“I'm Feeling Great!”

This chapter presents the case of “Tuula,” a 43-year-old physician assessed twice over a five-year period following multiple complaints of workplace alcohol use and professional misconduct. Despite initial self-reports and test data suggesting intact functioning, performance-based assessment—particularly the Rorschach—revealed signs of mild cognitive decline, affective constriction, interpersonal dysfunction, and avoidant coping. A dramatic unmasking event during the first assessment confirmed significant alcohol dependence and occupational impairment. In the follow-up assessment five years later, Tuula was more candid, and findings indicated widespread cognitive deterioration, moderate to severe depression, and significant difficulties in emotion regulation and interpersonal functioning. The second Rorschach confirmed many features seen earlier—constriction, simplistic processing, poor stress tolerance—but also revealed greater perceptual accuracy, emotional insight, and more adaptive engagement. The case highlights the unique value of the Rorschach in capturing subtle and dynamic aspects of psychological and neuropsychological functioning that elude self-report and cognitive tests, and illustrates how it can support differential diagnosis, track changes in psychological functioning over time, and contribute meaningfully to collaborative, therapeutic assessment in complex cases.