From Persecution to Depression: A Case of Chronic Depression—Associating the Rorschach, the TAT, and Winnicott

Abstract

In this article, I discuss a case study of a patient with depression, paranoid ideation, and other psychiatric difficulties who presented in a state of acute crisis. I review the Swiss Lausanne model of Rorschach and Thematic Apperception Test (TAT) interpretation, focusing on a psychoanalytic understanding of special contents and verbalizations. I then present a review of Comprehensive System (Exner, 2003) Structural Summary variables based on a modified Rorschach administration, while qualifying the meanings of these variables in light of the modified procedure. I conclude with a review of Winnicott's (1969) ideas on the paranoid potential, tie it to the main points of the case, and offer a 5-year follow-up of the patient's treatment. The case offers an approach to personality assessment that is informed by an international theory built on psychology and philosophy, and offers support for the use of an alternative theory-based, psychoanalytic method of data analysis.

Acknowledgments

Earlier versions of this article were presented at a workshop in Istanbul at the XXIst Congress of the International Society for the Rorschach and Projective Methods in July 2014, and at the symposium “Difficult Assessment Cases and Then Some: Psychodynamic Perspectives” at the March 2014 meeting of the Society for Personality Assessment in Arlington, VA.

The author deeply appreciates the helpful editorial suggestions of Dr. Jed Yalof and Dr. Bruce Smith, as well as the contribution of Dr. Anthony Bram, who kindly offered his time and collaboration to code responses, develop the Structural Summary, and suggest inferences based on the CS.