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S-HTP interpretation guide.md

Note that this is quite incorrect, actually.

Comprehensive HTP Drawing Analysis Checklist

HOUSE FEATURES

Windows

  • Complete absence: "Indicates isolation and emotional unavailability" [1][4]. "Suggests withdrawal from social interactions and introspection" [6]. "Observed in patients with severe negative symptoms, indicating a lack of openness to others" [7]. "Strongly linked to social withdrawal and defensive behavior" [9]. "Symbolizes isolation or lack of openness" [10]. "Predictive of withdrawal" [11].

  • Curtains/blinds: "Desire for privacy, emotional withdrawal" [3]. "Represents attempts to shield oneself from external judgment or social interaction" [7]. "Suggests controlled social interaction and avoidance tendencies" [9].

  • Stained glass patterns: "Concealing or shielding inner feelings" [3].

  • Small/narrow windows: "Suggest minimal engagement or insecurity" [1]. "Associated with introversion and defensive behavior" [5]. "Indicates constrained emotional expression" [6]. "Suggests social withdrawal and minimal interaction" [7]. "Linked to restricted interpersonal connections" [9]. "Reflects a limited willingness to engage" [10].

  • Oval windows: "Reflects liberal, nonconformist attitudes" [9].

  • Barred windows: "Symbolizes feelings of entrapment and emotional confinement." [7][9] "Associated with defensive behavior and fearfulness." [10][11]

  • High/low placement: "High placement reflects detachment or a sense of control." [1][7] "Low placement indicates vulnerability or submissiveness." [4][9]

  • Blinds on windows: Desire for privacy, emotional withdrawal. [3].

  • Number of windows: "Fewer windows reflect withdrawal and introversion." [1][7] "Numerous windows suggest openness and willingness to engage socially." [9][10]

  • Window decorations: "Indicates attempts to present oneself positively or mask internal disorganization." [5][10] "Reflects impression management or social desirability." [7][11]

  • Window proportion to house: "Suggests balance between social openness and privacy needs." [4][6] "Disproportionate windows indicate internal conflict or inconsistent self-perception." [9][11]

  • Additional house decorations (lie scale and empathy): "Attempts to idealize one's situation or mask internal distress" [6]. "Correlated with impression management tendencies" [5]. "Might be used to overcompensate for internal disorganization" [7].

  • Barred windows: "Symbolizes feelings of entrapment and emotional confinement" [7][9]. "Associated with defensive behavior and fearfulness" [10][11].

  • High/low placement: "High placement reflects detachment or a sense of control" [1][7]. "Low placement indicates vulnerability or submissiveness" [4][9].

  • Number of windows: "Fewer windows reflect withdrawal and introversion" [1][7]. "Numerous windows suggest openness and willingness to engage socially" [9][10].

  • Window decorations: "Indicates attempts to present oneself positively or mask internal disorganization" [5][10]. "Reflects impression management or social desirability" [7][11].

  • Window proportion to house: "Suggests balance between social openness and privacy needs" [4][6]. "Disproportionate windows indicate internal conflict or inconsistent self-perception" [9][11].

Doors

  • Missing doors: "Isolation and emotional unavailability" [4]. "Indicates resistance to outside influence or engagement" [5]. "Linked to reduced access to external support systems" [6]. "Common in negative symptoms, representing disconnection from social life" [7]. "Reflects defensive behavior" [9]. "Symbolizes withdrawal" [10]. "Predictive of isolation" [11].

  • Double doors: "Associated with a desire for romantic connection" [9].

  • Low-positioned doors: "Suggests vulnerability or submissiveness in interpersonal relationships" [7].

  • Inaccessible entrances: "Suggest extreme social avoidance" [1]. "Symbolic of emotional inaccessibility" [5]. "May represent a barrier to meaningful relationships" [6]. "Often seen in schizophrenia patients with severe avoidance behaviors" [7].

  • Door size: "Large doors suggest overcompensation for social insecurity" [1][7]. "Small doors indicate introversion or reluctance to engage" [9][10].

  • Door details: "Decorative elements reflect a desire to present oneself positively or conceal vulnerabilities" [4][6].

  • Open vs. closed doors: "Open doors symbolize social openness and willingness to interact" [1][7]. "Closed doors indicate guardedness or a need for privacy" [6][9].

  • Multiple doors: "Suggests a complex social self or varying accessibility in relationships" [4][9].

  • Path to the door: "A clear path represents accessibility and openness" [4].

Structure

  • Non-rectangular walls: "Suggests instability or lack of personal and familial security" [1]. "Indicative of inner chaos or conflict" [5]. "Reflects disorganization or lack of balance in life" [6]. "Linked to thought disorganization in schizophrenia" [7].

  • Slanted/curved wall lines: "Instability, anxiety, or indecision" [3]. "May indicate internal tension" [5]. "Symbolic of emotional turmoil" [6]. "Common in schizophrenia patients with anxiety-driven thought patterns" [7].

  • Disproportionate parts: "Observed in depressive individuals with disorganized self-concepts" [5]. "Associated with fragmented thought processes" [7].

  • Very small size: "Low self-esteem or withdrawal tendencies" [3]. "Reflects feelings of inadequacy" [5]. "Linked to introversion and low self-worth" [6]. "Frequently observed in negative symptom clusters" [7]. "Predictive of insecurity" [9]. "Reflects low self-confidence" [10]. "Highly predictive of insecurity or withdrawal" [11].

  • Very large size: "Reflects desire for more space" [1]. "Represents overcompensation for feelings of inadequacy" [6]. "Suggests compensatory behavior" [9]. "Indicates grandiosity" [10].

  • Leaning structure: "Suggests psychological stress or insecurity" [1]. "Symbolizes emotional or cognitive instability" [5]. "Linked to delusional tendencies in schizophrenia" [7]. "Predictive of psychological stress" [9]. "Represents instability" [10]. "Associated with emotional vulnerability and stress" [11].

  • Almost collapsed walls: "Reflects an overwhelming sense of vulnerability or defeat" [7]. "Symbolic of fragility or emotional breakdown" [9]. "Represents extreme insecurity" [10].

  • Walls/ditches around: "Represents emotional defensiveness or barriers" [7]. "Linked to defensive mechanisms" [9].

  • Foundation emphasis: "Highlights the importance of stability in the patient's life" [7]. "Associated with psychological grounding" [9].

  • Structural stability: "Stability and cognitive organization" [4]. "Indicates mental coherence and control" [5]. "Symbolic of emotional resilience" [6]. "Associated with groundedness in thought processes" [7]. "Reflects emotional balance" [9].

  • Roof characteristics/decorations: "Suggests anxiety-related meticulousness" [9].

  • Bottom page placement: "Feelings of insecurity or being overwhelmed" [3]. "Represents emotional burden or low confidence" [5]. "Indicative of a grounded but heavy emotional state" [6]. "Commonly associated with depressive or negative symptomatology" [7]. "Linked to dependency and insecurity" [9]. "Reflects emotional heaviness" [10]. "Predictive of insecurity or dependency" [11].

  • Two-dimensional vs three-dimensional: "Suggests limited emotional depth" [5]. "Indicative of constrained self-perception" [6]. "Observed in patients with reduced cognitive complexity" [7]. "Symbolic of simplistic thinking" [9]. "Reflects a lack of complexity in thought" [10]. "Associated with reduced vitality" [11].

  • Overall symmetry: "Reflects orderliness or lack thereof" [6]. "Related to cognitive coherence or disruption" [7]. "Suggests emotional balance" [9].

  • Architectural style: "Reflects cultural or personal identification with order and structure" [6][9]. "Complex or ornate designs may indicate anxiety-driven meticulousness" [10][11].

  • Landscaping elements (trees, flowers): "Symbolizes engagement with the environment and optimism" [4][6]. "Sparse landscaping reflects emotional detachment or apathy" [7][9].

  • Fencing/boundaries: "Indicates defensiveness or a desire to create emotional barriers" [6][10].

  • Environmental context: "Lack of context suggests disconnection from surroundings" [7][11]. "Rich context reflects emotional engagement and adaptability" [4][9].

  • Daisy/tulip-like flowers (immaturity): "Indicates regression or childlike qualities in emotional development" [9][10].

  • Texture/shading patterns: "Detailed shading suggests compulsiveness and perfectionism" [5][9]. "Sparse or absent textures reflect low engagement or emotional exhaustion" [7][10].

  • Bizarre house design elements: "Reflects distorted thinking or psychological disconnection" [1][7]. "Associated with psychotic symptoms or eccentricity" [9][11].

  • Path leading to the house: "A clear path indicates accessibility and openness" [4][6]. "No path suggests avoidance or emotional withdrawal" [7][10].

  • Sparse or empty house: "Reflects emotional barrenness or feelings of loss" [4].

  • Thin or thick walls: "Thin walls indicate vulnerability or weak emotional boundaries" [4].

TREE FEATURES

  • Tree-ground relationship: Stability and foundation [4].
  • Balanced tree structure: Emotional and social balance [4].
  • Truncated/cut-off: "Reflects emotional stunting or unresolved conflicts" [5][7]. "Symbolizes a lack of growth or psychological development" [9][11].
  • Visible Roots: Immaturity, unresolved conflicts. [11] Bare roots: Lack of stability or security [4].
  • Roots (dead/exposed): "Lack of support or grounding in life." [3] "Lack of stability or security.", "A sense of vulnerability but with a need for defense." [4] "Symbolizes disconnection from foundational supports or security." [10] "Immaturity, unresolved conflicts." [11]
  • Missing roots: "Reflects a lack of emotional grounding or sense of belonging" [6][7]. "Common in individuals experiencing instability or insecurity" [9][11].
  • Elaborate root system: "Indicates a need for stability and connection" [4][7]. "Associated with overcompensation for perceived vulnerability" [10][11].
  • Perspective variations: "Suggests complexity in thought processes or coping mechanisms" [5][6]. "Simplistic perspectives reflect rigid thinking or lack of depth" [7][9].

Trunk

  • Very thin trunk: "Indicates emotional fragility and instability" [3]. "Associated with psychological vulnerability" [7]. "Reflects insecurity and lack of emotional robustness" [10].
  • Thick trunk: "Reflects emotional resilience and robustness" [9]. "Associated with a strong psychological foundation" [10].
  • Swaying/unstable trunk: "Indicates psychological instability and insecurity" [3]. "Associated with emotional vulnerability and imbalance" [7]. "Reflects a lack of emotional grounding" [10][11].
  • Dark edges: "Symbolizes a need for boundaries or psychological stability" [9]. "Associated with heightened emotional stress" [11].
  • Bark details: "Indicates compulsiveness and perfectionism" [9]. "Linked to anxiety and a focus on detail" [11].
  • Trunk wounds: "Suggests unresolved psychological scars or emotional vulnerability" [7]. "Reflective of past trauma or insecurity" [9].
  • Trunk texture: "Reflects tension and an orientation towards detail" [9]. "Associated with anxiety and perfectionism" [11].
  • Split trunk: "Indicates internal conflict or emotional division" [11]. "Symbolizes fragmentation and psychological duality" [9].
  • Base stability: "Reflects emotional groundedness and psychological security" [4]. "Associated with a strong and stable foundation" [9][11].

Branches

  • Presence of branches and leaves: Connectivity and adaptability [4].
  • Dead branches: "Indicates emotional stagnation and feelings of loss" [3]. "Linked to hopelessness and despair" [7]. "Associated with depression and emotional withdrawal" [9][11].
  • Sharp/pointed branches: "Symbolizes aggression and inner hostility" [7]. "Associated with psychological tension and defensiveness" [9][11].
  • Branch extensions beyond paper: "Reflects escapism and avoidance of reality" [9]. "Associated with fantasy and detachment from challenges" [10][11].
  • Drooping branches: "Indicates emotional heaviness and sadness" [7]. "Associated with withdrawal and psychological fatigue" [9]. "Reflects depressive tendencies and low energy" [11].

Crown/Foliage

  • Dead/leafless crown: "Symbolizes emotional despondency and loss of vitality" [4]. "Associated with depression and withdrawal" [9]. "Reflects emotional numbness and hopelessness" [11].
  • Lush foliage: "Indicates optimism and emotional health" [9]. "Associated with growth and psychological resilience" [10]. "Reflects vitality and positive outlooks" [11].
  • Flattened crown: "Reflects feelings of external pressure and overwhelm" [7]. "Associated with psychological stress and external challenges" [9]. "Indicates emotional pressure and tension" [11].

PERSON FEATURES

  • Group/multiple figures: "Indicates the level of social interaction and perceived relationships" [4][7]. "Closer proximity suggests stronger relational ties, while distance reflects detachment" [9][11].
  • Activity-based interaction themes: "Depicts engagement with others and environmental context" [4][6]. "Absence of interactions suggests emotional isolation or withdrawal" [7][9].
  • Body orientation: "Indicates openness to social interaction when facing outward" [6][7]. "Inward orientation reflects introversion or defensiveness" [9][10].
  • Interaction with objects: "Positive interactions suggest engagement and adaptability" [6][7]. "Avoidance or destruction of objects reflects inner conflict or aggression" [9][11].
  • Positive interaction with other objects: "Symbolizes optimism and a healthy engagement with one's surroundings" [4][7]. "Associated with resilience and emotional well-being" [10][11].
  • Gender-specific features and size interpretations: "Larger figures in males suggest assertiveness, while smaller figures in females reflect cultural or emotional expectations" [6][9].
  • Shaded/blackened figures: "Reflects emotional distress, unresolved conflicts, or depressive tendencies" [7][9]. "Strongly linked to anxiety and suppressed emotions" [10][11].

Head/Face

  • Very small head: "Indicates feelings of inadequacy and cognitive insecurity" [3]. "Reflects poor self-esteem and vulnerability" [7]. "Associated with low self-worth and inferiority" [11].
  • Missing facial features: "Suggests emotional detachment and challenges in self-expression" [1]. "Associated with withdrawal and poor self-awareness" [7]. "Reflects emotional suppression and psychological struggles" [11].
  • Emphasized eyes: "Indicates vigilance and heightened anxiety" [1]. "Associated with hyper-awareness and inner tension" [7]. "Reflects fearfulness and suspicion" [11].
  • Very big eyes (shadowed): "Symbolizes heightened vigilance and paranoia" [3]. "Associated with mistrust and fearfulness" [9]. "Reflects emotional tension and suspicion" [11].
  • Missing mouth: "Indicates emotional suppression and challenges in communication" [3]. "Associated with poor self-expression and withdrawal" [7]. "Reflects suppression of emotions and inner struggles" [11].
  • Absent ears: "Reflects detachment and avoidance of social interactions" [1]. "Associated with isolation and poor interpersonal engagement" [11].

Body

  • Missing/blurred hands: "Reflects feelings of ineffectiveness and diminished agency" [3]. "Associated with avoidance behaviors and insecurity" [9]. "Indicates powerlessness and lack of control" [11].
  • Disproportionate body: "Indicates a distorted self-image and psychological disconnection" [3]. "Reflects poor self-concept and inner conflict" [9]. "Associated with fragmented self-perception and low self-esteem" [11].
  • Missing limbs: "Symbolizes feelings of helplessness and incompleteness" [4]. "Associated with insecurity and powerlessness" [9]. "Reflects lack of agency and psychological vulnerability" [11].
  • Rigid posture: "Indicates anxiety and excessive self-control" [1]. "Associated with over-control and psychological tension" [9]. "Reflects perfectionism and stress" [11].
  • Black-colored hands: "Reflects inner guilt and negative self-perception" [3]. "Associated with shame and self-blame" [10]. "Indicates remorse and psychological struggle" [11].
  • Thin feet: "Symbolizes instability and lack of grounding" [3]. "Associated with insecurity and lack of direction" [9]. "Reflects emotional unsteadiness and uncertainty" [11].
  • Clawed/sharp fingers: "Indicates aggression and defensiveness" [7]. "Associated with hostility and psychological tension" [9]. "Reflects inner conflict and aggression" [11].
  • Oversized hands: "Symbolizes dominance and exaggerated self-perception" [7]. "Associated with control-oriented behavior and grandiosity" [9]. "Reflects a need for control and influence" [11].
  • Incomplete figure: "Indicates psychological fragmentation and feelings of incompleteness" [1]. "Associated with poor self-concept and emotional instability" [9]. "Reflects low self-awareness and disconnection" [11].

GENERAL CHARACTERISTICS

  • Intensity gradients: "Variations in pressure symbolize emotional depth and complexity" [5][6]. "Flat gradients reflect monotony or emotional detachment" [7][10].
  • Interpersonal space markers: "Distance between figures symbolizes social boundaries or emotional detachment" [4][7]. "Proximity suggests closeness or dependency" [9][11].
  • Sequential drawing coherence: "Reflects organized thought processes and emotional stability" [4][6]. "Disjointed sequences indicate cognitive or emotional fragmentation" [9][10].
  • Reality adherence: "Realistic depictions symbolize grounded thinking" [5][6]. "Distorted or exaggerated elements reflect disconnection or psychosis" [7][11].
  • Content bizarreness scale: "Indicates the extent of detachment from reality or eccentricity in thought patterns" [7][9]. "Strongly linked to psychotic symptoms" [10][11].
  • Compositional balance score: "Reflects harmony and integration in emotional and cognitive states" [5][6]. "Imbalance suggests inner conflict or instability" [9][11].

Line Quality

  • Fluidity: "Reflects adaptability and confidence in emotional expression" [4][6]. "Rigid or constrained lines indicate emotional suppression or perfectionism" [9][10].
  • Emphasis on straight lines: "Indicates rigidity, over-control, or perfectionistic tendencies" [6][9]. "Associated with obsessive-compulsive traits" [10][11].
  • Line variability: "Smooth, consistent lines indicate emotional stability" [5][6]. "Erratic or uneven lines suggest instability or anxiety" [7][11].
  • Drawing pressure variations: "Heavy pressure reflects tension or unresolved anger" [5][9]. "Light pressure suggests emotional fatigue or low energy" [7][11].
  • Sketchy Lines: "Indicates timidity and a tendency to overthink under stress" [9]
  • Line confidence: "Indicates emotional stability or instability" [9]. "Suggests steadiness in emotional responses" [11].
  • Shading/blackening: "Suggests hidden emotions or unresolved inner conflicts" [3][5]. "Indicates tension or anxiety" [6][7]. "Associated with inner turmoil and emotional distress" [9][11].

Size/Space

  • Transitional space use: "Effective use of space indicates integration and balance" [4][6]. "Excessive blank space reflects emotional gaps or avoidance" [9][10].

  • Bird’s-eye view elements: "Indicates a detached or analytical perspective" [6][9]. "Reflects an attempt to gain control or distance from emotional situations" [10][11].

  • Figure size hierarchy: "Larger figures suggest dominance or exaggerated self-perception" [6][7]. "Smaller figures reflect low self-esteem or inferiority" [9][11].

  • Very small drawing: "Indicates low self-esteem and withdrawal" [9][5]. "Suggests feelings of inadequacy and insecurity" [6][7]. "Strongly linked to introversion and negative symptoms" [10][11].

  • Very big drawing: "Reflects overcompensation and grandiosity" [1][6]. "Suggests aggressive tendencies and externalized coping mechanisms" [7][9]. "Associated with exaggerated self-perceptions" [10][11].

  • Duplicated figures: "Indicates obsessive tendencies or repetitive thought patterns" [10]. "Strongly linked to obsessive-compulsive behavior" [11].

  • Proportional relationships: "Reflects balance and coherence in self-perception and external awareness" [6][7]. "Suggests emotional equilibrium and cognitive clarity" [11].

  • Page placement: "Reflects emotional positioning and groundedness" [5][6]. "Suggests stability or instability in psychological state" [7][10]. "Linked to emotional resilience or vulnerability" [11].

  • Space utilization: "Indicates openness or constriction in emotional expression" [5][6]. "Reflects engagement with surroundings and emotional availability" [9][11].

  • Balance: "Reflects emotional stability and mental harmony" [5][6]. "Associated with cognitive integration and coherence" [9][11].

  • Integration: "Indicates organized thinking and emotional coherence" [5][6]. "Linked to internal integration and mental consistency" [9][11].

  • Excessive separation: "Suggests psychological fragmentation and emotional disconnection" [11][6]. "Indicates social isolation and lack of coherence in thought processes" [7][10].

  • Ground line use: "Indicates grounding and stability in emotional life" [5][6]. "Reflects connection to reality and security" [9][11].

Motion/Theme

  • Lack of motion: "Indicates emotional flatness and low motivation" [11]. "Reflects stagnation and withdrawal" [5][7]. "Associated with depressive tendencies" [9][10].
  • Narrative elements: "Suggests a dynamic and interactive inner life" [5][6]. "Indicates relational engagement and emotional dynamism" [9][11].
  • Unusual themes (e.g., bizarre elements): "Suggests a break from reality and distorted perceptions" [11]. "Associated with eccentric thought patterns and psychosis" [9][10].

Emotional Indicators

  • Simplified drawing: "Indicates low mental energy and withdrawal" [11]. "Reflects reduced emotional engagement and depressive states" [5][9]. "Strongly linked to emotional exhaustion" [10].
  • Weak/intermittent lines: "Indicates indecision and emotional wavering" [11]. "Reflects hesitation and uncertainty in self-awareness" [9][10].
  • Emphasis on straight lines: "Indicates rigidity and over-control in emotional responses" [11]. "Associated with obsessive tendencies and perfectionism" [9][10].
  • Presence of shadows: "Indicates anxiety and unresolved conflicts" [11]. "Reflects inner turmoil and hidden fears" [5][9].

Important Considerations

  1. Cultural Influences: "Cultural context must be considered to interpret spatial and thematic elements accurately" [5][6].
  2. Holistic Interpretation: "Indicators should be evaluated in the context of the entire drawing to ensure meaningful insights" [6][9].
  3. Clinical Application: "Findings should complement other diagnostic tools for reliable and valid interpretations" [11][9].

Source studies: FROM [1] "Synthetic House-Tree-Person Drawing Test: A New Method for Screening Anxiety in Cancer Patients"

1. Line Quality (Emotional Instability)

  • Chaotic and Curved Lines (78.4% incidence): Indicates poor emotional control and anxiety.
  • Weak or Heavy Line Strength (65.3% incidence): Suggests difficulty in regulating emotions, revealing internal turmoil.

2. Size and Space Usage (Security Needs)

  • Very Big Drawing Size (67.7% incidence): Reflects an overwhelming response to external stressors, pointing to nervousness and heightened anxiety levels.
  • Duplicated Figures (67.7% incidence): Repeated shapes may act as defense mechanisms, reflecting underlying tension.

3. Specific Structural and Figurative Features (Social and Personal Connection)

  • Slanted/Curved Wall Lines (67.7%): Suggests instability and an inability to "hold things together."
  • Absence of Ears (61.7%): Indicates introversion, withdrawal, or difficulty engaging with external stimuli.
  • Angry Facial Expressions (62.3%): Reflects unresolved frustration or emotional distress.
  • Black/Shadow Coloring (Low but Significant): Represents suppressed fears or a sense of foreboding.
  • Chimney Presence/Absence: A chimney often symbolizes familial warmth; its absence indicates isolation.

4. Tree Characteristics (Growth and Resilience)

  • Discontinuous and Curved Tree Branches: Symbolize confusion or lack of direction in the face of challenges.
  • Triangular Tree Branches: Can indicate resilience or defensive postures toward stressors.

Statistical Validation

  • Logistic Regression Fitness: Nagelkerke R² = 0.492 shows moderate explanatory power for anxiety prediction.
  • Overall Accuracy: 88.6% of anxiety cases were correctly identified.
  • Correlation Coefficient: 0.55 (p<0.01) between S-HTP test results and SAS outcomes indicates meaningful agreement.
  • Key Predictive Features: The nine combined features (e.g., drawing size, line quality, horizon emphasis) consistently correlate with anxiety.

Interpretative Framework

The signals in the S-HTP test provide insight into different dimensions of anxiety:

  1. Emotional Regulation: Chaotic and weak lines reveal difficulty in processing emotional distress.
  2. Need for Security: Large drawings and structural elements like walls reflect the desire for stability.
  3. Social and Personal Connectivity: Features like ears, chimneys, and facial expressions indicate an individual’s engagement or withdrawal from others.

Clinical Implications

  1. Non-verbal Assessment: Particularly useful for patients unable or unwilling to articulate their emotional state.
  2. Complementary Diagnostic Tool: The S-HTP test enriches standard assessments like SAS by unveiling subconscious emotional and psychological dynamics.
  3. Cross-Cultural Sensitivity: Effective in cultures or settings where direct communication about mental health is stigmatized.

Combined Insights

The Claude analysis aligns with the study’s conclusions, emphasizing the S-HTP test's robustness in identifying anxiety through projective drawing techniques. Its nuanced interpretations provide valuable layers of understanding beyond quantitative self-assessments, making it a promising tool for psychological and clinical settings.

FROM [2] "Personality Traits and the Expression Area of Synthetic House-Tree-Person Drawings in Early Adolescent Japanese"

1. Expression Area of Human Figures

  • Larger Figures:

    • Traits:
      • Openness to Experience: Strong correlation (p < .01).
      • Agreeableness: Moderate correlation (p < .05).
      • Positive Perception: Reflects competence, confidence, and positive self-image.
    • Implications:
      • Higher engagement with the environment.
      • Satisfactory and confident social relationships.
    • Reliability:
      • Supported by consistent findings across studies.

  • Smaller Figures:

    • Traits:
      • Neuroticism: Strong correlation (p < .01).
      • Social Anxiety/Shyness: Associated tendencies.
    • Implications:
      • Hesitation in new or social settings.
      • Possible emotional withdrawal or insecurity.
    • Reliability:
      • Strong evidence with high statistical significance.

2. Expression Area of Houses

  • Larger Houses:

    • Traits:
      • Conscientiousness: Weak correlation (p < .10).
      • Connection to family and security.
    • Implications:
      • Reflects a structured and diligent personality.
      • Stronger ties to family dynamics or sense of safety.
    • Reliability:
      • Requires cautious interpretation due to weaker statistical support.

  • Smaller Houses:

    • Implications:
      • May indicate limited familial interaction or insecurity.
    • Reliability:
      • Less consistent evidence.

3. Expression Area of Trees

  • Larger Trees:
    • Traits:
      • Conscientiousness: Weak correlation (p < .10).
      • General activeness and positive coping styles.
    • Implications:
      • Represents aspirations for self-improvement and energy in problem-solving.
    • Reliability:
      • Moderate at best; needs further empirical validation.

4. Holistic Indicators

  • Proximity and Relationships Between Elements:

    • Closer placement suggests integrated relationships with self, family, and surroundings.
    • Isolated elements may indicate relational distance or disconnection.

  • Drawing Style and Confidence:

    • Detailed and confident strokes: Reflect assurance and a clear self-image.
    • Sparse or hesitant strokes: Suggest emotional restraint or low confidence.

5. Important Caveats

  • Drawing Skill:
    • Confidence in drawing ability can influence the size of elements.
  • Population Specificity:
    • Results are derived from Japanese adolescents and may not generalize universally.
  • Holistic Interpretation:
    • Expression areas must be analyzed alongside total impressions and inter-item relationships.
  • Statistical Strength:
    • Findings on human figures are more robust than those for houses and trees.

Reliability Key

  • ✓ Strong Evidence (p < .01): Human figure size for openness, neuroticism.
  • ✓ Moderate Evidence (p < .05): Human figure size for agreeableness.
  • ? Weak Evidence (p < .10): House and tree size for conscientiousness.

FROM [3] "The Development of a Scoring System for the Kinetic House-Tree-Person Drawing Test"

General Signs

  1. Unusually weak strength

    • Meaning: Low energy, depression, or lack of confidence.
    • Reliability: Moderate; frequently observed and consistent with depression symptoms.

  2. Discontinuous and curved lines

    • Meaning: Instability, anxiety, or indecision.
    • Reliability: Moderate; a commonly observed sign tied to emotional tension.

  3. Very small drawing size

    • Meaning: Low self-esteem or withdrawal tendencies.
    • Reliability: High; consistently correlated with depressive states.

  4. Shadow usage

    • Meaning: Hints at hidden emotions or unresolved internal conflicts.
    • Reliability: Moderate; common but context-dependent in interpretation.

  5. Drawn at the bottom of the page

    • Meaning: Feelings of insecurity or being overwhelmed.
    • Reliability: High; often reflects psychological distress.

House-Specific Signs

  1. No chimney

    • Meaning: Emotional detachment, lack of warmth (contextualized culturally).
    • Reliability: Low; influenced by cultural factors (e.g., in Taiwan, chimneys are rare).

  2. Blinds on windows

    • Meaning: Desire for privacy, emotional withdrawal.
    • Reliability: High; strong association with depression and anxiety.

  3. Emphasis on the bedroom

    • Meaning: Focus on personal or vulnerable aspects of life.
    • Reliability: Moderate; significant when emphasized disproportionately.

  4. Stained glass window

    • Meaning: Concealing or shielding inner feelings.
    • Reliability: High; rare but diagnostically meaningful when present.

Tree-Specific Signs

  1. Dead branches

    • Meaning: Hopelessness or feelings of loss.
    • Reliability: High; frequently linked to depression.

  2. Dead roots

    • Meaning: Lack of support or grounding in life.
    • Reliability: Moderate; notable when paired with other signs.

  3. Very thin trunk

    • Meaning: Emotional fragility or instability.
    • Reliability: High; strongly indicative of emotional distress.

  4. Swaying tree trunk

    • Meaning: Psychological instability or lack of support.
    • Reliability: Moderate; context-dependent.

Person-Specific Signs

  1. Very small head

    • Meaning: Feelings of inadequacy or diminished cognitive abilities.
    • Reliability: High; consistent correlation with low self-esteem.

  2. Very big eyes (shadowed)

    • Meaning: Hyper-vigilance, anxiety, or fear.
    • Reliability: Moderate; context-sensitive.

  3. No mouth

    • Meaning: Difficulty expressing oneself or emotional suppression.
    • Reliability: High; a strong indicator of suppressed emotions.

  4. Blurred or lightened hands

    • Meaning: Feelings of ineffectiveness or lack of action.
    • Reliability: High; frequently observed and meaningful.

  5. Black-colored hands

    • Meaning: Guilt or negative self-perception.
    • Reliability: Moderate; diagnostically significant but rare.

  6. Thin feet

    • Meaning: Lack of direction or instability in life.
    • Reliability: High; consistently linked to anxiety or lack of control.

  7. Disproportionately small body

    • Meaning: Diminished self-esteem or self-worth.
    • Reliability: High; strong correlation with depressive symptoms.

  8. Repeated erasures

    • Meaning: Indecision or lack of confidence.
    • Reliability: Moderate; a commonly observed sign.

  9. Shadow painting

    • Meaning: Focus on dark or unresolved emotions.
    • Reliability: High; strongly tied to psychological distress.

FROM [4] "Development of the Haiti House-Tree-Person Test (H-HTP): A Measure of Haitian Children’s Resilience and Vulnerability"

Resilience Indicators

  • House:

    • Path leading to the house: Accessibility and connection to the outside world.
    • Doors and windows: Openness to interaction and communication.
    • General impression of a positive, nurturing environment: Emotional safety and security.
    • Structural details present: Stability and cognitive organization.
    • Landscape features (e.g., trees, flowers): Engagement with the environment and optimism.

  • Tree:

    • Lush foliage and fruits: Growth, health, and vitality.
    • Tree-ground relationship (roots firmly embedded): Stability and foundation.
    • Balanced tree structure: Emotional and social balance.
    • Presence of branches and leaves: Connectivity and adaptability.
    • Cognitive complexity (e.g., dimensionality, details): Advanced coping mechanisms.

  • Person:

    • Smiling facial expression: Positive self-view and emotional well-being.
    • Appropriately clothed: Sense of dignity and protection.
    • Open arms and legs: Openness to relationships and interaction.
    • Positive interaction with other objects in the drawing: Engagement with social and environmental aspects.

Vulnerability Indicators

  • House:

    • No doors or windows: Isolation and emotional unavailability.
    • Sparse or empty house: Emotional barrenness or loss.
    • Thin or thick walls: Weak boundaries or overly defensive behavior.

  • Tree:

    • Dead or leafless tree: Loss of vitality or hope.
    • Bare roots: Lack of stability or security.
    • Single-line tree trunk: Fragility and emotional thinness.

  • Person:

    • No mouth: Inability to express feelings or thoughts.
    • No arms or legs: Lack of agency or capacity to act.
    • Sad or withdrawn facial expression: Depression or despair.
    • Small or disproportionate size: Low self-esteem or sense of insignificance.

Aggression Indicators

  • Tree:

    • Exposed bare roots: A sense of vulnerability but with a need for defense.

  • Person:

    • Aggressive posture or clenched fists: Externalized anger or defensive behavior.
    • Carrying weapons: Perceived threat or need for self-protection.
    • Large, imposing size: Overcompensation for vulnerability through intimidation.

How to Interpret the Checklist

  1. Resilience Signs:

    • High prevalence of resilience signs suggests adaptive coping, emotional strength, and a positive outlook.
    • Indicators like lush trees, accessible houses, and smiling people reflect a healthy psychological state.

  2. Vulnerability Signs:

    • A dominance of vulnerability indicators points to emotional distress, insecurity, or exposure to trauma.
    • Items like sparse houses, dead trees, and non-human features in persons signal significant psychosocial challenges.

  3. Aggression Signs:

    • The presence of aggression indicators, even in a few drawings, can be a red flag for unresolved trauma or externalized distress.
    • Clinicians should pay attention to aggressive symbols as they may indicate a defensive response to perceived threats.

  4. Mixed Signs:

    • Drawings may contain a mix of resilience, vulnerability, and aggression indicators. Interpreters should weigh the prominence of each category to gauge overall psychological well-being.

FROM [5] "Correlations among depressive symptoms, personality, and s-HTP drawings in south korean adults"

Depression Indicators (Statistically Significant)

  1. Disproportionate House Parts

    • Meaning: Reflects internal disorganization and emotional imbalance.
    • Reliability: Moderate (p = .048), consistently observed in participants with depression.

  2. Non-Rectangular Primary Walls (House)

    • Meaning: Suggests lack of structure or stability in personal or familial relationships.
    • Reliability: Strong (p = .011), significant in differentiating depressed individuals.

  3. Lack of Two-Dimensional Body Parts (Person)

    • Meaning: Simplified self-image and restricted self-concept.
    • Reliability: Moderate (p = .027), linked to depressive symptoms.

  4. Non-Proportionate Body Parts (Person)

    • Meaning: Suggests inner conflict or disconnection with self-image.
    • Reliability: Moderate (p = .050), observed in participants with depression.

Personality Correlations (Statistically Significant)

  1. Psychoticism

    • Two-Dimensional House Parts
      • Meaning: Limited depth in cognitive processing; reduced organization.
      • Reliability: Moderate (r = –.21).
    • Active Person Depiction
      • Meaning: Less engagement with environment or action-oriented behavior.
      • Reliability: Moderate (r = –.20).

  2. Neuroticism

    • Two-Dimensional Tree
      • Meaning: Simplistic coping mechanisms and low emotional complexity.
      • Reliability: Moderate (r = –.20).

  3. Impulsiveness

    • Central House Location on Vertical Line
      • Meaning: Disorganized thinking and lack of emotional grounding.
      • Reliability: Moderate (r = –.20).
    • Additional Person Decorations
      • Meaning: Masking vulnerabilities or creating exaggerated self-images.
      • Reliability: Moderate (r = –.22).

  4. Addiction

    • Two-Dimensional Tree
      • Meaning: Simplified emotional engagement and potential substance-related issues.
      • Reliability: Moderate (r = –.20).

  5. Lie Scale

    • Additional House Decorations
      • Meaning: An attempt to present an idealized version of oneself or environment.
      • Reliability: Moderate (r = .23).

  6. Empathy

    • Additional House Decorations
      • Meaning: Reduced emotional availability or excessive focus on external appearances.
      • Reliability: Moderate (r = –.22).
  • Strong Indicators: Non-rectangular house walls, disproportionate house and person parts.

FROM [6] "Developing a scale to measure total impression of synthetic house-tree-person drawings."

1. Size of Human Figures

  • Meaning: Reflects self-esteem and social competence.
  • Reliability:
    • Well-supported across studies (Koppitz, 1968; Swenson, 1957).
    • Gender differences: Smaller figures linked to higher social competence in boys but the opposite for girls (Kayamura, 2011).

2. Quality of Human Figures

  • Meaning: Poor quality human figures indicate unstable identity in adolescents.
  • Reliability: Supported by research (Aoyama & Ichikawa, 2006).

3. Relationships Between Human Figures

  • Meaning:
    • Indicates styles of communication and perception of others.
    • The number of human figures suggests trust levels.
  • Reliability:
    • Validated through studies by Kohketsu & Morita (2011).
    • Poor relationships between figures often correlate with alexithymic traits (Fukunishi et al., 1997).

4. Formal Features in Drawings

  • Key Indicators:
    • Line Quality: Smoothness indicates emotional stability.
    • Spatial Balance: Organized drawings suggest good cognitive integration.
    • Proportions and Distortions: May indicate cognitive or emotional disruptions.
  • Reliability: Recognized as critical in formal assessments (Nan & Hinz, 2012).

5. Four-Factor Structure (From the STID Scale)

a) Vitality Factor (Highly reliable: α = .84)

  • Confident, powerful, imposing, energetic, heavy, impressive, large, lively, clear.
  • Meaning: Reflects vigor and energy, fundamental aspects of mood.

b) Reality Factor (Highly reliable: α = .86)

  • Steady, polite, methodical, realistic, graphic, careful, orderly, delicate.
  • Meaning: Indicates structural accuracy and balance in the drawing.

c) Themes Factor (Highly reliable: α = .86)

  • Narrative, synthetic, unified, coherent, appealing, kinetic, deep.
  • Meaning: Reflects relational dynamics and the drawing's thematic coherence.

d) Gentleness Factor (Reliable: α = .78)

  • Warm, soft, bright, calm.
  • Meaning: Relates to agreeableness and relational qualities.

6. Context Consistency

  • Meaning: The integration of elements and their logical relationships.
  • Key Indicators: Well-balanced placement, unified themes, and realistic portrayals.
  • Reliability:
    • Identified as essential for assessing mental health.
    • Supported by structural equation modeling in STID analysis.

7. Total Impression

  • Meaning: Emphasizes holistic assessment rather than isolated signs.
  • Key Traits: Emotional stability (vitality, gentleness) and context consistency (reality, themes).
  • Reliability: Higher-order factors like emotional stability (α = .82) and context consistency (α = .71) enhance predictive validity.

FROM [7] "Performance of patients with different schizophrenia subtypes on the Synthetic House–Tree–Person Test"

1. Positive Symptoms (Hallucinations, Delusions, Bizarre Behavior)

  • Trees:

    • Pointed Crowns and Sharp Branches:
      • Meaning: Reflects fantasies, impulses, and aggressive tendencies.
      • Reliability: Strong correlation with hallucinations and delusions.
    • Colorful Trees with Flowers:
      • Meaning: Represents rich imagination, delusions, and bizarre thoughts.
      • Reliability: Statistically significant marker for positive symptoms.
    • Disordered/Confused Branch Patterns:
      • Meaning: Indicates thought disruption and mental disorganization.
      • Reliability: High correlation with positive formal thought disorders.

  • Human Figures:

    • Disproportionately Large Figures:
      • Meaning: Suggests extroversion, self-aggrandizement, or aggression.
      • Reliability: Frequently observed in individuals with positive symptoms.
    • Oversized Hands:
      • Meaning: Associated with delusions and hallucinations.
      • Reliability: Consistently significant across studies.
    • Oblique/Tilted Eyes:
      • Meaning: Correlated with distorted perceptions.
      • Reliability: Moderately reliable for thought and perception issues.

2. Negative Symptoms (Emotional Flatness, Lack of Motivation)

  • Trees:

    • Willow-like, Drooping Branches:
      • Meaning: Reflects weak will, emotional dullness, or depression.
      • Reliability: Strong correlation with anhedonia and apathy.
    • Trees in Landscape Settings:
      • Meaning: Suggests withdrawal and lack of social engagement.
      • Reliability: Consistently linked to negative symptomatology.
    • Knife-like Branch Tips:
      • Meaning: Symbolizes emotional numbness and detachment.
      • Reliability: Moderately reliable for emotional flatness.

  • Human Figures:

    • Limp, Shrunken Arms:
      • Meaning: Indicates lack of mental energy and social withdrawal.
      • Reliability: High reliability for severe anhedonia or avolition.
    • Small Overall Figure Size:
      • Meaning: Reflects introversion and lack of self-expression.
      • Reliability: Significant for social and attentional impairments.
    • Omitted Body Parts:
      • Meaning: Indicates attentional impairment or emotional detachment.
      • Reliability: Reliable for cognitive and emotional deficits.

  • House Features:

    • Narrow Windows:
      • Meaning: Suggests social withdrawal and minimal interaction.
      • Reliability: Strongly indicative of isolation.
    • Low-positioned Doors:
      • Meaning: Correlates with introversion and reduced social openness.
      • Reliability: Statistically significant in several analyses.
    • Walls/Ditches Around the House:
      • Meaning: Symbolizes defensive mechanisms and avoidance of interaction.
      • Reliability: Moderately reliable for negative symptom clusters.
    • Inaccessible Entrances:
      • Meaning: Suggests extreme social avoidance or anhedonia.
      • Reliability: Highly consistent for severe cases.

FROM [8] "Daiki Kato, Mikie Suzuki (2015) Relationships between human figures drawn by Japanese early adolescents: Applying the synthetic House-Tree-Person test."

1. Relationships Between Human Figures

  • Significance: Girls are more likely to depict relationships between human figures than boys.
  • Meaning: Suggests that female participants are more relationship-oriented and sensitive to interpersonal dynamics.
  • Reliability: High. Supported by statistical analysis (( \chi^2(1) = 7.85, p < .01 )) and consistent with findings on gender differences in relationship sensitivity among adolescents (Ochiai and Sato, 1996).

2. Gender-Based Differences in Drawings

  • Significance: Girls depict relational aspects more frequently than boys.
  • Meaning: Reflects general gender differences in social behaviors and self-disclosure tendencies.
  • Reliability: Moderate to high. Aligns with psychological research on gender differences in adolescence but requires further cross-cultural validation.

3. Placement and Interaction of Figures

  • Significance: The proximity and interaction of human figures in the drawing may indicate the participant's perception of social connections and intimacy.
  • Meaning: Closer or overlapping figures suggest stronger relational ties; isolated figures may reflect social detachment or independence.
  • Reliability: Moderate. This is consistent with projective test theory but may vary with cultural context.

4. Emotional Expression of Figures

  • Significance: The inclusion of facial expressions or body language (e.g., smiling, gestures) can indicate emotional states or attitudes toward relationships.
  • Meaning: Positive expressions may reflect warmth and openness, while neutral or negative expressions may indicate tension or emotional distance.
  • Reliability: Moderate. Emotional cues are subjective but provide useful insight when corroborated with other data.

5. Themes of Interaction

  • Significance: Depictions of activities or interactions (e.g., playing, talking) among figures suggest an active relationship dynamic.
  • Meaning: Indicates the participant's conceptualization of social roles and interactions.
  • Reliability: Moderate. Interpretation can be enriched with context about the participant’s environment.

FROM [9] "A Comparison of the Emotional Indicators on the House-Tree-Person Drawings and the Kinetic-House-Tree-Person Drawing"

General Drawing Characteristics

  1. Sketchy Lines

    • Meaning: Reflects timidity, anxiety, and a tendency to overthink under stress.
    • Reliability: High, consistent across samples for anxious tendencies.

  2. Paper Placement (Bottom, Center, or High)

    • Bottom Placement: Indicates insecurity and dependency.
    • Central Placement: Suggests relative security but potential inflexibility.
    • High Placement: Associated with ambition and high energy.
    • Reliability: High; well-documented across studies.

  3. Large Size of Drawing

    • Meaning: Reflects aggressive tendencies or compensatory behaviors for perceived inadequacies.
    • Reliability: Moderate; context-dependent.

House Features

  1. Double Doors

    • Meaning: In adults, reflects a desire for romantic or interpersonal connection.
    • Reliability: Moderate; culturally influenced.

  2. Curtained Windows

    • Meaning: Indicates withdrawal or controlled social interaction.
    • Reliability: High; consistently linked to withdrawal tendencies.

  3. Large House

    • Meaning: Suggests frustration with environmental constraints or a desire for more space (literal or metaphorical).
    • Reliability: High; frequently observed in frustrated individuals.

  4. Daisy/Tulip-Like Flowers

    • Meaning: Associated with immaturity or regression.
    • Reliability: Moderate; needs corroboration with other signs.

  5. Oval Windows (in Women)

    • Meaning: Reflects liberal, nonconformist attitudes.
    • Reliability: Low to moderate; culturally variable.

Tree Characteristics

  1. Bark Details

    • Meaning: Careful shading or detailing suggests compulsiveness or perfectionism.
    • Reliability: High for compulsive traits.

  2. Branch Extensions Beyond Paper

    • Meaning: Reflects fantasies or a tendency to escape reality.
    • Reliability: Moderate; significant but requires context.

  3. Numerous Leaves

    • Meaning: Indicates obsessive-compulsive tendencies or attempts to appear productive.
    • Reliability: High; frequently noted in such profiles.

  4. Trunk Characteristics (Dark Edges)

    • Meaning: Reflects a need for psychological stability or boundaries.
    • Reliability: High for identifying stability concerns.

Person Features

  1. Arms Behind Back

    • Meaning: Suggests reluctance to be open or engage socially.
    • Reliability: High; strongly linked to emotional withdrawal.

  2. Emphasized Eyes

    • Meaning: Indicates suspicion, vigilance, or heightened anxiety.
    • Reliability: High; consistent across studies.

  3. Omitted Feet

    • Meaning: Reflects feelings of limitation or lack of grounding.
    • Reliability: High; a consistent indicator of insecurity.

  4. Small Hands

    • Meaning: Suggests insecurity or feelings of inadequacy.
    • Reliability: Moderate; culturally influenced.

  5. Rigid Posture

    • Meaning: Reflects anxiety or a strong need for self-control.
    • Reliability: High, especially in anxious individuals.

  6. Emphasized Belt Buckle

    • Meaning: Symbolic of dependency or attachment needs.
    • Reliability: Moderate; context-dependent.

FROM [10] "A Psychometric Study of the Kinetic-House-Tree-Person Scoring System for People with Psychiatric Disorders in Taiwan"

Checklist of Significant Signs

1. General Characteristics

  1. Unusually Weak Strength

    • Meaning: Indicates depressive tendencies or lack of confidence.
    • Reliability: High test-retest reliability (Kappa > 0.6).

  2. Unusually Heavy Strength

    • Meaning: Reflects anger, tension, or emotional instability.
    • Reliability: Moderate reliability (Kappa > 0.4).

  3. Very Small Drawing Size

    • Meaning: Suggests low self-esteem, insecurity, or withdrawal.
    • Reliability: Moderate reliability.

  4. Very Big Drawing Size

    • Meaning: Indicates grandiosity or overcompensation.
    • Reliability: Strong reliability (Kappa = 0.716).

2. House Characteristics

  1. No Windows

    • Meaning: Symbolizes isolation, withdrawal, or lack of openness.
    • Reliability: Moderate; culturally sensitive interpretation required.

  2. No Chimney

    • Meaning: Traditionally linked to lack of family support or passivity but culturally influenced (e.g., Taiwanese architecture).
    • Reliability: Questionable due to cultural bias.

  3. Almost Collapsed Wall

    • Meaning: Represents fragility, vulnerability, or a sense of danger.
    • Reliability: Moderate reliability.

3. Tree Characteristics

  1. Dead Branches

    • Meaning: Reflects feelings of loss, stagnation, or failure to thrive.
    • Reliability: Good reliability (Kappa > 0.4).

  2. Dead Roots

    • Meaning: Symbolizes disconnection from foundational supports or security.
    • Reliability: Moderate reliability.

  3. Swaying Tree Trunk

    • Meaning: Indicates instability or lack of security.
    • Reliability: Moderate reliability.

4. Person Characteristics

  1. Blurred or Lightened Hands

    • Meaning: Indicates avoidance, lack of control, or diminished agency.
    • Reliability: High reliability (Kappa > 0.6).

  2. Clawed or Sharp Fingers

    • Meaning: Suggests defensiveness, aggression, or inner tension.
    • Reliability: Moderate reliability.

  3. Thin Feet

    • Meaning: Indicates a lack of groundedness or stability.
    • Reliability: Low reliability.

  4. No Mouth

    • Meaning: Suggests difficulty expressing oneself or emotional suppression.
    • Reliability: Low reliability.

Summary of Reliability

  • Inter-rater Reliability (ICC):

    • House Features: 0.85
    • Tree Features: 0.81
    • Person Features: 0.77
    • General Characteristics: 0.47

  • Test-retest Reliability (Kappa > 0.6):

    • "Birds' Eye View," "Repeatedly Erased Person," and "Blinds on Windows" all showed perfect reliability (Kappa = 1.0).
    • Other high-reliability signs include "Very Big Drawing Size" (Kappa = 0.716) and "Blurred or Lightened Hands" (Kappa > 0.6).

Important Considerations

  1. Cultural Context:

    • Items like "No Chimney" may reflect local architecture (e.g., Taiwanese housing) rather than psychological meaning, necessitating culturally sensitive interpretations.

  2. Clinical Utility:

    • The KHTP test is best used as a screening tool or supplementary assessment, particularly for individuals with communication difficulties.

  3. Further Research:

    • Validation across diverse populations is essential to enhance the scoring system's reliability and cross-cultural applicability.

This comprehensive review highlights that while certain signs reliably indicate psychological conditions, cultural and situational factors must be carefully considered to ensure accurate interpretation.

FROM [11] "Guo H, Feng B, Ma Y, Zhang X, Fan H, Dong Z, Chen T and Gong Q (2023) Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis. Front. Psychiatry 13:1041770. doi: 10.3389/fpsyt.2022.1041770"

1. Whole Drawing Characteristics (Most Predictive, OR = 4.20)

Whole drawing features are the strongest predictors, reflecting global psychological states.

  • Simplified drawing (OR = 9.64): Low mental energy, withdrawal.
  • Lack of theme (OR = 9.36): Emotional emptiness, lack of focus.
  • Small drawing size (OR = 5.71): Insecurity, low self-esteem.
  • Excessive separation among items (OR = 3.84): Psychological fragmentation.
  • Weak/intermittent lines (OR = 3.19): Indecision, unclear self-awareness.
  • Lack of motion (OR = 2.96): Depression, low motivation.
  • Shading/blackening (OR = 2.72): Anxiety, inner turmoil.
  • Missing elements (house/tree/person) (OR = 2.81): Defensive behavior, avoidance.
  • Emphasis on straight lines (OR = 11.75): Rigidity, over-control.
  • Presence of shadows (OR = 2.88): Indicates anxiety or unresolved conflict.

2. House Drawing Characteristics (OR = 3.95)

House-related features often reflect self-image, family dynamics, and interpersonal relationships.

  • Bizarre house design (OR = 4.64): Break from reality.
  • Missing door (OR = 4.52): Social withdrawal, defensiveness.
  • Very small house (OR = 4.24): Feelings of insecurity.
  • No windows (OR = 3.09): Isolation, lack of external engagement.
  • Leaning house (OR = 2.68): Psychological stress.
  • Decorated roof (OR = 2.32): Anxiety-related meticulousness.
  • Smoking chimney (OR = 2.27): Family conflict, inner tension.
  • Two-dimensional house (OR = 1.76): Simplistic or withdrawn thinking.

3. Tree Drawing Characteristics (OR = 2.70)

Trees symbolize growth, life energy, and adaptation to external stress.

  • Visible roots (OR = 4.35): Immaturity, unresolved conflicts.
  • Truncated/cut-off tree (OR = 2.90): Stunted emotional growth.
  • Flattened crown (OR = 2.82): Overwhelmed by external stress.
  • Bizarre tree (OR = 2.78): Distorted or unrealistic thinking.
  • Dead tree (OR = 2.67): Depression, hopelessness.
  • Very small tree (OR = 2.65): Low vitality, feelings of loneliness.
  • Sharp branches (OR = 2.35): Aggression, hostility.

4. Person Drawing Characteristics (OR = 2.16)

Human figures reflect self-concept, interpersonal relationships, and emotional health.

  • Incomplete person (OR = 4.90): Fragmented self-image.
  • Shaded/blackened person (OR = 4.63): Depression, emotional distress.
  • Drawn fist (OR = 3.66): Aggression, rebellion.
  • Negative expression (OR = 3.59): Emotional struggles, sadness.
  • Bizarre person (OR = 3.18): Psychological disconnection.
  • Very small person (OR = 3.02): Low self-esteem, lack of confidence.
  • Missing facial features (OR = 2.71): Poor self-awareness, detachment.
  • Poker face (OR = 2.09): Emotional emptiness.
  • Disproportionate body (OR = 1.99): Distorted self-image, body dysmorphia.
  • Single-line limbs (OR = 1.93): Simplistic thinking, withdrawal.
  • Missing limbs (OR = 1.82): Feelings of incompleteness or helplessness.

Specific Indicators by Disorder Type

The following predictors are more closely associated with specific types of disorders:

Affective Disorders (Depression, Anxiety)

  • Lack of motion (OR = 3.34): Emotional flatness, depression.
  • Leaning house (OR = 2.68): Psychological stress.
  • Decorated roof (OR = 2.32): Anxiety-related meticulousness.

Thought Disorders (Schizophrenia, Paranoia)

  • Excessive separation among items (OR = 6.09): Fragmented thought processes.
  • Missing windows (OR = 3.09): Isolation, detachment from reality.
  • Missing facial features (OR = 2.71): Detached or distorted self-perception.
  • Disproportionate body (OR = 1.99): Unrealistic or exaggerated self-image.

Insights

Report emphasizes the importance of interpreting HTP test results holistically and not in isolation. Whole drawing features are the most reliable predictors overall, followed by house-related details. The checklist includes nuanced differences between affective and thought disorders, guiding more precise clinical evaluations.

This is from studies: [1] Lijuan Sheng, Guifang Yang, Qian Pan, Chunfang Xia, Liping Zhao (2019 revision) Synthetic House-Tree-Person Drawing Test: A New Method for Screening Anxiety in Cancer Patients.

[2] Personality Traits and the Expression Area of Synthetic House-Tree-Person Drawings in Early Adolescent Japanese (Daiki Kato, Mikie Suzuki 2015).

[3] Chih-Ying Li, Tsyr-Jang Chen, Christine Helfrich, Ay-Woan Pan. The Development of a Scoring System for the Kinetic House-Tree-Person Drawing Test.

[4] Gargi Roysircar, Kevin O’Leary, Kimberly Colvin. Development of the Haiti House-Tree-Person Test (H-HTP): A Measure of Haitian Children’s Resilience and Vulnerability.

[5] Eun Jin Lee (2019) Correlations among depressive symptoms, personality, and synthetic house-tree-person drawings in South Korean adults.

[6] Daiki Kato, Mikie Suzuki (2016) Developing a scale to measure total impression of synthetic house-tree-person drawings.

[7] Zhou, A., Xie, P., Pan, C., Tian, Z., & Xie, J. (2019) Performance of patients with different schizophrenia subtypes on the Synthetic House–Tree–Person Test. Social Behavior and Personality: An international journal, 47(11), e8408.

[8] Daiki Kato, Mikie Suzuki (2015) Relationships between human figures drawn by Japanese early adolescents: Applying the synthetic House-Tree-Person test.

[9] Denise Ann Stoddard (2003) A Comparison of the Emotional Indicators on the House-Tree-Person Drawings and the Kinetic-House-Tree-Person Drawing.

[10] Chih-Ying Li, LyInn Chung, Ping-Chuan Hsiung, Tsyr-Jang Chen, Shu-Kai Liu, Ay-Woan Pan (2014) A Psychometric Study of the Kinetic-House-Tree-Person Scoring System for People with Psychiatric Disorders in Taiwan.

[11] Guo H, Feng B, Ma Y, Zhang X, Fan H, Dong Z, Chen T and Gong Q (2023) Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis. Front. Psychiatry 13:1041770. doi: 10.3389/fpsyt.2022.1041770

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