CJOT Vol. 53 No.

4
House-Tree-Person Projective Technique: A
'a' ration of its Use in Occupational Th *a ^ y
by Helen Polatajko and Ethel Kaiserman
The acute care psychiatric setting
requires that the occupational thera-
pist comes to an early decision re-
garding client treatment. In order to
do this, the occupational therapist
needs to have available efficient, re-
liable and valid evaluation tools.
Projective techniques have often
been used in occupational therapy
for evaluation. Symbols are felt to
uncover the ideas and feelings of an
individual. Rosenfeld (1982) wrote
that projective tests help in the es-
tablishment of the individual's
Helen Polatajko, PhD., OT(C), is an Associate
Professor, in the Department of Occupational
Therapy, Faculty of Applied Health Sciences,
cross appointment to Department of Educa-
tional Psychology Faculty of Education,
University of Western Ontario, London,
Ontario.
Ethel Kaiserman, B.O.T., OT(C), is an
Occupational Therapist, with Community
Occupational Therapy Associates, Toronto,
Ontario. At the time of the study she was the
Senior Occupational Therapist, Psychiatry,
Occupational Therapy Services, University
Hospital, 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 which
are not completely understood by
the individual or currently accept-
able to the individual is possible
The H.T.P. data were
being used to develop an
O. T. problem list and to
select O. T. treatment
strategies.
through the use of symbols (Mosey,
196 8). Unfortunately, at the present
time, none of the projective tests
developed specifically for the use in
occupational therapy, are standard-
ized or well researched.
The House-Tree-Person Projec-
tive Technique (H-T-P) provides an
instrument with a well-standardized
system of administration. This in-
strument was developed in 1948 by
Buck, a psychologist, primarily as a
test of intelligence. However, as
more exact tests of intelligence were
developed, it ceased to be used for
this purpose. Rather, its secondary
use, the identification of personality
traits and factors, predominated. In
a formalized manner, the client is
asked to draw first a house, then a
tree and finally a person. This is
followed by the `post-drawing inter-
rogation' consisting of 6 4 specific
questions and a follow-up of any
leads resulting from the answers to
these questions. The drawings, to-
gether with their responses to the
questions, are then interpreted to
provide data concerning the per-
ceived developmental, traumatic or
environmental problems of the
client. Jones (1981) has provided a
manual to guide these interpreta-
tions.
The H-T-P has been in use by
occupational therapists at University
Hospital, London, Ontario, as part
of an assessment procedure with
October/Octobre 1986

197
CJOT Vol. 53 No. 4
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 to
develop an occupational therapy
problem list and to select occupa-
tional therapy treatment strategies.
Subjectively, the therapists found
the use of the H-T-P to be an enjoy-
able and beneficial process giving
them greater insight into their
clients' problems and facilitating
rapport. It was also felt to provide
a forum for the establishment of a
consensus between therapist and
client regarding further assessment
and the treatment program. Howev-
er, the literature provided no empir-
ical evidence to support the use of
the H-T-P in this manner. The pur-
pose of the study was to investigate
the validity of the H-T-P in identify-
ing functional problems.
Literature Review
Initially, much of the work on the
H-T-P dealt with its use as a test of
intelligence. However, as indicated
above, with the advent of more valid
intelligence tests, its use and subse-
quently the research in this area
decreased 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 the
H-T-P as a method of identifying
stress factors and personality char-
acteristics and its use in psychiatric
occupational therapy.
As with many projective tech-
niques, the H-T-P received its impe-
tus from psychoanalytical theory
and evolved from empiricism and
practical clinical observations
(Robin & Haworth, 1971). Symboli-
cally potent concepts such as house,
tree and person are thought to be
saturated with the emotional and
ideational experiences associated
with the personality's development,
the drawing of these images compel-
ling projection on the part of the
drawer (Hammer, 1978). In regard
to his choice of the specific items,
Buck (1981) considered that the
house, tree and person: a) were items
familiar to all; b) were more will-
ingly accepted than other items, as
objects for drawing by subjects of all
ages; and c) stimulated more frank
and free verbalization than did other
items.
As Hammer (1978) describes, the
house, as a dwelling place, has been
found to arouse within the subject
associations concerning home life
and intra-familial relationships. The
drawing of the house may reflect the
subject's domestic situation in rela-
tionship to his spouse or the child-
hood relationship to parental figures
may still be apparent as residual
attitudes. The drawing of the tree
appears to reflect the subject's relati-
vely deeper and more unconscious
feelings about himself, whereas the
drawn person becomes the vehicle
for conveying the subject's closer-to-
conscious view of himself and his
relationship with his environment.
In this manner, a picture of the
conflicts and defenses as set in the
hierarchy of the subject's personality
structure is provided.
The research evidence to support
the validity and reliability of the
H-T-P in its use in the identification
of personality factors or stress factors
is scant and can be easily criticized.
Nevertheless, based on research
available at the time the last review-
er of the H-T-P for the Mental Mea-
surements Year Book concluded that
the H-T-P is a valuable tool:
The H-T-P is now, and no doubt will
continue to be, used as a rewarding
clinical technique in work with both
adults and children. The amount of
meaningful projective data to be
derived from the drawings (and the
inquiry, if used) will depend on the
experience and o rientation of the cli-
nician. The test can serve 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 the
evolution of projectives in general,
i.e., there was a loss of interest in
such tests for a period of time due
to the difficulty encountered in es-
tablishing rigorous evidence of the
reliability and validity of such tests
(Robin and Haworth, 1971).
There have been some studies
concerning the H-T-P in the more
recent past. A number have used the
H-T-P as a measure of change with
a variety of patient populations. For
example, Gording and Match (1968)
reported on a preliminary study
using the techniques of free-hand
figure drawings of a house, tree and
person (H-T-P) to investigate per-
sonality changes in 33 contact lens
wearers. Ernst, Beran, Badashi, Ko-
sovsky and Kleinhauz (1977) used
the H-T-P with elderly people with
a diagnosis of "chronic brain syn-
drome", to investigate the effects of
bi-weekly sensory stimulation and
group therapy over a period of three
months. Perkins and Wagemaker
(1977) administered the H-T-P four
times to a chronic schizophrenic un-
dergoing hemodialysis. Platzer
(1976) used the H-T-P in pre/post
test fashion with 40 subjects with
deficits in gross-motor skills and
self-concept, randomly assigned to
experimental and control groups to
determine program effectiveness.
All of the above investigators
reported changes due to treatment,
having confidence in the test-retest
reliability of the H-T-P. However,
these data cannot clearly be inter-
preted as support for the instru-
ment's test-retest reliability. Such
data is difficult to obtain due to the
nature of both the instrument and
its intended use (Haworth, 1965).
A number of studies have used the
H-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 patients
and 30 introverted patients. Both
groups were asked to draw same sex
drawings according to H-T-P test
instructions. Extroverts did not make
significantly larger drawings than
introverts. Even when extreme cases
of expansiveness or constriction were
used, the predictions of the H-T-P
were only slightly above chance.
Davis and Hoopes (1976) com-
pared the H-T-P drawings of a
matched sample of 80 deaf and 80
hearing, 7-10 year olds to assess
differences related to the handicap,
and the capacity of the H-T-P to
distinguish between children rated
by their teachers as poorly adjusted
and those rated well adjusted. No
differences were found between deaf
and hearing children in the drawing
198

October/Octobre 1986
CJOT Vol. 53 No. 4
of the ear or mouth of the human
figure, although there were signifi-
cant differences in the drawing of the
branch structure of the tree. Also, no
differences were found in the num-
bers of indicators of disturbance be-
tween the drawings of the subjects
rated as more and less well adjusted.
Kuhlman and Bieliauskas (1976)
administered the H-T-P to 30 black
and 30 white adolescents, matched
for sex, age, intelligence and socio-
economic level. No significant dif-
ferences were found between the two
groups on either the H-T-P, IQ mea-
sures or the adjustment ratings.
Hoover (1978) attempted to con-
struct a composite personality profile
for skydivers. Eighteen active ' sky-
divers (median age 24-6 years), were
administered the Rorschach,'' the
Hand, the H-T-P and Draw-A=Per-
son tests. No statistically significant
differences were found between the
skydivers and a matched group of
controls.
Gasparrini, Shealy and Walters
(1980) administered the H-T-P to 17
right hemisphere brain-damaged
patients, 19 left hemisphere brain-
damaged patients and 23 non brain-
damaged medical patients. Statisti-
cal analyses revealed significant
differences between groups in size
and spatial placement of drawings.
Blain, Bergner, Lewis and Gold-
stein (1981) conducted a study to
determine whether the H-T-P might
be used as a means to identify physi-
cally abused children. Protocols of
32 abused children, 32 nonabused
but disturbed children and 45 ap-
parently well-adjusted children. (ages
5-12 years) were examined for the
presence of 15 objectively scorable
items that emerged as good potential
discriminators from an earlier pilot
study. Results of several statistical
analyses indicate that (1) items taken
individually discriminated strongly
between abused and well-adjusted
subjects, but not between abused
and non-abused but disturbed sub-
jects; and (2) the 6 most discrimi-
nating individual items, discrimi-
nated reasonably well between
abused subjects and both of the
other groups.
In the six studies above, the inves-
tigators assumed differences be-
tween the groups being contrasted.
Three of the studies found some
differences (Davis et al. 1975;
Gasparrini et al. 1980; and Blain et
al. 1981). In all three studies the
groups being contrasted were credi-
bly different in some way, thus one
could assume the findings to support
the H-T-P as a valid indicator of
personality factors. However, it must
be remembered that unless there are
other external indicators of such dif-
ferences, the findings remain equiv-
ocal.
Similarly, for the studies that
failed to show differences between
groups it cannot be determined,
from these studies, if differences did
indeed exist or if the findings were
valid.
In some instances the
H. T.P. missed problems
while in others it
identified unique
problems not noted by
nursing or O. T.
Still other studies used the H-T-P
to investigate the characteristics of
a specific population. Doorbar
(1967) used the Wechsler Adult In-
telligence Scale, the Thematic Ap-
perception Test (TAT) and the
H-T-P with 34 transexuals.
Tropauer, Franz and Dilgard (1970)
studied 20 children with cystic fibro-
sis and 23 mothers of such children
using psychiatric interviews and the
H-T-P. Ullman, Moore and Reidy
(1977) compared the performance of
10 adult subjects with chronic atopic
eczema with matched controls on the
MMPI, H-T-P, selected TAT cards
and an open-ended psychiatric in-
terview. Seligman (1979) examined
personality and cognitive charac-
teristics of black foster children using
the Bender Gestalt Test, the H-T-P,
the Wide Range Achievement Test,
the Rorschach, a specially designed
sentence completion inventory, the
Weschler Intelligence Test and an
extensive 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 the
H-T-P in conjunction with a number
of other instruments and no clear
indication is given of the relative
contribution of the individual tests
or the correlation between the tests.
Only a few studies looked at the
identification of stress factors using
the H-T-P. Cooper and Caston
(1969) studied the size of human
figure drawings before and after
stress, (the stress being the an-
nouncement of impending heart sur-
gery). They found a trend for post-
stress drawings to be larger than
pre-test drawings. Peyru and De
Pastrana-Borrero (1977) proposed a
psychotherapeutic method centred
on the evaluation of changes in the
patients central oedipal conflict.
They used a battery of psychological
tests administered at regular inter-
vals during the course of therapy;
the H-T-P, the Bender-Gestalt Test,
the Rorshach and the Phillipson
Test, to identify stress in the form
of a focal oedipal conflict.
Finally one study was found which
looked at the significance of a partic-
ular symbol. Devore and Fryrear
(1976) compared the H-T-P draw-
ings of 1,844 juvenile delinquents
and a sample of the adolescents who
drew the tree with a hole or scar to
76 adolescents who drew a tree with
no hole or scar. The two groups were
compared with respect to 22 vari-
ables, including age, sex, urban or
rural residence, total number of si-
blings, reading placement and 8
MMPI scales. The two groups dif-
fered significantly on two variables:
IQ and the mania scale of the
MMPI. Subjects who drew a tree
with a hole were significantly more
intelligent and scored lower on the
mania scale.
As is evident from the above liter-
ature, the summary of the H-T-P
literature by Haworth in 1965 still
applies. The studies that exist have
a number of methodological flaws,
many of which are inherent to the
investigation of projective tech-
niques. Consequently, little or no
external validation exists for charac-
teristics or problems identified by the
October/Octobre 1986

199
CJOT Vol. 53 No. 4
H-T-P. This is necessary before the
instrument can be considered valid.
It was the intent of this study to
examine problems identified by the
H-T-P against some external criteria.
Method
The purpose of this study was to
determine if the H-T-P could validly
and efficiently identify a problem list
for occupational therapy treatment.
In order to do this, a comparative
study using blinded procedures was
carried out.
Sample:
All the clients referred to occupa-
tional therapy between September,
1983 and April, 1984, were consid-
ered for the study. Criteria for
inclusion were: (1) admission to the
psychiatric unit at University Hospi-
tal in London; (2) referral to
occupational therapy; and (3) signed
informed consent. Criteria for exclu-
sion were: (1) acute psychosis; (2)
second admission during the tenure
of the study; (3) research officer's
vacation schedule precluding testing
at designated time for specific
clients; (4) marked motor impair-
ment.
The resulting sample consisted of
40 clients, 10 males, 30 females, be-
tween the ages of 17 and 73 (X =
37.68; SD = 15.42) with a variety
of occupations (see Table 1). The
average length of stay was 4 to 5
weeks (X = 34.68 days; SD =
17.14). The number of admissions
ranged from 1 10 with this being
the first admission for 15 clients and
the second for nine. The clients suf-
fered from a variety of psychiatric
conditions with depression being the
most frequent psychiatric diagnosis
(see Table 2).
Procedures:
H-T-P: Each subject was adminis-
tered the H-T-P by a trained re-
search officer (RO) within the first
two weeks of referral to occupational
therapy. The H-T-P was adminis-
tered as outlined in Buck's manual
(1981), in any available space in the
occupational therapy department
where there would be no interrup-
tion for the duration of the testing.
All testing was done in the late
afternoon. The testing took approxi-
mately 40 minutes. After the testing,
the RO scored and interpreted the
H-T-P using Jolies' manual (1981).
Finally, the RO generated the H-T-P
problem list using the H-T-P dic-
tionary (see below for description)
to translate the H-T-P terms into
occupational therapy terms. The
H-T-P protocols and the H-T-P
problem lists were kept in a place
where the case occupational thera-
pist did not have access to the results
in order to keep the process blind.
Furthermore, only code numbers
appeared on all protocols.
The RO was a qualified occupa-
tional therapist with experience in
psychiatry. She was trained in the
administration and interpretation of
the H-T-P by the senior occupational
therapist on the unit. The training
proceeded as follows: (1) The RO
familiarized herself with selected
material available on the adminis-
tration and interpretation of the H-
T-P, i.e. Bieliauskas, 1980; Buck,
1981; Hammer, 1981; Jolles, 1981;
Wenck, 1981, and then worked
through these with the senior, iden-
tifying issues and discussing prob-
lems. (2) Subsequently, the RO
watched the senior administer one
test and then both the senior and
the RO were videotaped administer-
ing the H-T-P. These tapes were used
to establish inter-rater agreement.
Each viewed the other's video and
then scored the H-T-P independent-
ly. In total, four H-T-P's were ad-
ministered in this fashion. Once 80%
agreement was achieved, data col-
lection started. Halfway through
data collection inter-rater agreement
was again evaluated in the same
manner described above. In all in-
stances, inter-rater agreement was
above 80% ranging from 81% to
100%.
Occupational Therapy Assessment:
Concurrently, but independently,
the occupational therapist assigned
to the case administered the occupa-
tional therapy assessment to the
client. In all cases the occupational
therapist was one of the two occupa-
tional therapists assigned to the psy-
chiatric unit, one of whom was the
senior mentioned above.
The occupational therapy assess-
ment consisted of three parts: (1)
interview, (2) concrete task (tile tri-
vet), and (3) abstract task (collage).
It should be noted that this was a
dynamic assessment process, i.e., it
did not preclude therapeutic input
200

October/Octobre 1986
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CJOT Vol. 53 No. 4
during the assessment. All parts of
the assessment were administered on
a one-to-one basis in a setting similar
to 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 at
various times during the working
day, in four separate sessions lasting
for a total of approximately five
hours.
The interview, based on the Occu-
pational Therapy Services Initial In-
terview was always given first. (N.B.
This document, as other non-
published materials mentioned in
this paper are available from the
authors). This was followed by the
concrete task. In this task, the clients
were told where the tiles were and
asked to choose the color and design
for their trivet. They were then given
the glue and trivet and asked to glue
the tiles onto the trivet. After a
period of at least 24 hours (time for
the glue to dry) they were given
grout so that they could finish their
task. Throughout, discussion be-
tween the occupational therapist and
client centred on the choice of color
and pattern, any difficulties exhibit-
ed, and the relationship of these
difficulties to home and work.
The H.T.P. is an efficient
and useful tool,
particularly if it is
augmented by a work
assessment.
Lastly, the clients were asked to
produce a collage. They were given
the necessary equipment and asked
to pick a theme and pictures that
represented that theme. They were
then asked to cut these pictures out
and glue them on paper in any man-
ner they chose. Again, there was
discussion throughout, focusing on
the theme, the reason for the theme
and pictures chosen, their signifi-
cance to the client and any difficul-
ties in task performance.
At the end of this process, the
occupational therapist generated an
occupational therapy (OT) problem
list and placed it on the client's chart.
The RO did not have access to the
charts at this point in the study.
Nursing Evaluation:
This evaluation was carried out
within 48 hours of the admission of
the client to the unit. The evaluation
was always carried out on a one-to-
one basis by the nurse assigned to
the client. She/he did a nursing his-
tory and then generated the nursing
problem list which was placed on the
client's chart at that time.
October/Octobre 1986

201
CJOT Vol. 53 No. 4
Creation of the functional terms
Dictionary:
Given the difference in terminol-
ogy employed by the three profes-
sions involved in creating the 3
problem lists, (i.e., psychology in the
H-T-P, occupational therapy in the
O.T. assessment and nursing in the
nursing evaluation), it was necessary
to create a `dictionary' of terms. Par-
ticularly, it was the purpose of this
dictionary to provide a reference for
the translation of H-T-P terms into
OT terms. Initially, a one for one
translation was planned, however,
this proved to be impossible. Conse-
quently, it was necessary to establish
a list of major categories using
occupational therapy functional
words. Descriptors found on the
H-T-P were then grouped under
these categories (see Table 3 for ex-
amples).
The dictionary was given to 'ex-
perts' (psychiatric occupational ther-
apy faculty otherwise not associated
with this study) to: (1) evaluate the
face validity of the placement of
H-T-P descriptors under the various
categories and (2) expand the num-
ber of categories. The experts were
in agreement with the H-T-P terms
appearing under the various cate-
gories of the dictionary, only recate-
gorizing three terms.
The experts also did not create
new categories although they did
suggest the subdivision of the Activi-
ties of Daily Living category into two
subheadings (Dependence and
Independence). However, given the
nature of the occupational therapy
and the nursing data base, these
were inappropriate subheadings
and, therefore, were not used. This
was the dictionary used in all further
evaluation of the H-T-P problem
lists generated.
It should be noted that the use of
the dictionary resulted in a major
reduction of the data which must be
kept in mind in the interpretation
of the results of this study. This,
however, was unavoidable.
Comparison of Problem Lists:
Once all three evaluations were
completed with a client, the RO
transferred the three problem lists
from their respective sources onto a
summary sheet. The RO then com-
pared the problem lists and indicat-
ed on the summary sheet if there was
agreement between either the H-T-P
problem list and the OT problem list
or the H-T-P problem list ` and the
Nursing problem list. Often a judg-
ment was necessary to deem two
problems as the same.
To validate the judgments of the
RO and to remove any possible re-
searcher bias, the following steps
were 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 taken
on its own and the problems that
appeared to be essentially the same
were grouped under one subsumer,
e.g., the problems, major depression,
reactive depression, depressive neu-
rosis and recurrent depression were
all grouped under the subsumer de-
pression. (3) These subsumers were
then placed under the H-T-P dic-
tionary categories resulting in the
corresponding terms list (see
Table 4). From Table 4, it can be
seen that a number of subsumers
could not be placed under any of
the H-T-P dictionary categories. It
was, therefore, necessary to generate
a ninth category called `OTHER'
which was added to both the dic-
tionary and the corresponding terms
list. (4) The corresponding terms list
was then checked against the H-T-P
dictionary. Where there was a dis-
crepancy, the categorization of the
dictionary obtained. (5) For each
client, the corresponding list was
then used to check for matches be-
tween H-T-P problems and Nursing
problems and between H-T-P prob-
lems and OT problems, as appearing
on his/her individual summary
sheet. (6) The investigator's problem
match for each client was then veri-
fied against the RO's matched list
and percentage agreement between
RO and senior investigators was cal-
culated.
202

October/Octobre 1986
CJOT Vol. 53 No. 4
October/Octobre 1986

203
x 100
CJOT Vol. 53 No. 4
The mean percentage agreement
between the senior investigators and
the RO was 85.77% with a standard
deviation of 12.80. The mode was
100% 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 a
disagreement between the RO and
the investigators, it was the decision
of the investigators as indicated on
Table 4 that obtained. This was
done because Table 4 was generated
`blind', whereas the RO's judgment
was not made blind.
These data were used to calculate
the parameters of validity: percent-
age agreement and percentage ac-
counted for.
Percentage agreement, calculated
by the formula:
total number of
matches
x100
total number of
H-T-P problems
is simply the percentage of the prob-
lems identified by H-T-P that were
also identified by either OT or nurs-
ing. Problems unique to the H-T-P
lists would automatically reduce the
percentage agreement between the
lists. Since it is not known (nor was
it the purpose of this study to deter-
mine) whether the unique problems
are valid problems, this is an impor-
tant calculation, a method of calcu-
lating which does not penalize the
H-T-P for unique problems is also
important.
Percentage accounted for, calcu-
lated by the formula:
total number of
matches with
Nursing (or OT)
total number of
nursing (or OT)
problems
is the percentage of the problems
identified by nursing or OT that were
also identified by the H-T-P. This
calculation is not influenced by
unique H-T-P problems.
Comparison of time:
The average time required to per-
form each of the evaluations was
estimated as accurately as possible
by the people involved with the ad-
ministration of the assessments and
compared at face value.
Materials:
The H-T-P drawing form and
post-drawing interrogation
folder and scoring folder
A Catalog for the Qualitative
Interpretation of the House-
Tree-Person (H-T-P) (Jolles,
1981)
Functional Terms Dictionary
OPencils and erasers
Tile trivet 6" x 6" trivet, 121
5/16" square tiles of various
colors
OGlue
OGrout
OA sheet of paper 18" X 24"
OMagazines
OScissors
Results
The number of problems identi-
fied by each of the three methods
of assessment per client appear in
Table 5. As can be seen, the H-T-P
identified the largest number of
problems but in all cases the actual
number of problems was small.
The observation that H-T-P tend-
ed to identify more problems indi-
cated that there were problems
unique to the H-T-P, i.e., problems
not identified by either nursing or
OT. At the same time, there were
missing problems, i.e., problems
identified by nursing or OT that were
not identified by the H-T-P. The
H-T-P identified an average of two
unique problems per client over the
team effort and missed an average
of 1.03 of the client problems as
identified by nursing and an average
of .95 of the client problems as iden-
tified by OT (see Table 5).
agreement
% accounted for
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e

vs_
3
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CJOT Vol. 53 No. 4
The percentage agreement and
percentage accounted for appear in
Table 6. As can be seen, in all cases,
the percentage accounted for is the
greater. Also, both percentage
agreement and the percentage ac-
counted for between OT and the
H-T-P were higher than for nursing.
The nature of the problems iden-
tified by the H-T-P spanned all the
functional categories set out at the
creation of the dictionary as did the
nature of the problems unique to the
H-T-P and the nature of missing
problems. In the majority of cases
the missing problems appeared in-
frequently (see Table 7).
Of interest in Table 7 are the
category specific discrepancies be-
tween H-T-P and Nursing and OT
problems. Namely, sexual problems
were identified 30 times by the
H-T-P and 28 of these were unique
to the H-T-P. Likewise, 14 of the 39
self-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 of
4 different problems. Work problems
were identified 17 times in the H-T-P
but were missed 21 times when com-
pared to the OT lists. There were 6
different problems which were
missed repeatedly.
The H-T-P proved to be a consid-
erably more efficient tool compared
to the OT assessment. The average
time taken to administer the H-T-P,
including the post-drawing interro-
gation was 40 minutes. The interpre-
tation of the projective material and
the answers to the questions took
approximately another 50 minutes
per client, for a total of 90 minutes
for the complete administration of
the H-T-P. The OT assessment took
approximately 5 hours (300 minutes)
to complete per client.
Discussion
The H-T-P is clearly a more effi-
cient method of evaluation than the
OT assessment, taking 3+ hours less
to complete. Of particular impor-
tance here is the finding that this
gain in time is not accompanied by
a great loss of information. The
H-T-P identified 75.19% of the prob-
lems identified by the OT assess-
ment. Given that OT typically only
identified four problems, this means
that only one problem was missed.
If this is counter-balanced with the
observation that the H-T-P typically
identified two additional problems
over the OT list, it suggests that the
H-T-P is as proficient at identifying
problems as is the OT assessment.
In terms of the unique problems,
it must be remembered that there
was no method available to assess
the validity of these problems. How-
ever, the observation that many of
the unique problems were sexual
problems and, indeed, only 2 of the
30 sexual problems identified by the
H-T-P were identified elsewhere
suggests that the unique problems
may be indicative of areas where the
H-T-P is more proficient.
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205
CJOT - Vol. 53 - No. 4
In terms of the missing problems,
a similar phenomenon is suggested.
The H-T-P only identified work
problems in 17 instances but missed
21 occurrences of the work problems
identified by OT. This again could
be interpreted as a statement on the
relative areas of proficiency of the
two instruments.
Thus, it would appear that the
H-T-P is an efficient and useful tool
relative to the OT assessment, par-
ticularly if it is augmented by a work
assessment.
In comparison to the nursing eval-
uation, again the H-T-P seems to
account for a substantial proportion
of the problems identified (66.42%)
typically missing no problems. (It
should be noted that the low per-
centage agreement relative to a
mode of zero for missing problems
is more reflective of the small num-
bers being dealt with here than of
poor agreement). The area most fre-
quently having missing problems
was mood/affect. This occurred in
12 instances although there were
only 4 different problems. Since the
H-T-P did identify 34 mood/affect
problems, 8 of which were unique,
it suggests that the H-T-P is not
deficient in this area but that specific
problems should be looked at - such
an analysis was beyond the scope of
this paper.
In interpreting the results of this
research and in considering the im-
plications of these for the identifica-
tion of specific problems, the proce-
dures used here must be
remembered. It must be recognized
that in the process of creating the
dictionary, specific problems were
incorporated into major categories
and thus a lot of specific data were
lost. While this was a necessary pro-
cedure to allow for comparisons be-
tween lists, it resulted in reduction
of data and loss of specificity. Thus,
the results presented here can only
be considered in general terms.
Conclusion
Percentage of agreement between
Nursing and H-T-P and between OT
and H-T-P are low. This is assumed
to be, in part, a consequence of the
number of unique problems identi-
fled by the H-T-P. The percentage
accounted for was considerably
higher. Since this parameter is not
affected by unique problems, it is
considered to be more meaningful.
It is important to remember that the
latter is true only if the unique prob-
lems identified by the H-T-P are true
problems. If not, then percentage
agreement is a more accurate reflec-
tion of the performance of the HT-
P. This study was not intended to
verify whether unique problems
were true or false. However, since
the unique problems were largely in
one area, it seemed to reflect the
differences in the orientation of the
instruments (e.g., sexual problems).
Thus, the percentage accounted for
may indeed be the more significant
parameter.
In summary: The problems iden-
tified by the H-T-P were the same
as those identified by nursing and
OT in 66.4% and 75.2% of the cases
respectively. In some instances, the
H-T-P missed problems while in
others it identified unique problems
not noted by nursing or OT. There-
fore, for a thorough assessment, all
three procedures should be used.
However, given the high percentage
of OT problems accounted for by the
H-T-P, if a quick assessment is re-
quired, the H-T-P alone would be
appropriate - taking special care to
look for work-related problems.
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Acknowledgements
The authors wish to acknowledge with appre-
ciation the ongoing assistance, direction and
encouragement of Arlene Shimeld. Manager.
Occupational Therapy Se rvices. Unive rs ity
Hospital.
Rsum
Cette tude a tmene dans le but de dterminer si le test de dessin
valeur projective H.T.P. (House, Tree, Person) de Buck s'est avr
une mthode permettant d'identifier d'une manire valable et efficace
une liste de problmes pour le traitement d'ergothrapie. cette fin,
on a menune tude comparative double insu. Un chercheur entran
a administr le test de personnalit H.T.P. quarante clients dont il
ne savait rien, ces clients prsentaient des problmes psychiatriques aigus.
Ils ont galement t valus sur le plan de l'ergothrapie par leur
ergothrapeute et sur le plan des soins infirmiers par l'infirmire qui
leur tait assigne. Dans chacun des cas, une liste de problmes a t
dresse, ces listes ont alors tcompares afin de dfinir le pourcentage
de concordance entre les problmes. ainsi que le pourcentage de problmes
dj connus et le temps ncessaire pour fournir les diffrentes listes.
Le pourcentage de concordance entre les listes de proh!cnes obtenues
grce au test H.T.P. et par l'valuation sur le plan des sinus infirmiers.
et le pourcentage de concordance entre les listes obtenues par le test
H.T.P. et par l'valuation ergothrapeutique ont t respectivement de
32.88 et de 47.18. Les pourcentages des problmes connus ont t de
66.42 et de 75.19 respectivement. Les diffrences sont examines. Le
temps ncessaire pour administrer le test H.T.P. s'est avr considrable-
ment infrieur l'valuation ergothrapeutique traditionnelle. Pour
conclure, le test H.T.P. s'est avr un outil de dpista apprciable.
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