .46,
respectively. Additional information regarding
the construct validity of the ROD is provided
by Bornstein (1996), and Bornstein and
Masling (2005).
Procedure: Participants’ IDI, RPT, and ROD
scores were standardized (converted to Z),
and then differences between self-attributed
dependency scores (as measured by the IDI
and RPT) and implicit dependency scores (as
measured by the ROD) were calculated
individually for each participant; a positive
sign was assigned when self-attributed
dependency exceeded implicit dependency,
and a negative sign was used when this
pattern was reversed. Independent sample t-
 Sex differences in independency:29

tests were then conducted to determine The discontinuity between scores on the HD
whether the direction and magnitude (using subscale of the RPT and ROD scores were
absolute values of differences in standardized virtually identical in women (M = -0.00, SE =
scores) of implicit-self-attributed test scores 0.04) and men (M = -0.01, SE = 0.08). This
differed across sex. difference, 0.00, Bca 95% CI [-0.17, 0.18],
Results: was not significant t(1506) = 0.05, p = .959,
A series of independent sample t-tests was and yielded a trivial effect size, d = 0.0027.
used to determine whether men and women Taken together, the analyses summarized in
differed in the direction of implicit—self- Table 1 confirm that women obtain higher
attributed test score discontinuity using SPSS self-attributed dependency scores than
© Version 21. Significant sex differences implicit dependency scores, whereas men
were obtained in six of seven comparisons produce higher implicit dependency scores
(see Table 1). RPT Healthy Dependency than self-attributed dependency scores for
(HD) was the only index of self-attributed every IDI and RPT dimension except for the
dependency wherein implicit—self-attributed HD subscale of the RPT.
test score patterns did not differ across sex:
Table 1: Direction of Implicit—Self-Attributed Test Score Discontinuity Across Sex
Measure of Women Men
Self-Attributed
Dependency M SD M SD t p 95% CI Cohen’s d
IDI ER 0.05 1.36 -0.17 1.35 2.62* .009 [0.05, 0.38] .16
IDI LS 0.04 1.39 -0.14 1.39 2.09* .037 [0.01, 0.34] .13
IDI AA -0.06 1.39 0.19 1.42 -2.91* .004 [-0.42, -0.08] .18
IDI Total 0.07 1.38 -0.23 1.36 3.51** .000 [0.13, 0.46] .22
RPT DO 0.06 1.42 -0.19 1.35 2.90* .004 [0.08, 0.42] .18
RPT DD 0.04 1.39 -0.12 1.27 2.01* .045 [0.00, 0.31] .12
RPT HD -0.00 1.44 -0.01 1.49 0.05 .959 [-0.17, 0.18] .00
Note. n of women = 1,158; n of men = 350; df = 1,506 throughout. IDI = Interpersonal Dependency Inventory (Hirschfeld
et al., 1977); ER = Emotional Reliance on Others, LS = Lack of Self-Confidence, AA = Assertion of Autonomy. RPT =
Relationship Profile Test (Bornstein et al., 2003); DO = Destructive Overdependence, DD = Dysfunctional Detachment,
HD = Healthy Dependency. Implicit dependency was assessed via the Rorschach Oral Dependency (ROD) scale
(Masling et al., 1967). Equal variances not assumed for DD contrasts.
*p<.05 **p<.001
A second series of independent sample t-tests discontinuity. Only one significant difference
was used to determine whether men and across sex was obtained (see Table 2):
women differed with respect to magnitude of
implicit—self-attributed test score
Table 2: Magnitude of Implicit—Self-Attributed Test Score Discontinuity Across Sex

Measure of Self- Women Men

Attributed
Dependency M SD M SD t p 95% CI Cohen’s d
IDI ER 1.07 0.85 1.06 0.85 0.07 .941 [-0.10, 0.10] .01
IDI LS 1.10 0.86 1.10 0.86 -0.07 .946 [-0.11, 0.10] .00
IDI AA 1.08 0.88 1.13 0.88 -1.02 .309 [-0.16, 0.05] .06
IDI Total 1.09 0.85 1.07 0.87 0.40 .688 [-0.08, 0.12] .02
RPT DO 1.14 0.86 1.07 0.84 1.21 .226 [-0.04, 0.17] .08
30:Natoli & Bornstein
RPT DD 1.10 0.85 0.97
RPT HD 1.14 0.88 1.14
Note. n of women = 1,158; n of men = 350; df = 1,506 throughout. IDI = Interpersonal Dependency Inventory (Hirschfeld
et al., 1977); ER = Emotional Reliance on Others, LS = Lack of Self-Confidence, AA = Assertion of Autonomy. RPT =
Relationship Profile Test (Bornstein et al., 2003); DO = Destructive Overdependence, DD = Dysfunctional Detachment,
HD = Healthy Dependency. Implicit dependency was assessed via the Rorschach Oral Dependency (ROD) scale
(Masling et al., 1967). *p<.05
On an average, the magnitude of discontinuity
between scores on the RPT DD subscale and
ROD scores was larger for women (M = 1.10,
SE = 0.02), than for men (M = 0.97, SE =
0.04). This difference, 0.13, Bca 95% CI
[0.00, 0.31], was significant t(1506) = 2.52, p
= .012, and yielded a small effect size, d =
0.15. Thus, aside from RPT DD, women and
men do not differ in the magnitude of
implicit—self-attributed test score
discontinuity.
Discussion:
Our results suggest important differences
across sex in terms of the convergences and
divergences between self-attributed and
implicit dependency scores. Women tend to
present themselves on self-report tests as
being more dependent than an implicit
assessment of dependency would suggest,
whereas men tend to present themselves as
being less dependent than their implicit
dependency scores indicate.
In examining self-attributed—implicit
dependency score discontinuities for IDI and
RPT subscales more closely, relative to their
implicit dependency scores women were
found to report greater wishes for approval,
attention, and support from others. They
presented as possessing a strong desire for
contact with and emotional support from
others, and downplayed preferences for
independence. Regarding men, findings
indicate a propensity to minimize their wishes
for contact with, and emotional support from
others, and their desire for approval and
attention from other people. Men’s self-
attributed dependency scores also suggest a
pattern of downplaying desires for help in
decision-making and in social situations.
In contrast to other subscale comparisons, on
average, men and women in our sample
reported levels of healthy dependency
comparable to their implicit dependency
needs: The mean difference between scores
0.82 2.52* .012 [0.03, 0.23] .15
0.95 -0.10 .920 [-0.11, 0.10] .00
on the HD subscale of the RPT and ROD
scores were very close to zero for both men
and women. Healthy dependency is
characterized by flexible, adaptive, and
appropriate support seeking; individuals high
in healthy dependency perceive themselves
as competent and others as trustworthy, and
they are secure in intimacy and confident in
their autonomy. Some key features of healthy
dependency (e.g., situation-appropriate help
seeking) have been found to be more strongly
encouraged in women than men in many
Western societies, suggesting a cross-sex
difference should be found (Baumeister &
Leary, 1995; Bornstein et al., 1996; Whiffen &
Sasseville, 1991). Yet, results suggest that
women and men in our college student
sample attribute features of healthy
dependency to themselves similarly. Beyond
being more highly educated than a typical
young adult, college students tend to score
higher on measures of androgyny, which
might account for these patterns.
Our findings confirm differing directions of
implicit—self-attributed test score
discontinuities across sex. However, why
might an individual’s sex have differential
effects on explicit, self-report measures of
dependency versus implicit, performance-
based measures? One approach to
addressing this question is to interpret these
findings within the frameworks of gender
schema theory and social role theory. Both of
these theories describe processes that may
clarify the private, subjective experiences of
test takers as they respond to different types
of test items as well as the situational and
societal influences that function within an
individual during a multimethod assessment of
interpersonal dependency.
Gender Schema Theory: Gender schema
theory (Bem, 1981, 1984) asserts that gender
typing is the partial product of an individual
learning to invoke society’s definition of

masculinity and femininity in his or her
perceptions, and one’s self-concept becomes
assimilated into the gender schema. In
evaluating the gender clustering of words in
free recall, Bem (1981) found that thinking of
one gendered item enhanced the probability
of thinking of a similarly gendered item, and
demonstrated that sex-typed individuals
readily endorsed sex-appropriate attributes
while rejecting sex-inappropriate attributes.
Gender-schematic information processing
may be similarly engaged during the
assessment of self-attributed dependency:
Self-report measures of sex-typed traits are
likely to engage gender schematic processing
(see e.g., Bornstein, 2010). As a result, the
individual applies this schematic selectivity to
his or her self-perception and becomes more
likely to respond to test items in a manner
perceived as applicable to his or her own sex.
In contrast, gender-typed schemas are less
likely to be invoked by the ambiguous stimuli
involved in the more implicit performance-
based measures of dependency. Thus, while
completing self-reports it may be that feminine
gender-typed schemas promote women to
perceive a stronger presence of dependency-
related attitudes, feelings, or behaviors while
masculine gender-typed schemas limit the
acknowledgement of dependency in men.
Social Role Theory: Social role theory
(Eagly, 1987) emphasizes the influence
culturally shared expectations about gender-
appropriate qualities and behaviors have on
personality (see also Burn, 1996, for a parallel
discussion involving gender socialization
theory). Within this framework men and
women are assumed to behave in ways
consistent with gender stereotypes and are
expected to inhabit the conventional social
roles occupied by their sex within a particular
society. Consistent with the main tenet of
social role theory, the sex differences that
were found in this study may be partially
explained by differences in the expectation
and perceived suitability of being dependent,
which is likely to align differently with women
and men. Compared to an implicit measure,
the self-report measures of dependency were
more vulnerable to the influence of an
Sex differences in independency:31
individual’s expectations about gender-
appropriate qualities and behaviors (see
Bornstein & McLeod, 2016, for a discussion of
this issue). Consequently, women were
pressured to present themselves as
dependent on self-report measures of
dependency, whereas explicit measures
provided men the opportunity to deny features
of dependency and present themselves as
less dependent than they may actually be.
Limitations and Future Research
Directions:
A skeptic might argue that the present
findings remain open to question because the
validity of many RIM scores has been
questioned in recent years. However,
Bornstein’s (1999) meta-analysis of the
criterion referenced validity of self-report and
performance-based dependency scores
indicated that the validity coefficient
associated with ROD scores was comparable
to, or larger than, that associated with every
self-report index of dependency. Thus,
limitations in the validity of one or more
measures used in this study cannot explain
these results (see also Mihura et al., 2013, for
a discussion of this issue).
As is true of most investigations, however, the
current study is not free of limitations. First,
the sample was recruited from an
undergraduate student population in an
eastern United States university.
Consequently, there is less heterogeneity in
terms of age and socioeconomic status than
might be found within the general population.
Second, although sex was measured, sex role
was not; it may be that test score discontinuity
also reflects varying levels of masculinity and
femininity in women and men (e.g., Bornstein
et al., 1996). Future research should
measure masculinity and femininity as well as
biological sex and assess dependency test
score discontinuity within this context. Finally,
this study only used one performance-based
measure of dependency (i.e., the ROD); use
of multiple implicit measures of dependency in
future studies would strengthen the
generalizability of the present findings.
Sex differences comparable to those found
here likely extend beyond self-report and
32:Natoli & Bornstein
performance-based assessment methods;
future studies should explore whether similar
dependency test score discontinuities surface
when informant reports are examined, as
these perceptions may also be influenced by
sex role expectations and stereotypes.
Additionally, because sex and gender norms
tend to vary between cultures, the sex
differences in dependency score discontinuity
found in this study are likely to vary across
culture as well. Differences in social role
effects on gender-stereotyped perceptions of
others have been shown in some recent
cross-cultural studies (e.g., Steinmetz, Bosak,
Sczesny, & Eagly, 2014).
The sex differences identified in this study are
also not likely restricted to measures of
interpersonal dependency. There are various
gender-typed qualities (e.g., aggression,
antisocial and histrionic traits) for which an
individual’s sex and sex role orientation may
partially explain score discontinuity. It would
behoove researchers to examine implicit—
self-attributed test score discontinuities in
these domains as well. Future studies may
find it useful to utilize semantic priming to
more precisely evaluate the unique
interactions between the psychological
processes engaged by individuals as they
complete an assessment and the societal
influences concerning one’s sex on test
scores.
Finally, the patterns obtained in this study
provide additional support for the clinical utility
of multimethod assessment and the
importance of understanding individual
features that contribute to intra-individual
convergences and divergences between
scores derived from different methods. These
results have implications for methodologies
used in contemporary personality
assessment, both with respect to basic
science (i.e., laboratory research) as well as
application (e.g., in diagnostic assessment
and treatment planning). That is, considering
the way in which an individual’s sex interacts
with the assessment methods used can help
clarify his or her underlying personality
dynamics in heuristic and clinically useful
ways.
References:
Ainsworth, M. D. S. (1969). Object relations, dependency
and attachment: A theoretical review of the infant-
mother relationship. Child Development, 40, 969-
1025.
Alonso-Arbiol, I., Shaver, P. R., &Yárnoz, S. (2002).
Insecure attachment, gender roles, and interpersonal
dependency in the Basque country. Personal
Relationships, 9, 479-490.
Baumeister, R. F., & Leary, M. R. (1995). The need to
belong: Desire for interpersonal attachment as a
fundamental human motivation. Psychological
Bulletin, 117, 497-529.
Bem, S. L. (1981). Gender schema theory: A cognitive
account of sex typing. Psychological Review, 354-64.
Bem, S. L. (1984). Androgyny and gender schema theory:
A conceptual and empirical integration. Nebraska
Symposium on Motivation, 32, 179–226.
Bornstein, R. F. (1994). Adaptive and maladaptive
aspects of dependency: An integrative review.
American Journal of Orthopsychiatry, 64, 622-635.
Bornstein, R. F. (1995). Sex differences in objective and
projective dependency tests: A meta-analytic review.
Assessment, 2, 319-331.
Bornstein, R. F. (1996). Construct Validity of the
Rorschach Oral Dependency Scale, 1967-1995.
Psychological Assessment, 8, 200-205.
Bornstein, R. F. (1999). Criterion validity of objective and
projective dependency tests: A meta-analytic
assessment of behavioral prediction. Psychological
Assessment, 11, 48-57.
Bornstein, R. F. (2002). A process dissociation approach
to objective-projective test score interrelationships.
Journal of Personality Assessment, 78, 46-68.
Bornstein, R. F. (2003). Behaviorally referenced
experimentation and symptom validation: A paradigm
for 21st-century personality disorder research. Journal
of Personality Disorders, 17, 1-18.
Bornstein, R. F. (2005). The Dependent Patient: A
Practitioner’s Guide. Washington, DC: American
Psychological Association.
Bornstein, R. F. (2009). Heisenberg, Kandinsky, and the
heteromethod convergence problem: Lessons from
within and beyond psychology. Journal of Personality
Assessment, 91, 1-8.
Bornstein, R. F. (2010). Gender schemas, gender roles,
and expressive writing: Toward a process-focused
model. Sex Roles, 63, 173-177.
Bornstein, R. F. (2011). Toward a process-focused model
of test score validity: Improving psychological
assessment in science and practice. Psychological
Assessment, 23, 532-544.
Bornstein, R. F. (2012). From dysfunction to adaptation:
An interactionist model of dependency. Annual
Review of Clinical Psychology, 8, 291-316.
Bornstein, R. F. (2015). Personality assessment in the
diagnostic manuals: On mindfulness, multiple
methods, and test score discontinuities. Journal of
Personality Assessment, 97, 446-455.
Bornstein, R. F., Bowers, K. S., & Bonner, S. (1996).
Relationships of objective and projective dependency
scores to sex role orientation in college student

participants. Journal of Personality Assessment,
66, 555-568.
Bornstein, R. F., &Huprich, S. K. (2006). Construct
validity of the Relationship Profile Test: Three-
year retest reliability and links with core personality
traits, object relations, and interpersonal problems.
Journal of Personality Assessment, 86, 162-171.
Bornstein, R. F., & Languirand, M. A. (2003).Healthy
dependency. New York, NY: Newmarket.
Bornstein, R. F., Languirand, M. A., Geiselman, K. J.,
Creighton, J. A., West, M. A., Gallagher, H. A.,
&Eisenhart, E. A. (2003). Construct validity of the
Relationship Profile Test: A self-report measure of
dependency-detachment. Journal of Personality
Assessment, 80, 64-74.
Bornstein, R. F., Manning, K. A., Krukonis, A. B.,
Rossner, S. C., & Mastrosimone, C. C. (1993). Sex
differences in dependency: A comparison of objective
and projective measures. Journal of Personality
Assessment, 61, 169-181.
Bornstein, R. F., &Masling, J. M. (2005). The Rorschach
Oral Dependency Scale. In R. F. Bornstein & J. M.
Masling (Eds.), Scoring the Rorschach: Seven
validated systems (pp. 135-158). Mahwah, NJ:
Lawrence Erlbaum Associates, Inc.
Bornstein, R. F., & McLeod, B. A. (2016). Beyond biology:
Sex, gender, and personality disorders. In V. M.
Brabender & J. L. Mihura (Eds.), Handbook of Gender
and Sexuality in Psychological Assessment (pp. 211-
232). New York, NY: Routledge/Taylor & Francis.
Bornstein, R. F., Rossner, S. C., & Hill, E. R. (1994).
Retest reliability scores on objective and projective
measures of dependency: Relationship to life events
and interest interval. Journal of Personality
Assessment, 62, 398-415.
Burn, S. M. (1996).The social psychology of gender. New
York: McGraw-Hill.
Cizek, G. J., Rosenberg, S. L., & Koons, H. H.
(2008).Sources of validity evidence for educational
and psychological tests. Educational and
Psychological Measurement, 68, 397-412.
Eagly, A. H. (1987). Sex differences in social behavior: A
social-role interpretation. Hillsdale: Erlbaum.
Frank, E., Kupfer, D. J., Jacob, M., & Jarrett, D. (1987).
Personality features and response to acute treatment
in recurrent depression. Journal of Personality
Disorders, 1, 14-26.
Ganellen, R. J. (2007). Assessing normal and abnormal
personality functioning: Strengths and weaknesses of
self-report, observe, and performance-based
methods. Journal of Personality Assessment, 30-40.
Hirschfeld, R. M. A., Klerman, G. L., Gough, H. G.,
Barrett, J., Korchin, S. J., & Chodoff, P. (1977). A
measure of interpersonal dependency. Journal of
Personality Assessment, 41, 610-618.
Hogan, T. P., &Agnello, J. (2004). An empirical study of
reporting practices concerning measurement validity.
Educational and Psychological Measurement, 64,
802-812.
Maccoby, E. E., & Masters, J. C. (1970).Attachment and
dependency. In P. H. Mussen (Ed.), Carmichael’s
Sex differences in independency:33
manual of child psychology (Vol. 2, pp. 73-157). New
York, NY: Wiley.
Masling, J. M. (1986). Orality, pathology, and
interpersonal behavior. In J. Masling (Ed.), Empirical
studies of psychoanalytic theories (Vol. 2, pp. 73-
106). Hillsdale, NJ: Lawrence Erlbaum
Associates, Inc.
Masling, J. M. (2002). Speak, memory, or goodbye
Columbus. Journal of Personality Assessment, 4-30.
Masling, J. M., Rabie, L., & Blondheim, S. H. (1967).
Obesity, level of aspiration, and Rorschach and TAT
measures of oral dependence. Journal of Consulting
Psychology, 31, 233–239.
Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G.,
Moreland, K. L., Dies, R. R., … Reed, G. M. (2001).
Psychological testing and psychological assessment:
A review of evidence and issues. American
Psychologist, 56, 128-165.
Mihura, J. L., Meyer, G. J., Dumitrascu, N., & Bombel, G.
(2013). The validity of individual Rorschach
variables: Systematic reviews and meta-analyses of
the comprehensive system. Psychological Bulletin,
139, 548-605.
Millon, T. (1981).Disorders of personality. New York, NY:
Wiley.
Mischel, W. (1970).Sex-typing and socialization. In P. H.
Mussen (Ed.), Carmichael’s manual of child
psychology (Vol. 2, pp. 3-72). New York, NY: Wiley.
Parens, H., & Saul, L. J. (1971).Dependence in man. New
York, NY: International Universities Press.
Piotrowski, C. (2017). Rorschach research through the
lens of bibliometric analysis: Mapping investigatory
domain. Journal of Projective Psychology & Mental
Health, 24(1), 32-36.
Piotrowski, C. (2015). Projective test usage worldwide: A
review of applied settings 1995-2015. Journal of the
Indian Academy of Applied Psychology, 41(3), 9-19.
Rogers, R. (2003). Standardizing DSM-IV diagnoses: The
clinical applications of structured interviews. Journal
of Personality Assessment, 81, 220-225.
Steinmetz, J., Bosak, J., Sczesny, S., &Eagly, A. H.
(2014). Social role effects on gender stereotyping in
Germany and Japan. Asian Journal of Social
Psychology, 17, 52-60.
Walters, R. H., & Parke, R. D. (1964).Social motivation,
dependency, and susceptibility to social
influence.In L. Berkowitz (Ed.), Advances in
experimental social psychology (Vol. 1, pp. 231-
276). San Diego, CA: Academic Press.
Whiffen, V. E., & Sasseville, T. M. (1991). Dependency,
self-criticism, and recollections of parenting: Sex
differences and the role of depressive affect. Journal
of Social and Clinical Psychology, 10, 121-133.
Widiger, T. A., & Samuel, D. B. (2005).Evidence-based
assessment of personality disorders. Psychological
Assessment, 17, 278-287.
Zeigler-Hill, V., Fulton, J. J., & McLemore, C. (2012).
Discrepancies between explicit and implicit self-
esteem: Implications for mate retention strategies and
perceived infidelity. Jr of Soc Psy, 152,670-686.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 34-38

Rorschach Research through the Lens of Bibliometric Analysis:

Mapping Investigatory Domain
Chris Piotrowski
This study presents the results of an exploratory bibliometric „topical‟ analysis with regard to mainly primary
research regarding the Rorschach published in journal articles 2000-2016. The major aim is to a) determine the
scope and breadth of investigatory areas most emphasized by researchers during this time frame, and b) prompt
more advanced bibliometric study of the extant Rorschach literature in order to map the structure of scholarship
and research domain regarding this popular assessment method. The database PsycINFO was selected to
obtain the pool of references based on a „keyword‟ search of the term Rorschach. The search identified a total of
838 peer-reviewed articles from 2000 to 2016; of these, 747 were determined to be mostly „primary‟ articles and
served as the data-set for the analysis. The author tagged each article with a topical descriptor and maintained a
scoring template based on frequency counts across categories. The analysis identified 29 topical categories
which represented at least 1% of the total distribution. 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. The focus on norms/normative comparisons was quite apparent. The potential
impact of editorial preference/bias was discussed and limitations of the study were noted. Based on this analysis,
it appears that recent Rorschach scholarship is a) not cohesive in character, and b) reflects diverse research
domains representing disparate research interests. Hence, despite an extensive repository of literature, the
Rorschach remains an emerging area of study with an opaque sense of direction for future research.

Bibliometric analysis is a recognized and valid was portrayed in 6 popular introductory

means of gaining an objective perspective on
research trends of the extant literature (De
Bellis, 2009). Thus, obtaining a limpid view on
the scope of investigatory interest on specific
research topics seems a worthwhile scholarly
endeavor. Yet despite the vast volume of
studies and repository of knowledge on the
Rorschach method, little is known about the
breadth of research emphasis and structure of
published scholarship on this charismatic
assessment technique. An online search of
the PsycINFO database, conducted July 21
2016, highlights the perennial visibility and
extensive volume of extant literature on the
Rorschach, i.e., 641 books/book chapters,
1,020 dissertations, and 4,022 articles. This
prodigious research interest, to some extent,
reflects the continued popularity of the
Rorschach over the decades as one of the top
assessment techniques used in psychological
practice (Piotrowski, 2015a; Wright et al.,
2016), as well as interest internationally (e.g.,
Manickam & Dubey, 2005).
However, bibliometric studies regarding the
Rorschach have been sparse. Giegerich
(2014) examined how personality assessment
psychology textbooks. The analysis indicated
notable negative bias with regard to coverage
of projective techniques, particularly the
Rorschach. Research trends on the
Rorschach, from 1950-1985, have been found
to show a slight resurgence of scholarly
interest by the mid-1980s (Polyson et al.,
1986), whereas Reynolds and Sundberg
(1976), in a cited reference analysis, reported
that the Rorschach was referenced highly,
from 1951-1971, in the Buros Mental
Measurements Yearbook. Piotrowski and
Keller (1993) reported on the reference output
for studies on the shading response in
Rorschach research.
Since there has been recent research
attention devoted to bibliometric study on a
myriad of psychological topics in the mental
health field (e.g., Cox et al., 1995; Piotrowski,
2012) and across applied psychology
disciplines (Cascio & Aguinis, 2008; Miles &
Naumann, 2011; Piotrowski, 2016), a
contemporary examination regarding the
scope of research emphasis on the
Rorschach seems warranted. The current
bibliometric analysis is the first attempt to

Chris Piotrowski, Ph.D. University of West Florida (USA) Email: cpiotrowski@uwf.edu

Keywords: Rorschach Content Analysis, Bibliometric Analysis.

identify the breadth of investigatory interest on
the Rorschach Test in published research.
The focus will be on determining the main
areas of research focus, based on individual
study aim and design, across the pool of
published articles (2000-2016), with a focus
on the Rorschach. To that end, the aim is to
identify the major „topical‟ areas of
investigation in Rorschach research in recent
years.
Investigatory Approach:
In order to obtain a comprehensive pool of
articles on the Rorschach, a „keyword‟ online
search, using the term Rorschach, was
performed in the database PsycINFO. This
scholarly file is a recognized major repository
of published research in the social and
behavioral sciences (Perdue & Piotrowski,
1991; Piotrowski et al., 2005). Moreover,
PsycINFO indexes journals from allied fields
and coverage is international in scope
(Garcia-Perez, 2010). Thus, PsycINFO was
selected since the Rorschach has garnered
academic and professional interest across
many disciplines and in many countries
worldwide. The search produced 4,022 peer-
reviewed articles; of these, 838 were
published from 2000 to 2016. In order to
target mainly „primary‟ research, references
reporting corrections, commentaries/replies,
editorial remarks, book and software reviews,
and erratum were excluded. Thus, the data-
set for this bibliometric analysis comprised
747 articles.
Based on extensive experience conducting
bibliometric analyses on various research
topics and individual journals, the author
reviewed each study and determined the main
aim or focus of the article. A categorical
template, delineating topical areas, was
maintained. Each article was labeled with only
1 topical designation. A running-tab was
maintained until all 747 articles were
reviewed. Although a number of issues of
journals were declared a „special issue‟ on a
select major topic/research area, some
articles had a major emphasis outside of the
intended area of focus.
Readers should be aware that the current
analysis does not weigh individual research
Rorschach Research Bibliometric Analysis:35
findings, aims not to be evaluative, does not
side on controversial issues, does not review
the psychometric credibility of the Rorschach,
nor clarifies the merits of the Rorschach for
clinical assessment (see Meyer 2001).
Simply, this study is descriptive in nature with
the sole intent to present a „snapshot‟ on the
scope and breadth of „topical‟ focus regarding
scholarly research on the Rorschach, over the
past two decades.
Findings:
Table 1 displays, in rank order, the major
emphasized topical areas in Rorschach
research since the year 2000. Only those
topics that represented at least 1% of the
dataset are noted. Research on normative
data or issues has remained a perennial
concern over many decades, particularly with
regard to demographic groups, non-U.S.
samples, and unique norms for children and
adolescent samples (see Shaffer et al., 2007).
The influence of psychoanalytic perspectives
is evident in investigatory interest in
schizophrenia and other psychotic states,
psychosomatic formulations, psychodynamic
factors, and psychotherapy process and
outcome. To some extent, this orientation
reflects research presented in
psychoanalytically-oriented journals.
In viewing the categorical rankings, a couple
of observations are noteworthy. First, the
prevalence of studies on various eating
disorders. Second, a major focus on forensic
psychology issues, such as forensic
assessment, sexual offenders, psychopathy,
and child abuse. Finally, an appreciation for
the historical foundations of the Rorschach is
reflected in a myriad of reviews to the present
day.
Noteworthy, although the Wood et al.
controversy/debate (e.g., Garb et al., 2008;
Mihura et al., 2013; Wood et al., 2003) has
generated some attention in the literature in
the form of primary research (n=10), much of
the scholarly debate has been in the form of
commentaries/replies and rebuttals (and thus
not included in the current analysis). Scholarly
„exchanges‟ reported in journals tend to inflate
the exposure that select, controversial topics
36: Chris Piotrowski
receive based to some degree on editorial
preference (Moustafa, 2015).
Studies with a major focus on Rorschach
variables/indexes are as follows (in rank
order): Color (n=10), Movement (n=8), # of
Responses (n=5), Ego Impairment Index
(n=5), Mutuality of Autonomy (n=5), Oral
Dependency (n=5), Texture (n=4), R-
Perceptual Thinking Index (n=3).
Neglected Areas of Research: Topical
analysis frequently provides evidence on
areas of sparse research interest. The current
findings, regarding the distribution of major
subject categories, identified several salient
areas of psychological study largely neglected
by Rorschach researchers. Most noteworthy:
assessment training/education (n=6),
examiner/examinee interaction (n=3),
differential diagnosis (n=3), creativity (n=5),
anxiety (n=3), race/ethnic differences (n=2),
physically disabled (n=2), learning disabled
(n=3), aged populations (n=4), pain conditions
(n=4), grief states (n=1), social desirability
(n=1).
Preferential Editorial Selection: Publication
bias entails issues related to editorial
selection, non-significant results, and
decision-making on the part of researchers
regarding submission of their findings (e.g.,
Banks et al., 2012; Matias-Guiu & Garcia-
Ramos, 2011; Torgerson, 2006). Although the
current analysis does not directly address
publication bias, the issue of editorial
selection and preference may be a factor on
whether an individual paper „sees the light of
day‟. The current findings reveal a
disproportional number of articles on
norms/normative analysis and psychotic
states, and few articles across a myriad of
salient clinical issues. From a bibliometric
perspective, such findings can reflect bias in
the editorial process (see Bornstein 1991;
Moustafa, 2015) and potential conflict of
interest (Young, 2009). This effect may be
particularly evident in studies on aggregated
reviews of the literature (Coursol & Wagner,
1986). Interestingly, in a meta-analysis
involving the Rorschach, Parker et al. (1988)
commented, “The historical association
between the Journal of Personality
Assessment and the Rorschach may create
an editorial bias favorable to the Rorschach”
(p. 372).
Limitations: First, this analysis reports on
only the most recent 20% (2000-2016) of the
extant research on the Rorschach presented
in articles in the database PsycINFO; if a
complete examination of archival articles
(n=4000+) in the PsycINFO database was
conducted, a more comprehensive, historical
review would be evident. Undoubtedly,
additional studies would have been identified
via searches of adjutant databases in the
social sciences and in MEDLINE. Second, this
study reports a somewhat basic „topical‟
content analysis of the psychological
literature, from the perspective of one
examiner. Thus, a multi-rater design would
enhance scoring reliability. By design, only 1
designation was permitted. A weighted
scoring scheme would surely have produced
a more refined, accurate ranking.
Furthermore, in order to further our
understanding of the structure and influence
of scholarship regarding the Rorschach, more
advanced bibliometric methods (i.e., citation
analysis, citation mapping, co-citation
analysis) are required (see Hjorland, 2013;
Piotrowski, 2013), particularly as the
intellectual structure and volume of published
literature in the Assessment Psychology field
expands over time (see Adair & Vohra, 2003,
for a discussion).
Lastly, this analysis did not include the „Gray‟
literature (Conference papers and
proceedings, dissertations, working papers,
Google postings), nor the great volume of
unpublished papers that never see the light of
day. Most of this literature is not archival.
Indeed, the oft-referred to „File Drawer
Problem‟ contributes to publication bias and
limits findings in bibliometric studies (Franco
et al., 2014; Rotton et al., 1995). Indeed,
Lilienfeld et al. (2000) discussed the File
drawer problem in their extensive review of
the extant literature on projective techniques.
Thus, to what extent „unpublished‟ studies on
the Rorschach would have impacted the
current results is not discernable.
 Rorschach Research Bibliometric Analysis:37

Conclusions:
a) Despite copious levels of scholarship on Table 1: Major Topical Areas of Emphasis in Rorschach
inkblots for the past century, Rorschach Research Indexed in PsycINFO (2000-2016) Total n= 747
Major topical areas of study n %
research, overall, seems a diverse
Norms/Normative analyses (including 54 7
enterprise with disparate intellectual the 28 reported in 2007 JPA Suppl.
pursuits. From an international perspective, Int‟l samples)
the majority of Rorschach investigations Psychoses/Schizophrenia 50 6.5
overseas seem disengaged from Rorschach Eating disorders 24 3
research in the USA. The potent impact of Historical aspects 23 3
Exner‟s Comprehensive System, over Psychosomatic factors 23 3
several decades on the assessment field, Treatment planning/outcome 22 3
has now been challenged by the R-PAS. Aggression/hostility 21 3
Personality 20 2.5
Thus, there seems little cohesion in the field Psychodynamic issues 19 2.5
regarding the direction for future research Depression 18 2.5
on Rorschach assessment. Personality disorders 17 2.5
b) There has been sparse attention in Psychological trauma/PTSD 16 2
published articles regarding graduate-level Psychoanalytic perspectives 15 2
training and internship opportunities with the Cross-cultural comparisons 15 2
Reliability/Coding stability 15 2
Rorschach, perhaps reflecting diminishing Validity issues 14 2
levels of didactic coursework and clinical Neuropsychology/Brain imaging 13 2
experiences which have been noted in the Forensic assessment/issues 13 2
recent literature (Evans & Finn, 2016; Sex offenders 13 2
Piotrowski, 2015b). Where advanced R-PAS 12 1.5
students and novice practitioners, with an Medical diseases 12 1.5
avid interest in gaining competency in the SIS-Inkblot Test 11 1.5
Psychopathy 11 1.5
Rorschach can turn, seems a perplexing
Child sexual abuse 11 1.5
conundrum.
Suicide potential features 10 1.5
c) There appears to be a host of critical clinical Wood et al. controversy (excluding 10 1.5
areas that receive sparse investigatory comments/rebuttals)
attention. Whether this is a function of Color 10 1.5
disinterest on the part of investigators or Movement response 8 1
Drug abuse/Addiction 8 1
editorial preference/bias is difficult to
ascertain. Note. Values indicate # of articles; Categories with less
than 8 articles are not reported.
d) Contemporary Rorschach research tends to
highlight competing academic and
References:
professional dictates; i.e., training in clinical Adair, J.G., & Vohra, N. (2003). The explosion of
mandate for in-depth, multimethod knowledge, references, and citations: Psychology‟s
assessment protocols appears incongruent unique response to a crisis. American Psychologist,
with the reality of expedited testing 58, 15-23.
Banks, G.C., Kepes, S., & Banks, K.P. (2012). Publication
constraints in practice. bias: The antagonist of meta-analytic reviews and
e) Despite nearly a century of research, it effective policymaking. Educational Evaluation &
appears that the Rorschach is an emerging Policy Analysis, 34(3), 259-277.
area of study reflecting a myriad of scholarly Bornstein, R.F. (1991). Manuscript review in psychology:
Psychometrics, demand characteristics, and an
-interests and academic orientations. alternative model. Journal of Mind and Behavior,
f) The current findings are exploratory in 12(4), 429-467.
nature; more advanced bibliometric Cascio, W.F., &Aguinis, H. (2008). Research in I/O
methods need to be applied to the extant psychology from 1963 to 2007: Changes, choices,
and trends. Journal of Applied Psychology, 93,
literature in order to elucidate the 1062-1081.
investigatory structure of Rorschach Coursol, A., & Wagner, E.E. (1986). Effect of positive
research. findings on submission and acceptance rates: A
38: Chris Piotrowski
note on meta-analysis bias. Professional
Psychology: Research and Practice, 17, 136-137.
Cox, B.J., Wessel, I., Norton, G.R., Swinson, R.P.,
&Direnfeld, D.M. (1995). Publication trends in
anxiety disorders research: 1990-1992. Journal of Anxiety
Disorders, 9(6), 531-538.
De Bellis, N. (2009). Bibliometrics and citation analysis.
New York: Scarecrow Press.
Evans, F.B., & Finn, S.E. (2016).Training and
consultation in psychological assessment for
professional psychologists. Journal of Personality
Assessment, 98, 785-798.
Franco, A., Malhotra, N., &Simonovits, G. (2014).
Publication bias in the social sciences: Unlocking the
file drawer. Science, 345(6203), 1502-1505.
Garb, H.N., Wood, J.M., Lilienfeld, S.O., Nezworski, M.T.
(2005).Roots of the Rorschach controversy. Clinical
Psychology Review, 25, 97-118.
Garcia-Perez, M.A. (2010). Accuracy and completeness
of publication records in the Web of Science,
PsycINFO, and Google Scholar: A case study for the
computation of h indices in psychology. Journal of
the American Society Information Science &
Technology, 61, 2070-2085.
Giegerich, M. (2014). Personality assessment as
portrayed in introductory psychology textbooks: A
qualitative content analysis. Dissertation Abstracts
International, 74(9-B).
Hjorland, B. (2013). Citation analysis: A social and
dynamic approach to knowledge organization.
Information Processing and Management, 1313-
1325.
Manickam, L.S., & Dubey, B.L. (2005). Rorschach Inkblot
Test in India: Historical review and perspectives for
future action. Journal of Projective Psychology &
Mental Health, 12(1), 61-78.
Matias-Guiu, J., & Garcia-Ramos, R. (2011).Editorial bias
in scientific publications.Neurologia, 26(1), 1-5.
Meyer, G.J. (2001). Introduction to the final special
section in the special series on the utility of the
Rorschach for clinical assessment. Psychological
Assessment, 13(4), 419-422.
Mihura, J.L., Meyer, G.J., Dumitrascu, N., & Bombel, G.
(2013). The validity of individual Rorschach
variables: Systematic reviews and meta-analyses of
the Comprehensive System. Psychological Bulletin,
548-605.
Miles, J.A., &Naumann, S.E. (2011). Research trends in
the Academy of Management publications. Journal
of Management and Marketing Research, 6, 1-31.
Moustafa, K. (2015). Is there bias in editorial choice? Yes.
Scientometrics, 105, 2249-2251.
Parker, K. C., Hanson, R.K., &Hunsley, J. (1988). MMPI,
Rorschach, and WAIS: A meta-analytic comparison
of reliability, stability, and validity. Psychological
Bulletin, 103(3), 367-373.
Perdue, B., & Piotrowski, C. (1991). Online database use
in psychology: A survey of academic libraries.
Collection Management, 14, 133-137.
Piotrowski, C. (2016). Mapping the research domain in
the field of applied psychology: A bibliometric
analysis of the emerging literature. Journal of the
Indian Academy of Applied Psychology, 42(1), 11-
17.
Piotrowski, C. (2015a). Projective techniques usage
worldwide: A review of applied settings 1995-2015.
Journal of the Indian Academy of Applied
Psychology, 41(3), 9-19.
Piotrowski, C. (2015b). Clinical instruction on projective
techniques in the USA: A review of academic
training settings 1995-2014. Journal of Projective
Psychology & Mental Health, 22(2), 83-92.
Piotrowski, C. (2013). Bibliometrics and citation analysis
for the psychologist-manager: A review and select
readings. The Psychologist-Manager Journal, 53-71.
Piotrowski, C. (2012). Research areas of emphasis in
professional psychology: Past and current trends.
Journal of Instructional Psychology, 39(2), 131-135.
Piotrowski, C., & Keller, J.W. (1993). The Rorschach and
shading: Citation output from PsycINFO (1987-
1992). Psychological Reports, 72(2), 690.
Piotrowski, C., Perdue, B., & Armstrong, T. (2005).
Scholarly online database use in higher education: A
faculty survey. Education, 125, 443-445.
Polyson, J., Peterson, R., & Marshall, C. (1986). MMPI
and Rorschach: Three decades of research.
Professional Psychology: Research and Practice,
17(5), 476-478.
Reynolds, W.M., &Sundberg, N.D. (1976). Recent
research trends in testing. Journal of Personality
Assessment, 40, 229-233.
Rotton, J., Foos, P.W., Van Meek, L., & Levitt, M. (1995).
Publication practices and the File Drawer Problem: A
survey of published authors. Journal of Social
Behavior and Personality, 10(1), 1-13.
Shaffer, T.W., Erdberg, P., & Meyer, G.J. (2007).
Introduction to the JPA special supplement on
international reference samples for the Rorschach
Comprehensive System. Journal of Personality
Assessment, 89(Suppl 1), S2-S6.
Torgerson, C.J. (2006). Publication bias: The Achilles‟
heel of systematic review? British Journal of
Educational Studies, 54(1), 89-102.
Wood, J.M., Nezworski, M.T., &Lilienfeld, S. O. (2003).
What‟s wrong with the Rorschach? Science
confronts the controversial inkblot test. New York:
Wiley.
Wright, C.V., Beattie, S.G., Galper, D.I., et al. (2016).
Assessment practices of professional psychologists:
Results of a national survey. Professional
Psychology: Research and Practice, 47, 617-625.
Young, S.N. (2009). Bias in the research literature and
conflict of interest. Journal of Psychiatry and
Neuroscience, 34(6), 412-417.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 39-47

Fairy tales: The Emotional Processors of Childhood Conflicts

in Dynamic Interpretative Lens
Nilanjana Sanyal and Manisha Dasgupta
Fairy tales operate in accordance to the preamble set forward by the fantasy world of children, which makes
young readers to wander about in the enchanting world of magic, animation and anthropomorphism. Amidst
providing aid to their leisure times and enriching their vocabulary, imagination and creativity, fairy tales essentially
enable in “venting out” their emotions and unresolved conflicts in a safe ambience. The present article attempts to
probe into the psychoanalytic nuances of six well-known fairy tales by the Grimm Brothers to unfurl their
significance in enabling personality-development of young children along the penetrative lens. The psychoanalytic
explanation of the Mother Complex, its splitting into the good-mother and bad-mother, the notion of self-concept
and the development of the self-system along the different psychosexual stages towards growth and development
to attain emotional autonomy and vitality have been noted in the fairy tales‟ characters of Little Red Riding Hood,
Snow White and Seven Dwarfs, Hansel and Gretel, Cinderella, Rapunzel and the Sleeping Beauty. Implications of
the selected fairy tales have also been discussed along psychoanalytic themes.

The enchanting words, “Once upon a time…”
appeal to children across the world, by
indulging them to enter into a magical world of
fantasy and imagination. Fairy tales have
followed human societies though the ages
and still play a significant part in children‟s
lives. These stories have travelled through
oral storytelling as well as print, in times and
places of limited sources of entertainment as
well as in large metropolitan areas of the
electronic age. According to Marie-Lousie von
Franz (1995), “Fairy tales are most generally
human in their structure,” and “In each type of
tale, one can study the most basic structures
of human behavior.” Along the same tune,
Bruno Bettelheim finds folk fairy tales of great
value when it comes to the upbringing of
children. In his book, The Uses of
Enchantment (1989), Bettelheim studies their
universal importance in understanding
childhood development and states his
opinions on the way children work through the
psychological problems of maturing as:
In order to master the psychological problems
of growing up – overcoming narcissistic
disappointments, oedipal dilemmas, sibling
rivalries; becoming able to relinquish
childhood dependencies; gaining a feeling of
selfhood and of self-worth, and a sense of
moral obligation – a child needs to understand
what is going on within his conscious self so
that he can also cope with that which goes on
in his unconscious. He can achieve this
understanding and with it the ability to cope,
not through rational comprehension of the
nature and content of his unconscious, but by
becoming familiar with it through spinning out
daydreams – ruminating, rearranging, and
fantasizing about suitable story elements in
response to unconscious pressures. By doing
this, the child fits unconscious content into
conscious fantasies, which enable him to deal
with that content (Bettelheim, 1989).
This task of bridging childhood fantasies and
relating them to human behavior is carried out
exceptionally well amidst the thematic
ambience of varied fairy tales which get
transmitted across generations mainly through
oral-story-telling. According to Shapiro and
Katz (1978),Bettelheim interprets the symbolic
meaning of fairy tales in three levels:
• Firstly, a character is described as
representing crucial others in the child‟s life,
such as parents or siblings;
• Secondly, as representing an experienced
part of the personality (good or bad self);
and
• Thirdly, as representing internal processes
(id, ego, and superego).
This form of analysis closely resembles the
psychoanalytic interpretation of some
projective techniques. Fairy tales carry

Nilanjana Sanyal, Ph.D., Professor and Former Head, and Manisha Dasgupta, Ph.D., Asst. Professor, Department
of Psychology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009 (Corresponding email address:
dasguptam80@gmail.com).
Key words: Fairy tales, emotional processing, unresolved conflicts.
40: Sanyal & Dasgupta
important messages to the conscious, the
preconscious and the unconscious mind, on
whatever level each is functioning at the time.
By dealing with universal human problems,
particularly those which preoccupy the child‟s
mind, these stories speak to his budding ego
and encourage its development, while at the
same time, relieving preconscious and
unconscious pressures. As the stories unfold,
they giveconscious credence and body to Id
pressures and show ways to satisfy these that
are in line with ego and superego
requirements (Bettelheim, 1978). It is by dint
of fairy tales that the child fits unconscious
contentinto conscious fantasies, which then
enable him/ her to deal with that content. Fairy
tales offer new dimensions to the child‟s
imagination which would be impossible for
him to discover as truly on his own. More
importantly, the form and structure of fairy
tales suggest images to the child by which he
can structure his daydreams and with them
give better direction to his life. Fairy tale is
effectively a collective fantasy. As it is told and
retold, elements of the story added by the
individual teller fall away, like sifted sand,
while the more universal themes remain, so it
becomes valid for the group of people in
general (Jung, 1961). Hence, the need is felt
to explore six selected and widely popular
fairy tales of the Grimm Brothers (Grimm and
Grimm, 1975) in the canvas of interpersonal
relationships and human behavior along
psychoanalytic avenues.
I. Little Red Riding Hood (Little Red Cap):
Little Red Riding Hood (LRRH) is observed as
a „colourful‟ personality; she is a „genuine‟
child, being naïve, disobedient, impulsive and
playful. According to Bettelheim (1976), she is
universally loved because, “although she is
virtuous, she is tempted” (p. 172). LRRH‟s
impulse to explore the woods after leaving
home and not paying heed to the words of her
mother reflects her Pleasure Principle being
predominant. Major psychoanalytic
interpretations emphasize the sexual
connotations of the story as well as LRRH‟S
oedipal fantasies (Fromm, 1951; Roheim,
1953; Fairbairn, 1972). It also reflects the
heroine‟s separation anxiety and archaic
fears, expressed in the form of the wolf, being
temporarily separated from her mother
(Coulacoglou, 2008).
Fromm‟s (1951) interpretation emphasized the
significance of the red hood of the heroine,
which is said to symbolize menstruation and
serves as a signal of her forthcoming feminity.
Roheim (1953/ 1992) emphasizes the
significance of the aggressive actions, which
he claims to symbolize infantile oral
aggression. He refers to the mechanisms of
regression and projection whereby the infant‟s
wishes to devour her mother are projected on
the mother-grandmother-wolf. “Aggression is
combined with regression and it follows the
idea of being swallowed up, being beaten,
which is the key aspect of this aggression.
The cannibal child created a cannibal mother”
(p. 152). Fairbairn (1972) argues that the story
expresses anxiety over the destruction of the
object (mother) as the heroine‟s need for
incorporation takes the form of a devouring
wolf.
Bettelheim (1976) writes that this fairy tale
expresses ambivalence between the pleasure
and the reality principle. It also deals with the
oedipal conflict reactivated in puberty. Little
Red Cap‟s budding sexuality is directed
towards her father-wolf who is an
externalization of the dangers of
overwhelming oedipal longings. The father is
also portrayed as the hunter in his protective
and rescuing role. Thus we may observe the
splitting of the father figure into a ferocious
and threatening animal and into a benign and
helpful hunter.
Kant (1995), adopting a Jungian perspective,
argues that the wolf symbolizes the
instinctive/ primitive nature of the protagonist.
“She meets in the wolf part of her nature, the
part of herself that she denied: a Red Cap
who is dreamy, aggressive, impulsive,
desperate and dangerously greedy in her
search for life… As a wolf, she gets to know,
an aspect of herself that is loose, that does
not care about duties or about what others
think about her” (p. 14). In other words, she
confronts with the „shadow‟ aspect of her
personality (Jung, 1951/ 1959a; 1954/ 1959a;

1961). The wolf symbolizes the instinctive or
primitive nature of the heroine. He embodies
the threat of all asocial, unconscious,
devouring powers (the Id).
II. Snow White and Seven Dwarfs:
The queen-witch-stepmother represents the
pre-eminent antagonist of both the female and
child protagonist (Thomas, 1989). According
to Bettelheim (1976), the story of Snow White
deals with the oedipal conflicts between
mother and daughter and warns of the
disastrous effects of narcissism. The queen is
said to be fixated at the stage of primitive
narcissism and arrested at the oral
incorporative stage. She is envious of Snow
White‟s beauty and youth and wants to
incorporate her as symbolized by her intention
to eat her internal organs. The queen is
engulfed by obsessive vanity and envy which
direct her to engage in diabolic ploys
(Coulacoglou, Sanyal and Dasgupta, 2013).
Bettelheim interprets Snow White‟s temporary
death as a preparation period before entering
a more maturing stage, that of adolescence.
The witch-stepmother assumes the most
negative maternal characteristics. The witch
as an archetypal image represents a threat to
ego consciousness and its development. She
can also be considered as an image for the
development-inhibiting mother complex. The
possession of a magical, talking mirror adds
to her supernatural properties and narcissistic
personality traits. “The mirror represents her
obsession with her own beauty, her
compulsive narcissism, a material medium,
most often associated with beauty and self-
absorption” (Thomas, 1989, p. 70).Reflection
and the mirror are extremely important
themes in the fairy tale and in modern
psychology. They are central to our
understanding of how infants and young
children develop consciousness and a healthy
sense of self. Many psychologists have
recognized the importance of the mother-child
relationship in this process, Winnicott, being
an eminent one (Winnicott, 1967).If this
mirroring process is severely disturbed, the
adult can develop Narcissistic Personality
Disorder. Narcissism, as such, is a problem of
Emotional Processors of Childhood Conflicts:41
not having enough mirroring where
inadequate mirroring refers to both the total
amount and the quality of the mirroring. The
wicked step-mother fits the symptoms of
narcissistic personality disorder, having
symptoms of excessive rage and weak sense
of self. The hatred of the Queen for Snow
White sets the plot in motion, and her
persistence to murder Snow White eventually
leads to her own demise. This hysterical
vanity and jealousy of the Queen is psychotic,
reflecting too much of weakness in the self.
The Queen‟s actions are teeming with
underlying oedipal issues, as her insane
jealousy brings her to murder her own
stepdaughter. Instead of facing the reality of
the passing of time, and ageing with grace
while being joyful of her stepdaughter growing
and maturing into a beautiful woman, she
manically plans to rid herself of her opponent
by killing her. The queen is guilty of intense
narcissism and her reaction to Snow White
surpassing her, prompting her to view her
relationship with her daughter as a
competition to be won. Such competition
damages the connection between parent and
child and leads to the child resenting the
parent, and wishing for independence and to
be free from parental supervision.
From the point of view of Jungian psychology,
it is the queen‟s animus which gets confronted
when she looks into her own unconscious
when gazing in the mirror in dreams and
fantasies (Jung, 1961).The queen relies on
this masculine „authority‟ to tell her if she is
beautiful or not. This implies that the queen
had a very critical and judging animus
function. It is negative and powerful and
functions to make her feel good about herself
only so long as she satisfies the strict
requirements of „beauty‟ that she holds for
herself, owing to her damaged sense of self
(narcissistic injury). The inner negative
animus is never satisfied.
The mirror in the story also symbolizes the
threshold between consciousness and the
unconscious, and by looking into it, one may
look towards the depths of the unconscious.
And, the image that a mirror produces is
symbolic and can be made sense of in both
42: Sanyal & Dasgupta
the unconscious and the conscious worlds
(Von Franz, 1982).
The seven dwarfs, according to Bettelheim,
symbolize males arrested at a pre-oedipal
existence. Girard (1999) notes, that Snow
White may be considered as the eighth dwarf,
since her sexuality is still at a latent phase of
development.
Schechtman (1993), in her Jungian analysis
of Snow White, claims that the story reflects
the bitter battle of a woman against time,
against ageing and decline that come with
middle age. The witch, as an archetypal
image, symbolizes a threat to the ego. The
liberation of the princess from the witch-
mother, through the love of the prince,
represents the disengagement of the anima
from the mother image. The witch seems to
represent the archetype of the Dark Feminine.
This archetype, which is the opposite of the
Wise Old woman, entails traits like a
devouring, regressive quality and a pre-
human animalism.
Heuscher (1974) is of the opinion that the
story of Snow White reflects the ambivalent
relationship between mother and child. The
queen‟s materialistic personality threatens to
destroy the child‟s spiritual development. The
dwarfs represent supporting superego
images, while the stepmother represents the
inhibiting, punitive and cruel aspect of the
superego.
The journey of the child hero in the form of
Snow White can often be compared to the
developing years of adolescence, and after
her mission has been fulfilled, the hero stands
as a more mature and developed person on
the brink of adulthood, to be married to the
prince. The simple fact that an abundance of
fairy tales end with a marriage and the hero
living happily ever after suggests that the
journey that particular hero took spanned from
childhood to adulthood; with the struggles the
hero faced, reflecting the struggles of children,
finding their way through adolescence and
towards maturity. The initial fright and unease
that follows leaving home and the supposed
safety of the parents‟ arms is overcome, and
the heroes prove to themselves and the world
that they are capable of surviving, and
triumphing independently, without their help.
III. Hansel and Gretel:
The tale of Hansel and Gretel is a story (in the
Grimm Bothers‟ version) of a boy and a girl
who suffer rejection and are confronted with
excessive hostility of their mother. She says to
her husband, “Early tomorrow morning, we
will take the children out into the forest where
it is the thickest; there we will light a fire for
them, and give each of them one piece of
bread, and then we will go to our work and
leave them alone. They will not find the way
home again, and we shall be rid of them”
(Hansel and Gretel, 2011).
The mother generally represents the source of
all food to the children, so it is she who now is
experienced as abandoning them, as if in a
wilderness. It is the child‟s anxiety of
separation and deep disappointment when
Mother is no longer willing to meet all his/ her
oral demands which lead the child to believe
that suddenly the Mother has become
unloving, selfish, and rejecting. Since the
children know they need their parents
desperately, they attempt to return home after
being deserted. In fact, Hansel succeeds in
finding their way back from the forest the first
time they are abandoned. The story tells
about the debilitating consequences of trying
to deal with life‟s problems by means of
regression and denial, which reduce one‟s
ability to solve problems. The story of „Hansel
and Gretel‟ gives body to the anxieties and
learning tasks of the young child who must
overcome and sublimate his primitive
incorporative and hence destructive desires.
The children get lost in the woods and give full
reign to their oral regression when they
discover the little ginger-bread house which
represents an existence based on the most
primitive satisfactions. The children are
hungry, both physically and psychologically.
According to Bettelheim, a gingerbread
house, which one can „eat up,‟ is a symbol of
the mother, who in fact nurses the infant from
her body. Thus, the house at which Hansel
and Gretel are eating away blissfully and
without a care stands in the unconscious for

the good mother, who offers her body as a
source of nourishment. Bruno Bettelheim
(1985)interpreted the story mainly in terms of
the oral greediness of a child and the penalty
for it stemming from internal structures. The
witch, who is a personification of the
destructive aspects of orality, is as bent on
eating up the children as they are on
demolishing her gingerbread house. When the
children give in to untamed Id impulses, as
symbolized by their uncontrolled
voraciousness, they risk being destroyed.
Only when the dangers inherent in remaining
fixed to primitive orality with its destructive
propensities are recognized does the way to a
higher stage of development open up. Then it
turns out that the good, giving mother was
hidden deep down in the bad, destructive one,
because there are treasures to be gained: the
children inherit the witch‟s jewels, which
become valuable to them after their return
home – that is, after they can again find the
good parent. This suggests that as the
children transcend their oral anxiety, and free
themselves off relying on oral satisfaction for
security, they can also free themselves of the
image of the threatening mother – the witch –
and rediscover the good parents, whose
greater wisdom – the shared jewels – then
benefit all. This implies transcendental
development on the part of the children as far
as personality is concerned (Rogers, 1978,
1980; Maslow, 1971).
The story ends with the child heroes returning
to the home from which they started, and now
finding happiness there. Having overcome the
oedipal difficulties, mastering anxieties,
sublimating those of the cravings which
cannot be satisfied realistically, and learning
that wishful thinking has to be replaced by
intelligent action, the child is ready to live
happily again with his parents. This is
symbolized by the treasures Hansel and
Gretel bring home to share with their father.
Rather than expecting everything good to
come from the parents, the older child needs
to be able to make some contribution to the
emotional well-being of himself and his family.
Thus, industry is the virtue and real
achievement of the school-age child who has
Emotional Processors of Childhood Conflicts:43
fought through and mastered the oedipal
difficulties (Erikson, 1968). Here, the two
siblings cooperate in rescuing each other and
succeed because of their combined efforts.
The story directs the child toward
transcending their immature dependence on
their parents and reaching the next higher
stage of development, namely, cherishing
also the support of age mates (Freud, 1913/
1953, 1926/ 1959b; Erikson, 1968).
IV. Cinderella:
Grimm‟s „Cinderella‟ is an example of a story
in which the heroine is oppressed by her
stepmother and stepsisters and made to slave
for them, is met with no love and feels no
sense of companionship. Eventually she is
raised from the ashes of the fireside and
marries a prince, with some help from the
magic that is usually to be found in the world
of fairy tales. Cinderella‟s change of fortune –
her transformation from a ragged, kitchen
wrench into a princess – is a characteristic of
being a fairy tale hero.
Bettelheim shows how Cinderella is a
pubescent young girl, caught in the grip of
sibling rivalry and perception of negative
mother-image (who becomes like a
stepmother and she herself like an unwanted
orphan pinning for the love of her „dead‟
mother) (Heisig, 1977).The evidence of the
fairy tale itself is that it was dark forces which
constellated the problem at home between
her and the others in the family, dark forces
which provided her with temporary escape
into fantasy, and dark forces which saved her.
In Cinderella, the „body‟ is being used as a
scene for acting out rivalry among siblings.
„Through‟ the body or through the actions
undertaken towards it by Cinderella‟s sisters,
the cruelty representing the strength of the
aggressive drive could be expressed. The
sisters of Cinderella, who in the Grimms‟
version, were „beautiful yet evil‟ (Cinderella,
2011), tried to trick the prince by cutting off
parts of their feet. They did so, on the advice
and with the help of their mother, thus
attempting to fit into the shoe, a slipper that
Cinderella had lost and which could fit only
her. The cherished „slipper‟ perhaps
44: Sanyal & Dasgupta
represents phallic symbol in psychoanalytic
terms (Freud, 1925/ 1961). It is the step-
mother of Cinderella who forces her
daughters to undergo these cruel practices as
she wanted them to marry and to find,
perhaps through marriage, social acceptance.
According to Pines (2010), the early mother-
child relationship is developed through the
body; the attitude of the mother is practically
felt via the skin. Pines (2010) states that
“Through her handling of the child, the
mother‟s skin may convey the full range of
emotions, from tenderness and warmth and
love to disgust and hate” (p. 8). A child who is
vulnerable and does not have adequate
adaptation and defense mechanisms to cope
with emotional pain, uses the body to cope
with it (Lemma, 2010). Such a child did
probably not experience his or her mother as
a mirror. Joyce (2005b) in connection with the
theory of Winnicott, describes mirroring as a
situation in which “the baby gazes into her
eyes and sees himself” (p. 45). The theme of
Cinderella seems to revolve around negative
object-relations with the mother (being abused
physically and emotionally by her step-sisters
and step-mother) and finally finding the prince
as life partner with the aid of her fairy God-
Mother. The fairy God-Mother represents the
good mother self in her fantasy world
(Sullivan, 1953a, 1953b). It is ultimately the
victory of good over evil, thereby bringing
about the resolution of the Mother Complex of
the heroine portrayed. Besides, the use of
fantasy and the world of enchantment have
been portrayed in the magical spell of the fairy
God-Mother, which enable Cinderella to
attend the royal ball on three consecutive
days to fulfill her wishes. Thus regression
defense has been used in a creative manner
(Sanyal, 1992).
V. Rapunzel:
Rapunzel is the main character in the fairy
tale in the form of a flower/ herb, a beautiful
girl, an object of desire, and later a maiden in
a tower. She is the enchanted object of the
fairy-tale. The setting of this fairy tale refers to
the well-known concept of binaries – the
element of the two world; one – a
representation of the real (non-magical) world,
the other – representing the enchanted: the
world of the couple and the world of the
sorceress. The enchanted world is
encapsulated within high walls. It is only
visible through „a small rear window of the
couple‟s house,‟ symbolizing the naughty
peep hole (or Id impulses). The element of the
two worlds is also observed in the enchanted
world of the tower, again with „only a tiny
window at the very top‟ versus the forest,
representing the real world. Encapsulation is a
theme. Trespassers must pay with their lives.
The themes are trespassing/ transgression
and death. The enchanted world is described
as „splendid‟ and „beautiful‟ (the sorceress‟
garden), it is a desirable world. Desire is a
main theme because it brings about the
transgression. The „real‟ world of the couple is
a world where desires are created, the magic
or enchanted world where they are met. The
sorceress‟s task is to interpret the laws of the
enchanted world, uphold the division between
the two worlds and to punish trespassers
(symbol of the Super-ego). She symbolizes
the gatekeeper and she epitomizes that which
is magic. Rapunzel was originally the object of
her mother‟s desire (herb/ flower/ lettuce), she
is also the fruit (child) of her parents‟ sexual
desire, and finally she is her mother‟s desire
(she wanted a child).
Owing to trespassing the enchanted world,
the prince had become blind and could not
perceive the world through his eyes, thus the
world loses its distinction and he loses his
ability to distinguish the different worlds he
passes through. Had not the magic world
been encapsulated by high walls, he could
actually be trespassing without knowing it.
Another theme is blindness, literal as well as
symbolic. Rapunzel‟s lack of reflexivity, her
placid demeanor, missing rebellion and great
naiveté when she asks the sorceress why the
prince is so much lighter than her to haul up
into the tower is a blindness to her own
situation. Another theme is the divine couple,
the syzygy. In the real world, the prince is
believed to be the most desired object. Thus,
the most desired objects of the two worlds,
the prince and Rapunzel constitute the divine

couple, the syzygy. The significance of giving
birth to twins in the wilderness can also be
interpreted as a syzygy – an amalgamation of
the two worlds, the magic and the real.
Further, Rapunzel is assumed to be a
pubescent girl who is confined in the tower by
the sorceress (the tower again symbolizing
the phallus) (Freud, 1925/ 1961, 1924/ 1961).
Bettelheim (1978)is of the opinion that what
blocks an oedipal girl‟s uninterrupted blissful
existence with the father is an older, ill-
intentioned female (i.e., Mother). But since the
little girl also wants very much to continue
enjoying mother‟s loving care, there is also a
benevolent female in the past or background
of the fairy tale, whose happy memory is kept
intact, although she has become inoperative.
A little girl wishes to see herself as a young
and beautiful maiden (which Rapunzel grows
into) – a princess or the like – who is kept
captive by the selfish, evil female figure
(sorceress) and hence unavailable to the male
lover. This is perhaps how oedipal guilt is
overcome by the pubescent girl. The captive
princess‟ real father is depicted as
benevolent, but helpless to come to the
rescue of his lovely girl.
In a girl‟s oedipal fantasy, the mother is split
into two figures, the pre-oedipal wonderful;
good mother and the oedipal evil stepmother
(Bettelheim, 1978).The good mother would
never have been jealous of her daughter or to
have prevented the prince (father) and the girl
from living happily together. So for the oedipal
girl, belief and trust in the goodness of the
pre-oedipal mother, and deep loyalty to her,
tend to reduce the guilt about what the girl
wishes would happen to the stepmother who
stands in her way. If the father is less attentive
to his little girl than she desires, she can
endure such adversity because a prince will
arrive who will prefer her to all competitors.
This makes the girl to love her mother more
because she puts all her anger at the mother
competitor, who gets what she deserves.
Thus the child can have the best of both
worlds, which is what she needs to grow up
into a secure adult. In fantasy, Rapunzel can
win out over the stepmother whose efforts to
prevent her happiness with the prince fail. At
Emotional Processors of Childhood Conflicts:45
the same time, children of both sexes in
fantasy can retain at home the real father as
protector and the real mother who dispenses
all the care and satisfactions a child needs.
Rapunzel is also depicted in the fairy tale to
have beautiful hairs which form tresses
(symbolizing her sexuality). It is via her
tresses which the sorceress and the prince
used to enter the confined tower and hence
the enchanted world. Rapunzel was punished
by the bad-mother after learning of her
betrayal by cutting off her tresses (and
thereby disrobing her off her eminent vitality).
VI. Sleeping Beauty:
Adolescence is a period of great and rapid
change, characterized by periods of utter
passivity and lethargy alternating with frantic
activity, even dangerous behavior to „prove
oneself‟ or discharge inner tension (Berk,
1994; Hurlock, 1999). This back-and-forth
adolescent behavior finds expression in some
fairy tales by the hero‟s rushing after
adventures and then suddenly being turned to
stone by some enchantment. „The Sleeping
Beauty‟ emphasizes the long, quiet
concentration on oneself and a period of
withdrawing from reality.
In major life changes such as adolescence,
for successful growth-opportunities, both
active and quiescent periods are needed. The
turning inward, which in outer appearance
looks like passivity (or sleeping one‟s life
away), happens when internal mental
processes of such importance go within the
person that he has no energy for outwardly
directed action. Fairy tales like „The Sleeping
Beauty,‟ have the period of passivity for their
central topic. It permits the budding
adolescent not to worry during his inactive
period: he learns that things continue to
evolve. The happy ending assures the child
that he will not remain permanently stuck in
seemingly doing nothing, even if at the
moment it seems as if this period of quietude
will last for a hundred years (Bettelheim,
1978).
The long sleep of the beautiful maiden has
also other connotations. Whether it is Snow
White in her glass coffin or Sleeping Beauty
46: Sanyal & Dasgupta
on her bed, the adolescent dream of
everlasting youth and perfection is just that of
a dream. The alteration of the original curse,
which threatened death, to one of prolonged
sleep suggests that the two are not all that
different. If we do not want to change and
develop, then we might as well remain in a
death-like sleep. During their sleep the
heroine is a frigid one; and is in the phase of
isolation as far as narcissism is concerned. In
such self-involvement which excludes the rest
of the world, there is no suffering, but also no
knowledge to be gained, no feelings to be
experienced.
Any transition from one stage of development
to the next is fraught with dangers and
anxiety. A natural reaction to the threat of
having to grow up is to withdraw from a world
and life which imposes such difficulties.
Narcissistic withdrawal is a tempting reaction
to the stresses of adolescence, but, the story
warns, it leads to a dangerous, death-like
existence when it is embraced as an escape
from the vagaries of life. The entire world
becomes alive only to the person who herself
awakens to it. Only relating positively to the
other “awakens” us from the danger of
sleeping away our life.
Sleeping Beauty shares the experience of
falling into a deep sleep at a crucial point in
her psychosexual development which may be
explained in the light of “Each reawakening or
re-birth symbolizes the reaching of a higher
stage of maturity and understanding”
(Bettelheim, 1978). He suggests that “Change
signifies the need to give up something one
had enjoyed till then.” In his treatment of
„Sleeping Beauty,‟ Bettelheim interprets the
„curse‟ of the thirteenth wise woman fated to
befall the young maiden in the fifteenth year of
her age as symbolic of the arrival of puberty.
Sexual awakening, and the isolation which
accompanies it in the natural transition from
childhood to adulthood, cannot be avoided.
The end result is a transformation of
perception which Bettelheim attributes to
Sleeping Beauty‟s personal strength of
character, but which the story seems to
attribute merely to the passage of time: her
world falls asleep and then awakens, finding
her richly rewarded for the period of
dormancy. Sleeping Beauty can thus become
a model for all turning points in life where
transformation requires isolation.
Spinning is extremely tiresome work, which is
a common metaphor for industriousness in
fairy tales. The fairy tale historian Jack Zipes
points out that before the Industrial
Revolution, spinning was an essential
occupation for women and considered a
measure of a woman‟s worth. The episode of
spinning in the tale of Sleeping Beauty (by
dint of which the heroine pricked her finger)
perhaps attempts to hint at industriousness,
being a virtue of individuals (Erikson, 1968).
A mythical and more cosmic frame of
reference is also death within Sleeping
Beauty. In the story‟s own context, the
problem of life and death is introduced at the
very outset. The king and the queen long for a
child, as a way of insuring the continued life of
the crown under their name after they die.
And it ends with the statement that the
maiden and her prince “live happily until their
death.” The curse of death by dark forced
which marks the birth of the girl is changed
into a promise of rebirth. The overall feeling
one is left with is that death is but a state of
suspended animation. The tale does not
argue the reality of life after death. It simply
dramatizes the fundamental human desire for
immortality.
Critical observations resulting in
conclusion:
An important aspect of these stories is how
they present protagonists that children can
relate to, and show how those heroes
overcome the problems they face – the
problems children are afraid of having to face
themselves. Hearing these stories allows the
children reassurance that even though the
situation seems desperate, the clever and
dexterous child can take care of himself. The
child hero presented in fairy tales is often the
youngest child of the family or a stepchild, and
so the hero is repeatedly isolated from his
other siblings or from his parents, even
oppressed and disadvantaged. The heroes
are often small, seemingly unable to take care
of themselves and have to rely on others, but

through the course of the story manage to rise
above their woes. The presence of magic, the
existence of enchanted beings and objects,
and the frequent appearances of talking
animals enthrall young readers, but at the
same time reassure them that the parts of the
stories that frighten them do not exist to taunt
and torment them in reality. Fairy tales thus
have a transcendental role as far as
personality is concerned. This results in
therapeutic “‟emotional processing‟ of
unresolved conflicts at the level of their
fantasy. Hence fairy tales essentially serve as
thematic medium of working with emotions of
children in a secure, trustworthy and
unconditionally accepting ambience.
References:
Berk, L.E. (1996). Child Development, 3rd edition,
Prentice-Hall of India Pvt. Ltd., New Delhi.
Bettelheim, B. (1976). The uses of enchantment: The
meaning and importance of fairy tales. (New York:
Alfred A. Knopf).
Bettelheim, B. (1978). The Uses of Enchantment.The
meaning and importance of fairy
tales.Harmondsworth: Penguin.
Bettelheim, B. (1985). Cudowne I pozyteczne. O
znaczeniach I wartoschiach basin. Warszawa:
PanstwowyInstytutWydawniczy.
Bettelheim, B. (1989). The uses of enchantment: The
meaning and importance of fairy tales. NY: Vintage
Books.
Cinderella (2011).Received from the http://
en.wikipedia.org/ wiki/ Cinderella on August 25, 2011.
Coulacoglou, C. (2008). Exploring the child‟s personality:
Clinical and cross-cultural applications of the Fairy
Tale Test. Springfield Illinois: C.C. Thomas.
Coulacoglou, C., Sanyal, N., and Dasgupta, M. (2013).
The Fairy Tale Test: Manual (Indian) 2nd edition,
Hogrefe, USA.
Erikson, E.H. (1968). Identity: Youth and crisis. New York:
Norton.
Fairbairn, R. (1972). Psychoanalytic studies of the
personality. London: Routledge & Kegan.
Franz, Marie-Louise von (1995).Shadow and Evil in Fairy
Tales, (Revised Ed.) Shambala Publications, Inc.,
Boston USA.
Freud, S. (1913/ 1953). Totem and taboo.In Standard
edition (Vol, 13).
Freud, S. (1924/ 1961). The dissolution of the Oedipus
complex. In Standard edition (Vol. 19).
Freud, S. (1925/ 1961). Female sexuality.In Standard
edition (Vol. 20).
Freud, S. (1926/ 1959 b). The question of lay analysis.In
Standard edition (Vol. 20).
Fromm, E. (1951). The forgotten language: An
introduction to the understanding of dreams, fairy
tales and myths. New York: Hot, Rinehart & Winston.
Emotional Processors of Childhood Conflicts:47
Girard, M. (1999). Les contes de Grimm: Lecture
psychoanalytique (Grimm fairy tales; psychoanalytic
lecture). Paris: Imago.
Hansel and Gretel (2011).Received from the
http://en.wikipedia.org/wiki/ Hansel_and_Gretel on
August 25, 2011.
Heisig, J.W. (1977). Bruno Bettelheim and the Fairy
Tales.https://nirc.nanzan-u.ac.jp/en/files.../JWH-
Bruno-Bettelheim-and-the-Fairytales.pdf
Heuscher, J.E. (1974). A Psychiatric Study of Myths and
Fairy Tales. Springfield, Illinois: Grove Press, Inc.
Hurlock, E.B. (1999). Child Development, 6th edition,
Tata McGraw-Hill Edition, New Delhi.
Joyce, A. (2005b). The first six months: The baby getting
started. In: E Reiner, A. Joyce, R. James, M.
Twyman& Ch. Clulow (Ed.) Human Development: An
Introduction to the psychodynamics of growth,
maturity and aging. London, NY: Routledge
Jung, C.G. (1951/1959a). Aion: Researches into the
phenomenology of the self. In Collected works (Vol. 9,
pt.2).
Jung, C.G. (1954/ 1959a).Archetypes and the collective
unconscious.In Collected works (Vol9; Pt. 1).
Jung, C.G. (1961). Memories, dreams, reflections (A.
Jaffe, ed.). New York: Random House.
Kast, V. (1995).Folklore as therapy. New York: Fromm
International Publishing Corporation.
Lemma, A. (2010). Under the skin: A psychoanalytic
study of body modification. London, NY: Routledge,
Taylor and Francis Group.
Maslow, A.H. (1971). The farther reaches of human
nature. New York: Viking.
Pines, D. (2010).In Scheir, K.The consequences of the
neglect of children‟s developmental needs. The
relationship of the siblings. www.mellanrummet.net/
nr28-2013/artikel-consequencesoftheneglect.pdf
Rogers, C.R. (1978). The formative tendency. Journal of
Humanistic Psychology, 18(1), 23-26.
Rogers, C.R. (1980). A way of being. Boston: Houghton.
Roheim, G. (1953). Fire in the dragon and other
psychoanalytic essays on folklore. Princeton, NJ:
Princeton University Press.
Roheim, G. (1953/ 1992). Fairy tales and
dream.Psychoanalytic study of the child, 8, 393-403.
Sanyal, N. (1992). Where regression is creative: An
illustration from Tagore. Samiksha, Vol. 46, 101-114.
Schectman, J. (1993). The stepmother in fairy
tales.Bereavement and the feminine shadow, Sigo
Press, Boston.
Shapiro, R. & Katz, C.L. (1978).Fairy tales, splitting and
development. Contemporary Psychoanalysis, 591-02.
Sullivan, H..S. (1953a).Conceptions of modern
psychiatry. New York: Norton.
Sullivan, H.S. (1953b). The interpersonal theory of
psychiatry. New York: Norton.
Thomas, J. (1989). Inside the wolf‟s belly. Sheffield, U.K.:
Sheffield Academic Press.
Winnicott, D.W. (1967). Playing and Reality. In P. Lomas
(ed.). The Predicament of the Family: A Psycho-
analytical Symposium. London: Hogarth Press and
the Institute of Psychoanalysis.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 48-51

Efficacy of Cognitive Drill Therapy in Treatment of Specific Phobia

Bhavana Arya, Sandhya Verma and Rakesh Kumar
Specific phobia is a highly prevalent condition which may interfere in occupational and social life of persons
affected with this disorder. Cognitive Behavior Therapy and Desensitization Therapies have been well
documented as effective treatments for phobia. Cognitive Drill Therapy (CDT) is a potential candidate for addition
into the family of cognitive therapy which can address a large number of fearful conditions which could be
conceptualized as stimulus-bound anxiety in persons having anxiety disorders. In this paper, we are reporting a
case study of a person with specific phobia who was treated with CDT. The application of Cognitive Drill Therapy
resulted in significant reduction in the phobic condition.

CDT conceptualizes phobia in following four

Specific phobia is an anxiety disorder in which
exposure to specific object or situation elicits
a disproportionate fear reaction. The affected
person may go at a great length to avoid an
encounter with objects and situations of
phobia and if avoidance is not possible then
the person tends to remain in distress as long
as he/she remains in the presence of such
object/situation. Even an anticipation of the
encounter with phobic object/situation tends to
trigger fear response. The person usually
remains aware of the unreasonableness and
the excessive nature of the fear but this
awareness and realization does not help
him/her to get hold of the fear response.
Cognitive behavior therapy (CBT) is an
effective form of treatment in most anxiety
disorders (Lipka et al. 2013). Brand et al.
(2011) reported effectiveness of two sessions
of CBT in phobia. Virtual reality exposure
therapy (VRET), and exposure and response
prevention (ERP) are also well established
therapies for phobia (Price et al., 2011).
Dr. Rakesh Kumar developed a novel form of
treatment approach known as Cognitive Drill
Therapy (CDT) based on the theory of
conditioning, exposure, cognitive appraisal
and linguistic pattern to address anxiety
disorders, specifically phobia and OCD
(Kumar and Dubey, 2016).The case based
data generated so far suggest that CDT could
also serve to reduce irrational fears in
conditions of phobia and OCD (Kumar, et al.,
2012; Dwivedi & Kumar, 2015).
components, popularly known as OBSD
analysis:
1. Objects: It relates to all objects/situations
that trigger phobic reaction e.g. closed
places, insects, animals, crowd etc.
2. Body-Mind Reactions (BMR):It implies
physiological and psychological reactions
such as rapid heartbeat, breathing difficulty,
sweating, dry mouth, mind going blank,
trembling, dizziness etc. triggered by actual
exposure or anticipation of exposure to the
objects of phobia.
3. Safety Measures: The pattern of avoidance
or measures taken to curb the phobic
reactions such as taking someone while
being in the presence of objects/situations
of phobia is hinted at.
4. Danger Perception: It relates to the threat
perception and the linked thoughts. It is also
called as Imagined Feared Consequences
(IFC) such as thoughts of getting heart
attack, becoming unconscious, catching
germs, developing fatal diseases etc.
It is hypothesized that persons affected with
phobia, remain struck in first three
components which taken together are
classified as Top Layer. The affected person
rarely addresses the threat perception which
is classified as Bottom Layer. Persistence of
distorted threat perception maintains the
phobic reaction; hence, addressing this
bottom layer directly in the therapy would lead

Bhavana Arya, Ph.D. Asst. Professor, The IIS University, Jaipur, India. Sandhya Verma, Ph.D. Scientist, Defence
Institute of Psychological Research, DRDO, Delhi, India. Rakesh Kumar, Ph.D. Head, Department of Clinical
Psychology, Institute of Mental Health & Hospital, Agra-282002, India Email: jain.imhh@gmail.com
Keywords: Cognitive Drill Therapy (CDT), Specific Phobia, Exposure Therapy, Desensitization.

to rapid and substantial improvement in the
phobic reactions.
In CDT the thoughts of threat perception are
listed and their time-frame of future is
converted into past or present and then the
affected person is required to keep on verbally
or sub-vocally repeating (called drill) the
converted thoughts. Verbal exposure in this
form can elicit mild to severe BMR for which
periodic BMR rating is obtained on a scale of
0-100 where 0 refers to no fear or BMR and
100 means maximum. With continued
repetitions, the affected person experiences
sharp drop in fear reactions and BMR within a
few minutes. The process is accomplished for
all identified objects/situations and thoughts of
threat perception. We are reporting a case
study in which specific phobia was treated by
using CDT in this paper.
Case Summary:
Mrs. X, a 53 year old female suffered from
fear of using public washrooms. 12 years ago
she was travelling by road. Her family stopped
over at a highway hotel to use the facilities.
Two days later she was hospitalized due to
severe urine infection. The doctor informed
her that this was due to using an infected
toilet. Since then she had been avoiding any
public washrooms. With time she even
stopped using the other washrooms in her
own house except the one in her room. No
one was allowed to use her washroom. She
would never go out of her house for more than
a couple of hours in case she needed to use
the washroom. She quit her full time job as an
office assistant and picked up a part time job
close to her house so that she could rush
home in case she needed to use the
washroom. Once a fun-loving woman, she
stopped going out, watching movies and
going on vacation and became completely
home-bound. X was diagnosed with specific
phobia on the basis of significant clinical
distress on account of persistent anxiety and
impairment in social and occupational areas
since the past 12 years. On a subjective scale
Cognitive Drill Therapy: 49
of global rating of her phobia on 0-100 scale,
she rated it as 100, the maximum fear.
Her OBSD analysis was characterized by
following components:
1. Objects of Phobia: All washrooms except
the one in X‟s room. Specifically following
washrooms of following places were
identified: guestroom, cinema hall, train,
hotel, shopping mall, her office, neighbors
and relatives.
2. Body-Mind Reactions (BMR): Severe
BMR even with the thought of using other
washroom characterized by rapid heart
rate, breathing difficulty, sweating,
tightness in muscles etc.
3. Safety Behaviors: Complete avoidance of
all other washrooms except her own. She
has even down-graded her occupation
and restricted and re-designed her life
around this condition.
4. Danger Perception: Following thoughts of
danger perception were identified:
a. She may develop urine infection once
again
b. In case she catches infection, it would
be highly painful
c. In case of catching urine infection,
she would have to be hospitalized
once again
d. She will suffer once again with the
urine infection
Cognitive Drill Protocol: The following
components of Cognitive Drill Therapy were
executed in 8 sessions.
Psycho-education: This is a very important
component of CDT wherein the patient was
educated about the nature of phobia and the
nature of anxiety curve seen during exposure
to objects/situation of phobia. A definite
diagnosis of specific phobia was given to X.
She was also explained the two layer
structure of her phobia. The top layer
consisted of using washrooms and the bottom
50: Arya, Verma & Kumar
layer was the cognition of being infected. The
cognition reflected a future perspective. It took
almost three sessions to provide psycho-
education to X as she was deeply conditioned
with the fact that using a washroom which
was used by someone else will surely lead to
infection. She was made aware that her
experience of urine infection had occurred in
the past but her cognitions about it stretched
to the future. Imagined fear consequences
were explained to X.
Drill statements: Following drill statements
were formulated corresponding to her
thoughts of danger perception. In drill
statements, the future tenseof thoughts of
danger perception were converted into past or
present tense.
 I have developed urine infection once again;
 I have developed urine infection, it is highly
painful;
 I have developed urine infection, I am
hospitalized once again;
 I am suffering once again with the urine
infection.
Execution of Cognitive Drill: Having done
with psycho-education and drill statements,
Cognitive Drill was implemented. The drill was
implemented in following manner: “Imagine
the object of phobia and keep on repeating
drill statements one by one.” The objects and
drill statements were taken up in sequential
manner one by one. When the fear got
reduced to one object and one drill statement;
then next object or drill statement was taken
up. For example, she was required to imagine
and repeat “I am using washroom of my
office, I have caught urine infection”, this drill
was performed. Moment to moment BMR
rating at an interval of about 30 seconds were
obtained. If BMR escalated to high level,
pauses of 1-2 minutes were given. When
BMR got reduced in pause, the drills were
resumed. When she became comfortable with
this drill, the next drill was implemented, e.g. „I
am using my office washroom, I have caught
urine infection and got hospitalized”. Like this
all objects and thoughts of danger perception
were taken up.
Homework and Daring: Homework occupies
a very important place in CDT. X was asked
to repeat the danger statements at home in
between sessions. X was also encouraged to
use other washrooms. She could use it on fifth
day of therapy without feeling any anxiety.
Termination: Therapy was terminated after
eight sessions when X reported using other
washrooms with minimal or no fear reaction.
She reported feeling empowered after having
used it.
Post Therapy Assessment: Again subjective
global rating of phobia reaction was obtained
on a scale of 0-100. She reported minimal
fear of using other washrooms on this
assessment. X also showed a significant
upliftment in her mood and general
satisfaction.
Follow Up: Two weekly follow-up sessions
were conducted in which X reported
maintained improvement. She reported
fleeting thoughts of having urine infection
while using the washroom in her office but she
was able to push them aside.
Discussion:
The application of CDT produced significant
changes in the phobic reactions of X. Her
overall functioning showed positive gains. She
had significant improvement in her functioning
and general satisfaction levels. Cognitive drill
effectively exposes the patient to his/her
deeper level of thoughts of danger perception
and verbal exposure provides a unique
opportunity to expose the patient to the
underlying maladaptive cognition which
maintains the phobic reaction. A simple
exposure to the objects without an exposure
to the feared consequences, takes longer time
in habituation whereas the exposure to the
underlying thoughts tends to accelerate the
dissolution of phobic reaction. In reality, the
person is not phobic to the objects of phobia
as such; instead he/she is scared to the
possibilities of feared outcome which was
 Cognitive Drill Therapy:51

urine infection in this case. Exposure to wash
rooms, simply triggers the cognitive processes
that implicate repetition of the painful outcome
of the past. Cognitive drill therapy also
enhances self-efficacy; the person comes to
realize that if such an event gets repeated,
he/she would be able to handle it. She could
now push away the thoughts of urine infection
while using other washrooms and felt
confident that although repeated infection
could be a problem, she would be able to
handle such an infection and the resultant
pains. The cognitive re-interpretation is a
natural outcome of cognitive drill therapy.
Conclusion:
The case work-up suggested the role of
Cognitive Drill Therapy in reducing phobic
reaction to specific objects. This work-up
points out to the need for large scale studies
on various kinds of phobias using CDT. Also,
long-term follow-up should be conducted to
see if the acquired gains are maintained.
Formal assessments through standardized
tools would ensure objectivity. Moreover,
independent evaluator could be engaged in
assessing the course and outcome of CDT in
phobic condition to further enhance
objectivity.
References:
Brand, S., Annen, H., Holsboer-Trachsler, E., & Blaser, A.
(2011). Intensive two-day cognitive-behavioral
intervention decreases cortisol secretion in
soldiers suffering from specific phobia to wear
protective mask. J. of psychiatric research,
45(10), 1337-1345.
Dwivedi, S., & Kumar, R. (2015). Efficacy of Cognitive
Drill Therapy in Agoraphobia with Panic Disorder:
A Case Study. SIS J. of Proj. Psychology and
Mental Health, 22(2), 150-157.
Eysenck, H. J. (1979). The conditioning model of
neurosis. Behavioral and Brain Sciences, 2, 155–
199.
Eysenck, H. J., & Rachman, S. J. (1965).Causes and
cures of neurosis. London: Routledge & Kegan
Paul.
Kumar, R. Sameer, A., & Singh, B. (2012).Preliminary
Test of Cognitive Drill as an Intervention. Indian
J. of Clin. Psycho, 39, 67-74.
Kumar, R., & Dubey, B. L. (2016). Cognitive Drill Therapy:
A Potent Application of the Principles of
Psychology for OCD and Phobia. SIS J. of Proj.
Psychology and Mental Health, 23(2), 125-126.
Lipka, J., Hoffmann, M., Miltner, W. H., & Straube, T.
(2013).Effects of Cognitive-Behavioral Therapy
on Brain Responses to Subliminal and
Supraliminal Threat and Their Functional
Significance in Specific Phobia. Biological
Psychiatry.76(11):869-77
Pavlov, I. (1927). Conditioned reflexes. London: Oxford
University Press.
Price, M., Mehta, N., Tone, E. B., & Anderson, P. L.
(2011). Does engagement with exposure yield
better outcomes? Components of presence as a
predictor of treatment response for virtual reality
exposure therapy for social phobia.J.of anxiety
disorders, 25(6), 763-770.
Watson, J. B., & Rayner, R. (1920).Conditioned emotional
reactions. Journal of Experimental Psychology, 3,
1–14.

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 SIS J. Proj. Psy. & Ment. Health (2017) 24: 52-56

Response to the Blank Card of Thematic Apperception Test (TAT)

and its Correlation with Personality Factors
Anand Manjhi and Sunita Purty
The blank card (Card 16) of Thematic Apperception Test has extraordinary value in clinical assessment because
it has no structure and pure projection. It provides an opportunity to the subject to come out with whatever is
buried near the unconscious through writing a form of free association. The present study attempted to investigate
the responses to the blank card of TAT and correlate with personality profile of the subject. The study was
conducted at Post-Graduate Institute of Behavioral and Medical Sciences, Raipur (India). The sample consisted
of 60 subjects of which 30 persons had alcohol dependence syndrome diagnosed as per ICD-10 DCR (WHO,
1992) and 30 normal controls, who selected through purposive sampling technique. The blank card (card 16) of
TAT and 16 PF Form A (Hindi version) were administered on the subjects individually. The findings indicated that
the factor C of 16 PF was positively correlated with the (n) rejection and factor B, F and L were negatively
correlated with (n) dominance, succorance and blame avoidance respectively on blank card of TAT.

Personality may be defined as the underlying
causes within the person of individual
behavior and experience. After reviewing
several definitions of personality in
psychology, theology, philosophy, law,
sociology and common usage, Allport (1937)
proposed an operational definition that has
become a classic definition of personality, i.e.,
“Personality is the dynamic organization within
the individual of those psychophysical
systems that determine his unique adjustment
to the environment.”According to Mischel,
(1986) personality is the distinctive pattern of
behavior (including thoughts and emotions)
that characterize each individual’s adaptation
to the situation in his or her personality. There
is an emphasis on the idea that each person
has a unique personality. Even identical twins,
who have exactly the same genetic make-up,
have different personality although they
probably also have more in common than
unrelated people (Plomin, 1990).
The TAT (Murray, 1943) is one of the most
commonly used projective measures of
personality for clinical purposes (Rossini &
Moretti, 1997; Watkins et al., 1995). It
consists of a set of 20 black and white
pictures depicting relatively ambiguous
situations. In a typical TAT study, participants
are asked to make stories about the pictures,
and the stories are scored for several
underlying themes (e.g., affiliation,
aggression; Murray, 1943). Since its
inception, researchers have used the TAT to
evoke creative responses, but rarely included
the blank card (No. 16) in their assessment
procedures. In the Analysis of Fantasy, Henry
has emphasized the importance of the blank
card and writes “the extreme challenge which
it makes for the subject who must create for
himself the entire scene as well as its people,
events, and plot development” (Henry, 1956).
The blank card serves as a momentary
challenge to the subject’s creativity.
During 1940s, many clinicians were using a
limited number of cards and abbreviated
scoring systems to save time in administration
and scoring. In earlier studies the blank card
was used to tap subjects’ creativity. But in
terms of personality, the studies are lacking,
to the best of the researchers’ knowledge.
The present research was planned to
investigate the responses to the blank card of
TAT and its correlation with personality
factors.
Methodology:
Sample: The sample consists of 60 subjects,
of which 30 persons had alcohol dependence
syndrome diagnosed as per ICD-10 DCR
(WHO, 1992) in the age range of 18-50 years,
having education at least of 10th standard
who were taken from the OPD of Post-
Graduate Institute of Behavioral and Medical
Science, Raipur, and 30 matched normal
controls were also selected following

Anand Manjhi, Asst. Professor, and Sunita Purty, Lecturer, Dept. of Clinical Psychology, Post-Graduate Institute of
Behavioural and Medical Sciences, Raipur (C.G.)
Key words: Alcohol Dependence Syndrome, Personality
 Blank Card of TAT:53

purposive sampling. Persons with history of The blank card (card 16) of Thematic
other substance abuse, severe physical Apperception Test: In this study, only blank
illness, mental retardation, epilepsy and other card (card 16) of Thematic Apperception Test
neurological and psychiatric disorder were (TAT; Murray, 1943) was used as stimulus.
excluded from the study. Card 1 was administered as sample card for
Tools: Following tools were administered orientation before administering the blank
individually to the subjects: card.
Socio-demographic and clinical data sheet: A Procedure: The socio demographic data was
self-prepared socio-demographic and clinical collected from both the groups. The General
data sheet was used to collect basic Health Questionnaire-12 was administered for
information; e.g. age, education, marital status screening the normal control group and those
etc. who scored less than 3, were included in the
General Health Questionnaire (GHQ)-12: This study. Persons with alcohol dependent
questionnaire was developed by Goldberg syndrome group were screened by Michigan
(1972), consisting 12 items on behavioral and Alcoholism Screening Test (MAST), subjects
psychological functioning. The questionnaire scoring more than 13 were taken for the
screens out healthy persons with possible present study. The 16 PF Form A (Hindi
mental health issues on the basis of Version) and the Blank Card (card 16) of TAT
psychiatric morbidity. were administered to all the subjects
Michigan Alcoholism Screening Test (MAST): individually.
The MAST was developed by Selzer in 1971, Statistical Analysis: The data was analyzed
consisting 24-items screening instrument. The by using statistical package for social
test was applied on alcohol dependent group sciences (SPSS 16.0). Pearson correlation (r)
to identify the severity of alcohol abuse and was applied to see the relationship between
dependence. responses on TAT blank card and personality
16 P. F. - Form A: The Hindi adaptation of 16 factors.
PF (Kapoor, 1970) was administered to all Results
subjects.
Table 1: Shows the socio demographic characteristics of alcohol dependent patients and normal controls
Variables Alcohol Normal df χ²
dependent Control
patients (N=30) (N=30)
Age Below 30 years 8 (26.7%) 23 (76.7%) 1 15.02**
Above 30 years 22 (73.3%) 7 (23.3%)
Education in Up to 12 years 21 (70.0%) 10 (33.3%) 1 8.08**
years More than 12 years 9 (30.0%) 20 (66.7%)
Residence Rural 17 (56.7%) 10 (33.3%) 1 3.30
Urban 13 (43.3%) 20 (66.7%)
Religion Hindu 23 (76.7%) 24 (80.0%) 1 0.10
Non-Hindu 7 (23.3%) 6(20.0%)
Marital status Unmarried 20 (66.7%) 13 (43.3%) 1 3.30
Married 10 (33.3%) 17 (56.7%)
Family type Nuclear 18 (60.0%) 21 (70.0%) 1 0.66
Joint 12 (40.0%) 9 (30.0%)
Occupation Unemployed 21 (70.0%) 16 (53.3%) 1 0.66
Employed 9 (30.0%) 14 (46.7%)
Family income Up to Rs. 25000 18 (60.0%) 19 (63.3%) 1 0.071
per month More than Rs. 25000 12 (40.0%) 11 (36.7%)
**p<0.01
.
54: Manjhi & Purty

Table 2: Personality profile of Alcohol Dependent Patients and Normal Subjects on 16 PF Test
Variables Alcohol Dependent Normal Control Subjects df t-value
Patients (N=30) (N=30)
Mean SD Mean SD
Factor A 5.00 1.74 4.70 1.56 58 0.703
Factor B 3.87 1.76 4.77 1.96 58 1.873
Factor C 2.47 1.72 3.53 1.96 58 2.242*
Factor E 5.33 1.96 5.40 1.96 58 0.133
Factor F 5.40 1.52 5.57 1.38 58 0.444
Factor G 6.07 1.76 6.43 1.52 58 0.862
Factor H 5.53 2.01 5.50 1.63 58 0.070
Factor I 4.93 1.39 5.67 1.77 58 1.787
Factor L 7.30 1.72 5.03 1.63 58 2.294**
Factor M 6.57 1.94 6.83 1.51 58 0.594
Factor N 6.67 1.75 6.30 1.86 58 0.787
Factor O 6.17 1.76 5.57 1.40 58 1.217
Factor Q1 6.17 1.55 6.17 1.68 58 0.000
Factor Q2 5.53 2.03 5.57 1.65 58 0.070
Factor Q3 4.73 1.44 5.37 1.92 58 1.446
Factor Q4 5.77 1.45 5.83 1.42 58 0.180
**Significant at 0 .01, *Significant at 0.05 level
.
Table 3: Correlation between 16 personality factors and needs on blank card of TAT
Variables Agg Dom Exp Sex Succ Cha Aba Bla Ha Pas Rej
Factor A .261 .322 -.078 -.097 -.195 -.234 .209 .000 .000 .130 -065
Factor B -.380 - -.078 .232 .347 -.057 -.121 -.201 .090 -.039 .026
.322*
Factor C -.230 -.199 -.153 .059 .039 -.311 -.071 -.230 .039 .303 .434*
Factor E .063 -.098 .236 .088 -.354 -.402 -.221 -.037 .000 .000 .236
Factor F -.359 .063 .357 -.022 -.386* .107 .000 .074 .059 .134 .134
Factor G -.172 .115 -.165 -.116 -.077 -.010 .241 .100 .051 .629 .372
Factor H .286 .011 .063 .286 -.202 -.342 -.075 -.050 -.090 .079 .135
Factor I -.240 .085 -.085 -.037 .016 .111 -.044 .281 -.228 -.065 .179
Factor L .237 .042 -.205 .255 .269 -.047 .132 -.361* -.059 -.190 .138
Factor M .055 -.122 -.219 .113 -.215 -.009 .148 .334 -.041 .076 .017
Factor N .139 -.260 -.337 -.048 -.194 .130 .191 -.072 .323 -.194 -.129
Factor O -.198 .265 .128 -.096 .160 .283 -.146 .125 .096 -.096 .160
Factor Q1 .127 -.009 -.029 .218 -.036 -.204 .107 -.142 .036 -.254 -.036
Factor Q2 .015 -.029 -.138 -.134 .245 .129 ..030 -.050 .078 .078 .022
Factor Q3 -.232 -.119 .050 .035 -.094 .240 -.169 .035 .063 -.016 .142
Factor Q4 -.177 -.020 .324 .023 .101 .417 -.302 .160 .489 .132 .287
*P<0.05 Agg= Aggression, Dom=Dominance, Exp=Exposition, Sex=Sex, Succ= Succorance,
Cha=Change, Aba=Abasement, Bla=Blame avoidance, Ha=Harm avoidance, Pass=Passivity,
Rej=Rejection
Discussion:
and education variable respectively. In alcohol
Table 1 shows the socio demographic
dependent group only 26.7% subjects were
characteristics of both the study groups. For
below 30 years and 73.3 % were more than
this purpose the χ² was used. It is very clear
30 years whereas 76.7% were below 30 years
from the table that, there is significant
and only 23.3% were having above 30 years
difference found between alcohol dependent
in normal group. It is also clear from the table
group and normal control group in the age
that 70% of the subjects were having

education less than 12 years and only 30%
were having more than 12 years of education
in the alcohol dependent, whereas only 33.3%
were less than 12 years of education and
66.7% were having more than 12 years of
education among normal subjects.
While table 2 showed group difference
between study groups, t-test was used to
analyze the result. On the basis of test results
it was found that the alcohol dependent
patients were found to be significantly low
(factor C) in frustration tolerance. This may be
explained because of their unsatisfactory
conditions for which they are easily annoyed
and emotional in nature and have neurotic
symptoms like sleep disturbances and
psychosomatic complaints, but on the other
hand normal control subjects are more
emotionally stable, are realistic about their life
and have good ego strength (Alcohol
dependent patients: M= 2.47 ± 1.72, Normal
control subjects: M= 3.53 ± 1.96, t=2.242,
p>0.05 level).
Similar finding has been found in a study done
by Gross and Carpenter (1971), where they
found that in 16 PF, factor C was low among
alcoholics. Based on the findings they
concluded that alcoholics are emotionally
unstable. Another similar finding has been
concluded by a study done by IPAT staff
(1963) in alcoholics using 16 PF. They also
state alcoholics to have more concrete
thinking, have lower scholastic capacity. A
study conducted by Costello (1978) on
alcoholics using 16 PF also found that
alcoholics have low scores on factor C (easily
frustrated, emotionally unstable) which also
support the present study.
Further in the present study we found that
Alcohol dependent patients tend to be high on
Factor L which indicates that they are more
doubtful and mistrusting than normal control
subjects. They are often involved in their own
internal life, are not concerned about others in
comparison with normal control subjects
(Alcohol dependent patient: M=7.30 ± 1.72,
Normal control subjects: M= 5.03 ± 1.63,
t=2.294, p>0.01 level). A similar study has
Blank Card of TAT:55
been conducted by Kirchner et al. (1974) in a
sample of 49 male alcoholics who were
assessed on 16 PF. They found that alcoholic
males were more Suspicious (factor L) than
normal control subjects. Another study
conducted by Costello (1978) on alcoholics
concluded that alcoholics on 16 PF have high
scores on factor L which also support the
present study.
Table 3 showed correlation between needs on
blank card of TAT and 16 personality factors
in groups of alcohol dependence syndrome.
Analysis was done with Pearson correlation
and (r) values are shown in tables.
In the present study factor B of 16 PF was
negatively correlated with (n, dominance)
response of blank card of TAT. It indicates
that persons with alcohol dependence
syndrome have low mental capacity or have
low intelligence; they try to control the
environment to some extent in the direction of
their needs and sentiments.
Positive correlation was found in factor C of
16 PF and (n, rejection) blank card of TAT,
which indicates that alcohol dependent
patients are low in frustration tolerance for
their unsatisfactory conditions. Because of
that they get easily annoyed, so they keep or
exclude themselves from the environment or
people.
Further we found that Factor F was negatively
correlated with (n, succorance) on the blank
card, which indicates that persons diagnosed
with alcohol dependence syndrome are sober
and simple in nature but they have insecure
feelings and they need others’ support and
nursing to guide or advise them.
Negative correlation was found between
factor L of 16 PF and (n, Blame avoidance) on
the blank card of TAT, which shows that they
are less trusting and get involved in
sociopathic acts in order not to be rebuked by
others and to avoid blame.
It is notable that the correlational studies
between responses on blank card of Thematic
Apperception Test and 16 Personality Factor
56: Manjhi & Purty
have not been studied in persons with alcohol
dependence syndrome, to the best of our
knowledge. Thus more refined studies are
required to focus on such findings.
Conclusion:
Since 1946, researchers have used picture
cards from the TAT as stimuli to evoke
creative responses. The TAT manual provides
some general guidelines for an evaluation of
the responses. These guidelines are based on
Murray’s personality theory, which revolves
around the concepts of “needs” (tendencies in
the individual’s personality) (Vane, 1981). The
present study was designed to investigate the
relationship of needs on blank card with
personality factors where the authors found
that factor C of 16 PF was positively
correlated with the (n) rejection and factors B,
F and L were negatively correlated with (n)
dominance, succorance and blame avoidance
respectively on the blank card of TAT.
Further, it may be used as normative date
provided the sample size is increased and
becomes representative.
References
Allport, G.W. (1937). Personality-A psychological
interpretation. New York: Henry Holt and
Company
Costello, R. (1978). Empirical derivation of a partial
personality typology of alcoholics. Journal of
Studies of Alcoholism, 39, 1258-1266.
Goldberg, D. (1972). The detection of psychiatric illness
by questionnaire: A technique for the
identification and assessment of non-psychotic
psychiatric illness. London, New York: Oxford
University Press.
Gross, W. and Carpenter, L. (1971). Alcoholic
Personality; reality or fiction? Psychological
Reports, 28, 375-378.
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Inkblot Society on following URL:
SIS Abstracts: http://somaticinkblots.com/abstracts/
Copyright ©1994. SIS Center, India/Anchorage
Henry, William E. (1956). The Analysis of
Fantasy. New York: John Wiley and Sons.
IPAT, Staff (1963). Information Bulletin No. 8 to the 16 PF
Handbook. Champaign, IL Institute of Personality
and Ability Testing.
John H. Kirchner and Stanleys. Marzolf (1974) personality
of alcoholics as measured by sixteen personality
factor questionnaire and house-tree-person color-
choice characteristics. Psychological reports:
volume 35, issue 2, pp. 627-642.
Kapoor, S.D (1970). 16 PF. VSJ 1970 Hindi Edition, Form
A The Psycho-Centre, T-22, Green Park, New
Delhi.
Mischel, W. (1986): Introduction to Personality. Fort
Worth, Chicago: Holt, Rinehart and Winston, Inc.
Murray, H. A. (1938). Explorations in personality. New
York: Oxford University Press.
Murray, H. A. (1943). Thematic Apperception Test
Manual (TAT). U.S.A.: President and Fellows of
Harvard College, Press
Murray, H. A. (1965). Uses of the thematic apperception
test. In B. I. Murstein (Ed.), Handbook of
projective techniques (pp. 425–432). New York:
Basic Books.
Plomin, R., Chipuer, HM.,&Loehlin, JC. (1990).
Behavioral Genetics and Personality. In LA
Pervin (Ed.), Handbook of personality: Theory
and Research (pp. 225-43). New York, New York:
Guilford.
Rossini, E. D., & Moretti, R. J. (1997). Thematic
Apperception Test (TAT) interpretation: Practice
recommendations from a survey of clinical
psychology doctoral programs accredited by the
American Psychological Association.
Professional Psychology: Research and Practice,
28, 393–398. http://dx.doi.org/10.1037/0735-
7028.28.4.393.
Selzer, M.L. (1971). The Michigan Alcoholism Screening
Test (MAST): The quest for a new diagnostic
instrument. American Journal of Psychiatry, 127,
1653-1658.
Vane, J.R. (1981). The Thematic Apperception Test: A
review. Clinical Psychology Review, 1, 319-336.
World Health Organization, (1992).The ICD-10
Classification of Mental and Behavioural
Disorders, Geneva. A.I.T.B.S. Publishers &
Distributors (Rrgd.) Delhi-51.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 57-63

Mindfulness, Emotion Regulation, and Subjective Well-Being: Exploring the Link

Satchit P. Mandal, Yogesh K. Arya and Rakesh Pandey
Most studies though report that emotion regulation (ER) mediates the relationship of mindfulness with subjective
well-being (SWB), there is also an unexamined conjecture that ER skills cultivate mindfulness which consequently
enhances SWB. Present study attempts to empirically tests which of the said two models better explains the
mindfulness-well-being relationship. Two hundred eleven adults were assessed on the self-report measures of the
said constructs. Initially we tested the mediational model assuming that the use of ER (cognitive reappraisal &
suppression) would mediate the mindfulness-SWB relationship. This model was found to yield a good fit to the
data with some minor modification. The test of alternative model that assumes ER as an antecedent factor in
mindfulness – well-being relationship was also found to be a good fit to the data. The comparison of both models
revealed that later model yielded a better fit compared to the former model. These findings suggest that the
alternate possibility that better emotion regulation helps to attain a mindful state which in turn enhances
health/well-being appears to be a better explanatory model than the conventional model which assumes that
mindfulness exerts beneficial health effects through its emotion regulatory effect. The findings also implied that
there may be a circular relationship between mindfulness and emotion regulation. However, such speculations
need to be empirically tested in future.

The beneficial role of mindfulness has been
extensively explored in promoting self-
regulatory behaviors and health/well-being
(Mandal,et al, 2011; Mackenzie, et al., 2006;
Grossman, et al., 2004). A bulk of empirical
evidences support the idea that mindfulness
develops positive psychological resources
(Mandal et. al., 2011), induces self-regulatory
behaviours, enhances happiness and positive
emotional experiences (Brown & Ryan, 2003)
reduces stress (Mackenzie, et al.,2006),
improves positive functioning (Micheal&
Graham, 2011) as well as psychological well-
being (Brown & Ryan, 2003; Prazak, et.al,
2012). The mindfulness based intervention
(MBI) techniqueshave also been found to be
potentially effective in relapse prevention
(Segal et al. 2010), alleviating negative
psychological symptoms of anxiety (Baer
2003; Desrosiers,et al.,2014), eating disorders
(Morone, et.al., 2008) and fibromyalgia
(Grossman, et.al, 2007).
Researchers have tried to explore the
mediational processes through which
mindfulness promotes health and enhance
positive functioning and well-being. For
instance, Chambers, et al.,(2009) noted that
mindfulness improves health and well-being
by influencing some aspects of emotion
regulation such as relaxation and
metacognitive insight. Researchers have
documented the mediational role of emotion
regulation and other emotional traits in
mindfulness-health relationship (Mandal et al,
2011; Nykicek, 2011). The mindfulness not
only enhances the use of adaptive regulation
strategies such as cognitive reappraisal (i.e.,
restructuring of the emotional cues before the
initiation of the emotional responses; Nykicek,
2011) and positive re-appraisal (Hanley&
Garland, 2014; Goldin& Gross, 2010) but also
reduces the habitual maladaptive use of
suppression of emotions by promoting
emotional acceptance (Chambers, et.al,
2009).
The present study focuses on the said dual
emotion regulatory mechanisms i.e. cognitive
reappraisal (antecedent focused emotion
regulation) as well as expression suppression
(response focused emotion regulation). The
response focused emotion regulation (e.g.,
suppression) generally leads to reduced
positive affect (Gross & Levenson, 1997) and
well-being (Gross & John, 2003) whereas the
use of antecedent focused emotion regulation
like cognitive reappraisal enhances positive
affect and interpersonal functioning (Gross &
John, 2003) and reduces negative emotional
experiences (Ochsner & Gross, 2004). The
existing direct and indirect empirical

Satchit Prasun Mandal, Research Scientist ‗B‘, DRDO (Email: satchit.prasun@gmail.com), Yogesh Kumar Arya,
Ph.D., Associate Professor (Email: yogeshatbhu@gmail.com), and Rakesh Pandey, Ph.D., Professor & Head,
(Corresponding author) (Email: rpan_in@yahoo.com) Department of Psychology, Banaras Hindu University,
Varanasi, India-221005.
Key words: Mindfulness, emotion regulation, cognitive reappraisal, expression suppression, subjective well-being
58: Mandal, Arya & Pandey
evidences support the possibility that the
beneficial effect of mindfulness on health and
well-being may be an indirect (or mediated)
effect resulting from its emotion regulatory
effect i.e., by enhancing the use adaptive
emotion regulation strategies (e.g., cognitive
reappraisal) and reducing the use of
maladaptive strategies. The available
empirical evidences support the idea that
emotion regulation may be a mediational link
between mindfulness –health/well-being
relationship (Mandal et al, 2011; Nykicek,
2011). However, an alternate possibility also
exist that has never been subjected to
empirical verification i.e., emotion regulation is
an antecedent factor in mindfulness –
health/well-being relationship and thus the
direct effect of mindfulness on health/well-
being is likely to be potentiated by greater use
of adaptive and lower use of maladaptive
emotion regulation strategy.
This alternative hypothesis may be found in
the traditional Buddhist texts. According to the
traditional Pali scriptures like Satipatthana
sutra (Arousing of Mindfulness) the qualities
of mindfulness arise through complete
transfiguration of mind by contemplating on
body, feelings and consciousness (Soma
Thera, 2010). Mindfulness based
interventions programs like acceptance and
commitment therapy (ACT) and dialectic
behavioral therapy (DBT) chiefly focus on
modifying some emotional traits such as
emotional self-regulation, emotional
acceptance, observing feelings without
judgment and effective modulation of affect for
cultivating mindfulness and inducing its
related benefits (Cardaciotto, 2005; Linehan,
1993). These practices mainly prioritize the
role of emotional awareness, acceptance, and
regulation in cultivating mindfulness and
alleviating sufferings as well as increasing
well-being. These observations support the
alternative possibility that adaptive emotion
regulation may be a prerequisite (an
antecedent factor) for developing mindfulness
and thus may influence health/well-being
directly as well as indirectly by enhancing the
quality of mindfulness.
The present study aims to empirically test and
verify whether emotion regulation is a
potential mediator of the mindfulness-
health/well-being relationship or is it an
antecedent factor that enhances mindfulness
that in turn enhances health/well-being. The
later model assumes mindfulness as mediator
of the emotion regulation – health/well-being
relationship. The present study tests and
compares both the alternative model of
mindfulness – health/well-being relationship
using the covariance based structural
equation modeling approach.
Method:
Participants: The present study was
conducted on a sample of 211 adults
belonging to different colleges and universities
of the Varanasi city (India). Their age ranged
from 20 to 33 years (mean age = 23.08 years
and S.D= 2.63 years) and all of them
belonged to middle class socio-economic
status. It was an incidental sampling with
almost equal number of both sexes (Males =
109, Females = 102). None had history of
chronic illness.
Measures:
The Five Facet Mindfulness Questionnaire
(FFMQ; Baer, et al., 2006) is a 39 item
measure that assesses five facets of
mindfulness viz., observing (8 items),
describing (8 items), acting with awareness (8
items), non-judgment of inner experiences (8
items) and non-reactivity to inner experiences
(7 items). The Hindi version of the FFMQ
(Mandal, Arya and Pandey, 2011) was used in
the present study. The Hindi version of the
Emotion Regulation Questionnaire (ERQ;
Gross & John, 2003) developed by Khetrapal
and Baijal (2007) was used to assess the use
of two emotion regulation strategies viz.,
cognitive reappraisal and expression
suppression.
Positive and negative affectivity was assessed
using the Hindi version of Positive Negative
Affect Schedule (PANAS; Watson, Clark and
Tellegan, 1988) developed by Pandey and
Srivastava (2008). It consists of 20 mood
related adjectives (10 positive and 10
negative) that assesses two global
dimensions of affect: positive and negative
 Mindfulness, Emotion Regulation, & Subjective Well-Being:59
(Watson et al, 1988). Life satisfaction was
assessed using the Hindi version of
Satisfaction with Life Scale (SWLS; Diener,
et.al., 1985), adapted by Dubey and Pandey
(2010). The SWLS is a 5-item global measure
of life satisfaction.
Procedure: The aforesaid self-report
measures were administered either
individually or in small groups (in accordance
with standard instructions of each of the
measure) after getting informed consent the
participants. Before collecting back the
questionnaire booklet, all participants were
requested to ensure that they have responded
to each items of every questionnaire/scale.
Results:
Initially the first hypothetical model assuming
emotion regulation as mediator of the
mindfulness – well-being relationship was
tested. In this model the latent construct
mindfulness was represented by a regression
based composite score using the raw scores
Figure 1: The mindfulness - subjective well-being relationship model assuming emotion regulation strategies as mediator
(non-significant paths indicated by broken line and significant paths by dark line)
It is evident form Figure-1 that mindfulness
exerts a significant and direct effect on all the
components of SWB viz., positive affect (path
coefficient .28, p<.01), negative affect (path
coefficient -.33, p<.01) and life satisfaction
(path coefficient .40, p<.01) as well as one
aspect of emotion regulation i.e., suppression
(path coefficient -.35, p<.01). The reappraisal
was found to have significant direct effect on
positive affect (.14, p<.01) whereas
of all the five dimensions of mindfulness. The
two domains of emotion regulation (cognitive
appraisal and suppression) were used as
mediator variables. The positive affect,
negative affect, and life satisfaction were used
as criterion variable. None of the goodness of
fit indices for this base model was found to be
in acceptable range except the ratio of
maximum-likelihood chi-square to the degrees
of freedom [χ2/df =3.64, GFI=.92, AGFI=.82,
TLI=.73, CFI=.85, RMSEA=.112,
SRMR=.083].However, after two post hoc
modifications (allowing life satisfaction to
influence negative affect and positive affect
respectively) the revised model (Figure 1)
yielded a satisfactory model fit. The various
goodness fit indices valuesassociated with
this model were found to be in acceptable
range [χ2(2) = 3.580, p >.05, χ2/df =1.79,
GFI=.99, AGFI=.94, TLI=.94, CFI=.99,
RMSEA=.06, SRMR=.02].
suppression was having a direct but negative
effect on life satisfaction (-.16 p<.05)
respectively. Rest of the possible direct
effects was not found significant.
Apart from the aforesaid direct effects of
mindfulness on various components of well-
being, some indirect effects (mediated effects)
were also found significant. Such significant
indirect effects have been presented in Table-
1. It is evident from Table 1 that mindfulness
60: Mandal, Arya & Pandey

exerted a significant indirect effect on positive Mindfulness also indirectly influenced life
affect through life satisfaction (indirect effect = satisfaction through suppression (estimate
13.495, p<.05) as well as through suppression 7.539, p<.01) and reappraisal (estimate .05,
and life satisfaction (indirect effect =1.922, p<.05). Overall, the observed indirect effects
p<.05). Similarly mindfulness indirectly suggest that the use of suppression (and to
influenced negative affect through life some extent cognitive reappraisal) mediates
satisfaction (indirect effect =-18.347, p<.01) the relationship between mindfulness and
as well as through suppression and life SWB.
satisfaction (indirect effect = -2.614, p<.01).
Table 1: The Indirect Effects of Mindfulness on different components of SWB
Mindfulness On Positive Affect Mindfulness On Negative Affects Mindfulness On Life Satisfaction
Indirect paths Estimate Indirect paths Estimate Indirect paths Estimate

Through Reappraisal Through Suppression Through Suppression

1.712 -3.923 7.539**
(path c * e) (path a * h) (a * b)

Through Suppression Through Reappraisal

1.227 -.077 Through Reappraisal .050
( a * g) ( c * f)
(c * d)

Through Suppression, 1.922* Through Suppression, Life -2.614**

Life Satisfaction (a * b * n) Satisfaction (a * b * m)

Through Life Satisfaction Through Life Satisfaction

( r * n) 13.495* ( r * m) -18.347**

Sum of all indirect effects 18.356* -24.962** 7.589**

**p<.01, *p<.05,
The alternative model was also tested in
which the domains of emotion regulation were
considered as antecedent of mindfulnessand
the composite score of the latent construct of
mindfulness was hypothesized to directly
influence various domains of well-being. After
two minor modifications this model (Figure - 2)
was found to fit the data satisfactorily as
indicated by acceptable values of various
goodness of fit indices [X2(2) = 2.067, p >.05;
X2/df =1.033, GFI=.99, AGFI=.96, TLI=.99,
CFI=1.00, RMSEA=.01, SRMR=.02].

Figure 2.The mindfulness - subjective well-being relationship model assuming emotion regulation strategies as
antecedent factor (non-significant paths indicated by broken line and significant paths by dark line)
It is evident from figure 2 that like earlier have a significant direct effecton all the
model (Figure 1) mindfulness was found to components of subjective well-being viz.,
 Mindfulness, Emotion Regulation, & Subjective Well-Being:61

positive affect (path coefficient = .4, p<.01),
negative affect (path coefficient = -.32, p<.01),
and life satisfaction (path coefficient = .27,
p<.01). Similarly, suppression was found to
have a significant direct but negative effect on
mindfulness as well as life satisfaction (path
coefficients -.36 and -.16, respectively; p<.01).
However, reappraisal was found to exert a
direct significant effect on positive affect alone
(path coefficient .14, p<.05). Some of the
indirect effects in the previously mentioned
model (especially the indirect effect of
suppression on different components of SWB)
were also found to be significant (see Table –
2).

Table 2: The Indirect Effects of Suppression on different components of SWB through mindfulness
Suppression on Positive Affect Suppression on Negative Affects Suppression on Life
Satisfaction
Indirect paths Estimate Indirect paths Estimat Indirect paths Estimate
e
Through
Through Mindfulness Through Mindfulness Mindfulness
-.444** .547** -.549**
(path b * p) (path b * q) (path b * r)

Through Mindfulness Through Mindfulness

and Life Satisfaction -.140* and Life Satisfaction .190**
( b * r * n) ( b * r * m)

Through Life -.155* Through Life .211**

Satisfaction (d * n) Satisfaction (d * m)
Sum of all indirect
-.739** .948** -.549**
effects
**p<.01, *p<.05,

Observation of Table 2 reveals that
suppression reduces positive affect indirectly
by reducing mindfulness (indirect effect = -
.444, p<.01)and life satisfaction (indirect effect
= -.155, p<.05) on one hand and by
simultaneously decreasing mindfulness as
well as life satisfaction on the other (indirect
effect = -140, p<.05). Similarly, suppression
was found to indirectly enhance negative
affect by reducing mindfulness (indirect effect
= .547, p<.01) and life satisfaction (indirect
effect = .190, p<.01) as well as by
simultaneously reducing both mindfulness and
life satisfaction (indirect effect = .211, p<.01).
The comparison both the models (figure 1 and
figure 2) revealed that the model assuming
emotion regulation as an antecedent factor in
mindfulness-subjective well-being
relationship(figure 2) was a better fit
compared to the model which assumes
emotion regulation as a mediator of the
mindfulness – subjective well-being
relationship (Figure 2). The observed lower
values of the information theoretic measures
associated with alternate model (Figure 2;
AIC=40.06, BCC=41.37, BIC=103.75,
ECVI=.191, CAIC=122.75) as compared to
the original model (Figure 1; AIC=41.58,
BCC=42.89, BIC=105.27, ECVI=.198,
CAIC=124.25) provides empirical support to
the said conclusion.
Discussion:
The findings of the present study though
provide support to the notion that the
observed positive effect of mindfulness on
health and well-being may be mediated by its
emotion regulatory effects, the alternate
possibility that better emotion regulation helps
to attain a mindful state of mind which in turn
enhances health/well-being appears to be a
better explanatory model than the former. In
other words, the findings support the notion
that emotion regulation is an antecedent
factor in the mindfulness-subjective well-being
62: Mandal, Arya & Pandey
relationship. However, the conventional model
(that has also received some empirical
support in earlier literature) that assumes
emotion regulation as mediator of the
mindfulness-subjective well-being relationship
cannot be completely rejected or overruled
inasmuch as this model also yielded a good fit
to the data.
These findings brings to fore an alternative
explanation of the observed beneficial effect
of mindfulness on mental health. This
alternative explanatory model (that has been
found to be a better fit than the mediational
model) suggests that non-use or reduced use
of suppression (but not the more use of
reappraisal) leads to a mindful state
awareness which in turn enhances the
subjective well-being of an individual. In other
words, decrease in the tendency to suppress
emotional experience or reduced experiential
avoidance leads to greater tendency to be
mindful i.e. non-evaluation of experience,
emotional acceptance and expressivity,
flexible awareness. These findings
alsosuggest that people who are less likely to
suppress or modulate their emotional
experiences tend to be more emotionally
accepting, non-reactive and flexibly aware as
well as keen observer of the present life
experiences which in turn increase their life
satisfaction, positive affectivity and reduce
negative affectivity. This enhanced
mindfulness and related qualities (i.e., vivid
and flexible awareness over the
internal/external stimuli), being dispassionate
and non-reactive to emotional experiences in
turn leads to better health and well-being.It
can be said that suppressing authentic
emotional experiences creates a sense of
conflict between inner experience and outer
expression or a sense of being inauthentic to
one‘s true self, (Higgins, 1987; Rogers, 1951)
which turns an individual hyper-evaluative and
reactive to experiences that leads to lack of
life satisfaction (Michalos, 1985; Sheldon,
et.al., 1997). It has also been noted that
reduction in the use of expression
suppression reduces these discrepancies and
inauthenticity which are further associated
with the increased non-judgmental
acceptance of the inner experiences that
directly reduces negative affect (Mandal,
et.al., 2012) and increased satisfaction with
life.
However, it is important to reiterate again that
the initial hypothesis (i.e., emotion regulation
mediates the mindfulness – subjective well-
being relationship) could not be out rightly
rejected because this model also met the
contemporary standards of a good fit highly
satisfactory model. Although the alternative
possibility is more protuberant but the former
hypothesis may not be rejected. The
observation that both models may be equally
fit leads to the other possibility that there may
be a reciprocal or circular relationship
between mindfulness and emotion regulation.
Garland, Gaylord and Fredrickson (2011)
thought that mindfulness and its positive
emotional consequences follow a reciprocal
upward spiral relationship which counters the
self-perpetuating damaging effects of negative
emotions and finally promotes positive
functioning as well as well-being. The same
explanation can also be applied to the
mediating effects of enhanced emotion
regulatory capacities in mindfulness-
subjective well-being relationship.
Taken together, the present findings suggest
yet another possibility that adaptive
psychological processes are reciprocally
related to each other or alternatively, ―gain
spirals‖. However, the proposed existence of
a circular relationship between mindfulness
and emotion regulation needs further
empirical verification.
Conclusions:
The findings of the present study though
provides support to the notion that the
observed positive effects of mindfulness on
subjective well-being may be mediated by the
emotion regulatory effects of mindfulness, the
alternative theoretical formulation seems to be
a better explanatory model to understand the
health promoting effect of mindfulness.
Further, the observation of two opposite but
equally probable model suggest that
possibility of the circular relationship between
mindfulness and emotion regulation.
However, it would be premature to make such
 Mindfulness, Emotion Regulation, & Subjective Well-Being: 63
concussions until such speculation is
empirically verified.
References:
Baer, R. A. (2003). Mindfulness training as clinical
intervention: a conceptual and empirical review.
Clinical Psychology: Science and Practice, 125–143.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., &
Toney, L. (2006).Using self-report assessment
methods to explore facets of mindfulness.
Assessment, 13, 27–45.
Brown, K. W., & Ryan, R. M. (2003). The benefits of
being present: Mindfulness and its role in
psychological well-being. Journal of Personality and
Social Psychology, 84, 822–848.
Cardaciotto, L. (2005). Assessing Mindfulness: The
Development of a Bi-Dimensional Measure of
Awareness and Acceptance. Un Published
Ph.D.Thesis, Drexel University.
Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful
emotion regulation: An integrative review. Clin.Psy
Review, 29, 560–572.
Desrosiers A, Vine V, Curtiss J, Klemanski DH. (2014).
Observing nonreactively: A conditional process model
linking mindfulness facets, cognitive emotion
regulation strategies, and depression and anxiety
symptoms J.of Affective Disorders. 165, 31-37.
Dubey & Pandey (2010). Hindi adaptation and
psychometric evaluation of satisfaction with life scale.
Unpublished manuscript.
Garland, E. L., Gaylord, S. A., & Fredrickson, B. L.
(2011). Positive reappraisal mediates the stress-
reductive effects of mindfulness: An upward spiral
process. Mindfulness, 2(1), 59-67.
Goldin, P., & Gross, J., (2010). Effect of mindfulness
meditation training on the neural bases of emotion
regulation in social anxiety disorder. Emotion, 10, 83–
91.
Gross J. J., &Levenson, R. W. (1997).Hiding feelings:
the acute effects of inhibiting positive and negative
emotions. Journal of Abnormal Psychology, 106, 95–
103.
Gross, J.J., & John, O.P. (2003). Individual differences in
two emotion regulation processes: Implications for
affect, relationships, and well-being. Journal of
Personality and Social Psychology, 85, 348-362.
Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A.,
&Kesper, U. (2007). Mindfulness training as an
intervention for fibromyalgia: evidence of post
intervention and three year follow-up benefits in well-
being. Psychotherapy and Psychosomatics, 76, 226–
233.
Grossman, P., Niemann, L., Schmidt, S. &Walach, H.
(2004). Mindfulness-based stress reduction and
health benefits: A meta-analysis. Journal of
Psychosomatic Research, 57, 35-43.
Hanley, A. W., Garland, E. L., & Black, D. S. (2013).Use
of mindful reappraisal coping among meditation
practitioners. Journal of Clinical Psychology, 70(3),
294–301.
Higgins, E. T. (1987). Self-discrepancy: A theory relating
self and affect. Psychological Review, 94, 319-340.
Linehan, M. M. (1993). Cognitive-behavioral treatment of
borderline personality disorder. NY: Guilford Press.
Mackenzie, C. S., Poulin, P.A., Seidman-Carlson,
R.(2006). A brief mindfulness-based stress reduction
intervention for nurses and nurse aides. Applied
Nursing Research 19 (2), 105-109.
Mandal, S. P., Arya, Y. K., & Pandey, R. (2011).
Mindfulness, Emotion regulation and Subjective well-
being: An Overview of Pathways to Positive Mental
Health. Indian Journal of Social Science Researches,
8 (1-2), 159-167.
Mandal, S. P., Arya, Y. K., & Pandey, R. (2012).
Mindfulness and Mental Health: Mediational Role of
Positive and Negative Affect. Journal of Projective
Psychology & Mental Health, 19 (2), 150-159.
Michalos, A. C. (1985). Multiple discrepancies theory
(MDT). Social Indicators Research, 16, 347-413.
Micheal, L. S., & Graham, J. R. (2011). Mindfulness,
subjective well-being, and social work: Insight into
their interconnection from social work practitioners.
Social Work Education, 30, 1, 29-44.
Morone, N. E., Greco, C. M., & Weiner, D. (2008). ―I felt
like a new person‖—The effects of mindfulness
meditation on older adults with chronic pain:
Qualitative narrative analysis of diary entries. Journal
of Pain, 9, 841–848.
Nyklíček, I., (2011). Mindfulness, emotion regulation, and
health. In: I. Nyklíček, A. Vingerhoets, & M.
Zeelenberg, Emotion regulation and well-being (pp.
101-118). New York: Springer.
Ochsner, K. N., & Gross, J. J. (2004). Thinking makes it
so: A social cognitive neuroscience approach to
emotion regulation. In R. F. Baumeister& K.D. Vohs
(Eds.), Handbook of Self-Regulation: Research,
Theory, and Applications (pp. 229−255). New York:
The Guilford Press.
Pandey, R., & Srivastava, N. (2008).Psychometric
evaluation of a Hindi version of Positive-Negative
Affect Schedule. Industrial Psychiatry Journal, 17, 59-
54.
Prazak, M., Critelli, J. W., Martin, L. A., Miranda, V.,
Purdum, M. & Powers, C. (2012).Mindfulness and its
role in physical and psychological health. Applied
Psychology: Health and Well-being, 4, 91-105.
Rogers, C. (1951) Client-centered Therapy: Its current
practice, implications and theory. Boston: Houghton
Mifflin.
Segal, Z. V., Bieling, P., Young, T., MacQueen, G.,
Cooke, R., Martin, L., et al. (2010). Antidepressant
monotherapy vs. sequential pharmacotherapy and
mindfulness-based cognitive therapy, or placebo, for
relapse prophylaxis in recurrent depression. Archives
of General Psychiatry, 67, 1256–1264.
Thera, S. (2010). The Way of Mindfulness: The
Satipatthana Sutta and Its Commentary. Access to
Insight, http://www.accesstoinsight.org/lib/ authors/
soma/wayof.html
Watson, D., Clark, A., &Telegan, A. (1988). Development
and Validation of brief measure of positive and
negative affect: The PANAS scales. Journal of
Personality and Social Psychology, 54, 1063-1070.
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 64-68

Recovery-Focused Behavior Therapy (RFBT): A Case Study

Rakesh Kumar and Raj Kumar Sahu
Recovery-Focused Behavior Therapy (RFBT) is a very recent conceptualization which is being shared in this
paper which illustrates the application in a case of severe OCD. The patient is presented with an imaginary
scenario of perceived recovery and he/she is to conceptualize and demonstrate the behaviors preferably at action
level which he/she would be emitting upon the desired and perceived recovery. The patient being presented here
is a 36 years old female with six and half year‟s history of severe OCD having secondary depression and suicidal
attempts. She has been in psychiatric treatment for the past six years which resulted in temporary therapeutic
outcomes.Exposure and Response Prevention or Cognitive Drill Therapy were the choices available to us for
dealing with her severe OCD symptoms. Her score on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was
32 out of a maximum of 40 which indicated extreme severity of OCD. In view of her pervasive OCD behaviors and
the accompanied distress, it was thought that exposure to the objects of contamination and her underlying fears
would amount to activation of very severe body-mind reactions (BMR). Hence, a highly gentle form of
psychological method got developed on the fly which produced extra-ordinary improvements within three sessions
of one hour each. The method is termed as Recovery-Focused Behavior Therapy (RFBT). Her Y-BOCS scores
dropped to 17 out of maximum of 40 just after three daily sessions punctuated by one day gap due to Sunday;
suggesting a substantial reduction in OCD symptoms at the level of moderate severity from the baseline extreme
severity. Her affect and self-efficacy also improved perceptibly. The improvement was clinically corroborated with
her behaviors with contaminated objects, reports of her husband, our own observations and her reports. The
therapeutic intervention is discussed in details in the case study.

There are a few studies that examined the
prevalence of Obsessive-Compulsive
Disorder (OCD) in India. Khanna et al (1993)
reported a lifetime prevalence rate of 0.6% in
Indian sample; about 17% of OCD patients
are reported to have major depressive
disorder (Bhattacharyya et al., 2005). Khanna
et al. (1990) identified four reliable clusters in
OCD – Washing, checking, thoughts of past
and embarrassing behavior. Despite
voluminous researches, the exact cause of
OCD has not been discerned yet. However,
both biological and psychological mechanisms
are theorized to contribute to the onset and
maintenance of OCD. Exposure and
Response Prevention (ERP) was developed
in 1960s for the treatment of OCD and still it is
the most recommended and widely used
treatment option specifically for predominantly
compulsive type. The data from Randomized
Controlled Trials attest to the efficacy of ERP
in OCD (Jónsson&Hougaard, 2009). Other
forms of psychotherapies such as Cognitive
Behavior Therapy and Cognitive Drill Therapy
(Kumar et al., 2012) are also used to address
the problems in OCD. Exposure-based
therapies trigger anxiety reactions in the
patients by exposing the patients to the
Rakesh Kumar, Ph.D. Senior Clinical Psychologist; Raj Kumar Sahu, Psychiatry Resident; Institute of Mental
Health and Hospital, Agra-282002 India Email: jain.imhh@gmail.com
Key Words: OCD, Exposure-Response Prevention, Cognitive Drill Therapy, Behavior Therapy, Solution Focused
Brief Therapy.
objects of their OCD. The triggered anxiety
reaction may escalate even to a very high
level. Because of this anxiety-provoking
nature of exposure therapies, some patients
fail to engage themselves into the protocols of
exposure therapies, thereby depriving
themselves from the option of powerful form
of behavioral treatment.
The procedures of cognitive restructuring are
aimed at reducing the pain of anxiety evoked
by exposures. Although, exposure is used as
a behavioral test to examine if exposure to the
objects of OCD still elicit anxiety reaction after
addressing the underlying maladaptive
cognitions. The status of current knowledge
regarding psychological treatment suggests
that effective forms of psychological treatment
are available which can lead to improvement
in OCD. In view of the anxiety reactions
triggered by exposure and its impact on the
patient, a natural upgrade to the line of
thinking, is to formulate and revise the
treatments in a manner that elicit minimal
anxiety reactions in such patients and
successfully address the problems.
With this perspective, a novel form of
intervention was applied in a case of OCD.
The case is being presented ahead.

Clinical Background of the Case:
Mrs. V, a 36 years old married female from
lower socio-economic status was apparently
well about six and half years back, when she
started experiencing increased disgust while
cleaning the feces/urine of her one and half
years old son. She had to clean the floor and
clothes of her son repeatedly about 4-5 times
a day and began to ensure that everything is
clean. Her husband noticed that she was
spending more timewhile taking bath up to 45
minutes and was taking bath 2-3 times a day.
She also started taking more time in cleaning
activities such as washing her hands and feet
10-12 times a day. Her husband observed
that she has developed extreme disgust for
cats and crows because of soiling of clothes
in the verandah. She then began to clean floor
and clothes soiled by cat/crow multiple times
andcontinued until she got subjectively
convinced that the floor and clothes were
cleaned. Her duration of sleep got reduced
because she was now spendingmore time in
the cleaning chores. She reported lack of
sleep because she was unsure whether she
has cleaned everything. She also started
checking doors and windows to ensure if they
were properly bolted.The thoughts of dirt and
contamination were occupying her mind most
of the time. She began to havesuicidal
ideation because she was finding herself
unable to get rid of the thoughts of
contamination and the cleaning tasks. Her
condition was deteriorating. She was not
allowing her saree to get in touch with the
floor. She avoided sitting on the floor and
even was not allowing her son to sit either.
The task of preparing her son to go to school
was now assigned to her husband. She was
finding it difficult to do cooking. In the kitchen
her mind was getting preoccupied if any cat
has entered inside and licked the milk. She
kept covering the milk pot and kept a match
box over to ensure that it was not licked by
cat. The routine activities were getting
delayed by 1-2 hours. It was creating distress
in the family. Her husband used to become
angry over her behaviors and tried to
convince her that the objects are cleaned and
cat was not inside the house. Her husband
Recovery-Focused Behavior Therapy:65
took her to private psychiatrist in the nearby
city. She got intermittent and short-lived relief
because of psychiatric treatment. She was
getting perturbed both by the disorder as well
as the cost of treatment. She even attempted
suicide to get rid of all the distress.
At this point she approached us and was
diagnosed as a case of OCD with secondary
depression. Her psychiatric treatment was
initiated accordingly and also a referral for
psychological treatment. At the time of intake
in psychotherapy, Yale-Brown Obsessive-
Compulsive Scale (Y-BOCS) was
administered to assess the severity of her
OCD. She scored 32 out of a maximum of 40
on Y-BOCS. The rated severity was extreme.
She had prominent symptoms of both
obsessions and compulsions.
Psychological Intervention:
Given the nature of stimulus-bound anxiety,
we had a choice of Exposure and Response
Prevention; and Cognitive Drill Therapy. Due
to her extreme distress she was not amenable
to cognitive restructuring. Also, it was
apparent that exposure therapy would elicit
severe anxiety in her already anxious and
depressed state of mind. The exposure could
further sensitize her which could lead to drop
out and non-compliance of psychological
treatment. At this point, a novel form of
intervention was designed for her in the very
first session of psychotherapy. Altogether, five
sessions were conducted and the work-up is
summarized below:
Session-1 conducted on 24th September 2016:
Today, I (RK, First Author) had a middle aged
lady with six and half years h/o severe OCD of
contamination type and pathological doubts
and moderate to severe depression. She is on
regular psychiatric medication. CDT was an
obvious choice but would be painful and time-
consuming. A number of OCD behaviors were
shared by her. I, instead of choosing CDT,
employed exposure in a non-threatening and
gentle manner. I explained her that when she
would be free of OCD, how she would be
touching dirty objects! She will then become
comfortable in touching dirty objects, will not
clean herself, touch other objects with dirty
hands with ease and would not have any
66:Kumar & Sahu
discomfort in her body and mind (Body-Mind
Reactions: BMR). She quickly understood the
idea and the process. I modeled touching dirty
objects and kept repeating in the following
manner: “When she will be free of OCD, she
will touch dirty objects in the manner, I am
touching; she will not clean herself, touch
other objects as I am touching and will not
have BMR”.
Then, I asked her to do the same with a
number of objects. She touched several dirty
objects and repeated that she will touch dirty
objects like this, will touch other objects like
this, will not clean herself and also there will
be no BMR. This was the first session with a
novel format of exposure. I decided to monitor
the progress and repeat the same procedure
in next session. This form of exposure in
disguised and gentle form amused both of us.
Session-2 conducted on 26th September 2016:
Today I conducted the second session on this
lady. The master idea being implemented was
the following: *How would you handle dirty
objects upon recovery? - show me”. She
demonstrated by touching several dirty
objects such as bathroom tap, cistern, sitting
on the floor. I also showed her cat videos from
youtube and she was at ease. She was also
able to touch contaminated objects with ease
having little signs of BMR. I trained her
husband to deal with her in a similar manner.
She now began to develop optimism in
treatment. Let us see how she progresses.
We decided to pursue the same form of
exposure and monitor her condition.
Session-3 conducted on 27th September 2016:
Today I conducted the third session on the
lady with OCD. She is showing tremendous
improvement. She is now extremely
comfortable in touching dirty objects; she is
allowing her saree to get in touch with the
floor which she was not doing; she is
comfortable in sitting on the floor, even she
could lie down on the floor, she was able to
walk over dirty objects on road with no sign of
distress, she touched her arms and face with
dirty hands, she allowed her son to sit on the
floor and then sit on her lap, she is able to
touch her son and husband with dirty hands.
She has become quite optimistic and
acknowledging substantial improvement. She
said now she can touch any dirty object, she
even asked me to tell any dirty objects I
wanted her to touch and hold. She told that
she would not stop cleaning objects in her
house.
Her husband remained present in all the
sessions. He was being trained as a co-
therapist. She said that now onward she
would free her husband from domestic work.
She would do all domestic work and help her
husband in family occupation. Her affect has
become euthymic.
Session-4 conducted on 28th September 2016:
The fourth session was conducted today. She
is quite fine. She is able to sit and lie down on
the floor, comfortable to touch toilet objects
and touch her husband. Nothing much is left
to do for me. She gave elaborate descriptions
of the activities and handling of contaminated
objects with ease. She is highly motivated and
can touching dirty objects within normal limits.
Now she stopped verbalizing her problems
and difficulties. She mostly talks of solutions;
how she would handle contaminated objects.
In the first two sessions, I was active and
doing exposure on her, now she has become
active in describing normal behaviors and
handling dirty objects. On the baseline last
week, her Y-BOCS score was 32 (O=16;
C=16) out of a maximum of 40 which was
rated as Extreme Obsessions and
Compulsions. The most recent data on Y-
BOCS today yielded a score of 17 (O=10,
C=7) which indicates moderate level of OCD.
Session-5 conducted on 29th September 2016:
The fifth and last sessionwas conducted
today. She came with changed clothes. She is
quite comfortable. She is not holding her
saree now to prevent touch with the ground
and allowing her son to be on her lap. She is
able to view Google images and videos of
cats and crows. In treatment setting, no object
of OCD could trigger BMR in her. She is at
ease with all the objects. Her depression has
uplifted. She received ECT, medication and
RFB therapy. Her husband is advised not to
discuss her past behaviors of OCD as merely
talking of OCD symptoms can trigger the
BMR. He is also advised not to put her in

challenge mode as challenging her can be
intimidating and trigger BMR. She is advised
to continue with her medicines and the
manner of handling things as taught in
therapy sessions. Her husband confirmed to
the substantial improvement. At the end she
said, if any BMR gets triggered, she will
remember me and the method taught to
handle the situations. She is now put on follow
up to examine maintenance and
generalization of therapeutic gains.
Component and Mechanisms of
Treatment:
Having done first two sessions, I considered
and contemplated upon the nature and
mechanisms of this novel form of treatment.
The pertinent observations of this treatment
were:
1. The patient was required to put herself
psychologically in imagination in future and
report „when she would be recovered from
her problems completely, then how would
she handle contaminated objects? - show
me‟. This statement was coupled with
additional suggestions that „She would not
need cleaning herself, and there would be
no discomfort‟. Modeling was done by the
therapist to demonstrate her, how she
would be touching the contaminated objects
without discomfort and cleaning herself. I
myself touched a couple of contaminated
objects to show her the manner of touching.
Then she picked up and touched
contaminated objects and repeated verbally
at the same time that, she will be touching
contaminated objects like this; she will not
need cleaning and there would be no
discomfort.
2. One by one she was required to
demonstrate and verbalize above with 8-10
dirty objects present in therapist‟s office.
She touched all the objects in similar
manner. In the next sessions, she touched
dirty objects in the bathroom.
3. Her story of OCD was heard by me for 30
minutes and then I initiated the treatment in
the same session without psycho-
education. In subsequent sessions, I did not
initiate the discussions on her problems of
OCD and I discouraged her and her
Recovery-Focused Behavior Therapy:67
husband to narrate the problems. I told
them that merely talking about the problems
can trigger anxiety reactions; hence it is not
required to dwell into the narration or
discussion of the problems.
4. Second session onwards, she reported a
subjective feeling that her mind is now
turning towards normal state. In the first
session, she specifically had mentioned that
let us see if her mind gets disengaged from
OCD.
5. In the second session, she reported
negligible improvement. But when I
systematically interviewed her regarding her
behavior towards contaminated objects, she
was showing some positive signs and I
continued to apply the same procedure.
6. Since she is receiving the psychiatric
treatment also, it would be difficult to
partition the effects of this psychological
intervention vis-à-vis psychiatric treatment.
But the improvement in general is well-
correlated with the onset of psychological
treatment combined with continuing
psychiatric treatment.
Following components and mechanisms
occurred which might have contributed to her
progress and successful handling of
contaminated objects.
1. Suggestibility: She complied and accepted
the suggestions through verbal persuasion
and modeling and got engaged in the
handling of contaminated objects as
suggested to her.
2. Goal-Focused Thinking: We presented her
the goal, that at the end of treatment, she
would be naturally handling contaminated
objects in a manner she was handling prior
to the onset of her OCD. When the goal of
treatment was clear, her mind got engaged
in goal-oriented thinking and behaviors.
3. Motivation to Change: She had very high
motivation to change. She was struck and
did not know how to approach the task. This
method of dealing helped her to put her
motivation to change into action.
4. Exposure: The exposure was involved but
the anxiety activation was blocked
cognitively when an imaginative scenario of
future time, i.e when she is recovered, was
68:Kumar & Sahu
presented to her. This future perspective
successfully blocked anxiety activation and
she directly got into the handling of
contaminated objects without covert
feelings of anxiety and overwhelming
emotions.
5. Response Prevention: The compulsive
response was also blocked through
cognitive mediation when I said that upon
recovery she would not need cleaning.
6. Time-Reference: Anxiety by nature is an
apprehension and uncertainty regarding
future. In anxiety the mind projects into the
future and becomes scared. In this method,
imaginative future apprehensions were
converted into sense of security devoid of
anxiety. Also, the time-reference was in
operation when, I presented her a cognitive
framework of future. The future perspective
at cognitive level and emission of desired
behaviors in the current time, here and now,
rapidly aligned together and a shift might
have took place cognitively. This resulted in
adaptive cognitive re-interpretation, that,
when she is handling contaminated objects
in the present time, she can also do the
same behaviors of handling contaminated
objects in future.
7. Imagery Focus: A person in psychological
distress has two imageries: (a) healthy
imagery representing perceived healthy
behaviors (b) Unhealthy imagery
representing perceived unhealthy
behaviors. This imagery could be global
representation of one‟s self or any specific
domain of the self-such as contamination,
doubts. The awareness of the unhealthy
imagery and the behaviors representing
unhealthy imagery evokes an anxiety
response. The person wants to live
according to the healthy imagery. When a
person adopts an approach of removing
unhealthy imagery and the unhealthy
behaviors, it paradoxically attracts
disproportionate attention and the unhealthy
imagery gets reinforced. The more he tries
to eliminate unhealthy imagery, the more he
gets into the mental trap and anxious
patterns. For most efficient treatment, we
need to take away all the attention of the
person from unhealthy imagery and self and
focus on the perceived healthy imagery.
Since, healthy self-imagery already exists in
the mind; the person understands what
healthy behavior is and how it is emitted. A
simple and straightforward 'focus shift' from
unhealthy to healthy imagery does wonders
when we ask "show me how you are going
to do when you are fully recovered". Fully
recovered means two things (1) A centering
on healthy imagery (2) De-centering from
unhealthy imagery.
“Solution-Focused Brief Therapy (SFBT) is
an evidenced-based psychotherapy approach
that was developed by Steve de Shazer
(1940-2005), and Insoo Kim Berg (1934-2007)
and their colleagues in the late 1970‟s in
Milwaukee, Wisconsin. SFBT is future-
focused, goal-directed, and focuses on
solutions, rather than on the problems that
brought clients to seek therapy.”
(http://www.solutionfocused.net).
The approach adopted by us is similar but not
identical to the approach of Solution-Focused
Brief Therapy. Hence, instead of placing it
within the framework of SFBT, we are
considering assigning a different label
“Recovery Focused Behavior Therapy” to this
approach, because this would help us to
elaborate, make innovations and test it
extensively on more cases of OCD and other
psychiatric disorders.
References:
Khanna S, Gururaj G, Sriram TG. (1993) Epidemiology of
obsessive-compulsive disorder in India.Presented at
the First International Obsessive-Compulsive
Disorder Congress. Capri: March 9-12, 1993
Bhattacharyya S, Reddy YC, Khanna S (2005) Depressive
and anxiety disorder comorbidity in obsessive
compulsive disorder. Psychopathology. 38(6):315-9.
Kumar.R.,Sameer.A., Singh.B. (2012). Preliminary Test of
Cognitive Drill as an Intervention.Indian Jr. of Clinical
Psychology. 39, 67-74.
Jónsson H, Hougaard, E. (2009) Group cognitive
behavioural therapy for obsessive-compulsive
disorder: a systematic review and meta-analysis.
ActaPsychiatricaScandinavica. 19(2):98-106
Khanna, S., Kaliaperumal, V.G., Channabasavanna, S.M.
(1990) Clusters of obsessive-compulsive
phenomena in obsessive-compulsive disorder.
British Journal of Psychiatry.15(6):51-4
 SIS J. Proj. Psy. & Ment. Health (2017) 24: 69-70

SIS Society Honors Early Adventures into Space and Others of Note
Wilfred A. Cassell
 April 12th 1961 Soviet cosmonaut Yuri Gagarin is first man in space
 May 5 1961 American astronaut Alan Shepherd is second man in space
 February 20, 1962 John Glen is first U.S. astronaut to orbit earth
 June 16th 1963 Soviet Cosmonaut Valentina Tereshkova is first woman in space
 June 20, 1969 Neil Armstrong & Buzz Aldrin from the U.S.walk on the moon
 July 17, 1975 U.S. and U.S.S.R. space craft dock; crews work together for two days
 June 18th 1983 Sally Ride is the first American woman in space
 Oct. 15, 2003 Yang Liwei, China’s first astronaut
 2011 Guillaume Nery Without the aid of breathing equipment reached a record depth of 384 feet in
the Greek port of Kalamata
 Chris Hadfield the first Canadian to walk in space. He took some45,000 photographs in orbit and
published 192 of them in his public educating 2015 book entitled “You Are Here: Around the world
in 92 Minutes”.
 Sylvia Earle – An American oceanographer who spent her career developing huge marine parks
 Craig Venter – This American scientist who built the first man made genone (i.e. “LifeM made in the
laboratory”)during the early years of this century.
In addition to the above list of death defying someone with, say, the exact genes and a
brave adventurers into new special horizons similar temperament , so that you could tease
for human life, I would like to add to the ever apart the changes that come from being aloft
growing list, the names of two American for 12 months from those that are a result of
astronauts: Scot and Mark Kelly. These are growing one year older on Earth”. In the Kelly
identical twins who in a Jeffrey Kluger 2015 brothers – and only the Kelly brothers- NASA
Time magazine article were described as has the two person sample group
“Born factory loaded with the exact same
SIS clinicians and researchers are
genetic operating system”, “While there is
encouraged to actively seek opportunities to
quite a bit of data (on human health) for six
join with the various international investigators
months NASA needs to run long duration
presently studying the medical, psychiatric
tests. So NASA needs subjects to run long
and psychosocial factors both on-orbit and
duration tests”. “The biggest problem with our
post-spaceflight. While a Google search
exploratory ambitions is, simply, us. The
engine currently has 39 publications,
human body is a purpose –built machine,
unfortunately none relate to SIS projective
designed for the one -G gravity of Earth. Take
testing.
us into the zero G of space and it all comes
unsprung. Bones get brittle eyes lose their Last August at a meeting of the American
shape, hearts beat less efficiently since they Psychological Association, a panel of
no longer have to pump against gravity, and American NASA psychologists spoke about
balance goes awry. their two general goals: first to “weed out
candidates with potential for space stress
So NASA needs subjects to venture out to run
induced mental illness and second, to get rid
long duration tests. In a perfect experiment,
of people with the wrong psychological “stuff”.
every research subject in space would also
Interest in the former was first brought to the
have a control subject on the ground –

Wilfred A Cassell, M.D., FAPS, APC.,Editor Emeritus, SIS J. of Proj. Psycho.& Mental Health, Director, SIS Center,
Anchorage (USA) Email: siswilfredacassell@yahoo.com
Kew Word: Space and Mental Health
70: Wilfred A. Cassell
public’s attention in February 2007 when an
American (Female) astronaut
Lisa Nowk “allegedly tried to kill or kidnap a
woman whom she perceived as a competitor
to the affections of a fellow astronaut William
Oefelein”. While one case means little
statistically, it is consistent with the known
scientific data regarding the emotional
instability of many women during the
premenstrual phase, as well as their higher
incidence of certain mental health disorders
(e.g. Major Depression).
We now need toboth train space scientists
with regard to the significant potential for
adapting SIS Body-Mind-Spirit technology for
both health screening, psychological
treatment and research! Members of our SIS
Society are encouraged to be optimistic
regarding the power of scientific technology to
improve life on our planet and prevent its
destruction by deranged individuals
threatening modern forms of warfare.
I am stimulated by the Canadian astronaut
Chris Hadfield’s hopeful optimism about the
value of science in our ever evolving modern
world. He expressed this on 5/27/2015 in a 30
minute Skype session to high school students
PRICE LIST OF SOMATIC INKBLOT SERIES
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2 SIS-II: Booklet Form
3 SIS-II: Video
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Place Your Orders through Email to: Dr. Bankey L. Dubey, Ph.D., Director SIS Centre, 4406 Forest Rd,
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on Vancouver Island and published in the
Saanich News as follows: We need to
generate enough electricity to make the world
sustainable, it is of enormous benefit for our
species, and we need democratization of
intellect. It is important to have a longer -term
view. Coming back from space, having gone
around the Earth 100 times and seeing its
resiliency, I’m optimistic about humanity on
Earth”
Relevant References:
Fassbender C, Goeters K.M. Results of the ESA study on
selection of European astronaut applicantsActa
Astronaut 1992 Jul; 27:131-8
Fassbender C. Goeters K.M. Psychological evaluation of
European applicants: results of the 1991
application selection campaign Aviat Space Envir
Med 1994 Oct 65 (10Pt1):925-9
Sekiguchi C., Umikura S, Kume M, Psychological
evaluation of Japanese astronaut applicantsAviat
Space Environ Med 1994 Oct.65(10Pt 1)920-4
Santy P.A. Jones D.R. An overview of international issues
in astronaut psychological selectionAviat Space
Environ Med 1994 Oct.65 (10Pt1):900-3
Collins D.L. Psychological issues relevant to astronaut
selection Hum Perf Extrem Environ 2003 Spring
7(1): 43-67”
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SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH

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I, Dr. Naveen Gupta, hereby declare that the particulars given above are true to the best of my
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 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH:
ACHIEVEMENTS
Journal in WHO Listing
Members of Somatic Inkblot Society will be glad to know that SIS Journal of Projective Psychology and Mental
Health has been listed by World Health Organization (Global Forum for Health Research) among 25 indexed
journals that have published the highest number of articles on mental health from LMICs in Latin America, Africa and
Asia (Medline and PsycINFO). Extract from table-6 of “Research Capacity for Mental Health in Low - and Middle -
Income Countries: Results of a Mapping Project “(www.globalforumhealth.org) is given below:

Rank Journal Country Language

1 Revista de Psicoanalisis Argentina Spanish

2 Revista de Neurologia Spain Spanish
3 Revista Brasileria de Psiquiatria Brazil Eng.,Spani.,Portuguese
4 Arquivos de Neuro-psiquiatria Brazil Portuguese
5 Acta Psiquiatrica y psicologica de Amercia Laina Argentina Spanish
6 Journal of the Medical Association of Thailand Thailand English, Thai
7 7 British Journal of Psychiatry UK English
8 Acta Psychiatrica Scandinavica Denmark English
9 Salud Mentale Mexico Spanish
10 Vertex Argentina Spanish
11 Journal of Personality and Clinical Studies India English
12 Social Psychiatry and Psychiatric Epidemiology Germany English
13 Revista Medica de Chile Chile Spanish
14 South African Journal of Psychology South Africa Afrikaans, English
15 Psychological Reports USA English
16 South African Medical Journal South Africa Afrikaans, English
17 The Australian & New Zealand Jr. of Psychiatry Australia English
18 International Journal of Social Psychiatry U. K. English
19 Psychiatry Research Ireland English
20 Social Science & Medicine U. K. English
21 Revista De Saude Publica Brazil Portuguese
22 International Journal of Geriatric Psychiatry U. K. English
23 SIS Journal of Projective Psychology and Mental Health India English
24 Journal Brasilerio de Psiquiatria Brazil Portuguese
25 Psychiatry and Clinical Neurosciences Australia English

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 Abstracted in “APA” Psyc INFO “
Regd. No. 71632/99, RNI Delhi

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH

Volume: 24 Number: 01 January 2017

EDITORIAL CONSULTANTS :
EDITORS EMERITUS :
Abhilasha Singh, Ph.D., India
Wilfred A. Cassell, MD, FAPA,
AiloUhinki, Ps.D., Finland
Director, SIS Center, Anchorage, AK.99516
E-Mail: siswilfredacassell@yahoo.com Amool R. Singh, Ph.D., India
Anatoly B. Khromov, Ph.D., Russia
Bankey L. Dubey, Ph.D., Arvind K. Keshary, Ph.D., India
Director SIS Centre,4406 Forrest Rd,
Barry A. Ritzler, Ph.D., U.S.A.
Anchorage, AK 99517,
E-mail: bldubey@gmail.com Brig. D. Saldanha, M.D., India
Carina Coulacoglou, Ph.D., Greece
EDITOR-IN-CHIEF : David J. Sperbeck, Ph.D., USA.
Naveen Gupta, Ph.D., Dharmendra Jain, D.M., India
Director, Hindustan Institute of Mgt.& Computer Studies,
Dilpreet Singh, M.B.A. India
Farah, Mathura-281122,
Email: dr_naveengupta@yahoo.com Edward M. Petrosky, Ph.D., U.S.A.
H. Kumar, Ph.D., USA
EXECUTIVE EDITOR: JashobantaMahapatra, Ph.D., India
Rakesh Kumar, Ph.D. Jayanti Basu, Ph.D., India
Senior Clinical Psychologist Joachim von Weissenberg, M.Sc.
Institute of Mental Health & Hospital,
Agra-282002 (India).Email: jain.imhh@gmail.com Finland
Lisa Milne, Ph.D., Australia
EDITORS : M. Andrew Mayo, Ph.D., USA.
Anand Dubey, MBA, M.P.Singh, Ph.D., India
4406 Forrest Road, Anchorage, AK 99517 Manisha Dasgupta, Ph.D., India
Email: anand.dubey@gmail.com
Nalini Mishra, Ph.D., India
L. Sam S. Manickam, Ph.D., Padma Dwivedi, M.A., USA
Prof. Clinical Psycho., JSS University, Mysore-570004, Paola Nicolini, M.A., Italy
Email: lssmanickam@gmail.com Prasant K. Roy. M.Phil, India
Christopher Piotrowski, Ph.D. RadheShyam, Ph.D., India
Research Consultant, University of West Florida, Rakesh Pandey, Ph.D., India
504 Concordia Blvd. Pensacola, FL 32505 (USA) Ranjeet Kumar, Ph.D., India
Email: cpiotrowski@uwf.edu Robert B. Williams, Ph.D., Canada
NilanjanaSanyal, Ph.D., SandhyaraniMohanty, Ph.D., India
Prof. Dept. of Psycho. University of Calcutta, Sanjukta Das, Ph.D. India
92 A. P. C Road, Kolkata-700009 Stefano Reschini, M.A., Italy
Email: sanyal_nilanjana2004@rediffmai.com
Sudhir Kumar, M.D., India
PUBLICATION MANAGER: SuprakashChaudhury, M.D.,
Brijesh.K.Gupta, MBA Ph.D.,India
Yasho V. Verma, Ph.D., India
Yogesh K. Arya, Ph.D., India