house-tree-person projective technique a validation of its use in occupational therapy

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House-Tree-Person Projective Technique: Aa ration of its Use in Occupational Th *a yby Helen Polatajko and Ethel Kaiserman

The acute care psychiatric settingrequires that the occupational thera-pist comes to an early decision re-garding client treatment. In order todo this, the occupational therapistneeds to have available efficient, re-liable and valid evaluation tools.Projective techniques have oftenbeen used in occupational therapyfor evaluation. Symbols are felt touncover the ideas and feelings of anindividual. Rosenfeld 1982) wrotethat projective tests help in the es-tablishment of the individual's

Helen Polatajko, PhD., OT(C), is an AssociateProfessor, in the Department of OccupationalTherapy, Faculty of Applied Health Sciences,cross appointment to Department of Educa-tional Psychology Faculty of EducationUniversity of Western Ontario, London,Ontario.Ethel Kaiserman, B.O.T., OT(C), is anOccupational Therapist, with CommunityOccupational Therapy Associates, Toronto,Ontario. At the time of the study she was theSenior Occupational Therapist, Psychiatry,Occupational Therapy Services, UniversityHospital, London, Ontario.

present concept of self and environ-ment as well as his emotional self:It has been considered that the ex-pression of ideas and feelings whichare not completely understood bythe individual or currently accept-able to the individual is possible

The H.T.P. data werebeing used to develop anO. T. problem list and toselect O. T. treatmentstrategies.

through the use of symbols (Mosey,1 9 6 8 . Unfortunately, at the presenttime, none of the projective testsdeveloped specifically for the use inoccupational therapy, are standard-ized or well researched.

The House-Tree-Person Projec-tive Technique (H-T-P) provides aninstrument with a well-standardizedsystem of administration. This in-

strument was developed in 1 948 byBuck, a psychologist, primarily as atest of intelligence. However, asmore exact tests of intelligence weredeveloped, it ceased to be used forthis purpose. Rather, its secondaryuse, the identification of personalitytraits and factors, predominated. Ina formalized manner, the client isasked to draw first a house, then atree and finally a person. This isfollowed by the `post-drawing inter-rogation' consisting of 64 specificquestions and a follow-up of anyleads resulting from the answers tothese questions. The drawings, to-gether with their responses to thequestions, are then interpreted toprovide data concerning the per-ceived developmental, traumatic orenvironmental problems of theclient. Jones 1981) has provided amanual to guide these interpreta-tions.The H-T-P has been in use byoccupational therapists at UniversityHospital, London, Ontario, as partof an assessment procedure with

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acute psychiatric clients. The thera-pists felt that the information col-lected had implications for occupa-tional therapy treatment. Thus,H-T-P data were being used todevelop an occupational therapyproblem list and to select occupa-tional therapy treatment strategies.Subjectively, the therapists foundthe use of the H-T-P to be an enjoy-able and beneficial process giving

them greater insight into theirclients' problems and facilitatingrapport. It was also felt to providea forum for the establishment of aconsensus between therapist andclient regarding further assessmentand the treatment program. Howev-er, the literature provided no empir-ical evidence to support the use ofthe H-T-P in this manner. The pur-pose of the study was to investigatethe validity of the H-T-P in identify-ing functional problems.Literature Review

Initially, much of the work on theH-T-P dealt with its use as a test ofintelligence. However, as indicatedabove, with the advent of more validintelligence tests, its use and subse-quently the research in this areadecreased a good deal (Kuhlman &Bieliauskas, 1976; Kline & Svaste,1981). This literature is not of inter-est here and will not be discussed.Of interest here is the use of theH-T-P as a method of identifyingstress factors and personality char-acteristics and its use in psychiatricoccupational therapy.As with many projective tech-niques, the H-T-P received its impe-tus from psychoanalytical theoryand evolved from empiricism andpractical clinical observations(Robin & Haworth, 1971). Symboli-cally potent concepts such as house,tree and person are thought to besaturated with the emotional andideational experiences associatedwith the personality's development,the drawing of these images compel-ling projection on the part of thedrawer (Hammer, 1978). In regardto his choice of the specific items,Buck (1981) considered that thehouse, tree and person: a) were itemsfamiliar to all; b) were more will-

ingly accepted than other items, asobjects for drawing by subjects of allages; and c) stimulated more frankand free verbalization than did otheritems.

As Hammer (1978) describes, thehouse, as a dwelling place, has beenfound to arouse within the subjectassociations concerning home lifeand intra-familial relationships. Thedrawing of the house may reflect thesubject's domestic situation in rela-tionship to his spouse or the child-hood relationship to parental figuresmay still be apparent as residualattitudes. The drawing of the treeappears to reflect the subject's relati-vely deeper and more unconsciousfeelings about himself, whereas thedrawn person becomes the vehiclefor conveying the subject's closer-to-conscious view of himself and hisrelationship with his environment.In this manner, a picture of theconflicts and defenses as set in thehierarchy of the subject's personalitystructure is provided.The research evidence to supportthe validity and reliability of theH-T-P in its use in the identificationof personality factors or stress factorsis scant and can be easily criticized.Nevertheless, based on researchavailable at the time the last review-er of the H-T-P for the Mental Mea-surements Year Book concluded thatthe H-T-P is a valuable tool:

The H-T-P is now, and no doubt willcontinue to be, used as a rewardingclinical technique in work with bothadults and children. The amount ofmeaningful projective data to bederived from the drawings (and theinquiry, if used) will depend on theexperience and o ri entation of the cli-nician. The test can se rv e as a non-threatening `opener' before more for-mal testing (Haworth, 1965, p. 436).It should be noted that this review

is quite old. This is reflective of theevolution of projectives in general,i.e., there was a loss of interest insuch tests for a period of time dueto the difficulty encountered in es-tablishing rigorous evidence of thereliability and validity of such tests(Robin and Haworth, 1971).There have been some studiesconcerning the H-T-P in the morerecent past. A number have used theH-T-P as a measure of change with

a variety of patient populations. Forexample, Gording and Match (1968)reported on a preliminary studyusing the techniques of free-handfigure drawings of a house, tree andperson (H-T-P) to investigate per-sonality changes in 33 contact lenswearers. Ernst, Beran, Badashi, Ko-sovsky and Kleinhauz (1977) usedthe H-T-P with elderly people witha diagnosis of "chronic brain syn-drome", to investigate the effects ofbi-weekly sensory stimulation andgroup therapy over a period of threemonths. Perkins and Wagemaker(1977) administered the H-T-P fourtimes to a chronic schizophrenic un-dergoing hemodialysis. Platzer(1976) used the H-T-P in pre/posttest fashion with 40 subjects withdeficits in gross-motor skills andself-concept, randomly assigned toexperimental and control groups todetermine program effectiveness.All of the above investigatorsreported changes due to treatment,having confidence in the test-retestreliability of the H-T-P. However,these data cannot clearly be inter-preted as support for the instru-ment's test-retest reliability. Suchdata is difficult to obtain due to thenature of both the instrument andits intended use (Haworth, 1965).

A number of studies have used theH-T-P to identify differences in per-sonality between various groups.Wildman, Wildman and Smith(1967) asked hospital ward person-nel to select 30 extroverted patientsand 30 introverted patients. Bothgroups were asked to draw same sexdrawings according to H-T-P testinstructions. Extroverts did not makesignificantly larger drawings thanintroverts. Even when extreme casesof expansiveness or constriction wereused, the predictions of the H-T-Pwere only slightly above chance.Davis and Hoopes (1976) com-pared the H-T-P drawings of amatched sample of 80 deaf and 80hearing, 7-10 year olds to assessdifferences related to the handicap,and the capacity of the H-T-P todistinguish between children ratedby their teachers as poorly adjustedand those rated well adjusted. Nodifferences were found between deafand hearing children in the drawing

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CJOT Vol 53 No 4of the ear or mouth of the humanfigure, although there were signifi-cant differences in the drawing of thebranch structure of the tree. Also, nodifferences were found in the num-bers of indicators of disturbance be-tween the drawings of the subjectsrated as more and less well adjusted.

Kuhlman and Bieliauskas (1976)administered the H-T-P to 30 blackand 30 white adolescents, matchedfor sex, age, intelligence and socio-economic level. No significant dif-ferences were found between the twogroups on either the H-T-P, IQ mea-sures or the adjustment ratings.

Hoover (1978) attempted to con-struct a composite personality profilefor skydivers. Eighteen active ' sky-divers (median age 24-6 years), wereadministered the Rorschach,'' theHand, the H-T-P and Draw-A=Per-son tests. No statistically significantdifferences were found between theskydivers and a matched group ofcontrols.Gasparrini, Shealy and Walters(1980) administered the H-T-P to 17right hemisphere brain-damagedpatients, 19 left hemisphere brain-damaged patients and 23 non brain-damaged medical patients. Statisti-cal analyses revealed significantdifferences between groups in sizeand spatial placement of drawings.Blain, Bergner, Lewis and Gold-stein (1981) conducted a study todetermine whether the H-T-P mightbe used as a means to identify physi-cally abused children. Protocols of32 abused children, 32 nonabusedbut disturbed children and 45 ap-parently well-adjusted children. (ages5-12 years) were examined for thepresence of 15 objectively scorableitems that emerged as good potentialdiscriminators from an earlier pilotstudy. Results of several statisticalanalyses indicate that (1) items takenindividually discriminated stronglybetween abused and well-adjustedsubjects, but not between abusedand non-abused but disturbed sub-jects; and (2) the 6 most discrimi-nating individual items, discrimi-nated reasonably well betweenabused subjects and both of theother groups.

In the six studies above, the inves-tigators assumed differences be-

tween the groups being contrasted.Three of the studies found somedifferences (Davis et al. 1975;Gasparrini et al. 1980; and Blain etal. 1981). In all three studies thegroups being contrasted were credi-bly different in some way, thus onecould assume the findings to supportthe H-T-P as a valid indicator ofpersonality factors. However, it mustbe remembered that unless there areother external indicators of such dif-ferences, the findings remain equiv-ocal.Similarly, for the studies thatfailed to show differences betweengroups it cannot be determined,from these studies, if differences didindeed exist or if the findings werevalid.

In some instances theH. T.P. missed problemswhile in others itidentified uniqueproblems not noted bynursing or O. T.Still other studies used the H-T-Pto investigate the characteristics of

a specific population. Doorbar(1967) used the Wechsler Adult In-telligence Scale, the Thematic Ap-perception Test (TAT) and theH-T-P with 34 transexuals.Tropauer, Franz and Dilgard (1970)studied 20 children with cystic fibro-sis and 23 mothers of such childrenusing psychiatric interviews and theH-T-P. Ullman, Moore and Reidy(1977) compared the performance of10 adult subjects with chronic atopiceczema with matched controls on theMMPI, H-T-P, selected TAT cardsand an open-ended psychiatric in-terview. Seligman (1979) examinedpersonality and cognitive charac-teristics of black foster children usingthe Bender Gestalt Test, the H-T-P,the Wide Range Achievement Test,the Rorschach, a specially designedsentence completion inventory, theWeschler Intelligence Test and anextensive interview.These studies indicate the confi-dence of their investigators in the

H-T-P's ability to assist in the identi-fication of characteristics. However,they do not substantiate this, partic-ularly since these studies used theH-T-P in conjunction with a numberof other instruments and no clearindication is given of the relativecontribution of the individual testsor the correlation between the tests.Only a few studies looked at theidentification of stress factors usingthe H-T-P. Cooper and Caston(1969) studied the size of humanfigure drawings before and afterstress, (the stress being the an-nouncement of impending heart sur-gery). They found a trend for post-stress drawings to be larger thanpre-test drawings. Peyru and DePastrana-Borrero (1977) proposed apsychotherapeutic method centredon the evaluation of changes in thepatients central oedipal conflict.They used a battery of psychologicaltests administered at regular inter-vals during the course of therapy;the H-T-P, the Bender-Gestalt Test,the Rorshach and the PhillipsonTest, to identify stress in the formof a focal oedipal conflict.

Finally one study was found whichlooked at the significance of a partic-ular symbol. Devore and Fryrear(1976) compared the H-T-P draw-ings of 1,844 juvenile delinquentsand a sample of the adolescents whodrew the tree with a hole or scar to76 adolescents who drew a tree withno hole or scar. The two groups werecompared with respect to 22 vari-ables, including age, sex, urban orrural residence, total number of si-blings, reading placement and 8MMPI scales. The two groups dif-fered significantly on two variables:IQ and the mania scale of theMMPI. Subjects who drew a treewith a hole were significantly moreintelligent and scored lower on themania scale.

As is evident from the above liter-ature, the summary of the H-T-Pliterature by Haworth in 1965 stillapplies. The studies that exist havea number of methodological flaws,many of which are inherent to theinvestigation of projective tech-niques. Consequently, little or noexternal validation exists for charac-teristics or problems identified by the



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CJOT Vol. 53 No. 4

during the assessment. All parts ofthe assessment were administered ona one-to-one basis in a setting similarto that in which the H-T-P was ad-ministered, although in this instance,this was not always a private space.The assessment was administered atvarious times during the workingday, in four separate sessions lastingfor a total of approximately fivehours.

The interv iew, based on the Occu-pational Therapy Services Initial In-terview was always given first. (N.B.This document, as other non-published materials mentioned inthis paper are available from theauthors). This was followed by theconcrete task. In this task, the clientswere told where the tiles were andasked to choose the color and designfor their trivet. They were then giventhe glue and trivet and asked to gluethe tiles onto the trivet. After aperiod of at least 24 hours (time forthe glue to d ry) they were given

grout so that they could finish theirtask. Throughout, discussion be-tween the occupational therapist andclient centred on the choice of colorand pattern, any difficulties exhibit-ed, and the relationship of thesedifficulties to home and work.

The H.T.P. is an efficientand useful tool,

particularly if it isaugmented by a workassessment.

Lastly, the clients were asked toproduce a collage. They were giventhe necessary equipment and askedto pick a theme and pictures thatrepresented that theme. They werethen asked to cut these pictures out

and glue them on paper in any man-ner they chose. Again, there wasdiscussion throughout, focusing onthe theme, the reason for the themeand pictures chosen, their signifi-cance to the client and any difficul-ties in task performance.At the end of this process, theoccupational therapist generated anoccupational therapy (OT) problemlist and placed it on the client's chart.The RO did not have access to thecharts at this point in the study.

Nursing Evaluation:This evaluation was carried outwithin 48 hours of the admission of

the client to the unit. The evaluationwas always carried out on a one-to-one basis by the nurse assigned tothe client. She/he did a nursing his-tory and then generated the nursingproblem list which was placed on theclient's chart at that time.



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Creation of the functional termsDictionary:Given the difference in terminol-ogy employed by the three profes-sions involved in creating the 3

problem lists, (i.e., psychology in theH-T-P, occupational therapy in theO.T. assessment and nursing in thenursing evaluation), it was necessaryto create a dictionary' of terms. Par-ticularly, it was the purpose of thisdictionary to provide a reference forthe translation of H-T-P terms intoOT terms. Initially, a one for onetranslation was planned, however,this proved to be impossible. Conse-quently, it was necessary to establisha list of major categories usingoccupational therapy functionalwords. Descriptors found on theH-T-P were then grouped underthese categories (see Table 3 for ex-amples).

The dictionary was given to 'ex-perts' (psychiatric occupational ther-apy faculty otherwise not associatedwith this study) to: (1) evaluate the

face validity of the placement ofH-T-P descriptors under the variouscategories and (2) expand the num-ber of categories. The experts werein agreement with the H-T-P termsappearing under the various cate-gories of the dictionary, only recate-gorizing three terms.

The experts also did not createnew categories although they didsuggest the subdivision of the Activi-ties of Daily Living category into twosubheadings (Dependence andIndependence). However, given thenature of the occupational therapyand the nursing data base, thesewere inappropriate subheadingsand, therefore, were not used. Thiswas the dictionary used in all furtherevaluation of the H-T-P problemlists generated.

It should be noted that the use ofthe dictionary resulted in a majorreduction of the data which must bekept in mind in the interpretationof the results of this study. This,however, was unavoidable.

Comparison of Problem Lists:Once all three evaluations werecompleted with a client, the ROtransferred the three problem lists

from their respective sources onto asummary sheet. The RO then com-pared the problem lists and indicat-ed on the summary sheet if there wasagreement between either the H-T-Pproblem list and the OT problem listor the H-T-P problem list ` and theNursing problem list. Often a judg-ment was necessary to deem twoproblems as the same.To validate the judgments of theRO and to remove any possible re-searcher bias, the following stepswere taken by the two investigators:(1) independent of the RO, all prob-lems were extracted from the sum-mary sheets to create separate, de-tached lists of H-T-P problems,nursing problems and OT problems.(2 ) Each of these lists was then takenon its own and the problems thatappeared to be essentially the samewere grouped under one subsumer,e.g., the problems, major depression,reactive depression, depressive neu-rosis and recurrent depression wereall grouped under the subsumer de-pression. (3) These subsumers werethen placed under the H-T-P dic-tionary categories resulting in thecorresponding terms list seeTable 4). From Table 4, it can beseen that a number of subsumerscould not be placed under any ofthe H-T-P dictionary categories. Itwas, therefore, necessary to generatea ninth category called `OTHER'which was added to both the dic-tionary and the corresponding termslist. (4) The corresponding terms listwas then checked against the H-T-Pdictionary. Where there was a dis-crepancy, the categorization of thedictionary obtained. (5) For eachclient, the corresponding list wasthen used to check for matches be-tween H-T-P problems and Nursingproblems and between H-T-P prob-lems and OT problems, as appearingon his/her individual summarysheet. (6) The investigator's problemmatch for each client was then veri-fied against the RO's matched listand percentage agreement betweenRO and senior investigators was cal-culated.



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C J O T Vo l 5 3 No 4The mean percentage agreementbetween the senior investigators andthe RO w as 85.77% with a standarddeviation of 12.80. The mode was10 0% which occurred for 10 clients(25 of the population). This indi-cates fairly good agreement and,therefore, confidence in the data ob-

tained. Where there was adisagreement between the RO andthe investigators, it was the decisionof the investigators as indicated onTable 4 that obtained. This wasdone because Table 4 was generated`blind', whereas the RO's judgmentwas not made blind.These data w ere used to calculatethe parameters of validity: percent-age agreement and percentage ac-counted for.Percentage agreem ent, calculatedby the formula:total number of

matches x 1total number ofH-T-P problems

is simply the percentage of the prob-lems identified by H-T-P that werealso identified by either OT or nurs-ing. Problems unique to the H-T-Plists would automatically reduce thepercentage agreement between thelists. Since it is not known (nor wasit the purpose of this study to d eter-mine) whether the unique problems

are valid problems, this is an impor-tant calculation, a m ethod of calcu-lating which does not penalize theH-T-P for unique problems is alsoimportant.Percentage accounted for, calcu-lated by the formula:

total number ofmatches with

Nursing (or OT)total number ofnursing (or OT)

problemsis the percentage of the problemsidentified by nursing or OT that werealso identified by the H-T-P. Thiscalculation is not influenced byunique H-T-P problems.Comparison of time:

The average time required to per-form each of the evaluations wasestimated as accurately as possibleby the people involved with the ad-

ministration of the assessmen ts andcompared at face value.Materials:

The H-T-P drawing form andpost-drawing nterrogationfolder and scoring folder A Catalog for the QualitativeInterpretation of the House-Tree-Person (H-T-P) (Jolles,1981) Functional Terms DictionaryO Pencils and erasers Tile trivet 6" x 6" trivet, 121 5/16" square tiles of variouscolorsO GlueO GroutO A sheet of paper 18" X 24"O MagazinesO Scissors

ResultsThe number of problems identi-fied by each of the three methodsof assessment per client appear inTable 5. As can be seen, the H-T-Pidentified the largest number ofproblems but in all cases the actualnumber of problem s was small.The observation that H-T-P tend-ed to identify more problems indi-cated that there were problemsunique to the H-T-P, i.e., problems

not identified by either nursing orOT. At the same time, there weremissing problems, i.e., problemsidentified by nursing or OT that werenot identified by the H-T-P. TheH-T-P identified an average of twounique problems per client over theteam effort and missed an averageof 1.03 of the client problems asidentified by nursing and an averageof .95 of the client problems as iden-tified by O T (see Table 5).

agreement

accounted for



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The percentage agreement andpercentage accounted for appear inTable 6. As can be seen, in all cases,the percentage accounted for is thegreater. Also, both percentageagreement and the percentage ac-counted for between OT and theH-T-P were higher than for nursing.

The nature of the problems iden-tified by the H-T-P spanned all thefunctional categories set out at thecreation of the dictionary as did thenature of the problems unique to theH-T-P and the nature of missingproblems. In the majority of casesthe missing problems appeared in-frequently (see Table 7).

Of interest in Table 7 are thecategory specific discrepancies be-tween H-T-P and Nursing and OTproblems. Namely, sexual problemswere identified 30 times by theH-T-P and 28 of these were uniqueto the H-T-P. Likewise, 14 of the 39self-concept problems were identi-fied by the H-T-P alone. Alternati-vely, mood/affect problems were

missed 12 times compared to nurs-ing. These misses were comprised of4 different problems. Work problemswere identified 17 times in the H-T-Pbut were missed 21 times when com-pared to the OT lists. There were 6different problems which weremissed repeatedly.

The H-T-P proved to be a consid-erably more efficient tool comparedto the OT assessment. The averagetime taken to administer the H-T-P,including the post-drawing interro-gation was 40 minutes. The interpre-tation of the projective material andthe answers to the questions tookapproximately another 50 minutesper client, for a total of 90 minutesfor the complete administration ofthe H-T-P. The OT assessment tookapproximately 5 hours (300 minutes)to complete per client.

DiscussionThe H-T-P is clearly a more effi-cient method of evaluation than the

OT assessment, taking 3+ hours lessto complete. Of particular impor-tance here is the finding that thisgain in time is not accompanied bya great loss of information. TheH-T-P identified 75.19% of the prob-lems identified by the OT assess-ment. Given that OT typically onlyidentified four problems, this meansthat only one problem was missed.If this is counter-balanced with theobserv ation that the H-T-P typicallyidentified two additional problemsover the OT list, it suggests that theH-T-P is as proficient at identifyingproblems as is the OT assessment.

In terms of the unique problems,it must be remembered that therewas no method available to assessthe validity of these problems. How-ever, the observation that many ofthe unique problems were sexualproblems and, indeed, only 2 of the30 sexual problems identified by theH-T-P were identified elsewheresuggests that the unique problemsmay be indicative of areas where theH-T-P is more proficient.

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In terms of the missing problems,a similar phenomenon is suggested.The H-T-P only identified workproblems in 17 instances but missed21 occurrences of the work problemsidentified by OT. This again couldbe interpreted as a statement on therelative areas of proficiency of thetwo instruments.Thus, it would appear that theH-T-P is an efficient and useful toolrelative to the OT assessment, par-ticularly if it is augmented by a workassessment.

In comparison to the nursing eval-uation, again the H-T-P seems toaccount for a substantial proportionof the problems identified (66.42%)typically missing no problems. (Itshould be noted that the low per-centage agreement relative to amode of zero for missing problemsis more reflective of the small num-bers being dealt with here than ofpoor agreement). The area most fre-quently having missing problemswas mood/affect. This occurred in12 instances although there wereonly 4 different problems. Since theH-T-P did identify 34 mood/affectproblems, 8 of which were unique,it suggests that the H-T-P is notdeficient in this area but that specificproblems should be looked at - suchan analysis was beyond the scope ofthis paper.In interpreting the results of thisresearch and in considering the im-plications of these for the identifica-tion of specific problems, the proce-dures used here must beremembered. It must be recognizedthat in the process of creating thedictionary, specific problems wereincorporated into major categoriesand thus a lot of specific data werelost. While this was a necessary pro-cedure to allow for comparisons be-tween lists, it resulted in reductionof data and loss of specificity. Thus,the results presented here can onlybe considered in general terms.

ConclusionPercentage of agreement between

Nursing and H-T-P and between OTand H-T-P are low. This is assumedto be, in part, a consequence of thenumber of unique problems identi-

fled by the H-T-P. The percentageaccounted for was considerablyhigher. Since this parameter is notaffected by unique problems, it isconsidered to be more meaningful.It is important to remember that thelatter is true only if the unique prob-lems identified by the H-T-P are trueproblems. If not, then percentageagreement is a more accurate reflec-tion of the performance of the HT-P. This study was not intended toverify whether unique problemswere true or false. However, sincethe unique problems were largely inone area, it seemed to reflect thedifferences in the orientation of theinstruments (e.g., sexual problems).Thus, the percentage accounted formay indeed be the more significantparameter.In summary: The problems iden-tified by the H-T-P were the sameas those identified by nursing andOT in 66.4% and 75.2% of the casesrespectively. In some instances, theH-T-P missed problems while inothers it identified unique problemsnot noted by nursing or OT. There-fore, for a thorough assessment, allthree procedures should be used.However, given the high percentageof OT problems accounted for by theH-T-P, if a quick assessment is re-quired, the H-T-P alone would beappropriate - taking special care tolook for work-related problems.

REFERENCESBieliauskas, V.J. (19 80). The House Tree Per-

son (H-T-P) research review: 1980 edition,Los Angeles, Western Psychological Serv-ices.Blain, G.H., Bergner, R.M., Lewis, M.L. &Goldstein, M.A. (1981). The use of objecti-vely scorable House-Tree-Person indica-tors to establish child abuse. Journal ofClinical Psychology, 37, 673.Buck, J.N. (1981). The House-Tree-Person

Technique - revised manual: Los Angeles,Western Psychological Se rv ices.Cooper, L. & Caston, J. (1969). Size of figuresdrawn before and after stress. Perceptual

Motor Skills, 29, 57-58.Davis, C.J. & Hoopes, J.L. (1976). Compari-son of House-Tree-Person drawings ofyoung deaf and hearing children. SchoolPsychology Digest, 5, 29-35.Devore, J.E. & Fryrear, J.L. (1976). Analysisof juvenile delinquents' hole drawingresponses on the tree figure of the Hou se-Tree-Person Technique. Journal of ClinicalPsychology 32 731-736.

Doorbar, R.M . (19 67). Psychological testingof transsexuals: a brief report of resultsfrom the Wechsler Adult IntelligenceScale, The Thematic Apperception Test,and the House-Tree-Person Test. Transac-t ions of the New York Academ y of Sciences29 455-462.Ernst, P., Beran, B., Badash, D., Kosovsky,R. & Kleinhauz, M . (1977). Treatment ofthe aged mentally ill: further unmasking

of the effects of a diagnosis of chronic brainsyndrome. Journal of the American Geria-trics Society, 25, 466-469.

Gasparini, B., Shealy, C. & W alters, D. (19 80).Differences in size and spatial placementof drawings of left versus right hemispherebrain-damaged patients. Journal of Con-sulting Clinical Psychology, 48, 670-672.

Gording, E.J. & Match, E. (19 68). Personalitychanges of certain contact lens patients.Journal of the American Optometric Associ-ation, 39, 266-269.

Hammer, E.F. (1978). The Clinical Applica-tion for Projective Drawings. Charles C.Thomas. Springfield.

Hammer, E.F. (1981). The House-Tree-Person(H-T-P) clinical research manual. Los An-geles. Western Psychological Se rvices.Haworth, M .R. (1965). H-T-P: House-Tree-Person Projective Technique. In O.K.Buros (Ed). The Sixth Mental Measure-

ments Yearbook. Highland Park, N.J.:Gryphon Press, 6:214, 4 34-4 36.Hoover, T.O. (1978). Skydivers: Speculationsof Psychodynamics. Perceptual Motor

Skills, 47, 629-630.Jokes, 1. (1981). A catalog for the qualitativeinterpretation of the House-Tree-Person

(H-T-P). Los Angeles. W estern Psycholo-gical Services.Kline, P. & Svaste, X.B. (19 81). The House,Tree, Person Test (HTP) in Th ailand with4 and 5 year old children: A comparisonof Thai and British results. British Journal

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AcknowledgementsThe authors wish to acknowledge wi th appre-c iat ion the on going assistance, d i rec t ion andencouragement of Arlene Shimeld. Manager.Occupational Therapy Se rv ices. Unive rs ityHospital.

RsumCette tude a t mene dans le but de dterminer si le test de dessin valeur projective H.T.P. (House, Tree, Person) de Buck s est avrune mthode permettant d identifier d une manire valable et efficaceune liste de problmes pour le traitement d ergothrapie. cette fin,on a m en une tude compara t ive double insu. Un chercheur en t rana administr le test de personnalit H.T.P. quarante clients dont ilne s avait rien, ces cl ients prsentaient des problmes psychiatr iques aigus.Ils ont galement t valus sur le plan de l ergothrapie par leurergothrapeute et sur le plan des soins infirmiers par l infirmire quileur tait assigne. Dans ch acun d es cas, une l iste de problm es a tdresse, ces l istes ont alors t compares af in de df inir le pourcentagede con cordance e ntre les problmes. ainsi que le pourcentage de problmesdj connus et le temps ncessaire pour fournir les diffrentes listes.Le pourcentage de concordance e nt re les lis tes de proh cn es obtenuesgrce au test H.T.P. et par l 'valuation su r le plan des sinu s infirmiers.et le pourcentage de concordance en tre les listes obtenues par le testH.T.P. et par l valuation ergothrapeutique ont t respectivement de32.88 et de 47.18. Les pourcentages des problmes connus ont t e66.42 et de 75.19 respectivement. Les diffrences sont examines. Letemps ncessaire pour administrer le test H.T.P. s est avr considrable-ment infrieur l 'valuation ergothrapeutique traditionnelle. Pourconclure, le test H.T.P. s est avr un outil de dpista apprciable.

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house-tree-person projective technique a validation of its use in occupational therapy

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