“A Middle Finger”

This chapter presents the case of “Ville,” a 21-year-old man assessed in a specialized rehabilitation facility two years after sustaining a traumatic brain injury (TBI) and spinal cord injury in a motor-vehicle accident. An earlier assessment had also indicated attention-deficit/hyperactivity disorder and long-standing behavioral problems. Despite marked improvement in cognitive functioning and daily living skills, Ville continued to struggle with impulsivity, substance abuse, and relational instability. A multimethod assessment, including neuropsychological testing and the Rorschach scored according to Exner's Comprehensive System, revealed a complex clinical picture involving depression and features of a mixed personality disorder. The Rorschach offered critical insights into Ville's simplistic problem-solving, impulsivity, emotional avoidance, social hypervigilance and mistrust, perceptual inaccuracy, and distorted representations of self and others. Notably, it confirmed that TBI-related deficits were no longer present and highlighted the need to focus on persistent emotional and behavioral issues—findings not evident in cognitive or self-report data, but consistent with Ville's history. The case illustrates how the Rorschach can clarify psychopathological complexity, guide rehabilitation planning, and support therapeutic engagement in clients with overlapping neurocognitive and personality difficulties.