SHORT FORM

BELLAK T. A. T and C. A. T. Blank

For Recording and Analysing Thematic Apperception Test and Children’s Apperception Test

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------------------------------------------Sex------------------Age-------------------Date-------------------------------------------

(circle one)

Education------------------------------------------------------Occupation------------------------------------m. s. w. d-

Referred by ------------------------------------------Analysis by ----------------------------------------------------------------

After having obtained the stories analyse each story by using the variables on the left of the
page 2. Not every story will furnish information regarding each variable: the variables are presented as a
frame of reference to help avoid overlooking some dimension.

When all ten stories have been analysed it is easy to check each variable from left to right for all
ten stories and record an integrated summary on page 4. Page 6 gives available space for any oilier
notations. The stories then can be stapled inside the blank against page 5. For further instructions, see
Manual for T. A. T. Instructions by Leopold Bellak (N. Y., Psychological Corporation) or Manual for the C.
A. T. (C. P. S. Inc), or The T. A. T., and C. A. T., and S. A. T., in Clinical Use by Leopard Bellak, 3rd and
revised edition (N. Y., Crime & Stratton, 1974).

FINAL REPORT: Diagnostic Impressions and Recommendations

 Story No 1 Story No 2
1. Main theme (diagnostic level; if descriptive and
interpretative levels are desired, use a scratch sheet or
page 5).

2 Main hero; age______ sex______

Vocation__________
Abilities___________________________
Interests__________________Traits______________
Body Image___________________________
Adequacy (✓✓✓✓✓✓) and/ or self image_________

3. Main need and the drives of hero:

a) behavioural needs of hero (as in
story):______________________________________
Implying_____________________________________ ---------------------------- ---------------------------
b) figures, objects or circumstances introduced:
____________________________________________
____________________________________________
Implying need for or to_________________________
____________________________________________ ---------------------------- ---------------------------
c) figures, subjects or circumstances -
omitted_____________________________________
____________________________________________
Implying need for or to_________________________
____________________________________________

---------------------------- ---------------------------

4. Conception of environment (world) as:

___________________________________________

5. a) Parental figures (m____, f_____) are seen as

________________________________________
And subject’s reaction to “a” is ---------------------------- ---------------------------
_____________________________________________
b) Contempt. Figures (m____, f____) are seen as
_____________________________________________
And subject’s reaction to “b”
is___________________________________________ ---------------------------- ---------------------------

c) Junior figures (m____, f_____) are seen as

_____________________________________________
and subject’s reaction to “c” is____________________

_____________________________________________

6. Significant conflicts: __________________________

_____________________________________________

7. Nature of anxieties (✓)

Of physical harm and/ or punishment
_____________________________________________________
Of disapproval
_____________________________________________________
Of lack or loss of love _____________________________
Of illness or injury_________________________________
Of being deserted_________________________________
Of deprivation_____________________________________
Of being overpowered and helpless
_____________________________________________________
Of being devoured _________________
other________________________________________

8. Main defences against conflicts and fears: (✓✓✓✓)

Repression _______________________________
Reaction formation ____________________________
Regression ___________________________________
Denial______________________________________
Introjection__________________________________
Isolation____________________________________
Undoing____________________________________
Rationalization________________________________
Other______________________________________

9. Adequacy of superego as manifested by

“punishment” for “crime” being: ()

Appropriate ______________ inappropriate

_______________________________
Too severe (also indicated by immediacy of
punishment) _________________________________
Inconsistent __________________________________
Too lenient ___________________________________
Also; _______________________________________
Delayed initial response or pauses
____________________________________________
Manner ______________________________________
Other manifestations of super-ego interference
____________________________________________
10. Integration of the ego, manifesting itself in: (✓✓✓)

Hero: adequate ____________________________

Inadequate ______________________________
Outcome: happy ____________________________ ---------------------------- ---------------------------
Unhappy___________________________________
Realistic ______________________________
Unrealistic ______________________________
Drive Control ________________________________ ---------------------------- ---------------------------
Thought processes as revealed by plot being
(✓✓✓✓✓✓)
Stereotyped ___________________ Original
_____________________ Appropriate __________________
Complete _________________ Incomplete
___________________ Inappropriate
_____________________________________________
Syncretic _________________ Concrete
_________________ Contaminated _______________
Intelligence __________________________________
Maturational Level _____________________________
Organic Signs _______________________________
Story No 3 Story No 4 Story No 5 Story No 6 Story No 7 Story No 8
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Story No 9 Story No 10 SUMMARY
(1- 3) Unconscious structures and drives of Subject (based on
variable 1- 3).
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 4. Conception of World

5. Relationship to Others

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6. Significant Conflict:

7. Nature of Anxieties:
 8. Main Defence Used

9 Superego Structure

10. Integration and Strength of Ego

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