Disconfirmatory feedback in families of schizophrenics

A new approach to the study of family communication and psychopathology, in particular schizophrenia, using Saugstad's theory about use of language as its point of departure is presented. Conflicts between family members were observed and measured using a new unrevealed difference technique, the Colour Conflict Method (CCM). Communication was analysed in terms of continuous feedback processes, using the new computerized method, Confirmation-Disconfirmation Coding System (CONDIS). Feedback mechanisms in the internal communication of families of schizophrenics, normals, and non-schizophrenic pathological controls (n = 21) are described. The findings show that families of schizophrenics lack the ability to adapt their communication to changing situational requirements. When conflicts were introduced, families of schizophrenics-in contrast to non-schizophrenics within the extended schizophrenia spectrum and normals-increased their frequency of disconfirmatory feedback reactions instead of expressing disagreements openly. This was due to active disqualifications occurring between the parents and from the parents towards their schizophrenic offspring, who reacted with incomprehensible egocentric communication acts.     

Soft Meaning and Sincerity in the Family System

The concept of “sincerity” is often dismissed as being irrelevant to the understanding of families as systems, since sincerity is seen as a linear, intrapsychic construct. This paper makes the opposite argument. Much family communication involves a particular kind of “soft” meanings. Such meanings are flexible and open to varied interpretation, but their use is nevertheless framed by social rules. Sincerity rules function as social agreements to refrain from manipulating “soft” meaning in particular ways. The expectation that family members are (or are not) likely to communicate sincerely is a crucial systems property, altering both the interpersonal strategies and relationship structures that are likely to emerge within families. The analysis of soft meaning developed in this paper suggests new ways of understanding the rich, tangled, sometimes paradoxical communication typical of families. However, a number of premises frequently associated with family systems theory must be abandoned before a clear analysis of family communication can proceed.     

Communication Schemata Within the Family

Analyses from a random sample of 169 families established a dear relationship between schemata for marital and parent-child communication. Hypotheses were derived by theoretically relating the Relational Dimensions Inventory and the Revised Family Communication Patterns instrument. In families headed by Traditional, Separate, and Separate/Traditional couples, all three family members saw the family interaction as high on conformity orientation. In families headed by Independent and Traditional couples, all three family members saw the family interaction as high on conversational orientation. In general, couple types dovetail with the various family types. For example, Traditional couples have Consensual family interaction patterns in that they value conformity and conversation. Families who share the same family communication schemata appear to agree on a number of other dimensions of family life. A new scale, Family Communication Environment, which may be used to tap into family communication schemata, is presented.     

Lay definitions of family and social capital in later life

This study explores the lay definitions of family in old age and their consequences for social capital in using an egocentric network approach. Data were derived from a subsample of 578 elders (aged 65 and older) from the Vivre/Leben/Vivere (VLV) study, a large survey addressing family life and health conditions of older people in Switzerland. A hierarchical cluster analysis was performed to create a typology of family networks based on family members who were cited as significant. We identified six family networks: Conjugal, Son, Daughter, Sibling, Kinship, and Sparse. These feature bonding and bridging social capital unequally. Therefore, one should take into account the lay definitions of family to better understand social capital within families in later life.     

Interactive patterns detection in family communication with adolescents

Interactive patterns detection in family communication with adolescents. Nondistant communication is a relevant indicator for family functionality valuation. The goal of this study is to analyze this communication in order to identify specific kinds of leadership, interaction patterns and the relation between verbal and nonverbal elements in communication. The observational design exposed is an idiographic one, punctual and multidimensional, which uses field format as observation instrument. Participants were seven standardized families made up of both ancestors and an adolescent son or daughter. According to the family models analyzed, results show a predominantly democratic communication style in adults with recurrent support expressions. The sequential analysis incorporates only categories from the emitter point of view, and detects relevant sequences which show symmetric interaction between all three family members. Verbal and nonverbal channels provide complementary information. Depending on adolescents' gender different patterns in behaviour can be identified as well.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

Teaching Interpersonal Communication to Troubled Families

Assumptions family members make about each other exert considerable influence on communication in families. Rigidly held assumptions restrict the flow of information, reinforcing counterproductive behavioral patterns. Combining psychoanalytic and structural components, this paper offers a new approach to family intervention that addresses itself to the exchange of information within troubled families. Groups of families convene for a series of camping weekends. The shared life experience in a recreational setting plus the use of a teaching model help family members to break through rigid conceptualizations of themselves and others. In following the observational model, which slows down and fosters reciprocation in communication, family members pursue the following steps: (a) observe each other; (b) compare notes with a co-observer; (c) share observations with those observed; and (d) receive feedback from the observed.     

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.     

The symbolic drawing of the family life space.

Several innovative techniques have been developed in the last ten years for facilitating meaningful communication and interaction among family members. These techniques serve the purpose of highlighting relatively stable patterns of verbal and nonverbal communication among family members and bring to the surface various aspects of familial structure, thereby illuminating focal points for intervention. The purpose of the present article is to describe the technique of the Symbolic Drawing of the Family Life Space, to compare this technique with other techniques for facilitating communication and interaction among family members, and to illustrate the clinical use of this technique with case examples. In reviewing the literature, the authors extracted two types of symbolic and interactive procedures, which may be conveniently divided into those that tend to be task-centered and those that tend to be expressive modalities.     

Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73 ) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.     

Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Every year approximately 130 families participate in Intercept, a program for struggling teens and their families at the Voyageur Outward Bound School, because they are concerned about the loss of trust, poor communication, and/or other high-risk behaviors they are experiencing with their children. Though families hope for improvements in family functioning, little research has been done on the impact of this type of program on the parent/child relationship or how families function once they leave the program. This phenomenological study collected qualitative data from nine families to determine what positive relationship outcomes emerged between parent(s) and their adolescent child post-program, as well as what aspects of the program curriculum were helpful in improving the parent/child relationship. Results showed that communication among family members improved as a result of participation in the Outward Bound program, and families reported utilizing new skills they had learned, including the use of time-outs, improved listening, and other assertive communication tools. Families reported that the parent/child conference at the end of the program was the most helpful aspect of the Intercept curriculum for improving the parent/child relationship. Implications for family therapy include support for therapeutic wilderness programs as a viable intervention for families of high-risk teens struggling with communication.     

Establishing conventional communication systems: Is common knowledge necessary?

How do communities establish shared communication systems? The Common Knowledge view assumes that symbolic conventions develop through the accumulation of common knowledge regarding communication practices among the members of a community. In contrast with this view, it is proposed that coordinated communication emerges a by‐product of local interactions among dyads. A set of multi‐agent computer simulations show that a population of “egocentric” agents can establish and maintain symbolic conventions without common knowledge. In the simulations, convergence to a single conventional system was most likely and most efficient when agents updated their behavior on the basis of local rather than global, system‐level information. The massive feedback and parallelism present in the simulations gave rise to phenomena that are often assumed to result from complex strategic processing on the part of individual agents. The implications of these findings for the development of theories of language use are discussed.     

The Family Rorschach with families of schizophrenics: replication and extension

Using a modified version of procedures outlined by Shapiro and Wild (9), this study evaluates the use of a Family Rorschach technique as a means of distinguishing families of schizophrenic patients from those of psychiatrically hospitalized, nonschizophrenic individuals. The patients were diagnosed using Research Diagnostic Criteria, and families were matched for age, intelligence, and socioeconomic characteristics. Results showed that the families with schizophrenic offspring scored significantly lower (that is, they had more communication and attentional difficulties) than those with nonschizophrenic offspring; offspring gender and family constellation had little effect on scores. Subsequent analyses indicated that lower scores were not simply a reflection of the psychoticism of the patient. These findings suggest that families of schizophrenics have interpersonal communication difficulties that compromise their ability to maintain a shared focus of attention. The findings are consistent with the suggestion that deviant patterns of family communication in interaction with genetic vulnerability in an offspring may result in the development of a schizophrenic disorder.     

Sensory experience and family process: perceptual styles tend to run in but not necessarily run families

The science of family systems has begun to develop concepts and methods for objectively assessing important characteristics of families. Thus we now have ways of measuring differences among families with respect to cohesiveness, flexibility, clarity of communication, and shared views of social reality. We know practically nothing, however, about the origins of these differences among families. One possibility is that the skills or personal attributes of one or more individual members influences the characteristics of the family as a whole. This paper explores the hypothesis that the perceptual styles of individual members--the ways they organize their experience of their personal stimulus world--influence the shared perceptions the family develops of the social world in which it lives. We explored relationships between nine measures of perceptual style and problem-solving measures of the family's shared perception of its social world. The findings showed many similarities among members of the same family on several measures of perceptual style. However, perceptual style had only a few relationships with family performance in the problem-solving task.     

Enhancing Family Resilience Through Family Narrative Co-construction

We draw upon family resilience and narrative theory to describe an evidence-based method for intervening with military families who are impacted by multiple wartime deployments and psychological, stress-related, or physical parental injuries. Conceptual models of familial resilience provide a guide for understanding the mechanics of how families respond and recover from exposure to extreme events, and underscore the role of specific family processes and interaction patterns in promoting resilient capabilities. Leading family theorists propose that the family’s ability to make meaning of stressful and traumatic events and nurture protective beliefs are critical aspects of resilient adaptation. We first review general theoretical and empirical research contributions to understanding family resilience, giving special attention to the circumstances, challenges, needs, and strengths of American military families. Therapeutic narrative studies illustrate the processes through which family members acquire meaning-making capacities, and point to the essential role of parents’ in facilitating discussions of stressful experiences and co-constructing coherent and meaningful narratives. This helps children to make sense of these experiences and develop capacities for emotion regulation and coping. Family-based narrative approaches provide a structured opportunity to elicit parents’ and children’s individual narratives, assemble divergent storylines into a shared family narrative, and thereby enhance members’ capacity to make meaning of stressful experiences and adopt beliefs that support adaptation and growth. We discuss how family narratives can help to bridge intra-familial estrangements and re-engage communication and support processes that have been undermined by stress, trauma, or loss. We conclude by describing a family-based narrative intervention currently in use with thousands of military children and families across the USA.     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

Emerging Technologies and Family Communication: The Case of International Students

Families with members living in different countries have embraced emerging technologies but little is known of the impact of mediated communication among these families. Economic globalization and the emergence of accessible information communication technologies have been parallel to the unprecedented number of higher education students who now travel abroad to study. Understanding the students’ experience may expand our knowledge on how the adoption of emerging technology is shaping transnational family relationships. In this study, international students were interviewed to share their perspectives of how mediated family communication may impact their wellbeing. Students from 14 countries and attending a university in Spain participated in 12 in-depth interviews and one focus group (n?=?10). Overall, the results suggest emerging technologies enable the maintenance of close relationships, foster a sense of connectedness, and help students to better adapt to a new environment. Students’ choices of technology are influenced by accessibility factors and cost. The type of relationship students have with their families seem to become more pronounced with interactions mediated by emerging technology. Since members of the younger generation may be more technologically literate than their predecessors, a shift in the role of who controls the use of and supplies advice about technology is manifest, with young adults advising parents about technology choices. Therefore, the control of the communication—i.e., frequency and length—is transferred from parents to students. According to students, mediated family exchanges strengthen their physical, emotional, and social wellbeing. However, the continuous availability of the technology among family members may also be stressful.     

When perspective taking increases taking: reactive egoism in social interaction

Group members often reason egocentrically, believing that they deserve more than their fair share of group resources. Leading people to consider other members' thoughts and perspectives can reduce these egocentric (self-centered) judgments such that people claim that it is fair for them to take less; however, the consideration of others' thoughts and perspectives actually increases egoistic (selfish) behavior such that people actually take more of available resources. A series of experiments demonstrates this pattern in competitive contexts in which considering others' perspectives activates egoistic theories of their likely behavior, leading people to counter by behaving more egoistically themselves. This reactive egoism is attenuated in cooperative contexts. Discussion focuses on the implications of reactive egoism in social interaction and on strategies for alleviating its potentially deleterious effects.     

Family relationships in Greek insulin-dependent diabetics

This exploratory pilot study was designed to investigate the relationship between Greek Insulin Dependent Diabetics and their family members. A secondary purpose was to explore the availability of sources for diabetes related education and to assess whether diabetics and their family members had seen a psychologist for counselling. Twenty patients with Insulin Dependent Diabetes Mellitus (IDDM) (Group A) and their parents (Group B), were randomly selected from a group of families attending the Athens Diabetic Centre of Social Security. Children and parents were given a specially prepared questionnaire, which addressed the impact of IDDM on their relationships and daily activities. There was also an interview with each of them separately. The results indicate that sources of education for diabetics are limited in Greece and that the majority of diabetics and their families have never seen a psychologist with a view to assessment and support. It is concluded that the diabetics in this study were generally content in their relationships with their parents although overprotectiveness by parents is a problem sometimes experienced by the children. After the initial shock of the diagnosis of diabetes, the majority of the families gradually returned to their premorbid state and relationship patterns.