102-2-評估學-分析架構

以精神分析理論為基礎的評估測驗

（ Assessments Based on the Psychoanalytic Theory）

學習目標

1. 從職能治療角度認識表達性藝術和投射測驗

2. 從心理測驗角度認識：人格和精神病理學
（Psychopathology）測驗；客觀測驗和投射測驗

3. 了解投射技術和投射測五大技術

4. 學習評估自我功能的相關測驗

References
Bruce, M. A. & Borg, B. (2002).  Psychosocial frames of reference: core for occupation‐

based practice. Thorofare, NJ: Slack.
Burns, R. C. (1987).  Kinetic‐house‐tree‐person drawings: an interpretative manual.  New 

York: Brunner/Mazel Publishers.
Hemphill‐Pearson, B. (2008). Assessments in occupational therapy mental health: an 

integrative approach.  Thorofare, NJ: Slack.
Mosey, A. C. (1986). Psychosocial componen1ts of occupational therapy. New York: 

Raven. 

Definition of expressive media 2

• The Uniform Terminology for Occupational Therapy, 3rd edition, defines the term
self-expression as “using variety of styles and skills to express thoughts, feelings,
and needs.”

• Expressive modalities, or media as they are sometimes called, include art,
dance/movement, and language activities, such as journaling, poetry, or drama.

• Traditionally, occupational therapists have considered expressive media to be
painting, drawing, sculpture, or collage, but they include much more. They include
all the ways in which people are able to express themselves. For example, dressing
and costume also are forms of expression, as are photography and video.

• In an expressive assessment, the occupational therapist is trying to help the patient
recognize the emotions, self-concept, self-awareness, self-in relation-to-others,
communication skills, and the modes of expression he or she prefers.

Beginnings in Psychoanalysis 3

• Sigmund Freud: dream imagery.
• Carl Jung: examine the content of art and considered it to be indicative of

intrapsychic events.

• Later developments: Ego psychology and object relations
• Ego psychology
• “The ego and mechanisms of defense.”
• Object relations
• Object relations theory is derived from Freud’s ideas about how individuals

relate to their environment. The word “object” refers to either human or non-
human things

History of Drawing in Assessment 4

• Florence Goodenough

• an American psychologist published a drawing intelligence test in 1926.

• When it was first published, the editor pointed out that drawing was a more
accurate assessment of immigrant children’s intelligence than psychological
assessments that used a language unfamiliar to those children.

• Karen Machover

• a Canadian psychologist began publishing research findings in the 1940s.

• She focused on affective content, unlike Goodenough who focus on
intelligence testing.

• She used the term “projective” to describe this methodology.

• The first projective technique, known as the Inkblot Test had been
developed in 1921 by a Swiss psychologist, Herman Rorschach.

• Dale B. Harris

• In the early 1960s, Harris revised the original Draw-a-Man test that had
been standardized by Goodenough.

• Harris (1963) investigated normative development of human figure
drawings from childhood through adolescence and related drawing
maturation to intellectual development.

Assessment of Personality and Psychopathology 5

• Psychological assessment techniques are designed to evaluate a person’s
cognitive, emotional, behavioral and social functioning. One aspect of tests,
called personality tests, strives to uncover the structure and features of
one’s personality, or one’s characteristic way of thinking, feeling, and
behaving. Another group of tests is designed to measure signs and
symptoms of psychopathology.

Objective vs. Projective Tests

• Tests of personality and psychopathology can be further subdivided into two
specific types: objective and projective. Objective tests include standardized,
clear, specific items and questions that are presented to the respondent, as
well as a limited choice of response (e.g., “yes” or “no” to ta test item). In
contrast, projective tests present novel or ambiguous stimuli and include an
open-ended response format, such as a story from the respondent.

Objective Personality Tests 6

• Assessment methods that use a restricted response format (ordinal scale
ratings or true/false questions), and which contain extensively tested validity
scales to determine whether the person taking the test is responding
truthfully.

• Examples

 The Minnesota Multiphasic Personality Inventory (MMPI)
 The Multiple Aspects Personality Assessment (MAPA)
 The Big Five Personality Test

Projective Techniques

• Lindzey (1961) described a projective technique as an instrument that is
particularly sensitive to covert or unconscious aspects of behavior. It
encourages a wide variety of responses, is multidimensional, and evokes
rich or profuse responses with a minimum of awareness.

• Obrzut and Cumming (1983) stated that the central assumption with
projective techniques is that respondents will project or reflect their inner
needs, desires, and/or conflicts when asked to impose meaning or order on
ambiguous or unstructured stimuli.

投射技術的種類（Lindzey, 1959) 7

聯想技術 Rorschach Inkblot Test (Rorschach, 1921)   
(Association) Hand Test (e.g., Wagner, 1962)  

結構技術 Draw‐A‐Person Test (Machover, 1949)

(Construction) Thematic Apperception Test (Murray & Morgan, 1938)  

完成技術 Washington University Sentence Completion Test (Loevinger, 1976)
(Completion) Rosenzweig Picture Frustration Study (Rosenzweig, Fleming & Clark, 
1947)

檢選/排序技術 Szondi Test (Szondi, 1947)

(Arrangement/ Blacky Pictures Test (Blum, 1947)

Selection) Lischer Color Test (Luscher & Scott, 1969)

表達技術 Projective puppet play (e.g., Woltmann, 1960)
(Expression) Handwriting analysis (see Beyerstein & Beyerstein, 1992, for a 
review)

情結(Complex) 8

1. 多種觀念錯綜複雜結合在一起，所謂百感交集的心境即屬之。

2. 指被壓抑的情緒性的觀念；此等觀念平常存在於潛意識境界，一
旦表現於行為，多帶有反常的性質。精神分析論者持第二種解釋。

精神分析論常見的情結

• 伊底帕斯情結或稱戀母情結（Oedipus complex）

指男童依戀母親的情形

• 伊蕾克特拉情結或稱戀父情結(Electra complex)

指女童依戀父親的情形

• 戀子情結(Jocasta complex)
• 轉換型戀親情結（Inverted Oedipus complex）
• 自卑情結（Inferiority complex）

個體自幼依賴成人，生活無法自理。之後在對人事物的因應如失敗的機會多
於成功可能的威脅，會加重自卑感。

情結指標(Complex Indicator) 9

• 榮格理論

• 在字詞聯想測驗中，如受試者對某一單字的反應
顯得特別費力或勉強反應而顯得面紅耳赤時，即
顯示其情緒所在。

統覺(Apperception)

1. 新舊知覺經驗相互融合的心理歷程；在舊經驗的基礎上吸
收新的知覺經驗，然後統整為一新的經驗，是為統覺。

2. 將整個情境中各個別孤立的刺激關聯在一起，並賦予一種
主觀意義的心理歷程，也稱統覺。

防禦機轉（Defense Mechanism） 10

• 佛洛伊德最先採用此術語

• 用以解釋個體應付挫折情境時，為防止或減低焦慮或愧疚

的精神壓力所採用的一些習慣性的適應行為。

• 個體防禦的原因，一方面在減輕焦慮、壓力；另一方面在保
衛自我以維持人格結構的均衡和與外在社會的關係（如：角
色、地位等）。

Adaptive Behaviors Maladaptive Behaviors

防禦機轉（Defense Mechanism） 11

自戀防禦 不成熟防禦 神經質防禦 12

Narcissistic Defenses Immature Defenses Neurotic Defenses 成熟防禦

Denial Acting out Displacement Mature Defenses
Altruism

Distortion Blocking Distortion Anticipation

Primary idealization Hypochondriasis Externalization Asceticism

Projection Identification Repression Humor

Projective  Introjection Inhibition Sublimation
identification Suppression
Passive aggressive   Intellectualization
Splitting behavior
Isolation
Projection
Rationalization
Regression
Reaction formation
Schizoid fantasy (Reversal)

somatization Sexualization

Evaluative Tools (Mosey, Ch16, pp314~334) 13

• Assessments of Performance Components

– Evaluation of Sensory Integration
– Evaluation of Cognitive Function
– Evaluation of Psychological Function*
– Evaluation of Social Interaction

• Assessments of Occupational Performances

– Evaluation of Family Interaction
– Evaluation of Activities of Daily Living
– Evaluation of School/Work
– Evaluation of Play/Leisure/Recreation
– Evaluation of Temporal Adaptation

Early OT Projective Assessments 14

Name of Assessment Tasks Behavior and Constructs Assessed

Azima Battery Paper and pencil drawing of  Mood
(Azima ( Azima, 1959) man or woman Drives
Make an object out of clay Ego organization
Finger painting Object relations

Shoemyen Battery Tile mosaic trivet Responses to tasks
(Shoemyen, 1970) Finger painting
Carve object from 4‐inch 
vermiculite cube
Model human figure from 
clay

Goodman Battery Mosaic tile trivet Organization, discrimination, 
Spontaneous drawing sequencing, problem solving, ability 
Human figure drawing for independence, ego boundaries, 
Make an object out of clay preferences, emotional tone, object 
and style preferences, need for 
control, use of tools

Lerner Magazine  Given colored construction  Cognitive‐perceptual skills, nature and 
Picture paper and magazines; told  quality of defenses, affect, sense of 
to construct a collage self, quality of object relations

職能治療評估學講義

以精神分析理論為基礎的評估測驗

（ Assessments Based on the Psychoanalytic Theory）

目錄

Evaluation of Psychological Function (Mosey, pp321~322) ........................................................ 2 
Fidler Battery (1960s) ................................................................................................................... 2 
Free Choice of Selected Activities ................................................................................................ 2 
Fidler Battery (1990s) ................................................................................................................... 4 
Human Figure Drawing................................................................................................................. 5 
人、樹、房子問卷....................................................................................................................... 8 
完成句子測驗............................................................................................................................. 10 
Azima Diagnostic Rating Scale .................................................................................................. 12 
The Ehrenberg Comprehensive Assessment Process:................................................................. 15 
A Group Evaluation..................................................................................................................... 15 
Lerner Collage Scoring System .................................................................................................. 16 
Play/Activity History .................................................................................................................. 18 

Wei-Lieh Su, Lecturer
Department of Occupational Therapy, Kaohsiung Medical University
Office: CS507
Tel: 312-1101#2654
E-Mail: [email protected]

1

Evaluation of Psychological Function (Mosey, pp321~322)

To evaluative tools will be discussed relative to psychological function: the Fidler Battery
and the Free Choice of Selected Activities. Each of these, to some extent, involves the
use of projective techniques.
The Fidler Battery originally developed by Azimas, was later revised by Gail Fidler. It is
derived from a psychoanalytic orientation and is designed to identify intrapsychic content
through the production and exploration of symbols.

Fidler Battery (1960s)

Administration of the Battery involves:
1. Giving the client a box of colored pencils and drawing paper and asking the client to

draw whatever he or she wishes;
2. Giving the client a variety of different colored fingerpaints, water and paper suggesting

that they be used in any way the client wishes;
3. Giving the client a ball of moist clay and telling him or her to make anything the client

wishes.
After the client has completed each activity, the therapist asks the client to talk about
the method of proceeding, organization, color, content, feelings, ideas, and associations that
he or she has relative to the production. When the three activities have been completed and
discussed, the therapist asks the client to describe the various relationships he may have
perceived between the three activities and the products produced.
It is suggested that the Battery be given in a quiet room where the client and therapist
are alone and undisturbed. The therapist sits at the work table with the client in such a
position that he or she is able to observe the client’s facial expressions and work. Directions
are repeated if necessary but no suggestions are made. During discussion of each activity,
the therapist attempts to gain as much information as possible but does not lead the client or
attempt to elicit information that the client is not able or willing to express.
Data gained through the administration of the Battery and the discussions are
interpreted in conjunction with information acquired in a general interview and any other
available data. It is best not to “read” too much into the data gained from the Battery. Rather,
it is important to really listen to the client. The therapist should never think that he or she
knows more about the client than the client knows about him- or herself. It is, however,
useful to try to enter into the subjective experience of the client.
The Fidler Battery is used most appropriately and successfully with clients of average or
above intelligence who have some degree of verbal skill. Its use is inappropriate with clients
who are diagnosed as paranoid, aphasic, who have visual perception problems or
predominance of primary process thinking, or with individuals who are mentally retarded.

Free Choice of Selected Activities

Free Choice of Selected Activities is an evaluative tool that can be used with any types

of frame of reference, i.e., analytical, developmental, or acquisitional. The discussion

following the activity would most likely deal with the symbolic meaning of the client’s choice

2

of activity, the materials used, motions, and product produced when an analytic frame of
reference is being utilized. This may also be true to some extent if a developmental frame of
reference is being used. The discussion would be more oriented to everyday affairs when an
acquisitional frame of reference is being used as the basis for evaluation and change
process.

When using free choice of selected activities as an evaluative tool, the client and
therapist meet alone for approximately an hour. The therapist offers the client a choice of
approximately five activities. The client selects one. The therapist provides whatever
directions are needed, and the client is asked to carry the activity through to completion. The
therapist offers assistance only if it is evident that the client cannot finish the activity. The
therapist observes the client without initiating any conversation. If the client attempts to
engage the therapist in conversation of a casual nature, the therapist participates. This is not
a time for the client to discuss the nature of his or her problems. If the conversation drifts in
this direction too seriously, the therapist tells the client that the problems can and will be
discussed later and gently changes the subject. What the client says during the doing
process is important but more information can often be gained if the conversation is not
directly related to the client’s current difficulties in functioning.

Following the completion of the activity, discussion is focused on the client’s selection of
a particular activity, how it was performed, the client’s feelings and ideas about the process
and end product, and what the client thinks the activity says about his- or herself as a person.
It is sometimes useful to ask the client what would be the next activity selected if there was
sufficient time for its completion. The reason for this choice is then discussed.

The five activities available for selection should be short term (20 min to a half hour) and
require little direction on the part of the therapist. Each of the activities should have very
different characteristics with variation along the dimensions of structured-unstructured,
simple-complex, gross-to-fine motions, soft-to-resistant material, destructive-constructive,
facilitating-to-inhibiting symbolic expression, and color. The activities selected should, of
course, be appropriate to the client’s age, gender, and cultural background.

3

Fidler Battery (1990s)

Gail Fidler wrote about the occupational therapy assessment processes in an article,
“Psychological Evaluation of OT Activities,” in a 1948 issue of the American Journal of
Occupational Therapy. However, this article focused on evaluating the activity, rather than
on the patient. In the following year, Jay Fidler, a psychiatrist, wrote an article that included
advice about evaluating psychiatric patients. The Fidler Activity Laboratory, which evolved
from the 1959 “Diagnostic Battery” uses five activities done in a group setting and takes up
to 5 1/2 hours. The Diagnostic Battery consists of only three activities ─clay, drawing, and
finger painting─followed by a request for comments from the patient. The five activities in
the Fidler Activity Laboratory are:
1. Stencil cutout for coloring with a crayon
2. Finger painting
3. Collage with fabric and objects
4. Obstacle course
5. Circle ball tag game
This assessment attempts to look at the entire spectrum of emotions, attitudes,
interpersonal, cognitive, and sensorimotor skills.

※ Obstacle course
1. Slow walk─50 feet (~15 m)
2. Fast walk─50 feet
3. Jog─50 feet
4. Hop on right foot, 10 times, or as long as possible
5. Hop on left foot, 10 times, or as long as possible
6. balance beam─walk across, turn, walk back
7. Tire walk─as possible, walk forward in the holes of the tires
8. Bat ball─toss the whiffle ball in the air, and hit the ball with the plastic bat (three times)
9. Target ball─with a volley ball, from a distance of 15 feet, hit a 1-foot square target,

marked on the wall at 3 feet from the floor (three times) ─with a soft ball, from a
distance of 15 feet, hit a 1 foot square target, marked on the wall at 3 feet from the floor
(three times)

4

Human Figure Drawing

(Including the Kinetic Person Drawing and Kinetic Family Drawing)

Occupational therapists have used several versions of a draw-a-person test to assess body image in

children and adults. Many of these came out of psychology and were designed as assessment tools

for children, including the Draw-a-Man Test (Goodenough, 1926), later revised to the Draw-a-Person

(DAP) (Naglieri, 1988); the House-Tree-Person (Buck, 1966); and the Kinetic Family Drawings

(Burns & Kaufman, 1970, 1972).

The Kinetic-House-Tree-Person (K-H-T-P) Drawing Test

In the K-H-T-P test, the house, the tree, and the person are obtained on one piece of paper.
An 81/2” 11” paper is presented horizontally.
Instructions for obtaining the K-H-T-P are: “Drawing a house, a tree and a whole person on this

piece of paper with some kind of action. Try to draw a whole person, not a cartoon or stick person.”

The following questions are offered to demonstrate the wide range of possible experience while

analyzing a K-H-T-P.

 What story does the picture tell? What is your first impression? Whom and what do you see?

What is happening? How do you feel about what is happening? Is the picture warm? Cold?

 Is the house a place to hide from a world perceived as hostile? Is the house broken and empty

and deenergized? Is the house a portrayal of body symbols? Does the house portray success and

riches? A mansion? Does the house seem a home? Does it show signs of being lived in by a

family? Is it a home in which you would like to live?

 Does the person appear aggressive or hostile? Is the person blank or vacant or downcast? Is the

person alive? Does the person appear seductive? Does the person seem shy? Is part of the body

hidden or omitted? Does the person appear important, successful? Does the person appear part

of the counterculture? Is the person you would like to be?

 Is the tree alive or dead? Is the tree threatening or hostile? Is the tree weak and broken? Is the

tree sexualized? Is the tree continuous or segmented? Are the branches reaching upward?

Flowing downward? Does the trunk taper or broaden at the top? Does the tree seem energized?

Deenergized? Does the tree seem protective? Nurturing? Happy? Sad?

 Is the tree balanced? Is the tree too perfect? Has the tree been cut or hurt? Does the trunk have

knotholes or scars? Does the tree shelter the house? Shelter the person? If you were a tree,

would you like to be this tree?

 What do you notice about the energy areas of the picture? Is more energy (size, pressure,

movement) depicted in the house? The tree? The person?

 What do you notice about distances? Is the tree next to the house? Is the tree distant from the

house? Are the house and tree attached? What is the relative size of the house or tree or person?

Is the person interacting with the tree? The house? Is the interaction positive? Negative? If there

is a sun or a moon, is it over the house? The tree? The person?

 What styles are present? Lining at the bottom of the page? Lining at the top?

Compartmentalizing? Lining individual parts? Edging? Birdseye view? Encapsulation?

 What actions are depicted in each of the components in the drawing? Nurturing? Dependency?

Hostility? Dying? Lining? Supporting? Hiding?

 What symbols are present? How are the actions, styles, and symbols in the K-H-T-P related to

the action, styles and symbols in other kinetic drawing techniques such as the Kinetic Family

5

Drawing (K-F-D), or the Kinetic School Drawing (K-S-D)?

Maslow’s Modified Model Applied to Projective Drawing

Level 1: Belonging to life

Level 2: Belonging to body

Level 3: Belonging to society

Level 4: Belonging to self and not-self

Level 5: Belonging to all living things

Attachments, Distances, Order and Sizes of Figures in K-H-T-P Drawings

Attachments (person to house, house to tree, etc.) suggest some inability of the drawers to separate

and untangle various dimensions of their lives.

People who cannot untangle their lives and who fail to have clear, unobstructed paths seem to be

chronically unfulfilled and dissatisfied.

TABLE 1: Attachments TABLE 2: Scoring for Figures TABLE 3: Scoring for Additional

Other Than Self Figures

Attachments Present Present Present

H-T Anti-hero Anti-hero

H-P Deceased person Child

P-T Parent Deceased person

H-T-P Friend Parent

None Hero Friend

Relative Hero

Unknown Relative

Other Unknown

Other

Order of Figures in the K-H-T-P

Possible orders are H-T-P, H-P-T, T-H-P, T-P-H, P-H-T, P-T-H
1. Tree Drawn First

Life energy and growth are most important to the drawer. This is typical of person trying to grow
or stay alive. For example, suicidal persons or those losing their “will to live” will often draw the
tree first. People trying to “move upward” will also draw the tree first. Of course, the tree should
be viewed as part of the whole K-T-H-P if an interpretation is to have merit. Is the tree attached,
dead, circular, etc? Such information makes the “meaning” clearer.
2. House Drawn First
If the house is drawn first in the K-T-H-P, it may show:
①. Need to belong to the earth; a place to survive.
②. Need to belong to body. Many indicate body needs or obsessions.
③. Need to belong to society; house shows success or scorn for success.
④. A home for nurturing.
⑤. A home for giving and receiving nurturing: a creative joyful place.
3. Person Drawn First
①. Concern with control of feelings of belonging to earth.

6

②. Showing off or hiding body.
③. Showing” success” or scorn for “success.”
④. A nurturing person.
⑤. A giving and receiving joyful person.
⑥. If other than the self is drawn, it may reflect an obsession with a particular person, i.e., a

dead family member, a loved one, a hated one, a hero or an anti-hero.

Actions in Kinetic- K-T-H-P Drawings

Chopping, kite flying, sleeping, cleaning, listening, smoking, climbing, spraying, crawling, jumping,
sitting, working…

Styles in Kinetic- K-T-H-P Drawings

Styles seen in the whole K-H-T-P
Attachment, bird’s-eye views, compartmentalization, edging, encapsulation, extension of figures
above paper, extension of figures below paper, lining and cross-hatching at the bottom of a page,
lining at the top, underlining at the bottom of the age, underlining of individual figures, rejecting a
started drawing and redrawing an entire picture

Symbols in Kinetic- K-T-H-P Drawings

Balloons, Beds, Bicycle, Birds, Brooms, butterflies, Buttons, Cats, Circles, Clouds, Clowns, Cribs,
Dangerous objects, Drums, Garbage, Figures taking out the garbage, Heat, Fire theme, Electricity,
Lamp, Horses, Jump rope, Figure (other than self) jumping rope, Kites (and sometimes balloons),
Ladders, Lawnmowers, Leaves, Logs, Moon, Motorcycles, Numbers, Paintbrush, Rain, Refrigerators,
Shadows, Snakes, Snow, Stars, Stop signs, Stoves, Sun, Trains, Vacuum cleaners, Water themes, The
“X” syndrome

7

人、樹、房子問卷

人:

1. 這是個男人或女人(男孩或女孩) ?
2. 他(她)年紀多大了?
3. 他(她)是誰?
4. 是親戚、朋友或其他人?
5. 當你在做畫時，你想到誰? ?
6. 他(她)在做什麼?在什麼地方?
7. 他(她)在想什麼?
8. 他(她)覺得如何?為什麼?
9. 這個人使你想到什麼?
10. 這個人使你想起什麼?
11. 這個人好嗎?
12. 何處使你想到這樣?
13. 這個人快樂嗎?
14. 什麼地方使你有此印象?
15. 你覺得這個人怎樣?為什麼?
16. 你對大部份人也覺得這樣嗎?
17. 這幅畫中天氣如何?
18. 這個人使你想起誰?為什麼?
19. 這個人最需要什麼?
20. 這個人穿何種衣服?

8

樹:

1. 這棵樹的樹齡多少?
2. 長在那兒?名稱為何?
3. 你喜歡這棵樹嗎?為什麼?
4. 這棵樹生長的環境好嗎?缺乏什麼?．要如何照顧才能長得好?
5. 這棵樹使你聯想到什麼?

房子:

1. 這棟房子屬於誰的?在那兒?
2. 房子有多大?
3. 有無人住?
4. 屋中人各作何事?白天都做些什麼事?晚上都做些什麼事?
5. 如果這幢房子屬於你的，你要與誰同住?
6. 這"幢房子要如何隔間好?你希望住那個房間?
7. 通常這房子內的人相處得如何?
8. 這房子內的人曾共同計劃做過那些事或活動?
9. 這房子的內曾令你記憶最深刻的事是什麼?
10. 我對這房子的感覺?

填寫日期： 姓名:

9

姓名： 完成句子測驗 施測日期：
1. 我期待成為
2. 最快樂的時光 病歷號：
3. 我想知道
4. 回家後 10
5. 我後悔
6. 睡覺前
7. 男人
8. 最好
9. 我煩惱
10. 人們
11. 母親
12. 我覺得
13. 我最害怕
14. 在學校時
15. 我無法
16. 運動
17. 我從前
18. 我的神經
19. 別人
20. 我苦於

21. 我沒有能夠 11
22. 閱讀
23. 我的心理
24. 未來
25. 我需要
26. 婚姻
27. 我最會
28. 有時候
29. 讓我感到痛苦的事
30. 我痛恨
31. 這裡
32. 有麻煩的事
33. 我很
34. 我希望
35. 我的父親
36. 我暗地裡
37. 我
38. 跳舞
39. 我最擔心
40. 大多數的女人