T H E PATIENT SPEAKS: PSYCHOLOGIST-PATIENT RELATIONS 385

Although these comments by a former resident of a mental hospital may not be representative (in a strictly statistical sense) of patients-at-large, yet he does afford us some insights into areas that require intensive review by psychologists and related professional persons. He re-arouses questions in us that remain to be answer- ed by a continuing research effort. Will observation of our patient in informal settings contribute to more effective understanding of him? What is the most effective time relationship between LLinformal observation” and “more formal evalqa- tion?” Are we emphasizing immediate “service needs” of an institution to the detri- ment of understanding our patients sufficiently? What measures need be taken to educate the public about the necessity for our functioning on the therapeutic team? What are the psychologist’s functions in orienting the patient to the institutional milieu? These and related questions must be resolved if we are to enhance our re- lationships with patients and other persons concerned with their welfare.

SUMMARY The recorded comments of a former mental hospital patient are presented as a

means of increasing the psychologist’s understanding of his role in various inter- personal relationships. The subject expresses his attitusde on various issues of direct concern to psychologists and offers suggestions for improving the relations between psychologist and patient. His views reinforce the need for more critical evaluation of various functions of the psychologist.

SOCIOMETRIC CHOICE AND THE SZONDI TEST’ DAVID PEARL AND DURAND JACOBS

Veterans Administration Hospital Battle Creek, Michigan

Veterans Administraiion Hospital, Marion, Indiana

PROBLEM The Szondi test, according to the theorizing of both Szondi(4) and Deri@) may

be viewed as a test of interpersonal relations. According to their rationale, factors determining Szondi test behavior of subjects would also underlie the choice-rejection aspects of their interpersonal relations. It would follow then, that subjects with similar Szondi test behavior would demonstrate similarity in their interpersonal eval- uations. Conversely, one would expect those with similar affective judgments of people to be similar in Szondi test choices. The present study was directed at in- vestigating this inference. It was one of several which studied various aspects of sociopsychological dynamics within a privilege ward at a Veterans Administration neuropsychiatric hospital. Hypotheses formulated were:

Subjects with similar affective reactions to their wardmates, as indicated by sociometric analysis, would agree among themselves a significantly greater number of times in their evaluations of Szondi test photographs than would subjects with contradictory or unrelated sociometric choice-reject patterns.

Subjects with similar sociometric patterns would have significantly fewer disagreements in Szondi test choices than those with contradictory or unrelated ward choice patterns.

METHOD Thirty-nine adult male veteran patients assigned to a privilege ward served as

subjects. These patients formed a heterogeneous diagnostic group, including schizo- phrenic, neurotic and characterological diagnoses. All subjects had been ward mem- bers for at least two weeks and had ample opportunity to develop affective attitudes

1.

2.

?From the Veterans Adn~inistration Hospital, Battle Creek, Michigan.

386 DAVID PEARL AND DURAND JACOBS

Category

toward each other. In individual sessions, each subject was initially asked to rate the photographs of his wardmates on a continuum of liking, according to Q technique procedure(3). This was followed by the administration of the Szondi test.

By intercorrelating the sociometric choice patterns of these subjects, it became possible t o determine those with similar, contradictory, and unrelated affective evaluations of the ward population. A choice pattern correlation of .41, being signi- ficant a t the P .01 level was adopted as the criterion of similarity. Forty pairs of subjects with correlations meeting this criterion were selected as constituting those most similar in their inter-personal evaluations. For comparative purposes, a second group consisting of the 40 subject pairs with the largest negative correlations was formed. These two groups represented the extremes of sociometric agreement and any relationship of Szondi to sociometric choice similarity should be demonstrated most clearly by this comparison.

A previous analysis of the sociometric intercorrelations for all 39 subjects had revealed four clusters of patients. The members of each cluster tended to show sig- nificantly similar choice patterns. Conversely, with the exception of cluster 4, their choice patterns tended to show no significant relationship to that of other patients not in their cluster. These clusters may be viewed as representing the types of affect- ive choice patterns within the ward structure. As another test of the hypotheses, it would be expected that cluster members’ Szondi choices should be significantly more similar than those not falling within such a grouping. To permit such comparison, six patients were selected as a control group from the remaining non-clustered sub- jects. The average intercorrelation for these latter was .07 as contrasted to .40 for the cluster subjects.

For these tests of the hypotheses, comparisons were made with respect to the number of (a) agreements for Szondi photos rated as liked, (b) agreements for those rated as disliked, (c) total disagreements (a photograph liked by one and disliked by the other member of the two subjects being compared), and (d) total agreements.

Two approaches were employed in the analysis of this data. In the first, the number of agreements or disagreements were to be viewed as scores, and analyses of variance and comparisons of means were t o be utilized. In the second, these num- bers were to be treated as freqencies and chi squares were to be computed.

RESULTS Data and results of the comparison of Szondi photograph choices for positively

and negatively correlated sociometric pairs are given in Table 1. Analyses of differ- ences between means, utilizing t-tests, disclosed significant differences for three of the four comparisons, namely, total agreements, agreements for disliked photos, and number of disagreements. A chi square analysis of data provided similar results for these comparisons.

Positively Negatively Mean of Mean of Correlated Correlated Positively Negatively t Confidence

Pairs Pairs Correlated Correlated level Pairs Pairs

TABLE 1. COMPARISON OF SZONDI CHOICES FOR 40 POSITIVE AND 40 NEGATIVELY CORRELATED SOCIOMETRIC CHOICE PAIRS

I I

Agreements for “disliked“ photographs

Total number of agreements

Number of disagreements

205 164 5.13 4.10 2.59 P.01

369 315 9.23 7.88 2.26 P.05

145 184 3.63 4.60 2.26 P.05

Agreements for “liked” photographs 1 164 151 4.10 3.78 I 1.03 P.30

SOCIOMETRIC CHOICE AND THE SZONDI TEST 387

Category Means

Group Group Group Group Control F Confidence 1 2 3 4 Subjects Level

Agreements on ‘‘liked’’ photographs 1 3 . 7 4 . 1 5.7 3 .3 3 . 3 1 4.062 Not signif.

Total number of agreements 1 9.5 9 .4 9 .7 7 . 0 6 .2

Agreements on “disliked” photographs 1 5 .8 5 .3 4 .0 3 .7 2 .9 5.893 P.05

8.427 P.05

3.537 P.01

3.963 P.001

Number of disagreements 1 3.2 3 .3 3 . 8 3 .7 6 .1 I 7.803 P.05

4.539 P.001 3.719 P.001 .650 P.60

4.964 P.001 3.078 P.001 2.510 P.02

Except for two comparisons involving group 4, and one of group 3, highly sig- nificant differences were found between groups and the control subjects. Since the group clusters were homogeneous with respect to sociometric agreement, one would expect that no differences in cluster internal consistency would be found when the sociometric groups were compared between themselves. This expectation was borne out, as no significant differences were found when the in-group agreements were computed.

TABLE 3. COMPARISON OF SOCIOMETRIC GROUPS AND CONTROLS FOR SZONDI CHOICES I

Category

Agreements for “disliked” photo- graphs

Total number of agreements

Number of disagreements

Control Subjects vs. Group 1 Group 2 Group 3 Group 4

t Confidence1 t Con&&cel t Confidence Level Level

The failure to obtain significant differences between group 4 and the other groups may be due to the marginal quality of this group. It is composed of only three subjects whose average intercorrelation is smallest of all the sociometric clusters. Furthermore, as previously pointed out, these subjects had many more significant extra-cluster correlations than did members of the other sociometric groups. For these reasons, this group was dropped from consideration in further analyses.

Chi square analyses between the groups for the number of total like and dislike agreements, as well as number of disagreements, likewise revealed significant differ- ences (P .OOl). As in the t-test analyses, these were differences between the control subjects and the sociometric groupings.

388 DAVID PEARL AND DURAND JACOBS

DISCUSSION These findings support hypotheses 1 and 2, which were inferred from certain

aspects of Szondi theory. It must be stressed, however, that the Szondi genetic frame- work is only one of many which would encompass these results. Borstelmann and KIopfer(1, have pointed out the many serious shortcomings in this framework. Further examination of the Szondi data fails also to lend support to the Szondi diag- nostic framework, in that internal contradictions are found. Since significant differ- ences in the degree of consensus for Szondi test stimuli were found between the homo- geneous and control sociometric groups, we would expect to find significant differ- ences in one or more categories in a similar analysis of consensus for the eight Szondi diagnostic categories. However, no significant differences were found in agreements or disagreements for any of these categories. Deri@) has also hypothesized that the frequency of selection within a given category is a valid measure within the need system represented. The subsequent expectation that the extent of reaction to various categories would differ significantly among the homogeneous and control sociometric groups was not borne out by the data. This would suggest that either Deri’s hypothesis is gratuitous or that the breakdown of the stimuli photographs into these particular diagnostic categories is unwarranted.

A consideration of these results suggests that whatever merit the Szondi test possesses is due to the employment of the photographic medium. By providing cues, the photographs permit subjects to project their interpersonal attitudes and feelings. The Szondi and Deri mediating formulations are thus not essential. One may hypoth- esize that similarities in affective attitudinal patterns toward the Szondi test photo- graphs and the photographs of wardmates are due to underlying personality pro- cesses. Individuals having such personality processes in common would tend to re- act similarly in affective tone to the cues provided by photographs or individuals with whom they have contact. Data to be reported in detail in a subsequent publica- tion suggest that such processes are related to the self concept. Ratings of the ap- plicability of self concept statements given by members of the sociometric and con- trol groups, when categorized and treated by analysis of variance, disclosed signi- ficant interaction between sociometric groups and self concept categories.

SUMMARY AND CONCLUSIONS Forty pairs of patients with significantly similar ward sociometric choice pat-

terns were compared in Szondi test choices to forty ward patient pairs with the most dissimilar sociometric choices. In a like manner, four clusters of patients, each sim- ilar in the sociometric patterning of its members, were compared to a control group of patients whose choice patterns were unrelated. Results support hypotheses affirm- ing that significant differences would be found. While consistent with Szondi test theory, these results do not necessarily support such theory. Indeed, further analysis of the data discloses internal contradictions in the Szondi diagnostic framework. The results are seen as most satisfactorily explained within the framework of general perceptual theory.

REFERENCES 1. BORSTELMANN, L. J. and KLOPFER, W. G. The Szondi test: a review and critical evaluation.

2. DERI, S. Introduction to the S z o d i test, theory and practice. New York: Grune and Stratton, 1949. 3. STEPHENSON, W. T h e S tudy of Behavior: &-technique and i ts methodology. Chicago: University of

4. SZONDI, L. Triebdiagnostick. Bern: Hans Huber, 1947.

Psychol. Bull., 1953, 60, 112-132.

Chicago Press, 1954.