The word "syntality" refers to the personality of a group. Then, personality is to the individual, what syntality is to a group. When the syntality is based on group members own perceptions, it serves to reveal the most inner core of members feelings. The most promising focus for change in health care delivery may be derived from a careful and objective inspection of the syntality for group members involved.

The Life Style Analysis Test (LFSTYLE) is one of three psychological tests administered to patients entering into psychological therapy at the Cassel Research Center in Mornington, Australia. The other two tests are: The Independence and Regression Test (BALANCE), and The Need (gratification Test (NEEDS). These constitute a diagnostic batterv designed to provide the basis for developing a group "syntality" (group personality) for purposes of planning intervention strategies (Cassel, et. al., 1990). Each one of these tests is a computerized true/false standardized assessment instrument that provides a confidential profile of the present perceptions of an individual in relation to the particular test being used. For an average reader approximately 20 minutes of time is required per test. More specifically, in relation to health care the battery serves the following functions (Taylor, 1990):

1. Assess severity of stressors,
   
2. Assess degree of incapacity,
   
3. Planning of ego-ideal,
   
4. Help patient understand problem,
   
5. Plan intervention strategy, and
   
6. Serve as an objective record.

Each one of the three tests is designed to run on a PC like microcomputer with no less than 256 K of memory. They are available from Psychologists and Educators, Box 566, Chesterfield, Missouri 63006. The three tests are designed as a companion battery with each one fulfilling a specific role in helping plan for effective health care. Validation of this battery of tests has focused on three specific types of health care services:

I. Treatment in relation to mental health,
II. Chemical dependency rehabilitation, and
III. School dropout odyssey and fitness education.

The Life Style Analysis Test (LFSTYLE)

LFSTYLE was developed over the past decade at the CASSEL PSYCH CENTER in California, and is based largely on the Framingham studies in Massachusetts (Sandroff, 1987), and where the basis for coronary heart disease (CHD) was found to be significantly related to one's life style. The Type-A Personality was determined to often be an important precursor to CHD, and to involve a balance of positive and negative forces in one's life space (Friedman and Rosenman, 1974). Recently reported research depicts low self-esteem and a negative attitude to be associated with chemical dependency (Adler, 1990). The psychological findings of these two research projects have been carefully incorporated into LFSTYLE (Cassel, 1985; Gilley and Uhlig, 1985; and Adler, 1990).

Positive Life Style

The positive life style of an individual is presumed to represent one's "ego-strength" as a measure of fitness (wellness), or as the potential to be productive. It is comprised of four separate parts, each one representing an important element of one's positive life style:

1. SELF ESTEEM - perceived importance in relation to group,
2. SATISFACTION - contentment with present life situation,
3. INVOLVEMENT - degree or incidents of involvement, and
4. ASSERTIVENESS - amount of personal initiative

Each one of the four scores depicts a positive source of power for negotiating barriers in the life space. Together, they reflect the present strength of an individual for being productive in work, learning, or adapting to the life arena.

Negative Life Style

The negative life style of an individual is presumed to represent one's perceived stress load, and to constitute a negative force inhibiting the potential for productivity of an individual. It is comprised of four elements, each representing a part score (Rozzinni,et.al., 1988):

1. LONELINESS - lacking friends and purpose for life,
2. ANXIETY - presence of anxiety and frustration,
3. NEGATIVE ATTITUDE - over concerns about health, and
4. DEPRESSION - despair and hopelessness.

TOTAL SCORE - STRESS LOAD.

Each one of the four scores represents a high priority in terms of demands of the energies of an individual for containment. Together, they represent the present load of an individual with priority demands of energy in the work and learning place.

Ego-Strength and Stress Load

The important element in relation to LFSTYLE has to do with the critical balance of forces as represented by positive life style (ego-strength) and negative life style (stress load). Persons with high ego strength can be expected to deal more effectively with a heavier stress load than one, for example, with low ego strength. It is presumed that individuals with maybe twice the ego-strength on LFSTYLE in comparison to stress load would be expected to be reasonably productive in learning, at work or in interactions with people. Conversely, when the stress load is higher than the ego-strength, it is clear that the individual will be largely preoccupied with factors related to containment in elements of the negative life style (Cassel, 1985).

Accountability

Health Care like every other service being provided must be concerned with its effectiveness, or success. When a person comes to a clinic or health delivery agency, they come because they sense a problem in relation to their own wellness. Two major concerns must be included in determining the service to be rendered:

1. Severity of problem, and
2. Degree of incapacity, or global functioning.

Multiple Axial System

The DSM - 111 - R was developed in large part by The American Psychiatric Association, and was first published as DSM 11 back in 1982. Twenty-five advisory committees on diagnostic categories contributed to the last revision, and shortly thereafter the International Code of Mental Disorders was revised to agree precisely with DSM - 111 - R. A unique aspect of the initial DSM concept and later revisions is the "multiple axial system". Today all public monies spent for health services require all five of the axes to be accomplished before payment is made:

AXIS I - description of malady seeking help for,
AXIS II - diagnostic code for major problem,
AXIS III - physical involvements,
AXIS IV - severity of stressors, and
AXIS V - degree of incapacity, or global functioning.

Severity of Stressors

Axis IV of DSM - III - R deals with severity of stressors, and seeks to depict one's degree of good health status on a five point scale. Each of the five points on the severity of stressors scale is carefully defined, with 1 being least severe and 5 most:

Axis IV Stressors	LFSTYLE - stress load
1 - remission	20 to 30
2 - mild	30 to 39
3 - moderate	40 to 50
4 -severe	60 to 69
5 - extreme	70 to 80

The negative life style TOTAL SCORE - STESS LOAD is a direct projection of one's perceived severity of stressors. Each of the four part scores depicts the nature and structure of stressors as perceived by the individual. The TOTAL SCORE serves as an objective basis for assigning values to the five point stressor scale as depicted above; always tempered by the total clinical picture.

Degree of Incapacity

The most critical element in relation to one's wellness is the degree to which one is able to perform expected production, and based on corresponding healthy individuals. It represents a measure of their global functioning. AXIS V on DSM - 111 - R is intended to be used for this purpose. Here a ten point scale is required with 10 being totally incapacitated, and 100 having little or no incapacity present. Each position on the 10 point scale is described as follows:

100 percent	no symptoms
90	minimal symptoms
80	transient symptoms
70	mild symptoms
60	moderate symptoms
50	serious symptoms
40	reality impairment
30	dissociation/delusions
20	hurting self/others
10	suicidal

A comparison of EGO STRENGTH with STRESS LOAD on LIFESTYLE provides an objective basis for determining a patient's degree of global functioning. On the ten point incapacity scale scores above 50 should be associated with EGO-STRENGTH SCORES above 50, and STRESS LOAD score below 50. Incapacity ratings below 50 should be associated with EGO-STRENGTH scores below 50, and with STRESS LOAD scores above 50. That is to say that when the ego-strength is greater than the stress load on LFSTYLE, one would expect less than 50 percent of' incapacity. Conversely, when the stress load is greater than the ego-strength, one would expect greater than 50 percent incapacity; always tempered by the total clinical picture.

Intervention Success

The particular intervention strategy elected should bear some relation to the nature of malady, and which should be evident from an inspection of the part scores on LFSTYLE. On repeating the administration of LFSTYLE (not less than one month between tests) a measure or degree of success for the intervention strategy may be obtained. The higher the ego-strength in relation to stress, the more successful the strategy.

Subjects Involved in Study

One hundred and eighty six patients involved in psychological therapy at the Cassel Research Centre in Mornington, Victoria, Australia (1990-91) were involved. LFSTYLE was administered as a portion of the routine introductory assessment used in the planning for an appropriate intervention strategy. There were 99 females ranging in age from 15 to 70 years, with a mean (M) age of 36.96 and a standard deviation (SD) of 11.53, and 87 males ranging in age from 14 to 63, with a M age of 32.53 and a SD of 12.47. Females were significantly older than males at the .01 level of confidence. There was no significant difference in marriage status (1=not married, and 2= married) for male and female members.

Sexual Differences

A t-statistic was computed on the LFSTYLE scores between male and female members as depicted in Table 1. Only one of the positive life style scores showed a statistically significant difference at the .05 confidence level or better, SATISFACTION. This suggests that males were more satisfied with life than females. Similarly, only one of the negative life style scores showed a significant difference, HEALTH CONCERNS. This suggests that females were more concerned about health matters than males.