AZIMA

Battery Test
Evaluation in Psychosocial Dysfunction
Prepared by:
Hazel Anne A. Magsombol
BSOT3
CONTENTS
HISTORICAL DEVELOPMENT

ADMINISTRATION

USE OF BATTERY

BEHAVIORS ASSESSED
AZIMA DIAGNOSTIC
RATING SCALE
 PA RT 0 1
HISTORICAL DEVELOPMENT
Fern J. Cramer Azima, Ph.D.
 HISTORICAL DEVELOPMENT

• According to Azima, at the end of 1950s, he was involved in an assessment of

Psychiatric Occupational Therapy in Canada, but it resulted to criticism in Canada
and United States.
• After the setback, he was invited by American Occupational Therapy Society and
American Psychiatric Task force to present the new test procedure, philosophy and
dynamic orientation of the battery.
• The driving force of the battery was its simultaneous involvement in analytic group
therapy and studies in treating schizophrenia.

• The next studies linked with the battery was for prolonged sleep and sensory
deprivation. The concern about understanding and clarifying distorted object
relations was the central pivot of this. It is the regressive phenomena that occur
in severe psychopathological, drug, or marked states of stress.

• Back then, Psychiatric Occupational Therapy was focused exclusively with

traditional occupational and recreational functions and nominal with evaluation
and therapeutic “functions”
HISTORICAL DEVELOPMENT

But due to the battery and Azima, she convinced

occupational therapists that the key concept proposed for
dynamic occupational therapy is central position of the object.
“...presence of objects (ready made, offered, or created) and
dynamics of the object relations as referable to an available
external medium is and should be taken as the distinguishing
mark of occupational therapy from individual or group
psychotherapies.

The presence of non-structured which can be structured

according to emergence of internal happenings marks the point
of emphasis and of distinction of an ongoing process in
occupational therapy setting.” With this, she differentiated
psychotherapy and occupational therapy. In the former, patient
are required to only to have verbalization, but not doing and in
occupational therapy, it is both verbalization and doing at the
same time.
PA RT 0 2
ADMINISTRATION
ADMINISTRATION
Part I

Azima battery is the first activity-based

assessment with a standard procedure
published in Canadian occupational therapy

• Devised a simple battery that would encourage the free creation

of objects, utilizing → three media and subsequent free
association and inquiry phase
• The patient is asked to:
1. Do a free drawing with a pencil.
2. Draw a whole person and then a person of the opposite sex.
3. Make anything with clay
4. Do a finger painting
ADMINISTRATION
Part II

Testing this procedure to gain free

associations to each production

The battery is usually administered

individually with the Occupational Therapist.

Client is seated side by side before a small

table.
MATERIALS

8.5" x 11" 16" x 22" finger

bond paper painting paper

PENCIL
finger paints
(yellow, red, green, blue, brown, black)

paper towels clay in a

plastic
container
WATER CONTAINER
POSITION OF MATERIALS

finger paints arranged in a standard order (left to right):

yellow, red, green, blue, brown, black

container of water on the right side

clay (moistened in a plastic container) on left-hand side

paper towels are provided

■ NO other objects (ruler or tools) that are used in ceramics are allowed.

The preferred order of presentation: pencil → clay → finger painting

POSITION OF MATERIALS

CLIENT
 PROCEDURE
1. The Occupational Therapist asks the client’s :
➢ age
➢ education
➢ marital
➢ occupational status
2. After gaining some rapport, the OT gives instructions..
“As part of the evaluation routine of our hospital, I would like to carry out a battery
of tests with you. I am going to ask you to make some different things with the
various materials on this table. This is another investigation to help assess your
mode of functioning and some of the problem areas that are not always visible on
the surface, or even that you may be aware of. I may repeat the procedure at
various intervals and at discharge to assess your progress.”

3. The therapist moves slightly behind the client so as to be out of line of

vision.

4. Begins to record both time for each productions and the total test time.

5. The therapist keeps note of the client’s behavior of the drawing, clay &
finger-painting sequence, the verbalizations & total technique employed.
 PROCEDURE

CREATION PHASE
o The OT refrains from talking and responds minimally to allow the client
maximum concentration and externalization.
o It is preferable to commence the inquiry stage after all the productions
are finished.
o Exceptions to this rule are certain active children, organics or memory
damaged individuals where the inquiry for association phase is made as
each product is finished.
 PROCEDURE

ASSOCIATION PHASE
o As with other projective techniques, associations are gained by such
statements as:
“Please tell me now what you have made; describe to me what you
see and what you had in mind, and what comes to you now.”
o OT must be cautious not to project his own associations or directly
suggest meanings, but to show positive interest, a need for elaboration
and understanding of the productions.
 PROCEDURE

REMEMBER
✔ OT must not project his or her own associations or suggest
meanings
✔ The client’s motivation, behavior and rapport to the test situation
and examiner should be noted.
✔ For each part of the battery, the phases reaction and total time of:
○ Preparation
○ Production
○ Completion recorded
✔ For the interpretation of the battery an evaluation scale has been
published and the scale is divided into:
○ organization of mood
○ organization of drives
○ organization of ego
○ organization of object relations
✔ For completeness: the original scale is reproduced.
 PA RT 0 3
BEHAVIORS ASSESSED
BEHAVIORS ASSESSED

Aside from decoding of free associations, dreams, hypnosis, and

the psychological projective tests of drawing and especially the
Rorschach, few avenues are open to the exploration of an
individual’s inner world

The battery evokes tactile, spatial, visual, auditory, and often

olfactory sensory modalities. The change in media from dry to
wet, from flat to thick, and into three dimensional objects
extends to externalization processes for the testee.

The importance of evaluating reality contact, mood, level of

functioning, and the quality of the object relations should be
stressed.
Structural sequence, and content analysis are blended with the verbal analysis. Line,
form, organization of space, interrelationship of parts, and the total gestalt are primary
determinants, and act as the fulcrum of scale. Movement, color, texture, and
perspective add the dimensions of fantasy, spontaneity, sensitivity, and intelligence.
 BEHAVIORS ASSESSED

Phenomenological evaluations are preferred over

symbolic interpretations, unless clear associations
are given by the client.
The dynamics of the object as a whole system are defined by its
radiating and integrating subsystems, and they vary markedly from
syndrome to syndrome, from psychosis to neurosis and organic
features, including deterioration in form, distortion of perspective,
lack of angulation, line tremor, and retracing. Motor organization
and orientation to space may be traced over a number of weeks,
months, or years. Poor contact with reality is evidenced by bizarre,
eccentric, or original representations of poor form, color, and
content, as well as the presence of psychotic language and
reasoning.
 BEHAVIORS ASSESSED

Reports should be clear and factual; a brief

Behavioral Analysis of the client during the testing
procedure should precede the Examination
Analysis, where each part of the battery is briefly
detailed and interpreted.
The summary should present the salient findings to be included in
the client's chart, and should cover the following six areas:
1. Contact with reality
2. Degree of relatedness to others
3. Quality of mood expressiveness
4. Degree of ego control and coping
5. Degree of activity
6. Degree of clarity of communications as compared to
defensiveness

Differential diagnosis, treatment planning, and prognosis should be

attempted.
 PA RT 0 4
USES OF BATTERY
A projective technique using expressive media
designed to uncover attitudes, motivations,
and defense mechanisms of persons
hospitalised for psychiatric conditions.
USES OF AZIMA BATTERY

It is a way to assess the

An area that has been
relatively unexplored is the
battery's prognostic use
for psychotherapeutic
intervention
client’s ability to comply
with the test procedure
and to show sufficient
spontaneity, creativity and
easy association.
Changes in size, line pressure,
shading, repetition of theme, or
regression-progression gives an
independent assessment for
the clinical changes.

At the same time that the battery
has been used for diagnosis and
It allows further specific change detection, there is
significant usefulness for its
evaluation and therapeutic
adjuvant use in individual and
planning.
group therapy with adults,
adolescent, and children
Projective batteries and others
in this text are ways to render
the person’s hidden past into
a visual identifiable form which
gradually the ego recognizes
and codes into language.

With the proliferation of family therapy, a

family battery has been experimented
with, as well as a comparison of batteries
done independently by mother and child,
by twins, siblings etc. At times the patient
has been asked to “interpret” the
battery that his child has done, and this is
very often highly revealing of hidden
reciprocal family conflicts.
 AZIMA DIAGNOSTIC
RATING SCALE

Diagnostic Indexes

D – Drawing
F - Finger Paint
C - Clay
P - Plasticene
 AZIMA DIAGNOSTIC RATING SCALE
Organization Of Mood

ELATION-DEPRESSION
very happy to very sad
● Animate to inanimate
● Human to non-human
very fast to slow ● Symbolic to
comprehensible

• Degree of control - very controlled

to no control
• Intensity of color - very intense to
no intensity
• Extensity of color - mixed to small
• Range and purity of color - mixed to
no color
• Texture of color - very thick to none

Many to unique
• Control of form - controlled to
symbolic
• Form-movement - very mobile to
immobile
• Extensity of form - whole to part
• Purity of form - mixed to impure
 AZIMA DIAGNOSTIC RATING SCALE
Organization Of Mood

anxiety
Overt anxiety
Covert anxiety
Blocking- rapid movement
Smooth flow- choppy

Color shock - marked to none

Clarity - very clear to chnotic

● Distinct-shading-indistinct
● Continuity -discontinuity
● Controlled-uncontrolled
● Smooth-shaky
Degree of shading
Degree of smoothness
Degree of fuzziness
 AZIMA DIAGNOSTIC RATING SCALE
ORGANIZATION OF DRIVES
THE NATURE OF DRIVES
1. LIBIDINAL DRIVES
• Content overt libidinal content;
covert libidinal content
(symbolic)
• Degree of form control
• Degree of intensity of color,
texture, movement
• Mode of object handling
(stroking, rubbing, messing,
soiling, smearing, licking)
• The behavior toward the
therapist and object
1.Aggressive DRIVES
• Content: overt aggressive
content; covert aggressive
content
• Degree of form control
• Degree of intensity of
movement
• Mode of object handling
(scratching, nailing, twisting,
pressing, cutting, breaking
smashing, etc.)
• The behavior toward the
therapist and object
AZIMA DIAGNOSTIC RATING SCALE
ORGANIZATION OF DRIVES

THE content OF DRIVES

1. Oral (libidinal-aggressive) 2. anal (libidinal-aggressive)

• Active to passive responses • Active to passive responses

• Overt to covert and symbolic • Overt to covert arid symbolic
responses responses

2. phallic (libidinal-aggressive)

• Active to passive responses

• Overt to covert arid symbolic
responses
 AZIMA DIAGNOSTIC RATING SCALE
ORGANIZATION OF EGO

A. SYNTHETIC FUNCTIONS B. DEFENSIVE FUNCTIONS

1. Degree of organization of form,

color and movement 1. Repression
2. Degree of organization from 2. Reaction formation
one medium to another 3. Isolation
3. Use of the battery 4. Undoing
4. Tool approach to the battery 5. Projection
5. Completeness-incompleteness 6. Splitting
6. Comprehensibility- 7. Introjection
incomprehensibility (the degree 8. Withdrawal
of preponderance of secondary 9. Denial
and primary processes) 10. Regression
 AZIMA DIAGNOSTIC RATING SCALE
ORGANIZATION OF OBJECT RELATIONS

A. RELATION TO THE THERAPIST B. RELATION TO THE OBJECT

1. Libidinal-aggressive
1. Libidinal-aggressive
2. Indifferent
2. Indifferent
3. Inhibited
3. Inhibited
4. Problematic
4. Problematic
5. Realistic
5. Realistic

c. Content of the object d. Structure of the object

1. Human (mobile-immobile) 1. Recognizability

2. Animal (mobile-immobile) 2. Culture-sytonicity
3. Vegetable 3. Relation of parts
4. Inanimate 4. Completeness-
5. Void incompleteness
6. Bizarre 5. Realistic-symbolic
THANK YOU
Reference:
⇒ The Evaluative Process of Psychiatric Occupational Therapy by Barbara J.
Hemphill-Pearson