ABSTRACT Caregiver–child interactions starting in infancy play a crucial role in socio-emotional development, including the formation of object representations and defense mechanisms. Projective tests, such as the Thematic Apperception Test (TAT), have been used to explore these unconscious processes. In the TAT, participants create narratives based on images depicting characters in various emotional states and interpersonal situations. In doing so, participants project aspects of their internal world into the stories they construct. While the TAT has been effective in differentiating diagnostic groups and providing insights into socio-emotional functioning in both children and adults, few studies have directly compared TAT narratives between caregivers and children. This paper presents a case-based examination of caregiver–child TAT narratives drawn from data from a larger mixed-methods research study of 20 dyads. In this paper, six dyads were selected to illustrate how the process of in-depth analysis of key relational and emotional themes, language use, and narrative structure can offer important insights for treatment planning with children, caregivers, and families. The findings underscore how narrative material can illuminate relational patterns and guide individualized interventions in child and family therapy.

Narrative assessment procedures have a rich tradition in psychology and have been widely employed for clinical and research purposes. The Thematic Apperception Test (TAT; Murray, 1943) and the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) have been widely used for eliciting and coding narratives for psychological assessment. Recently, a critical review by Sinclair et al. (2023) asserted that there is insufficient evidence for the use of the SCORS-G in clinical settings, calling for a moratorium on its use. However, their critical review was limited in scope, did not include evidence counter to their position, nor did it acknowledge counterarguments previously presented by TAT experts. We address their concerns around standardization practices, reliability, validity, and clinical utility. In this comment, several meta-analyses assessing the reliability of the Social Cognition and Object Relations Scale/TAT were conducted. There were no significant differences in reliability between single versus average intraclass correlation coefficients, between Pearson's r and intraclass correlation coefficients, or between earlier versions of this scale. Good to excellent ranges were consistently found using three different benchmarks. Administration practices and the validity of this rating system were substantiated. Finally, we highlighted how the Social Cognition and Object Relations Scale/TAT interpretative process mirrors Evidence-Based Practices in Psychology (American Psychological Association, 2021), Professional Practice Guidelines in Psychological Assessment (Krishnamurthy et al., 2022), and free response measures (Meyer et al., 2015). When examining all available data, there is sufficient evidence to support that the SCORS-G is best used clinically when integrated with other data. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Sinclair et al.'s (2023) recent critique of the Social Cognition and Object Relations Scales-Global rating as used in clinical practice initiated a methodological conversation about its application to Thematic Apperception Test stories. Their critique included assertions about thematic apperceptive techniques more generally, such as the importance of standardization; normative data; psychometric approaches to validity and reliability; and cross-cultural generalizability. Since they cited two articles by me in some detail, not always accurately, I respond here with a discussion of the differing assumptions underlying narrative assessment methods, as compared to ability tests and structured self-report inventories, that I argue reflect differences in methodological worldviews and are supported by a history of empirical evidence. Those different assumptions shape construct conceptualization, response processes, score interpretation, sources of error variance, applicability of psychometric criteria used for more structured assessment methods, and the role of culture in the assessment process. Narrative methods require more suitable approaches to data collection, score interpretation, and evaluation of results than are available using normative tables and classical test theory. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

We thank Stein et al. (2026) and Jenkins (2026) for their commentaries on our critical review of the Social Cognition and Object Relations Scale-Global system as applied to the Thematic Apperception Test (Sinclair et al., 2023) and appreciate the opportunity to respond in kind. Although we acknowledge the considerable effort put into these response articles (analytically and conceptually), both fall short in addressing the myriad serious methodological and procedural concerns we raised in 2023 and do little to move the needle in support of this assessment technique. This article will review the many ways these responses misinterpret and misrepresent our original review and the voluminous methodological problems with the "meta-analyses" that are presented by Stein et al.-and the various ways they are statistically confounded, confusing, and scientifically unsound. Further, this article will highlight the considerable number of logical inconsistencies that are inherent within Stein et al.'s core arguments, as well as the numerous contradictions between Stein et al. and Jenkins-all of which seriously undermine the methodology itself. Given the many ethical ambiguities that arise as a result, we conclude with a repeat calling for a moratorium on this methodology until these issues are sufficiently resolved. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Language impairments are common in affective and psychotic disorders, yet their patterns and underlying pathomechanisms remain insufficiently understood. A transdiagnostic perspective provides a framework for identifying shared and disorder-specific language alterations across diagnostic boundaries. Combining natural language processing (NLP) with network analysis enables the investigation of complex associations between linguistic, cognitive, and psychopathological features. Spontaneous speech from N = 372 participants (119 MDD, 27 BD, 48 SSD and 178 HC) was elicited using four Thematic Apperception Test pictures (~12 min per participant). NLP models were applied to extract latent linguistic variables across various levels, including lexical diversity, syntactic complexity, semantic coherence, and disfluencies. Network analysis was used to relate linguistic variables, psychopathology (SAPS, SANS, HAM-A, HAM-D, YMRS, TLI, GAF), and cognitive performance (attention, verbal memory, recognition, and verbal fluency). Linguistic variables formed the densest network cluster, with type-token ratio, mean length of utterance, and syntactic complexity emerging as central nodes. Psychopathology variables were less cohesive, while TLI "Impoverishment", coherence mean, and executive functioning bridged linguistic, cognitive, and psychopathological domains. Network comparison tests revealed no significant differences in linguistic-cognitive network structure across HC, MDD, BD, and SSD. Linguistic networks show high structural consistency across healthy individuals and patients, whereas psychopathological symptom networks reflect transdiagnostic profiles. These findings support a dimensional and transdiagnostic framework underscore shared language-cognition mechanisms, and highlight executive functioning as key cross-domain connection, which opens up new avenues for dimensional research into the pathophysiological and etiological mechanisms underlying language dysfunctions.

Mature defense mechanisms support patients' engagement in psychotherapy. The Overall Defensive Functioning (ODF) scale of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Defensive Functioning Scale (DFS) is a measure of the maturity of patients' defenses. Immature defenses (e.g., splitting) and poor emotion regulation are hallmarks of borderline personality organization, and both can interfere with positive treatment engagement. We predicted that ODF would significantly and negatively correlate with the Personality Assessment Inventory Borderline (PAI-BOR) scales, PAI Treatment Rejection (PAI-RXR) scale, and the PAI Treatment Process Index (PAI-TPI). To our knowledge, no studies have examined the relationship between ODF scores, as measured by the DFS rating of Thematic Apperception Test (TAT) narratives, and defense levels, PAI-BOR Full Scale (PAI-BOR-FS), PAI-RXR, and PAI-TPI scales. The sample included 73 outpatients from an academic hospital. Patients were administered the PAI and a TAT protocol. Two psychologists independently rated 40 TAT protocols with the observer-rated DFS for reliability. Healthy defenses showed significant negative correlations with PAI-BOR-FS (r=-.27), PAI-BOR Negative Relationships (PAI-BOR-N) (r=-.38), and PAI-RXR (r=.30). The pathological defenses had positive correlations with four of the five PAI-BOR scales and the PAI-TPI. There were significant correlations between ODF and the treatment related scales, PAIRXR (r=.37, p<.01) and PAI-TPI (r=-.32, p<.01). ODF significantly and negatively correlated with the PAI BOR-FS (r=-.36, p<.01) and its subscales, Affective Instability (r=-.35, p<.01) and Negative Relationships (r=-.39, p<.01). High and low ODF groups had significant and meaningful differences on all seven PAI scales. Overall, these findings provide support for the construct validity and clinical utility of the DFS defense levels (healthy, neurotic, and pathological) and the global ODF.

Language disturbances are central features of serious mental illnesses, yet traditional clinical assessments often rely on subjective evaluation that may overlook subtle speech anomalies. This study employs natural language processing (NLP) to objectively analyze spontaneous speech in a transdiagnostic sample comprising individuals with affective (n = 119 Major Depressive Disorder, n = 27 Bipolar Disorder) and psychotic disorders (n = 37 Schizoaffective Disorder, n = 11 Schizophrenia), as well as healthy controls (n = 178). Participants provided approximately 12 min of speech elicited via four pictures from the Thematic Apperception Test, which were transcribed and analyzed for semantic and syntactic features. Explorative factor analysis identified three latent linguistic dimensions: (1) Syntactic Complexity, (2) Lexical Diversity and Fluency, and (3) Narrow Thematic Focus. These dimensions were differentially associated with clinical ratings of formal thought disorder and neuroanatomical measures obtained through structural and diffusion-weighted MRI. Notably, Syntactic Complexity and Lexical Diversity correlated with decreased fractional anisotropy (FA) in frontotemporal white matter tracts, while Narrow Thematic Focus was linked to reduced gray matter volume in the right posterior insula. Importantly, these associations persisted after controlling for diagnosis, medication status, and verbal IQ. These findings suggest that NLP-derived speech metrics can serve as sensitive indicators for language dysfunction in psychiatric conditions, offering a scalable approach to elucidate brain-behavior relationships and advance models of psychopathology.

The systemic-constructionist theory of family semantic polarities is an intersubjective model of personality and its psychopathological developments which has important implications for the psychotherapeutic process. This study analyses the narratives of a clinical group of individuals diagnosed with Narcissistic Personality Disorder (NPD) to investigate whether there is a predominant semantic organization and what the most common themes and meanings are. The narratives of 18 individuals diagnosed with NPD which emerged during the administration of the Thematic Apperception Test (TAT) were analyzed using the Family Semantics Grid (FSG). The quantitative analysis shows that in the narratives of individuals diagnosed with NPD none of the semantic organizations predominates over another. A qualitative analysis revealed the salience of themes related to the “winner-loser” definition of self, others, and relationships (power semantics), relational movement of “approaching-keeping distance” (freedom semantics), emotions such as “despair” and “anger” associated with exclusion (belonging semantics), and the polar meaning of “intransigent versus permissive” and the emotion of guilt (semantics of goodness). From a constructivist and constructionist perspective, narcissistic symptomatology appears as an attempt to achieve recognition of a superior status through admiration while maintaining emotional distance to protect the grandiose self-image. These findings may serve as a pilot for future, larger-scale investigations.

Animal welfare education could greatly benefit from customised robots to help children learn about pets and their behaviour, and thereby promote positive, safe child-pet interactions. To this end, we ran co-design workshops with animal welfare educators and children to identify key requirements for robotic pets from their perspectives. Our findings encompass a zoomorphic robot’s appearance, behaviour, and features, as well as concepts for a narrative surrounding the robot. Through comparing and contrasting the two groups, we find the importance of: negative reactions to undesirable behaviour from children; using the facial features and tail to provide cues signalling an animal’s internal state; and a natural, furry appearance and texture. We also contribute some novel activities for co-design with children, including branching storyboards inspired by thematic apperception tests and interactive narratives, and reflect on some of the key design challenges of achieving consensus between the groups, despite much overlap in their design concepts.

BackgroundMajor depressive disorder (MDD) remains underdiagnosed worldwide, partly due to reliance on self-reported symptoms and clinician-administered interviews.ObjectiveThis study examined whether a speech-based classification model using emotionally and thematically varied image-description tasks could effectively distinguish individuals with MDD from healthy controls.MethodsA total of 120 participants (59 with MDD, 61 healthy controls) completed four speech tasks: three emotionally valenced images (positive, neutral, negative) and one Thematic Apperception Test (TAT) stimulus. Speech responses were segmented, and 23 acoustic features were extracted per sample. Classification was performed using a long short-term memory (LSTM) neural network, with SHapley Additive exPlanations (SHAP) applied for feature interpretation. Four traditional machine learning models (support vector machine, decision tree, k-nearest neighbour, random forest) served as comparators. Within-subject variation in speech duration was assessed with repeated-measures Analysis of Variance.FindingsThe LSTM model outperformed traditional classifiers, capturing temporal and dynamic speech patterns. The positive-valence image task achieved the highest accuracy (87.5%), followed by the negative-valence (85.0%), TAT (84.2%) and neutral-valence (81.7%) tasks. SHAP analysis highlighted task-specific contributions of pitch-related and spectral features. Significant differences in speech duration across tasks (p<0.01) indicated that affective valence influenced speech production.ConclusionsEmotionally enriched and thematically ambiguous tasks enhanced automated MDD detection, with positive-valence stimuli providing the greatest discriminative power. SHAP interpretation underscored the importance of tailoring models to different speech inputs.Clinical implicationsSpeech-based models incorporating emotionally evocative and projective stimuli offer a scalable, non-invasive approach for early depression screening. Their reliance on natural speech supports cross-cultural application and reduces stigma and literacy barriers. Broader validation is needed to facilitate integration into routine screening and monitoring.

Digital devices, initially considered simply as amazing technical tools, are assuming the role of true ‘digital companions’ that accompany the dynamics of everyday life. The present study aims to analyse how devices influence affective representations of intersubjectivity. The 22 subjects who participated in the research were asked to narratively interpret four projective cards inspired by Murray’s Thematic Apperception Test (TAT), into which representations of technological devices were introduced. Leaning on psychoanalytic and interpersonal theory, the content analysis of the 88 narratives made it possible to investigate how four foundational experiences of subjectivity are influenced by technology: Childhood, Couple, Self-image, and Traumatic event. The exploration of the dynamics related to the digital object took into account affects, the relevance given to the digital object in the narrative, and its function in relation to interpersonal life. The results show that technology is an aid insofar as good communication exists on the real interpersonal level but is in no way sufficient as a substitute for the love object. In the life of a couple, the digital object becomes a source of conflict, on which the female protagonist, in particular, develops an intrusive dependence, or it is used as ammunition to break up the relationship, generating potentially traumatic experiences. However, there is no shortage of narratives in which devices have been used to immortalise positive aspects of the self, maintaining a genuine relational openness that is not dependent on narcissistic dynamics of external recognition.

This article examines the roles and applications of various types of psychological tests in personality assessment, particularly contrasting projective tests with objective tests. Psychological tests are not intended to determine pass or fail outcomes, but rather to gain a deep understanding of an individual’s psychological aspects. Projective tests, such as the Rorschach Inkblot Test and the Thematic Apperception Test (TAT), are utilized to reveal latent personality traits through ambiguous stimuli. In contrast, objective tests like the Minnesota Multiphasic Personality Inventory (MMPI) and the Edwards Personal Preference Schedule (EPPS) are designed to produce consistent and quantifiable data. This study employed a library research method, reviewing both primary and secondary sources to provide a comprehensive overview. In counseling practice, the choice of psychological test depends on the assessment goals and the client's conditions. The article emphasizes the necessity for professional competence and ethical considerations, including cultural sensitivity and the ability to accurately interpret test results.

Abstract Background Modification of psychosocial risk factors is an integral part of preventive cardiology. Through psychosocial interventions lifestyle changes can be facilitated with emphasis on the acquisition of purpose in life which may be associated with improved prognosis in cardiovascular disease. Purpose Τo examine the effect of interdisciplinary psychotherapeutic intervention in patients (pts) with increased cardiovascular risk. Patients and Methods: 20 pts were studied (18M/2F), age 55±10, 35-70 years, 50% with a history of myocardial infarction, 50% with a diagnosis of hypertension and/or dyslipidemia. Patients participated in a psychotherapeutic-educational group (Heart-Mind) coordinated by a cardiologist trained in systemic therapy approach and a psychotherapist. Group members participated in 10 (two-hour) meetings twice per month. The topic of each meeting was chosen by the group coordinators and dealt with risk factors (stress, smoking, diet, relationships, anger, expression of emotions). For the initial stimulus individual drawing, music and listening to life scenes were used. Group Therapy (SCIT), Self-Help Group and Mindfulness-Type Relaxation techniques were used. At baseline and at the end of the cycle, group members completed the validated Purpose in Life Questionnaire (PILQ) and Resilience Questionnaire (RESQ). The TAT (Thematic Apperception Test) evaluation method was also used which is a valid projective test to reveal an individual's perception of interpersonal relationships. Results There was a significant improvement in PILQ score comparing final vs baseline assessment (112±11 vs 104±14, p=0.014). There was also a non-statistically significant trend towards an improvement in final vs baseline RESQ score (166±24 vs 156±25, p=0.113). According to TAT qualitative analysis there was an impressive change in the participants stories. Instead of feeling incompetent, they revealed their anger and discomfort as they realized the pressing conditions of the context. Conclusion Heart-Mind interdisciplinary approach in the form of group psychotherapy may be a valuable intervention to facilitate clinically important lifestyle changes in cardiovascular disease mainly via an enhanced sense of purpose in life. A Heart-Mind interdisciplinary approach may by introduced as a new method of psychosocial intervention to be part of cardiac rehabilitation programs.

This study evaluates the process and outcomes of Cognitive Behavioral Therapy (CBT) for a client diagnosed with Social Anxiety Disorder (SAD). The client’s challenges, emotional states, and behaviors in social environments from childhood through adolescence are examined in detail. During the CBT process, strategies such as thought awareness, cognitive restructuring, and social skills development were employed. At the beginning and throughout the therapy, projective assessment tools like the Thematic Apperception Test (TAT) were utilized to analyze the client’s inner world and formulate an effective treatment plan. As a result of the therapeutic process, significant reductions in the client’s social anxiety symptoms were observed, along with more positive experiences in social interactions. The findings support the effectiveness of CBT as a treatment method for social anxiety disorder. However, considering the study’s limitations, further research involving larger populations and long-term follow-ups is recommended.

IntroductionDetection for individuals at ultra-high risk for bipolar disorder (UHR-BD) is crucial due to the exploration of potential biomarkers at the early stages of bipolar disorder, including language abnormalities. Formal thought disorder (FTD) is an important symptom that can be observed in BD, which may be mildly noticeable during the early stages of the disease. Automated methods have demonstrated the ability to evaluate FTD in psychotic disorders and can also be employed to evaluate FTD in the speech of individuals at UHR-BD.ObjectivesThis study aimed to investigate the differences in language between UHR-BD and healthy controls (HC) using natural language processing (NLP) methods.MethodsWe collected speech samples from 20 individuals at UHR-BD and 20 HC during descriptions of eight Thematic Apperception Test (TAT) pictures, which were then manually transcribed. After transcribing the text, word2vec was used to convert it into vectors. The semantic similarity between words was calculated using a moving window approach to windows of words sized 5-10. Finally, the mean and variance of similarities were determined.ResultsThe variances of similarities in the windows of 5 to 9 were increased in UHR-BD (p=0.004, p=0.005, p=0.01, p=0.02, and p=0.037, respectively). There was no significant difference regarding the mean similarity.ConclusionsTo our knowledge, this is the first study to evaluate language with NLP methods in individuals at UHR-BD. Our findings showed that the variance of semantic similarity differed between the two groups. This indicates NLP methods may be used in the UHR-BD group to detect FTD.Disclosure of InterestNone Declared

IntroductionMore than any other field in medicine, psychiatry is marked by an individual’s life experiences and the cultural context surrounding them. When a patient presents a set of somatic and seemingly unrelated symptoms that can’t be explained by an underlying physical condition, the diagnosis can become challenging. However, when these symptoms are seen through the lense of their particular cultural context and their traumatic family history, these manifestations start to make sense.ObjectivesThis paper aims to examine the relationship between transgenerational trauma and somatic manifestations without an underlying physical condition in an adult female partient N.MethodsIn order to investigate the psychological functioning of the patient N, we conducted a semi-structured interview followed by a set of psychological tests. We administered the Draw-a-Family Picture Test, the Rorschach Test and the Thematic Apperception Test (TAT). We also analysed the patient’s diary entries.ResultsN initially came to us with unexplained somatic symptoms and a generally depressive mood, finding it difficult to discuss certain topics like her sexual issues. The various elements we have collected through the tests and the interviews with the patient N have shed light on an event that occured within the father’s family, an incestuous rape. This event was the cause of the family’s breakdown, and we believe that the depressive symptoms, suicide attempts, as well as the incestuous atmosphere related to the patient N and her family are connected to this event and have continued to be unconsciously transmitted across generations.ConclusionsThis case study showed the importance of taking family history and cultural context into consideration when examining psychological functioning. Family secrets and seemingly unrelated past events can cause a transgenerational trauma affecting the descendants mental and physical health.Disclosure of InterestNone Declared

The puberty period for deaf adolescent requires psychic and physical reorganisation (body experienced, body spoken) as well as in their emotional relationships. The aim is to analyze the unconscious psychic processes in hearing impaired adolescents in order to better understand the issues of libidinal investments and the quality of bodily representations. Three clinical interviews and three Thematic Apperception Test (TAT) as a projective test were conducted with three adolescents met at the National Rehabilitation Center for Persons with Disabilities -Etoug-Ebe (CNRPH) in Yaoundé, Cameroon. The results show that bodily experiences and representations seem to function as vulnerabilities for these hearing-impaired adolescents. When interacting with family and peers, there is a disinvestment in objects in favour of an overinvestment in narcissism (narcissistic withdrawal).

Background:Thematic apperception test (TAT) is a personality assessment measure widely applied in various clinical conditions. By analyzing written stories, clinicians can unveil the unconscious dynamics of the mind, including unconscious needs, presses, emotions, and ego defense mechanisms. Natural language processing (NLP) encompasses text feature extraction techniques, such as tokenization, stemming, lemmatization, and removal of stopwords. Recently, NLP-based methods have gained popularity among researchers for analyzing psychological attributes and predicting human behavior. As the TAT is one of the most extensively utilized projective psychological tests with many clinical applications, it is pertinent to explore the potential impact of NLP on its scoring process.Aim:To assess if NLP-based algorithmic decision support can be used to accurately and precisely score across psychometric dimensions of TAT.Materials and Methods:An NLP-based algorithmic decision support system (NBADSS) was initially designed using the Python-based library “nltk.” Subsequently, 87 healthy participants aged 17–40 years were selected using purposive sampling. Personal history and background information were collected from each participant before they underwent psychometric assessments using the TAT. The TAT protocols were manually analyzed and then analyzed with the help of NBADSS by another researcher. Lastly, the scoring procedures’ findings were compared and statistically analyzed using Cohen’s Kappa test and ROC curve analysis.Results:The findings suggest that NBADSS is a valuable adjunct to quantifying TAT protocols objectively. NBADSS is found to be highly sensitive and specific in assessing needs, pressures, emotions, and defense mechanisms present in the stories.Conclusion:NBADSS is an objective means of uncovering underlying intrapsychic conflicts projected through TAT stories.

Pain and its chronicity are determined by a combination of organic diseases and the psychological suffering of the individual.It is an unpleasant sensory and emotional experience associated with actual or potential damage to a specific region of the body.The objective of this research was to explore the subjective experience of helplessness and pain perception in patients with chronic low back pain.A qualitative clinical study was conducted at a Spine Outpatient Clinic within a highly complex Hospital Service.The study included 10 male volunteer participants diagnosed with herniated discs and experiencing chronic low back pain.Data collection involved anamnesis, semi-structured clinical interviews, administration of the Visual Analogue Scale for Pain (VAS), and a reduced version of the Thematic Apperception Test (TAT).The perception of intense pain, as expressed during the interviews and through the VAS, was found to be related to experiences evoking feelings of helplessness, such as failed medication and surgical treatments, withdrawal from daily routines, and a decline in quality of life.In the TAT, narratives of helplessness were identified in participants' life stories, particularly in their accounts of treatment failures and disease progression.The findings underscore the importance of comprehensive health care that addresses the subjective aspects of the illness process.Furthermore, they highlight the need for psychologists to be integrated into interdisciplinary health care teams, providing psychological interventions for patients and their families with a focus on the emotional and psychosocial dimensions of pain.

This case series investigates the psychopathology of Agoraphobia by analysing the psychological profiles of three individuals undergoing treatment, selected for their diverse clinical presentations. We systematically utilized the Thematic Apperception Test (TAT) and the Temperament and Character Inventory (TCI) to examine underlying psychological and temperamental correlates.Agoraphobia often stems from stressful events like grief; a link possibly intensified in adult males experiencing instability. TAT narratives consistently, yet variably, reflected core conflicts: a deprived environment, and a passive, helpless, dependent hero. Themes included a need for succorance, fear of rejection/loss of possession, and struggles with controlling parental authority. Specifically, the fear of loss was tied to grief, potentially fuelling the