Minuchin's psychosomatic family model revised: a concept-validation study using a multitrait-multimethod approach

The convergent and discriminant validity of three operationalizations of the psychosomatic family features--enmeshment, rigidity, overprotectiveness, and lack of conflict resolution, as described by Minuchin and colleagues--are tested in families that include patients with eating disorders, especially anorexia nervosa and bulimia. We redefined the family features as dimensions and measured them with two behavioral methods (direct observation and behavioral product) and a self-report method. The two behavioral methods showed convergent as well as discriminant validity for the intensity of intrafamilial boundaries, the degree of the family's adaptability, and the family's way of handling conflicts. The self-report method showed only convergent validity for the latter dimension and discriminant validity for none of them. Besides intrafamilial conflict, the self-report method seemed to measure other constructs. A factor analysis of the family questionnaire indeed yielded three more evaluative constructs: conflict, cohesion, and disorganization. We interpreted these findings according to two usually interwoven mechanisms: the different research context (insider/outsider evaluation) in self-report and behavioral observation, and the different level of specification (micro/global evaluation) of certain operationalizations. We draw some conclusions about the psychosomatic family model and discuss the clinical implications of our findings.     

The Beavers Systems Model of Family Functioning

Family competence and family style are the two main dimensions of the Beavers Systems Model of Family Functioning. The competence dimension ranges from optimal through adequate, midrange and borderline to severely dysfunctional. The style dimension ranges from centripetal to centrifugal. When the two dimensions are combined, they diagramatically define nine distinct family groupings, three of which are relatively functional and six of which are thought to be sufficiently problematic to require clinical intervention. A family's status on the competence and style dimensions may be established with the Beavers interactional scales. The self-report family inventory may be used to evaluate family members' perceptions of their status on the competence dimension. The reliability and validity of the self-report instrument and observational rating scales have been documented in over thirty papers and books published by the Beavers research team since 1970. The model has proved useful in training, research and clinical work.     

The use of family myths as an aid to strategic therapy

The concept of family myth can be used by the therapist to help organize the wealth of information provided by a family in therapy. Rituals, symbols and metaphors can be viewed as structurally related components within the family myth system which enable the therapist to interpret non-literal, analogic communications as a coherent yet primarily symbolic, narrative about the family's shared perceptions of its functioning. The concept of myth is explored in relation to mythology, the family therapy literature, and a case study. Several strategic intervention strategies are proposed which utilize the family's own metaphors, symbols and rituals to re-edit the family myth. Re-editing the myth on a symbolic level should be associated with improved system functioning, including more concrete areas of the family's life.     

The process of enabling change: a study of therapist interventions in family therapy

We describe the application of discursive analysis to the task of researching family therapy process. Through the analysis of a central theme in two family therapy treatments, we found that individual family members move to using a wider range of discourses on the central theme by the end of therapy. Using the example of one family's therapy sessions, we examine how the therapist contributes to the new meanings and views that emerge, and present our analysis of the therapists' interventions in relation to the 'production' of these alternative meanings. It is argued that discourse analysis can fruitfully be applied to family therapy process research and could contribute to theoretical concepts of change and therapeutic competence.     

Ethical decision making in family therapy

In family therapy, effective clinical decisions promote the welfare and interests of the family and its individual members. However, the needs of the family and its individual members are often in conflict. Resolving this conflict is an ethical as well as a therapeutic dilemma. Kitchener has developed a model of ethical decision making that we have found useful in teaching students and supervisees how to resolve conflicts between the family's needs and the needs of its members. The purpose of this article is to discuss this model and show how it can be applied to clinical decision making.     

Training family therapists in observational skills

A study was conducted to develop procedures for training observational skills using concepts derived from structural family therapy. Experienced family therapists provided operational definitions of key concepts in family interaction, and videotaped segments of interactions were prepared which exemplified the concepts. A group of trainee family therapists was compared with a group of experienced therapists in the way they applied the concepts to interaction sequences in therapeutic sessions. In demonstrating that inexperienced trainees can be instructed relatively rapidly to identify and use structural concepts, the results suggested that this analytical approach to the training of family therapists shows considerable promise.     

Family system functioning: behavior in the laboratory and the family treatment setting

The Family System Functioning (FSF) scale is a new instrument for measuring dimensions of the intrafamilial environment thought to be important in recovery from major psychiatric illness. Modest statistical correlations were obtained when FSF ratings of laboratory-based family interactions were compared with researcher-guided therapist ratings of FSF based upon the family's behavior in family therapy sessions during the subsequent month. The data from these two settings provide support for the validity of some of the scales. Because of the modest size of the correlations, however, behavior in the laboratory setting may not always be an accurate indicator of how the family will behave in the early weeks of family therapy.     

A system for recording family sessions

A diagrammatic technique for recording family sessions is presented. The Interaction Chronogram is a visual display system originally devised for use in group psychotherapy by Cox, but can be modified for work with families. The system permits a family session to be summarized diagrammatically and aids review of a family's treatment. A 'diagnostic' and treatment session with one family is presented to illustrate the system's use.     

Using psychodynamic concepts in strategic family therapy: A suicidal adolescent case

This paper describes the treatment of a suicidal adolescent with strategic family therapy. The cotherapists conceptualized the case psychoanalytically and systemically. They propose that their understanding of psychodynamics enhanced their ability to tailor their interventions to the family's unique style and capacities. Rather than dismiss psychodynamic concepts as irrelevant to strategic family therapy, they maintain that an appreciation of individual members' ego strengths, defenses, affects, and unacknowledged impulses leads to the construction of more effective metaphors and a set of interventions more isomorphic to family patterns.     

Resistance in family logotherapy

The author describes a logotherapy view of family resistance and its occurrence in a variety of family situations. In family logotherapy resistance is understood as a manifestation of the human fear of meaning, which is a reaction to the family's discomfort with the two side effects of meaning awareness: vulnerability and responsibility.     

Proximity and hierarchy: orthogonal dimensions of family interconnectedness

The purpose of this research was to develop logical and empirically valid conceptual tools for investigating relationships between family patterns of interconnectedness and psychosocial functioning of children in the family. The family systems concept of boundary was analyzed into two component concepts: Proximity (interpersonal boundaries) and generational Hierarchy (subsystem boundaries). These concepts were operationalized as dimensions, and eight families were assessed by means of interaction coding, interview, and Kinetic Family Drawing to yield empirical verification of these dimensions. Findings indicated that Proximity and Hierarchy are reliable, valid, and independent dimensions of family interconnectedness. Weak generational Hierarchy was associated with increased levels of psychological dysfunction for both identified patients and their siblings. High Proximity was similarly associated with psychological dysfunction, but only for identified patients. The hypothesis that enmeshment is a composite pattern of high Proximity and weak Hierarchy was disconfirmed. Suggestions for future research include systemic analysis of deviation-counteracting and -amplifying relationships between patterns of Proximity and Hierarchy, on the one hand, and psychosocial dysfunction, on the other.     

Re-empowering a disabled family network

In this paper, we will present a case history of a disabled network which includes a multiproblem family and the social service agencies serving it. We will describe a five-step model for effective intervention into the entire system. Social service agents frequently become overwhelmed and therefore impotent in their attempts to help multiproblem families. In such cases, agents reflect the family's dysfunction by becoming dysfunctional themselves and their actions serve to increase the family's alienation from its community by reinforcing its stigmatized self-image. Our model focuses on building boundaries and creating hierarchies which encourage individuation within the family and empowers the network to effectively meet family needs.     

The interactional model of anxiety: an evaluation of the differential hypothesis

The interactional model of anxiety states that individuals who score high on trait anxiety measure for a specific situation dimension will respond with elevated state anxiety only in reaction to encounters with congruent situations. We tested this model by presenting subjects who scored high or low on ego threat, physical danger, novelty ambiguity, and daily routine trait measures with stressors representative of the four situation dimensions. The interactional model was partially supported for ego threat trait anxiety. However, results generally supported the influence of situation rather than the trait or interaction on anxiety response. The lack of trait factor independence for the novelty ambiguity and daily routine trait dimensions is discussed as a potential reason for the nonsupport of the interactional model. Finally, we suggest that the experimental design used in this study is a more accurate and vigorous test of the differential hypothesis than past research.     

Gender and family therapy: Adding a bi-level belief systems component to assessment

This article proposes that most couples requesting therapy describe gender socialized patterns as part of their relationship issues. Adding a component to assessment derived from principles of strategic and systemic family therapies and post-modernist feminist psychology which examines the couple's gendered belief system context is described. The belief system context is identified as the family's epistemology about gendering at the family belief system and sociocultural belief system level contexts. Three dimensions of the gendered belief system and a method for assessing the functionality of the belief system are discussed.     

Emotionally disturbed, adopted adolescents: early patterns of family adaptation

This article focuses on the development of compatibility or goodness-of-fit within adoptive families and on the possible contribution of such problems to emotional disturbance of adolescents. Subjects included 50 adopted adolescents in residential treatment (mean age = 14.96) and their families, and 50 nonadopted adolescents in treatment (mean age = 14.90) and their families. The child, both parents, and the child's caseworker were interviewed. Three distinctive interactional patterns presenting adaptational challenges are discussed: the family's adaptation to the child's hyperactivity, the family's adaptation to the child's avoidance of contact and cuddling from early infancy, and perceived incompatibility between the child's personality and the parents' style. Results are discussed in terms of behavioral and attributional contributions of both the child and parents to the development of compatibility. Implications for clinicians are discussed.     

A child's experience of parental depression: encouraging relational resilience in families with affective illness

In this article, we describe an approach that parents with affective illness can use to foster the emotional resilience of their children. Building on current research that emphasizes the need to formulate concepts of risk and resilience in terms of family or relational processes, we propose that affectively ill parents can promote resilience in their children by helping them express the affect they experience as a result of parental illness-related behavior. Risk and resilience are conceptualized in terms of a family's ability to process emotion or affect: a family's need to constrict affect is a risk factor, while the family's ability to elaborate affect encourages relational resilience. An object relations model is used to discuss the ways in which encouraging this elaboration of affect, especially negative affect, contributes to resilience in children. We describe ways in which a preventive intervention helps to increase parents' emotional responsiveness to their children. Using extensive narrative data from followup interviews with families and children, constriction and expansion of emotion in children concerning affectively ill parents are documented, by multiple interviewers, over a span of more than 5 years.     

The development of structural complexity in the child's concept of family: the effect of cognitive stage, sex, and intactness of family

Twenty-eight boys and 28 girls at each of the Piagetian preoperational, concrete operational, and formal operational cognitive stages were given an interview focusing on their concepts of family. Half of each group were from intact families, and half were from divorced families. Interviews were scored for two structural aspects of the concept of family: conceptual level, and use of dimensions that structure the concept. The complexity of children's concepts was strongly related to cognitive stage and, to a lesser degree, to sex. Frequency of use of concept dimensions was strongly affected by general developmental level, though not specifically cognitive stage, and by intactness of family, but to a lesser degree by sex. Specific information is provided on the effect of these factors on perceptions of family composition, parental roles, and breadth of family activities.     

Attachment within family systems: An overview

A family systems approach provides a context for the development and maintenance of dyadic attachment relationships. An attachment approach provides a focus on the expression of and response to attachment behavior within a family. Uniting the two approaches has implications for both research and intervention. Characteristics of attachment theory and family systems theory are briefly outlined: Both involve systemic thinking. Different styles of interacting at the level of the family as a whole, working models of relationships, and dyadic interactions appear to correspond in a coherent way. Further research is needed in order to identify which dimensions of family functioning are relevant to the development of secure attachments, and how the relevant dimensions may change with age and stage in the family life cycle. This will provide targets for preventive interventions, with the development of secure relationships as a primary goal.