 This paper highlights the clinical signs of suicidal risk behaviour assessing a Rorschach protocol.  A 21-year-old female with a diagnosis of borderline personality disorder (BPD) and a history of suicide attempt, is assessed upon an accurate clinical and personality evaluation with the Rorschach  projective method.
Authors discuss by a clinical and psychoanalytical perspective the role of projective identification and the suicidal risk signs in a Rorschach protocol, for appropriate diagnosis, manage and prevent of this phenomenon.


Mento, Carmela

Settineri, Salvatore

This paper highlights the clinical signs of suicidal risk behaviour assessing a Rorschach protocol.  A 21-year-old female with a diagnosis of borderline personality disorder (BPD) and a history of suicide attempt, is assessed upon an accurate clinical and personality evaluation with the Rorschach  projective method.



Authors discuss by a clinical and psychoanalytical perspective the role of projective identification and the suicidal risk signs in a Rorschach protocol, for appropriate diagnosis, manage and prevent of this phenomenon

Carmela Mento

Salvatore Settineri

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Projective identification and suicidal risk behaviour assessing a Rorschach protocol: a clinical case report.

Università degli Studi di Messina: Open Journals Messina

Mediterranean Journal of Clinical Psychology MJCP 
 
ISSN: 2282-1619 
 VOL IV N.2 (2016) 
 
Projective identification and suicidal risk behaviour assessing 
a Rorschach protocol: a clinical case report. 
 
CARMELA MENTO, SALVATORE SETTINERI 
Department of Biomedical and Dental Sciences and Morphofunctional 
Imaging, University of Messina, Italy  
Email Corresponding author: cmento@unime.it  
Abstract: This paper highlights the clinical signs of suicidal risk behaviour 
assessing a Rorschach protocol. A 21-year-old female with a diagnosis of 
borderline personality disorder (BPD) and a history of suicide attempt, is 
assessed upon an accurate clinical and personality evaluation with the 
Rorschach projective method. Authors discuss by a clinical and 
psychoanalytical perspective the role of projective identification and the 
suicidal risk signs in a Rorschach protocol, for appropriate manage and 
prevent of this phenomenon in personality disorders.  
Keywords: Suicidal risk behavior, Rorschach, Personality disorders.  
  
 
2     Mento C, Settineri S. 
Introduction  
The possibility of predicting suicidal gestures is an important clinical 
problem and requires the observation of a multi-causality of factors such as 
socio-demographic, critical life events, psychological and 
psychopathological.  
The ability to highlight the risk through the psycho-diagnostic method was 
analyzed in the literature, through forms of quantitative detection. The 
appearance of the prediction, however, remains an area of study in the 
developing world, as shown by the literature, in particular through the use of 
projective methods, i.e. the Rorschach method. The Rorschach experience 
involves the sharing of unconscious as conscious and mental contents 
(image) in a tendency for regression and the emergence of defence 
mechanisms. In example, projective identification a role in the infantile 
relationship with the mother. In a pathological use of this mechanism, the 
patient increasingly views the object world as persecutory (Stone & Boyer 
1987).  
In a Rorschach method of the assessment of personality, the analysis of 
unconscious representations, emerging from contact with an image 
unstructured, you can detect predictive signs of suicide risk. In literature 
there are historical studies focused on the analysis of the most frequent 
contained in the protocols with particular reference to table IV and trauma 
(Lindner 1946; Settineri et al., 2013) and VII, the single-sign i.e. color-
shading, transparency and cross section (Rierdan et al., 1978; Hansell et al., 
1988; Bishop et al., 2000), the multiple signs and the qualitative analysis 
(Farberow 1974; Exner & Wylie 1977; Colson & Hurwitz 1973; Conti et al., 
1996; Sarkheim 1955; Sapolsky 1963; Fowler et al., 2001, Yufit & Lester 
2005).  
Projective identification and suicidal risk behaviour   MJCP  3 
The psychodiagnostic of H. Rorschach (1921), in relation to the prediction 
of suicide, is used for both a deepening of the personality of the individual 
and as a contribution to psychiatric diagnosis; in literature is a valuable aid 
in the clinical assessment (Ulett et al., 1950; Cicioni et al., 2016). Study 
reveals specific personality traits i.e. low level of psychoemotional 
processing respect to normal subject. A study of using Rorschach 
concerning adolescent suicide risk, was analyzed in literature by Silberg et 
al., (1992). In literature the constellation of signs included affective 
variables (i.e. color-shading blends, color dominated responses, and morbid 
content) as measures of cognitive distortion, inaccurately perceived, human 
movement responses.  
The study of Hertz (1948) of the Rorschach in a suicidal patients analyzed 
the several patterns i.e. lack of insight, emotional immaturity, intense 
anxiety, depressed states, sex conflict, dysphoric thinking. A systematic 
study reported also depressed states (i.e. Ch response; F-), active conflict 
(i.e. content may indicate awareness of conflict or symbolic), ideational 
syntomathology (i.e. orig-) etc.  
In this study will be analyzed the suicide signs on the Rorschach protocol by 
a single clinical case report.  
Clinical data  
A 21 year-old female with borderline personality structure. Presence of 
demoralization and despair. There are difficulties in interpersonal 
relationships, conflict relationships. Affective immaturity. A family history 
of depression and personality disorder. Reported self-harm episodes in 
childhood (death of a sister). A history of dropping out.  
The psychopathological debut goes back about two years ago, when during 
pregnancy, shows that symptoms characterized by dysphoria, low impulse 
4     Mento C, Settineri S. 
control, aggression, suspiciousness, ideas of reference and jealousy. 
Towards the end of a sentimental relationship it arose a symptomatic 
characterized by thymic deflection and marked anxiety, emotional 
dependency. The Rorschach administration is previous to psychotherapy. 
The trend in psychotherapy is discontinuous.  
Clinical analysis of Rorschach elements  
· Table I time of latency 5’’ "I seem to bat wings" "Legs"  
"It 's as if there was someone in the midst of these wings, but does not seem 
human being is as if he had a suit behind"  
"Wolves, which protect the central figure" The prevalence of achromatic 
color dominates this board (Chf), since the first two responses, there is the 
emergence of anxiety not controlled, just like in the suicide attempt, in 
which there is an emergency instincts of which the subject is conscious. 
This is phenomenally different in pure achromatic color, without control 
(Ch), in clinical terms equivalent free of anguish. Proceeding, emerges the 
scene constructed with a negative content complex (orig -). This could prove 
both to the examiner that the object of the relationship in general. The 
emerging picture of the wolf, highlights from the perspective of archetypal 
passage of a mythological figure, by eating the corpses (hyenas) becomes 
the prey hunter (wolf), with emergence of psychotic elements (orig-).  
· Table II time of latency 1’’ "Puppies kissing"  
"Hearts united under and up two separate hearts" In the table, the subject 
starts with good performances that become persecutory proceeding, as if 
you are unable to keep the image and so resorts to the symbolic (the heart) 
as libido-aggression fusion.  
Projective identification and suicidal risk behaviour   MJCP  5 
· Table III time of latency 2’’ "Puppies kissing. Then I see two hearts united 
under and up two separate hearts " "Two girlfriends" "Here in the middle of 
their two hearts tied in the middle" "To look at me well seem of trans 
because they have breasts but look like men ... are not human" "They give 
me the impression of being magicians, I am fascinated by witchcraft. Here 
below are the black clouds, as if their own prayer of bad things, rites" "A 
little kiss" "Two seahorses on the contrary" In this table the formal fall and 
the identification of the object (content) touches the sexual area and 
highlights uncertainties in the transition from female to transsexual. It also 
appears a thought of archaic type (magician) closer to percepts type schizoid 
and the emergence of psychotic area (orig-). It may be noted in this table, 
the emergence of the archetypal image hardly contained, until the regression 
of thought with a devitalized percept (i.e.bone, pelvis).  
Table IV time of latency 1’’ "Two big feet of a man, of a good monster and 
I see behind a person who manipulates, my mother-in-law" "Serpents" "Two 
dogs" This table is characterized by a persecutory element level archetypal 
image of the negative is the archaic female witch (Mento & Settineri, 2016). 
The following figures have, however, characteristics and therapeutic 
functions (Ronnberg & Kathleen, 2010).   
Table V time of latency 2’’ "A black butterfly" "Two crocodiles with long 
face" Table V suggests how reality is experienced by the patient in 
agonizing fashion. Emerging content have aggressive characteristics and the 
performance of percepts and images emerging outlines the instinctual mode, 
sometimes more or less contained.   
Table VI time of latency 2 ''This distresses me. This gives me the 
impression of a mountain with a cross at the top. It reminds me of my 
grandmother " "Two people and here at the bottom of two girls, however, 
are always the same over there" "Two animals" In this table, sexual content, 
clear and fit verbalized intense anxiety.   
Table VII time of latency 1’’ "My sister and me. Two little girls with head 
feathers " "Two dogs resting on clouds" "A butterfly vague too broad 
wings" "In the hair, under the feathers, there are some ugly faces ... even the 
6     Mento C, Settineri S. 
clouds have ugly faces" This table shows the complex (orig-) originated by 
the negative internalization of the mother figure.   
Projective identification and suicidal risk behaviour MJCP 6  
· Table VIII time of latency 5’’  
“Two animals, like tigers ... .not, however, boh, I do not know, they are 
climbing something"  
"Two hands without thumbs holding paws" "Two feet" "These legs do not 
know why, but the ones that touch your hands are darker" In the table, the 
fall of percept (D) until the emergence of closer complexual psychotic area 
(Dd, hands) and cutting of hands, highlights the guilt accompanied by 
defense of denial mechanisms.  
Table IX time of latency 5’’ "Two angels on a cloud, even if they seem 
unformed faces looking under" "The orange parts seem magicians, could be, 
but I look good, belong to heaven, are pregnant, have a uterus, protect 
something with hands that are not hands" The archaic content and 
complessuale back in the alchemical form (magician) and being pregnant 
and pregnancy.   
Table X time of latency 3’’ "Two caterpillars instead" “Two blue spiders " " 
two crabs "  “two animals that are fighting with antennas with 
hearts" "These Greens look like hares” " two Angels " " These give me my 
son's feeling in stomach (Pink), a fetus that is  playing something (Central 
blue) “ "Two brushes of Barbie"  In the table, the emergence of complex, 
with self-content (my fetus) occurs in the nucleus to psychotic area (orig-) 
in combination with typically elements (pop).  Discussion   
In the clinical case, the emergence of archetypes in relation to psychotic 
contents, reflect on elements of psychotherapy which in this case, should the 
emergence of persecutory type projections since the presentation of Table I. 
Projective identification and suicidal risk behaviour   MJCP  7 
The image contains a double meaning that Rorschach Protocol frees itself, 
such as in female representation from maiden becomes Gorgon (Mento & 
Settineri, 2016). It is important to understand how to read the entire protocol 
you can recognize suicidal risk elements (low time of latency, root canals, 
poorly controlled impulses, projective identifications, orig -, archaic- 
contents, source of anguish).  
In a review of literature, each category of suicidal behavior, contains 
independent risk factors for the severity of the suicide attempt, and their 
combination is most important predictor of suicidal behaviour (Liotta et al., 
2015). The clinical risk factors for suicide are most important elements. The 
literature exploring the association between attempt suicide risk and other 
variables, i.e. several psychological characteristics, history of 
alcohol/substance abuse, psychopathology and personality disorders 
(Linehan et al., 2000; Mento C., et al., 2016). The literature of predictive 
signs of suicide risk, analyzed in quetso work, suggests the importance of a 
comprehensive analysis of the Rorschach protocol, associated with the 
clinical history and a competent rorschach clinicians for a prognostic 
configuration of risk behavior.  
In conclusion, the Rorschach data protocol of clinical case report, can 
provide relevant information of the psychological and psychopathological 
variables to be associated with risk of suicide behavior in a structure of 
borderline personality.  
References  
Bishop, J., Martin, A., Costanza, S., & Lane, R. C. (2000). Suicide Signs on 
the Rorschach. Journal of Contemporary Psychotherapy, 30(3), 289-305.  
Cicioni, R., Valgimigli, S., Donati, C., & Caravelli, T. (2016). Analisi 
qualitativa di 20 protocolli Rorschach di soggetti con tentato suicidio. 
8     Mento C, Settineri S. 
Rivista sperimentale di Freniatria.  
Colson, D. B., & Hurwitz, B. A. (1973). A new experimental approach to 
the relationship between color-shading and suicide attempts. Journal of 
personality assessment, 37(3), 237-241.  
Conti, L., Giannoni, A., Falco, P., Rossi, A., Passi Tognazzo, D. (1996), 
Death between reality and imagination. Rorschach's test in suicide 
attempters, Italian Journal of Suicidology. 6: 83-91.  
Exner Jr, J. E., & Wylie, J. (1977). Some Rorschach data concerning 
suicide. Journal of Personality Assessment, 41(4), 339-348.  
Farberow, N. L. (1974). Use of the Rorschach in predicting and 
understanding suicide. Journal of personality assessment, 38(5), 411-419.  
Fowler, J.C., Piers, C., Hilsenroth, M.J., Holdwick, D.J., Padawer, J.R. 
(2001) The Rorschach Suicide Constellation (S-CON): Assessing various 
degrees of lethality, Journal of Personality Assessment. 76: 333-351.  
Hansell A., Lerner H., Milden RS., Ludolph PS. (1988) Single-Sign 
Rorschach Suicide Indicators: A Validity Study Using a Depressed Inpatient 
Population. Journal of Personality Assessment. 52(4): 658-69.  
Hertz, M.R. (1948) Suicidal configurations in Rorschach records. Rorschach 
research exchange and Journal of projective techniques. 12, 1:3-58.  
Lindner R.M. (1946) Content analysis in Rorschach work. Rorscharch 
Research Exch. 10: 121-129.  
Liotta M., Mento C., Settineri S. (2015) Seriousness and lethality of 
attempted suicide: a systematic review. Aggression and Violent Behavior. 
21: 97-109.  
Projective identification and suicidal risk behaviour   MJCP  9 
Mento, C., Settineri, S. (2016). The Medusa Complex: The head separated 
from the body in the psychopathology of negative affects. Mediterranean 
Journal of Clinical Psychology, 4 (1).  
Mento, C., Lo Presti E., Mucciardi, M., Sinardi, A., Liotta, M.,  Settineri, S. 
(2015). Serious Suicide Attempts: Evidence on Variables for Manage and 
Prevent this Phenomenon. Community Mental Health Journal, 1-7.  
Rierdan, J., Lang, E., & Eddy, S. (1978). Suicide and transparency 
responses on the Rorschach: A replication. Journal of consulting and clinical 
psychology, 46(5), 1162.  
Ronnberg A., Kathleen M., The Book of Symbols: Reflection on archetypal 
images. Taschen. 2010.  
Sakheim, G. A. (1955). Suicidal responses on the Rorschach test: a 
validation study. Protocols of Suicidal Mental Hospital Patients Compared 
with Those of Non-Suicidal Patients. The Journal of nervous and mental 
disease, 122(4), 332-344.  
Sapolsky, A. (1963). An indicator of suicidal ideation on the Rorschach test. 
Journal of projective techniques and personality assessment, 27(3), 332- 
335.  
Settineri S., Lo Presti E., Liotta M., Mento C. (2013). Trauma and the 
Father Image: Fantasies and Complexes in the Rorschach Test. Open 
Psychology Journal, 6, 1-5.  
Silberg, J. L., & Armstrong, J. G. (1992). The Rorschach test for predicting 
suicide among depressed adolescent inpatients. Journal of personality 
assessment, 59(2), 290-303.  
Stone J.S., Boyer L.B. (1987) Projecyive identification: despair, suicide and 
10     Mento C, Settineri S. 
the Rorschach. Rorscharchiana. 16: 46-51.  
Ulett, G. A., Martin, D. W., & McBride, J. R. (1950). The Rorschach 
findings in a case of suicide. American Journal of Orthopsychiatry, 20(4), 
817.  
Yufit, R. I., & Lester, D. (Eds.). (2004). Assessment, treatment, and 
prevention of suicidal behavior. John Wiley & Sons.  
 
 
 
 
 
 
 
 
 
© 2014 by the Author(s); licensee Mediterranean Journal of Clinical Psychology, Messina, 
Italy. This article is an open access article, licensed under a Creative Commons Attribution 
3.0 Unported License. Mediterranean Journal of Clinical Psychology, Vol. IV, No. 2 
(2016). Doi: 10.6092/2282-1619/2016.4.1281  
 


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