by Dafna Yalon et al

As part of its monthly sessions, the Psychodiagnostic Section of the Israeli Association of Psychologists conducted an encounter aimed at investigating the relative potential of various psychological tests that were totally context-free. Each of six evaluators were given a single test carried out by the same subject, administered in the course of a psychological-didactic diagnosis performed by Eliora Saruf, a psychologist. To avoid possible “contamination”, the only parameters provided were the subject's gender (male) and his age (20), as well as the fact that he is right-handed.

The diagnosticians presented their findings at the meeting. A number of tests - Bender, House–Tree–Person, TAT, Rorschach, and Szondi - were examined separately. A graphological diagnosis was performed by Saffy Charash, who analyzed the subject's handwriting, while Dafna Yalon carried out an analysis of drawing tests - the Wartegg test, and the stars-waves test.

All the assessors expressed their reservations about this kind of work, which was not supported by anamnestic data and a battery of tests. As an intellectual exercise, though, it was an unusual experience. In general, the high parity found between the tests was surprising. At the same time, it was clearly proved that although the most important findings, such as suicidal tendency, were discovered in several tests, no trace of them was found in others. The various tests address different layers; thus, for example, the House - Tree test relates to the external layer of the façade, while others, like the Rorschach, Szondi, and Stars–Waves test, have an affinity with severe existential experiences that are very deep.

In addition, integrating the information obtained via all the tests enables one to identify potentials that remained hidden in some tests, but were discernible in others. Thus, excellent thinking capacity is clearly visible in the subject's handwriting, but there was no sign of it in the subject's Rorschach functioning. This specific case also proved that a battery of tests is vital in any diagnostic endeavor. The testological thinking that ‘one test is no test' should therefore be the guiding light of graphologists, who must be trained in analyzing supplementary tests for handwriting.

Some of the opinions are given here in full, and some in summary form, together with the overall report presented by Eliora Saruf, based on the full battery of tests and individual sessions with the subject. Identifying details have been removed or changed, and the handwriting samples are partial only, to prevent the identification of the subject.

Readers are requested not to use the diagnoses appearing in this paper, fully or partially, in any forum. They are presented here as material for thought and learning for professionals.

•  Handwriting Saffy Charash

Male, aged 20, right-handed – graphological report

Note: The handwriting arouses concern about dysgraphia - a disorder of organic origin. This fact influences the handwriting. The following analysis is based on the assumption that the characteristics of his handwriting may stem equally from a psychogenic and an organic source.

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The subject is gifted with above average intelligence levels. Has rapid perception and thinking. He perceives entireties rapidly, grasps the significance of matters and their chief aspects (possesses abilities and tendencies for abstract thinking). He takes in stimuli with great sensitivity, distinguishing between nuances. He is endowed with good discernment.

The subject's judgment is independent, though occasionally random and imprecise as well. He brings up original ideas and attempts to realize them in his own way, even if they don't accord with the logic of those around him.

It is almost certain that his talents are not fulfilled as achievements. His ability for methodical learning is not impressive, mainly due to interior unease and difficulties with concentration.

A notable trait in the subject's personality is emotional instability, which stems from interior conflicts and contradictions. In the emotional and functional spheres alike there are divides and contradictions; on the one hand, he is perplexed and unsure about the way ahead, but is also stubborn and spiteful, on the other. He projects vitality and alertness, while simultaneously foundering in emptiness and depression. He is highly vulnerable, frustrated, and anguished. His self-image is low. His masculine identity (internalization of the male figure of the father?) seems to be problematic. Also linked to this is his poor ability for containment: problems with tolerating and suffering pain and frustration. It is liable to be manifested in impulsive behavior and acting out. The strength of his ego and vitality are very labile, and prevent him from coping stably with existential difficulties. The impression is that the subject is in the throes of a severe emotional crisis. He is in a state of depression, and suffers from anxiety and unease. A sense of instability confronts the tendency for impulsiveness and perhaps acting out, as well. This combination arouses concern in respect of the subject's possible self-destructive (suicidal) activity.

•  The Wartegg drawing test Dafna Yalon

An analysis of the Wartegg test was carried out with a focus on the test's central motifs, to try and shed light on the principal issues, not necessarily to effect a full and systematic analysis of the test.

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a. First impression – strengths

Cooperation is noticeable – the subject did what he was asked to do, and worked systematically in the correct order (applying purposefulness without emotional preference).

In his daily functioning, his approach is ostensibly cerebral, grounded on theoretical perceptions and abstract, pseud-philosophical thinking (abstract headings). Although the Wartegg test is not intended to demonstrate intelligence, the subject's work style – rapid, concise, and purposeful - clearly reflects an exceedingly intelligent individual whose solutions are rather creative. His thinking is lively, and he possesses good abstraction capability. He is tremendously open, highly sensitive to stimuli around him, and can move easily from one issue to another. He grasps the main issue quickly, focuses on what is important, and constructs logical priorities. His performance is very quick; he tends to minimize efforts and seek short-cuts.  

b. First impression – situational

Strong internal agitation. His behavior is nervous and reactional: all the solutions are dynamic, which is an extremely rare constellation (dynamic object-solutions – 3,5,6,7 and picture-solutions with expression of mobility 1,2,8).  

Intake of stimuli:

Normal intake of stimuli in most fields: the subject responded to stimuli quite appropriately and generally went along with them, though in field 7 he went against the stimulus, on no account showing an independent response to them.

1,2,8 – curved, alive, from nature

3,4,5,6 – straight lines and mechanistic

In field 7 we discern a contradictory response (reaction-formation): a demonstratively aggressive ‘male' (animus) expression, in the most sensitive and ‘female' (anima) field. The conclusion is that, in general, there is high sensitivity, normal response to external stimuli, and adaptable functioning to reality. We identified his specific difficulty in accepting his inner sensitivity and tender side. He fails to communicate emotionally and to process emotions. As is common in adolescence, he introduces power, machismo, and opposition where containment and true emotional processing is required. According to his chronological age, such expressions should have already died away, and they have apparently become a habit.

It is interesting that, despite his attempts to give the impression that he is power-driven and trampling in the drawing motif (a car), the subject in fact continued with delicate graphic processing of points on the wheel. This unconscious performance indicates high receptivity and the implicit expression of emotions. Since they are not brought to consciousness, they operate in an implicit, unconscious manner, remaining at a very primary and undifferentiated level, as affects, not as processed and mature emotions. The erratic graphic processing shows that the emotional reactions are indeed short-term, like “emotional pyrotechnics”.  

The emotional situation

In field 2, we see an unusual and problematic solution for the thematics of externalizing emotions. The subject has a strong need for an emotional life, but is unable to express himself in his natural territory. The fishes (an emotional symbol, in themselves, relevant to the stimulus) are out of the ocean and so exposed to existential danger. Expressions of authentic emotions place him at risk. The absolute meagerness of the fish indicates emotional poverty and hunger. The caption “jumping fishes” expresses the mobile, unstable motif in emotions. In field 7, we saw the subject's difficulty in developing profound emotions, which is now compounded by the strong need for live emotions, and also the existential anxiety it evokes in him.

The lack of emotional maturity is accompanied by depersonalization of the physiognomic-solutions (1,4,8). There are deficiencies in interpersonal communications, stemming from his fear of relationships and being hurt. Detachment from the external environment began as a result of this. In addition, he also has difficulties in engaging with his personal problems and the past (the waves in field 2 and in Star-Wave test, see below). Out of his fear, he arrogantly declares his individualism, as if he has no need of people.

The gap between the subject's high cerebral level and his meager, problematic emotional functioning is troubling.

Dealing with aggression

Field 5 contains a suggestion of externalization of aggression and, especially against obstacles. There is a clear divide between implicit and explicit, here as well: There is a demonstration of gross aggression in the conscious motif - the cannon; however, it is apparently no more than a longing and in any case it is not productive aggression. The implicit expression of declared power-orientation found in the fragile line is disturbed along its flow (the weakest pressure, a line that is very thin, shaky, fragmented, and retouched) – a line that displays hypersensitivity, and severe vulnerability. In fact, the power-orientation is in a very unsure backbone, which evokes the strongest manifestation of vulnerability in the whole test. One can conclude that there is inability to contain frustrations and to bear the normative load of life. Consequently, he is liable to erupt and lose control, in outbursts. In this context, field 7 already showed us the expression of affect and difficulties with containment. Reinforcement for power-oriented ambivalence are also found in the numerous phallic elements (1,4,5,7). It is advisable to explore with him the issue of sexual identity that is at the core of the problems (a history of abuse? aggression related to sexual background? homosexuality?).

Field 3 deals with achievement-oriented motivation. The yearning to climb the ladder of success is very strong, but the staircase is unstable, and it is uncertain if it can take the load. The line is also seeking a way, and it lacks continuity and momentum, revealing that he doesn't have the real capacity for achievements. He is hesitant, cautious, and protects himself in his endeavors. And once again, there is an obvious gap between his aspirations and impressions of a successful individual, and his inability to perform as needed.

The experience of capability (potency)

At the present time, this is a problematic experience for the subject. In field 6, which relates to integration, the drawn frame shows a lack of integration, the ego's boundaries are shattered, and difficulty with containment is discernible (the retouched lines show that a certain effort has been made to control the situation, but without great success). He feels stuck in this situation, like the ball he drew in the picture. He is passive, subject to a situation that has been imposed on him and, as a result, he experiences impotence in endeavors that require an internal focus of control.

Field 4 is the field that arouses the most problematic themes: here too he feels programmed for automatic functioning. We can see doing, without being. At the core of his problematic, are those behaviors experienced as compulsive and automatic, that lack any emotional nuance or personal desire.

The experience of self-image

There is an matching problematic combination between field 1 – which relates to identity, and field 8 which is meant to express the experience of being protected. At least currently, the subject is in the throes of a life situation over which he has no control and which puts him at risk (subjectively, at least). He feels that he's being ‘activated' by external agents, thrown around and thrown away. The focus of control in his life is external at the moment, and he is very threatened by the unclear results, from the blows that are liable to land. He feels dwarfed, lacks confidence, standing on unstable ground: both the way ahead and his future seem unpredictable.

Conclusion

The strong agitation and affectivity exist on the basis of low vitality, and lead to a sense of blockage . In this combination, the false power-orientation found in fields 5 and 7 have a destructive potential – mostly directed against himself.

In drawing the lines, there is an impulsive tendency that accompanies risk-taking (field 2). It should be clarified whether this is an acute condition, resulting from an emotional crisis, or a more longstanding phenomenon with an organic basis (ADHD= Attention Deficiet with Hyperactivity Disorder). The advantage of graphology is the ability to examine the duration of disturbances retrospectively, to see whether they have an organic origin, in which they exist at all ages. Predominant here is the experience of losing control, disintegration, and agitative depression. He feels anxious and threatened by the forces exerted on him. Equally noticeable are his helplessness – when dealing with aggression and in the field of general performance, the sense of diminished ego, and the lack of integration. With the background of his incisive thinking and sharp understanding, he exists in a state of severe frustration. He displays great suffering and longing for a life that is located somewhere else, from which he's cut off. He lives in a huge gap between the emotional and cerebral functions, between aspirations and the ability to implement them, between arrogant isolation and an acute need to seek help. As a result, he is in great existential danger, and his continued development depends to a great extent on who's going to hit the ball (field 1).

Indicators for recommending a neurological examination for attention disorders

We recommend follow-up by examining his childhood handwriting, to explore whether the distress is a permanent aspect of his personality, not circumstantial. Issues that are very clear at this time are:

• Impulsiveness and hyperactivity/surplus movements (motifs; movements that sabotage form);
• Risk-taking – fish out of water and parachutist;
• Poor attention – openness 6, pressure fluctuations, unstable base-line;
• Distraction – the parachute's lines, parts of the car, the robot's smile;
• External focus of control;
• Large gaps.

Despite his great intelligence and insightful, focused perception, he does not have the ability to integrate information as a process, only a random, occasional conjunction (car, steps – combination of parts, without an encompassing line). Short-range observation.

3 - The Star-Wave Test (SWT) Dafna Yalon

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The general picture of the test projects emptiness, a vacuum. At the same time, in the drawn sections and in the empty ones too, where the quiet “cries out”, there is high expressivity. Despite its minimal components, the perception of the person who did the drawing is one of wholeness, applying organization that is not purely technical, but that builds up a whole, a picture, an experience, that jointly underscore the lack of integration within it.

The stars - which were meant to be static and structured - display a very dynamic expression. (Later we will see that the origins of the light, and of the cognitive illumination too, reveal an internal-external gap, that accords with the symbolism of the space on the left-right axis).

The waves show “a form-solution'. Though drawn in a sinusoidal shape, they lack momentum; there are no rhythmic changes of pressure in the line, which is executed in a static and precise way. Here too, the expression does not accord with the content: the rigidly motoric pattern does not match the motif of ocean waves, nor the instinctual symbolism in the lower half of the frame. The waves are not so much expressive as concealing and motionless.

Thus a wide gap is created between the over-alert (uneasy) spiritual-cognitive sphere, and the emotional-vital sphere, which is too restrained. Both are inadequate, and do not accord with one another. The lack of integration is also obvious in the clear spatial gap between the stars and the waves. In terms of developmental norms, this indicates a great lack of maturity, in accordance with the subject's age (the norm shows that the incidence of that gap falls from 62% at age 6 to 6% at age 18, in a consistently decreasing process). So it is reasonable to assume that the continuity of the developmental process has been delayed and ceased for too long a time, and that his adolescence has not ended.

The situation of the gap between the spiritual-cerebral world and the emotional-vital one has apparently been in place for many years, and has become second nature. This impression is based on the line which, in the waves, is very thin; in certain places it is sharp, and at the wave's center is almost sharp-hard. That line's quality indicates a sensory deficit, rationalization and emotional detachment. Moreover, the margins which are empty on both sides of the wave, show the emotional detachment from other people – on the right, and from himself – on the left. The developmental delay seems fixated, apparently due to real barriers to his relationship with the outside world, and his internal sense of detachment. He feels stuck.

Most important and interesting is the almost one-sided deformation pattern of the stars which – the closer they are to the right of the page, become less and less developed on their right hand side. In an emphatic way, they are blocked towards the outside, defensively holding back. In complete contrast to this, the left side of the stars are drawn skillfully, but with an enlarged and distorted form, sack-like. The problematic expressed here is a dual one: defensiveness against absorbing stimuli, relationships, and involvement with the outer world and the future, while in the sphere of interior experience there is overload and the internal pressure remains diffuse. The interior ferment is unprocessed, there is insufficient differentiation and clarity in understanding the factors activating him on the outside, and leading to his inner agitation. The affectivity impairs the cognitive abilities, the shaping of forms.

Sharpness is prominent, directed to the left and downwards, chiefly in four of the five stars, hinting at depression and self-directed aggression.

Yet even so, in contrast to the heaviness, the depression, and the internalized aggression, each of all the stars also display a pushing-accelerating movement to the right and upwards, towards externalization, aspirations, and yearning for development and advancement - outside and in the future. The stark contrast between the dynamic aspirations and the negligible ability to fulfill them, due to depression and specific inhibitions at the moment of truth, gives the sense of a person who is torn and divided from within, and apparently reflects an existential conflict. If one adds to this the frozen feelings, the meager vitality, and the lack of integration and detachment – the impression becomes even stronger that the test-taker is at a great risk, an existential one. As a result, the inward direction of the aggression - towards himself - is a cause for concern.

Summary of the diagnoses from the additional tests  

4. Drawing Tests Ms. Chamitser 

All the drawings – the house, tree, and human figures - express lack of maturity and they have infantile, regressive aspects. The subject may still have remnants of developmental or visual-motoric problems; the lines are crooked, and the perspective is wrong.

House drawing

The drawing of a house reflects the internal world, belonging, and the experience of self. This drawing apparently reflects an experience of restriction, detachment, flatness and emptiness. The house seems to be an external framework, and events inside it are unclear. The windows are small, the door has no handle, it is not anchored stably. The house is on the left. The chimney – which symbolizes vitality and enterprise - is empty and crooked - the issue of conflictual masculinity. Lack of perspective in the roof can show vulnerability relating to the head (literally or symbolically).

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Tree drawing

The tree is also detached and empty, like a shell. It has no roots, branches, or leaves. It constitutes a representation of an external framework, a schematic, restrictive façade; it is unclear whether this derives from emptiness and decline, or a question of defense.

The tree's lower section is open, the growth is intrusive, with an upward trend, but there is no equilibrium in the lines of the trunk. It expresses vulnerability; something “twisted” that started at the very beginning of his development. The lack of stability in self-image in general, and in body-image in particular, is typical of children who have difficulties in motor development and in balance.

Human Figure Drawing

Self-image and the sense of competence are impaired. The body is suspended in the air, seeming to float without a base. The direction of the feet is unclear and the soles are not stable. The shoulders are sloped, typical of children with motor problems, and with concrete problems in the region o the shoulders, or else there is a sense that the artist is unable to carry the weight of the world on his shoulders (the subject suffers from scoliosis). The hands are paw-like, a characteristic of individuals with developmental disorders.

There is a clear problem with consolidating identity: there is no distinction between the sexes, symmetry is impaired, there is no differentiation (apart from hair and the skirt), the drawing is grotesque. A problem with masculine identity is obvious.

The woman's skirt is sharp and aggressive, the hair is protuberant and rigid, she is portrayed as facing frontward and backwards at the same time; the encounter with a female figure and with internal female representations, is a cause for anxiety.

The drawing is frozen, there is no dimension of connection. The hands, eyes, and pursed mouth show that there is difficulty in object-relations, in relations with the world and the environment.

Most significant of all is the split between the head and the body, manifested in the break on the line and even in the directional discontinuity between them. The small head parallels the empty treetop and roof. There is a problem regarding the connection between the injured head and the experience of the body, in the integration of the drives. The detachment is symbolic, like a slaughter. There is a great risk of suicide: he is unwell, he feels disintegrated, has an inner experience of strong disconnection. In this context, we note that the floating figures also have non-human hands, perhaps those of angels. The large hands show the potential for aggression, which is liable to be self-directed.

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Summary

There appears to be a developmental difficulty that impacts on emotional development. Feelings of inferiority and lack of constancy are evident. There is a sense of castration and difficulty with encountering his female aspects. Object relations may be impaired. He is subject to depression and restriction.

5. The Rorschach Test Giora Zaki  

According to the considerable number of answers given, high productivity, cerebral diligence, and long-term work can be indicated. The issue of test-taker's interest in quantity, not quality, should be examined.

An analysis of the findings elicits that there is a suicidal constellation with many signs of depression. There is a clear activity potential in the emotional channel, since the subject is not flat, poor or emotionally inert. However, some of the emotions are labile in nature, non-uniform, inadequate, and are not in integration. He is liable to express them in outbursts, in an uncontrolled, and thus problematic, manner. Alongside the considerable potential for experiencing emotion and expressing it in a labile manner, we discern a central inhibiting component. In a psycho-dynamic view, there may be a good reason to put a lid on unmonitored expression, and to suffer in consequence. Inhibition has an attendant dysphoric and depressive component, of the emotions that cannot be expressed. Emotional life is also marked by great anger and aggression, very strong components that are burdensome for him, and reinforce the dysphoria. The combination of impulsive expressions with aggressive contents shows that the inhibitions of expressions started because they appear dangerous and are perceived as destructive. The outcome is sadness and depression.

There is an attempt to restrict emotional life, to live in a limited way in order to attain relative stability. The spheres of interest do not vary. Everything is sporadic. There is withdrawal in the degree of reactivity, and in the mode of perception in general: he perceives via form, not via the higher experiential dimensions. He lives an aggressive and hostile emotional life, with the attendant risk of lack of control; thus there are introversion, depression, and experiential narrowing.

Although in a quantitative analysis according to Exner, we see that the subject is capable of living a directed life, the quality of his reactions indicates the problematic inherent in almost every reaction. Most of the human movements that he mentions contain a perceptual contradiction - from a fantasy world, defensive, or non-integrative. These contents are imposed on him, and his strength is therefore insufficient. He does not lack resources, his thinking endeavors and emotional potential are clearly seen; however, his thinking is disturbed and his emotions are not controlled. This is not a neurotic personality.

The pressure that he experiences are of two kinds: moods as a primary need (drives, hunger – where he has accumulated a large primary deficit), and emotional inhibition (dysphoria and sadness). It is a chronic, persistent condition, but not an acute problem, a new situation, or a crisis that, once solved, there will be no problems. His low and fragile self-image, together with the tendency to self-neglect, reflects a depressed individual. On the other hand, there is much self-examination and awareness. The self-neglect is accompanied by outbursts of severe and hurtful self-criticism. Examining the self is a subtle, not a simple process, applying a sense of perspective, even mistrust. Although he attempts to please others through his behavior, the principal tendency in the interpersonal sphere has an aggressive nature. Relationships are considered as a flawed prism, that is not unmediated. Problematic object relations are evident. In the course of the test, he never saw whole and undistorted people. This is a severe diturbance, not a neurotic personality, but a more borderline disorder.

In the sphere of thought he attempts to organize normatively, but fails to do so. He does not observe enough parameters in the surroundings to organize them properly, and so he reacts impulsively and unemotionally. There seems to be a problem with concentration, the origin of which is unclear.

In contrast to intelligence, which was reflected in the handwriting, the Rorschach does not show high intellectual potential, quite the opposite, in fact. Little capacity for sophisticated combinatorics was found, nor for understanding and organizing information. It may be the case that he suppresses his thoughts. A tendency for negligence in observation was found. He is not at ease with unsophisticated life. There is some degree of ambitiousness, and substantial tension can be discerned between his need for restriction, getting by, and suppressing, and his aspiration to be someone else. He needs more than what there is. There is a strong fear of expressing powers and capabilities, due to his fear of the destructiveness that threatens him.

In perception of reality, there are no thinking diturbances, according to the norms. He can talk about everyday matters, is au courant with the world, and knows how to behave. Under the surface, however, his perception is deficient, particularly in his dealings and relations with people, and in terms of his self-image. Moreover, he is liable to make misconceptions that, with transference, could become distorted, even psychotic. There are no prolonged distorted perceptions but only distorted judgments in loaded situations with people, an area where the problem is severe, and he might act unwisely.

Summary

A depressive spectrum can be discerned, with a problematic emotional life: lability and hostility and, on the other hand, suppressed emotions, sadness, and dysphoria. Self-image is fragile, negligent, based on fantasy relations, which are not affective. He lives in the tension between the tendency for self-suppression and for restriction, together with the desire to burst into another place. In accordance with the norms, he is located in a borderline disorder, not a neurosis, and not a psychosis.

Another important factor is the painful, sometimes mistrustful self-observation, reinforced by his being constantly on the alert for danger, always wearing his ‘full metal jacket'. His passive appearance is deceptive, and although on the outside he behaves like a humiliated serf, underneath he is aggressive and distrustful. The pleasing aspect of his behavior is a disguise for rebelliousness. He does not give of himself, and relies on no one. This has great significance for his therapy.

Some of the contents that were expressed reveal a lack of maturity, belong to adolescence and are regressive. There were two responses that described an aggressive mouth with blood, biting an animal, verifying the thoughts about oral aggression and the borderline diagnosis. A response of this kind can also be interpreted as an projective identification, fear of aggression and the need to control it in a closed cycle. Together with the distrust and self-observation, thoughts about primitive defense mechanisms, and a borderline diagnosis, become even stronger.  

6. The Szondi Test Eliora Saruf

The evaluator shows the subject six series of eight pictures showing sketched faces, and the subject is asked to choose two that s/he likes, and two that s/he dislikes. The pictures show hospitalized patients, suffering from what was considered as psychiatric disorders in the 30s and 40s of the previous century – sadism, homosexuality, epilepsy, hysteria, catatonia, paranoia, mania, and depression. The phrasing and the form of assessment comply with the conventions prevailing when the test was developed.

The patterns of choice enable an examination of positive choices (liked) or negative choices (disliked) or ambivalence, into the following spheres:

• The sexual aspect: homosexuality and sadism. Femininity/masculinity, passivity/ activity.
• Emotions and aggression: epilepsy and hysteria.
• The ego factor, personality: paranoid and catatonic.
• Relationship and contact, object relations: mania and depression.

The findings:

•  This subject made a lot of choices from the axis of sexuality – sadism and homosexuality. He is foundering in the issue of sexual identity. Expresses this factor as longing for passive love, female identification, yearning for touch. In masculine identification, there is marked ambivalence between sadism and masochism, between the desire to gratify others, and aggression. As a result, there is a constellation of conflict leading to a high level of anxiety. Indeed, the subject's collaboration was accompanied by strong anxiety throughout the three hours of the diagnosis.

There are a need for primary love and an emotional immaturity. His feelings and conflicts resemble those often found at the end of the latency period along the development axis, according to Szondi.

•  In this test too, lively emotions and their covering-up were discovered. There is strong and restraining emotional tension. Impulsiveness is accompanied by a Superego that captures, arrests, and detains him, and doesn't allow him to express himself.

•  The subject marked three hysterical young men with a minus (dislike). This is a common exhibitionistic representation, but it is manifested as a covert dynamic which influences him. Expresses suppressed arrogance - the price of which are certain forms of detachment and anxiety.

Due to the emotional block, the Superego ostensibly supervises primary tendencies, narcissism, and impulsiveness and, as a result, his fantasy life is a rich one. There are numerous interior events, where the brakes on the Id engender high levels of anxiety. He doesn't know how to cope with bodily, sexual, and aggressive drives.

He submitted to the environment's power, like an obedient first-grader who has abandoned his dreams. He feels bad about his personal ability, which is appropriate for the conclusion of the latency period. He refrains from giving room for authentic self-expression, suppresses them, doesn't dare to live his life and to fulfill his plans, feels that he cannot express himself in the world.

The motive for his test taking was an interior one. He is aware of everything going on inside him, the distress, and the pain. He is unhappy with everything he does, his achievements lag behind his aspirations. He pursues his Ideal-Ego. His behavior is compulsive, leading to numerous corrections, and to dissatisfaction. He also needs to gratify others by choosing conformity as one aspect of his personality. On the other hand, there is an emphasis on the latent homosexual dynamic, which evokes tremendous pain and may explain part of his compulsiveness and the need for suppression.

•  Very few choices of mania and depression. There is a difficulty in communicating, interpersonal relationships: there may be a deep-seated personality disorder.

The picture that comes to light is a contradictory one. Unlike other findings, there is a narcissistic ability to adapt himself as required, and he absorbs events around him and adapts himself to them, assuming that others will serve him.

7. The Bender Test Dr. Avi Saruf

Normal visual perception without distortions. Does not show difficulty when shifting from the visual to the performance medium, and no difficulties were found in the visual-graphic-motoric sphere. In general, organization is normal, with the appropriate order. Stable size without significant fluctuations, without emphasized lability, appropriate abilities for grasping and recalling that reflect openness to learning.

An analysis of the forms themselves reflects the conflictual elements in his personality. Particularly noticeable is the need to create a framework for self-representation, as a kind of search for protection, preservation, boundaries and demarcation between the spheres, both against the outside world and against unwanted expressions of the self. A preoccupation with unresolved issues from the past is discernible, and overcharged thoughts, imaginings, and fantasies, with unprocessed contents that continue to impact on the present. Many signs reflect the difficulty in centering on aspects of the sense of masculinity and masculine identity, with the need to compensate for the feeling of insecurity and weakness in this areas, reflected in regressive attitudes and less mature functioning. Affect tends towards dejection, but there is also need for controlling the emotional domain in general, restraint, control, and holding.

Many signs attest to difficulties with authority, chiefly around the internalized relations with the father figure, an issue that seems also to have left its mark on the sense of masculinity and allied difficulties. Elements of dependent needs and relying on others come to light, but so do tension and anxiety about their being discovered. In the absence of a structured framework, his functioning tends to be more childish and regressive. Weakening of the defenses, the difficulty of persevering and assuming the Ego functions under pressure, and a rise of depressive affect are all noticeable.

Summary:

There are no findings of grapho-motoric problems in his development. We can see his need to control the emotional world, but the affect that is expressed tends towards dejection and sadness. Dependent needs arise but their expression is repressed, alongside aspects of insecurity and weakness for which he tries to compensate. A central conflictual theme deals with aspects of consolidating masculinity and the relationship with the father figure. When there is no framework, his function tends to be more regressive and his defenses weaken. There may be a situation of self-risk or self-injury.

8. Psychological-Didactic Diagnosis Report Eliora Saruf

The tests administered were:

Wechler for adults, Bender, drawings, TAT, Szondi, Ray visual, Ray auditory, handwriting.  

Background and reason for the psychological-didactic referral:

The subject, who is also the source of the following information, is a man of 20. He is the eldest son of the family. He was discharged from compulsory military service in the Israeli army due to suspicion that he was suffering from a disease of the intestines, and he continued serving as a volunteer in the army. Describes his service in positive terms. Relates that, ever since he started junior school, he was diagnosed with learning and emotional problems. He underwent didactic assessment several times and was helped by mental therapy. In the 2 nd -3 rd grade, he was diagnosed as dysgraphic. From 8 th grade onwards, he was diagnosed as suffering from a compulsive disorder, and was also treated on and off with medications. Recently he was diagnosed as suffering from dysthimia. Receives Affexin as well as Ritalin, which have been very helpful. Suffers from allergies and scoliosis…

…Over the years, he has undergone other assessments, to try and identify the reasons for his learning difficulties, since there have been high and low points in his achievements, as well as concentration problems. He is now interested in becoming more familiar with, and understanding the nature of, his difficulties in general, and his skills and capabilities in the learning sphere, as well as learning about the concentration difficulties diagnosed in his functioning.

In social terms, he defines himself as a very closed, shy child and adolescent, “like a shell”. At this time, he hopes to join his father's business and to develop additional new aspects of it, and is also weighing the options of going back to studies…

Appearance and behavior:

…A serious, considered approach during the meeting … during the tests, he projects much tension and anxiety. In his work, he tries hard to attain a perfect, exact performance, but this takes time and, in spite of constant corrections, he doesn't improve his output. There is only the sense of tremendous efforts, a Sisyphean fatigue. The repetitiveness and attempts to achieve perfection, with their strongly compulsive character, also lead to a certain loss of distinction between major and minor issues.

No problems were anticipated with his graphic work. He is right-handed, holds a pencil correctly, and it is clear that there is no problem in terms of perception, or visual-motoric aspects.

In general, he was totally cooperative, volunteered the most complete details about himself, and attempted to perform to the utmost those tasks involved in the tests. A great need to gratify others was found, to find out what “the rules” are, to avoid creating a disagreement or conflict, or to “cross the red line”.

Like his graphic work, there was a lot of lobbying to be “OK” during the sessions, to be liked, to respond to others, to obtain approval, permission, and agreement concerning the way he worked. In such behavior, he reveals many concerns about being oppositionary, assertive, and standing up for his rights.

Results of the Tests

Intellectual functioning is within the average. At the same time, there is considerable lability between the various tests, with no significant preference for the verbal over the performance sphere. He has wide-ranging knowledge about the world, attested to by his curiosity and interest about things around him. Internalization of social values is also good. Abstraction ability is normal, with average ability for analysis and synthesis, perception of the parts of the whole, as well as very good ability to learn new material, especially with practice and repetition.

Indeed, the tests showed a slight concentration disorder which, though it is not serious at the moment, might formerly have been more predominant. There is no evidence that it originated in attention and concentration disorders, and its source may be emotional, deriving from over-anxiety and obssessive thoughts, as we will see below.

As anticipated from his work, the output tests show a considerable lowering in the distinction between major and minor issues. Moreover, his ability to cope with social situations, to relate to nuances, and to weigh up procedures and results in advance is far lower than his general ability, and his cerebral knowledge of social conventions. In this area, we see impulsive behavior, hastiness, and difficulties in understanding the various shades of interactions …

…Occasionally, his thinking tends to be impulsive, and he often fails to take all elements into account. This can lead to errors in judgment and evaluation, especially in terms of social and interpersonal situations. However, he does have good capacity for sequential and coherent thinking, allied with the ability to draw logical conclusions and a good understanding of processes and events.

In his personality structure, he is characterized by the dilemmas typical to early adolescence, and even the end of the latency period. Many of his inner conflicts cause him much anxiety, and offer a partial explanation for the compulsive traits in his personality. There is a noticeable lack of consolidation in his identity, particularly in the area of consolidating sexual identity. He has a need to receive love and support passively, a need for attention that contains more childish characteristics. Facing this need are his typically adolescent conflicts, of preoccupation with displayed or repressed aggression and assertiveness, where he wants both to act openly and even more - to be inhibited and restrained. This duality – between the desire for self-expression, and repressive inhibition and censorship – is characteristic of many layers and themes in his personality, and apparently underlies the obsessive-compulsive structure as well. The resulting conflict between more aggressive expression and his inhibitions and repression, generates anxiety.

In the sphere of expressing emotions too, there is a recurrent expression of that conflict. On the one hand, we see the impulsive aspect, and the tendency to suddenly vent strong accumulated internal pressure, while on the other hand, a massive rejection of free and spontaneous expression clearly and openly goes into operation. He is characterized by emotional timidity.

Apparently, a controlling Superego system has been internalized within him, causing the repression of the drives. An outcome of this repression can be manifested in rich fantasy life or daydreams, since his emotions are not discharged but experienced as a subjective inner experience. His internalizing his feelings also cause an experience of painful introversion, where he is aware that he is directing his feeling inwardly. In the absence of any other expression, some of the affects will be somatically channeled. Those of his needs that have a more narcissistic quality are concealed and repressed, and this absence of normative attention and concentration on the self, are what underlie the emotions of dysphoria, which are described at greater length below.

The result of the struggle between the desire to vent and the censoring controls, reveals that his entire emotional domain is characterized by tension and agitation that are subjectively experienced as diffused and floating anxiety (strongly felt during the session, as well). This anxiety is non-specific, and is not consolidated around an object or issue (it is not phobic), but has a general, diffused character. It would appear that he is anxious about his own drives, whether they are aggressive or sexual in nature. As noted previously, the subject has accepted and internalized the demands made by society and surroundings, with their boundaries and limitations, while abandoning earlier childish and primary omnipotence. This makes his behavior conformist, conservative, accepting and identifying with the demands of society and its expectations, and he also applies marked self-control. At the same time, due to the adolescence problematics, an internal tension of emotional needs and drives is created. Those needs and drives try to enter the consciousness despite being repressed, and once again create tension and the sense of threat, though this phenomenon is characteristic of a younger age. He apparently feels incapable of expressing himself fully, or feels that he doesn't have the strength to implement his plans and desires. He tends to hesitate often, finding it hard to choose the preferable modus operandi. Thus, he shifts between more cerebral considerations to emotional sensations, and does not show consistency in the methods he uses for solving the problems he encounters.

Again, between the urge and the inhibition, and the tendency to extraversion and introversion, more tension, anxiety, and compulsiveness are generated. There seem to be deep-seated anxieties stemming from his lack of confidence around the issue of sexuality and, more generally, in confronting difficulties and fears about expressing himself, in society and in his environment.

In tandem, there is an Ideal-Ego inside him that confronts him with high demands of himself. However, he feels too overwhelmed and inhibited by reality to fulfill, realize, and carry out his wishes and plans. At a later stage, from a less overwhelming and childlike place, he experiences a persistent subjective gap, feeling that his self-expectations were not fulfilled. There will always be an inherent gap between his high aspirations and the actual level of his achievements. Without taking his objective achievements and successes into account, he will inevitably feel that whatever he achieved wasn't enough, and will push himself to achieving a perfect performance (like his repetitive work in the Bender test, which has a clear compulsive hallmark). Here too, a subjective and conscious experience was accompanied by an internal conflict between the wish for open, spontaneous expression, and self-censoring and inhibition.

The subject has low self-image, in conjunction with a sense of intellectual inferiority, often to the point of feeling deviant (He wishes ‘to be normal”. In his drawing of a woman: “She looks sort of confused, she can also be bad because of her problems, she doesn't know how to handle things”). Physical self-image also expresses a certain lack of differentiation and immaturity, relative to his age. The tremendous self-examination and self-criticism that he applies seem to underlie the severe dysphoric emotions that have been a part of him for a long time. (“Yossi is depressed and feels that he's failed”. “She's terribly sad because she can't fulfill herself…she'll keep constantly trying but because society is not ready for this, she won't succeed”, “This is someone in melancholy, lonely, his world is black”).

He expresses deep dependence on primary objects and ungratified oral needs, that are aggressively manifested and not always adequate (in Rorschach card III: “Something that's coming to eat, sort of teeth, something mostly bad, a black color, as if there's blood, the teeth are kind of attacking”).

Loyalty to people, ideas, or objects will characterize his behavior. His general attitude to the world will have a more idealistic, and less practical, nature. He will apply a conservative approach, and he will be worried by new things, and the need to invest in new objects. Here too, he is characterized by more passive approaches, with difficulties in abandoning existing relationships and beliefs.

Alongside the need for dependence, the subject has an oppositionary approach that is a fundamental worldview, and perhaps resistance to authority, as well. Though this is usually not expressed openly, but rather as a reaction-formation, his tendency to react impulsively seems to reveal this attitude more openly. As a rule, he displays a cautious approach to people, is afraid of others intruding into his personal sphere, and tries to maintain space and boundaries. While he himself feels loyal to the people he esteems, he has experienced other people as unreliable, and hence tends to be worried and cautious before forging relationships and commitments with others.

At present, though he is not characteristically narcissistic, he is focused on himself, his feelings, anxieties, and doubts. He is investing less and less in real relationships, where the internalized object relations are more internalized or part-objects. Despite his profound need for relationships, he is still marked by internal tension and uncertainty as to whether he can win the support and love he needs from those around him. This saps his energy to a great extent, and is accompanied by more feelings of frustration. His avoidance of emotional expressions, as we have described it, prevents him from being fully involved in interpersonal relationships. His awareness of his difficulties and internal conflicts, together with his fundamental willingness to examine himself and the core of his difficulties, contribute powerfully to the therapeutic process that he is undergoing, and provide an affirmative foundation for personal growth and development.

Summary:

The subject is characterized by a personality-based dynamic that is early adolescent in nature. The themes and conflicts that preoccupy him center on the formation of sexual identity, fluctuations around the expression of urges, difficulties with the spontaneous expression of feelings in the face of powerful inhibitions and self-criticism, and a strong Ideal-Ego that sets high self-demands, and opens the way to a marked depressive and dysphoric affect.

Many of the conflicts are accompanied by agitation, tension, and most of all – diffuse anxiety underlying the compulsive behaviors and thoughts. Some of the internal duality is conscious – the subject is aware of his distress and is seeking psychological therapy. The issues that can be dealt with in therapy, in terms of the inner condition, are: coping with more spontaneous expressions of his needs, desires, his feelings in particular; processing intra-family relationships - issues of dependence and interpersonal relationships with a passive nature; making aspirations and ideals more flexible, towards more realistic self-esteem and, accordingly, drawing up vocational-educational plans (that take cognitive-learning elements into account); examining the Superego, censoring, internal control and their flexibilization; developing strategies for coping with difficulties, and goals.